    [115th Congress Public Law 271]
    [From the U.S. Government Publishing Office]

    [[Page 3893]]

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

    [[Page 132 STAT. 3894]]

    Public Law 115-271
    115th Congress

                                     An Act

    To provide for opioid use disorder prevention, recovery, and treatment,
          and for other purposes. <<NOTE: Oct. 24, 2018 -  [H.R. 6]>>

        Be it enacted by the Senate and House of Representatives of the
    United States of America in Congress assembled, <<NOTE: Substance Use-
    Disorder Prevention that Promotes Opioid Recovery and Treatment for
    Patients and Communities Act.>>
    SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

        (a) <<NOTE: 21 USC 301 note.>>  Short Title.--This Act may be cited
    as the ``Substance Use-Disorder Prevention that Promotes Opioid Recovery
    and Treatment for Patients and Communities Act'' or the ``SUPPORT for
    Patients and Communities Act''.

        (b) Table of Contents.--The table of contents of this Act is as
    follows:

    Sec. 1. Short title; table of contents.

            TITLE I--MEDICAID PROVISIONS TO ADDRESS THE OPIOID CRISIS

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

           TITLE II--MEDICARE PROVISIONS TO ADDRESS THE OPIOID CRISIS

    Sec. 2001. Expanding the use of telehealth services for the treatment of
               opioid use disorder and other substance use disorders.
    Sec. 2002. Comprehensive screenings for seniors.
    Sec. 2003. Every prescription conveyed securely.
    Sec. 2004. Requiring prescription drug plan sponsors under Medicare to
               establish drug management programs for at-risk beneficiaries.
    Sec. 2005. Medicare coverage of certain services furnished by opioid
               treatment programs.
    Sec. 2006. Encouraging appropriate prescribing under Medicare for
               victims of opioid overdose.

    [[Page 132 STAT. 3895]]

    Sec. 2007. Automatic escalation to external review under a Medicare part
               D drug management program for at-risk beneficiaries.
    Sec. 2008. Suspension of payments by Medicare prescription drug plans
               and MA-PD plans pending investigations of credible
               allegations of fraud by pharmacies.

               TITLE III--FDA AND CONTROLLED SUBSTANCE PROVISIONS

                           Subtitle A--FDA Provisions

                              Chapter 1--In General

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

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

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

                    Chapter 3--Stop Illicit Drug Importation

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

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

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

                   Chapter 5--Postapproval Study Requirements

    Sec. 3041. Clarifying FDA postmarket authorities.

                   Subtitle B--Controlled Substance Provisions

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

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

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

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

                  Chapter 3--Safe Disposal of Unused Medication

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

         Chapter 4--Special Registration for Telemedicine Clarification

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

           Chapter 5--Synthetic Abuse and Labeling of Toxic Substances

    Sec. 3241. Controlled substance analogues.

                  Chapter 6--Access to Increased Drug Disposal

    Sec. 3251. Short title.
    Sec. 3252. Definitions.
    Sec. 3253. Authority to make grants.
    Sec. 3254. Application.
    Sec. 3255. Use of grant funds.
    Sec. 3256. Eligibility for grant.

    [[Page 132 STAT. 3896]]

    Sec. 3257. Duration of grants.
    Sec. 3258. Accountability and oversight.
    Sec. 3259. Duration of program.
    Sec. 3260. Authorization of appropriations.

                Chapter 7--Using Data To Prevent Opioid Diversion

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

                         Chapter 8--Opioid Quota Reform

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

                      Chapter 9--Preventing Drug Diversion

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

                                TITLE IV--OFFSETS

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

                       TITLE V--OTHER MEDICAID PROVISIONS

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

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

                    Subtitle B--Medicaid IMD Additional Info

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

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

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

                          Subtitle D--Medicaid Reentry

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

                        Subtitle E--Medicaid Partnership

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

                            Subtitle F--IMD CARE Act

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

                      Subtitle G--Medicaid Improvement Fund

    Sec. 5061. Medicaid Improvement Fund.

                       TITLE VI--OTHER MEDICARE PROVISIONS

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

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

    [[Page 132 STAT. 3897]]

                       Subtitle B--Abuse Deterrent Access

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

                  Subtitle C--Medicare Opioid Safety Education

    Sec. 6021. Medicare opioid safety education.

                    Subtitle D--Opioid Addiction Action Plan

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

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

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

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

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

            Subtitle G--Preventing Addiction for Susceptible Seniors

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

        Subtitle H--Expanding Oversight of Opioid Prescribing and Payment

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

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

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

            Subtitle J--Combating Opioid Abuse for Care in Hospitals

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

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

    Sec. 6101. Short title.

    [[Page 132 STAT. 3898]]

    Sec. 6102. Requiring Medicare Advantage plans and part D prescription
               drug plans to include information on risks associated with
               opioids and coverage of nonpharmacological therapies and
               nonopioid medications or devices used to treat pain.
    Sec. 6103. Requiring Medicare Advantage plans and prescription drug
               plans to provide information on the safe disposal of
               prescription drugs.
    Sec. 6104. Revising measures used under the Hospital Consumer Assessment
               of Healthcare Providers and Systems survey relating to pain
               management.

             Subtitle L--Fighting the Opioid Epidemic With Sunshine

    Sec. 6111. Fighting the opioid epidemic with sunshine.

                       TITLE VII--PUBLIC HEALTH PROVISIONS

                       Subtitle A--Awareness and Training

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

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

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

              Subtitle C--Indexing Narcotics, Fentanyl, and Opioids

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

               Subtitle D--Ensuring Access to Quality Sober Living

    Sec. 7031. National recovery housing best practices.

                   Subtitle E--Advancing Cutting Edge Research

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

                            Subtitle F--Jessie's Law

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

                Subtitle G--Protecting Pregnant Women and Infants

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

             Subtitle H--Substance Use Disorder Treatment Workforce

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

            Subtitle I--Preventing Overdoses While in Emergency Rooms

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

         Subtitle J--Alternatives to Opioids in the Emergency Department

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

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

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

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

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

    [[Page 132 STAT. 3899]]

                Subtitle M--Comprehensive Opioid Recovery Centers

    Sec. 7121. Comprehensive opioid recovery centers.

                        Subtitle N--Trauma-Informed Care

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

           Subtitle O--Eliminating Opioid Related Infectious Diseases

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

                Subtitle P--Peer Support Communities of Recovery

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

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

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

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

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

                       Subtitle S--Other Health Provisions

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

                            TITLE VIII--MISCELLANEOUS

           Subtitle A--Synthetics Trafficking and Overdose Prevention

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

             Subtitle B--Opioid Addiction Recovery Fraud Prevention

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

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

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

         Subtitle D--Peer Support Counseling Program for Women Veterans

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

                   Subtitle E--Treating Barriers to Prosperity

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

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

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

    [[Page 132 STAT. 3900]]

                           Subtitle G--Human Services

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

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

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

               Subtitle I--Fighting Opioid Abuse in Transportation

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

                  Subtitle J--Eliminating Kickbacks in Recovery

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

                     Subtitle K--Substance Abuse Prevention

    Sec. 8201. Short title.
    Sec. 8202. Reauthorization of the Office of National Drug Control
               Policy.
    Sec. 8203. Reauthorization of the Drug-Free Communities Program.
    Sec. 8204. Reauthorization of the National Community Anti-Drug Coalition
               Institute.
    Sec. 8205. Reauthorization of the High-Intensity Drug Trafficking Area
               Program.
    Sec. 8206. Reauthorization of drug court program.
    Sec. 8207. Drug court training and technical assistance.
    Sec. 8208. Drug overdose response strategy.
    Sec. 8209. Protecting law enforcement officers from accidental exposure.
    Sec. 8210. COPS Anti-Meth Program.
    Sec. 8211. COPS anti-heroin task force program.
    Sec. 8212. Comprehensive Addiction and Recovery Act education and
               awareness.
    Sec. 8213. Reimbursement of substance use disorder treatment
               professionals.
    Sec. 8214. Sobriety Treatment and Recovery Teams (START).
    Sec. 8215. Provider education.
    Sec. 8216. Definitions.
    Sec. 8217. Amendments to administration of the Office.
    Sec. 8218. Emerging threats committee, plan, and media campaign.
    Sec. 8219. Drug interdiction.
    Sec. 8220. GAO Audit.
    Sec. 8221. National Drug Control Strategy.
    Sec. 8222. Technical and conforming amendments to the Office of National
               Drug Control Policy Reauthorization Act of 1998.

                          Subtitle L--Budgetary Effects

    Sec. 8231. Budgetary effect.

            TITLE I--MEDICAID PROVISIONS TO ADDRESS THE OPIOID CRISIS

    SEC. 1001. AT-RISK YOUTH MEDICAID PROTECTION.

        (a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
    1396a) is amended--
                (1) in subsection (a)--
                        (A) by striking ``and'' at the end of paragraph
                    (82);

    [[Page 132 STAT. 3901]]

                        (B) by striking the period at the end of paragraph
                    (83) and inserting ``; and''; and
                        (C) by inserting after paragraph (83) the following
                    new paragraph:
                ``(84) provide that--
                        ``(A) the State shall not terminate eligibility for
                    medical assistance under the State plan for an
                    individual who is an eligible juvenile (as defined in
                    subsection (nn)(2)) because the juvenile is an inmate of
                    a public institution (as defined in subsection (nn)(3)),
                    but may suspend coverage during the period the juvenile
                    is such an inmate;
                        ``(B) in the case of an individual who is an
                    eligible juvenile described in paragraph (2)(A) of
                    subsection (nn), the State shall, prior to the
                    individual's release from such a public institution,
                    conduct a redetermination of eligibility for such
                    individual with respect to such medical assistance
                    (without requiring a new application from the
                    individual) and, if the State determines pursuant to
                    such redetermination that the individual continues to
                    meet the eligibility requirements for such medical
                    assistance, the State shall restore coverage for such
                    medical assistance to such an individual upon the
                    individual's release from such public institution; and
                        ``(C) in the case of an individual who is an
                    eligible juvenile described in paragraph (2)(B) of
                    subsection (nn), the State shall process any application
                    for medical assistance submitted by, or on behalf of,
                    such individual such that the State makes a
                    determination of eligibility for such individual with
                    respect to such medical assistance upon release of such
                    individual from such public institution.''; and
                (2) by adding at the end the following new subsection:

        ``(nn) Juvenile; Eligible Juvenile; Public Institution.--For
    purposes of subsection (a)(84) and this subsection:
                ``(1) Juvenile.--The term `juvenile' means an individual who
            is--
                        ``(A) under 21 years of age; or
                        ``(B) described in subsection (a)(10)(A)(i)(IX).
                ``(2) Eligible juvenile.--The term `eligible juvenile' means
            a juvenile who is an inmate of a public institution and who--
                        ``(A) was determined eligible for medical assistance
                    under the State plan immediately before becoming an
                    inmate of such a public institution; or
                        ``(B) is determined eligible for such medical
                    assistance while an inmate of a public institution.
                ``(3) Inmate of a public institution.--The term `inmate of a
            public institution' has the meaning given such term for purposes
            of applying the subdivision (A) following paragraph (30) of
            section 1905(a), taking into account the exception in such
            subdivision for a patient of a medical institution.''.

        (b) <<NOTE: 42 USC 1396a note.>>  No Change in Exclusion From
    Medical Assistance for Inmates of Public Institutions.--Nothing in this
    section shall be construed as changing the exclusion from medical
    assistance under the subdivision (A) following paragraph (30) of section
    1905(a) of the Social Security Act (42 U.S.C. 1396d(a)), as redesignated

    [[Page 132 STAT. 3902]]

    by section 1006(b)(2)(B) of this Act, including any applicable
    restrictions on a State submitting claims for Federal financial
    participation under title XIX of such Act for such assistance.

        (c) <<NOTE: 42 USC 1396a note.>>  No Change in Continuity of
    Eligibility Before Adjudication or Sentencing.--Nothing in this section
    shall be construed to mandate, encourage, or suggest that a State
    suspend or terminate coverage for individuals before they have been
    adjudicated or sentenced.

        (d) <<NOTE: 42 USC 1396a note.>>  Effective Date.--
                (1) In general.--Except as provided in paragraph (2), the
            amendments made by subsection (a) shall apply to eligibility of
            juveniles who become inmates of public institutions on or after
            the date that is 1 year after the date of the enactment of this
            Act.
                (2) Rule for changes requiring state legislation.--In the
            case of a State plan for medical assistance under title XIX of
            the Social Security Act which the Secretary of Health and Human
            Services determines requires State legislation (other than
            legislation appropriating funds) in order for the plan to meet
            the additional requirements imposed by the amendments made by
            subsection (a), the State plan shall not be regarded as failing
            to comply with the requirements of such title solely on the
            basis of its failure to meet these additional requirements
            before the first day of the first calendar quarter beginning
            after the close of the first regular session of the State
            legislature that begins after the date of the enactment of this
            Act. For purposes of the previous sentence, in the case of a
            State that has a 2-year legislative session, each year of such
            session shall be deemed to be a separate regular session of the
            State legislature.
    SEC. 1002. HEALTH INSURANCE FOR FORMER FOSTER YOUTH.

        (a) Coverage Continuity for Former Foster Care Children up to Age
    26.--
                (1) In general.--Section 1902(a)(10)(A)(i)(IX) of the Social
            Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(IX)) is amended--
                        (A) in item (bb), by striking ``are not described in
                    or enrolled under'' and inserting ``are not described in
                    and are not enrolled under'';
                        (B) in item (cc), by striking ``responsibility of
                    the State'' and inserting ``responsibility of a State'';
                    and
                        (C) in item (dd), by striking ``the State plan under
                    this title or under a waiver of the'' and inserting ``a
                    State plan under this title or under a waiver of such
                    a''.
                (2) <<NOTE: 42 USC 1396a note.>>  Effective date.--The
            amendments made by this subsection shall take effect with
            respect to foster youth who attain 18 years of age on or after
            January 1, 2023.

        (b) <<NOTE: 42 USC 1396a note.>>  Guidance.--Not later than 1 year
    after the date of the enactment of this Act, the Secretary of Health and
    Human Services shall issue guidance to States, with respect to the State
    Medicaid programs of such States--
                (1) on best practices for--
                        (A) removing barriers and ensuring streamlined,
                    timely access to Medicaid coverage for former foster
                    youth up to age 26; and

    [[Page 132 STAT. 3903]]

                        (B) conducting outreach and raising awareness among
                    such youth regarding Medicaid coverage options for such
                    youth; and
                (2) which shall include examples of States that have
            successfully extended Medicaid coverage to former foster youth
            up to age 26.
    SEC. 1003. DEMONSTRATION PROJECT TO INCREASE SUBSTANCE USE
                              PROVIDER CAPACITY UNDER THE MEDICAID
                              PROGRAM.

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

    [[Page 132 STAT. 3904]]

                          by the Assistant Secretary for Mental Health and
                          Substance Use for purposes of carrying out the
                          requirements of such section 303(g); and
                              ``(iii) are qualified under applicable State
                          law to provide substance use disorder treatment or
                          recovery services.
                        ``(D) Improved reimbursement for and expansion of,
                    through the provision of education, training, and
                    technical assistance, the number or treatment capacity
                    of providers participating under the State plan (or
                    waiver) that have the qualifications to address the
                    treatment or recovery needs of--
                              ``(i) individuals enrolled under the State
                          plan (or a waiver of such plan) who have neonatal
                          abstinence syndrome, in accordance with guidelines
                          issued by the American Academy of Pediatrics and
                          American College of Obstetricians and
                          Gynecologists relating to maternal care and infant
                          care with respect to neonatal abstinence syndrome;
                              ``(ii) pregnant women, postpartum women, and
                          infants, particularly the concurrent treatment, as
                          appropriate, and comprehensive case management of
                          pregnant women, postpartum women and infants,
                          enrolled under the State plan (or a waiver of such
                          plan);
                              ``(iii) adolescents and young adults between
                          the ages of 12 and 21 enrolled under the State
                          plan (or a waiver of such plan); or
                              ``(iv) American Indian and Alaska Native
                          individuals enrolled under the State plan (or a
                          waiver of such plan).
                ``(3) Planning grants.--
                        ``(A) In general.--The Secretary shall, with respect
                    to the first 18-month period of the demonstration
                    project conducted under paragraph (1), award planning
                    grants to at least 10 States selected in accordance with
                    subparagraph (B) for purposes of preparing an
                    application described in paragraph (4)(C) and carrying
                    out the activities described in subparagraph (C).
                        ``(B) Selection.--In selecting States for purposes
                    of this paragraph, the Secretary shall--
                              ``(i) select States that have a State plan (or
                          waiver of the State plan) approved under this
                          title;
                              ``(ii) select States in a manner that ensures
                          geographic diversity; and
                              ``(iii) give preference to States with a
                          prevalence of substance use disorders (in
                          particular opioid use disorders) that is
                          comparable to or higher than the national average
                          prevalence, as measured by aggregate per capita
                          drug overdoses, or any other measure that the
                          Secretary deems appropriate.
                        ``(C) Activities described.--Activities described in
                    this subparagraph are, with respect to a State, each of
                    the following:
                              ``(i) Activities that support the development
                          of an initial assessment of the behavioral health
                          treatment needs of the State to determine the
                          extent to which

    [[Page 132 STAT. 3905]]

                          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

    [[Page 132 STAT. 3906]]

                          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.

    [[Page 132 STAT. 3907]]

                                        ``(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:

    [[Page 132 STAT. 3908]]

                              ``(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

    [[Page 132 STAT. 3909]]

                                    under this subsection after the
                                    submission of such interim report; and
                                        ``(III) evaluating such
                                    demonstration project.
                        ``(C) AHRQ report.--Not later than 3 years after the
                    date of the enactment of this subsection, the Director
                    of the Agency for Healthcare Research and Quality, in
                    consultation with the Administrator of the Centers for
                    Medicare & Medicaid Services, shall submit to Congress a
                    summary on the experiences of States awarded planning
                    grants under paragraph (3) and States selected under
                    paragraph (4).
                ``(7) Data sharing and best practices.--During the period of
            the demonstration project under this subsection, the Secretary
            shall, in collaboration with States selected under paragraph
            (4), facilitate data sharing and the development of best
            practices between such States and States that were not so
            selected.
                ``(8) CMS funding.--There is appropriated, out of any funds
            in the Treasury not otherwise appropriated, $5,000,000 to the
            Centers for Medicare & Medicaid Services for purposes of
            implementing this subsection. Such amount shall remain available
            until expended.''.
    SEC. 1004. MEDICAID DRUG REVIEW AND UTILIZATION.

        (a) Medicaid Drug Utilization Review.--
                (1) State plan requirement.--Section 1902(a) of the Social
            Security Act (42 U.S.C. 1396a(a)), as amended by section 1001,
            is further amended--
                        (A) in paragraph (83), at the end, by striking
                    ``and'';
                        (B) in paragraph (84), at the end, by striking the
                    period and inserting ``; and''; and
                        (C) by inserting after paragraph (84) the following
                    new paragraph:
                ``(85) provide that the State is in compliance with the drug
            review and utilization requirements under subsection (oo)(1).''.
                (2) Drug review and utilization requirements.--Section 1902
            of the Social Security Act (42 U.S.C. 1396a), as amended by
            section 1001, is further amended by adding at the end the
            following new subsection:

        ``(oo) Drug Review and Utilization Requirements.--
                ``(1) In general.--For purposes of subsection (a)(85), the
            drug review and utilization requirements under this subsection
            are, subject to paragraph (3) and beginning October 1, 2019, the
            following:
                        ``(A) Claims review limitations.--
                              ``(i) In general.--The State has in place--
                                        ``(I) safety edits (as specified by
                                    the State) for subsequent fills for
                                    opioids and a claims review automated
                                    process (as designed and implemented by
                                    the State) that indicates when an
                                    individual enrolled under the State plan
                                    (or under a waiver of the State plan) is
                                    prescribed a subsequent fill of opioids
                                    in excess of any limitation that may be
                                    identified by the State;
                                        ``(II) safety edits (as specified by
                                    the State) on the maximum daily morphine
                                    equivalent that

    [[Page 132 STAT. 3910]]

                                    can be prescribed to an individual
                                    enrolled under the State plan (or under
                                    a waiver of the State plan) for
                                    treatment of chronic pain and a claims
                                    review automated process (as designed
                                    and implemented by the State) that
                                    indicates when an individual enrolled
                                    under the plan (or waiver) is prescribed
                                    the morphine equivalent for such
                                    treatment in excess of any limitation
                                    that may be identified by the State; and
                                        ``(III) a claims review automated
                                    process (as designed and implemented by
                                    the State) that monitors when an
                                    individual enrolled under the State plan
                                    (or under a waiver of the State plan) is
                                    concurrently prescribed opioids and--
                                                ``(aa) benzodiazepines; or
                                                ``(bb) antipsychotics.
                              ``(ii) Managed care entities.--The State
                          requires each managed care entity (as defined in
                          section 1932(a)(1)(B)) with respect to which the
                          State has a contract under section 1903(m) or
                          under section 1905(t)(3) to have in place, subject
                          to paragraph (3), with respect to individuals who
                          are eligible for medical assistance under the
                          State plan (or under a waiver of the State plan)
                          and who are enrolled with the entity, the
                          limitations described in subclauses (I) and (II)
                          of clause (i) and a claims review automated
                          process described in subclause (III) of such
                          clause.
                              ``(iii) Rules of construction.--Nothing in
                          this subparagraph may be construed as prohibiting
                          a State or managed care entity from designing and
                          implementing a claims review automated process
                          under this subparagraph that provides for
                          prospective or retrospective reviews of claims.
                          Nothing in this subparagraph shall be understood
                          as prohibiting the exercise of clinical judgment
                          from a provider enrolled as a participating
                          provider in a State plan (or waiver of the State
                          plan) or contracting with a managed care entity
                          regarding the best items and services for an
                          individual enrolled under such State plan (or
                          waiver).
                        ``(B) Program to monitor antipsychotic medications
                    by children.--The State has in place a program (as
                    designed and implemented by the State) to monitor and
                    manage the appropriate use of antipsychotic medications
                    by children enrolled under the State plan (or under a
                    waiver of the State plan) and submits annually to the
                    Secretary such information as the Secretary may require
                    on activities carried out under such program for
                    individuals not more than the age of 18 years generally
                    and children in foster care specifically.
                        ``(C) Fraud and abuse identification.--The State has
                    in place a process (as designed and implemented by the
                    State) that identifies potential fraud or abuse of
                    controlled substances by individuals enrolled under the
                    State plan (or under a waiver of the State plan), health
                    care providers prescribing drugs to individuals so
                    enrolled, and pharmacies dispensing drugs to individuals
                    so enrolled.

    [[Page 132 STAT. 3911]]

                        ``(D) Reports.--The State shall include in the
                    annual report submitted to the Secretary under section
                    1927(g)(3)(D) information on the limitations,
                    requirement, program, and processes applied by the State
                    under subparagraphs (A) through (C) in accordance with
                    such manner and time as specified by the Secretary.
                        ``(E) Clarification.--Nothing shall prevent a State
                    from satisfying the requirement--
                              ``(i) described in subparagraph (A) by having
                          safety edits or a claims review automated process
                          described in such subparagraph that was in place
                          before October 1, 2019;
                              ``(ii) described in subparagraph (B) by having
                          a program described in such subparagraph that was
                          in place before such date; or
                              ``(iii) described in subparagraph (C) by
                          having a process described in such subparagraph
                          that was in place before such date.
                ``(2) Annual report by secretary.--For each fiscal year
            beginning with fiscal year 2020, the Secretary shall submit to
            Congress a report on the most recent information submitted by
            States under paragraph (1)(D).
                ``(3) Exceptions.--
                        ``(A) Certain individuals exempted.--The drug review
                    and utilization requirements under this subsection shall
                    not apply with respect to an individual who--
                              ``(i) is receiving--
                                        ``(I) hospice or palliative care; or
                                        ``(II) treatment for cancer;
                              ``(ii) is a resident of a long-term care
                          facility, of a facility described in section
                          1905(d), or of another facility for which
                          frequently abused drugs are dispensed for
                          residents through a contract with a single
                          pharmacy; or
                              ``(iii) the State elects to treat as exempted
                          from such requirements.
                        ``(B)  Exception relating to ensuring access.--In
                    order to ensure reasonable access to health care, the
                    Secretary shall waive the drug review and utilization
                    requirements under this subsection, with respect to a
                    State, in the case of natural disasters and similar
                    situations, and in the case of the provision of
                    emergency services (as defined for purposes of section
                    1860D-4(c)(5)(D)(ii)(II)).''.
                (3) Managed care entities.--Section 1932 of the Social
            Security Act (42 U.S.C. 1396u-2) is amended by adding at the end
            the following new subsection:

        ``(i) Drug Utilization Review Activities and Requirements.--
    Beginning not later than October 1, 2019, each contract under a State
    plan with a managed care entity (other than a primary care case manager)
    under section 1903(m) shall provide that the entity is in compliance
    with the applicable provisions of section 438.3(s)(2) of title 42, Code
    of Federal Regulations, section 483.3(s)(4)) of such title, and section
    483.3(s)(5) of such title, as such provisions were in effect on March
    31, 2018.''.
        (b) Identifying and Addressing Inappropriate Prescribing and Billing
    Practices Under Medicaid.--

    [[Page 132 STAT. 3912]]

                (1) In general.--Section 1927(g) of the Social Security Act
            (42 U.S.C. 1396r-8(g)) is amended--
                        (A) in paragraph (1)(A)--
                              (i) by striking ``of section 1903(i)(10)(B)''
                          and inserting ``of section 1902(a)(54)'';
                              (ii) by striking ``, by not later than January
                          1, 1993,'';
                              (iii) by inserting after ``gross overuse,''
                          the following: ``excessive utilization,''; and
                              (iv) by striking ``or inappropriate or
                          medically unnecessary care'' and inserting
                          ``inappropriate or medically unnecessary care, or
                          prescribing or billing practices that indicate
                          abuse or excessive utilization''; and
                        (B) in paragraph (2)(B)--
                              (i) by inserting after ``gross overuse,'' the
                          following: ``excessive utilization,''; and
                              (ii) by striking ``or inappropriate or
                          medically unnecessary care'' and inserting
                          ``inappropriate or medically unnecessary care, or
                          prescribing or billing practices that indicate
                          abuse or excessive utilization''.
                (2) <<NOTE: 42 USC 1396r-8 note.>>  Effective date.--The
            amendments made by paragraph (1) shall take effect with respect
            to retrospective drug use reviews conducted on or after October
            1, 2020.
    SEC. 1005. GUIDANCE TO IMPROVE CARE FOR INFANTS WITH NEONATAL
                              ABSTINENCE SYNDROME AND THEIR MOTHERS;
                              GAO STUDY ON GAPS IN MEDICAID COVERAGE
                              FOR PREGNANT AND POSTPARTUM WOMEN WITH
                              SUBSTANCE USE DISORDER.

        (a) <<NOTE: 42 USC 1396a note.>>  Guidance.--Not later than 1 year
    after the date of the enactment of this Act, the Secretary of Health and
    Human Services shall issue guidance to improve care for infants with
    neonatal abstinence syndrome and their families. Such guidance shall
    include--
                (1) best practices from States with respect to innovative or
            evidenced-based payment models that focus on prevention,
            screening, treatment, plans of safe care, and postdischarge
            services for mothers and fathers with substance use disorders
            and babies with neonatal abstinence syndrome that improve care
            and clinical outcomes;
                (2) recommendations for States on available financing
            options under the Medicaid program under title XIX of such Act
            and under the Children's Health Insurance Program under title
            XXI of such Act for Children's Health Insurance Program Health
            Services Initiative funds for parents with substance use
            disorders, infants with neonatal abstinence syndrome, and home-
            visiting services;
                (3) guidance and technical assistance to State Medicaid
            agencies regarding additional flexibilities and incentives
            related to screening, prevention, and postdischarge services,
            including parenting supports, and infant-caregiver bonding,
            including breastfeeding when it is appropriate; and
                (4) guidance regarding suggested terminology and ICD codes
            to identify infants with neonatal abstinence syndrome and
            neonatal opioid withdrawal syndrome, which could include opioid-
            exposure, opioid withdrawal not requiring

    [[Page 132 STAT. 3913]]

            pharmacotherapy, and opioid withdrawal requiring
            pharmacotherapy.

        (b) GAO Study.--Not later than 1 year after the date of the
    enactment of this Act, the Comptroller General of the United States
    shall conduct a study, and submit to Congress a report, addressing gaps
    in coverage for pregnant women with substance use disorder under the
    Medicaid program under title XIX of the Social Security Act, and gaps in
    coverage for postpartum women with substance use disorder who had
    coverage during their pregnancy under the Medicaid program under such
    title.
    SEC. 1006. MEDICAID HEALTH HOMES FOR SUBSTANCE-USE-DISORDER
                              MEDICAID ENROLLEES.

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

    [[Page 132 STAT. 3914]]

                        ``(C) Best practices.--Not later than October 1,
                    2020, the Secretary shall make publicly available on the
                    internet website of the Centers for Medicare & Medicaid
                    Services best practices for designing and implementing
                    an SUD-focused State plan amendment, based on the
                    experiences of States that have State plan amendments
                    approved under this section that include SUD-eligible
                    individuals.
                        ``(D) Definitions.--For purposes of this paragraph:
                              ``(i) SUD-eligible individuals.--The term
                          `SUD-eligible individual' means, with respect to a
                          State, an individual who satisfies all of the
                          following:
                                        ``(I) The individual is an eligible
                                    individual with chronic conditions.
                                        ``(II) The individual is an
                                    individual with a substance use
                                    disorder.
                                        ``(III) The individual has not
                                    previously received health home services
                                    under any other State plan amendment
                                    approved for the State under this
                                    section by the Secretary.
                              ``(ii) SUD-focused state plan amendment.--The
                          term `SUD-focused State plan amendment' means a
                          State plan amendment under this section that is
                          designed to provide health home services primarily
                          to SUD-eligible individuals.''.

        (b) Requirement for State Medicaid Plans To Provide Coverage for
    Medication-Assisted Treatment.--
                (1) Requirement for state medicaid plans to provide coverage
            for medication-assisted treatment.--Section 1902(a)(10)(A) of
            the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended,
            in the matter preceding clause (i), by striking ``and (28)'' and
            inserting ``(28), and (29)''.
                (2) Inclusion of medication-assisted treatment as medical
            assistance.--Section 1905(a) of the Social Security Act (42
            U.S.C. 1396d(a)) is amended--
                        (A) in paragraph (28), by striking ``and'' at the
                    end;
                        (B) by redesignating paragraph (29) as paragraph
                    (30); and
                        (C) by inserting after paragraph (28) the following
                    new paragraph:
                ``(29) subject to paragraph (2) of subsection (ee), for the
            period beginning October 1, 2020, and ending September 30, 2025,
            medication-assisted treatment (as defined in paragraph (1) of
            such subsection); and''.
                (3) Medication-assisted treatment defined; waivers.--Section
            1905 of the Social Security Act (42 U.S.C. 1396d) is amended by
            adding at the end the following new subsection:

        ``(ee) Medication-Assisted Treatment.--
                ``(1) Definition.--For purposes of subsection (a)(29), the
            term `medication-assisted treatment'--
                        ``(A) means all drugs approved under section 505 of
                    the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
                    355), including methadone, and all biological products
                    licensed under section 351 of the Public Health Service
                    Act (42 U.S.C. 262) to treat opioid use disorders; and
                        ``(B) includes, with respect to the provision of
                    such drugs and biological products, counseling services
                    and behavioral therapy.

    [[Page 132 STAT. 3915]]

                ``(2) Exception.--The provisions of paragraph (29) of
            subsection (a) shall not apply with respect to a State for the
            period specified in such paragraph, if before the beginning of
            such period the State certifies to the satisfaction of the
            Secretary that implementing such provisions statewide for all
            individuals eligible to enroll in the State plan (or waiver of
            the State plan) would not be feasible by reason of a shortage of
            qualified providers of medication-assisted treatment, or
            facilities providing such treatment, that will contract with the
            State or a managed care entity with which the State has a
            contract under section 1903(m) or under section 1905(t)(3).''.
                (4) <<NOTE: 42 USC 1396a note.>>  Effective date.--
                        (A) In general.--Subject to subparagraph (B), the
                    amendments made by this subsection shall apply with
                    respect to medical assistance provided on or after
                    October 1, 2020, and before October 1, 2025.
                        (B) Exception for state legislation.--In the case of
                    a State plan under title XIX of the Social Security Act
                    (42 U.S.C. 1396 et seq.) that the Secretary of Health
                    and Human Services determines requires State legislation
                    in order for the respective plan to meet any requirement
                    imposed by the amendments made by this subsection, the
                    respective plan shall not be regarded as failing to
                    comply with the requirements of such title solely on the
                    basis of its failure to meet such an additional
                    requirement before the first day of the first calendar
                    quarter beginning after the close of the first regular
                    session of the State legislature that begins after the
                    date of the enactment of this Act. For purposes of the
                    previous sentence, in the case of a State that has a 2-
                    year legislative session, each year of the session shall
                    be considered to be a separate regular session of the
                    State legislature.
    SEC. 1007. CARING RECOVERY FOR INFANTS AND BABIES.

        (a) State Plan Amendment.--Section 1902(a) of the Social Security
    Act (42 U.S.C. 1396a(a)), as amended by sections 1001 and 1004, is
    further amended--
                (1) in paragraph (84)(C), by striking ``and'' after the
            semicolon;
                (2) in paragraph (85), by striking the period at the end and
            inserting ``; and''; and
                (3) by inserting after paragraph (85), the following new
            paragraph:
                ``(86) provide, at the option of the State, for making
            medical assistance available on an inpatient or outpatient basis
            at a residential pediatric recovery center (as defined in
            subsection (pp)) to infants with neonatal abstinence
            syndrome.''.

        (b) Residential Pediatric Recovery Center Defined.--Section 1902 of
    such Act (42 U.S.C. 1396a), as amended by sections 1001 and 1004, is
    further amended by adding at the end the following new subsection:
        ``(pp) Residential Pediatric Recovery Center Defined.--
                ``(1) In general.--For purposes of section 1902(a)(86), the
            term `residential pediatric recovery center' means a center or
            facility that furnishes items and services for which medical
            assistance is available under the State plan to infants with

    [[Page 132 STAT. 3916]]

            the diagnosis of neonatal abstinence syndrome without any other
            significant medical risk factors.
                ``(2) Counseling and services.--A residential pediatric
            recovery center may offer counseling and other services to
            mothers (and other appropriate family members and caretakers) of
            infants receiving treatment at such centers if such services are
            otherwise covered under the State plan under this title or under
            a waiver of such plan. Such other services may include the
            following:
                        ``(A) Counseling or referrals for services.
                        ``(B) Activities to encourage caregiver-infant
                    bonding.
                        ``(C) Training on caring for such infants.''.

        (c) <<NOTE: 42 USC 1396a note.>>  Effective Date.--The amendments
    made by this section take effect on the date of enactment of this Act
    and shall apply to medical assistance furnished on or after that date,
    without regard to final regulations to carry out such amendments being
    promulgated as of such date.
    SEC. 1008. PEER SUPPORT ENHANCEMENT AND EVALUATION REVIEW.

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

    [[Page 132 STAT. 3917]]

            Comptroller General of the United States determines appropriate.
    SEC. 1009. MEDICAID SUBSTANCE USE DISORDER TREATMENT VIA
                              TELEHEALTH.

        (a) <<NOTE: 42 USC 1396a note.>>  Definitions.--In this section:
                (1) Comptroller general.--The term ``Comptroller General''
            means the Comptroller General of the United States.
                (2) School-based health center.--The term ``school-based
            health center'' has the meaning given that term in section
            2110(c)(9) of the Social Security Act (42 U.S.C. 1397jj(c)(9)).
                (3) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services.
                (4) Underserved area.--The term ``underserved area'' means a
            health professional shortage area (as defined in section
            332(a)(1)(A) of the Public Health Service Act (42 U.S.C.
            254e(a)(1)(A))) and a medically underserved area (according to a
            designation under section 330(b)(3)(A) of the Public Health
            Service Act (42 U.S.C. 254b(b)(3)(A))).

        (b) <<NOTE: 42 USC 1396a note.>>  Guidance to States Regarding
    Federal Reimbursement for Furnishing Services and Treatment for
    Substance Use Disorders Under Medicaid Using Services Delivered Via
    Telehealth, Including in School-Based Health Centers.--Not later than 1
    year after the date of enactment of this Act, the Secretary, acting
    through the Administrator of the Centers for Medicare & Medicaid
    Services, shall issue guidance to States on the following:
                (1) State options for Federal reimbursement of expenditures
            under Medicaid for furnishing services and treatment for
            substance use disorders, including assessment, medication-
            assisted treatment, counseling, medication management, and
            medication adherence with prescribed medication regimes, using
            services delivered via telehealth. Such guidance shall also
            include guidance on furnishing services and treatments that
            address the needs of high-risk individuals, including at least
            the following groups:
                        (A) American Indians and Alaska Natives.
                        (B) Adults under the age of 40.
                        (C) Individuals with a history of non-fatal
                    overdose.
                        (D) Individuals with a co-occurring serious mental
                    illness and substance use disorder.
                (2) State options for Federal reimbursement of expenditures
            under Medicaid for education directed to providers serving
            Medicaid beneficiaries with substance use disorders using the
            hub and spoke model, through contracts with managed care
            entities, through administrative claiming for disease management
            activities, and under Delivery System Reform Incentive Payment
            (``DSRIP'') programs.
                (3) State options for Federal reimbursement of expenditures
            under Medicaid for furnishing services and treatment for
            substance use disorders for individuals enrolled in Medicaid in
            a school-based health center using services delivered via
            telehealth.

        (c) GAO Evaluation of Children's Access to Services and Treatment
    for Substance Use Disorders Under Medicaid.--
                (1) Study.--The Comptroller General shall evaluate
            children's access to services and treatment for substance use
            disorders under Medicaid. The evaluation shall include an
            analysis

    [[Page 132 STAT. 3918]]

            of State options for improving children's access to such
            services and treatment and for improving outcomes, including by
            increasing the number of Medicaid providers who offer services
            or treatment for substance use disorders in a school-based
            health center using services delivered via telehealth,
            particularly in rural and underserved areas. The evaluation
            shall include an analysis of Medicaid provider reimbursement
            rates for services and treatment for substance use disorders.
                (2) Report.--Not later than 1 year after the date of
            enactment of this Act, the Comptroller General shall submit to
            Congress a report containing the results of the evaluation
            conducted under paragraph (1), together with recommendations for
            such legislation and administrative action as the Comptroller
            General determines appropriate.

        (d) Report on Reducing Barriers to Using Services Delivered Via
    Telehealth and Remote Patient Monitoring for Pediatric Populations Under
    Medicaid.--
                (1) In general.--Not later than 1 year after the date of
            enactment of this Act, the Secretary, acting through the
            Administrator of the Centers for Medicare & Medicaid Services,
            shall issue a report to the Committee on Finance of the Senate
            and the Committee on Energy and Commerce of the House of
            Representatives identifying best practices and potential
            solutions for reducing barriers to using services delivered via
            telehealth to furnish services and treatment for substance use
            disorders among pediatric populations under Medicaid. The report
            shall include--
                        (A) analyses of the best practices, barriers, and
                    potential solutions for using services delivered via
                    telehealth to diagnose and provide services and
                    treatment for children with substance use disorders,
                    including opioid use disorder; and
                        (B) identification and analysis of the differences,
                    if any, in furnishing services and treatment for
                    children with substance use disorders using services
                    delivered via telehealth and using services delivered in
                    person, such as, and to the extent feasible, with
                    respect to--
                              (i) utilization rates;
                              (ii) costs;
                              (iii) avoidable inpatient admissions and
                          readmissions;
                              (iv) quality of care; and
                              (v) patient, family, and provider
                          satisfaction.
                (2) Publication.--The Secretary shall publish the report
            required under paragraph (1) on a public internet website of the
            Department of Health and Human Services.
    SEC. 1010. <<NOTE: 42 USC 1396a note.>>  ENHANCING PATIENT ACCESS
                              TO NON-OPIOID TREATMENT OPTIONS.

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

    [[Page 132 STAT. 3919]]

    but not limited to, evidence-based, non-opioid pharmacological therapies
    and non-pharmacological therapies.
    SEC. 1011. ASSESSING BARRIERS TO OPIOID USE DISORDER TREATMENT.

        (a) Study.--
                (1) In general.--The Comptroller General of the United
            States (in this section referred to as the ``Comptroller
            General'') shall conduct a study regarding the barriers to
            providing medication used in the treatment of substance use
            disorders under Medicaid distribution models such as the ``buy-
            and-bill'' model, and options for State Medicaid programs to
            remove or reduce such barriers. The study shall include analyses
            of each of the following models of distribution of substance use
            disorder treatment medications, particularly buprenorphine,
            naltrexone, and buprenorphine-naloxone combinations:
                        (A) The purchasing, storage, and administration of
                    substance use disorder treatment medications by
                    providers.
                        (B) The dispensing of substance use disorder
                    treatment medications by pharmacists.
                        (C) The ordering, prescribing, and obtaining
                    substance use disorder treatment medications on demand
                    from specialty pharmacies by providers.
                (2) Requirements.--For each model of distribution specified
            in paragraph (1), the Comptroller General shall evaluate how
            each model presents barriers or could be used by selected State
            Medicaid programs to reduce the barriers related to the
            provision of substance use disorder treatment by examining what
            is known about the effects of the model of distribution on--
                        (A) Medicaid beneficiaries' access to substance use
                    disorder treatment medications;
                        (B) the differential cost to the program between
                    each distribution model for medication-assisted
                    treatment; and
                        (C) provider willingness to provide or prescribe
                    substance use disorder treatment medications.

        (b) Report.--Not later than 15 months after the date of the
    enactment of this Act, the Comptroller General shall submit to Congress
    a report containing the results of the study conducted under subsection
    (a), together with recommendations for such legislation and
    administrative action as the Comptroller General determines appropriate.
    SEC. 1012. HELP FOR MOMS AND BABIES.

        (a) Medicaid State Plan.--Section 1905(a) of the Social Security Act
    (42 U.S.C. 1396d(a)), as amended by section 1006, is further amended by
    adding at the end the following new sentence: ``In the case of a woman
    who is eligible for medical assistance on the basis of being pregnant
    (including through the end of the month in which the 60-day period
    beginning on the last day of her pregnancy ends), who is a patient in an
    institution for mental diseases for purposes of receiving treatment for
    a substance use disorder, and who was enrolled for medical assistance
    under the State plan immediately before becoming a patient in an
    institution for mental diseases or who becomes eligible to enroll for
    such medical assistance while such a patient, the exclusion from the
    definition of `medical assistance' set forth in the subdivision (B)
    following paragraph (30) of the first sentence of this subsection

    [[Page 132 STAT. 3920]]

    shall not be construed as prohibiting Federal financial participation
    for medical assistance for items or services that are provided to the
    woman outside of the institution.''.
        (b) <<NOTE: 42 USC 1396d note.>>  Effective Date.--
                (1) In general.--Except as provided in paragraph (2), the
            amendment made by subsection (a) shall take effect on the date
            of enactment of this Act.
                (2) Rule for changes requiring state legislation.--In the
            case of a State plan under title XIX of the Social Security Act
            which the Secretary of Health and Human Services determines
            requires State legislation (other than legislation appropriating
            funds) in order for the plan to meet the additional requirements
            imposed by the amendment made by subsection (a), the State plan
            shall not be regarded as failing to comply with the requirements
            of such title solely on the basis of its failure to meet these
            additional requirements before the first day of the first
            calendar quarter beginning after the close of the first regular
            session of the State legislature that begins after the date of
            the enactment of this Act. For purposes of the previous
            sentence, in the case of a State that has a 2-year legislative
            session, each year of such session shall be deemed to be a
            separate regular session of the State legislature.
    SEC. 1013. SECURING FLEXIBILITY TO TREAT SUBSTANCE USE DISORDERS.

        Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)) is
    amended by adding at the end the following new paragraph:
        ``(7) Payment shall be made under this title to a State for
    expenditures for capitation payments described in section 438.6(e) of
    title 42, Code of Federal Regulations (or any successor regulation).''.
    SEC. 1014. MACPAC STUDY AND REPORT ON MAT UTILIZATION CONTROLS
                              UNDER STATE MEDICAID PROGRAMS.

        (a) Study.--The Medicaid and CHIP Payment and Access Commission
    shall conduct a study and analysis of utilization control policies
    applied to medication-assisted treatment for substance use disorders
    under State Medicaid programs, including policies and procedures applied
    both in fee-for-service Medicaid and in risk-based managed care
    Medicaid, which shall--
                (1) include an inventory of such utilization control
            policies and related protocols for ensuring access to medically
            necessary treatment;
                (2) determine whether managed care utilization control
            policies and procedures for medication-assisted treatment for
            substance use disorders are consistent with section
            438.210(a)(4)(ii) of title 42, Code of Federal Regulations; and
                (3) identify policies that--
                        (A) limit an individual's access to medication-
                    assisted treatment for a substance use disorder by
                    limiting the quantity of medication-assisted treatment
                    prescriptions, or the number of refills for such
                    prescriptions, available to the individual as part of a
                    prior authorization process or similar utilization
                    protocols; and
                        (B) apply without evaluating individual instances of
                    fraud, waste, or abuse.

        (b) Report.--Not later than 1 year after the date of the enactment
    of this Act, the Medicaid and CHIP Payment and Access

    [[Page 132 STAT. 3921]]

    Commission shall make publicly available a report containing the results
    of the study conducted under subsection (a).
    SEC. 1015. OPIOID ADDICTION TREATMENT PROGRAMS ENHANCEMENT.

        (a) T-MSIS Substance Use Disorder Data Book.--
                (1) In general.--Not later than the date that is 12 months
            after the date of enactment of this Act, the Secretary of Health
            and Human Services (in this section referred to as the
            ``Secretary'') shall publish on the public website of the
            Centers for Medicare & Medicaid Services a report with
            comprehensive data on the prevalence of substance use disorders
            in the Medicaid beneficiary population and services provided for
            the treatment of substance use disorders under Medicaid.
                (2) Content of report.--The report required under paragraph
            (1) shall include, at a minimum, the following data for each
            State (including, to the extent available, for the District of
            Columbia, Puerto Rico, the United States Virgin Islands, Guam,
            the Northern Mariana Islands, and American Samoa):
                        (A) The number and percentage of individuals
                    enrolled in the State Medicaid plan or waiver of such
                    plan in each of the major enrollment categories (as
                    defined in a public letter from the Medicaid and CHIP
                    Payment and Access Commission to the Secretary) who have
                    been diagnosed with a substance use disorder and whether
                    such individuals are enrolled under the State Medicaid
                    plan or a waiver of such plan, including the specific
                    waiver authority under which they are enrolled, to the
                    extent available.
                        (B) A list of the substance use disorder treatment
                    services by each major type of service, such as
                    counseling, medication-assisted treatment, peer support,
                    residential treatment, and inpatient care, for which
                    beneficiaries in each State received at least 1 service
                    under the State Medicaid plan or a waiver of such plan.
                        (C) The number and percentage of individuals with a
                    substance use disorder diagnosis enrolled in the State
                    Medicaid plan or waiver of such plan who received
                    substance use disorder treatment services under such
                    plan or waiver by each major type of service under
                    subparagraph (B) within each major setting type, such as
                    outpatient, inpatient, residential, and other home-based
                    and community-based settings.
                        (D) The number of services provided under the State
                    Medicaid plan or waiver of such plan per individual with
                    a substance use disorder diagnosis enrolled in such plan
                    or waiver for each major type of service under
                    subparagraph (B).
                        (E) The number and percentage of individuals
                    enrolled in the State Medicaid plan or waiver, by major
                    enrollment category, who received substance use disorder
                    treatment through--
                              (i) a medicaid managed care entity (as defined
                          in section 1932(a)(1)(B) of the Social Security
                          Act (42 U.S.C. 1396u-2(a)(1)(B))), including the
                          number of such individuals who received such
                          assistance through a prepaid inpatient health plan
                          or a prepaid ambulatory health plan;

    [[Page 132 STAT. 3922]]

                              (ii) a fee-for-service payment model; or
                              (iii) an alternative payment model, to the
                          extent available.
                        (F) The number and percentage of individuals with a
                    substance use disorder who receive substance use
                    disorder treatment services in an outpatient or home-
                    based and community-based setting after receiving
                    treatment in an inpatient or residential setting, and
                    the number of services received by such individuals in
                    the outpatient or home-based and community-based
                    setting.
                (3) Annual updates.--The Secretary shall issue an updated
            version of the report required under paragraph (1) not later
            than January 1 of each calendar year through 2024.
                (4) Use of t-msis data.--The report required under paragraph
            (1) and updates required under paragraph (3) shall--
                        (A) use data and definitions from the Transformed
                    Medicaid Statistical Information System (``T-MSIS'')
                    data set that is no more than 12 months old on the date
                    that the report or update is published; and
                        (B) as appropriate, include a description with
                    respect to each State of the quality and completeness of
                    the data and caveats describing the limitations of the
                    data reported to the Secretary by the State that is
                    sufficient to communicate the appropriate uses for the
                    information.

        (b) <<NOTE: 42 USC 1320d-2 note.>>  Making T-MSIS Data on Substance
    Use Disorders Available to Researchers.--
                (1) In general.--The Secretary shall publish in the Federal
            Register a system of records notice for the data specified in
            paragraph (2) for the Transformed Medicaid Statistical
            Information System, in accordance with section 552a(e)(4) of
            title 5, United States Code. The notice shall outline policies
            that protect the security and privacy of the data that, at a
            minimum, meet the security and privacy policies of SORN 09-70-
            0541 for the Medicaid Statistical Information System.
                (2) Required data.--The data covered by the systems of
            records notice required under paragraph (1) shall be sufficient
            for researchers and States to analyze the prevalence of
            substance use disorders in the Medicaid beneficiary population
            and the treatment of substance use disorders under Medicaid
            across all States (including the District of Columbia, Puerto
            Rico, the United States Virgin Islands, Guam, the Northern
            Mariana Islands, and American Samoa), forms of treatment, and
            treatment settings.
                (3) Initiation of data-sharing activities.--Not later than
            January 1, 2019, the Secretary shall initiate the data-sharing
            activities outlined in the notice required under paragraph (1).
    SEC. 1016. BETTER DATA SHARING TO COMBAT THE OPIOID CRISIS.

        (a) In General.--Section 1903(m) of the Social Security Act (42
    U.S.C. 1396b(m)), as amended by section 1013, is further amended by
    adding at the end the following new paragraph:
        ``(8)(A) The State agency administering the State plan under this
    title may have reasonable access, as determined by the State, to 1 or
    more prescription drug monitoring program databases administered or
    accessed by the State to the extent the State agency is permitted to
    access such databases under State law.

    [[Page 132 STAT. 3923]]

        ``(B) Such State agency may facilitate reasonable access, as
    determined by the State, to 1 or more prescription drug monitoring
    program databases administered or accessed by the State, to same extent
    that the State agency is permitted under State law to access such
    databases, for--
                ``(i) any provider enrolled under the State plan to provide
            services to Medicaid beneficiaries; and
                ``(ii) any managed care entity (as defined under section
            1932(a)(1)(B)) that has a contract with the State under this
            subsection or under section 1905(t)(3).

        ``(C) Such State agency may share information in such databases, to
    the same extent that the State agency is permitted under State law to
    share information in such databases, with--
                ``(i) any provider enrolled under the State plan to provide
            services to Medicaid beneficiaries; and
                ``(ii) any managed care entity (as defined under section
            1932(a)(1)(B)) that has a contract with the State under this
            subsection or under section 1905(t)(3).''.

        (b) <<NOTE: 42 USC 1396b note.>>  Security and Privacy.--All
    applicable State and Federal security and privacy protections and laws
    shall apply to any State agency, individual, or entity accessing 1 or
    more prescription drug monitoring program databases or obtaining
    information in such databases in accordance with section 1903(m)(8) of
    the Social Security Act (as added by subsection (a)).

        (c) <<NOTE: 42 USC 1396b note.>>  Effective Date.--The amendment
    made by subsection (a) shall take effect on the date of enactment of
    this Act.
    SEC. 1017. REPORT ON INNOVATIVE STATE INITIATIVES AND STRATEGIES
                              TO PROVIDE HOUSING-RELATED SERVICES AND
                              SUPPORTS TO INDIVIDUALS STRUGGLING WITH
                              SUBSTANCE USE DISORDERS UNDER MEDICAID.

        (a) In General.--Not later than 1 year after the date of enactment
    of this Act, the Secretary of Health and Human Services shall issue a
    report to Congress describing innovative State initiatives and
    strategies for providing housing-related services and supports under a
    State Medicaid program to individuals with substance use disorders who
    are experiencing or at risk of experiencing homelessness.
        (b) Content of Report.--The report required under subsection (a)
    shall describe the following:
                (1) Existing methods and innovative strategies developed and
            adopted by State Medicaid programs that have achieved positive
            outcomes in increasing housing stability among Medicaid
            beneficiaries with substance use disorders who are experiencing
            or at risk of experiencing homelessness, including Medicaid
            beneficiaries with substance use disorders who are--
                        (A) receiving treatment for substance use disorders
                    in inpatient, residential, outpatient, or home-based and
                    community-based settings;
                        (B) transitioning between substance use disorder
                    treatment settings; or
                        (C) living in supportive housing or another model of
                    affordable housing.
                (2) Strategies employed by Medicaid managed care
            organizations, primary care case managers, hospitals,
            accountable care organizations, and other care coordination
            providers

    [[Page 132 STAT. 3924]]

            to deliver housing-related services and supports and to
            coordinate services provided under State Medicaid programs
            across different treatment settings.
                (3) Innovative strategies and lessons learned by States with
            Medicaid waivers approved under section 1115 or 1915 of the
            Social Security Act (42 U.S.C. 1315, 1396n), including--
                        (A) challenges experienced by States in designing,
                    securing, and implementing such waivers or plan
                    amendments;
                        (B) how States developed partnerships with other
                    organizations such as behavioral health agencies, State
                    housing agencies, housing providers, health care
                    services agencies and providers, community-based
                    organizations, and health insurance plans to implement
                    waivers or State plan amendments; and
                        (C) how and whether States plan to provide Medicaid
                    coverage for housing-related services and supports in
                    the future, including by covering such services and
                    supports under State Medicaid plans or waivers.
                (4) Existing opportunities for States to provide housing-
            related services and supports through a Medicaid waiver under
            sections 1115 or 1915 of the Social Security Act (42 U.S.C.
            1315, 1396n) or through a State Medicaid plan amendment, such as
            the Assistance in Community Integration Service pilot program,
            which promotes supportive housing and other housing-related
            supports under Medicaid for individuals with substance use
            disorders and for which Maryland has a waiver approved under
            such section 1115 to conduct the program.
                (5) Innovative strategies and partnerships developed and
            implemented by State Medicaid programs or other entities to
            identify and enroll eligible individuals with substance use
            disorders who are experiencing or at risk of experiencing
            homelessness in State Medicaid programs.
    SEC. 1018. <<NOTE: 42 USC 1396a note.>>  TECHNICAL ASSISTANCE AND
                              SUPPORT FOR INNOVATIVE STATE STRATEGIES
                              TO PROVIDE HOUSING-RELATED SUPPORTS
                              UNDER MEDICAID.

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

           TITLE II--MEDICARE PROVISIONS TO ADDRESS THE OPIOID CRISIS

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

        (a) In General.--Section 1834(m) of the Social Security Act (42
    U.S.C. 1395m(m)) is amended--

    [[Page 132 STAT. 3925]]

                (1) in paragraph (2)(B)--
                        (A) in clause (i), in the matter preceding subclause
                    (I), by striking ``clause (ii)'' and inserting ``clause
                    (ii) and paragraph (6)(C)''; and
                        (B) in clause (ii), in the heading, by striking
                    ``for home dialysis therapy'';
                (2) in paragraph (4)(C)--
                        (A) in clause (i), by striking ``paragraph (6)'' and
                    inserting ``paragraphs (5), (6), and (7)''; and
                        (B) in clause (ii)(X), by inserting ``or telehealth
                    services described in paragraph (7)'' before the period
                    at the end; and
                (3) by adding at the end the following new paragraph:
                ``(7) Treatment of substance use disorder services furnished
            through telehealth.--The geographic requirements described in
            paragraph (4)(C)(i) shall not apply with respect to telehealth
            services furnished on or after July 1, 2019, to an eligible
            telehealth individual with a substance use disorder diagnosis
            for purposes of treatment of such disorder or co-occurring
            mental health disorder, as determined by the Secretary, at an
            originating site described in paragraph (4)(C)(ii) (other than
            an originating site described in subclause (IX) of such
            paragraph).''.

        (b) <<NOTE: 42 USC 1395m note.>>  Implementation.--The Secretary of
    Health and Human Services (in this section referred to as the
    ``Secretary'') may implement the amendments made by this section by
    interim final rule.

        (c) Report.--
                (1) In general.--Not later than 5 years after the date of
            the enactment of this Act, the Secretary shall submit to
            Congress a report on the impact of the implementation of the
            amendments made by this section with respect to telehealth
            services under section 1834(m) of the Social Security Act (42
            U.S.C. 1395m(m)) on--
                        (A) the utilization of health care items and
                    services under title XVIII of such Act (42 U.S.C. 1395
                    et seq.) related to substance use disorders, including
                    emergency department visits; and
                        (B) health outcomes related to substance use
                    disorders, such as opioid overdose deaths.
                (2) Funding.--For purposes of carrying out paragraph (1), in
            addition to funds otherwise available, the Secretary shall
            provide for the transfer, from the Federal Supplementary Medical
            Insurance Trust Fund under section 1841, of $3,000,000 to the
            Centers for Medicare & Medicaid Services Program Management
            Account to remain available until expended.
    SEC. 2002. COMPREHENSIVE SCREENINGS FOR SENIORS.

        (a) Initial Preventive Physical Examination.--Section 1861(ww) of
    the Social Security Act (42 U.S.C. 1395x(ww)) is amended--
                (1) in paragraph (1)--
                        (A) by striking ``paragraph (2) and'' and inserting
                    ``paragraph (2),''; and
                        (B) by inserting ``and the furnishing of a review of
                    any current opioid prescriptions (as defined in
                    paragraph (4)),'' after ``upon the agreement with the
                    individual,''; and
                (2) in paragraph (2)--

    [[Page 132 STAT. 3926]]

                        (A) by redesignating subparagraph (N) as
                    subparagraph (O); and
                        (B) by inserting after subparagraph (M) the
                    following new subparagraph:
                        ``(N) Screening for potential substance use
                    disorders.''; and
                (3) by adding at the end the following new paragraph:

        ``(4) For purposes of paragraph (1), the term `a review of any
    current opioid prescriptions' means, with respect to an individual
    determined to have a current prescription for opioids--
                ``(A) a review of the potential risk factors to the
            individual for opioid use disorder;
                ``(B) an evaluation of the individual's severity of pain and
            current treatment plan;
                ``(C) the provision of information on non-opioid treatment
            options; and
                ``(D) a referral to a specialist, as appropriate.''.

        (b) Annual Wellness Visit.--Section 1861(hhh)(2) of the Social
    Security Act (42 U.S.C. 1395x(hhh)(2)) is amended--
                (1) by redesignating subparagraph (G) as subparagraph (I);
            and
                (2) by inserting after subparagraph (F) the following new
            subparagraphs:
                        ``(G) Screening for potential substance use
                    disorders and referral for treatment as appropriate.
                        ``(H) The furnishing of a review of any current
                    opioid prescriptions (as defined in subsection
                    (ww)(4)).''.

        (c) <<NOTE: 42 USC 1395x note.>>  Rule of Construction.--Nothing in
    the amendments made by subsection (a) or (b) shall be construed to
    prohibit separate payment for structured assessment and intervention
    services for substance abuse furnished to an individual on the same day
    as an initial preventive physical examination or an annual wellness
    visit.

        (d) <<NOTE: 42 USC 1395x note.>>  Effective Date.--The amendments
    made by this section shall apply to examinations and visits furnished on
    or after January 1, 2020.
    SEC. 2003. EVERY PRESCRIPTION CONVEYED SECURELY.

        (a) In General.--Section 1860D-4(e) of the Social Security Act (42
    U.S.C. 1395w-104(e)) is amended by adding at the end the following:
                ``(7) Requirement of e-prescribing for controlled
            substances.--
                        ``(A) In general.--Subject to subparagraph (B), a
                    prescription for a covered part D drug under a
                    prescription drug plan (or under an MA-PD plan) for a
                    schedule II, III, IV, or V controlled substance shall be
                    transmitted by a health care practitioner electronically
                    in accordance with an electronic prescription drug
                    program that meets the requirements of paragraph (2).
                        ``(B) Exception for certain circumstances.--The
                    Secretary shall, through rulemaking, specify
                    circumstances and processes by which the Secretary may
                    waive the requirement under subparagraph (A), with
                    respect to a covered part D drug, including in the case
                    of--
                              ``(i) a prescription issued when the
                          practitioner and dispensing pharmacy are the same
                          entity;

    [[Page 132 STAT. 3927]]

                              ``(ii) a prescription issued that cannot be
                          transmitted electronically under the most recently
                          implemented version of the National Council for
                          Prescription Drug Programs SCRIPT Standard;
                              ``(iii) a prescription issued by a
                          practitioner who received a waiver or a renewal
                          thereof for a period of time as determined by the
                          Secretary, not to exceed one year, from the
                          requirement to use electronic prescribing due to
                          demonstrated economic hardship, technological
                          limitations that are not reasonably within the
                          control of the practitioner, or other exceptional
                          circumstance demonstrated by the practitioner;
                              ``(iv) a prescription issued by a practitioner
                          under circumstances in which, notwithstanding the
                          practitioner's ability to submit a prescription
                          electronically as required by this subsection,
                          such practitioner reasonably determines that it
                          would be impractical for the individual involved
                          to obtain substances prescribed by electronic
                          prescription in a timely manner, and such delay
                          would adversely impact the individual's medical
                          condition involved;
                              ``(v) a prescription issued by a practitioner
                          prescribing a drug under a research protocol;
                              ``(vi) a prescription issued by a practitioner
                          for a drug for which the Food and Drug
                          Administration requires a prescription to contain
                          elements that are not able to be included in
                          electronic prescribing, such as a drug with risk
                          evaluation and mitigation strategies that include
                          elements to assure safe use;
                              ``(vii) a prescription issued by a
                          practitioner--
                                        ``(I) for an individual who receives
                                    hospice care under this title; and
                                        ``(II) that is not covered under the
                                    hospice benefit under this title; and
                              ``(viii) a prescription issued by a
                          practitioner for an individual who is--
                                        ``(I) a resident of a nursing
                                    facility (as defined in section
                                    1919(a)); and
                                        ``(II) dually eligible for benefits
                                    under this title and title XIX.
                        ``(C) Dispensing.--(i) Nothing in this paragraph
                    shall be construed as requiring a sponsor of a
                    prescription drug plan under this part, MA organization
                    offering an MA-PD plan under part C, or a pharmacist to
                    verify that a practitioner, with respect to a
                    prescription for a covered part D drug, has a waiver (or
                    is otherwise exempt) under subparagraph (B) from the
                    requirement under subparagraph (A).
                        ``(ii) Nothing in this paragraph shall be construed
                    as affecting the ability of the plan to cover or the
                    pharmacists' ability to continue to dispense covered
                    part D drugs from otherwise valid written, oral, or fax
                    prescriptions that are consistent with laws and
                    regulations.
                        ``(iii) Nothing in this paragraph shall be construed
                    as affecting the ability of an individual who is being
                    prescribed a covered part D drug to designate a
                    particular pharmacy to dispense the covered part D drug
                    to the extent

    [[Page 132 STAT. 3928]]

                    consistent with the requirements under subsection (b)(1)
                    and under this paragraph.
                        ``(D) Enforcement.--The Secretary shall, through
                    rulemaking, have authority to enforce and specify
                    appropriate penalties for non-compliance with the
                    requirement under subparagraph (A).''.

        (b) <<NOTE: 42 USC 1395w-104 note.>>  Effective Date.--The amendment
    made by subsection (a) shall apply to coverage of drugs prescribed on or
    after January 1, 2021.

        (c) <<NOTE: 42 USC 1395w-104 note.>>  Update of Biometric Component
    of Multifactor Authentication.--Not later than 1 year after the date of
    enactment of this Act, the Attorney General shall update the
    requirements for the biometric component of multifactor authentication
    with respect to electronic prescriptions of controlled substances.
    SEC. 2004. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS UNDER
                              MEDICARE TO ESTABLISH DRUG MANAGEMENT
                              PROGRAMS FOR AT-RISK BENEFICIARIES.

        Section 1860D-4(c) of the Social Security Act (42 U.S.C. 1395w-
    104(c)) is amended--
                (1) in paragraph (1), by inserting after subparagraph (E)
            the following new subparagraph:
                        ``(F) With respect to plan years beginning on or
                    after January 1, 2022, a drug management program for at-
                    risk beneficiaries described in paragraph (5).''; and
                (2) in paragraph (5)(A), by inserting ``(and for plan years
            beginning on or after January 1, 2022, a PDP sponsor shall)''
            after ``A PDP sponsor may''.
    SEC. 2005. MEDICARE COVERAGE OF CERTAIN SERVICES FURNISHED BY
                              OPIOID TREATMENT PROGRAMS.

        (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
    U.S.C. 1395x(s)(2)) is amended--
                (1) in subparagraph (FF), by striking at the end ``and'';
                (2) in subparagraph (GG), by inserting at the end ``and'';
            and
                (3) by adding at the end the following new subparagraph:
                ``(HH) opioid use disorder treatment services (as defined in
            subsection (jjj)).''.

        (b) Opioid Use Disorder Treatment Services and Opioid Treatment
    Program Defined.--Section 1861 of the Social Security Act (42 U.S.C.
    1395x) is amended by adding at the end the following new subsection:
        ``(jjj) Opioid Use Disorder Treatment Services; Opioid Treatment
    Program.--
                ``(1) Opioid use disorder treatment services.--The term
            `opioid use disorder treatment services' means items and
            services that are furnished by an opioid treatment program for
            the treatment of opioid use disorder, including--
                        ``(A) opioid agonist and antagonist treatment
                    medications (including oral, injected, or implanted
                    versions) that are approved by the Food and Drug
                    Administration under section 505 of the Federal Food,
                    Drug, and Cosmetic Act for use in the treatment of
                    opioid use disorder;
                        ``(B) dispensing and administration of such
                    medications, if applicable;
                        ``(C) substance use counseling by a professional to
                    the extent authorized under State law to furnish such
                    services;

    [[Page 132 STAT. 3929]]

                        ``(D) individual and group therapy with a physician
                    or psychologist (or other mental health professional to
                    the extent authorized under State law);
                        ``(E) toxicology testing, and
                        ``(F) other items and services that the Secretary
                    determines are appropriate (but in no event to include
                    meals or transportation).
                ``(2) Opioid treatment program.--The term `opioid treatment
            program' means an entity that is an opioid treatment program (as
            defined in section 8.2 of title 42 of the Code of Federal
            Regulations, or any successor regulation) that--
                        ``(A) is enrolled under section 1866(j);
                        ``(B) has in effect a certification by the Substance
                    Abuse and Mental Health Services Administration for such
                    a program;
                        ``(C) is accredited by an accrediting body approved
                    by the Substance Abuse and Mental Health Services
                    Administration; and
                        ``(D) meets such additional conditions as the
                    Secretary may find necessary to ensure--
                              ``(i) the health and safety of individuals
                          being furnished services under such program; and
                              ``(ii) the effective and efficient furnishing
                          of such services.''.

        (c) Payment.--
                (1) In general.--Section 1833(a)(1) of the Social Security
            Act (42 U.S.C. 1395l(a)(1)) is amended--
                        (A) by striking ``and (bb)'' and inserting ``(bb)'';
                    and
                        (B) by inserting before the semicolon at the end the
                    following ``, and (cc) with respect to opioid use
                    disorder treatment services furnished during an episode
                    of care, the amount paid shall be equal to the amount
                    payable under section 1834(w) less any copayment
                    required as specified by the Secretary''.
                (2) Payment determination.--Section 1834 of the Social
            Security Act (42 U.S.C. 1395m) is amended by adding at the end
            the following new subsection:

        ``(w) Opioid Use Disorder Treatment Services.--
                ``(1) In general.--The Secretary shall pay to an opioid
            treatment program (as defined in paragraph (2) of section
            1861(jjj)) an amount that is equal to 100 percent of a bundled
            payment under this part for opioid use disorder treatment
            services (as defined in paragraph (1) of such section) that are
            furnished by such program to an individual during an episode of
            care (as defined by the Secretary) beginning on or after January
            1, 2020. The Secretary shall ensure, as determined appropriate
            by the Secretary, that no duplicative payments are made under
            this part or part D for items and services furnished by an
            opioid treatment program.
                ``(2) Considerations.--The Secretary may implement this
            subsection through one or more bundles based on the type of
            medication provided (such as buprenorphine, methadone,
            naltrexone, or a new innovative drug), the frequency of
            services, the scope of services furnished, characteristics of
            the individuals furnished such services, or other factors as the
            Secretary determine appropriate. In developing such bundles, the
            Secretary may consider payment rates paid to opioid treatment
            programs

    [[Page 132 STAT. 3930]]

            for comparable services under State plans under title XIX or
            under the TRICARE program under chapter 55 of title 10 of the
            United States Code.
                ``(3) Annual updates.--The Secretary shall provide an update
            each year to the bundled payment amounts under this
            subsection.''.

        (d) Including Opioid Treatment Programs as Medicare Providers.--
    Section 1866(e) of the Social Security Act (42 U.S.C. 1395cc(e)) is
    amended--
                (1) in paragraph (1), by striking at the end ``and'';
                (2) in paragraph (2), by striking the period at the end and
            inserting ``; and''; and
                (3) by adding at the end the following new paragraph:
                ``(3) opioid treatment programs (as defined in paragraph (2)
            of section 1861(jjj)), but only with respect to the furnishing
            of opioid use disorder treatment services (as defined in
            paragraph (1) of such section).''.
    SEC. 2006. ENCOURAGING APPROPRIATE PRESCRIBING UNDER MEDICARE FOR
                              VICTIMS OF OPIOID OVERDOSE.

        Section 1860D-4(c)(5)(C) of the Social Security Act (42 U.S.C.
    1395w-104(c)(5)(C)) is amended--
                (1) in clause (i), in the matter preceding subclause (I), by
            striking ``For purposes'' and inserting ``Except as provided in
            clause (v), for purposes''; and
                (2) by adding at the end the following new clause:
                              ``(v) Treatment of enrollees with a history of
                          opioid-related overdose.--
                                        ``(I) In general.--For plan years
                                    beginning not later than January 1,
                                    2021, a part D eligible individual who
                                    is not an exempted individual described
                                    in clause (ii) and who is identified
                                    under this clause as a part D eligible
                                    individual with a history of opioid-
                                    related overdose (as defined by the
                                    Secretary) shall be included as a
                                    potentially at-risk beneficiary for
                                    prescription drug abuse under the drug
                                    management program under this paragraph.
                                        ``(II) Identification and notice.--
                                    For purposes of this clause, the
                                    Secretary shall--
                                                ``(aa) identify part D
                                            eligible individuals with a
                                            history of opioid-related
                                            overdose (as so defined); and
                                                ``(bb) notify the PDP
                                            sponsor of the prescription drug
                                            plan in which such an individual
                                            is enrolled of such
                                            identification.''.
    SEC. 2007. AUTOMATIC ESCALATION TO EXTERNAL REVIEW UNDER A
                              MEDICARE PART D DRUG MANAGEMENT PROGRAM
                              FOR AT-RISK BENEFICIARIES.

        (a) In General.--Section 1860D-4(c)(5) of the Social Security Act
    (42 U.S.C. 1395ww-10(c)(5)) is amended--
                (1) in subparagraph (B), in each of clauses (ii)(III) and
            (iii)(IV), by striking ``and the option of an automatic
            escalation to external review'' and inserting ``, including
            notice that if on reconsideration a PDP sponsor affirms its
            denial, in whole or in part, the case shall be automatically
            forwarded to the

    [[Page 132 STAT. 3931]]

            independent, outside entity contracted with the Secretary for
            review and resolution''; and
                (2) in subparagraph (E), by striking ``and the option'' and
            all that follows and inserting the following: ``and if on
            reconsideration a PDP sponsor affirms its denial, in whole or in
            part, the case shall be automatically forwarded to the
            independent, outside entity contracted with the Secretary for
            review and resolution.''.

        (b) <<NOTE: 42 USC 1395w-104 note.>>  Effective Date.--The
    amendments made by subsection (a) shall apply beginning not later
    January 1, 2021.
    SEC. 2008. SUSPENSION OF PAYMENTS BY MEDICARE PRESCRIPTION DRUG
                              PLANS AND MA-PD PLANS PENDING
                              INVESTIGATIONS OF CREDIBLE ALLEGATIONS
                              OF FRAUD BY PHARMACIES.

        (a) In General.--Section 1860D-12(b) of the Social Security Act (42
    U.S.C. 1395w-112(b)) is amended by adding at the end the following new
    paragraph:
                ``(7) Suspension of payments pending investigation of
            credible allegations of fraud by pharmacies.--
                        ``(A) In general.--Section 1862(o)(1) shall apply
                    with respect to a PDP sponsor with a contract under this
                    part, a pharmacy, and payments to such pharmacy under
                    this part in the same manner as such section applies
                    with respect to the Secretary, a provider of services or
                    supplier, and payments to such provider of services or
                    supplier under this title. A PDP sponsor shall notify
                    the Secretary regarding the imposition of any payment
                    suspension pursuant to the previous sentence, such as
                    through the secure internet website portal (or other
                    successor technology) established under section 1859(i).
                        ``(B) Rule of construction.--Nothing in this
                    paragraph shall be construed as limiting the authority
                    of a PDP sponsor to conduct postpayment review.''.

        (b) Application to MA-PD Plans.--Section 1857(f)(3) of the Social
    Security Act (42 U.S.C. 1395w-27(f)(3)) is amended by adding at the end
    the following new subparagraph:
                        ``(D) Suspension of payments pending investigation
                    of credible allegations of fraud by pharmacies.--Section
                    1860D-12(b)(7).''.

        (c) Conforming Amendment.--Section 1862(o)(3) of the Social Security
    Act (42 U.S.C. 1395y(o)(3)) is amended by inserting ``, section 1860D-
    12(b)(7) (including as applied pursuant to section 1857(f)(3)(D)),''
    after ``this subsection''.
        (d) Clarification Relating to Credible Allegation of Fraud.--Section
    1862(o) of the Social Security Act (42 U.S.C. 1395y(o)) is amended by
    adding at the end the following new paragraph:
                ``(4) Credible allegation of fraud.--In carrying out this
            subsection, section 1860D-12(b)(7) (including as applied
            pursuant to section 1857(f)(3)(D)), and section 1903(i)(2)(C), a
            fraud hotline tip (as defined by the Secretary) without further
            evidence shall not be treated as sufficient evidence for a
            credible allegation of fraud.''.

        (e) <<NOTE: 42 USC 1395w-27 note.>>  Effective Date.--The amendments
    made by this section shall apply with respect to plan years beginning on
    or after January 1, 2020.

    [[Page 132 STAT. 3932]]

               TITLE III--FDA AND CONTROLLED SUBSTANCE PROVISIONS

                           Subtitle A--FDA Provisions

                              CHAPTER 1--IN GENERAL

    SEC. 3001. <<NOTE: 21 USC 355 note.>>  CLARIFYING FDA REGULATION
                              OF NON-ADDICTIVE PAIN PRODUCTS.

        (a) Public Meetings.--Not later than one year after the date of
    enactment of this Act, the Secretary of Health and Human Services
    (referred to in this section as the ``Secretary''), acting through the
    Commissioner of Food and Drugs, shall hold not less than one public
    meeting to address the challenges and barriers of developing non-
    addictive medical products intended to treat acute or chronic pain or
    addiction, which may include--
                (1) the manner by which the Secretary may incorporate the
            risks of misuse and abuse of a controlled substance (as defined
            in section 102 of the Controlled Substances Act (21 U.S.C. 802))
            into the risk benefit assessments under subsections (d) and (e)
            of section 505 of the Federal Food, Drug, and Cosmetic Act (21
            U.S.C. 355), section 510(k) of such Act (21 U.S.C. 360(k)), or
            section 515(c) of such Act (21 U.S.C. 360e(c)), as applicable;
                (2) the application of novel clinical trial designs
            (consistent with section 3021 of the 21st Century Cures Act
            (Public Law 114-255)), use of real world evidence (consistent
            with section 505F of the Federal Food, Drug, and Cosmetic Act
            (21 U.S.C. 355g)), and use of patient experience data
            (consistent with section 569C of the Federal Food, Drug, and
            Cosmetic Act (21 U.S.C. 360bbb-8c)) for the development of non-
            addictive medical products intended to treat pain or addiction;
                (3) the evidentiary standards and the development of opioid-
            sparing data for inclusion in the labeling of medical products
            intended to treat acute or chronic pain; and
                (4) the application of eligibility criteria under sections
            506 and 515B of the Federal Food, Drug, and Cosmetic Act (21
            U.S.C. 356, 360e-3) for non-addictive medical products intended
            to treat pain or addiction.

        (b) Guidance.--Not less than one year after the public meetings are
    conducted under subsection (a) the Secretary shall issue one or more
    final guidance documents, or update existing guidance documents, to help
    address challenges to developing non-addictive medical products to treat
    pain or addiction. Such guidance documents shall include information
    regarding--
                (1) how the Food and Drug Administration may apply sections
            506 and 515B of the Federal Food, Drug, and Cosmetic Act (21
            U.S.C. 356, 360e-3) to non-addictive medical products intended
            to treat pain or addiction, including the circumstances under
            which the Secretary--
                        (A) may apply the eligibility criteria under such
                    sections 506 and 515B to non-addictive medical products
                    intended to treat pain or addiction;

    [[Page 132 STAT. 3933]]

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

        (c) Definitions.--In this section--
                (1) the term ``medical product'' means a drug (as defined in
            section 201(g)(1) of the Federal Food, Drug, and Cosmetic Act
            (21 U.S.C. 321(g)(1))), biological product (as defined in
            section 351(i) of the Public Health Service Act (42 U.S.C.
            262(i))), or device (as defined in section 201(h) of the Federal
            Food, Drug, and Cosmetic Act (21 U.S.C. 321(h))); and
                (2) the term ``opioid-sparing'' means reducing, replacing,
            or avoiding the use of opioids or other controlled substances
            intended to treat acute or chronic pain.

    [[Page 132 STAT. 3934]]

    SEC. 3002. <<NOTE: 21 USC 355-1 note.>>  EVIDENCE-BASED OPIOID
                              ANALGESIC PRESCRIBING GUIDELINES AND
                              REPORT.

        (a) Guidelines.--The Commissioner of Food and Drugs shall develop
    evidence-based opioid analgesic prescribing guidelines for the
    indication-specific treatment of acute pain only for the relevant
    therapeutic areas where such guidelines do not exist.
        (b) Public Input.--In developing the guidelines under subsection
    (a), the Commissioner of Food and Drugs shall--
                (1) consult with stakeholders, which may include conducting
            a public meeting of medical professional societies (including
            any State-based societies), health care providers, State medical
            boards, medical specialties including pain medicine specialty
            societies, patient groups, pharmacists, academic or medical
            research entities, and other entities with experience in health
            care, as appropriate;
                (2) collaborate with the Director of the Centers for Disease
            Control and Prevention, as applicable and appropriate, and other
            Federal agencies with relevant expertise as appropriate; and
                (3) provide for a notice and comment period consistent with
            section 701(h) of the Federal Food, Drug, and Cosmetic Act (21
            U.S.C. 371(h)) for the submission of comments by the public.

        (c) Report.--Not later than 1 year after the date of enactment of
    this Act, or, if earlier, at the time the guidelines under subsection
    (a) are finalized, the Commissioner of Food and Drugs shall submit to
    the Committee on Energy and Commerce of the House of Representatives and
    the Committee on Health, Education, Labor, and Pensions of the Senate,
    and post on the public website of the Food and Drug Administration, a
    report on how the Food and Drug Administration will utilize the
    guidelines under subsection (a) to protect the public health and a
    description of the public health need with respect to each such
    indication-specific treatment guideline.
        (d) Updates.--The Commissioner of Food and Drugs shall
    periodically--
                (1) update the guidelines under subsection (a), informed by
            public input described in subsection (b); and
                (2) submit to the committees specified in subsection (c) and
            post on the public website of the Food and Drug Administration
            an updated report under such subsection.

        (e) Statement To Accompany Guidelines and Recommendations.--The
    Commissioner of Food and Drugs shall ensure that opioid analgesic
    prescribing guidelines and other recommendations developed under this
    section are accompanied by a clear statement that such guidelines or
    recommendations, as applicable--
                (1) are intended to help inform clinical decisionmaking by
            prescribers and patients; and
                (2) are not intended to be used for the purposes of
            restricting, limiting, delaying, or denying coverage for, or
            access to, a prescription issued for a legitimate medical
            purpose by an individual practitioner acting in the usual course
            of professional practice.

    [[Page 132 STAT. 3935]]

     CHAPTER 2-- <<NOTE: Stop Counterfeit Drugs by Regulating and Enhancing
        Enforcement Now Act.>> STOP COUNTERFEIT DRUGS BY REGULATING AND
    ENHANCING ENFORCEMENT NOW
    SEC. 3011. <<NOTE: 21 USC 301 note.>>  SHORT TITLE.

        This chapter may be cited as the ``Stop Counterfeit Drugs by
    Regulating and Enhancing Enforcement Now Act'' or the ``SCREEN Act''.
    SEC. 3012. NOTIFICATION, NONDISTRIBUTION, AND RECALL OF CONTROLLED
                              SUBSTANCES.

        (a) Prohibited Acts.--Section 301 of the Federal Food, Drug, and
    Cosmetic Act (21 U.S.C. 331) is amended by adding at the end the
    following:
        ``(eee) The failure to comply with any order issued under section
    569D.''.
        (b) Notification, Nondistribution, and Recall of Controlled
    Substances.--Subchapter E of chapter V of the Federal Food, Drug, and
    Cosmetic Act (21 U.S.C. 360bbb et seq.) is amended by adding at the end
    the following:
    ``SEC. 569D. <<NOTE: 21 USC 360bbb-8d.>>  NOTIFICATION,
                              NONDISTRIBUTION, AND RECALL OF
                              CONTROLLED SUBSTANCES.

        ``(a) Order To Cease Distribution and Recall.--
                ``(1) In general.--If the Secretary determines there is a
            reasonable probability that a controlled substance would cause
            serious adverse health consequences or death, the Secretary may,
            after providing the appropriate person with an opportunity to
            consult with the agency, issue an order requiring manufacturers,
            importers, distributors, or pharmacists, who distribute such
            controlled substance to immediately cease distribution of such
            controlled substance.
                ``(2) Hearing.--An order under paragraph (1) shall provide
            the person subject to the order with an opportunity for an
            informal hearing, to be held not later than 10 days after the
            date of issuance of the order, on whether adequate evidence
            exists to justify an amendment to the order, and what actions
            are required by such amended order pursuant to subparagraph (3).
                ``(3) Order resolution.--After an order is issued according
            to the process under paragraphs (1) and (2), the Secretary
            shall, except as provided in paragraph (4)--
                        ``(A) vacate the order, if the Secretary determines
                    that inadequate grounds exist to support the actions
                    required by the order;
                        ``(B) continue the order ceasing distribution of the
                    controlled substance until a date specified in such
                    order; or
                        ``(C) amend the order to require a recall of the
                    controlled substance, including any requirements to
                    notify appropriate persons, a timetable for the recall
                    to occur, and a schedule for updates to be provided to
                    the Secretary regarding such recall.
                ``(4) Risk assessment.--If the Secretary determines that the
            risk of recalling a controlled substance presents a greater
            health risk than the health risk of not recalling such
            controlled substance from use, an amended order under
            subparagraph (B) or (C) of paragraph (3) shall not include
            either a recall

    [[Page 132 STAT. 3936]]

            order for, or an order to cease distribution of, such controlled
            substance, as applicable.
                ``(5) Action following order.--Any person who is subject to
            an order pursuant to subparagraph (B) or (C) of paragraph (3)
            shall immediately cease distribution of or recall, as
            applicable, the controlled substance and provide notification as
            required by such order.

        ``(b) Notice to Persons Affected.--If the Secretary determines
    necessary, the Secretary may require the person subject to an order
    pursuant to paragraph (1) or an amended order pursuant to subparagraph
    (B) or (C) of paragraph (3) to provide either a notice of a recall order
    for, or an order to cease distribution of, such controlled substance, as
    applicable, under this section to appropriate persons, including persons
    who manufacture, distribute, import, or offer for sale such product that
    is the subject of an order and to the public. In providing such notice,
    the Secretary may use the assistance of health professionals who
    prescribed or dispensed such controlled substances.
        ``(c) Nondelegation.--An order described in subsection (a)(3) shall
    be ordered by the Secretary or an official designated by the Secretary.
    An official may not be so designated under this section unless the
    official is the Director of the Center for Drug Evaluation and Research
    or an official senior to such Director.
        ``(d) Savings Clause.--Nothing contained in this section shall be
    construed as limiting--
                ``(1) the authority of the Secretary to issue an order to
            cease distribution of, or to recall, any drug under any other
            provision of this Act or the Public Health Service Act; or
                ``(2) the ability of the Secretary to request any person to
            perform a voluntary activity related to any drug subject to this
            Act or the Public Health Service Act.''.

        (c) Controlled Substances Subject to Refusal.--The third sentence of
    section 801(a) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
    381(a)) is amended by inserting ``, or is a controlled substance subject
    to an order under section 569D'' before ``, or (4)''.
        (d) <<NOTE: 21 USC 331 note.>>  Effective Date.--Sections 301(eee)
    and 569D of the Federal Food, Drug, and Cosmetic Act, as added by
    subsections (a) and (b), shall be effective beginning on the date of
    enactment of this Act.
    SEC. 3013. SINGLE SOURCE PATTERN OF IMPORTED ILLEGAL DRUGS.

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

    [[Page 132 STAT. 3937]]

    SEC. 3014. <<NOTE: 21 USC 384f.>>  STRENGTHENING FDA AND CBP
                              COORDINATION AND CAPACITY.

        (a) In General.--The Secretary of Health and Human Services
    (referred to in this section as the ``Secretary''), acting through the
    Commissioner of Food and Drugs, shall coordinate with the Secretary of
    Homeland Security to carry out activities related to customs and border
    protection and in response to illegal controlled substances and drug
    imports, including at sites of import (such as international mail
    facilities), that will provide improvements to such facilities,
    technologies, and inspection capacity. Such Secretaries may carry out
    such activities through a memorandum of understanding between the Food
    and Drug Administration and the U.S. Customs and Border Protection.
        (b) FDA Import Facilities and Inspection Capacity.--
                (1) In general.--In carrying out this section, the Secretary
            shall, in collaboration with the Secretary of Homeland Security
            and the Postmaster General of the United States Postal Service,
            provide that import facilities in which the Food and Drug
            Administration operates or carries out activities related to
            drug imports within the international mail facilities include--
                        (A) facility upgrades and improved capacity in order
                    to increase and improve inspection and detection
                    capabilities, which may include, as the Secretary
                    determines appropriate--
                              (i) improvements to facilities, such as
                          upgrades or renovations, and support for the
                          maintenance of existing import facilities and
                          sites to improve coordination between Federal
                          agencies;
                              (ii) improvements in equipment and information
                          technology enhancement to identify unapproved,
                          counterfeit, or other unlawful controlled
                          substances for destruction;
                              (iii) the construction of, or upgrades to,
                          laboratory capacity for purposes of detection and
                          testing of imported goods;
                              (iv) upgrades to the security of import
                          facilities; and
                              (v) innovative technology and equipment to
                          facilitate improved and near-real-time information
                          sharing between the Food and Drug Administration,
                          the Department of Homeland Security, and the
                          United States Postal Service; and
                        (B) innovative technology, including controlled
                    substance detection and testing equipment and other
                    applicable technology, in order to collaborate with the
                    U.S. Customs and Border Protection to share near-real-
                    time information, including information about test
                    results, as appropriate.
                (2) Innovative technology.--Any technology used in
            accordance with paragraph (1)(B) shall be interoperable with
            technology used by other relevant Federal agencies, including
            the U.S. Customs and Border Protection, as the Secretary
            determines appropriate and practicable.

        (c) Report.--Not later than 6 months after the date of enactment of
    this Act, the Secretary, in consultation with the Secretary of Homeland
    Security and the Postmaster General of the United States Postal Service,
    shall report to the Committee on Energy

    [[Page 132 STAT. 3938]]

    and Commerce and the Committee on Homeland Security of the House of
    Representatives and the Committee on Health, Education, Labor, and
    Pensions and the Committee on Homeland Security and Governmental Affairs
    of the Senate on the implementation of this section, including a summary
    of progress made toward near-real-time information sharing and the
    interoperability of such technologies.

     CHAPTER 3-- <<NOTE: Stop Illicit Drug Importation Act of 2018.>> STOP
    ILLICIT DRUG IMPORTATION
    SEC. 3021. <<NOTE: 21 USC 301 note.>>  SHORT TITLE.

        This chapter may be cited as the ``Stop Illicit Drug Importation Act
    of 2018''.
    SEC. 3022. <<NOTE: 21 USC 384g.>>  RESTRICTING ENTRANCE OF ILLICIT
                              DRUGS.

        (a) Food and Drug Administration and U.S. Customs and Border
    Protection Cooperation.--
                (1) In general.--The Secretary of Health and Human Services
            (referred to in this section as the ``Secretary''), acting
            through the Commissioner of Food and Drugs and in consultation
            with the U.S. Customs and Border Protection, shall develop and
            periodically update a mutually agreed upon list of the
            controlled substances that the Secretary will refer to U.S.
            Customs and Border Protection, unless the Secretary and U.S.
            Customs and Border Protection agree otherwise, when such
            substances are offered for import via international mail and
            appear to violate the Controlled Substances Act (21 U.S.C. 801
            et seq.), the Controlled Substances Import and Export Act (21
            U.S.C. 951 et seq.), the Federal Food, Drug, and Cosmetic Act
            (21 U.S.C. 301 et seq.), or any other applicable law. The
            Secretary shall transfer controlled substances on such list to
            the U.S. Customs and Border Protection. If the Secretary
            identifies additional packages that appear to be the same as
            such package containing a controlled substance, such additional
            packages may also be transferred to U.S. Customs and Border
            Protection. The U.S. Customs and Border Protection shall receive
            such packages consistent with the requirements of the Controlled
            Substances Act (21 U.S.C. 801 et seq.).
                (2) Report.--Not later than 9 months after the date of
            enactment of this Act, the Secretary, acting through the
            Commissioner of Food and Drugs and in consultation with the
            Secretary of Homeland Security, shall report to the Committee on
            Energy and Commerce of the House of Representatives and the
            Committee on Health, Education, Labor, and Pensions of the
            Senate on the implementation of this section.

        (b) Debarment, Temporary Denial of Approval, and Suspension.--
                (1) Prohibited act.--Section 301(cc) of the Federal Food,
            Drug, and Cosmetic Act (21 U.S.C. 331(cc)) is amended--
                        (A) by inserting ``or a drug'' after ``food''; and
                        (B) by inserting ``from such activity'' after
                    ``person debarred''.
                (2) Debarment.--Section 306(b) of the Federal Food, Drug,
            and Cosmetic Act (21 U.S.C. 335a(b)) is amended--
                        (A) in paragraph (1)--
                              (i) in the matter preceding subparagraph (A),
                          by inserting ``or (3)'' after ``paragraph (2)'';

    [[Page 132 STAT. 3939]]

                              (ii) in subparagraph (A), by striking the
                          comma at the end and inserting a semicolon;
                              (iii) in subparagraph (B), by striking ``,
                          or'' and inserting a semicolon;
                              (iv) in subparagraph (C), by striking the
                          period and inserting ``; or''; and
                              (v) by adding at the end the following:
                        ``(D) a person from importing or offering for import
                    into the United States a drug.'';
                        (B) in paragraph (3)--
                              (i) in the heading, by inserting ``or drug''
                          after ``Food'';
                              (ii) in subparagraph (A), by striking ``; or''
                          and inserting a semicolon;
                              (iii) in subparagraph (B), by striking the
                          period and inserting a semicolon; and
                              (iv) by adding at the end the following:
                        ``(C) the person has been convicted of a felony for
                    conduct relating to the importation into the United
                    States of any drug or controlled substance (as defined
                    in section 102 of the Controlled Substances Act);
                        ``(D) the person has engaged in a pattern of
                    importing or offering for import--
                              ``(i) controlled substances that are
                          prohibited from importation under section 401(m)
                          of the Tariff Act of 1930 (19 U.S.C. 1401(m)); or
                              ``(ii) adulterated or misbranded drugs that
                          are--
                                        ``(I) not designated in an
                                    authorized electronic data interchange
                                    system as a product that is regulated by
                                    the Secretary; or
                                        ``(II) knowingly or intentionally
                                    falsely designated in an authorized
                                    electronic data interchange system as a
                                    product that is regulated by the
                                    Secretary.''; and
                        (C) by adding at the end the following:
                ``(5) Definition.--For purposes of paragraph (3)(D), the
            term `pattern of importing or offering for import' means
            importing or offering for import a drug described in clause (i)
            or (ii) of paragraph (3)(D) in an amount, frequency, or dosage
            that is inconsistent with personal or household use by the
            importer.''.

        (c) Imports and Exports.--Section 801(a) of the Federal Food, Drug,
    and Cosmetic Act (21 U.S.C. 381(a)), as amended, is further amended--
                (1) by striking ``, then such article shall be refused
            admission'' inserting ``or (5) such article is being imported or
            offered for import in violation of section 301(cc), then any
            such article described in any of clauses (1) through (5) shall
            be refused admission'';
                (2) by inserting ``If it appears from the examination of
            such samples or otherwise that the article is a counterfeit
            drug, such article shall be refused admission.'' before ``With
            respect to an article of food, if importation''; and
                (3) by striking ``Clause (2) of the third sentence'' and all
            that follows through the period at the end and inserting the
            following: ``Neither clause (2) nor clause (5) of the third
            sentence of this subsection shall be construed to prohibit the
            admission

    [[Page 132 STAT. 3940]]

            of narcotic drugs, the importation of which is permitted under
            the Controlled Substances Import and Export Act.''.

        (d) Certain Illicit Articles.--Section 801 of the Federal Food,
    Drug, and Cosmetic Act (21 U.S.C. 381), as amended, is amended by adding
    at the end the following--
        ``(u) Illicit Articles Containing Active Pharmaceutical
    Ingredients.--
                ``(1) In general.--For purposes of this section, an article
            that is being imported or offered for import into the United
            States may be treated by the Secretary as a drug if the
            article--
                        ``(A) is not--
                              ``(i) accompanied by an electronic import
                          entry for such article submitted using an
                          authorized electronic data interchange system; and
                              ``(ii) designated in such a system as an
                          article regulated by the Secretary (which may
                          include regulation as a drug, a device, a dietary
                          supplement, or other product that is regulated
                          under this Act); and
                        ``(B) is an ingredient that presents significant
                    public health concern and is, or contains--
                              ``(i) an active ingredient in a drug--
                                        ``(I) that is approved under section
                                    505 or licensed under section 351 of the
                                    Public Health Service Act; or
                                        ``(II) for which--
                                                ``(aa) an investigational
                                            use exemption has been
                                            authorized under section 505(i)
                                            of this Act or section 351(a) of
                                            the Public Health Service Act;
                                            and
                                                ``(bb) a substantial
                                            clinical investigation has been
                                            instituted, and such
                                            investigation has been made
                                            public; or
                              ``(ii) a substance that has a chemical
                          structure that is substantially similar to the
                          chemical structure of an active ingredient in a
                          drug or biological product described in subclause
                          (I) or (II) of clause (i).
                ``(2) Effect.--This subsection shall not be construed to
            bear upon any determination of whether an article is a drug
            within the meaning of section 201(g), other than for the
            purposes described in paragraph (1).''.

    CHAPTER 4 <<NOTE: Securing Opioids and Unused Narcotics with Deliberate
      Disposal and Packaging Act of 2018.>> --SECURING OPIOIDS AND UNUSED
    NARCOTICS WITH DELIBERATE DISPOSAL AND PACKAGING
    SEC. 3031. <<NOTE: 21 USC 301 note.>>  SHORT TITLE.

        This chapter may be cited as the ``Securing Opioids and Unused
    Narcotics with Deliberate Disposal and Packaging Act of 2018'' or the
    ``SOUND Disposal and Packaging Act''.
    SEC. 3032. SAFETY-ENHANCING PACKAGING AND DISPOSAL FEATURES.

         (a) Deliberate Disposal and Packaging Elements of Strategy.--
    Section 505-1(e) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
    355-1(e)) is amended by adding at the end the following:
                ``(4) Packaging and disposal.--The Secretary may require a
            risk evaluation mitigation strategy for a drug for which

    [[Page 132 STAT. 3941]]

            there is a serious risk of an adverse drug experience described
            in subparagraph (B) or (C) of subsection (b)(1), taking into
            consideration the factors described in subparagraphs (C) and (D)
            of subsection (f)(2) and in consultation with other relevant
            Federal agencies with authorities over drug disposal packaging,
            which may include requiring that--
                        ``(A) the drug be made available for dispensing to
                    certain patients in unit dose packaging, packaging that
                    provides a set duration, or another packaging system
                    that the Secretary determines may mitigate such serious
                    risk; or
                        ``(B) the drug be dispensed to certain patients with
                    a safe disposal packaging or safe disposal system for
                    purposes of rendering drugs nonretrievable (as defined
                    in section 1300.05 of title 21, Code of Federal
                    Regulations (or any successor regulation)) if the
                    Secretary determines that such safe disposal packaging
                    or system may mitigate such serious risk and is
                    sufficiently available.''.

        (b) Assuring Access and Minimizing Burden.--Section 505-1(f)(2)(C)
    of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(f)(2)(C))
    is amended--
                (1) in clause (i) by striking ``and'' at the end; and
                (2) by adding at the end the following:
                              ``(iii) patients with functional limitations;
                          and''.

        (c) Application to Abbreviated New Drug Applications.--Section 505-
    1(i) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(i)) is
    amended--
                (1) in paragraph (1)--
                        (A) by redesignating subparagraph (B) as
                    subparagraph (C); and
                        (B) inserting after subparagraph (A) the following:
                        ``(B) A packaging or disposal requirement, if
                    required under subsection (e)(4) for the applicable
                    listed drug.''; and
                (2) in paragraph (2)--
                        (A) in subparagraph (A), by striking ``and'' at the
                    end;
                        (B) by redesignating subparagraph (B) as
                    subparagraph (C); and
                        (C) by inserting after subparagraph (A) the
                    following:
                        ``(B) shall permit packaging systems and safe
                    disposal packaging or safe disposal systems that are
                    different from those required for the applicable listed
                    drug under subsection (e)(4); and''.

        (d) GAO Report.--Not later than 12 months after the date of
    enactment of this Act, the Comptroller General of the United States
    shall prepare and submit to Congress a report containing--
                (1) a description of available evidence, if any, on the
            effectiveness of site-of-use, in-home controlled substance
            disposal products and packaging technologies;
                (2) an evaluation of existing reference standards with
            respect to controlled substance disposal products and packaging
            technologies, including any such standards established by a
            standards development organization, and how such standards
            should be considered in ensuring effectiveness of such products
            and technologies;
                (3) identification of ways in which such disposal products
            intended for use by patients, consumers, and other end users
            that are not registrants under the Controlled Substances Act

    [[Page 132 STAT. 3942]]

            (21 U.S.C. 801 et seq.), are made available to the public and
            any barriers to the use of such disposal products;
                (4) identification of ways in which packaging technologies
            are made available to the public and any barriers to the use of
            such technologies;
                (5) a description of current Federal oversight, if any, of
            site-of-use, in-home controlled substance disposal products,
            including--
                        (A) identification of the Federal agencies that
                    oversee such products;
                        (B) identification of the methods of disposal of
                    controlled substances recommended by such agencies for
                    site-of-use, in-home disposal; and
                        (C) a description of the effectiveness of such
                    recommendations at preventing the diversion of legally
                    prescribed controlled substances;
                (6) a description of current Federal oversight, if any, of
            controlled substance packaging technologies, including--
                        (A) identification of the Federal agencies that
                    oversee such technologies;
                        (B) identification of the technologies recommended
                    by such agencies, including unit dose packaging,
                    packaging that provides a set duration, and other
                    packaging systems that may mitigate abuse or misuse; and
                        (C) a description of the effectiveness of such
                    recommendations at preventing the diversion of legally
                    prescribed controlled substances; and
                (7) recommendations, as appropriate, on--
                        (A) whether site-of-use, in-home controlled
                    substance disposal products and packaging technologies
                    require Federal oversight and, if so, which agency or
                    agencies should be responsible for such oversight and,
                    as applicable, review of such products or technologies;
                    and
                        (B) whether there are applicable standards that
                    should be considered to ensure the effectiveness of such
                    products.

                   CHAPTER 5--POSTAPPROVAL STUDY REQUIREMENTS

    SEC. 3041. CLARIFYING FDA POSTMARKET AUTHORITIES.

        (a) Definition of Adverse Drug Experience.--Section 505-1(b)(1)(E)
    of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(b)(1)(E))
    is amended by striking ``of the drug'' and inserting ``of the drug,
    which may include reduced effectiveness under the conditions of use
    prescribed in the labeling of such drug, but which may not include
    reduced effectiveness that is in accordance with such labeling''.
        (b) Safety Labeling Changes.--Section 505(o)(4) of the Federal Food,
    Drug, and Cosmetic Act (21 U.S.C. 355(o)(4)) is amended--
                (1) in subparagraph (A) by--
                        (A) striking ``Safety information'' and inserting
                    ``Safety or new effectiveness information''; and
                        (B) by striking ``If the Secretary becomes'' and all
                    that follows through ``in the labeling of the drug'' and
                    inserting ``If the Secretary becomes aware of new
                    information, including any new safety information or
                    information related

    [[Page 132 STAT. 3943]]

                    to reduced effectiveness, that the Secretary determines
                    should be included in the labeling of the drug'';
                (2) in clause (i) of subparagraph (B), by inserting before
            the semicolon ``, or new effectiveness information'';
                (3) in subparagraph (C) by striking ``safety information''
            and inserting ``safety or new effectiveness information''; and
                (4) in subparagraph (E) by striking ``safety information''
            and inserting ``safety or new effectiveness information''.

        (c) <<NOTE: 21 USC 355 note.>>  Guidance.--Not less than one year
    after the date of enactment of this Act, the Secretary of Health and
    Human Services shall issue guidance regarding the circumstances under
    which the Food and Drug Administration may require postmarket studies or
    clinical trials to assess the potential reduction in effectiveness of a
    drug and how such reduction in effectiveness could result in a change to
    the benefits of the drug and the risks to the patient. Such guidance
    shall also address how the Food and Drug Administration may apply this
    section and the amendments made thereby with respect to circumstances
    under which the Food and Drug Administration may require postmarket
    studies or clinical trials and safety labeling changes related to the
    use of controlled substances for acute or chronic pain.

                   Subtitle B--Controlled Substance Provisions

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

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

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

        (b) Eliminating Any Time Limitation for Nurse Practitioners and
    Physician Assistants To Become Qualifying

    [[Page 132 STAT. 3944]]

    Practitioners.--Clause (iii) of section 303(g)(2)(G) of the Controlled
    Substances Act (21 U.S.C. 823(g)(2)(G)) is amended--
                (1) in subclause (I), by striking ``or'' at the end; and
                (2) by amending subclause (II) to read as follows:
                        ``(II) a qualifying other practitioner, as defined
                    in clause (iv), who is a nurse practitioner or physician
                    assistant; or''.

        (c) Imposing a Time Limitation for Clinical Nurse Specialists,
    Certified Registered Nurse Anesthetists, and Certified Nurse Midwifes To
    Become Qualifying Practitioners.--Clause (iii) of section 303(g)(2)(G)
    of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)), as amended by
    subsection (b), is further amended by adding at the end the following:
                        ``(III) for the period beginning on October 1, 2018,
                    and ending on October 1, 2023, a qualifying other
                    practitioner, as defined in clause (iv), who is a
                    clinical nurse specialist, certified registered nurse
                    anesthetist, or certified nurse midwife.''.

        (d) Definition of Qualifying Other Practitioner.--Section
    303(g)(2)(G)(iv) of the Controlled Substances Act (21 U.S.C.
    823(g)(2)(G)(iv)) is amended by striking ``nurse practitioner or
    physician assistant'' each place it appears and inserting ``nurse
    practitioner, clinical nurse specialist, certified registered nurse
    anesthetist, certified nurse midwife, or physician assistant''.
        (e) Report by Secretary.--Not later than 2 years after the date of
    the enactment of this Act, the Secretary of Health and Human Services,
    in consultation with the Drug Enforcement Administration, shall submit
    to Congress a report that assesses the care provided by qualifying
    practitioners (as defined in section 303(g)(2)(G)(iii) of the Controlled
    Substances Act (21 U.S.C. 823(g)(2)(G)(iii))) who are treating, in the
    case of physicians, more than 100 patients, and in the case of
    qualifying practitioners who are not physicians, more than 30 patients.
    Such report shall include recommendations on future applicable patient
    number levels and limits. In preparing such report, the Secretary shall
    study, with respect to opioid use disorder treatment--
                (1) the average frequency with which qualifying
            practitioners see their patients;
                (2) the average frequency with which patients receive
            counseling, including the rates by which such counseling is
            provided by such a qualifying practitioner directly, or by
            referral;
                (3) the frequency of toxicology testing, including the
            average frequency with which random toxicology testing is
            administered;
                (4) the average monthly patient caseload for each type of
            qualifying practitioner;
                (5) the treatment retention rates for patients;
                (6) overdose and mortality rates; and
                (7) any available information regarding the diversion of
            drugs by patients receiving such treatment from such a
            qualifying practitioner.
    SEC. 3202. MEDICATION-ASSISTED TREATMENT FOR RECOVERY FROM
                              SUBSTANCE USE DISORDER.

        (a) Waivers for Maintenance Treatment or Detoxification.--Section
    303(g)(2)(G)(ii) of the Controlled Substances Act (21

    [[Page 132 STAT. 3945]]

    U.S.C. 823(g)(2)(G)(ii)) is amended by adding at the end the following:
                ``(VIII) The physician graduated in good standing from an
            accredited school of allopathic medicine or osteopathic medicine
            in the United States during the 5-year period immediately
            preceding the date on which the physician submits to the
            Secretary a written notification under subparagraph (B) and
            successfully completed a comprehensive allopathic or osteopathic
            medicine curriculum or accredited medical residency that--
                        ``(aa) included not less than 8 hours of training on
                    treating and managing opioid-dependent patients; and
                        ``(bb) included, at a minimum--
                              ``(AA) the training described in items (aa)
                          through (gg) of subclause (IV); and
                              ``(BB) training with respect to any other best
                          practice the Secretary determines should be
                          included in the curriculum, which may include
                          training on pain management, including assessment
                          and appropriate use of opioid and non-opioid
                          alternatives.''.

        (b) <<NOTE: 21 USC 823 note.>>  Treatment for Children.--The
    Secretary of Health and Human Services shall consider ways to ensure
    that an adequate number of qualified practitioners, as defined in
    subparagraph (G)(ii) of section 303(g)(2) of the Controlled Substances
    Act (21 U.S.C. 823(g)(2)), who have a specialty in pediatrics or the
    treatment of children or adolescents, are granted a waiver under such
    section 303(g)(2) to treat children and adolescents with substance use
    disorders.

        (c) Technical Amendment.--Section 102(24) of the Controlled
    Substances Act (21 U.S.C. 802(24)) is amended by striking ``Health,
    Education, and Welfare'' and inserting ``Health and Human Services''.
    SEC. 3203. <<NOTE: 21 USC 823 note.>>  GRANTS TO ENHANCE ACCESS TO
                              SUBSTANCE USE DISORDER TREATMENT.

        (a) In General.--The Secretary of Health and Human Services shall
    establish a grant program under which the Secretary may make grants to
    accredited schools of allopathic medicine or osteopathic medicine and
    teaching hospitals located in the United States to support the
    development of curricula that meet the requirements under subclause
    (VIII) of section 303(g)(2)(G)(ii) of the Controlled Substances Act, as
    added by section 3202(a) of this Act.
        (b) Authorization of Appropriations.--There is authorized to be
    appropriated, for grants under subsection (a), $4,000,000 for each of
    fiscal years 2019 through 2023.
    SEC. 3204. DELIVERY OF A CONTROLLED SUBSTANCE BY A PHARMACY TO BE
                              ADMINISTERED BY INJECTION OR
                              IMPLANTATION.

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

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

        ``Sec. 309A. <<NOTE: 21 USC 829a.>>   (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

    [[Page 132 STAT. 3946]]

    under this title, for the purpose of administering the controlled
    substance by the practitioner if--
                ``(1) the controlled substance is delivered by the pharmacy
            to the prescribing practitioner or the practitioner
            administering the controlled substance, as applicable, at the
            location listed on the practitioner's certificate of
            registration issued under this title;
                ``(2) the controlled substance is to be administered for the
            purpose of maintenance or detoxification treatment under section
            303(g)(2) and--
                        ``(A) the practitioner who issued the prescription
                    is a qualifying practitioner authorized under, and
                    acting within the scope of that section; and
                        ``(B) the controlled substance is to be administered
                    by injection or implantation;
                ``(3) the pharmacy and the practitioner are authorized to
            conduct the activities specified in this section under the law
            of the State in which such activities take place;
                ``(4) the prescription is not issued to supply any
            practitioner with a stock of controlled substances for the
            purpose of general dispensing to patients;
                ``(5) except as provided in subsection (b), the controlled
            substance is to be administered only to the patient named on the
            prescription not later than 14 days after the date of receipt of
            the controlled substance by the practitioner; and
                ``(6) notwithstanding any exceptions under section 307, the
            prescribing practitioner, and the practitioner administering the
            controlled substance, as applicable, maintain complete and
            accurate records of all controlled substances delivered,
            received, administered, or otherwise disposed of under this
            section, including the persons to whom controlled substances
            were delivered and such other information as may be required by
            regulations of the Attorney General.

        ``(b) Modification of Number of Days Before Which Controlled
    Substance Shall Be Administered.--
                ``(1) Initial 2-year period.--During the 2-year period
            beginning on the date of enactment of this section, the Attorney
            General, in coordination with the Secretary, may reduce the
            number of days described in subsection (a)(5) if the Attorney
            General determines that such reduction will--
                        ``(A) reduce the risk of diversion; or
                        ``(B) protect the public health.
                ``(2) Modifications after submission of report.--After the
            date on which the report described in section 3204(b) of the
            SUPPORT for Patients and Communities Act is submitted, the
            Attorney General, in coordination with the Secretary, may modify
            the number of days described in subsection (a)(5).
                ``(3) Minimum number of days.--Any modification under this
            subsection shall be for a period of not less than 7 days.''.

        (b) Study and Report.--Not later than 2 years after the date of
    enactment of this section, the Comptroller General of the United States
    shall conduct a study and submit to Congress a report on access to and
    potential diversion of controlled substances administered by injection
    or implantation.
        (c) Technical and Conforming Amendment.--The table of contents for
    the Comprehensive Drug Abuse Prevention and Control

    [[Page 132 STAT. 3947]]

    Act of 1970 is amended by inserting after the item relating to section
    309 the following:

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

     CHAPTER 2-- <<NOTE: Empowering Pharmacists in the Fight Against Opioid
    Abuse Act.>> EMPOWERING PHARMACISTS IN THE FIGHT AGAINST OPIOID ABUSE
    SEC. 3211. <<NOTE: 21 USC 801 note.>>  SHORT TITLE.

        This chapter may be cited as the ``Empowering Pharmacists in the
    Fight Against Opioid Abuse Act''.
    SEC. 3212. <<NOTE: 21 USC 829 note.>>  PROGRAMS AND MATERIALS FOR
                              TRAINING ON CERTAIN CIRCUMSTANCES UNDER
                              WHICH A PHARMACIST MAY DECLINE TO FILL A
                              PRESCRIPTION.

        (a) In General.--Not later than 1 year after the date of enactment
    of this Act, the Secretary of Health and Human Services, in consultation
    with the Administrator of the Drug Enforcement Administration,
    Commissioner of Food and Drugs, Director of the Centers for Disease
    Control and Prevention, and Assistant Secretary for Mental Health and
    Substance Use, shall develop and disseminate, as appropriate, materials
    for pharmacists, health care providers, and patients on--
                (1) circumstances under which a pharmacist may, consistent
            with section 309 of the Controlled Substances Act (21 U.S.C.
            829) and regulations thereunder, including section 1306.04 of
            title 21, Code of Federal Regulations, decline to fill a
            prescription for a controlled substance because the pharmacist
            suspects the prescription is fraudulent, forged, or of doubtful,
            questionable, or suspicious origin; and
                (2) other Federal requirements pertaining to declining to
            fill a prescription under such circumstances, including the
            partial fill of prescriptions for certain controlled substances.

        (b) Materials Included.--In developing materials under subsection
    (a), the Secretary of Health and Human Services shall include
    information for--
                (1) pharmacists on how to decline to fill a prescription and
            actions to take after declining to fill a prescription; and
                (2) other health care practitioners and the public on a
            pharmacist's ability to decline to fill prescriptions in certain
            circumstances and a description of those circumstances (as
            described in the materials developed under subsection (a)(1)).

        (c) Stakeholder Input.--In developing the programs and materials
    required under subsection (a), the Secretary of Health and Human
    Services shall seek input from relevant national, State, and local
    associations, boards of pharmacy, medical societies, licensing boards,
    health care practitioners, and patients, including individuals with
    chronic pain.

       CHAPTER 3-- <<NOTE: Safe Disposal of Unused Medication Act.>> SAFE
    DISPOSAL OF UNUSED MEDICATION
    SEC. 3221. <<NOTE: 21 USC 801 note.>>  SHORT TITLE.

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

    [[Page 132 STAT. 3948]]

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

        (a) In General.--Subsection (g) of section 302 of the Controlled
    Substances Act (21 U.S.C. 822) is amended by adding at the end the
    following:
        ``(5)(A) In the case of a person receiving hospice care, an employee
    of a qualified hospice program, acting within the scope of employment,
    may handle, without being registered under this section, any controlled
    substance that was lawfully dispensed to the person receiving hospice
    care, for the purpose of disposal of the controlled substance so long as
    such disposal occurs onsite in accordance with all applicable Federal,
    State, Tribal, and local law and--
                ``(i) the disposal occurs after the death of a person
            receiving hospice care;
                ``(ii) the controlled substance is expired; or
                ``(iii)(I) the employee is--
                              ``(aa) the physician of the person receiving
                          hospice care; and
                              ``(bb) registered under section 303(f); and
                        ``(II) the hospice patient no longer requires the
                    controlled substance because the plan of care of the
                    hospice patient has been modified.

        ``(B) For the purposes of this paragraph:
                ``(i) The terms `hospice care' and `hospice program' have
            the meanings given to those terms in section 1861(dd) of the
            Social Security Act.
                ``(ii) The term `employee of a qualified hospice program'
            means a physician, physician assistant, nurse, or other person
            who--
                        ``(I) is employed by, or pursuant to arrangements
                    made by, a qualified hospice program;
                        ``(II)(aa) is licensed to perform medical or nursing
                    services by the jurisdiction in which the person
                    receiving hospice care was located; and
                        ``(bb) is acting within the scope of such employment
                    in accordance with applicable State law; and
                        ``(III) has completed training through the qualified
                    hospice program regarding the disposal of controlled
                    substances in a secure and responsible manner so as to
                    discourage abuse, misuse, or diversion.
                ``(iii) The term `qualified hospice program' means a hospice
            program that--
                        ``(I) has written policies and procedures for
                    assisting in the disposal of the controlled substances
                    of a person receiving hospice care after the person's
                    death;
                        ``(II) at the time when the controlled substances
                    are first ordered--
                              ``(aa) provides a copy of the written policies
                          and procedures to the patient or patient
                          representative and family;
                              ``(bb) discusses the policies and procedures
                          with the patient or representative and the family
                          in a language and manner that they understand to
                          ensure that these parties are educated regarding
                          the safe disposal of controlled substances; and

    [[Page 132 STAT. 3949]]

                              ``(cc) documents in the patient's clinical
                          record that the written policies and procedures
                          were provided and discussed; and
                        ``(III) at the time following the disposal of the
                    controlled substances--
                              ``(aa) documents in the patient's clinical
                          record the type of controlled substance, dosage,
                          route of administration, and quantity so disposed;
                          and
                              ``(bb) the time, date, and manner in which
                          that disposal occurred.''.

        (b) <<NOTE: 21 USC 822 note.>>  Guidance.--The Attorney General may
    issue guidance to hospice programs (as defined in paragraph (5) of
    section 302(g) of the Controlled Substances Act (21 U.S.C. 822(g)), as
    added by subsection (a)) to assist the programs in satisfying the
    requirements under such paragraph (5).

        (c) <<NOTE: 21 USC 822 note.>>  Rule of Construction Relating to
    State and Local Law.--Nothing in this section or the amendments made by
    this section shall be construed to prevent a State or local government
    from imposing additional controls or restrictions relating to the
    regulation of the disposal of controlled substances in hospice care or
    hospice programs.
    SEC. 3223. GAO STUDY AND REPORT ON HOSPICE SAFE DRUG MANAGEMENT.

        (a) Study.--
                (1) In general.--The Comptroller General of the United
            States (in this section referred to as the ``Comptroller
            General'') shall conduct a study on the requirements applicable
            to, and challenges of, hospice programs with regard to the
            management and disposal of controlled substances in the home of
            an individual.
                (2) Contents.--In conducting the study under paragraph (1),
            the Comptroller General shall include--
                        (A) an overview of any challenges encountered by
                    selected hospice programs regarding the disposal of
                    controlled substances, such as opioids, in a home
                    setting, including any key changes in policies,
                    procedures, or best practices for the disposal of
                    controlled substances over time; and
                        (B) a description of Federal requirements, including
                    requirements under the Medicare program, for hospice
                    programs regarding the disposal of controlled substances
                    in a home setting, and oversight of compliance with
                    those requirements.

        (b) Report.--Not later than 18 months after the date of enactment of
    this Act, the Comptroller General shall submit to Congress a report
    containing the results of the study conducted under subsection (a),
    together with recommendations, if any, for such legislation and
    administrative action as the Comptroller General determines appropriate.

     CHAPTER 4 <<NOTE: Special Registration for Telemedicine Clarification
    Act of 2018.>> --SPECIAL REGISTRATION FOR TELEMEDICINE CLARIFICATION
    SEC. 3231. <<NOTE: 21 USC 801 note.>>  SHORT TITLE.

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

    [[Page 132 STAT. 3950]]

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

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

           CHAPTER 5--SYNTHETIC ABUSE AND LABELING OF TOXIC SUBSTANCES

    SEC. 3241. CONTROLLED SUBSTANCE ANALOGUES.

        Section 203 of the Controlled Substances Act (21 U.S.C. 813) is
    amended--
                (1) by striking ``A controlled'' and inserting ``(a) In
            General.--A controlled''; and
                (2) by adding at the end the following:

        ``(b) Determination.--In determining whether a controlled substance
    analogue was intended for human consumption under subsection (a), the
    following factors may be considered, along with any other relevant
    factors:
                ``(1) The marketing, advertising, and labeling of the
            substance.
                ``(2) The known efficacy or usefulness of the substance for
            the marketed, advertised, or labeled purpose.
                ``(3) The difference between the price at which the
            substance is sold and the price at which the substance it is
            purported to be or advertised as is normally sold.
                ``(4) The diversion of the substance from legitimate
            channels and the clandestine importation, manufacture, or
            distribution of the substance.
                ``(5) Whether the defendant knew or should have known the
            substance was intended to be consumed by injection, inhalation,
            ingestion, or any other immediate means.
                ``(6) Any controlled substance analogue that is
            manufactured, formulated, sold, distributed, or marketed with
            the intent to avoid the provisions of existing drug laws.

        ``(c) Limitation.--For purposes of this section, evidence that a
    substance was not marketed, advertised, or labeled for human
    consumption, by itself, shall not be sufficient to establish that the
    substance was not intended for human consumption.''.

      CHAPTER 6 <<NOTE: Access to Increased Drug Disposal Act of 2018.>> --
    ACCESS TO INCREASED DRUG DISPOSAL
    SEC. 3251. <<NOTE: 21 USC 822a note.>>  SHORT TITLE.

        This chapter may be cited as the ``Access to Increased Drug Disposal
    Act of 2018''.
    SEC. 3252. DEFINITIONS.

        In this chapter--

    [[Page 132 STAT. 3951]]

                (1) the term ``Attorney General'' means the Attorney
            General, acting through the Assistant Attorney General for the
            Office of Justice Programs;
                (2) the term ``authorized collector'' means a narcotic
            treatment program, a hospital or clinic with an on-site
            pharmacy, a retail pharmacy, or a reverse distributor, that is
            authorized as a collector under section 1317.40 of title 21,
            Code of Federal Regulations (or any successor regulation);
                (3) the term ``covered grant'' means a grant awarded under
            section 3003; and
                (4) the term ``eligible collector'' means a person who is
            eligible to be an authorized collector.
    SEC. 3253. AUTHORITY TO MAKE GRANTS.

        The Attorney General shall award grants to States to enable the
    States to increase the participation of eligible collectors as
    authorized collectors.
    SEC. 3254. APPLICATION.

        A State desiring a covered grant shall submit to the Attorney
    General an application that, at a minimum--
                (1) identifies the single State agency that oversees
            pharmaceutical care and will be responsible for complying with
            the requirements of the grant;
                (2) details a plan to increase participation rates of
            eligible collectors as authorized collectors; and
                (3) describes how the State will select eligible collectors
            to be served under the grant.
    SEC. 3255. USE OF GRANT FUNDS.

        A State that receives a covered grant, and any subrecipient of the
    grant, may use the grant amounts only for the costs of installation,
    maintenance, training, purchasing, and disposal of controlled substances
    associated with the participation of eligible collectors as authorized
    collectors.
    SEC. 3256. ELIGIBILITY FOR GRANT.

        The Attorney General shall award a covered grant to 5 States, not
    less than 3 of which shall be States in the lowest quartile of States
    based on the participation rate of eligible collectors as authorized
    collectors, as determined by the Attorney General.
    SEC. 3257. DURATION OF GRANTS.

        The Attorney General shall determine the period of years for which a
    covered grant is made to a State.
    SEC. 3258. ACCOUNTABILITY AND OVERSIGHT.

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

    [[Page 132 STAT. 3952]]

    SEC. 3259. <<NOTE: 21 USC 822a note.>>  DURATION OF PROGRAM.

        The Attorney General may award covered grants for each of the first
    5 fiscal years beginning after the date of enactment of this Act.
    SEC. 3260. AUTHORIZATION OF APPROPRIATIONS.

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

       CHAPTER 7-- <<NOTE: Using Data To Prevent Opioid Diversion Act of
    2018.>> USING DATA TO PREVENT OPIOID DIVERSION
    SEC. 3271. <<NOTE: 21 USC 801 note.>>  SHORT TITLE.

        This chapter may be cited as the ``Using Data To Prevent Opioid
    Diversion Act of 2018''.
    SEC. 3272. <<NOTE: 21 USC 827 note.>>  PURPOSE.

        (a) In General.--The purpose of this chapter is to provide drug
    manufacturers and distributors with access to anonymized information
    through the Automated Reports and Consolidated Orders System to help
    drug manufacturers and distributors identify, report, and stop
    suspicious orders of opioids and reduce diversion rates.
        (b) Rule of Construction.--Nothing in this chapter should be
    construed to absolve a drug manufacturer, drug distributor, or other
    Drug Enforcement Administration registrant from the responsibility of
    the manufacturer, distributor, or other registrant to--
                (1) identify, stop, and report suspicious orders; or
                (2) maintain effective controls against diversion in
            accordance with section 303 of the Controlled Substances Act (21
            U.S.C. 823) or any successor law or associated regulation.
    SEC. 3273. AMENDMENTS.

        (a) Records and Reports of Registrants.--Section 307 of the
    Controlled Substances Act (21 U.S.C. 827) is amended--
                (1) by redesignating subsections (f), (g), and (h) as
            subsections (g), (h), and (i), respectively;
                (2) by inserting after subsection (e) the following:

        ``(f)(1) The Attorney General shall, not less frequently than
    quarterly, make the following information available to manufacturer and
    distributor registrants through the Automated Reports and Consolidated
    Orders System, or any subsequent automated system developed by the Drug
    Enforcement Administration to monitor selected controlled substances:
                ``(A) The total number of distributor registrants that
            distribute controlled substances to a pharmacy or practitioner
            registrant, aggregated by the name and address of each pharmacy
            and practitioner registrant.
                ``(B) The total quantity and type of opioids distributed,
            listed by Administration Controlled Substances Code Number, to
            each pharmacy and practitioner registrant described in
            subparagraph (A).

        ``(2) The information required to be made available under paragraph
    (1) shall be made available not later than the 30th day of the first
    month following the quarter to which the information relates.

    [[Page 132 STAT. 3953]]

        ``(3)(A) All registered manufacturers and distributors shall be
    responsible for reviewing the information made available by the Attorney
    General under this subsection.
        ``(B) In determining whether to initiate proceedings under this
    title against a registered manufacturer or distributor based on the
    failure of the registrant to maintain effective controls against
    diversion or otherwise comply with the requirements of this title or the
    regulations issued thereunder, the Attorney General may take into
    account that the information made available under this subsection was
    available to the registrant.''; and
                (3) by inserting after subsection (i), as so redesignated,
            the following:

        ``(j) All of the reports required under this section shall be
    provided in an electronic format.''.
        (b) Cooperative Arrangements.--Section 503 of the Controlled
    Substances Act (21 U.S.C. 873) is amended by striking subsection (c) and
    inserting the following:
        ``(c)(1) The Attorney General shall, once every 6 months, prepare
    and make available to regulatory, licensing, attorneys general, and law
    enforcement agencies of States a standardized report containing
    descriptive and analytic information on the actual distribution
    patterns, as gathered through the Automated Reports and Consolidated
    Orders System, or any subsequent automated system, pursuant to section
    307 and which includes detailed amounts, outliers, and trends of
    distributor and pharmacy registrants, in such States for the controlled
    substances contained in schedule II, which, in the discretion of the
    Attorney General, are determined to have the highest abuse.
        ``(2) If the Attorney General publishes the report described in
    paragraph (1) once every 6 months as required under paragraph (1),
    nothing in this subsection shall be construed to bring an action in any
    court to challenge the sufficiency of the information or to compel the
    Attorney General to produce any documents or reports referred to in this
    subsection.''.
        (c) Civil and Criminal Penalties.--Section 402 of the Controlled
    Substances Act (21 U.S.C. 842) is amended--
                (1) in subsection (a)--
                        (A) in paragraph (15), by striking ``or'' at the
                    end;
                        (B) in paragraph (16), by striking the period at the
                    end and inserting ``; or''; and
                        (C) by inserting after paragraph (16) the following:
                ``(17) in the case of a registered manufacturer or
            distributor of opioids, to fail to review the most recent
            information, directly related to the customers of the
            manufacturer or distributor, made available by the Attorney
            General in accordance with section 307(f).''; and
                (2) in subsection (c)--
                        (A) in paragraph (1), by striking subparagraph (B)
                    and inserting the following:

        ``(B)(i) Except as provided in clause (ii), in the case of a
    violation of paragraph (5), (10), or (17) of subsection (a), the civil
    penalty shall not exceed $10,000.
        ``(ii) In the case of a violation described in clause (i) committed
    by a registered manufacturer or distributor of opioids and related to
    the reporting of suspicious orders for opioids, failing to maintain
    effective controls against diversion of opioids, or failing to review
    the most recent information made available by the Attorney General

    [[Page 132 STAT. 3954]]

    in accordance with section 307(f), the penalty shall not exceed
    $100,000.''; and
                        (B) in paragraph (2)--
                              (i) in subparagraph (A), by inserting ``or
                          (D)'' after ``subparagraph (B)''; and
                              (ii) by adding at the end the following:

        ``(D) In the case of a violation described in subparagraph (A) that
    was a violation of paragraph (5), (10), or (17) of subsection (a)
    committed by a registered manufacturer or distributor of opioids that
    relates to the reporting of suspicious orders for opioids, failing to
    maintain effective controls against diversion of opioids, or failing to
    review the most recent information made available by the Attorney
    General in accordance with section 307(f), the criminal fine under title
    18, United States Code, shall not exceed $500,000.''.
    SEC. 3274. REPORT.

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

    CHAPTER 8-- <<NOTE: Opioid Quota Reform Act.>> OPIOID QUOTA REFORM
    SEC. 3281. <<NOTE: 21 USC 801 note.>>  SHORT TITLE.

        This chapter may be cited as the ``Opioid Quota Reform Act''.
    SEC. 3282. STRENGTHENING CONSIDERATIONS FOR DEA OPIOID QUOTAS.

        (a) In General.--Section 306 of the Controlled Substances Act (21
    U.S.C. 826) is amended--
                (1) in subsection (a)--
                        (A) by inserting ``(1)'' after ``(a)'';
                        (B) in the second sentence, by striking
                    ``Production'' and inserting ``Except as provided in
                    paragraph (2), production''; and
                        (C) by adding at the end the following:

        ``(2) The Attorney General may, if the Attorney General determines
    it will assist in avoiding the overproduction, shortages, or diversion
    of a controlled substance, establish an aggregate or individual
    production quota under this subsection, or a procurement quota
    established by the Attorney General by regulation, in terms of
    pharmaceutical dosage forms prepared from or containing the controlled
    substance.'';
                (2) in subsection (b), in the first sentence, by striking
            ``production'' and inserting ``manufacturing'';
                (3) in subsection (c), by striking ``October'' and inserting
            ``December''; and
                (4) by adding at the end the following:

        ``(i)(1)(A) In establishing any quota under this section, or any
    procurement quota established by the Attorney General by regulation, for
    fentanyl, oxycodone, hydrocodone, oxymorphone, or hydromorphone (in this
    subsection referred to as a `covered controlled substance'), the
    Attorney General shall estimate the amount

    [[Page 132 STAT. 3955]]

    of diversion of the covered controlled substance that occurs in the
    United States.
        ``(B) In estimating diversion under this paragraph, the Attorney
    General--
                ``(i) shall consider information the Attorney General, in
            consultation with the Secretary of Health and Human Services,
            determines reliable on rates of overdose deaths and abuse and
            overall public health impact related to the covered controlled
            substance in the United States; and
                ``(ii) may take into consideration whatever other sources of
            information the Attorney General determines reliable.

        ``(C) After estimating the amount of diversion of a covered
    controlled substance, the Attorney General shall make appropriate quota
    reductions, as determined by the Attorney General, from the quota the
    Attorney General would have otherwise established had such diversion not
    been considered.
        ``(2)(A) For any year for which the approved aggregate production
    quota for a covered controlled substance is higher than the approved
    aggregate production quota for the covered controlled substance for the
    previous year, the Attorney General, in consultation with the Secretary
    of Health and Human Services, shall include in the final order an
    explanation of why the public health benefits of increasing the quota
    clearly outweigh the consequences of having an increased volume of the
    covered controlled substance available for sale, and potential
    diversion, in the United States.
        ``(B) Not later than 1 year after the date of enactment of this
    subsection, and every year thereafter, the Attorney General shall submit
    to the Committee on the Judiciary, the Committee on Health, Education,
    Labor, and Pensions, and the Committee on Appropriations of the Senate
    and the Committee on the Judiciary, the Committee on Energy and
    Commerce, and the Committee on Appropriations of the House of
    Representatives the following information with regard to each covered
    controlled substance:
                ``(i) An anonymized count of the total number of
            manufacturers issued individual manufacturing quotas that year
            for the covered controlled substance.
                ``(ii) An anonymized count of how many such manufacturers
            were issued an approved manufacturing quota that was higher than
            the quota issued to that manufacturer for the covered controlled
            substance in the previous year.

        ``(3) Not later than 1 year after the date of enactment of this
    subsection, the Attorney General shall submit to Congress a report on
    how the Attorney General, when fixing and adjusting production and
    manufacturing quotas under this section for covered controlled
    substances, will--
                ``(A) take into consideration changes in the accepted
            medical use of the covered controlled substances; and
                ``(B) work with the Secretary of Health and Human Services
            on methods to appropriately and anonymously estimate the type
            and amount of covered controlled substances that are submitted
            for collection from approved drug collection receptacles, mail-
            back programs, and take-back events.''.

        (b) Conforming Change. <<NOTE: 21 USC 826 note.>> --The Law Revision
    Counsel is directed to amend the heading for subsection (b) of section
    826 of title 21, United States Code, by striking ``Production'' and
    inserting ``Manufacturing''.

    [[Page 132 STAT. 3956]]

    CHAPTER 9 <<NOTE: Preventing Drug Diversion Act of 2018.>> --PREVENTING
    DRUG DIVERSION
    SEC. 3291. <<NOTE: 21 USC 801 note.>>  SHORT TITLE.

        This chapter may be cited as the ``Preventing Drug Diversion Act of
    2018''.
    SEC. 3292. IMPROVEMENTS TO PREVENT DRUG DIVERSION.

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

        (b) Suspicious Orders.--Part C of the Controlled Substances Act (21
    U.S.C. 821 et seq.) is amended by adding at the end the following:
    ``SEC. 312. <<NOTE: 21 USC 832.>>  SUSPICIOUS ORDERS.

        ``(a) Reporting.--Each registrant shall--
                ``(1) design and operate a system to identify suspicious
            orders for the registrant;
                ``(2) ensure that the system designed and operated under
            paragraph (1) by the registrant complies with applicable Federal
            and State privacy laws; and
                ``(3) upon discovering a suspicious order or series of
            orders, notify the Administrator of the Drug Enforcement
            Administration and the Special Agent in Charge of the Division
            Office of the Drug Enforcement Administration for the area in
            which the registrant is located or conducts business.

        ``(b) Suspicious Order Database.--
                ``(1) In general.--Not later than 1 year after the date of
            enactment of this section, the Attorney General shall establish
            a centralized database for collecting reports of suspicious
            orders.
                ``(2) Satisfaction of reporting requirements.--If a
            registrant reports a suspicious order to the centralized
            database established under paragraph (1), the registrant shall
            be considered to have complied with the requirement under
            subsection (a)(3) to notify the Administrator of the Drug
            Enforcement Administration and the Special Agent in Charge of
            the Division Office of the Drug Enforcement Administration for
            the area in which the registrant is located or conducts
            business.

        ``(c) Sharing Information With the States.--
                ``(1) In general.--The Attorney General shall prepare and
            make available information regarding suspicious orders in a
            State, including information in the database established under
            subsection (b)(1), to the point of contact for purposes of
            administrative, civil, and criminal oversight relating to the
            diversion of controlled substances for the State, as designated
            by the Governor or chief executive officer of the State.
                ``(2) Timing.--The Attorney General shall provide
            information in accordance with paragraph (1) within a reasonable
            period of time after obtaining the information.

    [[Page 132 STAT. 3957]]

                ``(3) Coordination.--In establishing the process for the
            provision of information under this subsection, the Attorney
            General shall coordinate with States to ensure that the Attorney
            General has access to information, as permitted under State law,
            possessed by the States relating to prescriptions for controlled
            substances that will assist in enforcing Federal law.''.

        (c) Reports to Congress.--
                (1) Definition.--In this subsection, the term ``suspicious
            order'' has the meaning given that term in section 102 of the
            Controlled Substances Act, as amended by this chapter.
                (2) One-time report.--Not later than 1 year after the date
            of enactment of this Act, the Attorney General shall submit to
            Congress a report on the reporting of suspicious orders, which
            shall include--
                        (A) a description of the centralized database
                    established under section 312 of the Controlled
                    Substances Act, as added by this section, to collect
                    reports of suspicious orders;
                        (B) a description of the system and reports
                    established under section 312 of the Controlled
                    Substances Act, as added by this section, to share
                    information with States;
                        (C) information regarding how the Attorney General
                    used reports of suspicious orders before the date of
                    enactment of this Act and after the date of enactment of
                    this Act, including how the Attorney General received
                    the reports and what actions were taken in response to
                    the reports; and
                        (D) descriptions of the data analyses conducted on
                    reports of suspicious orders to identify, analyze, and
                    stop suspicious activity.
                (3) Additional reports.--Not later than 1 year after the
            date of enactment of this Act, and annually thereafter until the
            date that is 5 years after the date of enactment of this Act,
            the Attorney General shall submit to Congress a report
            providing, for the previous year--
                        (A) the number of reports of suspicious orders;
                        (B) a summary of actions taken in response to
                    reports, in the aggregate, of suspicious orders; and
                        (C) a description of the information shared with
                    States based on reports of suspicious orders.
                (4) One-time gao report.--Not later than 1 year after the
            date of enactment of this Act, the Comptroller General of the
            United States, in consultation with the Administrator of the
            Drug Enforcement Administration, shall submit to Congress a
            report on the reporting of suspicious orders, which shall
            include an evaluation of the utility of real-time reporting of
            potential suspicious orders of opioids on a national level using
            computerized algorithms, including the extent to which such
            algorithms--
                        (A) would help ensure that potentially suspicious
                    orders are more accurately captured, identified, and
                    reported in real time to suppliers before orders are
                    filled;
                        (B) may produce false positives of suspicious order
                    reports that could result in market disruptions for
                    legitimate orders of opioids; and

    [[Page 132 STAT. 3958]]

                        (C) would reduce the overall length of an
                    investigation that prevents the diversion of suspicious
                    orders of opioids.

                                TITLE IV--OFFSETS

    SEC. 4001. PROMOTING VALUE IN MEDICAID MANAGED CARE.

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

    [[Page 132 STAT. 3959]]

                ``(iii) The term `other specified entity' means--
                        ``(I) a prepaid inpatient health plan, as defined in
                    section 438.2 of title 42, Code of Federal Regulations
                    (or any successor regulation); and
                        ``(II) a prepaid ambulatory health plan, as defined
                    in such section (or any successor regulation).''.
    SEC. 4002. REQUIRING REPORTING BY GROUP HEALTH PLANS OF
                              PRESCRIPTION DRUG COVERAGE INFORMATION
                              FOR PURPOSES OF IDENTIFYING PRIMARY
                              PAYER SITUATIONS UNDER THE MEDICARE
                              PROGRAM.

        Clause (i) of section 1862(b)(7)(A) of the Social Security Act (42
    U.S.C. 1395y(b)(7)(A)) is amended to read as follows:
                              ``(i) secure from the plan sponsor and plan
                          participants such information as the Secretary
                          shall specify for the purpose of identifying
                          situations where the group health plan is or has
                          been--
                                        ``(I) a primary plan to the program
                                    under this title; or
                                        ``(II) for calendar quarters
                                    beginning on or after January 1, 2020, a
                                    primary payer with respect to benefits
                                    relating to prescription drug coverage
                                    under part D; and''.
    SEC. 4003. ADDITIONAL RELIGIOUS EXEMPTION FROM HEALTH COVERAGE
                              RESPONSIBILITY REQUIREMENT.

        (a) In General.--Section 5000A(d)(2)(A) of the Internal Revenue Code
    of 1986 is amended to read as follows:
                        ``(A) Religious conscience exemptions.--
                              ``(i) In general.--Such term shall not include
                          any individual for any month if such individual
                          has in effect an exemption under section
                          1311(d)(4)(H) of the Patient Protection and
                          Affordable Care Act which certifies that--
                                        ``(I) such individual is a member of
                                    a recognized religious sect or division
                                    thereof which is described in section
                                    1402(g)(1), and is adherent of
                                    established tenets or teachings of such
                                    sect or division as described in such
                                    section; or
                                        ``(II) such individual is a member
                                    of a religious sect or division thereof
                                    which is not described in section
                                    1402(g)(1), who relies solely on a
                                    religious method of healing, and for
                                    whom the acceptance of medical health
                                    services would be inconsistent with the
                                    religious beliefs of the individual.
                              ``(ii) Special rules.--
                                        ``(I) Medical health services
                                    defined.--For purposes of this
                                    subparagraph, the term `medical health
                                    services' does not include routine
                                    dental, vision and hearing services,
                                    midwifery services, vaccinations,
                                    necessary medical services provided to
                                    children, services required by law or by
                                    a third party, and such other services
                                    as the Secretary of Health and Human
                                    Services may provide in implementing
                                    section 1311(d)(4)(H) of the Patient
                                    Protection and Affordable Care Act.
                                        ``(II) Attestation required.--Clause
                                    (i)(II) shall apply to an individual for
                                    months in a taxable

    [[Page 132 STAT. 3960]]

                                    year only if the information provided by
                                    the individual under section
                                    1411(b)(5)(A) of such Act includes an
                                    attestation that the individual has not
                                    received medical health services during
                                    the preceding taxable year.''.

        (b) <<NOTE: 26 USC 5000A note.>>  Effective Date.--The amendment
    made by subsection (a) shall apply to taxable years beginning after
    December 31, 2018.

        (c) <<NOTE: 26 USC 5000A note.>>  Construction.--Nothing in the
    amendment made by subsection (a) shall preempt any State law requiring
    the provision of medical treatment for children, especially those who
    are seriously ill.
    SEC. 4004. MODERNIZING THE REPORTING OF BIOLOGICAL AND BIOSIMILAR
                              PRODUCTS.

        Subtitle B of title XI of the Medicare Prescription Drug,
    Improvement, and Modernization Act of 2003 (Public Law 108-173) is
    amended--
                (1) in section 1111 <<NOTE: 21 USC 355 note.>> , as amended
            by section 3(1) of the Patient Right to Know Drug Prices Act--
                        (A) in the paragraph (3) inserted by such section
                    3(1), by striking ``an application'' and inserting ``a
                    biosimilar biological product application'';
                        (B) in the paragraph (4) inserted by such section
                    3(1), by inserting ``application'' before ``under
                    section 351(k) of the Public Health Service Act'';
                        (C) in the paragraph (5) inserted by such section
                    3(1), by striking ``for licensure of a biological
                    product under section 351(k) of the Public Health
                    Service Act'' and inserting ``under section 351(k) of
                    the Public Health Service Act for licensure of a
                    biological product as biosimilar to, or interchangeable
                    with, a reference product'';
                        (D) in paragraph (7), as redesignated and amended by
                    such section 3(1), by striking ``or under section 351(a)
                    of the Public Health Service Act'' and inserting ``or
                    the owner, or exclusive licensee, of a patent included
                    in a list provided under section 351(l)(3) of the Public
                    Health Service Act''; and
                        (E) in the paragraph (12) added by such section
                    3(1), by striking ``means a brand name drug for which a
                    license is in effect under section 351(a)'' and
                    inserting ``has the meaning given such term in section
                    351(i)''; and
                (2) in section 1112, as amended by section 3(2) of the
            Patient Right to Know Drug Prices Act--
                        (A) in subsection (a)--
                              (i) in paragraph (1), by striking ``for which
                          a statement under section 351(l)(3)(B)(ii)(I) of
                          the Public Health Service Act has been provided'';
                              (ii) in paragraph (2)--
                                        (I) in subparagraph (C)(i), by
                                    striking ``brand name'' and inserting
                                    ``listed''; and
                                        (II) by amending clause (ii) of
                                    subparagraph (C) to read as follows:
                              ``(ii) any of the time periods referred to in
                          section 351(k)(6) of the Public Health Service Act
                          as such period applies to such biosimilar
                          biological product application or to any other
                          biosimilar biological product application based on
                          the same reference product.'';

    [[Page 132 STAT. 3961]]

                        (B) in subsection (b)--
                              (i) in the subsection heading, by inserting
                          ``or Biosimilar Biological Product Applicant''
                          after ``Applicant'';
                              (ii) in paragraph (1)(B), by striking the
                          first sentence and inserting the following: ``A
                          biosimilar biological product applicant that has
                          submitted a biosimilar biological product
                          application that references a reference product
                          and another biosimilar biological product
                          applicant that has submitted a biosimilar
                          biological product application that references the
                          same reference product shall each file the
                          agreement in accordance with subsection (c).'';
                          and
                              (iii) in paragraph (2)--
                                        (I) by striking ``2 generic drug
                                    applicants'' and inserting ``2 or more
                                    generic drug applicants''; and
                                        (II) by striking ``or an agreement
                                    between 2 biosimilar biological product
                                    applicants regarding the 1-year period
                                    referred to in section 351(k)(6)(A) of
                                    the Public Health Service Act as it
                                    applies to the biosimilar biological
                                    product applications with which the
                                    agreement is concerned'' and inserting
                                    ``, an agreement between 2 or more
                                    biosimilar biological product applicants
                                    regarding a time period referred to in
                                    section 351(k)(6) of the Public Health
                                    Service Act as it applies to the
                                    biosimilar biological product, or an
                                    agreement between 2 or more biosimilar
                                    biological product applicants regarding
                                    the manufacture, marketing, or sale of a
                                    biosimilar biological product''; and
                        (C) in subsection (c)(2), by inserting ``were
                    entered into within 30 days of,'' after ``condition
                    for,''.

    TITLE V <<NOTE: Individuals in Medicaid Deserve Care that is Appropriate
    and Responsible in its Execution Act.>> --OTHER MEDICAID PROVISIONS

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

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

        Section 1139B of the Social Security Act (42 U.S.C. 1320b-9b) is
    amended--
                (1) in subsection (b)--
                        (A) in paragraph (3)--
                              (i) by striking ``Not later than January 1,
                          2013'' and inserting the following:
                        ``(A) Voluntary reporting.--Not later than January
                    1, 2013''; and
                              (ii) by adding at the end the following:
                        ``(B) Mandatory reporting with respect to behavioral
                    health measures.--Beginning with the State report
                    required under subsection (d)(1) for 2024, the Secretary

    [[Page 132 STAT. 3962]]

                    shall require States to use all behavioral health
                    measures included in the core set of adult health
                    quality measures and any updates or changes to such
                    measures to report information, using the standardized
                    format for reporting information and procedures
                    developed under subparagraph (A), regarding the quality
                    of behavioral health care for Medicaid eligible
                    adults.''; and
                        (B) in paragraph (5), by adding at the end the
                    following new subparagraph:
                        ``(C) Behavioral health measures.--Beginning with
                    respect to State reports required under subsection
                    (d)(1) for 2024, the core set of adult health quality
                    measures maintained under this paragraph (and any
                    updates or changes to such measures) shall include
                    behavioral health measures.''; and
                (2) in subsection (d)(1)(A)--
                        (A) by striking ``the such plan'' and inserting
                    ``such plan''; and
                        (B) by striking ``subsection (a)(5)'' and inserting
                    ``subsection (b)(5) and, beginning with the report for
                    2024, all behavioral health measures included in the
                    core set of adult health quality measures maintained
                    under such subsection (b)(5) and any updates or changes
                    to such measures (as required under subsection
                    (b)(3))''.

     Subtitle B <<NOTE: Medicaid Institutes for Mental Disease Are Decisive
    in Delivering Inpatient Treatment for Individuals but Opportunities for
      Needed Access are Limited without Information Needed about Facility
    Obligations Act.>> --Medicaid IMD Additional Info
    SEC. 5011. SHORT TITLE.

        This subtitle may be cited as the ``Medicaid Institutes for Mental
    Disease Are Decisive in Delivering Inpatient Treatment for Individuals
    but Opportunities for Needed Access are Limited without Information
    Needed about Facility Obligations Act'' or the ``Medicaid IMD ADDITIONAL
    INFO Act''.
    SEC. 5012. MACPAC EXPLORATORY STUDY AND REPORT ON INSTITUTIONS FOR
                              MENTAL DISEASES REQUIREMENTS AND
                              PRACTICES UNDER MEDICAID.

        (a) In General.--Not later than January 1, 2020, the Medicaid and
    CHIP Payment and Access Commission established under section 1900 of the
    Social Security Act (42 U.S.C. 1396) shall conduct an exploratory study,
    using data from a representative sample of States, and submit to
    Congress a report on at least the following information, with respect to
    services furnished to individuals enrolled under State plans under the
    Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.)
    (or waivers of such plans) who are patients in institutions for mental
    diseases and for which payment is made through fee-for-service or
    managed care arrangements under such State plans (or waivers):
                (1) A description of such institutions for mental diseases
            in each such State, including at a minimum--
                        (A) the number of such institutions in the State;
                        (B) the facility type of such institutions in the
                    State; and
                        (C) any coverage limitations under each such State
                    plan (or waiver) on scope, duration, or frequency of
                    such services.

    [[Page 132 STAT. 3963]]

                (2) With respect to each such institution for mental
            diseases in each such State, a description of--
                        (A) such services provided at such institution;
                        (B) the process, including any timeframe, used by
                    such institution to clinically assess and reassess such
                    individuals; and
                        (C) the discharge process used by such institution,
                    including any care continuum of relevant services or
                    facilities provided or used in such process.
                (3) A description of--
                        (A) any Federal waiver that each such State has for
                    such institutions and the Federal statutory authority
                    for such waiver; and
                        (B) any other Medicaid funding sources used by each
                    such State for funding such institutions, such as
                    supplemental payments.
                (4) A summary of State requirements (such as certification,
            licensure, and accreditation) applied by each such State to such
            institutions in order for such institutions to receive payment
            under the State plan (or waiver) and how each such State
            determines if such requirements have been met.
                (5) A summary of State standards (such as quality standards,
            clinical standards, and facility standards) that such
            institutions must meet to receive payment under such State plans
            (or waivers) and how each such State determines if such
            standards have been met.
                (6) If determined appropriate by the Commission,
            recommendations for policies and actions by Congress and the
            Centers for Medicare & Medicaid Services, such as on how State
            Medicaid programs may improve care and improve standards and
            including a recommendation for how the Centers for Medicare &
            Medicaid Services can improve data collection from such programs
            to address any gaps in information.

        (b) Stakeholder Input.--In carrying out subsection (a), the Medicaid
    and CHIP Payment and Access Commission shall seek input from State
    Medicaid directors and stakeholders, including at a minimum the
    Substance Abuse and Mental Health Services Administration, Centers for
    Medicare & Medicaid Services, State Medicaid officials, State mental
    health authorities, Medicaid beneficiary advocates, health care
    providers, and Medicaid managed care organizations.
        (c) Definitions.--In this section:
                (1) Representative sample of states.--The term
            ``representative sample of States'' means a non-probability
            sample in which at least two States are selected based on the
            knowledge and professional judgment of the selector.
                (2) State.--The term ``State'' means each of the 50 States,
            the District of Columbia, and any commonwealth or territory of
            the United States.
                (3) Institution for mental diseases.--The term ``institution
            for mental diseases'' has the meaning given such term in section
            435.1010 of title 42, Code of Federal Regulations, or any
            successor regulation.

    [[Page 132 STAT. 3964]]

    Subtitle C <<NOTE: CHIP Mental Health and Substance Use Disorder Parity
    Act.>> --CHIP Mental Health and Substance Use Disorder Parity
    SEC. 5021. <<NOTE: 42 USC 1305 note.>>  SHORT TITLE.

        This subtitle may be cited as the ``CHIP Mental Health and Substance
    Use Disorder Parity Act''.
    SEC. 5022. ENSURING ACCESS TO MENTAL HEALTH AND SUBSTANCE USE
                              DISORDER SERVICES FOR CHILDREN AND
                              PREGNANT WOMEN UNDER THE CHILDREN'S
                              HEALTH INSURANCE PROGRAM.

        (a) In General.--Section 2103(c)(1) of the Social Security Act (42
    U.S.C. 1397cc(c)(1)) is amended by adding at the end the following new
    subparagraph:
                        ``(E) Mental health and substance use disorder
                    services (as defined in paragraph (5)).''.

        (b) Mental Health and Substance Use Disorder Services.--
                (1) In general.--Section 2103(c) of the Social Security Act
            (42 U.S.C. 1397cc(c)) is amended--
                        (A) by redesignating paragraphs (5), (6), (7), and
                    (8) as paragraphs (6), (7), (8), and (9), respectively;
                    and
                        (B) by inserting after paragraph (4) the following
                    new paragraph:
                ``(5) Mental health and substance use disorder services.--
            Regardless of the type of coverage elected by a State under
            subsection (a), child health assistance provided under such
            coverage for targeted low-income children and, in the case that
            the State elects to provide pregnancy-related assistance under
            such coverage pursuant to section 2112, such pregnancy-related
            assistance for targeted low-income pregnant women (as defined in
            section 2112(d)) shall--
                        ``(A) include coverage of mental health services
                    (including behavioral health treatment) necessary to
                    prevent, diagnose, and treat a broad range of mental
                    health symptoms and disorders, including substance use
                    disorders; and
                        ``(B) be delivered in a culturally and
                    linguistically appropriate manner.''.
                (2) Conforming amendments.--
                        (A) Section 2103(a) of the Social Security Act (42
                    U.S.C. 1397cc(a)) is amended, in the matter before
                    paragraph (1), by striking ``paragraphs (5), (6), and
                    (7)'' and inserting ``paragraphs (5), (6), (7), and
                    (8)''.
                        (B) Section 2110(a) of the Social Security Act (42
                    U.S.C. 1397jj(a)) is amended--
                              (i) in paragraph (18), by striking ``substance
                          abuse'' each place it appears and inserting
                          ``substance use''; and
                              (ii) in paragraph (19), by striking
                          ``substance abuse'' and inserting ``substance
                          use''.
                        (C) Section 2110(b)(5)(A)(i) of the Social Security
                    Act (42 U.S.C. 1397jj(b)(5)(A)(i)) is amended by
                    striking ``subsection (c)(5)'' and inserting
                    ``subsection (c)(6)''.

        (c) Assuring Access to Care.--Section 2102(a)(7)(B) of the Social
    Security Act (42 U.S.C. 1397bb(c)(2)) is amended by striking

    [[Page 132 STAT. 3965]]

    ``section 2103(c)(5)'' and inserting ``paragraphs (5) and (6) of section
    2103(c)''.
        (d) Mental Health Services Parity.--Subparagraph (A) of paragraph
    (7) of section 2103(c) of the Social Security Act (42 U.S.C. 1397cc(c))
    (as redesignated by subsection (b)(1)) is amended to read as follows:
                        ``(A) In general.--A State child health plan shall
                    ensure that the financial requirements and treatment
                    limitations applicable to mental health and substance
                    use disorder services (as described in paragraph (5))
                    provided under such plan comply with the requirements of
                    section 2726(a) of the Public Health Service Act in the
                    same manner as such requirements or limitations apply to
                    a group health plan under such section.''.

        (e) <<NOTE: 42 USC 1397bb note.>>  Effective Date.--
                (1) In general.--Subject to paragraph (2), the amendments
            made by this section shall take effect with respect to child
            health assistance provided on or after the date that is 1 year
            after the date of the enactment of this Act.
                (2) Exception for state legislation.--In the case of a State
            child health plan under title XXI of the Social Security Act (or
            a waiver of such plan), which the Secretary of Health and Human
            Services determines requires State legislation in order for the
            respective plan (or waiver) to meet any requirement imposed by
            the amendments made by this section, the respective plan (or
            waiver) shall not be regarded as failing to comply with the
            requirements of such title solely on the basis of its failure to
            meet such an additional requirement before the first day of the
            first calendar quarter beginning after the close of the first
            regular session of the State legislature that begins after the
            date of enactment of this section. For purposes of the previous
            sentence, in the case of a State that has a 2-year legislative
            session, each year of the session shall be considered to be a
            separate regular session of the State legislature.

    Subtitle D <<NOTE: Medicaid Reentry Act.>> --Medicaid Reentry
    SEC. 5031 <<NOTE: 42 USC 1396a note.>> . SHORT TITLE.

        This subtitle may be cited as the ``Medicaid Reentry Act''.
    SEC. 5032 <<NOTE: 42 USC 1396a note.>> . PROMOTING STATE
                              INNOVATIONS TO EASE TRANSITIONS
                              INTEGRATION TO THE COMMUNITY FOR CERTAIN
                              INDIVIDUALS.

        (a) Stakeholder Group Development of Best Practices; State Medicaid
    Program Innovation.--
                (1) Stakeholder group best practices.--Not later than 6
            months after the date of the enactment of this Act, the
            Secretary of Health and Human Services shall convene a
            stakeholder group of representatives of managed care
            organizations, Medicaid beneficiaries, health care providers,
            the National Association of Medicaid Directors, and other
            relevant representatives from local, State, and Federal jail and
            prison systems to develop best practices (and submit to the
            Secretary and Congress a report on such best practices) for
            States--

    [[Page 132 STAT. 3966]]

                        (A) to ease the health care-related transition of an
                    individual who is an inmate of a public institution from
                    the public institution to the community, including best
                    practices for ensuring continuity of health insurance
                    coverage or coverage under the State Medicaid plan under
                    title XIX of the Social Security Act, as applicable, and
                    relevant social services; and
                        (B) to carry out, with respect to such an
                    individual, such health care-related transition not
                    later than 30 days after such individual is released
                    from the public institution.
                (2) State medicaid program innovation.--The Secretary of
            Health and Human Services shall work with States on innovative
            strategies to help individuals who are inmates of public
            institutions and otherwise eligible for medical assistance under
            the Medicaid program under title XIX of the Social Security Act
            transition, with respect to enrollment for medical assistance
            under such program, seamlessly to the community.

        (b) Guidance on Innovative Service Delivery Systems Demonstration
    Project Opportunities.--Not later than 1 year after the date of the
    enactment of this Act, the Secretary of Health and Human Services,
    through the Administrator of the Centers for Medicare & Medicaid
    Services, shall issue a State Medicaid Director letter, based on best
    practices developed under subsection (a)(1), regarding opportunities to
    design demonstration projects under section 1115 of the Social Security
    Act (42 U.S.C. 1315) to improve care transitions for certain individuals
    who are soon-to-be former inmates of a public institution and who are
    otherwise eligible to receive medical assistance under title XIX of such
    Act, including systems for, with respect to a period (not to exceed 30
    days) immediately prior to the day on which such individuals are
    expected to be released from such institution--
                (1) providing assistance and education for enrollment under
            a State plan under the Medicaid program under title XIX of such
            Act for such individuals during such period; and
                (2) providing health care services for such individuals
            during such period.

        (c) Rule of Construction.--Nothing under title XIX of the Social
    Security Act or any other provision of law precludes a State from
    reclassifying or suspending (rather than terminating) eligibility of an
    individual for medical assistance under title XIX of the Social Security
    Act while such individual is an inmate of a public institution.

     Subtitle E <<NOTE: Medicaid Providers Are Required To Note Experiences
    in Record Systems to Help In-need Patients Act.>> --Medicaid Partnership
    SEC. 5041. <<NOTE: 42 USC 1305 note.>>  SHORT TITLE.

        This subtitle may be cited as the ``Medicaid Providers Are Required
    To Note Experiences in Record Systems to Help In-need Patients Act'' or
    the ``Medicaid PARTNERSHIP Act''.
    SEC. 5042. MEDICAID PROVIDERS ARE REQUIRED TO NOTE EXPERIENCES IN
                              RECORD SYSTEMS TO HELP IN-NEED PATIENTS.

        (a) Requirements Under the Medicaid Program Relating to Qualified
    Prescription Drug Monitoring Programs and Prescribing Certain Controlled
    Substances.--Title XIX of the

    [[Page 132 STAT. 3967]]

    Social Security Act (42 U.S.C. 1396 et seq.) is amended by inserting
    after section 1943 the following new section:
    ``SEC. 1944. <<NOTE: 42 USC 1396w-3a.>>  REQUIREMENTS RELATING TO
                              QUALIFIED PRESCRIPTION DRUG MONITORING
                              PROGRAMS AND PRESCRIBING CERTAIN
                              CONTROLLED SUBSTANCES.

        ``(a) In General.--Subject to subsection (d), beginning October 1,
    2021, a State--
                ``(1) shall require each covered provider to check, in
            accordance with such timing, manner, and form as specified by
            the State, the prescription drug history of a covered individual
            being treated by the covered provider through a qualified
            prescription drug monitoring program described in subsection (b)
            before prescribing to such individual a controlled substance;
            and
                ``(2) in the case that such a provider is not able to
            conduct such a check despite a good faith effort by such
            provider--
                        ``(A) shall require the provider to document such
                    good faith effort, including the reasons why the
                    provider was not able to conduct the check; and
                        ``(B) may require the provider to submit, upon
                    request, such documentation to the State.

        ``(b) Qualified Prescription Drug Monitoring Program Described.--A
    qualified prescription drug monitoring program described in this
    subsection is, with respect to a State, a prescription drug monitoring
    program administered by the State that, at a minimum, satisfies each of
    the following criteria:
                ``(1) The program facilitates access by a covered provider
            to, at a minimum, the following information with respect to a
            covered individual, in as close to real-time as possible:
                        ``(A) Information regarding the prescription drug
                    history of a covered individual with respect to
                    controlled substances.
                        ``(B) The number and type of controlled substances
                    prescribed to and filled for the covered individual
                    during at least the most recent 12-month period.
                        ``(C) The name, location, and contact information
                    (or other identifying number selected by the State, such
                    as a national provider identifier issued by the National
                    Plan and Provider Enumeration System of the Centers for
                    Medicare & Medicaid Services) of each covered provider
                    who prescribed a controlled substance to the covered
                    individual during at least the most recent 12-month
                    period.
                ``(2) The program facilitates the integration of information
            described in paragraph (1) into the workflow of a covered
            provider, which may include the electronic system the covered
            provider uses to prescribe controlled substances.

    A qualified prescription drug monitoring program described in this
    subsection, with respect to a State, may have in place, in accordance
    with applicable State and Federal law, a data-sharing agreement with the
    State Medicaid program that allows the medical director and pharmacy
    director of such program (and any designee of such a director who
    reports directly to such director) to access the information described
    in paragraph (1) in an electronic format. The State Medicaid program
    under this title may facilitate reasonable and limited access, as
    determined by the State and ensuring documented beneficiary protections
    regarding the use of such data,

    [[Page 132 STAT. 3968]]

    to such qualified prescription drug monitoring program for the medical
    director or pharmacy director of any managed care entity (as defined
    under section 1932(a)(1)(B)) that has a contract with the State under
    section 1903(m) or under section 1905(t)(3), or the medical director or
    pharmacy director of any entity that has a contract to manage the
    pharmaceutical benefit with respect to individuals enrolled in the State
    plan (or under a waiver of the State plan). All applicable State and
    Federal security and privacy laws shall apply to the directors or
    designees of such directors of any State Medicaid program or entity
    accessing a qualified prescription drug monitoring program under this
    section.
        ``(c) Application of Privacy Rules Clarification.--The Secretary
    shall clarify privacy requirements, including requirements under the
    regulations promulgated pursuant to section 264(c) of the Health
    Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2
    note), related to the sharing of data under subsection (b) in the same
    manner as the Secretary is required under subparagraph (J) of section
    1860D-4(c)(5) to clarify privacy requirements related to the sharing of
    data described in such subparagraph.
        ``(d) Ensuring Access.--In order to ensure reasonable access to
    health care, the Secretary shall waive the application of the
    requirement under subsection (a), with respect to a State, in the case
    of natural disasters and similar situations, and in the case of the
    provision of emergency services (as defined for purposes of section
    1860D-4(c)(5)(D)(ii)(II)).
        ``(e) Reports.--
                ``(1) State reports.--Each State shall include in the annual
            report submitted to the Secretary under section 1927(g)(3)(D),
            beginning with such reports submitted for 2023, information
            including, at a minimum, the following information for the most
            recent 12-month period:
                        ``(A) The percentage of covered providers (as
                    determined pursuant to a process established by the
                    State) who checked the prescription drug history of a
                    covered individual through a qualified prescription drug
                    monitoring program described in subsection (b) before
                    prescribing to such individual a controlled substance.
                        ``(B) Aggregate trends with respect to prescribing
                    controlled substances such as--
                              ``(i) the quantity of daily morphine milligram
                          equivalents prescribed for controlled substances;
                              ``(ii) the number and quantity of daily
                          morphine milligram equivalents prescribed for
                          controlled substances per covered individual; and
                              ``(iii) the types of controlled substances
                          prescribed, including the dates of such
                          prescriptions, the supplies authorized (including
                          the duration of such supplies), and the period of
                          validity of such prescriptions, in different
                          populations (such as individuals who are elderly,
                          individuals with disabilities, and individuals who
                          are enrolled under both this title and title
                          XVIII).
                        ``(C) Whether or not the State requires (and a
                    detailed explanation as to why the State does or does
                    not require) pharmacists to check the prescription drug
                    history of a covered individual through a qualified
                    prescription drug

    [[Page 132 STAT. 3969]]

                    monitoring program described in subsection (b) before
                    dispensing a controlled substance to such individual.
                        ``(D) An accounting of any data or privacy breach of
                    a qualified prescription drug monitoring program
                    described in subsection (b), the number of covered
                    individuals impacted by each such breach, and a
                    description of the steps the State has taken to address
                    each such breach, including, to the extent required by
                    State or Federal law or otherwise determined appropriate
                    by the State, alerting any such impacted individual and
                    law enforcement of the breach.
                ``(2) Report by cms.--Not later than October 1, 2023, the
            Administrator of the Centers for Medicare & Medicaid Services
            shall publish on the publicly available website of the Centers
            for Medicare & Medicaid Services a report including the
            following information:
                        ``(A) Guidance for States on how States can increase
                    the percentage of covered providers who use qualified
                    prescription drug monitoring programs described in
                    subsection (b).
                        ``(B) Best practices for how States and covered
                    providers should use such qualified prescription drug
                    monitoring programs to reduce the occurrence of abuse of
                    controlled substances.

        ``(f) Increase to FMAP and Federal Matching Rates for Certain
    Expenditures Relating to Qualified Prescription Drug Monitoring
    Programs.--
                ``(1) In general.--With respect to a State that meets the
            condition described in paragraph (2) and any quarter occurring
            during fiscal year 2019 or fiscal year 2020, the Federal medical
            assistance percentage or Federal matching rate that would
            otherwise apply to such State under section 1903(a) for such
            quarter, with respect to expenditures by the State for
            activities under the State plan (or a waiver of such plan) to
            design, develop, or implement a prescription drug monitoring
            program (and to make connections to such program) that satisfies
            the criteria described in paragraphs (1) and (2) of subsection
            (b), shall be equal to 100 percent.
                ``(2) Condition.--The condition described in this paragraph,
            with respect to a State, is that the State (in this paragraph
            referred to as the `administering State') has in place
            agreements with all States that are contiguous to such
            administering State that, when combined, enable covered
            providers in all such contiguous States to access, through the
            prescription drug monitoring program, the information that is
            described in subsection (b)(1) of covered individuals of such
            administering State and that covered providers in such
            administering State are able to access through such program.

        ``(g) Rule of Construction.--Nothing in this section prevents a
    State from requiring pharmacists to check the prescription drug history
    of covered individuals through a qualified prescription drug monitoring
    program before dispensing controlled substances to such individuals.
        ``(h) Definitions.--In this section:
                ``(1) Controlled substance.--The term `controlled substance'
            means a drug that is included in schedule II of section 202(c)
            of the Controlled Substances Act and, at the option

    [[Page 132 STAT. 3970]]

            of the State involved, a drug included in schedule III or IV of
            such section.
                ``(2) Covered individual.--The term `covered individual'
            means, with respect to a State, an individual who is enrolled in
            the State plan (or under a waiver of such plan). Such term does
            not include an individual who--
                        ``(A) is receiving--
                              ``(i) hospice or palliative care; or
                              ``(ii) treatment for cancer;
                        ``(B) is a resident of a long-term care facility, of
                    a facility described in section 1905(d), or of another
                    facility for which frequently abused drugs are dispensed
                    for residents through a contract with a single pharmacy;
                    or
                        ``(C) the State elects to treat as exempted from
                    such term.
                ``(3) Covered provider.--
                        ``(A) In general.--The term `covered provider'
                    means, subject to subparagraph (B), with respect to a
                    State, a health care provider who is participating under
                    the State plan (or waiver of the State plan) and
                    licensed, registered, or otherwise permitted by the
                    State to prescribe a controlled substance (or the
                    designee of such provider).
                        ``(B) Exceptions.--
                              ``(i) In general.--Beginning October 1, 2021,
                          for purposes of this section, such term does not
                          include a health care provider included in any
                          type of health care provider determined by the
                          Secretary to be exempt from application of this
                          section under clause (ii).
                              ``(ii) Exceptions process.--Not later than
                          October 1, 2020, the Secretary, after consultation
                          with the National Association of Medicaid
                          Directors, national health care provider
                          associations, Medicaid beneficiary advocates, and
                          advocates for individuals with rare diseases,
                          shall determine, based on such consultations, the
                          types of health care providers (if any) that
                          should be exempted from the definition of the term
                          `covered provider' for purposes of this
                          section.''.

        (b) <<NOTE: 42 USC 1396w-3a note.>>  Guidance.--Not later than
    October 1, 2019, the Administrator of the Centers for Medicare &
    Medicaid Services, in consultation with the Director of the Centers for
    Disease Control and Prevention, shall issue guidance on best practices
    on the uses of prescription drug monitoring programs required of
    prescribers and on protecting the privacy of Medicaid beneficiary
    information maintained in and accessed through prescription drug
    monitoring programs.

        (c) <<NOTE: 42 USC 1396w-3a note.>>  Development of Model State
    Practices.--
                (1) In general.--Not later than October 1, 2020, the
            Secretary of Health and Human Services shall develop and publish
            model practices to assist State Medicaid program operations in
            identifying and implementing strategies to utilize data-sharing
            agreements described in the matter following paragraph (2) of
            section 1944(b) of the Social Security Act, as added by
            subsection (a), for the following purposes:
                        (A) Monitoring and preventing fraud, waste, and
                    abuse.
                        (B) Improving health care for individuals enrolled
                    in a State plan under title XIX of such Act (or under a
                    waiver of such plan) who--

    [[Page 132 STAT. 3971]]

                              (i) transition in and out of coverage under
                          such title;
                              (ii) may have sources of health care coverage
                          in addition to coverage under such title; or
                              (iii) pay for prescription drugs with cash.
                        (C) Any other purposes specified by the Secretary.
                (2) Elements of model practices.--The model practices
            described in paragraph (1)--
                        (A) shall include strategies for assisting States in
                    allowing the medical director or pharmacy director (or
                    designees of such a director) of managed care
                    organizations or pharmaceutical benefit managers to
                    access information with respect to all covered
                    individuals served by such managed care organizations or
                    pharmaceutical benefit managers to access as a single
                    data set, in an electronic format; and
                        (B) shall include any appropriate beneficiary
                    protections and privacy guidelines.
                (3) Consultation.--In developing model practices under this
            subsection, the Secretary shall consult with the National
            Association of Medicaid Directors, managed care entities (as
            defined in section 1932(a)(1)(B) of the Social Security Act)
            with contracts with States pursuant to section 1903(m) of such
            Act, pharmaceutical benefit managers, physicians and other
            health care providers, beneficiary advocates, and individuals
            with expertise in health care technology related to prescription
            drug monitoring programs and electronic health records.

        (d) Report by Comptroller General.--Not later than October 1, 2020,
    the Comptroller General of the United States shall issue a report
    examining the operation of prescription drug monitoring programs
    administered by States, including data security and access standards
    used by such programs.

                            Subtitle F--IMD CARE Act

    SEC. 5051. <<NOTE: 42 USC 1305 note.>>  SHORT TITLE.

        This title may be cited as the ``Individuals in Medicaid Deserve
    Care that is Appropriate and Responsible in its Execution Act'' or the
    ``IMD CARE Act''.
    SEC. 5052. STATE OPTION TO PROVIDE MEDICAID COVERAGE FOR CERTAIN
                              INDIVIDUALS WITH SUBSTANCE USE DISORDERS
                              WHO ARE PATIENTS IN CERTAIN INSTITUTIONS
                              FOR MENTAL DISEASES.

        (a) In General.--Title XIX of the Social Security Act (42 U.S.C.
    1396 et seq.), as amended by preceding sections of this Act, is further
    amended--
                (1) in section 1905(a), in the subdivision (B) that follows
            paragraph (30), by inserting ``(except in the case of services
            provided under a State plan amendment described in section
            1915(l))'' before the period; and
                (2) in section 1915, by adding at the end the following new
            subsection:

        ``(l) State Plan Amendment Option to Provide Medical Assistance for
    Certain Individuals Who Are Patients in Certain Institutions for Mental
    Diseases.--

    [[Page 132 STAT. 3972]]

                ``(1) In general.--With respect to calendar quarters
            beginning during the period beginning October 1, 2019, and
            ending September 30, 2023, a State may elect, through a State
            plan amendment, to provide medical assistance for items and
            services furnished to an eligible individual who is a patient in
            an eligible institution for mental diseases in accordance with
            the requirements of this subsection.
                ``(2) Payments.--Subject to paragraphs (3) and (4), amounts
            expended under a State plan amendment under paragraph (1) for
            services described in such paragraph furnished, with respect to
            a 12-month period, to an eligible individual who is a patient in
            an eligible institution for mental diseases shall be treated as
            medical assistance for which payment is made under section
            1903(a) but only to the extent that such services are furnished
            for not more than a period of 30 days (whether or not
            consecutive) during such 12-month period.
                ``(3) Maintenance of effort.--
                        ``(A) In general.--As a condition for a State
                    receiving payments under section 1903(a) for medical
                    assistance provided in accordance with this subsection,
                    the State shall (during the period in which it so
                    furnished such medical assistance through a State plan
                    amendment under this subsection) maintain on an annual
                    basis a level of funding expended by the State (and
                    political subdivisions thereof) other than under this
                    title from non-Federal funds for--
                              ``(i) items and services furnished to eligible
                          individuals who are patients in eligible
                          institutions for mental diseases that is not less
                          than the level of such funding for such items and
                          services for the most recently ended fiscal year
                          as of the date of enactment of this subsection or,
                          if higher, for the most recently ended fiscal year
                          as of the date the State submits a State plan
                          amendment to the Secretary to provide such medical
                          assistance in accordance with this subsection; and
                              ``(ii) items and services (including services
                          described in subparagraph (B)) furnished to
                          eligible individuals in outpatient and community-
                          based settings that is not less than the level of
                          such funding for such items and services for the
                          most recently ended fiscal year as of the date of
                          enactment of this subsection or, if higher, for
                          the most recently ended fiscal year as of the date
                          the State submits a State plan amendment to the
                          Secretary to provide such medical assistance in
                          accordance with this subsection.
                        ``(B) Services described.--For purposes of
                    subparagraph (A)(ii), services described in this
                    subparagraph are the following:
                              ``(i) Outpatient and community-based substance
                          use disorder treatment.
                              ``(ii) Evidence-based recovery and support
                          services.
                              ``(iii) Clinically-directed therapeutic
                          treatment to facilitate recovery skills, relapse
                          prevention, and emotional coping strategies.
                              ``(iv) Outpatient medication-assisted
                          treatment, related therapies, and pharmacology.
                              ``(v) Counseling and clinical monitoring.

    [[Page 132 STAT. 3973]]

                              ``(vi) Outpatient withdrawal management and
                          related treatment designed to alleviate acute
                          emotional, behavioral, cognitive, or biomedical
                          distress resulting from, or occurring with, an
                          individual's use of alcohol and other drugs.
                              ``(vii) Routine monitoring of medication
                          adherence.
                              ``(viii) Other outpatient and community-based
                          services for the treatment of substance use
                          disorders, as designated by the Secretary.
                        ``(C) State reporting requirement.--
                              ``(i) In general.--Prior to approval of a
                          State plan amendment under this subsection, as a
                          condition for a State receiving payments under
                          section 1903(a) for medical assistance provided in
                          accordance with this subsection, the State shall
                          report to the Secretary, in accordance with the
                          process established by the Secretary under clause
                          (ii), the information deemed necessary by the
                          Secretary under such clause.
                              ``(ii) Process.--Not later than the date that
                          is 8 months after the date of enactment of this
                          subsection, the Secretary shall establish a
                          process for States to report to the Secretary, at
                          such time and in such manner as the Secretary
                          deems appropriate, such information as the
                          Secretary deems necessary to verify a State's
                          compliance with subparagraph (A).
                ``(4) Ensuring a continuum of services.--
                        ``(A) In general.--As a condition for a State
                    receiving payments under section 1903(a) for medical
                    assistance provided in accordance with this subsection,
                    the State shall carry out each of the requirements
                    described in subparagraphs (B) through (D).
                        ``(B) Notification.--Prior to approval of a State
                    plan amendment under this subsection, the State shall
                    notify the Secretary of how the State will ensure that
                    eligible individuals receive appropriate evidence-based
                    clinical screening prior to being furnished with items
                    and services in an eligible institution for mental
                    diseases, including initial and periodic assessments to
                    determine the appropriate level of care, length of stay,
                    and setting for such care for each individual.
                        ``(C) Outpatient services; inpatient and residential
                    services.--
                              ``(i) Outpatient services.--The State shall,
                          at a minimum, provide medical assistance for
                          services that could otherwise be covered under the
                          State plan, consistent with each of the following
                          outpatient levels of care:
                                        ``(I) Early intervention for
                                    individuals who, for a known reason, are
                                    at risk of developing substance-related
                                    problems and for individuals for whom
                                    there is not yet sufficient information
                                    to document a diagnosable substance use
                                    disorder.
                                        ``(II) Outpatient services for less
                                    than 9 hours per week for adults, and
                                    for less than 6 hours per week for
                                    adolescents, for recovery or
                                    motivational enhancement therapies and
                                    strategies.

    [[Page 132 STAT. 3974]]

                                        ``(III) Intensive outpatient
                                    services for 9 hours or more per week
                                    for adults, and for 6 hours or more per
                                    week for adolescents, to treat
                                    multidimensional instability.
                                        ``(IV) Partial hospitalization
                                    services for 20 hours or more per week
                                    for adults and adolescents to treat
                                    multidimensional instability that does
                                    not require 24-hour care.
                              ``(ii) Inpatient and residential services.--
                          The State shall provide medical assistance for
                          services that could otherwise be covered under the
                          State plan, consistent with at least 2 of the
                          following inpatient and residential levels of
                          care:
                                        ``(I) Clinically managed, low-
                                    intensity residential services that
                                    provide adults and adolescents with 24-
                                    hour living support and structure with
                                    trained personnel and at least 5 hours
                                    of clinical service per week per
                                    individual.
                                        ``(II) Clinically managed,
                                    population-specific, high-intensity
                                    residential services that provide adults
                                    with 24-hour care with trained
                                    counselors to stabilize multidimensional
                                    imminent danger along with less intense
                                    milieu and group treatment for those
                                    with cognitive or other impairments
                                    unable to use full active milieu or
                                    therapeutic community.
                                        ``(III) Clinically managed, medium-
                                    intensity residential services for
                                    adolescents, and clinically managed,
                                    high-intensity residential services for
                                    adults, that provide 24-hour care with
                                    trained counselors to stabilize
                                    multidimensional imminent danger and
                                    preparation for outpatient treatment.
                                        ``(IV) Medically monitored, high-
                                    intensity inpatient services for
                                    adolescents, and medically monitored,
                                    intensive inpatient services withdrawal
                                    management for adults, that provide 24-
                                    hour nursing care, make physicians
                                    available for significant problems in
                                    Dimensions 1, 2, or 3, and provide
                                    counseling services 16 hours per day.
                                        ``(V) Medically managed, intensive
                                    inpatient services for adolescents and
                                    adults that provide 24-hour nursing care
                                    and daily physician care for severe,
                                    unstable problems in Dimensions 1, 2 or
                                    3.
                        ``(D) Transition of care.--In order to ensure an
                    appropriate transition for an eligible individual from
                    receiving care in an eligible institution for mental
                    diseases to receiving care at a lower level of clinical
                    intensity within the continuum of care (including
                    outpatient services), the State shall ensure that--
                              ``(i) a placement in such eligible institution
                          for mental diseases would allow for an eligible
                          individual's successful transition to the
                          community, considering such factors as proximity
                          to an individual's support network (such as family
                          members, employment, and counseling and other
                          services near an individual's residence); and

    [[Page 132 STAT. 3975]]

                              ``(ii) all eligible institutions for mental
                          diseases that furnish items and services to
                          individuals for which medical assistance is
                          provided under the State plan--
                                        ``(I) are able to provide care at
                                    such lower level of clinical intensity;
                                    or
                                        ``(II) have an established
                                    relationship with another facility or
                                    provider that is able to provide care at
                                    such lower level of clinical intensity
                                    and accepts patients receiving medical
                                    assistance under this title under which
                                    the eligible institution for mental
                                    diseases may arrange for individuals to
                                    receive such care from such other
                                    facility or provider.
                ``(5) Application to managed care.--Payments for, and
            limitations to, medical assistance furnished in accordance with
            this subsection shall be in addition to and shall not be
            construed to limit or supersede the ability of States to make
            monthly capitation payments to managed care organizations for
            individuals receiving treatment in institutions for mental
            diseases in accordance with section 438.6(e) of title 42, Code
            of Federal Regulations (or any successor regulation).
                ``(6) Other medical assistance.--The provision of medical
            assistance for items and services furnished to an eligible
            individual who is a patient in an eligible institution for
            mental diseases in accordance with the requirements of this
            subsection shall not prohibit Federal financial participation
            for medical assistance for items or services that are provided
            to such eligible individual in or away from the eligible
            institution for mental disease during any period in which the
            eligible individual is receiving items or services in accordance
            with this subsection.
                ``(7) Definitions.--In this subsection:
                        ``(A) Dimensions 1, 2, or 3.--The term `Dimensions
                    1, 2, or 3' has the meaning given that term for purposes
                    of the publication of the American Society of Addiction
                    Medicine entitled `The ASAM Criteria: Treatment Criteria
                    for Addictive Substance-Related, and Co-Occurring
                    Conditions, 2013'.
                        ``(B) Eligible individual.--The term `eligible
                    individual' means an individual who--
                              ``(i) with respect to a State, is enrolled for
                          medical assistance under the State plan or a
                          waiver of such plan;
                              ``(ii) is at least 21 years of age;
                              ``(iii) has not attained 65 years of age; and
                              ``(iv) has at least 1 substance use disorder.
                        ``(C) Eligible institution for mental diseases.--The
                    term `eligible institution for mental diseases' means an
                    institution for mental diseases that--
                              ``(i) follows reliable, evidence-based
                          practices; and
                              ``(ii) offers at least 2 forms of medication-
                          assisted treatment for substance use disorders on
                          site, including, in the case of medication-
                          assisted treatment for opioid use disorder, at
                          least 1 antagonist and 1 partial agonist.
                        ``(D) Institution for mental diseases.--The term
                    `institution for mental diseases' has the meaning given
                    that term in section 1905(i).''.

    [[Page 132 STAT. 3976]]

        (b) <<NOTE: 42 USC 1396n note.>>  Rule of Construction.--Nothing in
    the amendments made by subsection (a) shall be construed as encouraging
    a State to place an individual in an inpatient or a residential care
    setting where a home or community-based care setting would be more
    appropriate for the individual, or as preventing a State from conducting
    or pursuing a demonstration project under section 1115 of the Social
    Security Act to improve access to, and the quality of, substance use
    disorder treatment for eligible populations.

                      Subtitle G--Medicaid Improvement Fund

    SEC. 5061. MEDICAID IMPROVEMENT FUND.

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

                       TITLE VI--OTHER MEDICARE PROVISIONS

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

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

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

        Subtitle B <<NOTE: Abuse Deterrent Access Act of 2018.>> --Abuse
    Deterrent Access
    SEC. 6011. SHORT TITLE.

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

    [[Page 132 STAT. 3977]]

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

        (a) In General.--Not later than 1 year after the date of the
    enactment of this Act, the Secretary of Health and Human Services shall
    conduct a study and submit to Congress a report on--
                (1) the adequacy of access to abuse-deterrent opioid
            formulations for individuals with chronic pain enrolled in an
            MA-PD plan under part C of title XVIII of the Social Security
            Act or a prescription drug plan under part D of such title of
            such Act, taking into account any barriers preventing such
            individuals from accessing such formulations under such MA-PD or
            part D plans, such as cost-sharing tiers, fail-first
            requirements, the price of such formulations, and prior
            authorization requirements; and
                (2) the effectiveness of abuse-deterrent opioid formulations
            in preventing opioid abuse or misuse; the impact of the use of
            abuse-deterrent opioid formulations on the use or abuse of other
            prescription or illicit opioids (including changes in deaths
            from such opioids); and other public health consequences of the
            use of abuse-deterrent opioid formulations, such as an increase
            in rates of human immunodeficiency virus.

        (b) Definition of Abuse-Deterrent Opioid Formulation.--In this
    section, the term ``abuse-deterrent opioid formulation'' means an opioid
    that is a prodrug or that has certain abuse-deterrent properties, such
    as physical or chemical barriers, agonist or antagonist combinations,
    aversion properties, delivery system mechanisms, or other features
    designed to prevent abuse of such opioid.

                  Subtitle C--Medicare Opioid Safety Education

    SEC. 6021. MEDICARE OPIOID SAFETY EDUCATION.

        (a) In General.--Section 1804 of the Social Security Act (42 U.S.C.
    1395b-2) is amended by adding at the end the following new subsection:
        ``(d) The notice provided under subsection (a) shall include--
                ``(1) references to educational resources regarding opioid
            use and pain management;
                ``(2) a description of categories of alternative, non-opioid
            pain management treatments covered under this title; and
                ``(3) a suggestion for the beneficiary to talk to a
            physician regarding opioid use and pain management.''.

        (b) <<NOTE: 42 USC 1395b-2 note.>>  Effective Date.--The amendment
    made by subsection (a) shall apply to notices distributed prior to each
    Medicare open enrollment period beginning after January 1, 2019.

        Subtitle D <<NOTE: Opioid Addiction Action Plan Act.>> --Opioid
    Addiction Action Plan
    SEC. 6031. SHORT TITLE.

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

    [[Page 132 STAT. 3978]]

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

        (a) In General.--Not later than January 1, 2020, the Secretary of
    Health and Human Services (in this section referred to as the
    ``Secretary''), in collaboration with the Pain Management Best Practices
    Inter-Agency Task Force convened under section 101(b) of the
    Comprehensive Addiction and Recovery Act of 2016 (Public Law 114-198),
    shall develop an action plan as described in subsection (b).
        (b) Action Plan Components.--The action plan shall include a review
    by the Secretary of Medicare and Medicaid payment and coverage policies
    that may be viewed as potential obstacles to an effective response to
    the opioid crisis, and recommendations, as determined appropriate by the
    Secretary, on the following:
                (1) A review of payment and coverage policies under the
            Medicare program under title XVIII of the Social Security Act
            and the Medicaid program under title XIX of such Act, including
            a review of coverage and payment under such programs of all
            medication-assisted treatment approved by the Food and Drug
            Administration related to the treatment of opioid use disorder
            and other therapies that manage chronic and acute pain and treat
            and minimize risk of opioid misuse and abuse, including in such
            review, payment under the Medicare prospective payment system
            for inpatient hospital services under section 1886(d) of such
            Act (42 U.S.C. 1395ww(d)) and the Medicare prospective payment
            system for hospital outpatient department services under section
            1833(t) of such Act (42 U.S.C. 1395I(t)), to determine whether
            those payment policies resulted in incentives or disincentives
            that have contributed to the opioid crisis.
                (2) Recommendations for payment and service delivery models
            to be tested as appropriate by the Center for Medicare and
            Medicaid Innovation and other federally authorized demonstration
            projects, including value-based models, that may encourage the
            use of appropriate medication-assisted treatment approved by the
            Food and Drug Administration for the treatment of opioid use
            disorder and other therapies that manage chronic and acute pain
            and treat and minimize risk of opioid misuse and abuse.
                (3) Recommendations for data collection that could
            facilitate research and policy-making regarding prevention of
            opioid use disorder as well as data that would aid the Secretary
            in making coverage and payment decisions under the Medicare and
            Medicaid programs related to the access to appropriate opioid
            dependence treatments.
                (4) A review of Medicare and Medicaid beneficiaries' access
            to the full range of medication-assisted treatment approved by
            the Food and Drug Administration for the treatment of opioid use
            disorder and other therapies that manage chronic and acute pain
            and treat and minimize risk of opioid misuse and abuse,
            including access of beneficiaries residing in rural or medically
            underserved communities.
                (5) A review of payment and coverage policies under the
            Medicare program and the Medicaid program related to medical
            devices that are non-opioid based treatments approved by the

    [[Page 132 STAT. 3979]]

            Food and Drug Administration for the management of acute pain
            and chronic pain, for monitoring substance use withdrawal and
            preventing overdoses of controlled substances, and for treating
            substance use disorder, including barriers to patient access.

        (c) Stakeholder Meetings.--
                (1) In general.--Beginning not later than 3 months after the
            date of the enactment of this section, the Secretary shall
            convene a public stakeholder meeting to solicit public comment
            on the components of the action plan described in subsection
            (b).
                (2) Participants.--Participants of meetings described in
            paragraph (1) shall include representatives from the Food and
            Drug Administration and National Institutes of Health,
            biopharmaceutical industry members, medical researchers, health
            care providers, the medical device industry, the Medicare
            program, the Medicaid program, and patient advocates.

        (d) Request for Information.--Not later than 3 months after the date
    of the enactment of this section, the Secretary shall issue a request
    for information seeking public feedback regarding ways in which the
    Centers for Medicare & Medicaid Services can help address the opioid
    crisis through the development of and application of the action plan.
        (e) Report to Congress.--Not later than June 1, 2020, the Secretary
    shall submit to Congress, and make public, a report that includes--
                (1) a summary of the results of the Secretary's review and
            any recommendations under the action plan;
                (2) the Secretary's planned next steps with respect to the
            action plan; and
                (3) an evaluation of price trends for drugs used to reverse
            opioid overdoses (such as naloxone), including recommendations
            on ways to lower such prices for consumers.

        (f) Definition of Medication-Assisted Treatment.--In this section,
    the term ``medication-assisted treatment'' includes opioid treatment
    programs, behavioral therapy, and medications to treat substance abuse
    disorder.

       Subtitle E <<NOTE: Advancing High Quality Treatment for Opioid Use
      Disorders in Medicare Act.>> --Advancing High Quality Treatment for
    Opioid Use Disorders in Medicare
    SEC. 6041 <<NOTE: 42 USC 1305 note.>> . SHORT TITLE.

        This subtitle may be cited as the ``Advancing High Quality Treatment
    for Opioid Use Disorders in Medicare Act''.
    SEC. 6042. OPIOID USE DISORDER TREATMENT DEMONSTRATION PROGRAM.

        Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
    amended by inserting after section 1866E (42 U.S.C. 1395cc-5) the
    following new section:
    ``SEC. 1866F. <<NOTE: 42 USC 1395cc-6.>>  OPIOID USE DISORDER
                                TREATMENT DEMONSTRATION PROGRAM.

        ``(a) Implementation of 4-Year Demonstration Program.--

    [[Page 132 STAT. 3980]]

                ``(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--

    [[Page 132 STAT. 3981]]

                              ``(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

    [[Page 132 STAT. 3982]]

                              ``(iii) submit to the Secretary, in such form,
                          manner, and frequency as specified by the
                          Secretary, with respect to each applicable
                          beneficiary for whom opioid use disorder treatment
                          services are furnished by the opioid use disorder
                          care team, data and such other information as the
                          Secretary determines appropriate to--
                                        ``(I) monitor and evaluate the
                                    Program;
                                        ``(II) determine if minimum criteria
                                    are met under clause (ii); and
                                        ``(III) determine the incentive
                                    payment under subsection (e).
                ``(3) Eligible practitioner defined.--For purposes of this
            section, the term `eligible practitioner' means a physician or
            other health care practitioner, such as a nurse practitioner,
            that--
                        ``(A) is enrolled under section 1866(j)(1);
                        ``(B) is authorized to prescribe or dispense
                    narcotic drugs to individuals for maintenance treatment
                    or detoxification treatment; and
                        ``(C) has in effect a waiver in accordance with
                    section 303(g) of the Controlled Substances Act for such
                    purpose and is otherwise in compliance with regulations
                    promulgated by the Substance Abuse and Mental Health
                    Services Administration to carry out such section.

        ``(d) Participation of Applicable Beneficiaries.--
                ``(1) Applicable beneficiary defined.--In this section, the
            term `applicable beneficiary' means an individual who--
                        ``(A) is entitled to, or enrolled for, benefits
                    under part A and enrolled for benefits under part B;
                        ``(B) is not enrolled in a Medicare Advantage plan
                    under part C;
                        ``(C) has a current diagnosis for an opioid use
                    disorder; and
                        ``(D) meets such other criteria as the Secretary
                    determines appropriate.
            Such term shall include an individual who is dually eligible for
            benefits under this title and title XIX if such individual
            satisfies the criteria described in subparagraphs (A) through
            (D).
                ``(2) Voluntary beneficiary participation; limitation on
            number of beneficiaries.--An applicable beneficiary may
            participate in the Program on a voluntary basis and may
            terminate participation in the Program at any time. Not more
            than 20,000 applicable beneficiaries may participate in the
            Program at any time.
                ``(3) Services.--In order to participate in the Program, an
            applicable beneficiary shall agree to receive opioid use
            disorder treatment services from a participant. Participation
            under the Program shall not affect coverage of or payment for
            any other item or service under this title for the applicable
            beneficiary.
                ``(4) Beneficiary access to services.--Nothing in this
            section shall be construed as encouraging providers to limit
            applicable beneficiary access to services covered under this

    [[Page 132 STAT. 3983]]

            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.

    [[Page 132 STAT. 3984]]

                                        ``(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.''.

    [[Page 132 STAT. 3985]]

      Subtitle F-- <<NOTE: Responsible Education Achieves Care and Healthy
       Outcomes for Users' Treatment Act of 2018.>> Responsible Education
    Achieves Care and Healthy Outcomes for Users' Treatment
    SEC. 6051. <<NOTE: 42 USC 1305 note.>>  SHORT TITLE.

        This subtitle may be cited as the ``Responsible Education Achieves
    Care and Healthy Outcomes for Users' Treatment Act of 2018'' or the
    ``REACH OUT Act of 2018''.
    SEC. 6052. GRANTS TO PROVIDE TECHNICAL ASSISTANCE TO OUTLIER
                              PRESCRIBERS OF OPIOIDS.

        (a) Grants Authorized.--The Secretary of Health and Human Services
    (in this section referred to as the ``Secretary'') shall, through the
    Centers for Medicare & Medicaid Services, award grants, contracts, or
    cooperative agreements to eligible entities for the purposes described
    in subsection (b).
        (b) Use of Funds.--Grants, contracts, and cooperative agreements
    awarded under subsection (a) shall be used to support eligible entities
    through technical assistance--
                (1) to educate and provide outreach to outlier prescribers
            of opioids about best practices for prescribing opioids;
                (2) to educate and provide outreach to outlier prescribers
            of opioids about non-opioid pain management therapies; and
                (3) to reduce the amount of opioid prescriptions prescribed
            by outlier prescribers of opioids.

        (c) <<NOTE: 42 USC 1395w-104 note.>>  Application.--Each eligible
    entity seeking to receive a grant, contract, or cooperative agreement
    under subsection (a) shall submit to the Secretary an application, at
    such time, in such manner, and containing such information as the
    Secretary may require.

        (d) Geographic Distribution.--In awarding grants, contracts, and
    cooperative agreements under this section, the Secretary shall
    prioritize establishing technical assistance resources in each State.
        (e) Definitions.--In this section:
                (1) Eligible entity.--The term ``eligible entity'' means--
                        (A) an organization--
                              (i) that has demonstrated experience providing
                          technical assistance to health care professionals
                          on a State or regional basis; and
                              (ii) that has at least--
                                        (I) one individual who is a
                                    representative of consumers on its
                                    governing body; and
                                        (II) one individual who is a
                                    representative of health care providers
                                    on its governing body; or
                        (B) an entity that is a quality improvement entity
                    with a contract under part B of title XI of the Social
                    Security Act (42 U.S.C. 1320c et seq.).
                (2) Outlier prescriber of opioids.--The term ``outlier
            prescriber of opioids'' means, with respect to a period, a
            prescriber identified by the Secretary under subparagraph
            (D)(ii) of section 1860D-4(c)(4) of the Social Security Act (42
            U.S.C. 1395w-104(c)(4)), as added by section 6065 of this Act,
            to be an outlier prescriber of opioids for such period.
                (3) Prescribers.--The term ``prescriber'' means any health
            care professional, including a nurse practitioner or physician

    [[Page 132 STAT. 3986]]

            assistant, who is licensed to prescribe opioids by the State or
            territory in which such professional practices.

        (f) Funding.--For purposes of implementing this section, $75,000,000
    shall be available from the Federal Supplementary Medical Insurance
    Trust Fund under section 1841 of the Social Security Act (42 U.S.C.
    1395t), to remain available until expended.

     Subtitle G <<NOTE: Preventing Addiction for Susceptible Seniors Act of
    2018.>> --Preventing Addiction for Susceptible Seniors
    SEC. 6061. <<NOTE: 42 USC 1305 note.>>  SHORT TITLE.

        This subtitle may be cited as the ``Preventing Addiction for
    Susceptible Seniors Act of 2018'' or the ``PASS Act of 2018''.
    SEC. 6062. ELECTRONIC PRIOR AUTHORIZATION FOR COVERED PART D
                              DRUGS.

        Section 1860D-4(e)(2) of the Social Security Act (42 U.S.C. 1395w-
    104(e)(2)) is amended by adding at the end the following new
    subparagraph:
                        ``(E) Electronic prior authorization.--
                              ``(i) In general.--Not later than January 1,
                          2021, the program shall provide for the secure
                          electronic transmission of--
                                        ``(I) a prior authorization request
                                    from the prescribing health care
                                    professional for coverage of a covered
                                    part D drug for a part D eligible
                                    individual enrolled in a part D plan (as
                                    defined in section 1860D-23(a)(5)) to
                                    the PDP sponsor or Medicare Advantage
                                    organization offering such plan; and
                                        ``(II) a response, in accordance
                                    with this subparagraph, from such PDP
                                    sponsor or Medicare Advantage
                                    organization, respectively, to such
                                    professional.
                              ``(ii) Electronic transmission.--
                                        ``(I) Exclusions.--For purposes of
                                    this subparagraph, a facsimile, a
                                    proprietary payer portal that does not
                                    meet standards specified by the
                                    Secretary, or an electronic form shall
                                    not be treated as an electronic
                                    transmission described in clause (i).
                                        ``(II) Standards.--In order to be
                                    treated, for purposes of this
                                    subparagraph, as an electronic
                                    transmission described in clause (i),
                                    such transmission shall comply with
                                    technical standards adopted by the
                                    Secretary in consultation with the
                                    National Council for Prescription Drug
                                    Programs, other standard setting
                                    organizations determined appropriate by
                                    the Secretary, and stakeholders
                                    including PDP sponsors, Medicare
                                    Advantage organizations, health care
                                    professionals, and health information
                                    technology software vendors.
                                        ``(III) Application.--
                                    Notwithstanding any other provision of
                                    law, for purposes of this subparagraph,
                                    the Secretary may require the use of
                                    such standards adopted under subclause
                                    (II) in lieu of

    [[Page 132 STAT. 3987]]

                                    any other applicable standards for an
                                    electronic transmission described in
                                    clause (i) for a covered part D drug for
                                    a part D eligible individual.''.
    SEC. 6063. PROGRAM INTEGRITY TRANSPARENCY MEASURES UNDER MEDICARE
                              PARTS C AND D.

        (a) In General.--Section 1859 of the Social Security Act (42 U.S.C.
    1395w-28) is amended by adding at the end the following new subsection:
        ``(i) Program Integrity Transparency Measures.--
                ``(1) Program integrity portal.--
                        ``(A) In general.--Not later than 2 years after the
                    date of the enactment of this subsection, the Secretary
                    shall, after consultation with stakeholders, establish a
                    secure internet website portal (or other successor
                    technology) that would allow a secure path for
                    communication between the Secretary, MA plans under this
                    part, prescription drug plans under part D, and an
                    eligible entity with a contract under section 1893 (such
                    as a Medicare drug integrity contractor or an entity
                    responsible for carrying out program integrity
                    activities under this part and part D) for the purpose
                    of enabling through such portal (or other successor
                    technology)--
                              ``(i) the referral by such plans of
                          substantiated or suspicious activities, as defined
                          by the Secretary, of a provider of services
                          (including a prescriber) or supplier related to
                          fraud, waste, and abuse for initiating or
                          assisting investigations conducted by the eligible
                          entity; and
                              ``(ii) data sharing among such MA plans,
                          prescription drug plans, and the Secretary.
                        ``(B) Required uses of portal.--The Secretary shall
                    disseminate the following information to MA plans under
                    this part and prescription drug plans under part D
                    through the secure internet website portal (or other
                    successor technology) established under subparagraph
                    (A):
                              ``(i) Providers of services and suppliers that
                          have been referred pursuant to subparagraph (A)(i)
                          during the previous 12-month period.
                              ``(ii) Providers of services and suppliers who
                          are the subject of an active exclusion under
                          section 1128 or who are subject to a suspension of
                          payment under this title pursuant to section
                          1862(o) or otherwise.
                              ``(iii) Providers of services and suppliers
                          who are the subject of an active revocation of
                          participation under this title, including for not
                          satisfying conditions of participation.
                              ``(iv) In the case of such a plan that makes a
                          referral under subparagraph (A)(i) through the
                          portal (or other successor technology) with
                          respect to activities of substantiated or
                          suspicious activities of fraud, waste, or abuse of
                          a provider of services (including a prescriber) or
                          supplier, if such provider (including a
                          prescriber) or supplier has been the subject of an
                          administrative action under this title or title XI
                          with respect to similar activities, a notification
                          to such plan of such action so taken.

    [[Page 132 STAT. 3988]]

                        ``(C) Rulemaking.--For purposes of this paragraph,
                    the Secretary shall, through rulemaking, specify what
                    constitutes substantiated or suspicious activities of
                    fraud, waste, and abuse, using guidance such as what is
                    provided in the Medicare Program Integrity Manual 4.8.
                    In carrying out this subsection, a fraud hotline tip (as
                    defined by the Secretary) without further evidence shall
                    not be treated as sufficient evidence for substantiated
                    fraud, waste, or abuse.
                        ``(D) HIPAA compliant information only.--For
                    purposes of this subsection, communications may only
                    occur if the communications are permitted under the
                    Federal regulations (concerning the privacy of
                    individually identifiable health information)
                    promulgated under section 264(c) of the Health Insurance
                    Portability and Accountability Act of 1996.
                ``(2) Quarterly reports.--Beginning not later than 2 years
            after the date of the enactment of this subsection, the
            Secretary shall make available to MA plans under this part and
            prescription drug plans under part D in a timely manner (but no
            less frequently than quarterly) and using information submitted
            to an entity described in paragraph (1) through the portal (or
            other successor technology) described in such paragraph or
            pursuant to section 1893, information on fraud, waste, and abuse
            schemes and trends in identifying suspicious activity.
            Information included in each such report shall--
                        ``(A) include administrative actions, pertinent
                    information related to opioid overprescribing, and other
                    data determined appropriate by the Secretary in
                    consultation with stakeholders; and
                        ``(B) be anonymized information submitted by plans
                    without identifying the source of such information.
                ``(3) Clarification.--Nothing in this subsection shall
            preclude or otherwise affect referrals to the Inspector General
            of the Department of Health and Human Services or other law
            enforcement entities.''.

        (b) Contract Requirement to Communicate Plan Corrective Actions
    Against Opioids Over-prescribers.--Section 1857(e) of the Social
    Security Act (42 U.S.C. 1395w-27(e)) is amended by adding at the end the
    following new paragraph:
                ``(5) Communicating plan corrective actions against opioids
            over-prescribers.--
                        ``(A) In general.--Beginning with plan years
                    beginning on or after January 1, 2021, a contract under
                    this section with an MA organization shall require the
                    organization to submit to the Secretary, through the
                    process established under subparagraph (B), information
                    on the investigations, credible evidence of suspicious
                    activities of a provider of services (including a
                    prescriber) or supplier related to fraud, and other
                    actions taken by such plans related to inappropriate
                    prescribing of opioids.
                        ``(B) Process.--Not later than January 1, 2021, the
                    Secretary shall, in consultation with stakeholders,
                    establish a process under which MA plans and
                    prescription drug plans shall submit to the Secretary
                    information described in subparagraph (A).

    [[Page 132 STAT. 3989]]

                        ``(C) Regulations.--For purposes of this paragraph,
                    including as applied under section 1860D-12(b)(3)(D),
                    the Secretary shall, pursuant to rulemaking--
                              ``(i) specify a definition for the term
                          `inappropriate prescribing' and a method for
                          determining if a provider of services prescribes
                          inappropriate prescribing; and
                              ``(ii) establish the process described in
                          subparagraph (B) and the types of information that
                          shall be submitted through such process.''.

        (c) Reference Under Part D to Program Integrity Transparency
    Measures.--Section 1860D-4 of the Social Security Act (42 U.S.C. 1395w-
    104) is amended by adding at the end the following new subsection:
        ``(m) Program Integrity Transparency Measures.--For program
    integrity transparency measures applied with respect to prescription
    drug plan and MA plans, see section 1859(i).''.
    SEC. 6064. EXPANDING ELIGIBILITY FOR MEDICATION THERAPY MANAGEMENT
                              PROGRAMS UNDER PART D.

        Section 1860D-4(c)(2)(A)(ii) of the Social Security Act (42 U.S.C.
    1395w-104(c)(2)(A)(ii)) is amended--
                (1) by redesignating subclauses (I) through (III) as items
            (aa) through (cc), respectively, and adjusting the margins
            accordingly;
                (2) by striking ``are part D eligible individuals who--''
            and inserting ``are the following:
                                        ``(I) Part D eligible individuals
                                    who--''; and
                (3) by adding at the end the following new subclause:
                                        ``(II) Beginning January 1, 2021,
                                    at-risk beneficiaries for prescription
                                    drug abuse (as defined in paragraph
                                    (5)(C)).''.
    SEC. 6065. COMMIT TO OPIOID MEDICAL PRESCRIBER ACCOUNTABILITY AND
                              SAFETY FOR SENIORS.

        Section 1860D-4(c)(4) of the Social Security Act (42 U.S.C. 1395w-
    104(c)(4)) is amended by adding at the end the following new
    subparagraph:
                        ``(D) Notification and additional requirements with
                    respect to outlier prescribers of opioids.--
                              ``(i) Notification.--Not later than January 1,
                          2021, the Secretary shall, in the case of a
                          prescriber identified by the Secretary under
                          clause (ii) to be an outlier prescriber of
                          opioids, provide, subject to clause (iv), an
                          annual notification to such prescriber that such
                          prescriber has been so identified and that
                          includes resources on proper prescribing methods
                          and other information as specified in accordance
                          with clause (iii).
                              ``(ii) Identification of outlier prescribers
                          of opioids.--
                                        ``(I) In general.--The Secretary
                                    shall, subject to subclause (III), using
                                    the valid prescriber National Provider
                                    Identifiers included pursuant to
                                    subparagraph (A) on claims for covered
                                    part D drugs for part D eligible
                                    individuals enrolled in prescription
                                    drug plans under this part or MA-PD
                                    plans under part C and based on the
                                    thresholds

    [[Page 132 STAT. 3990]]

                                    established under subclause (II),
                                    identify prescribers that are outlier
                                    opioids prescribers for a period of time
                                    specified by the Secretary.
                                        ``(II) Establishment of
                                    thresholds.--For purposes of subclause
                                    (I) and subject to subclause (III), the
                                    Secretary shall, after consultation with
                                    stakeholders, establish thresholds,
                                    based on prescriber specialty and
                                    geographic area, for identifying whether
                                    a prescriber in a specialty and
                                    geographic area is an outlier prescriber
                                    of opioids as compared to other
                                    prescribers of opioids within such
                                    specialty and area.
                                        ``(III) Exclusions.--The following
                                    shall not be included in the analysis
                                    for identifying outlier prescribers of
                                    opioids under this clause:
                                                ``(aa) Claims for covered
                                            part D drugs for part D eligible
                                            individuals who are receiving
                                            hospice care under this title.
                                                ``(bb) Claims for covered
                                            part D drugs for part D eligible
                                            individuals who are receiving
                                            oncology services under this
                                            title.
                                                ``(cc) Prescribers who are
                                            the subject of an investigation
                                            by the Centers for Medicare &
                                            Medicaid Services or the
                                            Inspector General of the
                                            Department of Health and Human
                                            Services.
                              ``(iii) Contents of notification.--The
                          Secretary shall include the following information
                          in the notifications provided under clause (i):
                                        ``(I) Information on how such
                                    prescriber compares to other prescribers
                                    within the same specialty and geographic
                                    area.
                                        ``(II) Information on opioid
                                    prescribing guidelines, based on input
                                    from stakeholders, that may include the
                                    Centers for Disease Control and
                                    Prevention guidelines for prescribing
                                    opioids for chronic pain and guidelines
                                    developed by physician organizations.
                                        ``(III) Other information determined
                                    appropriate by the Secretary.
                              ``(iv) Modifications and expansions.--
                                        ``(I) Frequency.--Beginning 5 years
                                    after the date of the enactment of this
                                    subparagraph, the Secretary may change
                                    the frequency of the notifications
                                    described in clause (i) based on
                                    stakeholder input and changes in opioid
                                    prescribing utilization and trends.
                                        ``(II) Expansion to other
                                    prescriptions.--The Secretary may expand
                                    notifications under this subparagraph to
                                    include identifications and
                                    notifications with respect to concurrent
                                    prescriptions of covered Part D drugs
                                    used in combination with opioids that
                                    are considered to have adverse side
                                    effects when so used in such
                                    combination, as determined by the
                                    Secretary.
                              ``(v) Additional requirements for persistent
                          outlier prescribers.--In the case of a prescriber
                          who

    [[Page 132 STAT. 3991]]

                          the Secretary determines is persistently
                          identified under clause (ii) as an outlier
                          prescriber of opioids, the following shall apply:
                                        ``(I) Such prescriber may be
                                    required to enroll in the program under
                                    this title under section 1866(j) if such
                                    prescriber is not otherwise required to
                                    enroll, but only after other appropriate
                                    remedies have been provided, such as the
                                    provision of education funded through
                                    section 6052 of the SUPPORT for Patients
                                    and Communities Act, for a period
                                    determined by the Secretary as
                                    sufficient to correct the prescribing
                                    patterns that lead to identification of
                                    such prescriber as a persistent outlier
                                    prescriber of opioids. The Secretary
                                    shall determine the length of the period
                                    for which such prescriber is required to
                                    maintain such enrollment, which shall be
                                    the minimum period necessary to correct
                                    such prescribing patterns.
                                        ``(II) Not less frequently than
                                    annually (and in a form and manner
                                    determined appropriate by the
                                    Secretary), the Secretary, consistent
                                    with clause(iv)(I), shall communicate
                                    information on such prescribers to
                                    sponsors of a prescription drug plan and
                                    Medicare Advantage organizations
                                    offering an MA-PD plan.
                              ``(vi) Public availability of information.--
                          The Secretary shall make aggregate information
                          under this subparagraph available on the internet
                          website of the Centers for Medicare & Medicaid
                          Services. Such information shall be in a form and
                          manner determined appropriate by the Secretary and
                          shall not identify any specific prescriber. In
                          carrying out this clause, the Secretary shall
                          consult with interested stakeholders.
                              ``(vii) Opioids defined.--For purposes of this
                          subparagraph, the term `opioids' has such meaning
                          as specified by the Secretary.
                              ``(viii) Other activities.--Nothing in this
                          subparagraph shall preclude the Secretary from
                          conducting activities that provide prescribers
                          with information as to how they compare to other
                          prescribers that are in addition to the activities
                          under this subparagraph, including activities that
                          were being conducted as of the date of the
                          enactment of this subparagraph.''.
    SEC. 6066. NO ADDITIONAL FUNDS AUTHORIZED.

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

    [[Page 132 STAT. 3992]]

    Subtitle H <<NOTE: Expanding Oversight of Opioid Prescribing and Payment
    Act of 2018.>> --Expanding Oversight of Opioid Prescribing and Payment
    SEC. 6071. SHORT TITLE.

        This subtitle may be cited as the ``Expanding Oversight of Opioid
    Prescribing and Payment Act of 2018''.
    SEC. 6072. MEDICARE PAYMENT ADVISORY COMMISSION REPORT ON OPIOID
                              PAYMENT, ADVERSE INCENTIVES, AND DATA
                              UNDER THE MEDICARE PROGRAM.

        Not later than March 15, 2019, the Medicare Payment Advisory
    Commission shall submit to Congress a report on, with respect to the
    Medicare program under title XVIII of the Social Security Act, the
    following:
                (1) A description of how the Medicare program pays for pain
            management treatments (both opioid and non-opioid pain
            management alternatives) in both inpatient and outpatient
            hospital settings.
                (2) The identification of incentives under the hospital
            inpatient prospective payment system under section 1886 of the
            Social Security Act (42 U.S.C. 1395ww) and incentives under the
            hospital outpatient prospective payment system under section
            1833(t) of such Act (42 U.S.C. 1395l(t)) for prescribing opioids
            and incentives under each such system for prescribing non-opioid
            treatments, and recommendations as the Commission deems
            appropriate for addressing any of such incentives that are
            adverse incentives.
                (3) A description of how opioid use is tracked and monitored
            through Medicare claims data and other mechanisms and the
            identification of any areas in which further data and methods
            are needed for improving data and understanding of opioid use.
    SEC. 6073. NO ADDITIONAL FUNDS AUTHORIZED.

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

       Subtitle I <<NOTE: Dr. Todd Graham Pain Management, Treatment, and
     Recovery Act of 2018.>> --Dr. Todd Graham Pain Management, Treatment,
    and Recovery
    SEC. 6081. <<NOTE: 42 USC 1305 note.>>  SHORT TITLE.

        This subtitle may be cited as the ``Dr. Todd Graham Pain Management,
    Treatment, and Recovery Act of 2018''.
    SEC. 6082. REVIEW AND ADJUSTMENT OF PAYMENTS UNDER THE MEDICARE
                              OUTPATIENT PROSPECTIVE PAYMENT SYSTEM TO
                              AVOID FINANCIAL INCENTIVES TO USE
                              OPIOIDS INSTEAD OF NON-OPIOID
                              ALTERNATIVE TREATMENTS.

        (a) Outpatient Prospective Payment System.--Section 1833(t) of the
    Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end
    the following new paragraph:
                ``(22) Review and revisions of payments for non-opioid
            alternative treatments.--

    [[Page 132 STAT. 3993]]

                        ``(A) In general.--With respect to payments made
                    under this subsection for covered OPD services (or
                    groups of services), including covered OPD services
                    assigned to a comprehensive ambulatory payment
                    classification, the Secretary--
                              ``(i) shall, as soon as practicable, conduct a
                          review (part of which may include a request for
                          information) of payments for opioids and evidence-
                          based non-opioid alternatives for pain management
                          (including drugs and devices, nerve blocks,
                          surgical injections, and neuromodulation) with a
                          goal of ensuring that there are not financial
                          incentives to use opioids instead of non-opioid
                          alternatives;
                              ``(ii) may, as the Secretary determines
                          appropriate, conduct subsequent reviews of such
                          payments; and
                              ``(iii) shall consider the extent to which
                          revisions under this subsection to such payments
                          (such as the creation of additional groups of
                          covered OPD services to classify separately those
                          procedures that utilize opioids and non-opioid
                          alternatives for pain management) would reduce
                          payment incentives to use opioids instead of non-
                          opioid alternatives for pain management.
                        ``(B) Priority.--In conducting the review under
                    clause (i) of subparagraph (A) and considering revisions
                    under clause (iii) of such subparagraph, the Secretary
                    shall focus on covered OPD services (or groups of
                    services) assigned to a comprehensive ambulatory payment
                    classification, ambulatory payment classifications that
                    primarily include surgical services, and other services
                    determined by the Secretary which generally involve
                    treatment for pain management.
                        ``(C) Revisions.--If the Secretary identifies
                    revisions to payments pursuant to subparagraph (A)(iii),
                    the Secretary shall, as determined appropriate, begin
                    making such revisions for services furnished on or after
                    January 1, 2020. Revisions under the previous sentence
                    shall be treated as adjustments for purposes of
                    application of paragraph (9)(B).
                        ``(D) Rules of construction.--Nothing in this
                    paragraph shall be construed to preclude the Secretary--
                              ``(i) from conducting a demonstration before
                          making the revisions described in subparagraph
                          (C); or
                              ``(ii) prior to implementation of this
                          paragraph, from changing payments under this
                          subsection for covered OPD services (or groups of
                          services) which include opioids or non-opioid
                          alternatives for pain management.''.

        (b) Ambulatory Surgical Centers.--Section 1833(i) of the Social
    Security Act (42 U.S.C. 1395l(i)) is amended by adding at the end the
    following new paragraph:
        ``(8) The Secretary shall conduct a similar type of review as
    required under paragraph (22) of section 1833(t)), including the second
    sentence of subparagraph (C) of such paragraph, to payment for services
    under this subsection, and make such revisions under

    [[Page 132 STAT. 3994]]

    this paragraph, in an appropriate manner (as determined by the
    Secretary).''.
    SEC. 6083. EXPANDING ACCESS UNDER THE MEDICARE PROGRAM TO
                              ADDICTION TREATMENT IN FEDERALLY
                              QUALIFIED HEALTH CENTERS AND RURAL
                              HEALTH CLINICS.

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

        (b) Rural Health Clinic.--Section 1833 of the Social Security Act
    (42 U.S.C. 1395l) is amended--
                (1) by redesignating the subsection (z) relating to medical
            review of spinal subluxation services as subsection (aa); and
                (2) by adding at the end the following new subsection:

    [[Page 132 STAT. 3995]]

        ``(bb) Additional Payments for Certain Rural Health Clinics With
    Physicians or Practitioners Receiving DATA 2000 Waivers.--
                ``(1) In general.--In the case of a rural health clinic with
            respect to which, beginning on or after January 1, 2019, rural
            health clinic services (as defined in section 1861(aa)(1)) are
            furnished for the treatment of opioid use disorder by a
            physician or practitioner who meets the requirements described
            in paragraph (3), the Secretary shall, subject to availability
            of funds under paragraph (4), make a payment (at such time and
            in such manner as specified by the Secretary) to such rural
            health clinic after receiving and approving an application
            described in paragraph (2). Such payment shall be in an amount
            determined by the Secretary, based on an estimate of the average
            costs of training for purposes of receiving a waiver described
            in paragraph (3)(B). Such payment may be made only one time with
            respect to each such physician or practitioner.
                ``(2) Application.--In order to receive a payment described
            in paragraph (1), a rural health clinic shall submit to the
            Secretary an application for such a payment at such time, in
            such manner, and containing such information as specified by the
            Secretary. A rural health clinic may apply for such a payment
            for each physician or practitioner described in paragraph (1)
            furnishing services described in such paragraph at such clinic.
                ``(3) Requirements.--For purposes of paragraph (1), the
            requirements described in this paragraph, with respect to a
            physician or practitioner, are the following:
                        ``(A) The physician or practitioner is employed by
                    or working under contract with a rural health clinic
                    described in paragraph (1) that submits an application
                    under paragraph (2).
                        ``(B) The physician or practitioner first receives a
                    waiver under section 303(g) of the Controlled Substances
                    Act on or after January 1, 2019.
                ``(4) Funding.--For purposes of making payments under this
            subsection, there are appropriated, out of amounts in the
            Treasury not otherwise appropriated, $2,000,000, which shall
            remain available until expended.''.
    SEC. 6084. STUDYING THE AVAILABILITY OF SUPPLEMENTAL BENEFITS
                              DESIGNED TO TREAT OR PREVENT SUBSTANCE
                              USE DISORDERS UNDER MEDICARE ADVANTAGE
                              PLANS.

        (a) In General.--Not later than 2 years after the date of the
    enactment of this Act, the Secretary of Health and Human Services (in
    this section referred to as the ``Secretary'') shall submit to Congress
    a report on the availability of supplemental health care benefits (as
    described in section 1852(a)(3)(A) of the Social Security Act (42 U.S.C.
    1395w-22(a)(3)(A))) designed to treat or prevent substance use disorders
    under Medicare Advantage plans offered under part C of title XVIII of
    such Act. Such report shall include the analysis described in subsection
    (c) and any differences in the availability of such benefits under
    specialized MA plans for special needs individuals (as defined in
    section 1859(b)(6) of such Act (42 U.S.C. 1395w-28(b)(6))) offered to
    individuals entitled to medical assistance under title XIX of such Act
    and other such Medicare Advantage plans.

    [[Page 132 STAT. 3996]]

        (b) Consultation.--The Secretary shall develop the report described
    in subsection (a) in consultation with relevant stakeholders,
    including--
                (1) individuals entitled to benefits under part A or
            enrolled under part B of title XVIII of the Social Security Act;
                (2) entities who advocate on behalf of such individuals;
                (3) Medicare Advantage organizations;
                (4) pharmacy benefit managers; and
                (5) providers of services and suppliers (as such terms are
            defined in section 1861 of such Act (42 U.S.C. 1395x)).

        (c) Contents.--The report described in subsection (a) shall include
    an analysis on the following:
                (1) The extent to which plans described in such subsection
            offer supplemental health care benefits relating to coverage
            of--
                        (A) medication-assisted treatments for opioid use,
                    substance use disorder counseling, peer recovery support
                    services, or other forms of substance use disorder
                    treatments (whether furnished in an inpatient or
                    outpatient setting); and
                        (B) non-opioid alternatives for the treatment of
                    pain.
                (2) Challenges associated with such plans offering
            supplemental health care benefits relating to coverage of items
            and services described in subparagraph (A) or (B) of paragraph
            (1).
                (3) The impact, if any, of increasing the applicable rebate
            percentage determined under section 1854(b)(1)(C) of the Social
            Security Act (42 U.S.C. 1395w-24(b)(1)(C)) for plans offering
            such benefits relating to such coverage would have on the
            availability of such benefits relating to such coverage offered
            under Medicare Advantage plans.
                (4) Potential ways to improve upon such coverage or to
            incentivize such plans to offer additional supplemental health
            care benefits relating to such coverage.
    SEC. 6085. CLINICAL PSYCHOLOGIST SERVICES MODELS UNDER THE CENTER
                              FOR MEDICARE AND MEDICAID INNOVATION;
                              GAO STUDY AND REPORT.

        (a) CMI Models.--Section 1115A(b)(2)(B) of the Social Security Act
    (42 U.S.C. 1315a(b)(2)(B)), as amended by section 6001, is further
    amended by adding at the end the following new clauses:
                              ``(xxvi) Supporting ways to familiarize
                          individuals with the availability of coverage
                          under part B of title XVIII for qualified
                          psychologist services (as defined in section
                          1861(ii)).
                              ``(xxvii) Exploring ways to avoid unnecessary
                          hospitalizations or emergency department visits
                          for mental and behavioral health services (such as
                          for treating depression) through use of a 24-hour,
                          7-day a week help line that may inform individuals
                          about the availability of treatment options,
                          including the availability of qualified
                          psychologist services (as defined in section
                          1861(ii)).''.

        (b) GAO Study and Report.--Not later than 18 months after the date
    of the enactment of this Act, the Comptroller General of the United
    States shall conduct a study, and submit to Congress

    [[Page 132 STAT. 3997]]

    a report, on mental and behavioral health services under the Medicare
    program under title XVIII of the Social Security Act, including an
    examination of the following:
                (1) Information about services furnished by psychiatrists,
            clinical psychologists, and other professionals.
                (2) Information about ways that Medicare beneficiaries
            familiarize themselves about the availability of Medicare
            payment for qualified psychologist services (as defined in
            section 1861(ii) of the Social Security Act (42 U.S.C.
            1395x(ii)) and ways that the provision of such information could
            be improved.
    SEC. 6086. DR. TODD GRAHAM PAIN MANAGEMENT STUDY.

        (a) In General.--Not later than 1 year after the date of enactment
    of this Act, the Secretary of Health and Human Services (referred to in
    this section as the ``Secretary'') shall conduct a study analyzing best
    practices as well as payment and coverage for pain management services
    under title XVIII of the Social Security Act and submit to the Committee
    on Ways and Means and the Committee on Energy and Commerce of the House
    of Representatives and the Committee on Finance of the Senate a report
    containing options for revising payment to providers and suppliers of
    services and coverage related to the use of multi-disciplinary,
    evidence-based, non-opioid treatments for acute and chronic pain
    management for individuals entitled to benefits under part A or enrolled
    under part B of title XVIII of the Social Security Act. The Secretary
    shall make such report available on the public website of the Centers
    for Medicare & Medicaid Services.
        (b) Consultation.--In developing the report described in subsection
    (a), the Secretary shall consult with--
                (1) relevant agencies within the Department of Health and
            Human Services;
                (2) licensed and practicing osteopathic and allopathic
            physicians, behavioral health practitioners, physician
            assistants, nurse practitioners, dentists, pharmacists, and
            other providers of health services;
                (3) providers and suppliers of services (as such terms are
            defined in section 1861 of the Social Security Act (42 U.S.C.
            1395x));
                (4) substance abuse and mental health professional
            organizations;
                (5) pain management professional organizations and advocacy
            entities, including individuals who personally suffer chronic
            pain;
                (6) medical professional organizations and medical specialty
            organizations;
                (7) licensed health care providers who furnish alternative
            pain management services;
                (8) organizations with expertise in the development of
            innovative medical technologies for pain management;
                (9) beneficiary advocacy organizations; and
                (10) other organizations with expertise in the assessment,
            diagnosis, treatment, and management of pain, as determined
            appropriate by the Secretary.

        (c) Contents.--The report described in subsection (a) shall include
    the following:
                (1) An analysis of payment and coverage under title XVIII of
            the Social Security Act with respect to the following:

    [[Page 132 STAT. 3998]]

                        (A) Evidence-based treatments and technologies for
                    chronic or acute pain, including such treatments that
                    are covered, not covered, or have limited coverage under
                    such title.
                        (B) Evidence-based treatments and technologies that
                    monitor substance use withdrawal and prevent overdoses
                    of opioids.
                        (C) Evidence-based treatments and technologies that
                    treat substance use disorders.
                        (D) Items and services furnished by practitioners
                    through a multi-disciplinary treatment model for pain
                    management, including the patient-centered medical home.
                        (E) Items and services furnished to beneficiaries
                    with psychiatric disorders, substance use disorders, or
                    who are at risk of suicide, or have comorbidities and
                    require consultation or management of pain with one or
                    more specialists in pain management, mental health, or
                    addiction treatment.
                (2) An evaluation of the following:
                        (A) Barriers inhibiting individuals entitled to
                    benefits under part A or enrolled under part B of such
                    title from accessing treatments and technologies
                    described in subparagraphs (A) through (E) of paragraph
                    (1).
                        (B) Costs and benefits associated with potential
                    expansion of coverage under such title to include items
                    and services not covered under such title that may be
                    used for the treatment of pain, such as acupuncture,
                    therapeutic massage, and items and services furnished by
                    integrated pain management programs.
                        (C) Pain management guidance published by the
                    Federal Government that may be relevant to coverage
                    determinations or other coverage requirements under
                    title XVIII of the Social Security Act.
                (3) An assessment of all guidance published by the
            Department of Health and Human Services on or after January 1,
            2016, relating to the prescribing of opioids. Such assessment
            shall consider incorporating into such guidance relevant
            elements of the ``Va/DoD Clinical Practice Guideline for Opioid
            Therapy for Chronic Pain'' published in February 2017 by the
            Department of Veterans Affairs and Department of Defense,
            including adoption of elements of the Department of Defense and
            Department of Veterans Affairs pain rating scale.
                (4) The options described in subsection (d).
                (5) The impact analysis described in subsection (e).

        (d) Options.--The options described in this subsection are, with
    respect to individuals entitled to benefits under part A or enrolled
    under part B of title XVIII of the Social Security Act, legislative and
    administrative options for accomplishing the following:
                (1) Improving coverage of and payment for pain management
            therapies without the use of opioids, including interventional
            pain therapies, and options to augment opioid therapy with other
            clinical and complementary, integrative health services to
            minimize the risk of substance use disorder, including in a
            hospital setting.
                (2) Improving coverage of and payment for medical devices
            and non-opioid based pharmacological and non-pharmacological

    [[Page 132 STAT. 3999]]

            therapies approved or cleared by the Food and Drug
            Administration for the treatment of pain as an alternative or
            augment to opioid therapy.
                (3) Improving and disseminating treatment strategies for
            beneficiaries with psychiatric disorders, substance use
            disorders, or who are at risk of suicide, and treatment
            strategies to address health disparities related to opioid use
            and opioid abuse treatment.
                (4) Improving and disseminating treatment strategies for
            beneficiaries with comorbidities who require a consultation or
            comanagement of pain with one or more specialists in pain
            management, mental health, or addiction treatment, including in
            a hospital setting.
                (5) Educating providers on risks of coadministration of
            opioids and other drugs, particularly benzodiazepines.
                (6) Ensuring appropriate case management for beneficiaries
            who transition between inpatient and outpatient hospital
            settings, or between opioid therapy to non-opioid therapy, which
            may include the use of care transition plans.
                (7) Expanding outreach activities designed to educate
            providers of services and suppliers under the Medicare program
            and individuals entitled to benefits under part A or under part
            B of such title on alternative, non-opioid therapies to manage
            and treat acute and chronic pain.
                (8) Creating a beneficiary education tool on alternatives to
            opioids for chronic pain management.

        (e) Impact Analysis.--The impact analysis described in this
    subsection consists of an analysis of any potential effects implementing
    the options described in subsection (d) would have--
                (1) on expenditures under the Medicare program; and
                (2) on preventing or reducing opioid addiction for
            individuals receiving benefits under the Medicare program.

      Subtitle <<NOTE: Combating Opioid Abuse for Care in Hospitals Act of
    2018.>>  J--Combating Opioid Abuse for Care in Hospitals
    SEC. 6091. <<NOTE: 42 USC 1305 note.>>  SHORT TITLE.

        This subtitle may be cited as the ``Combating Opioid Abuse for Care
    in Hospitals Act of 2018'' or the ``COACH Act of 2018''.
    SEC. 6092. <<NOTE: 42 USC 1395c note.>>  DEVELOPING GUIDANCE ON
                              PAIN MANAGEMENT AND OPIOID USE DISORDER
                              PREVENTION FOR HOSPITALS RECEIVING
                              PAYMENT UNDER PART A OF THE MEDICARE
                              PROGRAM.

        (a) In General.--Not later than July 1, 2019, the Secretary of
    Health and Human Services (in this section referred to as the
    ``Secretary'') shall develop and publish on the public website of the
    Centers for Medicare & Medicaid Services guidance for hospitals
    receiving payment under part A of title XVIII of the Social Security Act
    (42 U.S.C. 1395c et seq.) on pain management strategies and opioid use
    disorder prevention strategies with respect to individuals entitled to
    benefits under such part.
        (b) Consultation.--In developing the guidance described in
    subsection (a), the Secretary shall consult with relevant stakeholders,
    including--
                (1) medical professional organizations;

    [[Page 132 STAT. 4000]]

                (2) providers and suppliers of services (as such terms are
            defined in section 1861 of the Social Security Act (42 U.S.C.
            1395x));
                (3) health care consumers or groups representing such
            consumers; and
                (4) other entities determined appropriate by the Secretary.

        (c) Contents.--The guidance described in subsection (a) shall
    include, with respect to hospitals and individuals described in such
    subsection, the following:
                (1) Best practices regarding evidence-based screening and
            practitioner education initiatives relating to screening and
            treatment protocols for opioid use disorder, including--
                        (A) methods to identify such individuals at-risk of
                    opioid use disorder, including risk stratification;
                        (B) ways to prevent, recognize, and treat opioid
                    overdoses; and
                        (C) resources available to such individuals, such as
                    opioid treatment programs, peer support groups, and
                    other recovery programs.
                (2) Best practices for such hospitals to educate
            practitioners furnishing items and services at such hospital
            with respect to pain management and substance use disorders,
            including education on--
                        (A) the adverse effects of prolonged opioid use;
                        (B) non-opioid, evidence-based, non-pharmacological
                    pain management treatments;
                        (C) monitoring programs for individuals who have
                    been prescribed opioids; and
                        (D) the prescribing of naloxone along with an
                    initial opioid prescription.
                (3) Best practices for such hospitals to make such
            individuals aware of the risks associated with opioid use (which
            may include use of the notification template described in
            paragraph (4)).
                (4) A notification template developed by the Secretary, for
            use as appropriate, for such individuals who are prescribed an
            opioid that--
                        (A) explains the risks and side effects associated
                    with opioid use (including the risks of addiction and
                    overdose) and the importance of adhering to the
                    prescribed treatment regimen, avoiding medications that
                    may have an adverse interaction with such opioid, and
                    storing such opioid safely and securely;
                        (B) highlights multimodal and evidence-based non-
                    opioid alternatives for pain management;
                        (C) encourages such individuals to talk to their
                    health care providers about such alternatives;
                        (D) provides for a method (through signature or
                    otherwise) for such an individual, or person acting on
                    such individual's behalf, to acknowledge receipt of such
                    notification template;
                        (E) is worded in an easily understandable manner and
                    made available in multiple languages determined
                    appropriate by the Secretary; and
                        (F) includes any other information determined
                    appropriate by the Secretary.

    [[Page 132 STAT. 4001]]

                (5) Best practices for such hospital to track opioid
            prescribing trends by practitioners furnishing items and
            services at such hospital, including--
                        (A) ways for such hospital to establish target
                    levels, taking into account the specialties of such
                    practitioners and the geographic area in which such
                    hospital is located, with respect to opioids prescribed
                    by such practitioners;
                        (B) guidance on checking the medical records of such
                    individuals against information included in prescription
                    drug monitoring programs;
                        (C) strategies to reduce long-term opioid
                    prescriptions; and
                        (D) methods to identify such practitioners who may
                    be over-prescribing opioids.
                (6) Other information the Secretary determines appropriate,
            including any such information from the Opioid Safety Initiative
            established by the Department of Veterans Affairs or the Opioid
            Overdose Prevention Toolkit published by the Substance Abuse and
            Mental Health Services Administration.
    SEC. 6093. REQUIRING THE REVIEW OF QUALITY MEASURES RELATING TO
                              OPIOIDS AND OPIOID USE DISORDER
                              TREATMENTS FURNISHED UNDER THE MEDICARE
                              PROGRAM AND OTHER FEDERAL HEALTH CARE
                              PROGRAMS.

        Section 1890A of the Social Security Act (42 U.S.C. 1395aaa-1) is
    amended by adding at the end the following new subsection:
        ``(g) Technical Expert Panel Review of Opioid and Opioid Use
    Disorder Quality Measures.--
                ``(1) In general.--Not later than 180 days after the date of
            the enactment of this subsection, the Secretary shall establish
            a technical expert panel for purposes of reviewing quality
            measures relating to opioids and opioid use disorders, including
            care, prevention, diagnosis, health outcomes, and treatment
            furnished to individuals with opioid use disorders. The
            Secretary may use the entity with a contract under section
            1890(a) and amend such contract as necessary to provide for the
            establishment of such technical expert panel.
                ``(2) Review and assessment.--Not later than 1 year after
            the date the technical expert panel described in paragraph (1)
            is established (and periodically thereafter as the Secretary
            determines appropriate), the technical expert panel shall--
                        ``(A) review quality measures that relate to opioids
                    and opioid use disorders, including existing measures
                    and those under development;
                        ``(B) identify gaps in areas of quality measurement
                    that relate to opioids and opioid use disorders, and
                    identify measure development priorities for such measure
                    gaps; and
                        ``(C) make recommendations to the Secretary on
                    quality measures with respect to opioids and opioid use
                    disorders for purposes of improving care, prevention,
                    diagnosis, health outcomes, and treatment, including
                    recommendations for revisions of such measures, need for
                    development of new measures, and recommendations for
                    including such measures in the Merit-Based Incentive
                    Payment System under section 1848(q), the alternative
                    payment models under section 1833(z)(3)(C), the shared
                    savings program

    [[Page 132 STAT. 4002]]

                    under section 1899, the quality reporting requirements
                    for inpatient hospitals under section
                    1886(b)(3)(B)(viii), and the hospital value-based
                    purchasing program under section 1886(o).
                ``(3) Consideration of measures by secretary.--The Secretary
            shall consider--
                        ``(A) using opioid and opioid use disorder measures
                    (including measures used under the Merit-Based Incentive
                    Payment System under section 1848(q), measures
                    recommended under paragraph (2)(C), and other such
                    measures identified by the Secretary) in alternative
                    payment models under section 1833(z)(3)(C) and in the
                    shared savings program under section 1899; and
                        ``(B) using opioid measures described in
                    subparagraph (A), as applicable, in the quality
                    reporting requirements for inpatient hospitals under
                    section 1886(b)(3)(B)(viii), and in the hospital value-
                    based purchasing program under section 1886(o).
                ``(4) Prioritization of measure development.--The Secretary
            shall prioritize for measure development the gaps in quality
            measures identified under paragraph (2)(B).
                ``(5) Prioritization of measure endorsement.--The
            Secretary--
                        ``(A) during the period beginning on the date of the
                    enactment of this subsection and ending on December 31,
                    2023, shall prioritize the endorsement of measures
                    relating to opioids and opioid use disorders by the
                    entity with a contract under subsection (a) of section
                    1890 in connection with endorsement of measures
                    described in subsection (b)(2) of such section; and
                        ``(B) on and after January 1, 2024, may prioritize
                    the endorsement of such measures by such entity.''.
    SEC. 6094. TECHNICAL EXPERT PANEL ON REDUCING SURGICAL SETTING
                              OPIOID USE; DATA COLLECTION ON
                              PERIOPERATIVE OPIOID USE.

        (a) Technical Expert Panel on Reducing Surgical Setting Opioid
    Use.--
                (1) In general.--Not later than 6 months after the date of
            the enactment of this Act, the Secretary of Health and Human
            Services shall convene a technical expert panel, including
            medical and surgical specialty societies and hospital
            organizations, to provide recommendations on reducing opioid use
            in the inpatient and outpatient surgical settings and on best
            practices for pain management, including with respect to the
            following:
                        (A) Approaches that limit patient exposure to
                    opioids during the perioperative period, including pre-
                    surgical and post-surgical injections, and that identify
                    such patients at risk of opioid use disorder pre-
                    operation.
                        (B) Shared decision making with patients and
                    families on pain management, including a review of
                    payment to ensure payment under the Medicare program
                    under title XVIII of the Social Security Act accounts
                    for time spent on shared decision making.
                        (C) Education on the safe use, storage, and disposal
                    of opioids.

    [[Page 132 STAT. 4003]]

                        (D) Prevention of opioid misuse and abuse after
                    discharge.
                        (E) Development of a clinical algorithm to identify
                    and treat at-risk, opiate-tolerant patients and reduce
                    reliance on opioids for acute pain during the
                    perioperative period.
                (2) Report.--Not later than 1 year after the date of the
            enactment of this Act, the Secretary shall submit to Congress
            and make public a report containing the recommendations
            developed under paragraph (1) and an action plan for broader
            implementation of pain management protocols that limit the use
            of opioids in the perioperative setting and upon discharge from
            such setting.

        (b) Data Collection on Perioperative Opioid Use.--Not later than 1
    year after the date of the enactment of this Act, the Secretary of
    Health and Human Services shall submit to Congress a report that
    contains the following:
                (1) The diagnosis-related group codes identified by the
            Secretary as having the highest volume of surgeries.
                (2) With respect to each of such diagnosis-related group
            codes so identified, a determination by the Secretary of the
            data that is both available and reported on opioid use following
            such surgeries, such as with respect to--
                        (A) surgical volumes, practices, and opioid
                    prescribing patterns;
                        (B) opioid consumption, including--
                              (i) perioperative days of therapy;
                              (ii) average daily dose at the hospital,
                          including dosage greater than 90 milligram
                          morphine equivalent;
                              (iii) post-discharge prescriptions and other
                          combination drugs that are used before
                          intervention and after intervention;
                              (iv) quantity and duration of opioid
                          prescription at discharge; and
                              (v) quantity consumed and number of refills;
                        (C) regional anesthesia and analgesia practices,
                    including pre-surgical and post-surgical injections;
                        (D) naloxone reversal;
                        (E) post-operative respiratory failure;
                        (F) information about storage and disposal; and
                        (G) such other information as the Secretary may
                    specify.
                (3) Recommendations for improving data collection on
            perioperative opioid use, including an analysis to identify and
            reduce barriers to collecting, reporting, and analyzing the data
            described in paragraph (2), including barriers related to
            technological availability.
    SEC. 6095. <<NOTE: 42 USC 1395hh note.>>  REQUIRING THE POSTING
                              AND PERIODIC UPDATE OF OPIOID
                              PRESCRIBING GUIDANCE FOR MEDICARE
                              BENEFICIARIES.

        (a) In General.--Not later than 180 days after the date of the
    enactment of this Act, the Secretary of Health and Human Services (in
    this section referred to as the ``Secretary'') shall post on the public
    website of the Centers for Medicare & Medicaid Services all guidance
    published by the Department of Health and

    [[Page 132 STAT. 4004]]

    Human Services on or after January 1, 2016, relating to the prescribing
    of opioids and applicable to opioid prescriptions for individuals
    entitled to benefits under part A of title XVIII of the Social Security
    Act (42 U.S.C. 1395c et seq.) or enrolled under part B of such title of
    such Act (42 U.S.C. 1395j et seq.).
        (b) Update of Guidance.--
                (1) Periodic update.--The Secretary shall, in consultation
            with the entities specified in paragraph (2), periodically (as
            determined appropriate by the Secretary) update guidance
            described in subsection (a) and revise the posting of such
            guidance on the website described in such subsection.
                (2) Consultation.--The entities specified in this paragraph
            are the following:
                        (A) Medical professional organizations.
                        (B) Providers and suppliers of services (as such
                    terms are defined in section 1861 of the Social Security
                    Act (42 U.S.C. 1395x)).
                        (C) Health care consumers or groups representing
                    such consumers.
                        (D) Other entities determined appropriate by the
                    Secretary.

    Subtitle <<NOTE: Providing Reliable Options for Patients and Educational
       Resources Act of 2018. 42 USC 1305 note.>>  K--Providing Reliable
    Options for Patients and Educational Resources
    SEC. 6101. SHORT TITLE.

        This subtitle may be cited as the ``Providing Reliable Options for
    Patients and Educational Resources Act of 2018'' or the ``PROPER Act of
    2018''.
    SEC. 6102. REQUIRING MEDICARE ADVANTAGE PLANS AND PART D
                              PRESCRIPTION DRUG PLANS TO INCLUDE
                              INFORMATION ON RISKS ASSOCIATED WITH
                              OPIOIDS AND COVERAGE OF
                              NONPHARMACOLOGICAL THERAPIES AND
                              NONOPIOID MEDICATIONS OR DEVICES USED TO
                              TREAT PAIN.

        Section 1860D-4(a)(1) of the Social Security Act (42 U.S.C. 1395w-
    104(a)(1)) is amended--
                (1) in subparagraph (A), by inserting ``, subject to
            subparagraph (C),'' before ``including'';
                (2) in subparagraph (B), by adding at the end the following
            new clause:
                              ``(vi) For plan year 2021 and each subsequent
                          plan year, subject to subparagraph (C), with
                          respect to the treatment of pain--
                                        ``(I) the risks associated with
                                    prolonged opioid use; and
                                        ``(II) coverage of
                                    nonpharmacological therapies, devices,
                                    and nonopioid medications--
                                                ``(aa) in the case of an MA-
                                            PD plan under part C, under such
                                            plan; and
                                                ``(bb) in the case of a
                                            prescription drug plan, under
                                            such plan and under parts A and
                                            B.''; and
                (3) by adding at the end the following new subparagraph:
                        ``(C) Targeted provision of information.--A PDP
                    sponsor of a prescription drug plan may, in lieu of
                    disclosing

    [[Page 132 STAT. 4005]]

                    the information described in subparagraph (B)(vi) to
                    each enrollee under the plan, disclose such information
                    through mail or electronic communications to a subset of
                    enrollees under the plan, such as enrollees who have
                    been prescribed an opioid in the previous 2-year
                    period.''.
    SEC. 6103. REQUIRING MEDICARE ADVANTAGE PLANS AND PRESCRIPTION
                              DRUG PLANS TO PROVIDE INFORMATION ON THE
                              SAFE DISPOSAL OF PRESCRIPTION DRUGS.

        (a) Medicare Advantage.--Section 1852 of the Social Security Act (42
    U.S.C. 1395w-22) is amended by adding at the end the following new
    subsection:
        ``(n) Provision of Information Relating to the Safe Disposal of
    Certain Prescription Drugs.--
                ``(1) In general.--In the case of an individual enrolled
            under an MA or MA-PD plan who is furnished an in-home health
            risk assessment on or after January 1, 2021, such plan shall
            ensure that such assessment includes information on the safe
            disposal of prescription drugs that are controlled substances
            that meets the criteria established under paragraph (2). Such
            information shall include information on drug takeback programs
            that meet such requirements determined appropriate by the
            Secretary and information on in-home disposal.
                ``(2) Criteria.--The Secretary shall, through rulemaking,
            establish criteria the Secretary determines appropriate with
            respect to information provided to an individual to ensure that
            such information sufficiently educates such individual on the
            safe disposal of prescription drugs that are controlled
            substances.''.

        (b) Prescription Drug Plans.--Section 1860D-4(c)(2)(B) of the Social
    Security Act (42 U.S.C. 1395w-104(c)(2)(B)) is amended--
                (1) by striking ``may include elements that promote'';
                (2) by redesignating clauses (i) through (iii) as subclauses
            (I) through (III) and adjusting the margins accordingly;
                (3) by inserting before subclause (I), as so redesignated,
            the following new clause:
                              ``(i) may include elements that promote--'';
                (4) in subclause (III), as so redesignated, by striking the
            period at the end and inserting ``; and''; and
                (5) by adding at the end the following new clause:
                              ``(ii) with respect to plan years beginning on
                          or after January 1, 2021, shall provide for--
                                        ``(I) the provision of information
                                    to the enrollee on the safe disposal of
                                    prescription drugs that are controlled
                                    substances that meets the criteria
                                    established under section 1852(n)(2),
                                    including information on drug takeback
                                    programs that meet such requirements
                                    determined appropriate by the Secretary
                                    and information on in-home disposal; and
                                        ``(II) cost-effective means by which
                                    an enrollee may so safely dispose of
                                    such drugs.''.

    [[Page 132 STAT. 4006]]

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

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

             Subtitle L--Fighting the Opioid Epidemic With Sunshine

    SEC. 6111. FIGHTING THE OPIOID EPIDEMIC WITH SUNSHINE.

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

    [[Page 132 STAT. 4007]]

            be submitted under section 1128G of the Social Security Act (42
            U.S.C. 1320a-7h) on or after January 1, 2022.

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

                       TITLE VII--PUBLIC HEALTH PROVISIONS

                       Subtitle A--Awareness and Training

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

        (a) In General.--Not later than 3 years after the date of the
    enactment of this Act, the Secretary of Health and Human Services, in
    coordination with the Surgeon General of the Public Health Service,
    shall submit to the Committee on Energy and Commerce of the House of
    Representatives and the Committee on Health, Education, Labor, and
    Pensions of the Senate a report on the health effects of new
    psychoactive substances, including synthetic drugs, used by adolescents
    and young adults.
        (b) New Psychoactive Substance Defined.--For purposes of subsection
    (a), the term ``new psychoactive substance'' means a controlled
    substance analogue (as defined in section 102(32) of the Controlled
    Substances Act (21 U.S.C. 802(32)).
    SEC. 7002. FIRST RESPONDER TRAINING.

        Section 546 of the Public Health Service Act (42 U.S.C. 290ee-1) is
    amended--
                (1) in subsection (c)--
                        (A) in paragraph (2), by striking ``and'' at the
                    end;
                        (B) in paragraph (3), by striking the period and
                    inserting ``; and''; and
                        (C) by adding at the end the following:
                ``(4) train and provide resources for first responders and
            members of other key community sectors on safety around
            fentanyl, carfentanil, and other dangerous licit and illicit
            drugs to protect themselves from exposure to such drugs and
            respond appropriately when exposure occurs.'';
                (2) in subsection (d), by striking ``and mechanisms for
            referral to appropriate treatment for an entity receiving a
            grant under this section'' and inserting ``mechanisms for
            referral to appropriate treatment, and safety around fentanyl,
            carfentanil, and other dangerous licit and illicit drugs'';
                (3) in subsection (f)--
                        (A) in paragraph (3), by striking ``and'' at the
                    end;
                        (B) in paragraph (4), by striking the period and
                    inserting ``; and''; and
                        (C) by adding at the end the following:

    [[Page 132 STAT. 4008]]

                ``(5) the number of first responders and members of other
            key community sectors trained on safety around fentanyl,
            carfentanil, and other dangerous licit and illicit drugs.'';
                (4) by redesignating subsection (g) as subsection (h);
                (5) by inserting after subsection (f) the following:

        ``(g) Other Key Community Sectors.--In this section, the term `other
    key community sectors' includes substance use disorder treatment
    providers, emergency medical services agencies, agencies and
    organizations working with prison and jail populations and offender
    reentry programs, health care providers, harm reduction groups,
    pharmacies, community health centers, tribal health facilities, and
    mental health providers.''; and
                (6) in subsection (h), as so redesignated, by striking
            ``$12,000,000 for each of fiscal years 2017 through 2021'' and
            inserting ``$36,000,000 for each of fiscal years 2019 through
            2023''.

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

    SEC. 7011. <<NOTE: 42 USC 247d-10 note.>>  PILOT PROGRAM FOR
                              PUBLIC HEALTH LABORATORIES TO DETECT
                              FENTANYL AND OTHER SYNTHETIC OPIOIDS.

        (a) Grants.--The Secretary of Health and Human Services (referred to
    in this section as the ``Secretary'') shall award grants to, or enter
    into cooperative agreements with, Federal, State, and local agencies to
    improve coordination between public health laboratories and laboratories
    operated by law enforcement agencies, such as Customs and Border
    Protection and the Drug Enforcement Administration, to improve detection
    of synthetic opioids, including fentanyl and its analogues, as described
    in subsection (b).
        (b) Detection Activities.--The Secretary, in consultation with the
    Director of the National Institute of Standards and Technology, the
    Director of the Centers for Disease Control and Prevention, the Attorney
    General of the United States, and the Administrator of the Drug
    Enforcement Administration, shall, for purposes of this section, develop
    or identify--
                (1) best practices for safely handling and testing synthetic
            opioids, including fentanyl and its analogues, including with
            respect to reference materials, instrument calibration, and
            quality control protocols;
                (2) reference materials and quality control standards
            related to synthetic opioids, including fentanyl and its
            analogues, to enhance--
                        (A) clinical diagnostics;
                        (B) postmortem data collection; and
                        (C) portable testing equipment utilized by law
                    enforcement and public health officials; and
                (3) procedures for the identification of new and emerging
            synthetic opioid formulations and procedures for reporting those
            findings to appropriate law enforcement agencies and Federal,
            State, and local public health laboratories and health
            departments, as appropriate.

        (c) Laboratories.--The Secretary shall require recipients of grants
    or cooperative agreements under subsection (a) to--

    [[Page 132 STAT. 4009]]

                (1) follow the best practices established under subsection
            (b) and have the appropriate capabilities to provide laboratory
            testing of controlled substances, such as synthetic fentanyl,
            and biospecimens for the purposes of aggregating and reporting
            public health information to Federal, State, and local public
            health officials, laboratories, and other entities the Secretary
            deems appropriate;
                (2) work with law enforcement agencies and public health
            authorities, as practicable;
                (3) provide early warning information to Federal, State, and
            local law enforcement agencies and public health authorities
            regarding trends or other data related to the supply of
            synthetic opioids, including fentanyl and its analogues;
                (4) provide biosurveillance capabilities with respect to
            identifying trends in adverse health outcomes associated with
            non-fatal exposures; and
                (5) provide diagnostic testing, as appropriate and
            practicable, for non-fatal exposures of emergency personnel,
            first responders, and other individuals.

        (d) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $15,000,000 for each of fiscal
    years 2019 through 2023.

              Subtitle C--Indexing Narcotics, Fentanyl, and Opioids

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

        Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.)
    is amended by adding at the end the following new section:
    ``SEC. 1711. <<NOTE: 42 USC 300u-16.>>  ESTABLISHMENT OF SUBSTANCE
                              USE DISORDER INFORMATION DASHBOARD.

        ``(a) In General.--Not later than 6 months after the date of the
    enactment of this section, the Secretary of Health and Human Services
    shall, in consultation with the Director of National Drug Control
    Policy, establish and periodically update, on the Internet website of
    the Department of Health and Human Services, a public information
    dashboard that--
                ``(1) provides links to information on programs within the
            Department of Health and Human Services related to the reduction
            of opioid and other substance use disorders;
                ``(2) provides access, to the extent practicable and
            appropriate, to publicly available data, which may include data
            from agencies within the Department of Health and Human Services
            and--
                        ``(A) other Federal agencies;
                        ``(B) State, local, and Tribal governments;
                        ``(C) nonprofit organizations;
                        ``(D) law enforcement;
                        ``(E) medical experts;
                        ``(F) public health educators; and
                        ``(G) research institutions regarding prevention,
                    treatment, recovery, and other services for opioid and
                    other substance use disorders;

    [[Page 132 STAT. 4010]]

                ``(3) provides data on substance use disorder prevention and
            treatment strategies in different regions of and populations in
            the United States;
                ``(4) identifies information on alternatives to controlled
            substances for pain management, such as approaches studied by
            the National Institutes of Health Pain Consortium, the National
            Center for Complimentary and Integrative Health, and other
            institutes and centers at the National Institutes of Health, as
            appropriate; and
                ``(5) identifies guidelines and best practices for health
            care providers regarding treatment of substance use disorders.

        ``(b) Controlled Substance Defined.--In this section, the term
    `controlled substance' has the meaning given that term in section 102 of
    the Controlled Substances Act (21 U.S.C. 802).''.
    SEC. 7022. <<NOTE: 42 USC 290aa note.>>  INTERDEPARTMENTAL
                              SUBSTANCE USE DISORDERS COORDINATING
                              COMMITTEE.

        (a) Establishment.--Not later than 3 months after the date of the
    enactment of this Act, the Secretary of Health and Human Services (in
    this section referred to as the ``Secretary'') shall, in coordination
    with the Director of National Drug Control Policy, establish a
    committee, to be known as the Interdepartmental Substance Use Disorders
    Coordinating Committee (in this section referred to as the
    ``Committee''), to coordinate Federal activities related to substance
    use disorders.
        (b) Membership.--
                (1) Federal members.--The Committee shall be composed of the
            following Federal representatives, or the designees of such
            representatives:
                        (A) The Secretary, who shall serve as the Chair of
                    the Committee.
                        (B) The Attorney General of the United States.
                        (C) The Secretary of Labor.
                        (D) The Secretary of Housing and Urban Development.
                        (E) The Secretary of Education.
                        (F) The Secretary of Veterans Affairs.
                        (G) The Commissioner of Social Security.
                        (H) The Assistant Secretary for Mental Health and
                    Substance Use.
                        (I) The Director of National Drug Control Policy.
                        (J) Representatives of other Federal agencies that
                    support or conduct activities or programs related to
                    substance use disorders, as determined appropriate by
                    the Secretary.
                (2) Non-federal members.--The Committee shall include a
            minimum of 15 non-Federal members appointed by the Secretary, of
            which--
                        (A) at least two such members shall be an individual
                    who has received treatment for a diagnosis of a
                    substance use disorder;
                        (B) at least two such members shall be a director of
                    a State substance abuse agency;
                        (C) at least two such members shall be a
                    representative of a leading research, advocacy, or
                    service organization for adults with substance use
                    disorder;
                        (D) at least two such members shall--

    [[Page 132 STAT. 4011]]

                              (i) be a physician, licensed mental health
                          professional, advance practice registered nurse,
                          or physician assistant; and
                              (ii) have experience in treating individuals
                          with substance use disorders;
                        (E) at least one such member shall be a substance
                    use disorder treatment professional who provides
                    treatment services at a certified opioid treatment
                    program;
                        (F) at least one such member shall be a substance
                    use disorder treatment professional who has research or
                    clinical experience in working with racial and ethnic
                    minority populations;
                        (G) at least one such member shall be a substance
                    use disorder treatment professional who has research or
                    clinical mental health experience in working with
                    medically underserved populations;
                        (H) at least one such member shall be a State-
                    certified substance use disorder peer support
                    specialist;
                        (I) at least one such member shall be a drug court
                    judge or a judge with experience in adjudicating cases
                    related to substance use disorder;
                        (J) at least one such member shall be a public
                    safety officer with extensive experience in interacting
                    with adults with a substance use disorder; and
                        (K) at least one such member shall be an individual
                    with experience providing services for homeless
                    individuals with a substance use disorder.

        (c) Terms.--
                (1) In general.--A member of the Committee appointed under
            subsection (b)(2) shall be appointed for a term of 3 years and
            may be reappointed for one or more 3-year terms.
                (2) Vacancies.--A vacancy on the Committee shall be filled
            in the same manner in which the original appointment was made.
            Any individual appointed to fill a vacancy for an unexpired term
            shall be appointed for the remainder of such term and may serve
            after the expiration of such term until a successor has been
            appointed.

        (d) Meetings.--The Committee shall meet not fewer than two times
    each year.
        (e) Duties.--The Committee shall--
                (1) identify areas for improved coordination of activities,
            if any, related to substance use disorders, including research,
            services, supports, and prevention activities across all
            relevant Federal agencies;
                (2) identify and provide to the Secretary recommendations
            for improving Federal programs for the prevention and treatment
            of, and recovery from, substance use disorders, including by
            expanding access to prevention, treatment, and recovery
            services;
                (3) analyze substance use disorder prevention and treatment
            strategies in different regions of and populations in the United
            States and evaluate the extent to which Federal substance use
            disorder prevention and treatment strategies are aligned with
            State and local substance use disorder prevention and treatment
            strategies;

    [[Page 132 STAT. 4012]]

                (4) make recommendations to the Secretary regarding any
            appropriate changes with respect to the activities and
            strategies described in paragraphs (1) through (3);
                (5) make recommendations to the Secretary regarding public
            participation in decisions relating to substance use disorders
            and the process by which public feedback can be better
            integrated into such decisions; and
                (6) make recommendations to ensure that substance use
            disorder research, services, supports, and prevention activities
            of the Department of Health and Human Services and other Federal
            agencies are not unnecessarily duplicative.

        (f) Annual Report.--Not later than 1 year after the date of the
    enactment of this Act, and annually thereafter for the life of the
    Committee, the Committee shall publish on the Internet website of the
    Department of Health and Human Services, which may include the public
    information dashboard established under section 1711 of the Public
    Health Service Act, as added by section 7021, a report summarizing the
    activities carried out by the Committee pursuant to subsection (e),
    including any findings resulting from such activities.
        (g) Working Groups.--The Committee may establish working groups for
    purposes of carrying out the duties described in subsection (e). Any
    such working group shall be composed of members of the Committee (or the
    designees of such members) and may hold such meetings as are necessary
    to enable the working group to carry out the duties delegated to the
    working group.
        (h) Federal Advisory Committee Act.--The Federal Advisory Committee
    Act (5 U.S.C. App.) shall apply to the Committee only to the extent that
    the provisions of such Act do not conflict with the requirements of this
    section.
        (i) Sunset.--The Committee shall terminate on the date that is 6
    years after the date on which the Committee is established under
    subsection (a).
    SEC. 7023. <<NOTE: 42 USC 300u-16 note.>>  NATIONAL MILESTONES TO
                              MEASURE SUCCESS IN CURTAILING THE OPIOID
                              CRISIS.

        (a) In General.--Not later than 180 days after the date of enactment
    of this Act, the Secretary of Health and Human Services (referred to in
    this section as the ``Secretary''), in coordination with the
    Administrator of the Drug Enforcement Administration and the Director of
    the Office of National Drug Control Policy, shall develop or identify
    existing national indicators (referred to in this section as the
    ``national milestones'') to measure success in curtailing the opioid
    crisis, with the goal of significantly reversing the incidence and
    prevalence of opioid misuse and abuse, and opioid-related morbidity and
    mortality in the United States within 5 years of such date of enactment.
        (b) National Milestones to End the Opioid Crisis.--The national
    milestones under subsection (a) shall include the following:
                (1) Not fewer than 10 indicators or metrics to accurately
            and expediently measure progress in meeting the goal described
            in subsection (a), which shall, as appropriate, include,
            indicators or metrics related to--
                        (A) the number of fatal and non-fatal opioid
                    overdoses;
                        (B) the number of emergency room visits related to
                    opioid misuse and abuse;

    [[Page 132 STAT. 4013]]

                        (C) the number of individuals in sustained recovery
                    from opioid use disorder;
                        (D) the number of infections associated with illicit
                    drug use, such as HIV, viral hepatitis, and infective
                    endocarditis, and available capacity for treating such
                    infections;
                        (E) the number of providers prescribing medication-
                    assisted treatment for opioid use disorders, including
                    in primary care settings, community health centers,
                    jails, and prisons;
                        (F) the number of individuals receiving treatment
                    for opioid use disorder; and
                        (G) additional indicators or metrics, as
                    appropriate, such as metrics pertaining to specific
                    populations, including women and children, American
                    Indians and Alaskan Natives, individuals living in rural
                    and non-urban areas, and justice-involved populations,
                    that would further clarify the progress made in
                    addressing the opioid crisis.
                (2) A reasonable goal, such as a percentage decrease or
            other specified metric, that signifies progress in meeting the
            goal described in subsection (a), and annual targets to help
            achieve that goal.

        (c) Consideration of Other Substance Use Disorders.--In developing
    the national milestones under subsection (b), the Secretary shall, as
    appropriate, consider other substance use disorders in addition to
    opioid use disorder.
        (d) Extension of Period.--If the Secretary determines that the goal
    described in subsection (a) will not be achieved with respect to any
    indicator or metric established under subsection (b)(2) within 5 years
    of the date of enactment of this Act, the Secretary may extend the
    timeline for meeting such goal with respect to that indicator or metric.
    The Secretary shall include with any such extension a rationale for why
    additional time is needed and information on whether significant changes
    are needed in order to achieve such goal with respect to the indicator
    or metric.
        (e) Annual Status Update.--Not later than one year after the date of
    enactment of this Act, the Secretary shall make available on the
    Internet website of the Department of Health and Human Services, and
    submit to the Committee on Health, Education, Labor, and Pensions of the
    Senate and the Committee on Energy and Commerce of the House of
    Representatives, an update on the progress, including expected progress
    in the subsequent year, in achieving the goals detailed in the national
    milestones. Each such update shall include the progress made in the
    first year or since the previous report, as applicable, in meeting each
    indicator or metric in the national milestones.
    SEC. 7024. STUDY ON PRESCRIBING LIMITS.

        Not later than 2 years after the date of enactment of this Act, the
    Secretary of Health and Human Services, in consultation with the
    Attorney General of the United States, shall submit to the Committee on
    Health, Education, Labor, and Pensions of the Senate and the Committee
    on Energy and Commerce of the House of Representatives a report on the
    impact of Federal and State laws and regulations that limit the length,
    quantity, or dosage of opioid prescriptions. Such report shall address--
                (1) the impact of such limits on--

    [[Page 132 STAT. 4014]]

                        (A) the incidence and prevalence of overdose related
                    to prescription opioids;
                        (B) the incidence and prevalence of overdose related
                    to illicit opioids;
                        (C) the prevalence of opioid use disorders;
                        (D) medically appropriate use of, and access to,
                    opioids, including any impact on travel expenses and
                    pain management outcomes for patients, whether such
                    limits are associated with significantly higher rates of
                    negative health outcomes, including suicide, and whether
                    the impact of such limits differs based on the clinical
                    indication for which opioids are prescribed;
                (2) whether such limits lead to a significant increase in
            burden for prescribers of opioids or prescribers of treatments
            for opioid use disorder, including any impact on patient access
            to treatment, and whether any such burden is mitigated by any
            factors such as electronic prescribing or telemedicine; and
                (3) the impact of such limits on diversion or misuse of any
            controlled substance in schedule II, III, or IV of section
            202(c) of the Controlled Substances Act (21 U.S.C. 812(c)).

               Subtitle D--Ensuring Access to Quality Sober Living

    SEC. 7031. NATIONAL RECOVERY HOUSING BEST PRACTICES.

        Part D of title V of the Public Health Service Act (42 U.S.C. 290dd
    et seq.) is amended by adding at the end the following new section:
    ``SEC. 550. <<NOTE: 42 USC 290ee-5.>>  NATIONAL RECOVERY HOUSING
                            BEST PRACTICES.

        ``(a) Best Practices for Operating Recovery Housing.--
                ``(1) In general.--The Secretary, in consultation with the
            individuals and entities specified in paragraph (2), shall
            identify or facilitate the development of best practices, which
            may include model laws for implementing suggested minimum
            standards, for operating recovery housing.
                ``(2) Consultation.--In carrying out the activities
            described in paragraph (1), the Secretary shall consult with, as
            appropriate--
                        ``(A) relevant divisions of the Department of Health
                    and Human Services, including the Substance Abuse and
                    Mental Health Services Administration, the Office of
                    Inspector General, the Indian Health Service, and the
                    Centers for Medicare & Medicaid Services;
                        ``(B) the Secretary of Housing and Urban
                    Development;
                        ``(C) directors or commissioners, as applicable, of
                    State health departments, tribal health departments,
                    State Medicaid programs, and State insurance agencies;
                        ``(D) representatives of health insurance issuers;
                        ``(E) national accrediting entities and reputable
                    providers of, and analysts of, recovery housing
                    services, including Indian tribes, tribal organizations,
                    and tribally designated housing entities that provide
                    recovery housing services, as applicable;
                        ``(F) individuals with a history of substance use
                    disorder; and

    [[Page 132 STAT. 4015]]

                        ``(G) other stakeholders identified by the
                    Secretary.

        ``(b) Identification of Fraudulent Recovery Housing Operators.--
                ``(1) In general.--The Secretary, in consultation with the
            individuals and entities described in paragraph (2), shall
            identify or facilitate the development of common indicators that
            could be used to identify potentially fraudulent recovery
            housing operators.
                ``(2) Consultation.--In carrying out the activities
            described in paragraph (1), the Secretary shall consult with, as
            appropriate, the individuals and entities specified in
            subsection (a)(2) and the Attorney General of the United States.
                ``(3) Requirements.--
                        ``(A) Practices for identification and reporting.--
                    In carrying out the activities described in paragraph
                    (1), the Secretary shall consider how law enforcement,
                    public and private payers, and the public can best
                    identify and report fraudulent recovery housing
                    operators.
                        ``(B) Factors to be considered.--In carrying out the
                    activities described in paragraph (1), the Secretary
                    shall identify or develop indicators, which may include
                    indicators related to--
                              ``(i) unusual billing practices;
                              ``(ii) average lengths of stays;
                              ``(iii) excessive levels of drug testing (in
                          terms of cost or frequency); and
                              ``(iv) unusually high levels of recidivism.

        ``(c) Dissemination.--The Secretary shall, as appropriate,
    disseminate the best practices identified or developed under subsection
    (a) and the common indicators identified or developed under subsection
    (b) to--
                ``(1) State agencies, which may include the provision of
            technical assistance to State agencies seeking to adopt or
            implement such best practices;
                ``(2) Indian tribes, tribal organizations, and tribally
            designated housing entities;
                ``(3) the Attorney General of the United States;
                ``(4) the Secretary of Labor;
                ``(5) the Secretary of Housing and Urban Development;
                ``(6) State and local law enforcement agencies;
                ``(7) health insurance issuers;
                ``(8) recovery housing entities; and
                ``(9) the public.

        ``(d) Requirements.--In carrying out the activities described in
    subsections (a) and (b), the Secretary, in consultation with appropriate
    individuals and entities described in subsections (a)(2) and (b)(2),
    shall consider how recovery housing is able to support recovery and
    prevent relapse, recidivism, or overdose (including overdose death),
    including by improving access and adherence to treatment, including
    medication-assisted treatment.
        ``(e) Rule of Construction.--Nothing in this section shall be
    construed to provide the Secretary with the authority to require States
    to adhere to minimum standards in the State oversight of recovery
    housing.
        ``(f) Definitions.--In this section:
                ``(1) The term `recovery housing' means a shared living
            environment free from alcohol and illicit drug use and centered

    [[Page 132 STAT. 4016]]

            on peer support and connection to services that promote
            sustained recovery from substance use disorders.
                ``(2) The terms `Indian tribe' and `tribal organization'
            have the meanings given those terms in section 4 of the Indian
            Self-Determination and Education Assistance Act (25 U.S.C.
            5304).
                ``(3) The term `tribally designated housing entity' has the
            meaning given that term in section 4 of the Native American
            Housing Assistance and Self-Determination Act of 1996 (25 U.S.C.
            4103).

        ``(g) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $3,000,000 for the period of
    fiscal years 2019 through 2021.''.

                   Subtitle E--Advancing Cutting Edge Research

    SEC. 7041. UNIQUE RESEARCH INITIATIVES.

        Section 402(n)(1) of the Public Health Service Act (42 U.S.C.
    282(n)(1)) is amended--
                (1) in subparagraph (A), by striking ``or'';
                (2) in subparagraph (B), by striking the period and
            inserting ``; or''; and
                (3) by adding at the end the following:
                        ``(C) high impact cutting-edge research that fosters
                    scientific creativity and increases fundamental
                    biological understanding leading to the prevention,
                    diagnosis, or treatment of diseases and disorders, or
                    research urgently required to respond to a public health
                    threat.''.
    SEC. 7042. PAIN RESEARCH.

        Section 409J(b) of the Public Health Service Act (42 U.S.C. 284q(b))
    is amended--
                (1) in paragraph (5)--
                        (A) in subparagraph (A), by striking ``and treatment
                    of pain and diseases and disorders associated with
                    pain'' and inserting ``treatment, and management of pain
                    and diseases and disorders associated with pain,
                    including information on best practices for the
                    utilization of non-pharmacologic treatments, non-
                    addictive medical products, and other drugs or devices
                    approved or cleared by the Food and Drug
                    Administration'';
                        (B) in subparagraph (B), by striking ``on the
                    symptoms and causes of pain;'' and inserting the
                    following: ``on--
                              ``(i) the symptoms and causes of pain,
                          including the identification of relevant
                          biomarkers and screening models and the
                          epidemiology of acute and chronic pain;
                              ``(ii) the diagnosis, prevention, treatment,
                          and management of acute and chronic pain,
                          including with respect to non-pharmacologic
                          treatments, non-addictive medical products, and
                          other drugs or devices approved or cleared by the
                          Food and Drug Administration; and
                              ``(iii) risk factors for, and early warning
                          signs of, substance use disorders in populations
                          with acute and chronic pain; and''; and

    [[Page 132 STAT. 4017]]

                        (C) by striking subparagraphs (C) through (E) and
                    inserting the following:
                        ``(C) make recommendations to the Director of NIH--
                              ``(i) to ensure that the activities of the
                          National Institutes of Health and other Federal
                          agencies are free of unnecessary duplication of
                          effort;
                              ``(ii) on how best to disseminate information
                          on pain care and epidemiological data related to
                          acute and chronic pain; and
                              ``(iii) on how to expand partnerships between
                          public entities and private entities to expand
                          collaborative, cross-cutting research.'';
                (2) by redesignating paragraph (6) as paragraph (7); and
                (3) by inserting after paragraph (5) the following:
                ``(6) Report.--The Secretary shall ensure that
            recommendations and actions taken by the Director with respect
            to the topics discussed at the meetings described in paragraph
            (4) are included in appropriate reports to Congress.''.

                            Subtitle F--Jessie's Law

    SEC. 7051. <<NOTE: 42 USC 290dd-2 note.>>  INCLUSION OF OPIOID
                              ADDICTION HISTORY IN PATIENT RECORDS.

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

        (b) Requirements.--In identifying or facilitating the development of
    best practices under subsection (a), as applicable, the Secretary, in
    consultation with appropriate stakeholders, shall consider the
    following:
                (1) The potential for addiction relapse or overdose,
            including overdose death, when opioid medications are prescribed
            to a patient recovering from opioid use disorder.
                (2) The benefits of displaying information about a patient's
            opioid use disorder history in a manner similar to other
            potentially lethal medical concerns, including drug allergies
            and contraindications.

    [[Page 132 STAT. 4018]]

                (3) The importance of prominently displaying information
            about a patient's opioid use disorder when a physician or
            medical professional is prescribing medication, including
            methods for avoiding alert fatigue in providers.
                (4) The importance of a variety of appropriate medical
            professionals, including physicians, nurses, and pharmacists,
            having access to information described in this section when
            prescribing or dispensing opioid medication, consistent with
            Federal and State laws and regulations.
                (5) The importance of protecting patient privacy, including
            the requirements related to consent for disclosure of substance
            use disorder information under all applicable laws and
            regulations.
                (6) All applicable Federal and State laws and regulations.
    SEC. 7052. <<NOTE: 42 USC 290dd-2 note.>>  COMMUNICATION WITH
                              FAMILIES DURING EMERGENCIES.

        (a)  Promoting Awareness of Authorized Disclosures During
    Emergencies.--The Secretary of Health and Human Services shall annually
    notify health care providers regarding permitted disclosures under
    Federal health care privacy law during emergencies, including overdoses,
    of certain health information to families, caregivers, and health care
    providers.
        (b) Use of Material.--For the purposes of carrying out subsection
    (a), the Secretary of Health and Human Services may use material
    produced under section 7053 of this Act or section 11004 of the 21st
    Century Cures Act (42 U.S.C. 1320d-2 note).
    SEC. 7053. <<NOTE: 42 USC 290dd-2 note.>>  DEVELOPMENT AND
                              DISSEMINATION OF MODEL TRAINING PROGRAMS
                              FOR SUBSTANCE USE DISORDER PATIENT
                              RECORDS.

        (a) Initial Programs and Materials.--Not later than 1 year after the
    date of the enactment of this Act, the Secretary of Health and Human
    Services (in this section referred to as the ``Secretary''), in
    consultation with appropriate experts, shall identify the following
    model programs and materials (or if no such programs or materials exist,
    recognize private or public entities to develop and disseminate such
    programs and materials):
                (1) Model programs and materials for training health care
            providers (including physicians, emergency medical personnel,
            psychiatrists, psychologists, counselors, therapists, nurse
            practitioners, physician assistants, behavioral health
            facilities and clinics, care managers, and hospitals, including
            individuals such as general counsels or regulatory compliance
            staff who are responsible for establishing provider privacy
            policies) concerning the permitted uses and disclosures,
            consistent with the standards and regulations governing the
            privacy and security of substance use disorder patient records
            promulgated by the Secretary under section 543 of the Public
            Health Service Act (42 U.S.C. 290dd-2) for the confidentiality
            of patient records.
                (2) Model programs and materials for training patients and
            their families regarding their rights to protect and obtain
            information under the standards and regulations described in
            paragraph (1).

        (b) Requirements.--The model programs and materials described in
    paragraphs (1) and (2) of subsection (a) shall address circumstances
    under which disclosure of substance use disorder patient records is
    needed to--

    [[Page 132 STAT. 4019]]

                (1) facilitate communication between substance use disorder
            treatment providers and other health care providers to promote
            and provide the best possible integrated care;
                (2) avoid inappropriate prescribing that can lead to
            dangerous drug interactions, overdose, or relapse; and
                (3) notify and involve families and caregivers when
            individuals experience an overdose.

        (c) Periodic Updates.--The Secretary shall--
                (1) periodically review and update the model program and
            materials identified or developed under subsection (a); and
                (2) disseminate such updated programs and materials to the
            individuals described in subsection (a)(1).

        (d) Input of Certain Entities.--In identifying, reviewing, or
    updating the model programs and materials under this section, the
    Secretary shall solicit the input of relevant stakeholders.
        (e) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section--
                (1) $4,000,000 for fiscal year 2019;
                (2) $2,000,000 for each of fiscal years 2020 and 2021; and
                (3) $1,000,000 for each of fiscal years 2022 and 2023.

                Subtitle G--Protecting Pregnant Women and Infants

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

        (a) In General.--Not later than 18 months after the date of the
    enactment of this Act, the Secretary of Health and Human Services, in
    coordination with the Centers for Disease Control and Prevention, the
    National Institutes of Health, the Indian Health Service, and the
    Substance Abuse and Mental Health Services Administration, shall develop
    and submit to the Committee on Health, Education, Labor, and Pensions of
    the Senate and the Committee on Energy and Commerce of the House of
    Representatives a report that includes--
                (1) information on opioid, non-opioid, and non-pharmacologic
            pain management practices during pregnancy and after pregnancy;
                (2) recommendations for increasing public awareness and
            education about substance use disorders, including opioid use
            disorders, during and after pregnancy, including available
            treatment resources in urban and rural areas;
                (3) recommendations to prevent, identify, and reduce
            substance use disorders, including opioid use disorders, during
            pregnancy to improve care for pregnant women with substance use
            disorders and their infants; and
                (4) an identification of areas in need of further research
            with respect to acute and chronic pain management during and
            after pregnancy.

        (b) No Additional Funds.--No additional funds are authorized to be
    appropriated for purposes of carrying out subsection (a).
    SEC. 7062. <<NOTE: 42 USC 290bb-1 note.>>  PROTECTING MOMS AND
                              INFANTS.

        (a) Report.--
                (1) In general.--Not later than 60 days after the date of
            enactment of this Act, the Secretary of Health and Human

    [[Page 132 STAT. 4020]]

            Services (referred to in this section as the ``Secretary'')
            shall submit to the Committee on Health, Education, Labor, and
            Pensions of the Senate and the Committee on Energy and Commerce
            of the House of Representatives, and make available to the
            public on the Internet website of the Department of Health and
            Human Services, a report regarding the implementation of the
            recommendations in the strategy relating to prenatal opioid use,
            including neonatal abstinence syndrome, developed pursuant to
            section 2 of the Protecting Our Infants Act of 2015 (Public Law
            114-91). Such report shall include--
                        (A) an update on the implementation of the
                    recommendations in the strategy, including information
                    regarding the agencies involved in the implementation;
                    and
                        (B) information on additional funding or authority
                    the Secretary requires, if any, to implement the
                    strategy, which may include authorities needed to
                    coordinate implementation of such strategy across the
                    Department of Health and Human Services.
                (2) Periodic updates.--The Secretary shall periodically
            update the report under paragraph (1).

        (b) Residential Treatment Programs for Pregnant and Postpartum
    Women.--Section 508(s) of the Public Health Service Act (42 U.S.C.
    290bb-1(s)) is amended by striking ``$16,900,000 for each of fiscal
    years 2017 through 2021'' and inserting ``$29,931,000 for each of fiscal
    years 2019 through 2023''.
    SEC. 7063. EARLY INTERVENTIONS FOR PREGNANT WOMEN AND INFANTS.

        (a) Development of Educational Materials by Center for Substance
    Abuse Prevention.--Section 515(b) of the Public Health Service Act (42
    U.S.C. 290bb-21(b)) is amended--
                (1) in paragraph (13), by striking ``and'' at the end;
                (2) in paragraph (14), by striking the period at the end and
            inserting ``; and''; and
                (3) by adding at the end the following:
                ``(15) in consultation with relevant stakeholders and in
            collaboration with the Director of the Centers for Disease
            Control and Prevention, develop educational materials for
            clinicians to use with pregnant women for shared decision making
            regarding pain management and the prevention of substance use
            disorders during pregnancy.''.

        (b) Guidelines and Recommendations by Center for Substance Abuse
    Treatment.--Section 507(b) of the Public Health Service Act (42 U.S.C.
    290bb(b)) is amended--
                (1) in paragraph (13), by striking ``and'' at the end;
                (2) in paragraph (14), by striking the period at the end and
            inserting a semicolon; and
                (3) by adding at the end the following:
                ``(15) in cooperation with the Secretary, implement and
            disseminate, as appropriate, the recommendations in the report
            entitled `Protecting Our Infants Act: Final Strategy' issued by
            the Department of Health and Human Services in 2017; and''.

        (c) Support of Partnerships by Center for Substance Abuse
    Treatment.--Section 507(b) of the Public Health Service

    [[Page 132 STAT. 4021]]

    Act (42 U.S.C. 290bb(b)), as amended by subsection (b), is further
    amended by adding at the end the following:
                ``(16) in cooperation with relevant stakeholders, and
            through public-private partnerships, encourage education about
            substance use disorders for pregnant women and health care
            providers who treat pregnant women and babies.''.
    SEC. 7064. PRENATAL AND POSTNATAL HEALTH.

        Section 317L of the Public Health Service Act (42 U.S.C. 247b-13) is
    amended--
                (1) in subsection (a)--
                        (A) by amending paragraph (1) to read as follows:
                ``(1) to collect, analyze, and make available data on
            prenatal smoking and alcohol and other substance abuse and
            misuse, including--
                        ``(A) data on--
                              ``(i) the incidence, prevalence, and
                          implications of such activities; and
                              ``(ii) the incidence and prevalence of
                          implications and outcomes, including neonatal
                          abstinence syndrome and other maternal and child
                          health outcomes associated with such activities;
                          and
                        ``(B) additional information or data, as
                    appropriate, on family health history, medication
                    exposures during pregnancy, demographic information,
                    such as race, ethnicity, geographic location, and family
                    history, and other relevant information, to inform such
                    analysis;'';
                        (B) in paragraph (2)--
                              (i) by striking ``prevention of'' and
                          inserting ``prevention and long-term outcomes
                          associated with''; and
                              (ii) by striking ``illegal drug use'' and
                          inserting ``other substance abuse and misuse'';
                        (C) in paragraph (3), by striking ``and cessation
                    programs; and'' and inserting ``, treatment, and
                    cessation programs;'';
                        (D) in paragraph (4), by striking ``illegal drug
                    use.'' and inserting ``other substance abuse and misuse;
                    and''; and
                        (E) by adding at the end the following:
                ``(5) to issue public reports on the analysis of data
            described in paragraph (1), including analysis of--
                        ``(A) long-term outcomes of children affected by
                    neonatal abstinence syndrome;
                        ``(B) health outcomes associated with prenatal
                    smoking, alcohol, and substance abuse and misuse; and
                        ``(C) relevant studies, evaluations, or information
                    the Secretary determines to be appropriate.'';
                (2) in subsection (b), by inserting ``tribal entities,''
            after ``local governments,'';
                (3) by redesignating subsection (c) as subsection (d);
                (4) by inserting after subsection (b) the following:

        ``(c) Coordinating Activities.--To carry out this section, the
    Secretary may--
                ``(1) provide technical and consultative assistance to
            entities receiving grants under subsection (b);

    [[Page 132 STAT. 4022]]

                ``(2) ensure a pathway for data sharing between States,
            tribal entities, and the Centers for Disease Control and
            Prevention;
                ``(3) ensure data collection under this section is
            consistent with applicable State, Federal, and Tribal privacy
            laws; and
                ``(4) coordinate with the National Coordinator for Health
            Information Technology, as appropriate, to assist States and
            Tribes in implementing systems that use standards recognized by
            such National Coordinator, as such recognized standards are
            available, in order to facilitate interoperability between such
            systems and health information technology systems, including
            certified health information technology.''; and
                (5) in subsection (d), as so redesignated, by striking
            ``2001 through 2005'' and inserting ``2019 through 2023''.
    SEC. 7065. PLANS OF SAFE CARE.

        (a) In General.--Section 105(a) of the Child Abuse Prevention and
    Treatment Act (42 U.S.C. 5106(a)) is amended by adding at the end the
    following:
                ``(7) Grants to states to improve and coordinate their
            response to ensure the safety, permanency, and well-being of
            infants affected by substance use.--
                        ``(A) Program authorized.--The Secretary is
                    authorized to make grants to States for the purpose of
                    assisting child welfare agencies, social services
                    agencies, substance use disorder treatment agencies,
                    hospitals with labor and delivery units, medical staff,
                    public health and mental health agencies, and maternal
                    and child health agencies to facilitate collaboration in
                    developing, updating, implementing, and monitoring plans
                    of safe care described in section 106(b)(2)(B)(iii).
                    Section 112(a)(2) shall not apply to the program
                    authorized under this paragraph.
                        ``(B) Distribution of funds.--
                              ``(i) Reservations.--Of the amounts made
                          available to carry out subparagraph (A), the
                          Secretary shall reserve--
                                        ``(I) no more than 3 percent for the
                                    purposes described in subparagraph (G);
                                    and
                                        ``(II) up to 3 percent for grants to
                                    Indian Tribes and tribal organizations
                                    to address the needs of infants born
                                    with, and identified as being affected
                                    by, substance abuse or withdrawal
                                    symptoms resulting from prenatal drug
                                    exposure or a fetal alcohol spectrum
                                    disorder and their families or
                                    caregivers, which to the extent
                                    practicable, shall be consistent with
                                    the uses of funds described under
                                    subparagraph (D).
                              ``(ii) Allotments to states and territories.--
                          The Secretary shall allot the amount made
                          available to carry out subparagraph (A) that
                          remains after application of clause (i) to each
                          State that applies for such a grant, in an amount
                          equal to the sum of--
                                        ``(I) $500,000; and
                                        ``(II) an amount that bears the same
                                    relationship to any funds made available
                                    to carry out subparagraph (A) and
                                    remaining after application

    [[Page 132 STAT. 4023]]

                                    of clause (i), as the number of live
                                    births in the State in the previous
                                    calendar year bears to the number of
                                    live births in all States in such year.
                              ``(iii) Ratable reduction.--If the amount made
                          available to carry out subparagraph (A) is
                          insufficient to satisfy the requirements of clause
                          (ii), the Secretary shall ratably reduce each
                          allotment to a State.
                        ``(C) Application.--A State desiring a grant under
                    this paragraph shall submit an application to the
                    Secretary at such time and in such manner as the
                    Secretary may require. Such application shall include--
                              ``(i) a description of--
                                        ``(I) the impact of substance use
                                    disorder in such State, including with
                                    respect to the substance or class of
                                    substances with the highest incidence of
                                    abuse in the previous year in such
                                    State, including--
                                                ``(aa) the prevalence of
                                            substance use disorder in such
                                            State;
                                                ``(bb) the aggregate rate of
                                            births in the State of infants
                                            affected by substance abuse or
                                            withdrawal symptoms or a fetal
                                            alcohol spectrum disorder (as
                                            determined by hospitals,
                                            insurance claims, claims
                                            submitted to the State Medicaid
                                            program, or other records), if
                                            available and to the extent
                                            practicable; and
                                                ``(cc) the number of infants
                                            identified, for whom a plan of
                                            safe care was developed, and for
                                            whom a referral was made for
                                            appropriate services, as
                                            reported under section
                                            106(d)(18);
                                        ``(II) the challenges the State
                                    faces in developing, implementing, and
                                    monitoring plans of safe care in
                                    accordance with section
                                    106(b)(2)(B)(iii);
                                        ``(III) the State's lead agency for
                                    the grant program and how that agency
                                    will coordinate with relevant State
                                    entities and programs, including the
                                    child welfare agency, the substance use
                                    disorder treatment agency, hospitals
                                    with labor and delivery units, health
                                    care providers, the public health and
                                    mental health agencies, programs funded
                                    by the Substance Abuse and Mental Health
                                    Services Administration that provide
                                    substance use disorder treatment for
                                    women, the State Medicaid program, the
                                    State agency administering the block
                                    grant program under title V of the
                                    Social Security Act (42 U.S.C. 701 et
                                    seq.), the State agency administering
                                    the programs funded under part C of the
                                    Individuals with Disabilities Education
                                    Act (20 U.S.C. 1431 et seq.), the
                                    maternal, infant, and early childhood
                                    home visiting program under section 511
                                    of the Social Security Act (42 U.S.C.
                                    711), the State judicial system, and
                                    other agencies, as determined by the
                                    Secretary, and Indian Tribes and tribal
                                    organizations, as appropriate, to
                                    implement the activities under this
                                    paragraph;

    [[Page 132 STAT. 4024]]

                                        ``(IV) how the State will monitor
                                    local development and implementation of
                                    plans of safe care, in accordance with
                                    section 106(b)(2)(B)(iii)(II), including
                                    how the State will monitor to ensure
                                    plans of safe care address differences
                                    between substance use disorder and
                                    medically supervised substance use,
                                    including for the treatment of a
                                    substance use disorder;
                                        ``(V) if applicable, how the State
                                    plans to utilize funding authorized
                                    under part E of title IV of the Social
                                    Security Act (42 U.S.C. 670 et seq.) to
                                    assist in carrying out any plan of safe
                                    care, including such funding authorized
                                    under section 471(e) of such Act (as in
                                    effect on October 1, 2018) for mental
                                    health and substance abuse prevention
                                    and treatment services and in-home
                                    parent skill-based programs and funding
                                    authorized under such section 472(j) (as
                                    in effect on October 1, 2018) for
                                    children with a parent in a licensed
                                    residential family-based treatment
                                    facility for substance abuse; and
                                        ``(VI) an assessment of the
                                    treatment and other services and
                                    programs available in the State to
                                    effectively carry out any plan of safe
                                    care developed, including identification
                                    of needed treatment, and other services
                                    and programs to ensure the well-being of
                                    young children and their families
                                    affected by substance use disorder, such
                                    as programs carried out under part C of
                                    the Individuals with Disabilities
                                    Education Act (20 U.S.C. 1431 et seq.)
                                    and comprehensive early childhood
                                    development services and programs such
                                    as Head Start programs;
                              ``(ii) a description of how the State plans to
                          use funds for activities described in subparagraph
                          (D) for the purposes of ensuring State compliance
                          with requirements under clauses (ii) and (iii) of
                          section 106(b)(2)(B); and
                              ``(iii) an assurance that the State will
                          comply with requirements to refer a child
                          identified as substance-exposed to early
                          intervention services as required pursuant to a
                          grant under part C of the Individuals with
                          Disabilities Education Act (20 U.S.C. 1431 et
                          seq.).
                        ``(D) Uses of funds.--Funds awarded to a State under
                    this paragraph may be used for the following activities,
                    which may be carried out by the State directly, or
                    through grants or subgrants, contracts, or cooperative
                    agreements:
                              ``(i) Improving State and local systems with
                          respect to the development and implementation of
                          plans of safe care, which--
                                        ``(I) shall include parent and
                                    caregiver engagement, as required under
                                    section 106(b)(2)(B)(iii)(I), regarding
                                    available treatment and service options,
                                    which may include resources available
                                    for pregnant, perinatal, and postnatal
                                    women; and
                                        ``(II) may include activities such
                                    as--

    [[Page 132 STAT. 4025]]

                                                ``(aa) developing policies,
                                            procedures, or protocols for the
                                            administration or development of
                                            evidence-based and validated
                                            screening tools for infants who
                                            may be affected by substance use
                                            withdrawal symptoms or a fetal
                                            alcohol spectrum disorder and
                                            pregnant, perinatal, and
                                            postnatal women whose infants
                                            may be affected by substance use
                                            withdrawal symptoms or a fetal
                                            alcohol spectrum disorder;
                                                ``(bb) improving assessments
                                            used to determine the needs of
                                            the infant and family;
                                                ``(cc) improving ongoing
                                            case management services;
                                                ``(dd) improving access to
                                            treatment services, which may be
                                            prior to the pregnant woman's
                                            delivery date; and
                                                ``(ee) keeping families
                                            safely together when it is in
                                            the best interest of the child.
                              ``(ii) Developing policies, procedures, or
                          protocols in consultation and coordination with
                          health professionals, public and private health
                          facilities, and substance use disorder treatment
                          agencies to ensure that--
                                        ``(I) appropriate notification to
                                    child protective services is made in a
                                    timely manner, as required under section
                                    106(b)(2)(B)(ii);
                                        ``(II) a plan of safe care is in
                                    place, in accordance with section
                                    106(b)(2)(B)(iii), before the infant is
                                    discharged from the birth or health care
                                    facility; and
                                        ``(III) such health and related
                                    agency professionals are trained on how
                                    to follow such protocols and are aware
                                    of the supports that may be provided
                                    under a plan of safe care.
                              ``(iii) Training health professionals and
                          health system leaders, child welfare workers,
                          substance use disorder treatment agencies, and
                          other related professionals such as home visiting
                          agency staff and law enforcement in relevant
                          topics including--
                                        ``(I) State mandatory reporting laws
                                    established under section
                                    106(b)(2)(B)(i) and the referral and
                                    process requirements for notification to
                                    child protective services when child
                                    abuse or neglect reporting is not
                                    mandated;
                                        ``(II) the co-occurrence of
                                    pregnancy and substance use disorder,
                                    and implications of prenatal exposure;
                                        ``(III) the clinical guidance about
                                    treating substance use disorder in
                                    pregnant and postpartum women;
                                        ``(IV) appropriate screening and
                                    interventions for infants affected by
                                    substance use disorder, withdrawal
                                    symptoms, or a fetal alcohol spectrum
                                    disorder and the requirements under
                                    section 106(b)(2)(B)(iii); and

    [[Page 132 STAT. 4026]]

                                        ``(V) appropriate multigenerational
                                    strategies to address the mental health
                                    needs of the parent and child together.
                              ``(iv) Establishing partnerships, agreements,
                          or memoranda of understanding between the lead
                          agency and other entities (including health
                          professionals, health facilities, child welfare
                          professionals, juvenile and family court judges,
                          substance use and mental disorder treatment
                          programs, early childhood education programs,
                          maternal and child health and early intervention
                          professionals (including home visiting providers),
                          peer-to-peer recovery programs such as parent
                          mentoring programs, and housing agencies) to
                          facilitate the implementation of, and compliance
                          with, section 106(b)(2) and clause (ii) of this
                          subparagraph, in areas which may include--
                                        ``(I) developing a comprehensive,
                                    multi-disciplinary assessment and
                                    intervention process for infants,
                                    pregnant women, and their families who
                                    are affected by substance use disorder,
                                    withdrawal symptoms, or a fetal alcohol
                                    spectrum disorder, that includes
                                    meaningful engagement with and takes
                                    into account the unique needs of each
                                    family and addresses differences between
                                    medically supervised substance use,
                                    including for the treatment of substance
                                    use disorder, and substance use
                                    disorder;
                                        ``(II) ensuring that treatment
                                    approaches for serving infants, pregnant
                                    women, and perinatal and postnatal women
                                    whose infants may be affected by
                                    substance use, withdrawal symptoms, or a
                                    fetal alcohol spectrum disorder, are
                                    designed to, where appropriate, keep
                                    infants with their mothers during both
                                    inpatient and outpatient treatment; and
                                        ``(III) increasing access to all
                                    evidence-based medication-assisted
                                    treatment approved by the Food and Drug
                                    Administration, behavioral therapy, and
                                    counseling services for the treatment of
                                    substance use disorders, as appropriate.
                              ``(v) Developing and updating systems of
                          technology for improved data collection and
                          monitoring under section 106(b)(2)(B)(iii),
                          including existing electronic medical records, to
                          measure the outcomes achieved through the plans of
                          safe care, including monitoring systems to meet
                          the requirements of this Act and submission of
                          performance measures.
                        ``(E) Reporting.--Each State that receives funds
                    under this paragraph, for each year such funds are
                    received, shall submit a report to the Secretary,
                    disaggregated by geographic location, economic status,
                    and major racial and ethnic groups, except that such
                    disaggregation shall not be required if the results
                    would reveal personally identifiable information on,
                    with respect to infants identified under section
                    106(b)(2)(B)(ii)--
                              ``(i) the number who experienced removal
                          associated with parental substance use;

    [[Page 132 STAT. 4027]]

                              ``(ii) the number who experienced removal and
                          subsequently are reunified with parents, and the
                          length of time between such removal and
                          reunification;
                              ``(iii) the number who are referred to
                          community providers without a child protection
                          case;
                              ``(iv) the number who receive services while
                          in the care of their birth parents;
                              ``(v) the number who receive post-
                          reunification services within 1 year after a
                          reunification has occurred; and
                              ``(vi) the number who experienced a return to
                          out-of-home care within 1 year after
                          reunification.
                        ``(F) Secretary's report to congress.--The Secretary
                    shall submit an annual report to the Committee on
                    Health, Education, Labor, and Pensions and the Committee
                    on Appropriations of the Senate and the Committee on
                    Education and the Workforce and the Committee on
                    Appropriations of the House of Representatives that
                    includes the information described in subparagraph (E)
                    and recommendations or observations on the challenges,
                    successes, and lessons derived from implementation of
                    the grant program.
                        ``(G) Assisting states' implementation.--The
                    Secretary shall use the amount reserved under
                    subparagraph (B)(i)(I) to provide written guidance and
                    technical assistance to support States in complying with
                    and implementing this paragraph, which shall include--
                              ``(i) technical assistance, including programs
                          of in-depth technical assistance, to additional
                          States, territories, and Indian Tribes and tribal
                          organizations in accordance with the substance-
                          exposed infant initiative developed by the
                          National Center on Substance Abuse and Child
                          Welfare;
                              ``(ii) guidance on the requirements of this
                          Act with respect to infants born with and
                          identified as being affected by substance use or
                          withdrawal symptoms or fetal alcohol spectrum
                          disorder, as described in clauses (ii) and (iii)
                          of section 106(b)(2)(B), including by--
                                        ``(I) enhancing States'
                                    understanding of requirements and
                                    flexibilities under the law, including
                                    by clarifying key terms;
                                        ``(II) addressing state-identified
                                    challenges with developing,
                                    implementing, and monitoring plans of
                                    safe care, including those reported
                                    under subparagraph (C)(i)(II);
                                        ``(III) disseminating best practices
                                    on implementation of plans of safe care,
                                    on such topics as differential response,
                                    collaboration and coordination, and
                                    identification and delivery of services
                                    for different populations, while
                                    recognizing needs of different
                                    populations and varying community
                                    approaches across States; and
                                        ``(IV) helping States improve the
                                    long-term safety and well-being of young
                                    children and their families;

    [[Page 132 STAT. 4028]]

                              ``(iii) supporting State efforts to develop
                          information technology systems to manage plans of
                          safe care; and
                              ``(iv) preparing the Secretary's report to
                          Congress described in subparagraph (F).
                        ``(H) Sunset.--The authority under this paragraph
                    shall sunset on September 30, 2023.''.

        (b) Repeal.--The Abandoned Infants Assistance Act of 1988 (42 U.S.C.
    5117aa et seq.) <<NOTE: 42 USC 5101 note, 5117aa, 5117aa-11, 5117aa-12,
    5117aa-21, 5117aa-22.>>  is repealed.

             Subtitle H--Substance Use Disorder Treatment Workforce

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

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

              ``PART F--SUBSTANCE USE DISORDER TREATMENT WORKFORCE

    ``SEC. 781. <<NOTE: 42 USC 295h.>>  LOAN REPAYMENT PROGRAM FOR
                            SUBSTANCE USE DISORDER TREATMENT
                            WORKFORCE.

        ``(a) In General.--The Secretary, acting through the Administrator
    of the Health Resources and Services Administration, shall carry out a
    program under which--
                ``(1) the Secretary enters into agreements with individuals
            to make payments in accordance with subsection (b) on the
            principal of and interest on any eligible loan; and
                ``(2) the individuals each agree to the requirements of
            service in substance use disorder treatment employment, as
            described in subsection (d).

        ``(b) Payments.--For each year of obligated service by an individual
    pursuant to an agreement under subsection (a), the Secretary shall make
    a payment to such individual as follows:
                ``(1) Service in a shortage area.--The Secretary shall pay--
                        ``(A) for each year of obligated service by an
                    individual pursuant to an agreement under subsection
                    (a), \1/6\ of the principal of and interest on each
                    eligible loan of the individual which is outstanding on
                    the date the individual began service pursuant to the
                    agreement; and
                        ``(B) for completion of the sixth and final year of
                    such service, the remainder of such principal and
                    interest.
                ``(2) Maximum amount.--The total amount of payments under
            this section to any individual shall not exceed $250,000.

        ``(c) Eligible Loans.--The loans eligible for repayment under this
    section are each of the following:
                ``(1) Any loan for education or training for a substance use
            disorder treatment employment.
                ``(2) Any loan under part E of title VIII (relating to
            nursing student loans).

    [[Page 132 STAT. 4029]]

                ``(3) Any Federal Direct Stafford Loan, Federal Direct PLUS
            Loan, Federal Direct Unsubsidized Stafford Loan, or Federal
            Direct Consolidation Loan (as such terms are used in section 455
            of the Higher Education Act of 1965).
                ``(4) Any Federal Perkins Loan under part E of title I of
            the Higher Education Act of 1965.
                ``(5) Any other Federal loan as determined appropriate by
            the Secretary.

        ``(d) Requirements of Service.--Any individual receiving payments
    under this program as required by an agreement under subsection (a)
    shall agree to an annual commitment to full-time employment, with no
    more than 1 year passing between any 2 years of covered employment, in
    substance use disorder treatment employment in the United States in--
                ``(1) a Mental Health Professional Shortage Area, as
            designated under section 332; or
                ``(2) a county (or a municipality, if not contained within
            any county) where the mean drug overdose death rate per 100,000
            people over the past 3 years for which official data is
            available from the State, is higher than the most recent
            available national average overdose death rate per 100,000
            people, as reported by the Centers for Disease Control and
            Prevention.

        ``(e) Ineligibility for Double Benefits.--No borrower may, for the
    same service, receive a reduction of loan obligations or a loan
    repayment under both--
                ``(1) this section; and
                ``(2) any Federally supported loan forgiveness program,
            including under section 338B, 338I, or 846 of this Act, or
            section 428J, 428L, 455(m), or 460 of the Higher Education Act
            of 1965.

        ``(f) Breach.--
                ``(1) Liquidated damages formula.--The Secretary may
            establish a liquidated damages formula to be used in the event
            of a breach of an agreement entered into under subsection (a).
                ``(2) Limitation.--The failure by an individual to complete
            the full period of service obligated pursuant to such an
            agreement, taken alone, shall not constitute a breach of the
            agreement, so long as the individual completed in good faith the
            years of service for which payments were made to the individual
            under this section.

        ``(g) Additional Criteria.--The Secretary--
                ``(1) may establish such criteria and rules to carry out
            this section as the Secretary determines are needed and in
            addition to the criteria and rules specified in this section;
            and
                ``(2) shall give notice to the committees specified in
            subsection (h) of any criteria and rules so established.

        ``(h) Report to Congress.--Not later than 5 years after the date of
    enactment of this section, and every other year thereafter, the
    Secretary shall prepare and submit to the Committee on Energy and
    Commerce of the House of Representatives and the Committee on Health,
    Education, Labor, and Pensions of the Senate a report on--
                ``(1) the number and location of borrowers who have
            qualified for loan repayments under this section; and

    [[Page 132 STAT. 4030]]

                ``(2) the impact of this section on the availability of
            substance use disorder treatment employees nationally and in
            shortage areas and counties described in subsection (d).

        ``(i) Definition.--In this section:
                ``(1) The terms `Indian tribe' and `tribal organization'
            have the meanings given those terms in section 4 of the Indian
            Self-Determination and Education Assistance Act.
                ``(2) The term `municipality' means a city, town, or other
            public body created by or pursuant to State law, or an Indian
            tribe.
                ``(3) The term `substance use disorder treatment employment'
            means full-time employment (including a fellowship)--
                        ``(A) where the primary intent and function of the
                    position is the direct treatment or recovery support of
                    patients with or in recovery from a substance use
                    disorder, including master's level social workers,
                    psychologists, counselors, marriage and family
                    therapists, psychiatric mental health practitioners,
                    occupational therapists, psychology doctoral interns,
                    and behavioral health paraprofessionals and physicians,
                    physician assistants, and nurses, who are licensed or
                    certified in accordance with applicable State and
                    Federal laws; and
                        ``(B) which is located at a substance use disorder
                    treatment program, private physician practice, hospital
                    or health system-affiliated inpatient treatment center
                    or outpatient clinic (including an academic medical
                    center-affiliated treatment program), correctional
                    facility or program, youth detention center or program,
                    inpatient psychiatric facility, crisis stabilization
                    unit, community health center, community mental health
                    or other specialty community behavioral health center,
                    recovery center, school, community-based organization,
                    telehealth platform, migrant health center, health
                    program or facility operated by an Indian tribe or
                    tribal organization, Federal medical facility, or any
                    other facility as determined appropriate for purposes of
                    this section by the Secretary.

        ``(j) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section $25,000,000 for each of fiscal
    years 2019 through 2023.''.
    SEC. 7072. CLARIFICATION REGARDING SERVICE IN SCHOOLS AND OTHER
                              COMMUNITY-BASED SETTINGS.

        Subpart III of part D of title III of the Public Health Service Act
    (42 U.S.C. 254l et seq.) is amended by adding at the end the following:
    ``SEC. 338N. <<NOTE: 42 USC 254v.>>  CLARIFICATION REGARDING
                              SERVICE IN SCHOOLS AND OTHER COMMUNITY-
                              BASED SETTINGS.

        ``(a) Schools and Community-based Settings.--An entity to which a
    participant in the Scholarship Program or the Loan Repayment Program
    (referred to in this section as a `participant') is assigned under
    section 333 may direct such participant to provide service as a
    behavioral or mental health professional at a school or other community-
    based setting located in a health professional shortage area.
        ``(b) Obligated Service.--

    [[Page 132 STAT. 4031]]

                ``(1) In general.--Any service described in subsection (a)
            that a participant provides may count towards such participant's
            completion of any obligated service requirements under the
            Scholarship Program or the Loan Repayment Program, subject to
            any limitation imposed under paragraph (2).
                ``(2) Limitation.--The Secretary may impose a limitation on
            the number of hours of service described in subsection (a) that
            a participant may credit towards completing obligated service
            requirements, provided that the limitation allows a member to
            credit service described in subsection (a) for not less than 50
            percent of the total hours required to complete such obligated
            service requirements.

        ``(c) Rule of Construction.--The authorization under subsection (a)
    shall be notwithstanding any other provision of this subpart or subpart
    II.''.
    SEC. 7073. PROGRAMS FOR HEALTH CARE WORKFORCE.

        (a) Program for Education and Training in Pain Care.--Section 759 of
    the Public Health Service Act (42 U.S.C. 294i) is amended--
                (1) in subsection (a), by striking ``hospices, and other
            public and private entities'' and inserting ``hospices, tribal
            health programs (as defined in section 4 of the Indian Health
            Care Improvement Act), and other public and nonprofit private
            entities'';
                (2) in subsection (b)--
                        (A) in the matter preceding paragraph (1), by
                    striking ``award may be made under subsection (a) only
                    if the applicant for the award agrees that the program
                    carried out with the award will include'' and inserting
                    ``entity receiving an award under this section shall
                    develop a comprehensive education and training plan that
                    includes'';
                        (B) in paragraph (1)--
                              (i) by inserting ``preventing,'' after
                          ``diagnosing,''; and
                              (ii) by inserting ``non-addictive medical
                          products and non-pharmacologic treatments and''
                          after ``including'';
                        (C) in paragraph (2)--
                              (i) by inserting ``Federal, State, and local''
                          after ``applicable''; and
                              (ii) by striking ``the degree to which'' and
                          all that follows through ``effective pain care''
                          and inserting ``opioids'';
                        (D) in paragraph (3), by inserting ``, integrated,
                    evidence-based pain management, and, as appropriate,
                    non-pharmacotherapy'' before the semicolon;
                        (E) in paragraph (4), by striking ``; and'' and
                    inserting ``;''; and
                        (F) by striking paragraph (5) and inserting the
                    following:
                ``(5) recent findings, developments, and advancements in
            pain care research and the provision of pain care, which may
            include non-addictive medical products and non-pharmacologic
            treatments intended to treat pain; and
                ``(6) the dangers of opioid abuse and misuse, detection of
            early warning signs of opioid use disorders (which may

    [[Page 132 STAT. 4032]]

            include best practices related to screening for opioid use
            disorders, training on screening, brief intervention, and
            referral to treatment), and safe disposal options for
            prescription medications (including such options provided by law
            enforcement or other innovative deactivation mechanisms).'';
                (3) in subsection (d), by inserting ``prevention,'' after
            ``diagnosis,''; and
                (4) in subsection (e), by striking ``2010 through 2012'' and
            inserting ``2019 through 2023''.

        (b) Mental and Behavioral Health Education and Training Program.--
    Section 756 of the Public Health Service Act (42 U.S.C. 294e-1) is
    amended--
                (1) in subsection (a)--
                        (A) in paragraph (1), by inserting ``, trauma,''
                    after ``focus on child and adolescent mental health'';
                    and
                        (B) in paragraphs (2) and (3), by inserting
                    ``trauma-informed care and'' before ``substance use
                    disorder prevention and treatment services''; and
                (2) in subsection (f), by striking ``2018 through 2022'' and
            inserting ``2019 through 2023''.

            Subtitle I--Preventing Overdoses While in Emergency Rooms

    SEC. 7081. <<NOTE: 42 USC 290dd-4.>>  PROGRAM TO SUPPORT
                              COORDINATION AND CONTINUATION OF CARE
                              FOR DRUG OVERDOSE PATIENTS.

        (a) In General.--The Secretary of Health and Human Services
    (referred to in this section as the ``Secretary'') shall identify or
    facilitate the development of best practices for--
                (1) emergency treatment of known or suspected drug overdose;
                (2) the use of recovery coaches, as appropriate, to
            encourage individuals who experience a non-fatal overdose to
            seek treatment for substance use disorder and to support
            coordination and continuation of care;
                (3) coordination and continuation of care and treatment,
            including, as appropriate, through referrals, of individuals
            after a drug overdose; and
                (4) the provision or prescribing of overdose reversal
            medication, as appropriate.

        (b) Grant Establishment and Participation.--
                (1) In general.--The Secretary shall award grants on a
            competitive basis to eligible entities to support implementation
            of voluntary programs for care and treatment of individuals
            after a drug overdose, as appropriate, which may include
            implementation of the best practices described in subsection
            (a).
                (2) Eligible entity.--In this section, the term ``eligible
            entity'' means--
                        (A) a State substance abuse agency;
                        (B) an Indian Tribe or tribal organization; or
                        (C) an entity that offers treatment or other
                    services for individuals in response to, or following,
                    drug overdoses or a drug overdose, such as an emergency
                    department, in consultation with a State substance abuse
                    agency.

    [[Page 132 STAT. 4033]]

                (3) Application.--An eligible entity desiring a grant under
            this section shall submit an application to the Secretary, at
            such time and in such manner as the Secretary may require, that
            includes--
                        (A) evidence that such eligible entity carries out,
                    or is capable of contracting and coordinating with other
                    community entities to carry out, the activities
                    described in paragraph (4);
                        (B) evidence that such eligible entity will work
                    with a recovery community organization to recruit,
                    train, hire, mentor, and supervise recovery coaches and
                    fulfill the requirements described in paragraph (4)(A);
                    and
                        (C) such additional information as the Secretary may
                    require.
                (4) Use of grant funds.--An eligible entity awarded a grant
            under this section shall use such grant funds to--
                        (A) hire or utilize recovery coaches to help support
                    recovery, including by--
                              (i) connecting patients to a continuum of care
                          services, such as--
                                        (I) treatment and recovery support
                                    programs;
                                        (II) programs that provide non-
                                    clinical recovery support services;
                                        (III) peer support networks;
                                        (IV) recovery community
                                    organizations;
                                        (V) health care providers, including
                                    physicians and other providers of
                                    behavioral health and primary care;
                                        (VI) education and training
                                    providers;
                                        (VII) employers;
                                        (VIII) housing services; and
                                        (IX) child welfare agencies;
                              (ii) providing education on overdose
                          prevention and overdose reversal to patients and
                          families, as appropriate;
                              (iii) providing follow-up services for
                          patients after an overdose to ensure continued
                          recovery and connection to support services;
                              (iv) collecting and evaluating outcome data
                          for patients receiving recovery coaching services;
                          and
                              (v) providing other services the Secretary
                          determines necessary to help ensure continued
                          connection with recovery support services,
                          including culturally appropriate services, as
                          applicable;
                        (B) establish policies and procedures, pursuant to
                    Federal and State law, that address the provision of
                    overdose reversal medication, the administration of all
                    drugs or devices approved or cleared under the Federal
                    Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) and
                    all biological products licensed under section 351 of
                    the Public Health Service Act (42 U.S.C. 262) to treat
                    substance use disorder, and subsequent continuation of,
                    or referral to, evidence-based treatment for patients
                    with a substance use disorder who have experienced a
                    non-fatal drug overdose, in order to support long-term
                    treatment, prevent relapse, and reduce recidivism and
                    future overdose; and

    [[Page 132 STAT. 4034]]

                        (C) establish integrated models of care for
                    individuals who have experienced a non-fatal drug
                    overdose which may include patient assessment, follow
                    up, and transportation to and from treatment facilities.
                (5) Additional permissible uses.--In addition to the uses
            described in paragraph (4), a grant awarded under this section
            may be used, directly or through contractual arrangements, to
            provide--
                        (A) all drugs or devices approved or cleared under
                    the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301
                    et seq.) and all biological products licensed under
                    section 351 of the Public Health Service Act (42 U.S.C.
                    262) to treat substance use disorders or reverse
                    overdose, pursuant to Federal and State law;
                        (B) withdrawal and detoxification services that
                    include patient evaluation, stabilization, and
                    preparation for treatment of substance use disorder,
                    including treatment described in subparagraph (A), as
                    appropriate; or
                        (C) mental health services provided by a certified
                    professional who is licensed and qualified by education,
                    training, or experience to assess the psychosocial
                    background of patients, to contribute to the appropriate
                    treatment plan for patients with substance use disorder,
                    and to monitor patient progress.
                (6) Preference.--In awarding grants under this section, the
            Secretary shall give preference to eligible entities that meet
            any or all of the following criteria:
                        (A) The eligible entity is a critical access
                    hospital (as defined in section 1861(mm)(1) of the
                    Social Security Act (42 U.S.C. 1395x(mm)(1))), a low
                    volume hospital (as defined in section 1886(d)(12)(C)(i)
                    of such Act (42 U.S.C. 1395ww(d)(12)(C)(i))), a sole
                    community hospital (as defined in section
                    1886(d)(5)(D)(iii) of such Act (42 U.S.C.
                    1395ww(d)(5)(D)(iii))), or a hospital that receives
                    disproportionate share hospital payments under section
                    1886(d)(5)(F) of the Social Security Act (42 U.S.C.
                    1395ww(d)(5)(F)).
                        (B) The eligible entity is located in a State with
                    an age-adjusted rate of drug overdose deaths that is
                    above the national overdose mortality rate, as
                    determined by the Director of the Centers for Disease
                    Control and Prevention, or under the jurisdiction of an
                    Indian Tribe with an age-adjusted rate of drug overdose
                    deaths that is above the national overdose mortality
                    rate, as determined through appropriate mechanisms as
                    determined by the Secretary in consultation with Indian
                    Tribes.
                        (C) The eligible entity demonstrates that recovery
                    coaches will be placed in both health care settings and
                    community settings.
                (7) Period of grant.--A grant awarded to an eligible entity
            under this section shall be for a period of not more than 5
            years.

        (c) Definitions.--In this section:
                (1) Indian tribe; tribal organization.--The terms ``Indian
            Tribe'' and ``tribal organization'' have the meanings given the
            terms ``Indian tribe'' and ``tribal organization'' in section 4
            of the Indian Self-Determination and Education Assistance Act
            (25 U.S.C. 5304).

    [[Page 132 STAT. 4035]]

                (2) Recovery coach.--the term ``recovery coach'' means an
            individual--
                        (A) with knowledge of, or experience with, recovery
                    from a substance use disorder; and
                        (B) who has completed training from, and is
                    determined to be in good standing by, a recovery
                    services organization capable of conducting such
                    training and making such determination.
                (3) Recovery community organization.--The term ``recovery
            community organization'' has the meaning given such term in
            section 547(a) of the Public Health Service Act (42 U.S.C.
            290ee-2(a)).

        (d) Reporting Requirements.--
                (1) Reports by grantees.--Each eligible entity awarded a
            grant under this section shall submit to the Secretary an annual
            report for each year for which the entity has received such
            grant that includes information on--
                        (A) the number of individuals treated by the entity
                    for non-fatal overdoses, including the number of non-
                    fatal overdoses where overdose reversal medication was
                    administered;
                        (B) the number of individuals administered
                    medication-assisted treatment by the entity;
                        (C) the number of individuals referred by the entity
                    to other treatment facilities after a non-fatal
                    overdose, the types of such other facilities, and the
                    number of such individuals admitted to such other
                    facilities pursuant to such referrals; and
                        (D) the frequency and number of patients with
                    reoccurrences, including readmissions for non-fatal
                    overdoses and evidence of relapse related to substance
                    use disorder.
                (2) Report by secretary.--Not later than 5 years after the
            date of enactment of this Act, the Secretary shall submit to
            Congress a report that includes an evaluation of the
            effectiveness of the grant program carried out under this
            section with respect to long term health outcomes of the
            population of individuals who have experienced a drug overdose,
            the percentage of patients treated or referred to treatment by
            grantees, and the frequency and number of patients who
            experienced relapse, were readmitted for treatment, or
            experienced another overdose.

        (e) Privacy.--The requirements of this section, including with
    respect to data reporting and program oversight, shall be subject to all
    applicable Federal and State privacy laws.
        (f) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $10,000,000 for each of fiscal
    years 2019 through 2023.

         Subtitle J--Alternatives to Opioids in the Emergency Department

    SEC. 7091. <<NOTE: 42 USC 294i note.>>  EMERGENCY DEPARTMENT
                              ALTERNATIVES TO OPIOIDS DEMONSTRATION
                              PROGRAM.

        (a) Demonstration Program Grants.--
                (1) In general.--The Secretary of Health and Human Services
            (in this section referred to as the ``Secretary'') shall

    [[Page 132 STAT. 4036]]

            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

    [[Page 132 STAT. 4037]]

            emergency departments, outpatient clinics, critical access
            hospitals, Federally qualified health centers, Indian Health
            Service health facilities, and tribal hospitals.

        (e) Report to the Secretary.--Each recipient of a grant under this
    section shall submit to the Secretary (during the period of such grant)
    annual reports on the progress of the program funded through the grant.
    These reports shall include, in accordance with all applicable State and
    Federal privacy laws--
                (1) a description of and specific information about the
            opioid alternative pain management programs, including the
            demographic characteristics of patients who were treated with an
            alternative pain management protocol, implemented in hospitals,
            emergency departments, and other acute care settings;
                (2) data on the opioid alternative pain management
            strategies used, including the number of opioid prescriptions
            written--
                        (A) during a baseline period before the program
                    began; or
                        (B) at various stages of the program; and
                (3) data on patients who were eventually prescribed opioids
            after alternative pain management protocols and treatments were
            utilized; and
                (4) any other information the Secretary determines
            appropriate.

        (f) Report to Congress.--Not later than 1 year after completion of
    the demonstration program under this section, the Secretary shall submit
    a report to the Congress on the results of the demonstration program and
    include in the report--
                (1) the number of applications received and the number
            funded;
                (2) a summary of the reports described in subsection (e),
            including data that allows for comparison of programs; and
                (3) recommendations for broader implementation of pain
            management strategies that encourage the use of alternatives to
            opioids in hospitals, emergency departments, or other acute care
            settings.

        (g) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $10,000,000 for each of fiscal
    years 2019 through 2021.

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

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

        Part D of title V of the Public Health Service Act, as amended by
    section 7031, is further amended by adding at the end the following new
    section:
    ``SEC. 551. <<NOTE: 42 USC 290ee-6.>>  REGIONAL CENTERS OF
                            EXCELLENCE IN SUBSTANCE USE DISORDER
                            EDUCATION.

        ``(a) In General.--The Secretary, in consultation with appropriate
    agencies, shall award cooperative agreements to eligible entities for
    the designation of such entities as Regional Centers of Excellence in
    Substance Use Disorder Education for purposes of

    [[Page 132 STAT. 4038]]

    improving health professional training resources with respect to
    substance use disorder prevention, treatment, and recovery.
        ``(b) Eligibility.--To be eligible to receive a cooperative
    agreement under subsection (a), an entity shall--
                ``(1) be an accredited entity that offers education to
            students in various health professions, which may include--
                        ``(A) a teaching hospital;
                        ``(B) a medical school;
                        ``(C) a certified behavioral health clinic; or
                        ``(D) any other health professions school, school of
                    public health, or Cooperative Extension Program at
                    institutions of higher education, as defined in section
                    101 of the Higher Education Act of 1965, engaged in the
                    prevention, treatment, or recovery of substance use
                    disorders;
                ``(2) demonstrate community engagement and partnerships with
            community stakeholders, including entities that train health
            professionals, mental health counselors, social workers, peer
            recovery specialists, substance use treatment programs,
            community health centers, physician offices, certified
            behavioral health clinics, research institutions, and law
            enforcement; and
                ``(3) submit to the Secretary an application containing such
            information, at such time, and in such manner, as the Secretary
            may require.

        ``(c) Activities.--An entity receiving an award under this section
    shall develop, evaluate, and distribute evidence-based resources
    regarding the prevention and treatment of, and recovery from, substance
    use disorders. Such resources may include information on--
                ``(1) the neurology and pathology of substance use
            disorders;
                ``(2) advancements in the treatment of substance use
            disorders;
                ``(3) techniques and best practices to support recovery from
            substance use disorders;
                ``(4) strategies for the prevention and treatment of, and
            recovery from substance use disorders across patient
            populations; and
                ``(5) other topic areas that are relevant to the objectives
            described in subsection (a).

        ``(d) Geographic Distribution.--In awarding cooperative agreements
    under subsection (a), the Secretary shall take into account regional
    differences among eligible entities and shall make an effort to ensure
    geographic distribution.
        ``(e) Evaluation.--The Secretary shall evaluate each project carried
    out by an entity receiving an award under this section and shall
    disseminate the findings with respect to each such evaluation to
    appropriate public and private entities.
        ``(f) Funding.--There is authorized to be appropriated to carry out
    this section, $4,000,000 for each of fiscal years 2019 through 2023.''.
    SEC. 7102. <<NOTE: 42 USC 290bb-7a.>>  YOUTH PREVENTION AND
                              RECOVERY.

        (a)  Substance Abuse Treatment Services for Children, Adolescents,
    and Young Adults.--Section 514 of the Public Health Service Act (42
    U.S.C. 290bb-7) is amended--
                (1) in the section heading, by striking ``children and
            adolescents'' and inserting ``children, adolescents, and young
            adults'';

    [[Page 132 STAT. 4039]]

                (2) in subsection (a)(2), by striking ``children,
            including'' and inserting ``children, adolescents, and young
            adults, including''; and
                (3) by striking ``children and adolescents'' each place it
            appears and inserting ``children, adolescents, and young
            adults''.

        (b) Resource Center.--The Secretary of Health and Human Services
    (referred to in this section as the ``Secretary'', except as otherwise
    provided), in consultation with the Secretary of Education and other
    heads of agencies, including the Assistant Secretary for Mental Health
    and Substance Use and the Administrator of the Health Resources and
    Services Administration, as appropriate, shall establish a resource
    center to provide technical support to recipients of grants under
    subsection (c).
        (c) Youth Prevention and Recovery Initiative.--
                (1) In general.--The Secretary, in consultation with the
            Secretary of Education, shall administer a program to provide
            support for communities to support the prevention of, treatment
            of, and recovery from, substance use disorders for children,
            adolescents, and young adults.
                (2) Definitions.--In this subsection:
                        (A) Eligible entity.--The term ``eligible entity''
                    means--
                              (i) a local educational agency that is seeking
                          to establish or expand substance use prevention or
                          recovery support services at one or more high
                          schools;
                              (ii) a State educational agency;
                              (iii) an institution of higher education (or
                          consortia of such institutions), which may include
                          a recovery program at an institution of higher
                          education;
                              (iv) a local board or one-stop operator;
                              (v) a nonprofit organization with appropriate
                          expertise in providing services or programs for
                          children, adolescents, or young adults, excluding
                          a school;
                              (vi) a State, political subdivision of a
                          State, Indian tribe, or tribal organization; or
                              (vii) a high school or dormitory serving high
                          school students that receives funding from the
                          Bureau of Indian Education.
                        (B) Foster care.--The term ``foster care'' has the
                    meaning given such term in section 1355.20(a) of title
                    45, Code of Federal Regulations (or any successor
                    regulations).
                        (C) High school.--The term ``high school'' has the
                    meaning given such term in section 8101 of the
                    Elementary and Secondary Education Act of 1965 (20
                    U.S.C. 7801).
                        (D) Homeless youth.--The term ``homeless youth'' has
                    the meaning given the term ``homeless children or
                    youths'' in section 725 of the McKinney-Vento Homeless
                    Assistance Act (42 U.S.C. 11434a).
                        (E) Indian tribe; tribal organization.--The terms
                    ``Indian tribe'' and ``tribal organization'' have the
                    meanings given such terms in section 4 of the Indian
                    Self-Determination and Education Assistance Act (25
                    U.S.C. 5304).
                        (F) Institution of higher education.--The term
                    ``institution of higher education'' has the meaning
                    given such term in section 101 of the Higher Education
                    Act of 1965 (20 U.S.C. 1001) and includes a
                    ``postsecondary

    [[Page 132 STAT. 4040]]

                    vocational institution'' as defined in section 102(c) of
                    such Act (20 U.S.C. 1002(c)).
                        (G) Local educational agency.--The term ``local
                    educational agency'' has the meaning given such term in
                    section 8101 of the Elementary and Secondary Education
                    Act of 1965 (20 U.S.C. 7801).
                        (H) Local board; one-stop operator.--The terms
                    ``local board'' and ``one-stop operator'' have the
                    meanings given such terms in section 3 of the Workforce
                    Innovation and Opportunity Act (29 U.S.C. 3102).
                        (I) Out-of-school youth.--The term ``out-of-school
                    youth'' has the meaning given such term in section
                    129(a)(1)(B) of the Workforce Innovation and Opportunity
                    Act (29 U.S.C. 3164(a)(1)(B)).
                        (J) Recovery program.--The term ``recovery program''
                    means a program--
                              (i) to help children, adolescents, or young
                          adults who are recovering from substance use
                          disorders to initiate, stabilize, and maintain
                          healthy and productive lives in the community; and
                              (ii) that includes peer-to-peer support
                          delivered by individuals with lived experience in
                          recovery, and communal activities to build
                          recovery skills and supportive social networks.
                        (K) State educational agency.--The term ``State
                    educational agency'' has the meaning given such term in
                    section 8101 of the Elementary and Secondary Education
                    Act (20 U.S.C. 7801).
                (3) Best practices.--The Secretary, in consultation with the
            Secretary of Education, shall--
                        (A) identify or facilitate the development of
                    evidence-based best practices for prevention of
                    substance misuse and abuse by children, adolescents, and
                    young adults, including for specific populations such as
                    youth in foster care, homeless youth, out-of-school
                    youth, and youth who are at risk of or have experienced
                    trafficking that address--
                              (i) primary prevention;
                              (ii) appropriate recovery support services;
                              (iii) appropriate use of medication-assisted
                          treatment for such individuals, if applicable, and
                          ways of overcoming barriers to the use of
                          medication-assisted treatment in such population;
                          and
                              (iv) efficient and effective communication,
                          which may include the use of social media, to
                          maximize outreach efforts;
                        (B) disseminate such best practices to State
                    educational agencies, local educational agencies,
                    schools and dormitories funded by the Bureau of Indian
                    Education, institutions of higher education, recovery
                    programs at institutions of higher education, local
                    boards, one-stop operators, family and youth homeless
                    providers, and nonprofit organizations, as appropriate;
                        (C) conduct a rigorous evaluation of each grant
                    funded under this subsection, particularly its impact on
                    the indicators described in paragraph (7)(B); and
                        (D) provide technical assistance for grantees under
                    this subsection.

    [[Page 132 STAT. 4041]]

                (4) Grants authorized.--The Secretary, in consultation with
            the Secretary of Education, shall award 3-year grants, on a
            competitive basis, to eligible entities to enable such entities,
            in coordination with Indian tribes, if applicable, and State
            agencies responsible for carrying out substance use disorder
            prevention and treatment programs, to carry out evidence-based
            programs for--
                        (A) prevention of substance misuse and abuse by
                    children, adolescents, and young adults, which may
                    include primary prevention;
                        (B) recovery support services for children,
                    adolescents, and young adults, which may include
                    counseling, job training, linkages to community-based
                    services, family support groups, peer mentoring, and
                    recovery coaching; or
                        (C) treatment or referrals for treatment of
                    substance use disorders, which may include the use of
                    medication-assisted treatment, as appropriate.
                (5) Special consideration.--In awarding grants under this
            subsection, the Secretary shall give special consideration to
            the unique needs of tribal, urban, suburban, and rural
            populations.
                (6) Application.--To be eligible for a grant under this
            subsection, an entity shall submit to the Secretary an
            application at such time, in such manner, and containing such
            information as the Secretary may require. Such application shall
            include--
                        (A) a description of--
                              (i) the impact of substance use disorders in
                          the population that will be served by the grant
                          program;
                              (ii) how the eligible entity has solicited
                          input from relevant stakeholders, which may
                          include faculty, teachers, staff, families,
                          students, and experts in substance use disorder
                          prevention, treatment, and recovery in developing
                          such application;
                              (iii) the goals of the proposed project,
                          including the intended outcomes;
                              (iv) how the eligible entity plans to use
                          grant funds for evidence-based activities, in
                          accordance with this subsection to prevent,
                          provide recovery support for, or treat substance
                          use disorders amongst such individuals, or a
                          combination of such activities; and
                              (v) how the eligible entity will collaborate
                          with relevant partners, which may include State
                          educational agencies, local educational agencies,
                          institutions of higher education, juvenile justice
                          agencies, prevention and recovery support
                          providers, local service providers, including
                          substance use disorder treatment programs,
                          providers of mental health services, youth serving
                          organizations, family and youth homeless
                          providers, child welfare agencies, and primary
                          care providers, in carrying out the grant program;
                          and
                        (B) an assurance that the eligible entity will
                    participate in the evaluation described in paragraph
                    (3)(C).
                (7) Reports to the secretary.--Each eligible entity awarded
            a grant under this subsection shall submit to the Secretary a
            report at such time and in such manner as the Secretary may
            require. Such report shall include--

    [[Page 132 STAT. 4042]]

                        (A) a description of how the eligible entity used
                    grant funds, in accordance with this subsection,
                    including the number of children, adolescents, and young
                    adults reached through programming; and
                        (B) a description, including relevant data, of how
                    the grant program has made an impact on the intended
                    outcomes described in paragraph (6)(A)(iii), including--
                              (i) indicators of student success, which, if
                          the eligible entity is an educational institution,
                          shall include student well-being and academic
                          achievement;
                              (ii) substance use disorders amongst children,
                          adolescents, and young adults, including the
                          number of overdoses and deaths amongst children,
                          adolescents, and young adults served by the grant
                          during the grant period; and
                              (iii) other indicators, as the Secretary
                          determines appropriate.
                (8) Report to congress.--The Secretary shall, not later than
            October 1, 2022, submit a report to the Committee on Health,
            Education, Labor, and Pensions of the Senate and the Committee
            on Energy and Commerce and the Committee on Education and the
            Workforce of the House of Representatives a report summarizing
            the effectiveness of the grant program under this subsection,
            based on the information submitted in reports required under
            paragraph (7).
                (9) Authorization of appropriations.--There is authorized to
            be appropriated $10,000,000 to carry out this subsection for
            each of fiscal years 2019 through 2023.

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

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

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

    [[Page 132 STAT. 4043]]

                Subtitle M--Comprehensive Opioid Recovery Centers

    SEC. 7121. COMPREHENSIVE OPIOID RECOVERY CENTERS.

        (a) In General.--Part D of title V of the Public Health Service Act
    (42 U.S.C. 290dd et seq.), as amended by sections 7031 and 7101, is
    further amended by adding at the end the following new section:
    ``SEC. 552. <<NOTE: 42 USC 290ee-7.>>  COMPREHENSIVE OPIOID
                            RECOVERY CENTERS.

        ``(a) In General.--The Secretary shall award grants on a competitive
    basis to eligible entities to establish or operate a comprehensive
    opioid recovery center (referred to in this section as a `Center'). A
    Center may be a single entity or an integrated delivery network.
        ``(b) Grant Period.--
                ``(1) In general.--A grant awarded under subsection (a)
            shall be for a period of not less than 3 years and not more than
            5 years.
                ``(2) Renewal.--A grant awarded under subsection (a) may be
            renewed, on a competitive basis, for additional periods of time,
            as determined by the Secretary. In determining whether to renew
            a grant under this paragraph, the Secretary shall consider the
            data submitted under subsection (h).

        ``(c) Minimum Number of Centers.--The Secretary shall allocate the
    amounts made available under subsection (j) such that not fewer than 10
    grants may be awarded. Not more than one grant shall be made to entities
    in a single State for any one period.
        ``(d) Application.--
                ``(1) Eligible entity.--An entity is eligible for a grant
            under this section if the entity offers treatment and other
            services for individuals with a substance use disorder.
                ``(2) Submission of application.--In order to be eligible
            for a grant under subsection (a), an entity shall submit an
            application to the Secretary at such time and in such manner as
            the Secretary may require. Such application shall include--
                        ``(A) evidence that such entity carries out, or is
                    capable of coordinating with other entities to carry
                    out, the activities described in subsection (g); and
                        ``(B) such other information as the Secretary may
                    require.

        ``(e) Priority.--In awarding grants under subsection (a), the
    Secretary shall give priority to eligible entities--
                ``(1) located in a State with an age-adjusted rate of drug
            overdose deaths that is above the national overdose mortality
            rate, as determined by the Director of the Centers for Disease
            Control and Prevention; or
                ``(2) serving an Indian Tribe (as defined in section 4 of
            the Indian Self-Determination and Education Assistance Act) with
            an age-adjusted rate of drug overdose deaths that is above the
            national overdose mortality rate, as determined through
            appropriate mechanisms determined by the Secretary in
            consultation with Indian Tribes.

    [[Page 132 STAT. 4044]]

        ``(f) Preference.--In awarding grants under subsection (a), the
    Secretary may give preference to eligible entities utilizing technology-
    enabled collaborative learning and capacity building models, including
    such models as defined in section 2 of the Expanding Capacity for Health
    Outcomes Act (Public Law 114-270; 130 Stat. 1395), to conduct the
    activities described in this section.
        ``(g) Center Activities.--Each Center shall, at a minimum, carry out
    the following activities directly, through referral, or through
    contractual arrangements, which may include carrying out such activities
    through technology-enabled collaborative learning and capacity building
    models described in subsection (f):
                ``(1) Treatment and recovery services.--Each Center shall--
                        ``(A) Ensure that intake, evaluations, and periodic
                    patient assessments meet the individualized clinical
                    needs of patients, including by reviewing patient
                    placement in treatment settings to support meaningful
                    recovery.
                        ``(B) Provide the full continuum of treatment
                    services, including--
                              ``(i) all drugs and devices approved or
                          cleared under the Federal Food, Drug, and Cosmetic
                          Act and all biological products licensed under
                          section 351 of this Act to treat substance use
                          disorders or reverse overdoses, pursuant to
                          Federal and State law;
                              ``(ii) medically supervised withdrawal
                          management, that includes patient evaluation,
                          stabilization, and readiness for and entry into
                          treatment;
                              ``(iii) counseling provided by a program
                          counselor or other certified professional who is
                          licensed and qualified by education, training, or
                          experience to assess the psychological and
                          sociological background of patients, to contribute
                          to the appropriate treatment plan for the patient,
                          and to monitor patient progress;
                              ``(iv) treatment, as appropriate, for patients
                          with co-occurring substance use and mental
                          disorders;
                              ``(v) testing, as appropriate, for infections
                          commonly associated with illicit drug use;
                              ``(vi) residential rehabilitation, and
                          outpatient and intensive outpatient programs;
                              ``(vii) recovery housing;
                              ``(viii) community-based and peer recovery
                          support services;
                              ``(ix) job training, job placement assistance,
                          and continuing education assistance to support
                          reintegration into the workforce; and
                              ``(x) other best practices to provide the full
                          continuum of treatment and services, as determined
                          by the Secretary.
                        ``(C) Ensure that all programs covered by the Center
                    include medication-assisted treatment, as appropriate,
                    and do not exclude individuals receiving medication-
                    assisted treatment from any service.
                        ``(D) Periodically conduct patient assessments to
                    support sustained and clinically significant recovery,
                    as defined by the Assistant Secretary for Mental Health
                    and Substance Use.

    [[Page 132 STAT. 4045]]

                        ``(E) Provide onsite access to medication, as
                    appropriate, and toxicology services; for purposes of
                    carrying out this section.
                        ``(F) Operate a secure, confidential, and
                    interoperable electronic health information system.
                        ``(G) Offer family support services such as child
                    care, family counseling, and parenting interventions to
                    help stabilize families impacted by substance use
                    disorder, as appropriate.
                ``(2) Outreach.--Each Center shall carry out outreach
            activities regarding the services offered through the Centers,
            which may include--
                        ``(A) training and supervising outreach staff, as
                    appropriate, to work with State and local health
                    departments, health care providers, the Indian Health
                    Service, State and local educational agencies, schools
                    funded by the Indian Bureau of Education, institutions
                    of higher education, State and local workforce
                    development boards, State and local community action
                    agencies, public safety officials, first responders,
                    Indian Tribes, child welfare agencies, as appropriate,
                    and other community partners and the public, including
                    patients, to identify and respond to community needs;
                        ``(B) ensuring that the entities described in
                    subparagraph (A) are aware of the services of the
                    Center; and
                        ``(C) disseminating and making publicly available,
                    including through the internet, evidence-based resources
                    that educate professionals and the public on opioid use
                    disorder and other substance use disorders, including
                    co-occurring substance use and mental disorders.

        ``(h) Data Reporting and Program Oversight.--With respect to a grant
    awarded under subsection (a), not later than 90 days after the end of
    the first year of the grant period, and annually thereafter for the
    duration of the grant period (including the duration of any renewal
    period for such grant), the entity shall submit data, as appropriate, to
    the Secretary regarding--
                ``(1) the programs and activities funded by the grant;
                ``(2) health outcomes of the population of individuals with
            a substance use disorder who received services from the Center,
            evaluated by an independent program evaluator through the use of
            outcomes measures, as determined by the Secretary;
                ``(3) the retention rate of program participants; and
                ``(4) any other information that the Secretary may require
            for the purpose of--ensuring that the Center is complying with
            all the requirements of the grant, including providing the full
            continuum of services described in subsection (g)(1)(B).

        ``(i) Privacy.--The provisions of this section, including with
    respect to data reporting and program oversight, shall be subject to all
    applicable Federal and State privacy laws.
        ``(j) Authorization of Appropriations.--There is authorized to be
    appropriated $10,000,000 for each of fiscal years 2019 through 2023 for
    purposes of carrying out this section.''.
        (b) Reports to Congress.--
                (1) Preliminary report.--Not later than 3 years after the
            date of the enactment of this Act, the Secretary of Health and
            Human Services shall submit to Congress a preliminary

    [[Page 132 STAT. 4046]]

            report that analyzes data submitted under section 552(h) of the
            Public Health Service Act, as added by subsection (a).
                (2) Final report.--Not later than 2 years after submitting
            the preliminary report required under paragraph (1), the
            Secretary of Health and Human Services shall submit to Congress
            a final report that includes--
                        (A) an evaluation of the effectiveness of the
                    comprehensive services provided by the Centers
                    established or operated pursuant to section 552 of the
                    Public Health Service Act, as added by subsection (a),
                    with respect to health outcomes of the population of
                    individuals with substance use disorder who receive
                    services from the Center, which shall include an
                    evaluation of the effectiveness of services for
                    treatment and recovery support and to reduce relapse,
                    recidivism, and overdose; and
                        (B) recommendations, as appropriate, regarding ways
                    to improve Federal programs related to substance use
                    disorders, which may include dissemination of best
                    practices for the treatment of substance use disorders
                    to health care professionals.

                        Subtitle N--Trauma-Informed Care

    SEC. 7131. <<NOTE: 42 USC 242t.>>  CDC SURVEILLANCE AND DATA
                              COLLECTION FOR CHILD, YOUTH, AND ADULT
                              TRAUMA.

        (a) Data Collection.--The Director of the Centers for Disease
    Control and Prevention (referred to in this section as the ``Director'')
    may, in cooperation with the States, collect and report data on adverse
    childhood experiences through the Behavioral Risk Factor Surveillance
    System, the Youth Risk Behavior Surveillance System, and other relevant
    public health surveys or questionnaires.
        (b) Timing.--The collection of data under subsection (a) may occur
    biennially.
        (c) Data From Rural Areas.--The Director shall encourage each State
    that participates in collecting and reporting data under subsection (a)
    to collect and report data from rural areas within such State, in order
    to generate a statistically reliable representation of such areas.
        (d) Data From Tribal Areas.--The Director may, in cooperation with
    Indian Tribes (as defined in section 4 of the Indian Self-Determination
    and Education Assistance Act) and pursuant to a written request from an
    Indian Tribe, provide technical assistance to such Indian Tribe to
    collect and report data on adverse childhood experiences through the
    Behavioral Risk Factor Surveillance System, the Youth Risk Behavior
    Surveillance System, or another relevant public health survey or
    questionnaire.
        (e) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $2,000,000 for each of fiscal
    years 2019 through 2023.
    SEC. 7132. TASK FORCE TO DEVELOP BEST PRACTICES FOR TRAUMA-
                              INFORMED IDENTIFICATION, REFERRAL, AND
                              SUPPORT.

        (a) Establishment.--There is established a task force, to be known
    as the Interagency Task Force on Trauma-Informed Care (in this section
    referred to as the ``task force'') that shall identify, evaluate, and
    make recommendations regarding--

    [[Page 132 STAT. 4047]]

                (1) best practices with respect to children and youth, and
            their families as appropriate, who have experienced or are at
            risk of experiencing trauma; and
                (2) ways in which Federal agencies can better coordinate to
            improve the Federal response to families impacted by substance
            use disorders and other forms of trauma.

        (b) Membership.--
                (1) Composition.--The task force shall be composed of the
            heads of the following Federal departments and agencies, or
            their designees:
                        (A) The Centers for Medicare & Medicaid Services.
                        (B) The Substance Abuse and Mental Health Services
                    Administration.
                        (C) The Agency for Healthcare Research and Quality.
                        (D) The Centers for Disease Control and Prevention.
                        (E) The Indian Health Service.
                        (F) The Department of Veterans Affairs.
                        (G) The National Institutes of Health.
                        (H) The Food and Drug Administration.
                        (I) The Health Resources and Services
                    Administration.
                        (J) The Department of Defense.
                        (K) The Office of Minority Health of the Department
                    of Health and Human Services.
                        (L) The Administration for Children and Families.
                        (M) The Office of the Assistant Secretary for
                    Planning and Evaluation of the Department of Health and
                    Human Services.
                        (N) The Office for Civil Rights of the Department of
                    Health and Human Services.
                        (O) The Office of Juvenile Justice and Delinquency
                    Prevention of the Department of Justice.
                        (P) The Office of Community Oriented Policing
                    Services of the Department of Justice.
                        (Q) The Office on Violence Against Women of the
                    Department of Justice.
                        (R) The National Center for Education Evaluation and
                    Regional Assistance of the Department of Education.
                        (S) The National Center for Special Education
                    Research of the Institute of Education Science.
                        (T) The Office of Elementary and Secondary Education
                    of the Department of Education.
                        (U) The Office for Civil Rights of the Department of
                    Education.
                        (V) The Office of Special Education and
                    Rehabilitative Services of the Department of Education.
                        (W) The Bureau of Indian Affairs of the Department
                    of the Interior.
                        (X) The Veterans Health Administration of the
                    Department of Veterans Affairs.
                        (Y) The Office of Special Needs Assistance Programs
                    of the Department of Housing and Urban Development.
                        (Z) The Office of Head Start of the Administration
                    for Children and Families.
                        (AA) The Children's Bureau of the Administration for
                    Children and Families.
                        (BB) The Bureau of Indian Education of the
                    Department of the Interior.

    [[Page 132 STAT. 4048]]

                        (CC) Such other Federal agencies as the Secretaries
                    determine to be appropriate.
                (2) Date of appointments.--The heads of Federal departments
            and agencies shall appoint the corresponding members of the task
            force not later than 60 days after the date of enactment of this
            Act.
                (3) Chairperson.--The task force shall be chaired by the
            Assistant Secretary for Mental Health and Substance Use, or the
            Assistant Secretary's designee.

        (c) Task Force Duties.--The task force shall--
                (1) solicit input from stakeholders, including frontline
            service providers, educators, mental health professionals,
            researchers, experts in infant, child, and youth trauma, child
            welfare professionals, and the public, in order to inform the
            activities under paragraph (2); and
                (2) identify, evaluate, make recommendations, and update
            such recommendations not less than annually, to the general
            public, the Secretary of Education, the Secretary of Health and
            Human Services, the Secretary of Labor, the Secretary of the
            Interior, the Attorney General, and other relevant cabinet
            Secretaries, and Congress regarding--
                        (A) a set of evidence-based, evidence-informed, and
                    promising best practices with respect to--
                              (i) prevention strategies for individuals at
                          risk of experiencing or being exposed to trauma,
                          including trauma as a result of exposure to
                          substance use;
                              (ii) the identification of infants, children
                          and youth, and their families as appropriate, who
                          have experienced or are at risk of experiencing
                          trauma;
                              (iii) the expeditious referral to and
                          implementation of trauma-informed practices and
                          supports that prevent and mitigate the effects of
                          trauma, which may include whole-family and multi-
                          generational approaches; and
                              (iv) community based or multi-generational
                          practices that support children and their
                          families;
                        (B) a national strategy on how the task force and
                    member agencies will collaborate, prioritize options
                    for, and implement a coordinated approach, which may
                    include--
                              (i) data sharing;
                              (ii) providing support to infants, children,
                          and youth, and their families as appropriate, who
                          have experienced or are at risk of experiencing
                          trauma;
                              (iii) identifying options for coordinating
                          existing grants that support infants, children,
                          and youth, and their families as appropriate, who
                          have experienced, or are at risk of experiencing,
                          exposure to substance use or other trauma,
                          including trauma related to substance use; and
                              (iv) other ways to improve coordination,
                          planning, and communication within and across
                          Federal agencies, offices, and programs, to better
                          serve children and families impacted by substance
                          use disorders; and
                        (C) existing Federal authorities at the Department
                    of Education, Department of Health and Human Services,
                    Department of Justice, Department of Labor, Department

    [[Page 132 STAT. 4049]]

                    of the Interior, and other relevant agencies, and
                    specific Federal grant programs to disseminate best
                    practices on, provide training in, or deliver services
                    through, trauma-informed practices, and disseminate such
                    information--
                              (i) in writing to relevant program offices at
                          such agencies to encourage grant applicants in
                          writing to use such funds, where appropriate, for
                          trauma-informed practices; and
                              (ii) to the general public through the
                          internet website of the task force.

        (d) Best Practices.--In identifying, evaluating, and recommending
    the set of best practices under subsection (c), the task force shall--
                (1) include guidelines for providing professional
            development and education for front-line services providers,
            including school personnel, early childhood education program
            providers, providers from child- or youth-serving organizations,
            housing and homeless providers, primary and behavioral health
            care providers, child welfare and social services providers,
            juvenile and family court personnel, health care providers,
            individuals who are mandatory reporters of child abuse or
            neglect, trained nonclinical providers (including peer mentors
            and clergy), and first responders, in--
                        (A) understanding and identifying early signs and
                    risk factors of trauma in infants, children, and youth,
                    and their families as appropriate, including through
                    screening processes and services;
                        (B) providing practices to prevent and mitigate the
                    impact of trauma, including by fostering safe and stable
                    environments and relationships; and
                        (C) developing and implementing policies,
                    procedures, or systems that--
                              (i) are designed to quickly refer infants,
                          children, youth, and their families as
                          appropriate, who have experienced or are at risk
                          of experiencing trauma to the appropriate trauma-
                          informed screening and support and age-appropriate
                          treatment, and to ensure such infants, children,
                          youth, and family members receive such support;
                              (ii) utilize and develop partnerships with
                          early childhood education programs, local social
                          services organizations, such as organizations
                          serving youth, and clinical mental health or other
                          health care providers with expertise in providing
                          support services and age-appropriate trauma-
                          informed and evidence-based treatment aimed at
                          preventing or mitigating the effects of trauma;
                              (iii) educate children and youth to--
                                        (I) understand and identify the
                                    signs, effects, or symptoms of trauma;
                                    and
                                        (II) build the resilience and coping
                                    skills to mitigate the effects of
                                    experiencing trauma;
                              (iv) promote and support multi-generational
                          practices that assist parents, foster parents, and
                          kinship and other caregivers in accessing
                          resources related to, and developing environments
                          conducive to, the prevention and mitigation of
                          trauma; and

    [[Page 132 STAT. 4050]]

                              (v) collect and utilize data from screenings,
                          referrals, or the provision of services and
                          supports to evaluate outcomes and improve
                          processes for trauma-informed services and
                          supports that are culturally sensitive,
                          linguistically appropriate, and specific to age
                          ranges and sex, as applicable;
                (2) recommend best practices that are designed to avoid
            unwarranted custody loss or criminal penalties for parents or
            guardians in connection with infants, children, and youth who
            have experienced or are at risk of experiencing trauma; and
                (3) recommend opportunities for local- and State-level
            partnerships that--
                        (A) are designed to quickly identify and refer
                    children and families, as appropriate, who have
                    experienced or are at risk of experiencing exposure to
                    trauma, including related to substance use;
                        (B) utilize and develop partnerships with early
                    childhood education programs, local social services
                    organizations, and health care services aimed at
                    preventing or mitigating the effects of exposure to
                    trauma, including related to substance use;
                        (C) offer community-based prevention activities,
                    including educating families and children on the effects
                    of exposure to trauma, such as trauma related to
                    substance use, and how to build resilience and coping
                    skills to mitigate those effects;
                        (D) in accordance with Federal privacy protections,
                    utilize non-personally-identifiable data from
                    screenings, referrals, or the provision of services and
                    supports to evaluate and improve processes addressing
                    exposure to trauma, including related to substance use;
                    and
                        (E) are designed to prevent separation and support
                    reunification of families if in the best interest of the
                    child.

        (e) Operating Plan.--Not later than 120 days after the date of
    enactment of this Act, the task force shall hold the first meeting. Not
    later than 2 years after such date of enactment, the task force shall
    submit to the Secretary of Education, Secretary of Health and Human
    Services, Secretary of Labor, Secretary of the Interior, the Attorney
    General, and Congress an operating plan for carrying out the activities
    of the task force described in subsection (c)(2). Such operating plan
    shall include--
                (1) a list of specific activities that the task force plans
            to carry out for purposes of carrying out duties described in
            subsection (c)(2), which may include public engagement;
                (2) a plan for carrying out the activities under subsection
            (c)(2);
                (3) a list of members of the task force and other
            individuals who are not members of the task force that may be
            consulted to carry out such activities;
                (4) an explanation of Federal agency involvement and
            coordination needed to carry out such activities, including any
            statutory or regulatory barriers to such coordination;
                (5) a budget for carrying out such activities;
                (6) a proposed timeline for implementing recommendations and
            efforts identified under subsection (c); and

    [[Page 132 STAT. 4051]]

                (7) other information that the task force determines
            appropriate as related to its duties.

        (f) Final Report.--Not later than 3 years after the date of the
    first meeting of the task force, the task force shall submit to the
    general public, Secretary of Education, Secretary of Health and Human
    Services, Secretary of Labor, Secretary of the Interior, the Attorney
    General, other relevant cabinet Secretaries, the Committee on Energy and
    Commerce and the Committee on Education and the Workforce of the House
    of Representatives and the Committee on Health, Education, Labor, and
    Pensions of the Senate, and Congress, a final report containing all of
    the findings and recommendations required under this section, and shall
    make such report available online in an accessible format.
        (g) Additional Reports.--In addition to the final report under
    subsection (f). the task force shall submit--
                (1) a report to Congress identifying any recommendations
            identified under subsection (c) that require additional
            legislative authority to implement; and
                (2) a report to the Governors describing the opportunities
            for local- and State-level partnerships, professional
            development, or best practices recommended under subsection
            (d)(3).

        (h) Definitions.--In this section--
                (1) the term ``early childhood education program'' has the
            meaning given such term in section 103 of the Higher Education
            Act of 1965 (20 U.S.C. 1003);
                (2) The term ``Governor'' means the chief executive officer
            of a State; and
                (3) the term ``State'' means each of the several States, the
            District of Columbia, the Commonwealth of Puerto Rico, the
            Virgin Islands, Guam, American Samoa, and the Commonwealth of
            the Northern Mariana Islands.

        (i) Sunset.--The task force shall sunset on the date that is 60 days
    after the submission of the final report under subsection (f), but not
    later than September 30, 2023.
    SEC. 7133. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE.

        Section 582(j) of the Public Health Service Act (42 U.S.C. 290hh-
    1(j)) (relating to grants to address the problems of persons who
    experience violence-related stress) is amended by striking ``$46,887,000
    for each of fiscal years 2018 through 2022'' and inserting ``$63,887,000
    for each of fiscal years 2019 through 2023''.
    SEC. 7134. <<NOTE: 42 USC 280h-7.>>  GRANTS TO IMPROVE TRAUMA
                              SUPPORT SERVICES AND MENTAL HEALTH CARE
                              FOR CHILDREN AND YOUTH IN EDUCATIONAL
                              SETTINGS.

        (a) Grants, Contracts, and Cooperative Agreements Authorized.--The
    Secretary, in coordination with the Assistant Secretary for Mental
    Health and Substance Use, is authorized to award grants to, or enter
    into contracts or cooperative agreements with, State educational
    agencies, local educational agencies, Indian Tribes (as defined in
    section 4 of the Indian Self-Determination and Education Assistance Act)
    or their tribal educational agencies, a school operated by the Bureau of
    Indian Education, a Regional Corporation, or a Native Hawaiian
    educational organization, for the purpose of increasing student access
    to evidence-based trauma support services and mental health care by
    developing innovative initiatives, activities, or programs to link local
    school systems with

    [[Page 132 STAT. 4052]]

    local trauma-informed support and mental health systems, including those
    under the Indian Health Service.
        (b) Duration.--With respect to a grant, contract, or cooperative
    agreement awarded or entered into under this section, the period during
    which payments under such grant, contract or agreement are made to the
    recipient may not exceed 4 years.
        (c) Use of Funds.--An entity that receives a grant, contract, or
    cooperative agreement under this section shall use amounts made
    available through such grant, contract, or cooperative agreement for
    evidence-based activities, which shall include any of the following:
                (1) Collaborative efforts between school-based service
            systems and trauma-informed support and mental health service
            systems to provide, develop, or improve prevention, screening,
            referral, and treatment and support services to students, such
            as providing trauma screenings to identify students in need of
            specialized support.
                (2) To implement schoolwide positive behavioral
            interventions and supports, or other trauma-informed models of
            support.
                (3) To provide professional development to teachers, teacher
            assistants, school leaders, specialized instructional support
            personnel, and mental health professionals that--
                        (A) fosters safe and stable learning environments
                    that prevent and mitigate the effects of trauma,
                    including through social and emotional learning;
                        (B) improves school capacity to identify, refer, and
                    provide services to students in need of trauma support
                    or behavioral health services; or
                        (C) reflects the best practices for trauma-informed
                    identification, referral, and support developed by the
                    Task Force under section 7132.
                (4) Services at a full-service community school that focuses
            on trauma-informed supports, which may include a full-time site
            coordinator, or other activities consistent with section 4625 of
            the Elementary and Secondary Education Act of 1965 (20 U.S.C.
            7275).
                (5) Engaging families and communities in efforts to increase
            awareness of child and youth trauma, which may include sharing
            best practices with law enforcement regarding trauma-informed
            care and working with mental health professionals to provide
            interventions, as well as longer term coordinated care within
            the community for children and youth who have experienced trauma
            and their families.
                (6) To provide technical assistance to school systems and
            mental health agencies.
                (7) To evaluate the effectiveness of the program carried out
            under this section in increasing student access to evidence-
            based trauma support services and mental health care.
                (8) To establish partnerships with or provide subgrants to
            Head Start agencies (including Early Head Start agencies),
            public and private preschool programs, child care programs
            (including home-based providers), or other entities described in
            subsection (a), to include such entities described in this
            paragraph in the evidence-based trauma initiatives, activities,
            support services, and mental health systems established under
            this section in order to provide, develop, or improve
            prevention,

    [[Page 132 STAT. 4053]]

            screening, referral, and treatment and support services to young
            children and their families.

        (d) Applications.--To be eligible to receive a grant, contract, or
    cooperative agreement under this section, an entity described in
    subsection (a) shall submit an application to the Secretary at such
    time, in such manner, and containing such information as the Secretary
    may reasonably require, which shall include the following:
                (1) A description of the innovative initiatives, activities,
            or programs to be funded under the grant, contract, or
            cooperative agreement, including how such program will increase
            access to evidence-based trauma support services and mental
            health care for students, and, as applicable, the families of
            such students.
                (2) A description of how the program will provide
            linguistically appropriate and culturally competent services.
                (3) A description of how the program will support students
            and the school in improving the school climate in order to
            support an environment conducive to learning.
                (4) An assurance that--
                        (A) persons providing services under the grant,
                    contract, or cooperative agreement are adequately
                    trained to provide such services; and
                        (B) teachers, school leaders, administrators,
                    specialized instructional support personnel,
                    representatives of local Indian Tribes or tribal
                    organizations as appropriate, other school personnel,
                    and parents or guardians of students participating in
                    services under this section will be engaged and involved
                    in the design and implementation of the services.
                (5) A description of how the applicant will support and
            integrate existing school-based services with the program in
            order to provide mental health services for students, as
            appropriate.
                (6) A description of the entities in the community with
            which the applicant will partner or to which the applicant will
            provide subgrants in accordance with subsection (c)(8).

        (e) Interagency Agreements.--
                (1) Local interagency agreements.--To ensure the provision
            of the services described in subsection (c), a recipient of a
            grant, contract, or cooperative agreement under this section, or
            their designee, shall establish a local interagency agreement
            among local educational agencies, agencies responsible for early
            childhood education programs, Head Start agencies (including
            Early Head Start agencies), juvenile justice authorities, mental
            health agencies, child welfare agencies, and other relevant
            agencies, authorities, or entities in the community that will be
            involved in the provision of such services.
                (2) Contents.--In ensuring the provision of the services
            described in subsection (c), the local interagency agreement
            shall specify with respect to each agency, authority, or entity
            that is a party to such agreement--
                        (A) the financial responsibility for the services;
                        (B) the conditions and terms of responsibility for
                    the services, including quality, accountability, and
                    coordination of the services; and

    [[Page 132 STAT. 4054]]

                        (C) the conditions and terms of reimbursement among
                    such agencies, authorities, or entities, including
                    procedures for dispute resolution.

        (f) Evaluation.--The Secretary shall reserve not more than 3 percent
    of the funds made available under subsection (l) for each fiscal year
    to--
                (1) conduct a rigorous, independent evaluation of the
            activities funded under this section; and
                (2) disseminate and promote the utilization of evidence-
            based practices regarding trauma support services and mental
            health care.

        (g) Distribution of Awards.--The Secretary shall ensure that grants,
    contracts, and cooperative agreements awarded or entered into under this
    section are equitably distributed among the geographical regions of the
    United States and among tribal, urban, suburban, and rural populations.
        (h) Rule of Construction.--Nothing in this section shall be
    construed--
                (1) to prohibit an entity involved with a program carried
            out under this section from reporting a crime that is committed
            by a student to appropriate authorities; or
                (2) to prevent Federal, State, and tribal law enforcement
            and judicial authorities from exercising their responsibilities
            with regard to the application of Federal, tribal, and State law
            to crimes committed by a student.

        (i) Supplement, Not Supplant.--Any services provided through
    programs carried out under this section shall supplement, and not
    supplant, existing mental health services, including any special
    education and related services provided under the Individuals with
    Disabilities Education Act (20 U.S.C. 1400 et seq.).
        (j) Consultation With Indian Tribes.--In carrying out subsection
    (a), the Secretary shall, in a timely manner, meaningfully consult with
    Indian Tribes and their representatives to ensure notice of eligibility.
        (k) Definitions.--In this section:
                (1) Elementary school.--The term ``elementary school'' has
            the meaning given such term in section 8101 of the Elementary
            and Secondary Education Act of 1965 (20 U.S.C. 7801).
                (2) Evidence-based.--The term ``evidence-based'' has the
            meaning given such term in section 8101(21)(A)(i) of the
            Elementary and Secondary Education Act of 1965 (20 U.S.C.
            7801(21)(A)(i)).
                (3) Native hawaiian educational organization.--The term
            ``Native Hawaiian educational organization'' has the meaning
            given such term in section 6207 of the Elementary and Secondary
            Education Act of 1965 (20 U.S.C. 7517).
                (4) Local educational agency.--The term ``local educational
            agency'' has the meaning given such term in section 8101 of the
            Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
                (5) Regional corporation.--The term ``Regional Corporation''
            has the meaning given the term in section 3 of the Alaska Native
            Claims Settlement Act (43 U.S.C. 1602)).
                (6) School.--The term ``school'' means a public elementary
            school or public secondary school.

    [[Page 132 STAT. 4055]]

                (7) School leader.--The term ``school leader'' has the
            meaning given such term in section 8101 of the Elementary and
            Secondary Education Act of 1965 (20 U.S.C. 7801).
                (8) Secondary school.--The term ``secondary school'' has the
            meaning given such term in section 8101 of the Elementary and
            Secondary Education Act of 1965 (20 U.S.C. 7801).
                (9) Secretary.--The term ``Secretary'' means the Secretary
            of Education.
                (10) Specialized instructional support personnel.--The term
            ``specialized instructional support personnel'' has the meaning
            given such term in section 8101 of the Elementary and Secondary
            Education Act of 1965 (20 U.S.C. 7801).
                (11) State educational agency.--The term ``State educational
            agency'' has the meaning given such term in section 8101 of the
            Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).

        (l) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section, $50,000,000 for each of fiscal
    years 2019 through 2023.
    SEC. 7135. <<NOTE: 42 USC 280h-8.>>  RECOGNIZING EARLY CHILDHOOD
                              TRAUMA RELATED TO SUBSTANCE ABUSE.

        (a) Dissemination of Information.--The Secretary of Health and Human
    Services shall disseminate information, resources, and, if requested,
    technical assistance to early childhood care and education providers and
    professionals working with young children on--
                (1) ways to properly recognize children who may be impacted
            by trauma, including trauma related to substance use by a family
            member or other adult; and
                (2) how to respond appropriately in order to provide for the
            safety and well-being of young children and their families.

        (b) Goals.--The information, resources, and technical assistance
    provided under subsection (a) shall--
                (1) educate early childhood care and education providers and
            professionals working with young children on understanding and
            identifying the early signs and risk factors of children who
            might be impacted by trauma, including trauma due to exposure to
            substance use;
                (2) suggest age-appropriate communication tools, procedures,
            and practices for trauma-informed care, including ways to
            prevent or mitigate the effects of trauma;
                (3) provide options for responding to children impacted by
            trauma, including due to exposure to substance use, that
            consider the needs of the child and family, including
            recommending resources and referrals for evidence-based services
            to support such family; and
                (4) promote whole-family and multi-generational approaches
            to keep families safely together when it is in the best interest
            of the child.

        (c) Coordination.--The Secretary of Health and Human Services shall
    coordinate with the task force to develop best practices for trauma-
    informed identification, referral, and support authorized under section
    7132 in disseminating the information, resources, and technical
    assistance described under subsection (b).

    [[Page 132 STAT. 4056]]

        (d) Rule of Construction.--Such information, resources, and if
    applicable, technical assistance, shall not be construed to amend the
    requirements under--
                (1) the Child Care and Development Block Grant Act of 1990
            (42 U.S.C. 9858 et seq.);
                (2) the Head Start Act (42 U.S.C. 9831 et seq.); or
                (3) the Individuals with Disabilities Education Act (20
            U.S.C. 1400 et seq.).

           Subtitle O--Eliminating Opioid Related Infectious Diseases

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

        Section 317N of the Public Health Service Act (42 U.S.C. 247b-15) is
    amended to read as follows:
    ``SEC. 317N. SURVEILLANCE AND EDUCATION REGARDING INFECTIONS
                              ASSOCIATED WITH ILLICIT DRUG USE AND
                              OTHER RISK FACTORS.

        ``(a) In General.--The Secretary, acting through the Director of the
    Centers for Disease Control and Prevention, may (directly or through
    grants to public and nonprofit private entities) provide for programs
    for the following:
                ``(1) To cooperate with States and Indian tribes in
            implementing or maintaining a national system to determine the
            incidence of infections commonly associated with illicit drug
            use, such as viral hepatitis, human immunodeficiency virus, and
            infective endocarditis, and to assist the States in determining
            the prevalence of such infections, which may include the
            reporting of cases of such infections.
                ``(2) To identify, counsel, and offer testing to individuals
            who are at risk of infections described in paragraph (1)
            resulting from illicit drug use, receiving blood transfusions
            prior to July 1992, or other risk factors.
                ``(3) To provide appropriate referrals for counseling,
            testing, and medical treatment of individuals identified under
            paragraph (2) and to ensure, to the extent practicable, the
            provision of appropriate follow-up services.
                ``(4) To develop and disseminate public information and
            education programs for the detection and control of infections
            described in paragraph (1), with priority given to high-risk
            populations as determined by the Secretary.
                ``(5) To improve the education, training, and skills of
            health professionals in the detection and control of infections
            described in paragraph (1), including to improve coordination of
            treatment of substance use disorders and infectious diseases,
            with priority given to substance use disorder treatment
            providers, pediatricians and other primary care providers,
            obstetrician-gynecologists, and infectious disease clinicians,
            including HIV clinicians.

        ``(b) Laboratory Procedures.--The Secretary may (directly or through
    grants to public and nonprofit private entities) carry out programs to
    provide for improvements in the quality of clinical-

    [[Page 132 STAT. 4057]]

    laboratory procedures regarding infections described in subsection
    (a)(1).
        ``(c) Definition.--In this section, the term `Indian tribe' has the
    meaning given that term in section 4 of the Indian Self-Determination
    and Education Assistance Act.
        ``(d) Authorization of Appropriations.--For the purpose of carrying
    out this section, there are authorized to be appropriated $40,000,000
    for each of the fiscal years 2019 through 2023.''.

                Subtitle P--Peer Support Communities of Recovery

    SEC. 7151. BUILDING COMMUNITIES OF RECOVERY.

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

        ``(a) Definition.--In this section, the term `recovery community
    organization' means an independent nonprofit organization that--
                ``(1) mobilizes resources within and outside of the recovery
            community, which may include through a peer support network, to
            increase the prevalence and quality of long-term recovery from
            substance use disorders; and
                ``(2) is wholly or principally governed by people in
            recovery for substance use disorders who reflect the community
            served.

        ``(b) Grants Authorized.--The Secretary shall award grants to
    recovery community organizations to enable such organizations to
    develop, expand, and enhance recovery services.
        ``(c) Federal Share.--The Federal share of the costs of a program
    funded by a grant under this section may not exceed 85 percent.
        ``(d) Use of Funds.--Grants awarded under subsection (b)--
                ``(1) shall be used to develop, expand, and enhance
            community and statewide recovery support services; and
                ``(2) may be used to--
                        ``(A) build connections between recovery networks,
                    including between recovery community organizations and
                    peer support networks, and with other recovery support
                    services, including--
                              ``(i) behavioral health providers;
                              ``(ii) primary care providers and physicians;
                              ``(iii) educational and vocational schools;
                              ``(iv) employers;
                              ``(v) housing services;
                              ``(vi) child welfare agencies; and
                              ``(vii) other recovery support services that
                          facilitate recovery from substance use disorders,
                          including non-clinical community services;
                        ``(B) reduce stigma associated with substance use
                    disorders; and
                        ``(C) conduct outreach on issues relating to
                    substance use disorders and recovery, including--
                              ``(i) identifying the signs of substance use
                          disorder;
                              ``(ii) the resources available to individuals
                          with substance use disorder and to families of an
                          individual

    [[Page 132 STAT. 4058]]

                          with a substance use disorder, including programs
                          that mentor and provide support services to
                          children;
                              ``(iii) the resources available to help
                          support individuals in recovery; and
                              ``(iv) related medical outcomes of substance
                          use disorders, the potential of acquiring an
                          infection commonly associated with illicit drug
                          use, and neonatal abstinence syndrome among
                          infants exposed to opioids during pregnancy.

        ``(e) Special Consideration.--In carrying out this section, the
    Secretary shall give special consideration to the unique needs of rural
    areas, including areas with an age-adjusted rate of drug overdose deaths
    that is above the national average and areas with a shortage of
    prevention and treatment services.
        ``(f) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $5,000,000 for each of fiscal
    years 2019 through 2023.''.
    SEC. 7152. PEER SUPPORT TECHNICAL ASSISTANCE CENTER.

        Title V of the Public Health Service Act (42 U.S.C. 290dd et seq.)
    is amended by inserting after section 547 the following:
    ``SEC. 547A. <<NOTE: 42 USC 290ee-2a.>>  PEER SUPPORT TECHNICAL
                              ASSISTANCE CENTER.

        ``(a) Establishment.--The Secretary, acting through the Assistant
    Secretary, shall establish or operate a National Peer-Run Training and
    Technical Assistance Center for Addiction Recovery Support (referred to
    in this section as the `Center').
        ``(b) Functions.--The Center established under subsection (a) shall
    provide technical assistance and support to recovery community
    organizations and peer support networks, including such assistance and
    support related to--
                ``(1) training on identifying--
                        ``(A) signs of substance use disorder;
                        ``(B) resources to assist individuals with a
                    substance use disorder, or resources for families of an
                    individual with a substance use disorder; and
                        ``(C) best practices for the delivery of recovery
                    support services;
                ``(2) the provision of translation services, interpretation,
            or other such services for clients with limited English speaking
            proficiency;
                ``(3) data collection to support research, including for
            translational research;
                ``(4) capacity building; and
                ``(5) evaluation and improvement, as necessary, of the
            effectiveness of such services provided by recovery community
            organizations.

        ``(c) Best Practices.--The Center established under subsection (a)
    shall periodically issue best practices for use by recovery community
    organizations and peer support networks.
        ``(d) Recovery Community Organization.--In this section, the term
    `recovery community organization' has the meaning given such term in
    section 547.
        ``(e) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $1,000,000 for each of fiscal
    years 2019 through 2023.''.

    [[Page 132 STAT. 4059]]

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

    SEC. 7161. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

        (a) In General.--Part J of title III of the Public Health Service
    Act (42 U.S.C. 280b et seq.) is amended by inserting after section 392
    (42 U.S.C. 280b-1) the following:
    ``SEC. 392A. <<NOTE: 42 USC 280b-1.>>  PREVENTING OVERDOSES OF
                              CONTROLLED SUBSTANCES.

        ``(a) Evidence-Based Prevention Grants.--
                ``(1) In general.--The Director of the Centers for Disease
            Control and Prevention may--
                        ``(A) to the extent practicable, carry out and
                    expand any evidence-based prevention activities
                    described in paragraph (2);
                        ``(B) provide training and technical assistance to
                    States, localities, and Indian tribes for purposes of
                    carrying out such activity; and
                        ``(C) award grants to States, localities, and Indian
                    tribes for purposes of carrying out such activity.
                ``(2) Evidence-based prevention activities.--An evidence-
            based prevention activity described in this paragraph is any of
            the following activities:
                        ``(A) Improving the efficiency and use of a new or
                    currently operating prescription drug monitoring
                    program, including by--
                              ``(i) encouraging all authorized users (as
                          specified by the State or other entity) to
                          register with and use the program;
                              ``(ii) enabling such users to access any
                          updates to information collected by the program in
                          as close to real-time as possible;
                              ``(iii) improving the ease of use of such
                          program;
                              ``(iv) providing for a mechanism for the
                          program to notify authorized users of any
                          potential misuse or abuse of controlled substances
                          and any detection of inappropriate prescribing or
                          dispensing practices relating to such substances;
                              ``(v) encouraging the analysis of prescription
                          drug monitoring data for purposes of providing de-
                          identified, aggregate reports based on such
                          analysis to State public health agencies, State
                          substance abuse agencies, State licensing boards,
                          and other appropriate State agencies, as permitted
                          under applicable Federal and State law and the
                          policies of the prescription drug monitoring
                          program and not containing any protected health
                          information, to prevent inappropriate prescribing,
                          drug diversion, or abuse and misuse of controlled
                          substances, and to facilitate better coordination
                          among agencies;
                              ``(vi) enhancing interoperability between the
                          program and any health information technology
                          (including

    [[Page 132 STAT. 4060]]

                          certified health information technology),
                          including by integrating program data into such
                          technology;
                              ``(vii) updating program capabilities to
                          respond to technological innovation for purposes
                          of appropriately addressing the occurrence and
                          evolution of controlled substance overdoses;
                              ``(viii) facilitating and encouraging data
                          exchange between the program and the prescription
                          drug monitoring programs of other States;
                              ``(ix) enhancing data collection and quality,
                          including improving patient matching and
                          proactively monitoring data quality;
                              ``(x) providing prescriber and dispenser
                          practice tools, including prescriber practice
                          insight reports for practitioners to review their
                          prescribing patterns in comparison to such
                          patterns of other practitioners in the specialty;
                          and
                              ``(xi) meeting the purpose of the program
                          established under section 399O, as described in
                          section 399O(a).
                        ``(B) Promoting community or health system
                    interventions.
                        ``(C) Evaluating interventions to prevent controlled
                    substance overdoses.
                        ``(D) Implementing projects to advance an innovative
                    prevention approach with respect to new and emerging
                    public health crises and opportunities to address such
                    crises, such as enhancing public education and awareness
                    on the risks associated with opioids.
                ``(3) Additional grants.--The Director may award grants to
            States, localities, and Indian Tribes--
                        ``(A) to carry out innovative projects for grantees
                    to rapidly respond to controlled substance misuse,
                    abuse, and overdoses, including changes in patterns of
                    controlled substance use; and
                        ``(B) for any other evidence-based activity for
                    preventing controlled substance misuse, abuse, and
                    overdoses as the Director determines appropriate.
                ``(4) Research.--The Director, in coordination with the
            Assistant Secretary for Mental Health and Substance Use and the
            National Mental Health and Substance Use Policy Laboratory
            established under section 501A, as appropriate and applicable,
            may conduct studies and evaluations to address substance use
            disorders, including preventing substance use disorders or other
            related topics the Director determines appropriate.

        ``(b) Enhanced Controlled Substance Overdose Data Collection,
    Analysis, and Dissemination Grants.--
                ``(1) In general.--The Director of the Centers for Disease
            Control and Prevention may--
                        ``(A) to the extent practicable, carry out any
                    controlled substance overdose data collection activities
                    described in paragraph (2);
                        ``(B) provide training and technical assistance to
                    States, localities, and Indian tribes for purposes of
                    carrying out such activity;

    [[Page 132 STAT. 4061]]

                        ``(C) award grants to States, localities, and Indian
                    tribes for purposes of carrying out such activity; and
                        ``(D) coordinate with the Assistant Secretary for
                    Mental Health and Substance Use to collect data pursuant
                    to section 505(d)(1)(A) (relating to the number of
                    individuals admitted to emergency departments as a
                    result of the abuse of alcohol or other drugs).
                ``(2) Controlled substance overdose data collection and
            analysis activities.--A controlled substance overdose data
            collection, analysis, and dissemination activity described in
            this paragraph is any of the following activities:
                        ``(A) Improving the timeliness of reporting data to
                    the public, including data on fatal and nonfatal
                    overdoses of controlled substances.
                        ``(B) Enhancing the comprehensiveness of controlled
                    substance overdose data by collecting information on
                    such overdoses from appropriate sources such as
                    toxicology reports, autopsy reports, death scene
                    investigations, and emergency departments.
                        ``(C) Modernizing the system for coding causes of
                    death related to controlled substance overdoses to use
                    an electronic-based system.
                        ``(D) Using data to help identify risk factors
                    associated with controlled substance overdoses.
                        ``(E) Supporting entities involved in providing
                    information on controlled substance overdoses, such as
                    coroners, medical examiners, and public health
                    laboratories to improve accurate testing and
                    standardized reporting of causes and contributing
                    factors to controlled substances overdoses and analysis
                    of various opioid analogues to controlled substance
                    overdoses.
                        ``(F) Working to enable and encourage the access,
                    exchange, and use of information regarding controlled
                    substance overdoses among data sources and entities.

        ``(c) Definitions.--In this section:
                ``(1) Controlled substance.--The term `controlled substance'
            has the meaning given that term in section 102 of the Controlled
            Substances Act.
                ``(2) Indian tribe.--The term `Indian tribe' has the meaning
            given that term in section 4 of the Indian Self-Determination
            and Education Assistance Act.

        ``(d) Authorization of Appropriations.--For purposes of carrying out
    this section, section 399O of this Act, and section 102 of the
    Comprehensive Addiction and Recovery Act of 2016 (Public Law 114-198),
    there is authorized to be appropriated $496,000,000 for each of fiscal
    years 2019 through 2023.''.
        (b) Education and Awareness.--Section 102 of the Comprehensive
    Addiction and Recovery Act of 2016 (Public Law 114-198) is amended--
                (1) by amending subsection (a) to read as follows:

        ``(a) In General.--The Secretary of Health and Human Services,
    acting through the Director of the Centers for Disease Control and
    Prevention and in coordination with the heads of other departments and
    agencies, shall advance education and awareness regarding the risks
    related to misuse and abuse of opioids, as appropriate, which may
    include developing or improving existing

    [[Page 132 STAT. 4062]]

    programs, conducting activities, and awarding grants that advance the
    education and awareness of--
                ``(1) the public, including patients and consumers--
                        ``(A) generally; and
                        ``(B) regarding such risks related to unused opioids
                    and the dispensing options under section 309(f) of the
                    Controlled Substances Act, as applicable; and
                ``(2) providers, which may include--
                        ``(A) providing for continuing education on
                    appropriate prescribing practices;
                        ``(B) education related to applicable State or local
                    prescriber limit laws, information on the use of non-
                    addictive alternatives for pain management, and the use
                    of overdose reversal drugs, as appropriate;
                        ``(C) disseminating and improving the use of
                    evidence-based opioid prescribing guidelines across
                    relevant health care settings, as appropriate, and
                    updating guidelines as necessary;
                        ``(D) implementing strategies, such as best
                    practices, to encourage and facilitate the use of
                    prescriber guidelines, in accordance with State and
                    local law;
                        ``(E) disseminating information to providers about
                    prescribing options for controlled substances, including
                    such options under section 309(f) of the Controlled
                    Substances Act, as applicable; and
                        ``(F) disseminating information, as appropriate, on
                    the National Pain Strategy developed by or in
                    consultation with the Assistant Secretary for Health;
                    and
                ``(3) other appropriate entities.''; and
                (2) in subsection (b)--
                        (A) by striking ``opioid abuse'' each place such
                    term appears and inserting ``opioid misuse and abuse'';
                    and
                        (B) in paragraph (2), by striking ``safe disposal of
                    prescription medications and other'' and inserting
                    ``non-addictive treatment options, safe disposal options
                    for prescription medications, and other applicable''.
    SEC. 7162. PRESCRIPTION DRUG MONITORING PROGRAM.

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

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

    [[Page 132 STAT. 4063]]

                                        ``(II) more timely inclusion of data
                                    within a PDMP;
                                        ``(III) active management of the
                                    PDMP, in part by sending proactive or
                                    unsolicited reports to providers to
                                    inform prescribing; and
                                        ``(IV) ensuring the highest level of
                                    ease in use of and access to PDMPs by
                                    providers and their delegates, to the
                                    extent that State laws allow;
                              ``(ii) in consultation with the Office of the
                          National Coordinator for Health Information
                          Technology, improving the intrastate
                          interoperability of PDMPs by--
                                        ``(I) making PDMPs more actionable
                                    by integrating PDMPs within electronic
                                    health records and health information
                                    technology infrastructure; and
                                        ``(II) linking PDMP data to other
                                    data systems within the State,
                                    including--
                                                ``(aa) the data of pharmacy
                                            benefit managers, medical
                                            examiners and coroners, and the
                                            State's Medicaid program;
                                                ``(bb) worker's compensation
                                            data; and
                                                ``(cc) prescribing data of
                                            providers of the Department of
                                            Veterans Affairs and the Indian
                                            Health Service within the State;
                              ``(iii) in consultation with the Office of the
                          National Coordinator for Health Information
                          Technology, improving the interstate
                          interoperability of PDMPs through--
                                        ``(I) sharing of dispensing data in
                                    near-real time across State lines; and
                                        ``(II) integration of automated
                                    queries for multistate PDMP data and
                                    analytics into clinical workflow to
                                    improve the use of such data and
                                    analytics by practitioners and
                                    dispensers; or
                              ``(iv) improving the ability to include
                          treatment availability resources and referral
                          capabilities within the PDMP.
                ``(2) Legislation.--As a condition on the receipt of support
            under this section, the Secretary shall require a State or
            locality to demonstrate that it has enacted legislation or
            regulations--
                        ``(A) to provide for the implementation of the PDMP;
                    and
                        ``(B) to permit the imposition of appropriate
                    penalties for the unauthorized use and disclosure of
                    information maintained by the PDMP.

        ``(b) PDMP Strategies.--The Secretary shall encourage a State or
    locality, in establishing, improving, or maintaining a PDMP, to
    implement strategies that improve--
                ``(1) the reporting of dispensing in the State or locality
            of a controlled substance to an ultimate user so the reporting
            occurs not later than 24 hours after the dispensing event;
                ``(2) the consultation of the PDMP by each prescribing
            practitioner, or their designee, in the State or locality before
            initiating treatment with a controlled substance, or any
            substance as required by the State to be reported to the PDMP,

    [[Page 132 STAT. 4064]]

            and over the course of ongoing treatment for each prescribing
            event;
                ``(3) the consultation of the PDMP before dispensing a
            controlled substance, or any substance as required by the State
            to be reported to the PDMP;
                ``(4) the proactive notification to a practitioner when
            patterns indicative of controlled substance misuse by a patient,
            including opioid misuse, are detected;
                ``(5) the availability of data in the PDMP to other States,
            as allowable under State law; and
                ``(6) the availability of nonidentifiable information to the
            Centers for Disease Control and Prevention for surveillance,
            epidemiology, statistical research, or educational purposes.

        ``(c) Drug Misuse and Abuse.--In consultation with practitioners,
    dispensers, and other relevant and interested stakeholders, a State
    receiving support under this section--
                ``(1) shall establish a program to notify practitioners and
            dispensers of information that will help to identify and prevent
            the unlawful diversion or misuse of controlled substances;
                ``(2) may, to the extent permitted under State law, notify
            the appropriate authorities responsible for carrying out drug
            diversion investigations if the State determines that
            information in the PDMP maintained by the State indicates an
            unlawful diversion or abuse of a controlled substance;
                ``(3) may conduct analyses of controlled substance program
            data for purposes of providing appropriate State agencies with
            aggregate reports based on such analyses in as close to real-
            time as practicable, regarding prescription patterns flagged as
            potentially presenting a risk of misuse, abuse, addiction,
            overdose, and other aggregate information, as appropriate and in
            compliance with applicable Federal and State laws and provided
            that such reports shall not include protected health
            information; and
                ``(4) may access information about prescriptions, such as
            claims data, to ensure that such prescribing and dispensing
            history is updated in as close to real-time as practicable, in
            compliance with applicable Federal and State laws and provided
            that such information shall not include protected health
            information.

        ``(d) Evaluation and Reporting.--As a condition on receipt of
    support under this section, the State shall report on interoperability
    with PDMPs of other States and Federal agencies, where appropriate,
    intrastate interoperability with health information technology systems
    such as electronic health records, health information exchanges, and e-
    prescribing, where appropriate, and whether or not the State provides
    automatic, up-to-date, or daily information about a patient when a
    practitioner (or the designee of a practitioner, where permitted)
    requests information about such patient.
        ``(e) Evaluation and Reporting.--A State receiving support under
    this section shall provide the Secretary with aggregate nonidentifiable
    information, as permitted by State law, to enable the Secretary--
                ``(1) to evaluate the success of the State's program in
            achieving the purpose described in subsection (a); or
                ``(2) to prepare and submit to the Congress the report
            required by subsection (i)(2).

    [[Page 132 STAT. 4065]]

        ``(f) Education and Access to the Monitoring System.--A State
    receiving support under this section shall take steps to--
                ``(1) facilitate prescribers and dispensers, and their
            delegates, as permitted by State law, to use the PDMP, to the
            extent practicable; and
                ``(2) educate prescribers and dispensers, and their
            delegates on the benefits of the use of PDMPs.

        ``(g) Electronic Format.--The Secretary may issue guidelines
    specifying a uniform electronic format for the reporting, sharing, and
    disclosure of information pursuant to PDMPs. To the extent possible,
    such guidelines shall be consistent with standards recognized by the
    Office of the National Coordinator for Health Information Technology.
        ``(h) Rules of Construction.--
                ``(1) Functions otherwise authorized by law.--Nothing in
            this section shall be construed to restrict the ability of any
            authority, including any local, State, or Federal law
            enforcement, narcotics control, licensure, disciplinary, or
            program authority, to perform functions otherwise authorized by
            law.
                ``(2) Additional privacy protections.--Nothing in this
            section shall be construed as preempting any State from imposing
            any additional privacy protections.
                ``(3) Federal privacy requirements.--Nothing in this section
            shall be construed to supersede any Federal privacy or
            confidentiality requirement, including the regulations
            promulgated under section 264(c) of the Health Insurance
            Portability and Accountability Act of 1996 (Public Law 104-191;
            110 Stat. 2033) and section 543 of this Act.
                ``(4) No federal private cause of action.--Nothing in this
            section shall be construed to create a Federal private cause of
            action.

        ``(i) Progress Report.--Not later than 3 years after the date of
    enactment of this section, the Secretary shall--
                ``(1) complete a study that--
                        ``(A) determines the progress of grantees in
                    establishing and implementing PDMPs consistent with this
                    section;
                        ``(B) provides an analysis of the extent to which
                    the operation of PDMPs has--
                              ``(i) reduced inappropriate use, abuse,
                          diversion of, and overdose with, controlled
                          substances;
                              ``(ii) established or strengthened initiatives
                          to ensure linkages to substance use disorder
                          treatment services; or
                              ``(iii) affected patient access to appropriate
                          care in States operating PDMPs;
                        ``(C) determine the progress of grantees in
                    achieving interstate interoperability and intrastate
                    interoperability of PDMPs, including an assessment of
                    technical, legal, and financial barriers to such
                    progress and recommendations for addressing these
                    barriers;
                        ``(D) determines the progress of grantees in
                    implementing near real-time electronic PDMPs;
                        ``(E) provides an analysis of the privacy
                    protections in place for the information reported to the
                    PDMP in each State or locality receiving support under
                    this section and

    [[Page 132 STAT. 4066]]

                    any recommendations of the Secretary for additional
                    Federal or State requirements for protection of this
                    information;
                        ``(F) determines the progress of States or
                    localities in implementing technological alternatives to
                    centralized data storage, such as peer-to-peer file
                    sharing or data pointer systems, in PDMPs and the
                    potential for such alternatives to enhance the privacy
                    and security of individually identifiable data; and
                        ``(G) evaluates the penalties that States or
                    localities have enacted for the unauthorized use and
                    disclosure of information maintained in PDMPs, and the
                    criteria used by the Secretary to determine whether such
                    penalties qualify as appropriate for purposes of
                    subsection (a)(2); and
                ``(2) submit a report to the Congress on the results of the
            study.

        ``(j) Advisory Council.--
                ``(1) Establishment.--A State or locality may establish an
            advisory council to assist in the establishment, improvement, or
            maintenance of a PDMP consistent with this section.
                ``(2) Limitation.--A State or locality may not use Federal
            funds for the operations of an advisory council to assist in the
            establishment, improvement, or maintenance of a PDMP.
                ``(3) Sense of congress.--It is the sense of the Congress
            that, in establishing an advisory council to assist in the
            establishment, improvement, or maintenance of a PDMP, a State or
            locality should consult with appropriate professional boards and
            other interested parties.

        ``(k) Definitions.--For purposes of this section:
                ``(1) The term `controlled substance' means a controlled
            substance (as defined in section 102 of the Controlled
            Substances Act) in schedule II, III, or IV of section 202 of
            such Act.
                ``(2) The term `dispense' means to deliver a controlled
            substance to an ultimate user by, or pursuant to the lawful
            order of, a practitioner, irrespective of whether the dispenser
            uses the Internet or other means to effect such delivery.
                ``(3) The term `dispenser' means a physician, pharmacist, or
            other person that dispenses a controlled substance to an
            ultimate user.
                ``(4) The term `interstate interoperability' with respect to
            a PDMP means the ability of the PDMP to electronically share
            reported information with another State if the information
            concerns either the dispensing of a controlled substance to an
            ultimate user who resides in such other State, or the dispensing
            of a controlled substance prescribed by a practitioner whose
            principal place of business is located in such other State.
                ``(5) The term `intrastate interoperability' with respect to
            a PDMP means the integration of PDMP data within electronic
            health records and health information technology infrastructure
            or linking of a PDMP to other data systems within the State,
            including the State's Medicaid program, workers' compensation
            programs, and medical examiners or coroners.
                ``(6) The term `nonidentifiable information' means
            information that does not identify a practitioner, dispenser, or
            an ultimate user and with respect to which there is no
            reasonable

    [[Page 132 STAT. 4067]]

            basis to believe that the information can be used to identify a
            practitioner, dispenser, or an ultimate user.
                ``(7) The term `PDMP' means a prescription drug monitoring
            program that is State-controlled.
                ``(8) The term `practitioner' means a physician, dentist,
            veterinarian, scientific investigator, pharmacy, hospital, or
            other person licensed, registered, or otherwise permitted, by
            the United States or the jurisdiction in which the individual
            practices or does research, to distribute, dispense, conduct
            research with respect to, administer, or use in teaching or
            chemical analysis, a controlled substance in the course of
            professional practice or research.
                ``(9) The term `State' means each of the 50 States, the
            District of Columbia, and any commonwealth or territory of the
            United States.
                ``(10) The term `ultimate user' means a person who has
            obtained from a dispenser, and who possesses, a controlled
            substance for the person's own use, for the use of a member of
            the person's household, or for the use of an animal owned by the
            person or by a member of the person's household.
                ``(11) The term `clinical workflow' means the integration of
            automated queries for prescription drug monitoring programs data
            and analytics into health information technologies such as
            electronic health record systems, health information exchanges,
            and/or pharmacy dispensing software systems, thus streamlining
            provider access through automated queries.''.

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

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

        (a) In General.--The Secretary of Health and Human Services (in this
    section referred to as the ``Secretary'') shall conduct a review of
    entities that receive Federal funding for the provision of substance use
    disorder treatment services. The review shall include:
                (1) The length of time the entity has provided substance use
            disorder treatment services and the geographic area served by
            the entity.
                (2) A detailed analysis of the patient population served by
            the entity, including but not limited to the number of patients,
            types of diagnosed substance use disorders and the demographic
            information of such patients, including sex, race, ethnicity,
            and socioeconomic status.
                (3) Detailed information on the types of substance use
            disorders for which the entity has the experience, capability,
            and capacity to provide such services.
                (4) An analysis of how the entity handles patients requiring
            treatment for a substance use disorder that the organization is
            not able to treat.
                (5) An analysis of what is needed in order to improve the
            entity's ability to meet the addiction treatment needs of the
            communities served by that entity.

    [[Page 132 STAT. 4068]]

                (6) Based on the identified needs of the communities served,
            a description of unmet needs and inadequate services and how
            such needs and services could be better addressed to treat
            individuals with methamphetamine, cocaine, including crack
            cocaine, heroin, opioid, and other substance use disorders.

        (b) Report.--Not later than 2 years after the date of the enactment
    of this Act, the Secretary shall develop and submit to Congress a plan
    to direct appropriate resources to entities that provide substance use
    disorder treatment services in order to address inadequacies in services
    or funding identified through the survey described in subsection (a).

                       Subtitle S--Other Health Provisions

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

        (a) In General.--Section 1003 of the 21st Century Cures Act (Public
    Law 114-255) <<NOTE: 42 USC 290ee-3 note.>>  is amended--
                (1) in subsection (a)--
                        (A) by striking ``the authorization of
                    appropriations under subsection (b) to carry out the
                    grant program described in subsection (c)'' and
                    inserting ``subsection (h) to carry out the grant
                    program described in subsection (b)''; and
                        (B) by inserting ``and Indian Tribes'' after
                    ``States'';
                (2) by striking subsection (b);
                (3) by redesignating subsections (c) through (e) as
            subsections (b) through (d), respectively;
                (4) by redesignating subsection (f) as subsection (j);
                (5) in subsection (b), as so redesignated--
                        (A) in paragraph (1)--
                              (i) in the paragraph heading, by inserting
                          ``and tribal'' after ``State'';
                              (ii) by striking ``States for the purpose of
                          addressing the opioid abuse crisis within such
                          States'' and inserting ``States and Indian Tribes
                          for the purpose of addressing the opioid abuse
                          crisis within such States and Indian Tribes'';
                              (iii) by inserting ``or Indian Tribes'' after
                          ``preference to States''; and
                              (iv) by inserting before the period of the
                          second sentence ``or other Indian Tribes, as
                          applicable''; and
                        (B) in paragraph (2)--
                              (i) in the matter preceding subparagraph (A),
                          by striking ``to a State'';
                              (ii) in subparagraph (A), by striking
                          ``Improving State'' and inserting ``Establishing
                          or improving'';
                              (iii) in subparagraph (C), by inserting
                          ``preventing diversion of controlled substances,''
                          after ``treatment programs,''; and
                              (iv) in subparagraph (E), by striking ``as the
                          State determines appropriate, related to
                          addressing the opioid abuse crisis within the
                          State'' and inserting ``as the State or Indian
                          Tribe determines appropriate, related to
                          addressing the opioid abuse crisis within the
                          State or Indian Tribe, including directing
                          resources

    [[Page 132 STAT. 4069]]

                          in accordance with local needs related to
                          substance use disorders'';
                (6) in subsection (c), as so redesignated, by striking
            ``subsection (c)'' and inserting ``subsection (b)'';
                (7) in subsection (d), as so redesignated--
                        (A) in the matter preceding paragraph (1), by
                    striking ``the authorization of appropriations under
                    subsection (b)'' and inserting ``subsection (h)''; and
                        (B) in paragraph (1), by striking ``subsection (c)''
                    and inserting ``subsection (b)''; and
                (8) by inserting after subsection (d), as so redesignated,
            the following:

        ``(e) Indian Tribes.--
                ``(1) Definition.--For purposes of this section, the term
            `Indian Tribe' has the meaning given the term `Indian tribe' in
            section 4 of the Indian Self-Determination and Education
            Assistance Act (25 U.S.C. 5304).
                ``(2) Appropriate mechanisms.--The Secretary, in
            consultation with Indian Tribes, shall identify and establish
            appropriate mechanisms for Tribes to demonstrate or report the
            information as required under subsections (b), (c), and (d).

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

    [[Page 132 STAT. 4070]]

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

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

        (b) Applicability.--The amendments made by subsection (a) shall
    apply with respect to the second annual report required under such
    section 13003 and each such annual report thereafter.
    SEC. 7183. <<NOTE: 42 USC 290ee-8.>>  CAREER ACT.

        (a) In General.--The Secretary of Health and Human Services
    (referred to in this section as the ``Secretary''), in consultation with
    the Secretary of Labor, shall continue or establish a program to support
    individuals in substance use disorder treatment and recovery to live
    independently and participate in the workforce.
        (b) Grants Authorized.--In carrying out the activities under this
    section, the Secretary shall, on a competitive basis, award grants for a
    period of not more than 5 years to entities to enable such entities to
    carry out evidence-based programs to help individuals in substance use
    disorder treatment and recovery to live independently and participate in
    the workforce. Such entities shall coordinate, as applicable, with
    Indian tribes or tribal organizations (as applicable), State boards and
    local boards (as defined in section 3 of the Workforce Innovation and
    Opportunity Act (29 U.S.C. 3102), lead State agencies with
    responsibility for a workforce investment activity (as defined in such
    section 3), and State agencies responsible for carrying out substance
    use disorder prevention and treatment programs.
        (c) Priority.--
                (1) In general.--In awarding grants under this section, the
            Secretary shall give priority based on the State in which the
            entity is located. Priority shall be given among States
            according to a formula based on the rates described in paragraph
            (2) and weighted as described in paragraph (3).
                (2) Rates.--The rates described in this paragraph are the
            following:
                        (A) The amount by which the rate of drug overdose
                    deaths in the State, adjusted for age, is above the
                    national

    [[Page 132 STAT. 4071]]

                    overdose mortality rate, as determined by the Director
                    of the Centers for Disease Control and Prevention.
                        (B) The amount by which the rate of unemployment for
                    the State, based on data provided by the Bureau of Labor
                    Statistics for the preceding 5 calendar years for which
                    there is available data, is above the national average.
                        (C) The amount by which rate of labor force
                    participation in the State, based on data provided by
                    the Bureau of Labor Statistics for the preceding 5
                    calendar years for which there is available data, is
                    below the national average.
                (3) Weighting.--The rates described in paragraph (2) shall
            be weighted as follows:
                        (A) The rate described in paragraph (2)(A) shall be
                    weighted 70 percent.
                        (B) The rate described in paragraph (2)(B) shall be
                    weighted 15 percent.
                        (C) The rate described in paragraph (2)(C) shall be
                    weighted 15 percent.

        (d) Preference.--In awarding grants under this section, the
    Secretary shall give preference to entities located in areas within
    States with the greatest need, with such need based on the highest
    mortality rate related to substance use disorder.
        (e) Definitions.--In this section:
                (1) Eligible entity.--The term ``eligible entity'' means an
            entity that offers treatment or recovery services for
            individuals with substance use disorders, and partners with one
            or more local or State stakeholders, which may include local
            employers, community organizations, the local workforce
            development board, local and State governments, and Indian
            Tribes or tribal organizations, to support recovery, independent
            living, and participation in the workforce.
                (2) Indian tribes; tribal organization.--The terms ``Indian
            Tribe'' and ``tribal organization'' have the meanings given the
            terms ``Indian tribe'' and ``tribal organization'' in section 4
            of the Indian Self-Determination and Education Assistance Act
            (25 U.S.C. 5304).
                (3) State.--The term ``State'' includes only the several
            States and the District of Columbia.

        (f) Applications.--An eligible entity shall submit an application at
    such time and in such manner as the Secretary may require. In submitting
    an application, the entity shall demonstrate the ability to partner with
    local stakeholders, which may include local employers, community
    stakeholders, the local workforce development board, local and State
    governments, and Indian Tribes or tribal organizations, as applicable,
    to--
                (1) identify gaps in the workforce due to the prevalence of
            substance use disorders;
                (2) in coordination with statewide employment and training
            activities, including coordination and alignment of activities
            carried out by entities provided grant funds under section 8041,
            help individuals in recovery from a substance use disorder
            transition into the workforce, including by providing career
            services, training services as described in paragraph (2) of
            section 134(c) of the Workforce Innovation and Opportunity Act
            (29 U.S.C. 3174(c)), and related services described in section
            134(a)(3) of such Act (42 U.S.C. 3174(a)); and

    [[Page 132 STAT. 4072]]

                (3) assist employers with informing their employees of the
            resources, such as resources related to substance use disorders
            that are available to their employees.

        (g) Use of Funds.--An entity receiving a grant under this section
    shall use the funds to conduct one or more of the following activities:
                (1) Hire case managers, care coordinators, providers of peer
            recovery support services, as described in section 547(a) of the
            Public Health Service Act (42 U.S.C. 290ee-2(a)), or other
            professionals, as appropriate, to provide services that support
            treatment, recovery, and rehabilitation, and prevent relapse,
            recidivism, and overdose, including by encouraging--
                        (A) the development and strengthening of daily
                    living skills; and
                        (B) the use of counseling, care coordination, and
                    other services, as appropriate, to support recovery from
                    substance use disorders.
                (2) Implement or utilize innovative technologies, which may
            include the use of telemedicine.
                (3) In coordination with the lead State agency with
            responsibility for a workforce investment activity or local
            board described in subsection (b), provide--
                        (A) short-term prevocational training services; and
                        (B) training services that are directly linked to
                    the employment opportunities in the local area or the
                    planning region.

        (h) Support for State Strategy.--An eligible entity shall include in
    its application under subsection (f) information describing how the
    services and activities proposed in such application are aligned with
    the State, outlying area, or Tribal strategy, as applicable, for
    addressing issues described in such application and how such entity will
    coordinate with existing systems to deliver services as described in
    such application.
        (i) Data Reporting and Program Oversight.--Each eligible entity
    awarded a grant under this section shall submit to the Secretary a
    report at such time and in such manner as the Secretary may require.
    Such report shall include a description of--
                (1) the programs and activities funded by the grant;
                (2) outcomes of the population of individuals with a
            substance use disorder the grantee served through activities
            described in subsection (g); and
                (3) any other information that the Secretary may require for
            the purpose of ensuring that the grantee is complying with all
            of the requirements of the grant.

        (j) Reports to Congress.--
                (1) Preliminary report.--Not later than 2 years after the
            end of the first year of the grant period under this section,
            the Secretary shall submit to Congress a preliminary report that
            analyzes reports submitted under subsection (i).
                (2) Final report.--Not later than 2 years after submitting
            the preliminary report required under paragraph (1), the
            Secretary shall submit to Congress a final report that
            includes--
                        (A) a description of how the grant funding was used,
                    including the number of individuals who received
                    services under subsection (g)(3) and an evaluation of
                    the effectiveness of the activities conducted by the
                    grantee with respect

    [[Page 132 STAT. 4073]]

                    to outcomes of the population of individuals with
                    substance use disorder who receive services from the
                    grantee; and
                        (B) recommendations related to best practices for
                    health care professionals to support individuals in
                    substance use disorder treatment or recovery to live
                    independently and participate in the workforce.

        (k) Authorization of Appropriations.--There is authorized to be
    appropriated $5,000,000 for each of fiscal years 2019 through 2023 for
    purposes of carrying out this section.

                            TITLE VIII--MISCELLANEOUS

     Subtitle <<NOTE: Synthetics Trafficking and Overdose Prevention Act of
         2018. 19 USC 1 note.>>  A--Synthetics Trafficking and Overdose
    Prevention
    SEC. 8001. SHORT TITLE.

        This subtitle may be cited as the ``Synthetics Trafficking and
    Overdose Prevention Act of 2018'' or ``STOP Act of 2018''.
    SEC. 8002. CUSTOMS FEES.

        (a) In General.--Section 13031(b)(9) of the Consolidated Omnibus
    Budget Reconciliation Act of 1985 (19 U.S.C. 58c(b)(9)) is amended by
    adding at the end the following:
                ``(D)(i) With respect to the processing of items that are
            sent to the United States through the international postal
            network by `Inbound Express Mail service' or `Inbound EMS' (as
            that service is described in the mail classification schedule
            referred to in section 3631 of title 39, United States Code),
            the following payments are required:
                        ``(I) $1 per Inbound EMS item.
                        ``(II) If an Inbound EMS item is formally entered,
                    the fee provided for under subsection (a)(9), if
                    applicable.
                ``(ii) Notwithstanding section 451 of the Tariff Act of 1930
            (19 U.S.C. 1451), the payments required by clause (i), as
            allocated pursuant to clause (iii)(I), shall be the only
            payments required for reimbursement of U.S. Customs and Border
            Protection for customs services provided in connection with the
            processing of an Inbound EMS item.
                ``(iii)(I) The payments required by clause (i)(I) shall be
            allocated as follows:
                        ``(aa) 50 percent of the amount of the payments
                    shall be paid on a quarterly basis by the United States
                    Postal Service to the Commissioner of U.S. Customs and
                    Border Protection in accordance with regulations
                    prescribed by the Secretary of the Treasury to reimburse
                    U.S. Customs and Border Protection for customs services
                    provided in connection with the processing of Inbound
                    EMS items.
                        ``(bb) 50 percent of the amount of the payments
                    shall be retained by the Postal Service to reimburse the
                    Postal Service for services provided in connection with
                    the customs processing of Inbound EMS items.
                ``(II) Payments received by U.S. Customs and Border
            Protection under subclause (I)(aa) shall, in accordance with
            section 524 of the Tariff Act of 1930 (19 U.S.C. 1524), be
            deposited in the Customs User Fee Account and used to directly

    [[Page 132 STAT. 4074]]

            reimburse each appropriation for the amount paid out of that
            appropriation for the costs incurred in providing services to
            international mail facilities. Amounts deposited in accordance
            with the preceding sentence shall be available until expended
            for the provision of such services.
                ``(III) Payments retained by the Postal Service under
            subclause (I)(bb) shall be used to directly reimburse the Postal
            Service for the costs incurred in providing services in
            connection with the customs processing of Inbound EMS items.
                ``(iv) Beginning in fiscal year 2021, the Secretary, in
            consultation with the Postmaster General, may adjust, not more
            frequently than once each fiscal year, the amount described in
            clause (i)(I) to an amount commensurate with the costs of
            services provided in connection with the customs processing of
            Inbound EMS items, consistent with the obligations of the United
            States under international agreements.''.

        (b) Conforming Amendments.--Section 13031(a) of the Consolidated
    Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 58c(a)) is
    amended--
                (1) in paragraph (6), by inserting ``(other than an item
            subject to a fee under subsection (b)(9)(D))'' after ``customs
            officer''; and
                (2) in paragraph (10)--
                        (A) in subparagraph (C), in the matter preceding
                    clause (i), by inserting ``(other than Inbound EMS items
                    described in subsection (b)(9)(D))'' after ``release'';
                    and
                        (B) in the flush at the end, by inserting ``or of
                    Inbound EMS items described in subsection (b)(9)(D),''
                    after ``(C),''.

        (c) <<NOTE: 19 USC 58c note.>>  Effective Date.--The amendments made
    by this section shall take effect on January 1, 2020.
    SEC. 8003. MANDATORY ADVANCE ELECTRONIC INFORMATION FOR POSTAL
                              SHIPMENTS.

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

    [[Page 132 STAT. 4075]]

                    as practicable in relation to the transportation of the
                    shipment, consistent with subparagraph (H).
                        ``(iv) Regulations prescribed under clause (i) shall
                    allow for the requirements for the transmission to the
                    Commissioner of information described in paragraphs (1)
                    and (2) for mail shipments described in clause (i) to be
                    implemented in phases, as appropriate, by--
                              ``(I) setting incremental targets for
                          increasing the percentage of such shipments for
                          which information is required to be transmitted to
                          the Commissioner; and
                              ``(II) taking into consideration--
                                        ``(aa) the risk posed by such
                                    shipments;
                                        ``(bb) the volume of mail shipped to
                                    the United States by or through a
                                    particular country; and
                                        ``(cc) the capacities of foreign
                                    postal operators to provide that
                                    information to the Postal Service.
                        ``(v)(I) Notwithstanding clause (iv), the Postal
                    Service shall, not later than December 31, 2018, arrange
                    for the transmission to the Commissioner of the
                    information described in paragraphs (1) and (2) for not
                    less than 70 percent of the aggregate number of mail
                    shipments, including 100 percent of mail shipments from
                    the People's Republic of China, described in clause (i).
                        ``(II) If the requirements of subclause (I) are not
                    met, the Comptroller General of the United States shall
                    submit to the appropriate congressional committees, not
                    later than June 30, 2019, a report--
                              ``(aa) assessing the reasons for the failure
                          to meet those requirements; and
                              ``(bb) identifying recommendations to improve
                          the collection by the Postal Service of the
                          information described in paragraphs (1) and (2).
                        ``(vi)(I) Notwithstanding clause (iv), the Postal
                    Service shall, not later than December 31, 2020, arrange
                    for the transmission to the Commissioner of the
                    information described in paragraphs (1) and (2) for 100
                    percent of the aggregate number of mail shipments
                    described in clause (i).
                        ``(II) The Commissioner, in consultation with the
                    Postmaster General, may determine to exclude a country
                    from the requirement described in subclause (I) to
                    transmit information for mail shipments described in
                    clause (i) from the country if the Commissioner
                    determines that the country--
                              ``(aa) does not have the capacity to collect
                          and transmit such information;
                              ``(bb) represents a low risk for mail
                          shipments that violate relevant United States laws
                          and regulations; and
                              ``(cc) accounts for low volumes of mail
                          shipments that can be effectively screened for
                          compliance with relevant United States laws and
                          regulations through an alternate means.
                        ``(III) The Commissioner shall, at a minimum on an
                    annual basis, re-evaluate any determination made under
                    subclause (II) to exclude a country from the requirement

    [[Page 132 STAT. 4076]]

                    described in subclause (I). If, at any time, the
                    Commissioner determines that a country no longer meets
                    the requirements under subclause (II), the Commissioner
                    may not further exclude the country from the requirement
                    described in subclause (I).
                        ``(IV) The Commissioner shall, on an annual basis,
                    submit to the appropriate congressional committees--
                              ``(aa) a list of countries with respect to
                          which the Commissioner has made a determination
                          under subclause (II) to exclude the countries from
                          the requirement described in subclause (I); and
                              ``(bb) information used to support such
                          determination with respect to such countries.
                        ``(vii)(I) The Postmaster General shall, in
                    consultation with the Commissioner, refuse any shipments
                    received after December 31, 2020, for which the
                    information described in paragraphs (1) and (2) is not
                    transmitted as required under this subparagraph, except
                    as provided in subclause (II).
                        ``(II) If remedial action is warranted in lieu of
                    refusal of shipments pursuant to subclause (I), the
                    Postmaster General and the Commissioner shall take
                    remedial action with respect to the shipments, including
                    destruction, seizure, controlled delivery or other law
                    enforcement initiatives, or correction of the failure to
                    provide the information described in paragraphs (1) and
                    (2) with respect to the shipments.
                        ``(viii) Nothing in this subparagraph shall be
                    construed to limit the authority of the Secretary to
                    obtain information relating to international mail
                    shipments from private carriers or other appropriate
                    parties.
                        ``(ix) In this subparagraph, the term `appropriate
                    congressional committees' means--
                              ``(I) the Committee on Finance and the
                          Committee on Homeland Security and Governmental
                          Affairs of the Senate; and
                              ``(II) the Committee on Ways and Means, the
                          Committee on Oversight and Government Reform, and
                          the Committee on Homeland Security of the House of
                          Representatives.''.
                (2) Joint strategic plan on mandatory advance information.--
            Not later than 60 days after the date of the enactment of this
            Act, the Secretary of Homeland Security and the Postmaster
            General shall develop and submit to the appropriate
            congressional committees a joint strategic plan detailing
            specific performance measures for achieving--
                        (A) the transmission of information as required by
                    section 343(a)(3)(K) of the Trade Act of 2002, as
                    amended by paragraph (1); and
                        (B) the presentation by the Postal Service to U.S.
                    Customs and Border Protection of all mail targeted by
                    U.S. Customs and Border Protection for inspection.

        (b) Capacity Building.--
                (1) In general.--Section 343(a) of the Trade Act of 2002
            (Public Law 107-210; 19 U.S.C. 2071 note) is amended by adding
            at the end the following:
                ``(5) Capacity building.--

    [[Page 132 STAT. 4077]]

                        ``(A) In general.--The Secretary, with the
                    concurrence of the Secretary of State, and in
                    coordination with the Postmaster General and the heads
                    of other Federal agencies, as appropriate, may provide
                    technical assistance, equipment, technology, and
                    training to enhance the capacity of foreign postal
                    operators--
                              ``(i) to gather and provide the information
                          required by paragraph (3)(K); and
                              ``(ii) to otherwise gather and provide postal
                          shipment information related to--
                                        ``(I) terrorism;
                                        ``(II) items the importation or
                                    introduction of which into the United
                                    States is prohibited or restricted,
                                    including controlled substances; and
                                        ``(III) such other concerns as the
                                    Secretary determines appropriate.
                        ``(B) Provision of equipment and technology.--With
                    respect to the provision of equipment and technology
                    under subparagraph (A), the Secretary may lease, loan,
                    provide, or otherwise assist in the deployment of such
                    equipment and technology under such terms and conditions
                    as the Secretary may prescribe, including
                    nonreimbursable loans or the transfer of ownership of
                    equipment and technology.''.
                (2) Joint strategic plan on capacity building.--Not later
            than 1 year after the date of the enactment of this Act, the
            Secretary of Homeland Security and the Postmaster General shall,
            in consultation with the Secretary of State, jointly develop and
            submit to the appropriate congressional committees a joint
            strategic plan--
                        (A) detailing the extent to which U.S. Customs and
                    Border Protection and the United States Postal Service
                    are engaged in capacity building efforts under section
                    343(a)(5) of the Trade Act of 2002, as added by
                    paragraph (1);
                        (B) describing plans for future capacity building
                    efforts; and
                        (C) assessing how capacity building has increased
                    the ability of U.S. Customs and Border Protection and
                    the Postal Service to advance the goals of this subtitle
                    and the amendments made by this subtitle.

        (c) Report and Consultations by Secretary of Homeland Security and
    Postmaster General.--
                (1) Report.--Not later than 180 days after the date of the
            enactment of this Act, and annually thereafter until 3 years
            after the Postmaster General has met the requirement under
            clause (vi) of subparagraph (K) of section 343(a)(3) of the
            Trade Act of 2002, as amended by subsection (a)(1), the
            Secretary of Homeland Security and the Postmaster General shall,
            in consultation with the Secretary of State, jointly submit to
            the appropriate congressional committees a report on compliance
            with that subparagraph that includes the following:
                        (A) An assessment of the status of the regulations
                    required to be promulgated under that subparagraph.
                        (B) An update regarding new and existing agreements
                    reached with foreign postal operators for the
                    transmission of the information required by that
                    subparagraph.

    [[Page 132 STAT. 4078]]

                        (C) A summary of deliberations between the United
                    States Postal Service and foreign postal operators with
                    respect to issues relating to the transmission of that
                    information.
                        (D) A summary of the progress made in achieving the
                    transmission of that information for the percentage of
                    shipments required by that subparagraph.
                        (E) An assessment of the quality of that information
                    being received by foreign postal operators, as
                    determined by the Secretary of Homeland Security, and
                    actions taken to improve the quality of that
                    information.
                        (F) A summary of policies established by the
                    Universal Postal Union that may affect the ability of
                    the Postmaster General to obtain the transmission of
                    that information.
                        (G) A summary of the use of technology to detect
                    illicit synthetic opioids and other illegal substances
                    in international mail parcels and planned acquisitions
                    and advancements in such technology.
                        (H) Such other information as the Secretary of
                    Homeland Security and the Postmaster General consider
                    appropriate with respect to obtaining the transmission
                    of information required by that subparagraph.
                (2) Consultations.--Not later than 180 days after the date
            of the enactment of this Act, and every 180 days thereafter
            until the Postmaster General has met the requirement under
            clause (vi) of section 343(a)(3)(K) of the Trade Act of 2002, as
            amended by subsection (a)(1), to arrange for the transmission of
            information with respect to 100 percent of the aggregate number
            of mail shipments described in clause (i) of that section, the
            Secretary of Homeland Security and the Postmaster General shall
            provide briefings to the appropriate congressional committees on
            the progress made in achieving the transmission of that
            information for that percentage of shipments.

        (d) Government Accountability Office Report.--Not later than June
    30, 2019, the Comptroller General of the United States shall submit to
    the appropriate congressional committees a report--
                (1) assessing the progress of the United States Postal
            Service in achieving the transmission of the information
            required by subparagraph (K) of section 343(a)(3) of the Trade
            Act of 2002, as amended by subsection (a)(1), for the percentage
            of shipments required by that subparagraph;
                (2) assessing the quality of the information received from
            foreign postal operators for targeting purposes;
                (3) assessing the specific percentage of targeted mail
            presented by the Postal Service to U.S. Customs and Border
            Protection for inspection;
                (4) describing the costs of collecting the information
            required by such subparagraph (K) from foreign postal operators
            and the costs of implementing the use of that information;
                (5) assessing the benefits of receiving that information
            with respect to international mail shipments;
                (6) assessing the feasibility of assessing a customs fee
            under section 13031(b)(9) of the Consolidated Omnibus Budget
            Reconciliation Act of 1985, as amended by section 8002, on
            international mail shipments other than Inbound Express Mail
            service in a manner consistent with the obligations of the
            United States under international agreements; and

    [[Page 132 STAT. 4079]]

                (7) identifying recommendations, including recommendations
            for legislation, to improve the compliance of the Postal Service
            with such subparagraph (K), including an assessment of whether
            the detection of illicit synthetic opioids in the international
            mail would be improved by--
                        (A) requiring the Postal Service to serve as the
                    consignee for international mail shipments containing
                    goods; or
                        (B) designating a customs broker to act as an
                    importer of record for international mail shipments
                    containing goods.

        (e) Technical Correction.--Section 343 of the Trade Act of 2002
    (Public Law 107-210; 19 U.S.C. 2071 note) is amended in the section
    heading by striking ``advanced'' and inserting ``advance''.
        (f) Appropriate Congressional Committees Defined.--In this section,
    the term ``appropriate congressional committees'' means--
                (1) the Committee on Finance and the Committee on Homeland
            Security and Governmental Affairs of the Senate; and
                (2) the Committee on Ways and Means, the Committee on
            Oversight and Government Reform, and the Committee on Homeland
            Security of the House of Representatives.
    SEC. 8004. <<NOTE: 19 USC 1415 note.>>  INTERNATIONAL POSTAL
                              AGREEMENTS.

        (a) Existing Agreements.--
                (1) In general.--In the event that any provision of this
            subtitle, or any amendment made by this subtitle, is determined
            to be in violation of obligations of the United States under any
            postal treaty, convention, or other international agreement
            related to international postal services, or any amendment to
            such an agreement, the Secretary of State should negotiate to
            amend the relevant provisions of the agreement so that the
            United States is no longer in violation of the agreement.
                (2) Rule of construction.--Nothing in this subsection shall
            be construed to permit delay in the implementation of this
            subtitle or any amendment made by this subtitle.

        (b) Future Agreements.--
                (1) Consultations.--Before entering into, on or after the
            date of the enactment of this Act, any postal treaty,
            convention, or other international agreement related to
            international postal services, or any amendment to such an
            agreement, that is related to the ability of the United States
            to secure the provision of advance electronic information by
            foreign postal operators, the Secretary of State should consult
            with the appropriate congressional committees (as defined in
            section 8003(f)).
                (2) Expedited negotiation of new agreement.--To the extent
            that any new postal treaty, convention, or other international
            agreement related to international postal services would improve
            the ability of the United States to secure the provision of
            advance electronic information by foreign postal operators as
            required by regulations prescribed under section 343(a)(3)(K) of
            the Trade Act of 2002, as amended by section 8003(a)(1), the
            Secretary of State should expeditiously conclude such an
            agreement.
    SEC. 8005. <<NOTE: 19 USC 1415 note.>>  COST RECOUPMENT.

        (a) In General.--The United States Postal Service shall, to the
    extent practicable and otherwise recoverable by law, ensure

    [[Page 132 STAT. 4080]]

    that all costs associated with complying with this subtitle and
    amendments made by this subtitle are charged directly to foreign
    shippers or foreign postal operators.
        (b) Costs Not Considered Revenue.--The recovery of costs under
    subsection (a) shall not be deemed revenue for purposes of subchapter I
    and II of chapter 36 of title 39, United States Code, or regulations
    prescribed under that chapter.
    SEC. 8006. <<NOTE: 19 USC 1583a.>>  DEVELOPMENT OF TECHNOLOGY TO
                              DETECT ILLICIT NARCOTICS.

        (a) In General.--The Postmaster General and the Commissioner of U.S.
    Customs and Border Protection, in coordination with the heads of other
    agencies as appropriate, shall collaborate to identify and develop
    technology for the detection of illicit fentanyl, other synthetic
    opioids, and other narcotics and psychoactive substances entering the
    United States by mail.
        (b) Outreach to Private Sector.--The Postmaster General and the
    Commissioner shall conduct outreach to private sector entities to gather
    information regarding the current state of technology to identify areas
    for innovation relating to the detection of illicit fentanyl, other
    synthetic opioids, and other narcotics and psychoactive substances
    entering the United States.
    SEC. 8007. CIVIL PENALTIES FOR POSTAL SHIPMENTS.

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

    [[Page 132 STAT. 4081]]

                        ``(C) has an increasing error rate in compliance
                    with section 343(a)(3)(K) of the Trade Act of 2002,
            civil penalties may be imposed against the United States Postal
            Service until corrective action, satisfactory to U.S. Customs
            and Border Protection, is taken.''.
    SEC. 8008. <<NOTE: 19 USC 1436a.>>  REPORT ON VIOLATIONS OF
                              ARRIVAL, REPORTING, ENTRY, AND CLEARANCE
                              REQUIREMENTS AND FALSITY OR LACK OF
                              MANIFEST.

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

        (c) Appropriate Congressional Committees Defined.--In this section,
    the term ``appropriate congressional committees'' means--
                (1) the Committee on Finance and the Committee on Homeland
            Security and Governmental Affairs of the Senate; and
                (2) the Committee on Ways and Means, the Committee on
            Oversight and Government Reform, and the Committee on Homeland
            Security of the House of Representatives.
    SEC. 8009. EFFECTIVE DATE; REGULATIONS.

        (a) <<NOTE: 19 USC 1436 note.>>  Effective Date.--This subtitle and
    the amendments made by this subtitle (other than the amendments made by
    section 8002) shall take effect on the date of the enactment of this
    Act.

        (b) <<NOTE: 19 USC 58c note.>>  Regulations.--Not later than 1 year
    after the date of the enactment of this Act, such regulations as are
    necessary to carry out this subtitle and the amendments made by this
    subtitle shall be prescribed.

    [[Page 132 STAT. 4082]]

       Subtitle <<NOTE: Opioid Addiction Recovery Fraud Prevention Act of
    2018.>>  B--Opioid Addiction Recovery Fraud Prevention
    SEC. 8021. <<NOTE: 15 USC 58 note.>>  SHORT TITLE.

        This subtitle may be cited as the ``Opioid Addiction Recovery Fraud
    Prevention Act of 2018''.
    SEC. 8022. <<NOTE: 15 USC 45d note.>>  DEFINITIONS.

        For purposes of this subtitle only, and not be construed or applied
    as to challenge or affect the characterization, definition, or treatment
    under any other statute, regulation, or rule:
                (1) Substance use disorder treatment product.--The term
            ``substance use disorder treatment product'' means a product for
            use or marketed for use in the treatment, cure, or prevention of
            a substance use disorder, including an opioid use disorder.
                (2) Substance use disorder treatment service.--The term
            ``substance use disorder treatment service'' means a service
            that purports to provide referrals to treatment, treatment, or
            recovery housing for people diagnosed with, having, or
            purporting to have a substance use disorder, including an opioid
            use disorder.
    SEC. 8023. <<NOTE: 15 USC 45d.>>  UNFAIR OR DECEPTIVE ACTS OR
                              PRACTICES WITH RESPECT TO SUBSTANCE USE
                              DISORDER TREATMENT SERVICE AND PRODUCTS.

        (a) Unlawful Activity.--It is unlawful to engage in an unfair or
    deceptive act or practice with respect to any substance use disorder
    treatment service or substance use disorder treatment product.
        (b) Enforcement by the Federal Trade Commission.--
                (1) Unfair or deceptive acts or practices.--A violation of
            subsection (a) shall be treated as a violation of a rule under
            section 18 of the Federal Trade Commission Act (15 U.S.C. 57a)
            regarding unfair or deceptive acts or practices.
                (2) Powers of the federal trade commission.--
                        (A) In general.--The Federal Trade Commission shall
                    enforce this section in the same manner, by the same
                    means, and with the same jurisdiction, powers, and
                    duties as though all applicable terms and provisions of
                    the Federal Trade Commission Act (15 U.S.C. 41 et seq.)
                    were incorporated into and made a part of this section.
                        (B) Privileges and immunities.--Any person who
                    violates subsection (a) shall be subject to the
                    penalties and entitled to the privileges and immunities
                    provided in the Federal Trade Commission Act as though
                    all applicable terms and provisions of the Federal Trade
                    Commission Act (15 U.S.C. 41 et seq.) were incorporated
                    and made part of this section.

        (c) Authority Preserved.--Nothing in this subtitle shall be
    construed to limit the authority of the Federal Trade Commission or the
    Food and Drug Administration under any other provision of law.

    [[Page 132 STAT. 4083]]

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

    SEC. 8041. <<NOTE: 29 USC 3225a.>>  ADDRESSING ECONOMIC AND
                              WORKFORCE IMPACTS OF THE OPIOID CRISIS.

        (a) Definitions.--Except as otherwise expressly provided, in this
    section:
                (1) WIOA definitions.--The terms ``core program'',
            ``individual with a barrier to employment'', ``local area'',
            ``local board'', ``one-stop operator'', ``outlying area'',
            ``State'', ``State board'', and ``supportive services'' have the
            meanings given the terms in section 3 of the Workforce
            Innovation and Opportunity Act (29 U.S.C. 3102).
                (2) Education provider.--The term ``education provider''
            means--
                        (A) an institution of higher education, as defined
                    in section 101 of the Higher Education Act of 1965 (20
                    U.S.C. 1001); or
                        (B) a postsecondary vocational institution, as
                    defined in section 102(c) of such Act (20 U.S.C.
                    1002(c)).
                (3) Eligible entity.--The term ``eligible entity'' means--
                        (A) a State workforce agency;
                        (B) an outlying area; or
                        (C) a Tribal entity.
                (4) Participating partnership.--The term ``participating
            partnership'' means a partnership--
                        (A) evidenced by a written contract or agreement;
                    and
                        (B) including, as members of the partnership, a
                    local board receiving a subgrant under subsection (d)
                    and 1 or more of the following:
                              (i) The eligible entity.
                              (ii) A treatment provider.
                              (iii) An employer or industry organization.
                              (iv) An education provider.
                              (v) A legal service or law enforcement
                          organization.
                              (vi) A faith-based or community-based
                          organization.
                              (vii) Other State or local agencies, including
                          counties or local governments.
                              (viii) Other organizations, as determined to
                          be necessary by the local board.
                              (ix) Indian Tribes or tribal organizations.
                (5) Program participant.--The term ``program participant''
            means an individual who--
                        (A) is a member of a population of workers described
                    in subsection (e)(2) that is served by a participating
                    partnership through the pilot program under this
                    section; and
                        (B) enrolls with the applicable participating
                    partnership to receive any of the services described in
                    subsection (e)(3).
                (6) Provider of peer recovery support services.--The term
            ``provider of peer recovery support services'' means a provider
            that delivers peer recovery support services through an
            organization described in section 547(a) of the Public Health
            Service Act (42 U.S.C. 290ee-2(a)).

    [[Page 132 STAT. 4084]]

                (7) Secretary.--The term ``Secretary'' means the Secretary
            of Labor.
                (8) State workforce agency.--The term ``State workforce
            agency'' means the lead State agency with responsibility for the
            administration of a program under chapter 2 or 3 of subtitle B
            of title I of the Workforce Innovation and Opportunity Act (29
            U.S.C. 3161 et seq., 3171 et seq.).
                (9) Substance use disorder.--The term ``substance use
            disorder'' has the meaning given such term by the Assistant
            Secretary for Mental Health and Substance Use.
                (10) Treatment provider.--The term ``treatment provider''--
                        (A) means a health care provider that--
                              (i) offers services for treating substance use
                          disorders and is licensed in accordance with
                          applicable State law to provide such services; and
                              (ii) accepts health insurance for such
                          services, including coverage under title XIX of
                          the Social Security Act (42 U.S.C. 1396 et seq.);
                          and
                        (B) may include--
                              (i) a nonprofit provider of peer recovery
                          support services;
                              (ii) a community health care provider;
                              (iii) a Federally qualified health center (as
                          defined in section 1861(aa) of the Social Security
                          Act (42 U.S.C. 1395x));
                              (iv) an Indian health program (as defined in
                          section 3 of the Indian Health Care Improvement
                          Act (25 U.S.C. 1603)), including an Indian health
                          program that serves an urban center (as defined in
                          such section); and
                              (v) a Native Hawaiian health center (as
                          defined in section 12 of the Native Hawaiian
                          Health Care Improvement Act (42 U.S.C. 11711)).
                (11) Tribal entity.--The term ``Tribal entity'' includes any
            Indian Tribe, tribal organization, Indian-controlled
            organization serving Indians, Native Hawaiian organization, or
            Alaska Native entity, as such terms are defined or used in
            section 166 of the Workforce Innovation and Opportunity Act (29
            U.S.C. 3221).

        (b) Pilot Program and Grants Authorized.--
                (1) In general.--The Secretary, in consultation with the
            Secretary of Health and Human Services, shall carry out a pilot
            program to address economic and workforce impacts associated
            with a high rate of a substance use disorder. In carrying out
            the pilot program, the Secretary shall make grants, on a
            competitive basis, to eligible entities to enable such entities
            to make subgrants to local boards to address the economic and
            workforce impacts associated with a high rate of a substance use
            disorder.
                (2) Grant amounts.--The Secretary shall make each such grant
            in an amount that is not less than $500,000, and not more than
            $5,000,000, for a fiscal year.

        (c) Grant Applications.--
                (1) In general.--An eligible entity applying for a grant
            under this section shall submit an application to the Secretary
            at such time and in such form and manner as the Secretary

    [[Page 132 STAT. 4085]]

            may reasonably require, including the information described in
            this subsection.
                (2) Significant impact on community by opioid and substance
            use disorder-related problems.--
                        (A) Demonstration.--An eligible entity shall include
                    in the application--
                              (i) information that demonstrates significant
                          impact on the community by problems related to
                          opioid abuse or another substance use disorder,
                          by--
                                        (I) identifying the counties,
                                    communities, regions, or local areas
                                    that have been significantly impacted
                                    and will be served through the grant
                                    (each referred to in this section as a
                                    ``service area''); and
                                        (II) demonstrating for each such
                                    service area, an increase equal to or
                                    greater than the national increase in
                                    such problems, between--
                                                (aa) 1999; and
                                                (bb) 2016 or the latest year
                                            for which data are available;
                                            and
                              (ii) a description of how the eligible entity
                          will prioritize support for significantly impacted
                          service areas described in clause (i)(I).
                        (B) Information.--To meet the requirements described
                    in subparagraph (A)(i)(II), the eligible entity may use
                    information including data on--
                              (i) the incidence or prevalence of opioid
                          abuse and other substance use disorders;
                              (ii) the age-adjusted rate of drug overdose
                          deaths, as determined by the Director of the
                          Centers for Disease Control and Prevention;
                              (iii) the rate of non-fatal hospitalizations
                          related to opioid abuse or other substance use
                          disorders;
                              (iv) the number of arrests or convictions, or
                          a relevant law enforcement statistic, that
                          reasonably shows an increase in opioid abuse or
                          another substance use disorder; or
                              (v) in the case of an eligible entity
                          described in subsection (a)(3)(C), other
                          alternative relevant data as determined
                          appropriate by the Secretary.
                        (C) Support for state strategy.--The eligible entity
                    may include in the application information describing
                    how the proposed services and activities are aligned
                    with the State, outlying area, or Tribal strategy, as
                    applicable, for addressing problems described in
                    subparagraph (A) in specific service areas or across the
                    State, outlying area, or Tribal land.
                (3) Economic and employment conditions demonstrate
            additional federal support needed.--
                        (A) Demonstration.--An eligible entity shall include
                    in the application information that demonstrates that a
                    high rate of a substance use disorder has caused, or is
                    coincident to--
                              (i) an economic or employment downturn in the
                          service area; or
                              (ii) persistent economically depressed
                          conditions in such service area.

    [[Page 132 STAT. 4086]]

                        (B) Information.--To meet the requirements of
                    subparagraph (A), an eligible entity may use information
                    including--
                              (i) documentation of any layoff, announced
                          future layoff, legacy industry decline, decrease
                          in an employment or labor market participation
                          rate, or economic impact, whether or not the
                          result described in this clause is overtly related
                          to a high rate of a substance use disorder;
                              (ii) documentation showing decreased economic
                          activity related to, caused by, or contributing to
                          a high rate of a substance use disorder, including
                          a description of how the service area has been
                          impacted, or will be impacted, by such a decrease;
                              (iii) information on economic indicators,
                          labor market analyses, information from public
                          announcements, and demographic and industry data;
                              (iv) information on rapid response activities
                          (as defined in section 3 of the Workforce
                          Innovation and Opportunity Act (29 U.S.C. 3102))
                          that have been or will be conducted, including
                          demographic data gathered by employer or worker
                          surveys or through other methods;
                              (v) data or documentation, beyond anecdotal
                          evidence, showing that employers face challenges
                          filling job vacancies due to a lack of skilled
                          workers able to pass a drug test; or
                              (vi) any additional relevant data or
                          information on the economy, workforce, or another
                          aspect of the service area to support the
                          application.

        (d) Subgrant Authorization and Application Process.--
                (1) Subgrants authorized.--
                        (A) In general.--An eligible entity receiving a
                    grant under subsection (b)--
                              (i) may use not more than 5 percent of the
                          grant funds for the administrative costs of
                          carrying out the grant;
                              (ii) in the case of an eligible entity
                          described in subparagraph (A) or (B) of subsection
                          (a)(3), shall use the remaining grant funds to
                          make subgrants to local entities in the service
                          area to carry out the services and activities
                          described in subsection (e); and
                              (iii) in the case of an eligible entity
                          described in subsection (a)(3)(C), shall use the
                          remaining grant funds to carry out the services
                          and activities described in subsection (e).
                        (B) Equitable distribution.--In making subgrants
                    under this subsection, an eligible entity shall ensure,
                    to the extent practicable, the equitable distribution of
                    subgrants, based on--
                              (i) geography (such as urban and rural
                          distribution); and
                              (ii) significantly impacted service areas as
                          described in subsection (c)(2).
                        (C) Timing of subgrant funds distribution.--An
                    eligible entity making subgrants under this subsection
                    shall

    [[Page 132 STAT. 4087]]

                    disburse subgrant funds to a local board receiving a
                    subgrant from the eligible entity by the later of--
                              (i) the date that is 90 days after the date on
                          which the Secretary makes the funds available to
                          the eligible entity; or
                              (ii) the date that is 15 days after the date
                          that the eligible entity makes the subgrant under
                          subparagraph (A)(ii).
                (2) Subgrant application.--
                        (A) In general.--A local board desiring to receive a
                    subgrant under this subsection from an eligible entity
                    shall submit an application at such time and in such
                    manner as the eligible entity may reasonably require,
                    including the information described in this paragraph.
                        (B) Contents.--Each application described in
                    subparagraph (A) shall include--
                              (i) an analysis of the estimated performance
                          of the local board in carrying out the proposed
                          services and activities under the subgrant--
                                        (I) based on--
                                                (aa) primary indicators of
                                            performance described in section
                                            116(c)(1)(A)(i) of the Workforce
                                            Innovation and Opportunity Act
                                            (29 U.S.C. 3141(c)(1)(A)(i), to
                                            assess estimated effectiveness
                                            of the proposed services and
                                            activities, including the
                                            estimated number of individuals
                                            with a substance use disorder
                                            who may be served by the
                                            proposed services and
                                            activities;
                                                (bb) the record of the local
                                            board in serving individuals
                                            with a barrier to employment;
                                            and
                                                (cc) the ability of the
                                            local board to establish a
                                            participating partnership; and
                                        (II) which may include or utilize--
                                                (aa) data from the National
                                            Center for Health Statistics of
                                            the Centers for Disease Control
                                            and Prevention;
                                                (bb) data from the Center
                                            for Behavioral Health Statistics
                                            and Quality of the Substance
                                            Abuse and Mental Health Services
                                            Administration;
                                                (cc) State vital statistics;
                                                (dd) municipal police
                                            department records;
                                                (ee) reports from local
                                            coroners; or
                                                (ff) other relevant data;
                                            and
                              (ii) in the case of a local board proposing to
                          serve a population described in subsection
                          (e)(2)(B), a demonstration of the workforce
                          shortage in the professional area to be addressed
                          under the subgrant (which may include substance
                          use disorder treatment and related services, non-
                          addictive pain therapy and pain management
                          services, mental health care treatment services,
                          emergency response services, or mental health
                          care), which shall include information that can
                          demonstrate such a shortage, such as--
                                        (I) the distance between--

    [[Page 132 STAT. 4088]]

                                                (aa) communities affected by
                                            opioid abuse or another
                                            substance use disorder; and
                                                (bb) facilities or
                                            professionals offering services
                                            in the professional area; or
                                        (II) the maximum capacity of
                                    facilities or professionals to serve
                                    individuals in an affected community, or
                                    increases in arrests related to opioid
                                    or another substance use disorder,
                                    overdose deaths, or nonfatal overdose
                                    emergencies in the community.

        (e) Subgrant Services and Activities.--
                (1) In general.--Each local board that receives a subgrant
            under subsection (d) shall carry out the services and activities
            described in this subsection through a participating
            partnership.
                (2) Selection of population to be served.--A participating
            partnership shall elect to provide services and activities under
            the subgrant to one or both of the following populations of
            workers:
                        (A) Workers, including dislocated workers,
                    individuals with barriers to employment, new entrants in
                    the workforce, or incumbent workers (employed or
                    underemployed), each of whom--
                              (i) is directly or indirectly affected by a
                          high rate of a substance use disorder; and
                              (ii) voluntarily confirms that the worker, or
                          a friend or family member of the worker, has a
                          history of opioid abuse or another substance use
                          disorder.
                        (B) Workers, including dislocated workers,
                    individuals with barriers to employment, new entrants in
                    the workforce, or incumbent workers (employed or
                    underemployed), who--
                              (i) seek to transition to professions that
                          support individuals with a substance use disorder
                          or at risk for developing such disorder, such as
                          professions that provide--
                                        (I) substance use disorder treatment
                                    and related services;
                                        (II) services offered through
                                    providers of peer recovery support
                                    services;
                                        (III) non-addictive pain therapy and
                                    pain management services;
                                        (IV) emergency response services; or
                                        (V) mental health care; and
                              (ii) need new or upgraded skills to better
                          serve such a population of struggling or at-risk
                          individuals.
                (3) Services and activities.--Each participating partnership
            shall use funds available through a subgrant under this
            subsection to carry out 1 or more of the following:
                        (A) Engaging employers.--Engaging with employers
                    to--
                              (i) learn about the skill and hiring
                          requirements of employers;
                              (ii) learn about the support needed by
                          employers to hire and retain program participants,
                          and other individuals with a substance use
                          disorder, and the support needed by such employers
                          to obtain their

    [[Page 132 STAT. 4089]]

                          commitment to testing creative solutions to
                          employing program participants and such
                          individuals;
                              (iii) connect employers and workers to on-the-
                          job or customized training programs before or
                          after layoff to help facilitate reemployment;
                              (iv) connect employers with an education
                          provider to develop classroom instruction to
                          complement on-the-job learning for program
                          participants and such individuals;
                              (v) help employers develop the curriculum
                          design of a work-based learning program for
                          program participants and such individuals;
                              (vi) help employers employ program
                          participants or such individuals engaging in a
                          work-based learning program for a transitional
                          period before hiring such a program participant or
                          individual for full-time employment of not less
                          than 30 hours a week; or
                              (vii) connect employers to program
                          participants receiving concurrent outpatient
                          treatment and job training services.
                        (B) Screening services.--Providing screening
                    services, which may include--
                              (i) using an evidence-based screening method
                          to screen each individual seeking participation in
                          the pilot program to determine whether the
                          individual has a substance use disorder;
                              (ii) conducting an assessment of each such
                          individual to determine the services needed for
                          such individual to obtain or retain employment,
                          including an assessment of strengths and general
                          work readiness; or
                              (iii) accepting walk-ins or referrals from
                          employers, labor organizations, or other entities
                          recommending individuals to participate in such
                          program.
                        (C) Individual treatment and employment plan.--
                    Developing an individual treatment and employment plan
                    for each program participant--
                              (i) in coordination, as appropriate, with
                          other programs serving the participant such as the
                          core programs within the workforce development
                          system under the Workforce Innovation and
                          Opportunity Act (29 U.S.C. 3101 et seq.); and
                              (ii) which shall include providing a case
                          manager to work with each participant to develop
                          the plan, which may include--
                                        (I) identifying employment and
                                    career goals;
                                        (II) exploring career pathways that
                                    lead to in-demand industries and
                                    sectors, as determined by the State
                                    board and the head of the State
                                    workforce agency or, as applicable, the
                                    Tribal entity;
                                        (III) setting appropriate
                                    achievement objectives to attain the
                                    employment and career goals identified
                                    under subclause (I); or
                                        (IV) developing the appropriate
                                    combination of services to enable the
                                    participant to achieve

    [[Page 132 STAT. 4090]]

                                    the employment and career goals
                                    identified under subclause (I).
                        (D) Outpatient treatment and recovery care.--In the
                    case of a participating partnership serving program
                    participants described in paragraph (2)(A) with a
                    substance use disorder, providing individualized and
                    group outpatient treatment and recovery services for
                    such program participants that are offered during the
                    day and evening, and on weekends. Such treatment and
                    recovery services--
                              (i) shall be based on a model that utilizes
                          combined behavioral interventions and other
                          evidence-based or evidence-informed interventions;
                          and
                              (ii) may include additional services such as--
                                        (I) health, mental health,
                                    addiction, or other forms of outpatient
                                    treatment that may impact a substance
                                    use disorder and co-occurring
                                    conditions;
                                        (II) drug testing for a current
                                    substance use disorder prior to
                                    enrollment in career or training
                                    services or prior to employment;
                                        (III) linkages to community
                                    services, including services offered by
                                    partner organizations designed to
                                    support program participants; or
                                        (IV) referrals to health care,
                                    including referrals to substance use
                                    disorder treatment and mental health
                                    services.
                        (E) Supportive services.--Providing supportive
                    services, which shall include services such as--
                              (i) coordinated wraparound services to provide
                          maximum support for program participants to assist
                          the program participants in maintaining employment
                          and recovery for not less than 12 months, as
                          appropriate;
                              (ii) assistance in establishing eligibility
                          for assistance under Federal, State, Tribal, and
                          local programs providing health services, mental
                          health services, vocational services, housing
                          services, transportation services, social
                          services, or services through early childhood
                          education programs (as defined in section 103 of
                          the Higher Education Act of 1965 (20 U.S.C.
                          1003));
                              (iii) services offered through providers of
                          peer recovery support services;
                              (iv) networking and mentorship opportunities;
                          or
                              (v) any supportive services determined
                          necessary by the local board.
                        (F) Career and job training services.--Offering
                    career services and training services, and related
                    services, concurrently or sequentially with the services
                    provided under subparagraphs (B) through (E). Such
                    services shall include the following:
                              (i) Services provided to program participants
                          who are in a pre-employment stage of the program,
                          which may include--
                                        (I) initial education and skills
                                    assessments;
                                        (II) traditional classroom training
                                    funded through individual training
                                    accounts under chapter 3 of subtitle B
                                    of title I of the Workforce

    [[Page 132 STAT. 4091]]

                                    Innovation and Opportunity Act (29
                                    U.S.C. 3171 et seq.);
                                        (III) services to promote
                                    employability skills such as
                                    punctuality, personal maintenance
                                    skills, and professional conduct;
                                        (IV) in-depth interviewing and
                                    evaluation to identify employment
                                    barriers and to develop individual
                                    employment plans;
                                        (V) career planning that includes--
                                                (aa) career pathways leading
                                            to in-demand, high-wage jobs;
                                            and
                                                (bb) job coaching, job
                                            matching, and job placement
                                            services;
                                        (VI) provision of payments and fees
                                    for employment and training-related
                                    applications, tests, and certifications;
                                    or
                                        (VII) any other appropriate career
                                    service or training service described in
                                    section 134(c) of the Workforce
                                    Innovation and Opportunity Act (29
                                    U.S.C. 3174(c)).
                              (ii) Services provided to program participants
                          during their first 6 months of employment to
                          ensure job retention, which may include--
                                        (I) case management and support
                                    services, including a continuation of
                                    the services described in clause (i);
                                        (II) a continuation of skills
                                    training, and career and technical
                                    education, described in clause (i) that
                                    is conducted in collaboration with the
                                    employers of such participants;
                                        (III) mentorship services and job
                                    retention support for such participants;
                                    or
                                        (IV) targeted training for managers
                                    and workers working with such
                                    participants (such as mentors), and
                                    human resource representatives in the
                                    business in which such participants are
                                    employed.
                              (iii) Services to assist program participants
                          in maintaining employment for not less than 12
                          months, as appropriate.
                        (G) Proven and promising practices.--Leading efforts
                    in the service area to identify and promote proven and
                    promising strategies and initiatives for meeting the
                    needs of employers and program participants.
                (4) Limitations.--A participating partnership may not use--
                        (A) more than 10 percent of the funds received under
                    a subgrant under subsection (d) for the administrative
                    costs of the partnership;
                        (B) more than 10 percent of the funds received under
                    such subgrant for the provision of treatment and
                    recovery services, as described in paragraph (3)(D); and
                        (C) more than 10 percent of the funds received under
                    such subgrant for the provision of supportive services
                    described in paragraph (3)(E) to program participants.

        (f) Performance Accountability.--

    [[Page 132 STAT. 4092]]

                (1) Reports.--The Secretary shall establish quarterly
            reporting requirements for recipients of grants and subgrants
            under this section that, to the extent practicable, are based on
            the performance accountability system under section 116 of the
            Workforce Innovation and Opportunity Act (29 U.S.C. 3141) and,
            in the case of a grant awarded to an eligible entity described
            in subsection (a)(3)(C), section 166(h) of such Act (29 U.S.C.
            3221(h)), including the indicators described in subsection
            (c)(1)(A)(i) of such section 116 and the requirements for local
            area performance reports under subsection (d) of such section
            116.
                (2) Evaluations.--
                        (A) Authority to enter into agreements.--The
                    Secretary shall ensure that an independent evaluation is
                    conducted on the pilot program carried out under this
                    section to determine the impact of the program on
                    employment of individuals with substance use disorders.
                    The Secretary shall enter into an agreement with
                    eligible entities receiving grants under this section to
                    pay for all or part of such evaluation.
                        (B) Methodologies to be used.--The independent
                    evaluation required under this paragraph shall use
                    experimental designs using random assignment or, when
                    random assignment is not feasible, other reliable,
                    evidence-based research methodologies that allow for the
                    strongest possible causal inferences.

        (g) Funding.--
                (1) Covered fiscal year.--In this subsection, the term
            ``covered fiscal year'' means any of fiscal years 2019 through
            2023.
                (2) Using funding for national dislocated worker grants.--
            Subject to paragraph (4) and notwithstanding section
            132(a)(2)(A) and subtitle D of the Workforce Innovation and
            Opportunity Act (29 U.S.C. 3172(a)(2)(A), 3221 et seq.), the
            Secretary may use, to carry out the pilot program under this
            section for a covered fiscal year--
                        (A) funds made available to carry out section 170 of
                    such Act (29 U.S.C. 3225) for that fiscal year;
                        (B) funds made available to carry out section 170 of
                    such Act that remain available for that fiscal year; and
                        (C) funds that remain available under section 172(f)
                    of such Act (29 U.S.C. 3227(f)).
                (3) Availability of funds.--Funds appropriated under section
            136(c) of such Act (29 U.S.C. 3181(c)) and made available to
            carry out section 170 of such Act for a fiscal year shall remain
            available for use under paragraph (2) for a subsequent fiscal
            year until expended.
                (4) Limitation.--The Secretary may not use more than
            $100,000,000 of the funds described in paragraph (2) for any
            covered fiscal year under this section.

    [[Page 132 STAT. 4093]]

         Subtitle D--Peer Support Counseling Program for Women Veterans

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

        (a) In General.--Section 1720F(j) of title 38, United States Code,
    is amended by adding at the end the following new paragraph:
        ``(4)(A) As part of the counseling program under this subsection,
    the Secretary shall emphasize appointing peer support counselors for
    women veterans. To the degree practicable, the Secretary shall seek to
    recruit women peer support counselors with expertise in--
                ``(i) female gender-specific issues and services;
                ``(ii) the provision of information about services and
            benefits provided under laws administered by the Secretary; or
                ``(iii) employment mentoring.

        ``(B) To the degree practicable, the Secretary shall emphasize
    facilitating peer support counseling for women veterans who are eligible
    for counseling and services under section 1720D of this title, have
    post-traumatic stress disorder or suffer from another mental health
    condition, are homeless or at risk of becoming homeless, or are
    otherwise at increased risk of suicide, as determined by the Secretary.
        ``(C) The Secretary shall conduct outreach to inform women veterans
    about the program and the assistance available under this paragraph.
        ``(D) In carrying out this paragraph, the Secretary shall coordinate
    with such community organizations, State and local governments,
    institutions of higher education, chambers of commerce, local business
    organizations, organizations that provide legal assistance, and other
    organizations as the Secretary considers appropriate.
        ``(E) In carrying out this paragraph, the Secretary shall provide
    adequate training for peer support counselors, including training
    carried out under the national program of training required by section
    304(c) of the Caregivers and Veterans Omnibus Health Services Act of
    2010 (38 U.S.C. 1712A note).''.
        (b) <<NOTE: 38 USC 1720F note.>>  Funding.--The Secretary of
    Veterans Affairs shall carry out paragraph (4) of section 1720F(j) of
    title 38, United States Code, as added by subsection (a), using funds
    otherwise made available to the Secretary. No additional funds are
    authorized to be appropriated by reason of such paragraph.

        (c) Report to Congress.--Not later than 2 years after the date of
    the enactment of this Act, the Secretary of Veterans Affairs shall
    submit to the Committees on Veterans' Affairs of the Senate and House of
    Representatives a report on the peer support counseling program under
    section 1720F(j) of title 38, United States Code, as amended by this
    section. Such report shall include--
                (1) the number of peer support counselors in the program;
                (2) an assessment of the effectiveness of the program; and
                (3) a description of the oversight of the program.

    [[Page 132 STAT. 4094]]

      Subtitle <<NOTE: Treating Barriers to Prosperity Act of 2018.>>  E--
    Treating Barriers to Prosperity
    SEC. 8061. <<NOTE: 40 USC 101 note.>>  SHORT TITLE.

        This subtitle may be cited as the ``Treating Barriers to Prosperity
    Act of 2018''.
    SEC. 8062. DRUG ABUSE MITIGATION INITIATIVE.

        (a) In General.--Chapter 145 of title 40, United States Code, is
    amended by inserting after section 14509 the following:
    ``Sec. 14510. <<NOTE: 40 USC 14510.>>  Drug abuse mitigation
                        initiative

        ``(a) In General.--The Appalachian Regional Commission may provide
    technical assistance to, make grants to, enter into contracts with, or
    otherwise provide amounts to individuals or entities in the Appalachian
    region for projects and activities to address drug abuse, including
    opioid abuse, in the region, including projects and activities--
                ``(1) to facilitate the sharing of best practices among
            States, counties, and other experts in the region with respect
            to reducing such abuse;
                ``(2) to initiate or expand programs designed to eliminate
            or reduce the harm to the workforce and economic growth of the
            region that results from such abuse;
                ``(3) to attract and retain relevant health care services,
            businesses, and workers; and
                ``(4) to develop relevant infrastructure, including
            broadband infrastructure that supports the use of telemedicine.

        ``(b) Limitation on Available Amounts.--Of the cost of any activity
    eligible for a grant under this section--
                ``(1) not more than 50 percent may be provided from amounts
            appropriated to carry out this section; and
                ``(2) notwithstanding paragraph (1)--
                        ``(A) in the case of a project to be carried out in
                    a county for which a distressed county designation is in
                    effect under section 14526, not more than 80 percent may
                    be provided from amounts appropriated to carry out this
                    section; and
                        ``(B) in the case of a project to be carried out in
                    a county for which an at-risk designation is in effect
                    under section 14526, not more than 70 percent may be
                    provided from amounts appropriated to carry out this
                    section.

        ``(c) Sources of Assistance.--Subject to subsection (b), a grant
    provided under this section may be provided from amounts made available
    to carry out this section in combination with amounts made available--
                ``(1) under any other Federal program (subject to the
            availability of subsequent appropriations); or
                ``(2) from any other source.

        ``(d) Federal Share.--Notwithstanding any provision of law limiting
    the Federal share under any other Federal program, amounts made
    available to carry out this section may be used to increase that Federal
    share, as the Appalachian Regional Commission determines to be
    appropriate.''.

    [[Page 132 STAT. 4095]]

        (b) Clerical Amendment.--The analysis for chapter 145 of title 40,
    United States Code, <<NOTE: 40 USC 14501 prec.>>  is amended by
    inserting after the item relating to section 14509 the following:

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

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

    SEC. 8071. <<NOTE: 42 USC 5301 note.>>  PILOT PROGRAM TO HELP
                              INDIVIDUALS IN RECOVERY FROM A SUBSTANCE
                              USE DISORDER BECOME STABLY HOUSED.

        (a) Authorization of Appropriations.--There is authorized to be
    appropriated under this section such sums as may be necessary for each
    of fiscal years 2019 through 2023 for assistance to States to provide
    individuals in recovery from a substance use disorder stable, temporary
    housing for a period of not more than 2 years or until the individual
    secures permanent housing, whichever is earlier.
        (b) Allocation of Appropriated Amounts.--
                (1) In general.--The amounts appropriated or otherwise made
            available to States under this section shall be allocated based
            on a funding formula established by the Secretary of Housing and
            Urban Development (referred to in this section as the
            ``Secretary'') not later than 60 days after the date of
            enactment of this Act.
                (2) Criteria.--
                        (A) In general.--The funding formula required under
                    paragraph (1) shall ensure that any amounts appropriated
                    or otherwise made available under this section are
                    allocated to States with an age-adjusted rate of drug
                    overdose deaths that is above the national overdose
                    mortality rate, according to the Centers for Disease
                    Control and Prevention.
                        (B) Priority.--
                              (i) In general.--Among such States, priority
                          shall be given to States with the greatest need,
                          as such need is determined by the Secretary based
                          on the following factors, and weighting such
                          factors as described in clause (ii):
                                        (I) The highest average rates of
                                    unemployment based on data provided by
                                    the Bureau of Labor Statistics for
                                    calendar years 2013 through 2017.
                                        (II) The lowest average labor force
                                    participation rates based on data
                                    provided by the Bureau of Labor
                                    Statistics for calendar years 2013
                                    through 2017.
                                        (III) The highest age-adjusted rates
                                    of drug overdose deaths based on data
                                    from the Centers for Disease Control and
                                    Prevention.
                              (ii) Weighting.--The factors described in
                          clause (i) shall be weighted as follows:
                                        (I) The rate described in clause
                                    (i)(I) shall be weighted at 15 percent.

    [[Page 132 STAT. 4096]]

                                        (II) The rate described in clause
                                    (i)(II) shall be weighted at 15 percent.
                                        (III) The rate described in clause
                                    (i)(III) shall be weighted at 70
                                    percent.
                (3) Distribution.--Amounts appropriated or otherwise made
            available under this section shall be distributed according to
            the funding formula established by the Secretary under paragraph
            (1) not later than 30 days after the establishment of such
            formula.

        (c) Use of Funds.--
                (1) In general.--Any State that receives amounts pursuant to
            this section shall expend at least 30 percent of such funds
            within one year of the date funds become available to the
            grantee for obligation.
                (2) Priority.--Any State that receives amounts pursuant to
            this section shall distribute such amounts giving priority to
            entities with the greatest need and ability to deliver effective
            assistance in a timely manner.
                (3) Administrative costs.--Any State that receives amounts
            pursuant to this section may use up to 5 percent of any grant
            for administrative costs.

        (d) Rules of Construction.--
                (1) In general.--Except as otherwise provided by this
            section, amounts appropriated, or amounts otherwise made
            available to States under this section shall be treated as
            though such funds were community development block grant funds
            under title I of the Housing and Community Development Act of
            1974 (42 U.S.C. 5301 et seq.).
                (2) No match.--No matching funds shall be required in order
            for a State to receive any amounts under this section.

        (e) Authority to Waive or Specify Alternative Requirements.--
                (1) In general.--In administering any amounts appropriated
            or otherwise made available under this section, the Secretary
            may waive or specify alternative requirements to any provision
            under title I of the Housing and Community Development Act of
            1974 (42 U.S.C. 5301 et seq.) except for requirements related to
            fair housing, nondiscrimination, labor standards, the
            environment, and requirements that activities benefit persons of
            low- and moderate-income, upon a finding that such a waiver is
            necessary to expedite or facilitate the use of such funds.
                (2) Notice of intent.--The Secretary shall provide written
            notice of its intent to exercise the authority to specify
            alternative requirements under paragraph (1) to the Committee on
            Banking, Housing, and Urban Affairs of the Senate and the
            Committee on Financial Services of the House of Representatives
            not later than 15 business days before such exercise of
            authority occurs.
                (3) Notice to the public.--The Secretary shall provide
            written notice of its intent to exercise the authority to
            specify alternative requirements under paragraph (1) to the
            public via notice, on the internet website of the Department of
            Housing and Urban Development, and by other appropriate means,
            not later than 15 business days before such exercise of
            authority occurs.

    [[Page 132 STAT. 4097]]

        (f) Technical Assistance.--For the 2-year period following the date
    of enactment of this Act, the Secretary may use not more than 2 percent
    of the funds made available under this section for technical assistance
    to grantees.
        (g) State.--For purposes of this section the term ``State'' includes
    any State as defined in section 102 of the Housing and Community
    Development Act of 1974 (42 U.S.C. 5302) and the District of Columbia.

                           Subtitle G--Human Services

    SEC. 8081. <<NOTE: 42 USC 290bb-11 note.>>  SUPPORTING FAMILY-
                              FOCUSED RESIDENTIAL TREATMENT.

        (a) Definitions.--In this section:
                (1) Family-focused residential treatment program.--The term
            ``family-focused residential treatment program'' means a trauma-
            informed residential program primarily for substance use
            disorder treatment for pregnant and postpartum women and parents
            and guardians that allows children to reside with such women or
            their parents or guardians during treatment to the extent
            appropriate and applicable.
                (2) Medicaid program.--The term ``Medicaid program'' means
            the program established under title XIX of the Social Security
            Act (42 U.S.C. 1396 et seq.).
                (3) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services.
                (4) Title iv-e program.--The term ``title IV-E program''
            means the program for foster care, prevention, and permanency
            established under part E of title IV of the Social Security Act
            (42 U.S.C. 670 et seq.).

        (b) Guidance on Family-focused Residential Treatment Programs.--
                (1) In general.--Not later than 180 days after the date of
            enactment of this Act, the Secretary, in consultation with
            divisions of the Department of Health and Human Services
            administering substance use disorder or child welfare programs,
            shall develop and issue guidance to States identifying
            opportunities to support family-focused residential treatment
            programs for the provision of substance use disorder treatment.
            Before issuing such guidance, the Secretary shall solicit input
            from representatives of States, health care providers with
            expertise in addiction medicine, obstetrics and gynecology,
            neonatology, child trauma, and child development, health plans,
            recipients of family-focused treatment services, and other
            relevant stakeholders.
                (2) Additional requirements.--The guidance required under
            paragraph (1) shall include descriptions of the following:
                        (A) Existing opportunities and flexibilities under
                    the Medicaid program, including under waivers authorized
                    under section 1115 or 1915 of the Social Security Act
                    (42 U.S.C. 1315, 1396n), for States to receive Federal
                    Medicaid funding for the provision of substance use
                    disorder treatment for pregnant and postpartum women and
                    parents and guardians and, to the extent applicable,
                    their children, in family-focused residential treatment
                    programs.

    [[Page 132 STAT. 4098]]

                        (B) How States can employ and coordinate funding
                    provided under the Medicaid program, the title IV-E
                    program, and other programs administered by the
                    Secretary to support the provision of treatment and
                    services provided by a family-focused residential
                    treatment facility such as substance use disorder
                    treatment and services, including medication-assisted
                    treatment, family, group, and individual counseling,
                    case management, parenting education and skills
                    development, the provision, assessment, or coordination
                    of care and services for children, including necessary
                    assessments and appropriate interventions, non-emergency
                    transportation for necessary care provided at or away
                    from a program site, transitional services and supports
                    for families leaving treatment, and other services.
                        (C) How States can employ and coordinate funding
                    provided under the Medicaid program and the title IV-E
                    program (including as amended by the Family First
                    Prevention Services Act enacted under title VII of
                    division E of Public Law 115-123, and particularly with
                    respect to the authority under subsections (a)(2)(C) and
                    (j) of section 472 and section 474(a)(1) of the Social
                    Security Act (42 U.S.C. 672, 674(a)(1)) (as amended by
                    section 50712 of Public Law 115-123) to provide foster
                    care maintenance payments for a child placed with a
                    parent who is receiving treatment in a licensed
                    residential family-based treatment facility for a
                    substance use disorder) to support placing children with
                    their parents in family-focused residential treatment
                    programs.
    SEC. 8082. IMPROVING RECOVERY AND REUNIFYING FAMILIES.

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

    [[Page 132 STAT. 4099]]

                        ``(B) assistance in receiving the appropriate
                    benefits to aid the parent or guardian in recovery;
                        ``(C) services to assist the parent or guardian in
                    prioritizing issues identified in assessments,
                    establishing goals for resolving such issues that are
                    consistent with the goals of the treatment provider,
                    child welfare agency, courts, and other agencies
                    involved with the parent or guardian or their children,
                    and making a coordinated plan for achieving such goals;
                        ``(D) home visiting services coordinated with the
                    child welfare agency and treatment provider involved
                    with the parent or guardian or their children;
                        ``(E) case management services to remove barriers
                    for the parent or guardian to participate and continue
                    in treatment, as well as to re-engage a parent or
                    guardian who is not participating or progressing in
                    treatment;
                        ``(F) access to services needed to monitor the
                    parent's or guardian's compliance with program
                    requirements;
                        ``(G) frequent reporting between the treatment
                    provider, child welfare agency, courts, and other
                    agencies involved with the parent or guardian or their
                    children to ensure appropriate information on the
                    parent's or guardian's status is available to inform
                    decision-making; and
                        ``(H) assessments and recommendations provided by a
                    recovery coach to the child welfare caseworker
                    responsible for documenting the parent's or guardian's
                    progress in treatment and recovery as well as the status
                    of other areas identified in the treatment plan for the
                    parent or guardian, including a recommendation regarding
                    the expected safety of the child if the child is
                    returned to the custody of the parent or guardian that
                    can be used by the caseworker and a court to make
                    permanency decisions regarding the child.
                ``(3) Responsibilities of the secretary.--
                        ``(A) In general.--The Secretary shall, through a
                    grant or contract with 1 or more entities, conduct and
                    evaluate the family recovery and reunification program
                    under the project.
                        ``(B) Requirements.--In identifying 1 or more
                    entities to conduct the evaluation of the family
                    recovery and reunification program, the Secretary
                    shall--
                              ``(i) determine that the area or areas in
                          which the program will be conducted have
                          sufficient substance use disorder treatment
                          providers and other resources (other than those
                          provided with funds made available to carry out
                          the project) to successfully conduct the program;
                              ``(ii) determine that the area or areas in
                          which the program will be conducted have enough
                          potential program participants, and will serve a
                          sufficient number of parents or guardians and
                          their children, so as to allow for the formation
                          of a control group, evaluation results to be
                          adequately powered, and preliminary results of the
                          evaluation to be available within 4 years of the
                          program's implementation;
                              ``(iii) provide the entity or entities with
                          technical assistance for the program design,
                          including by

    [[Page 132 STAT. 4100]]

                          working with 1 or more entities that are or have
                          been involved in recovery coaching programs that
                          have been rigorously evaluated and shown to
                          increase family reunification and protect children
                          so as to make sure the program conducted under the
                          project adheres closely to the elements and
                          protocol determined to be most effective in such
                          other recovery coaching programs;
                              ``(iv) assist the entity or entities in
                          securing adequate coaching, treatment, child
                          welfare, court, and other resources needed to
                          successfully conduct the family recovery and
                          reunification program under the project; and
                              ``(v) ensure the entity or entities will be
                          able to monitor the impacts of the program in the
                          area or areas in which it is conducted for at
                          least 5 years after parents or guardians and their
                          children are randomly assigned to participate in
                          the program or to be part of the program's control
                          group.
                ``(4) Evaluation requirements.--
                        ``(A) In general.--The Secretary, in consultation
                    with the entity or entities conducting the family
                    recovery and reunification program under the project,
                    shall conduct an evaluation to determine whether the
                    program has been implemented effectively and resulted in
                    improvements for children and families. The evaluation
                    shall have 3 components: a pilot phase, an impact study,
                    and an implementation study.
                        ``(B) Pilot phase.--The pilot phase component of the
                    evaluation shall consist of the Secretary providing
                    technical assistance to the entity or entities
                    conducting the family recovery and reunification program
                    under the project to ensure--
                              ``(i) the program's implementation adheres
                          closely to the elements and protocol determined to
                          be most effective in other recovery coaching
                          programs that have been rigorously evaluated and
                          shown to increase family reunification and protect
                          children; and
                              ``(ii) random assignment of parents or
                          guardians and their children to be participants in
                          the program or to be part of the program's control
                          group is being carried out.
                        ``(C) Impact study.--The impact study component of
                    the evaluation shall determine the impacts of the family
                    recovery and reunification program conducted under the
                    project on the parents and guardians and their children
                    participating in the program. The impact study component
                    shall--
                              ``(i) be conducted using an experimental
                          design that uses a random assignment research
                          methodology;
                              ``(ii) consistent with previous studies of
                          other recovery coaching programs that have been
                          rigorously evaluated and shown to increase family
                          reunification and protect children, measure
                          outcomes for parents and guardians and their
                          children over multiple time periods, including for
                          a period of 5 years; and

    [[Page 132 STAT. 4101]]

                              ``(iii) include measurements of family
                          stability and parent, guardian, and child safety
                          for program participants and the program control
                          group that are consistent with measurements of
                          such factors for participants and control groups
                          from previous studies of other recovery coaching
                          programs so as to allow results of the impact
                          study to be compared with the results of such
                          prior studies, including with respect to
                          comparisons between program participants and the
                          program control group regarding--
                                        ``(I) safe family reunification;
                                        ``(II) time to reunification;
                                        ``(III) permanency (such as through
                                    measures of reunification, adoption, or
                                    placement with guardians);
                                        ``(IV) safety (such as through
                                    measures of subsequent maltreatment);
                                        ``(V) parental or guardian treatment
                                    persistence and engagement;
                                        ``(VI) parental or guardian
                                    substance use;
                                        ``(VII) juvenile delinquency;
                                        ``(VIII) cost; and
                                        ``(IX) other measurements agreed
                                    upon by the Secretary and the entity or
                                    entities operating the family recovery
                                    and reunification program under the
                                    project.
                        ``(D) Implementation study.--The implementation
                    study component of the evaluation shall be conducted
                    concurrently with the conduct of the impact study
                    component and shall include, in addition to such other
                    information as the Secretary may determine, descriptions
                    and analyses of--
                              ``(i) the adherence of the family recovery and
                          reunification program conducted under the project
                          to other recovery coaching programs that have been
                          rigorously evaluated and shown to increase family
                          reunification and protect children; and
                              ``(ii) the difference in services received or
                          proposed to be received by the program
                          participants and the program control group.
                        ``(E) Report.--The Secretary shall publish on an
                    internet website maintained by the Secretary the
                    following information:
                              ``(i) A report on the pilot phase component of
                          the evaluation.
                              ``(ii) A report on the impact study component
                          of the evaluation.
                              ``(iii) A report on the implementation study
                          component of the evaluation.
                              ``(iv) A report that includes--
                                        ``(I) analyses of the extent to
                                    which the program has resulted in
                                    increased reunifications, increased
                                    permanency, case closures, net savings
                                    to the State or States involved (taking
                                    into account both costs borne by States
                                    and the Federal government), or other
                                    outcomes, or if the program did not
                                    produce such outcomes, an analysis of
                                    why

    [[Page 132 STAT. 4102]]

                                    the replication of the program did not
                                    yield such results;
                                        ``(II) if, based on such analyses,
                                    the Secretary determines the program
                                    should be replicated, a replication
                                    plan; and
                                        ``(III) such recommendations for
                                    legislation and administrative action as
                                    the Secretary determines appropriate.
                ``(5) Appropriation.--In addition to any amounts otherwise
            made available to carry out this subpart, out of any money in
            the Treasury of the United States not otherwise appropriated,
            there are appropriated $15,000,000 for fiscal year 2019 to carry
            out the project, which shall remain available through fiscal
            year 2026.''.

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

        (c) <<NOTE: 42 USC 671 note.>>  Effective Date.--The amendments made
    by subsection (b) shall take effect as if included in section 50711 of
    division E of Public Law 115-123.
    SEC. 8083. <<NOTE: 42 USC 290bb-11.>>  BUILDING CAPACITY FOR
                              FAMILY-FOCUSED RESIDENTIAL TREATMENT.

        (a) Definitions.--In this section:
                (1) Eligible entity.--The term ``eligible entity'' means a
            State, county, local, or tribal health or child welfare agency,
            a private nonprofit organization, a research organization, a
            treatment service provider, an institution of higher education
            (as defined under section 101 of the Higher Education Act of
            1965 (20 U.S.C. 1001)), or another entity specified by the
            Secretary.
                (2) Family-focused residential treatment program.--The term
            ``family-focused residential treatment program'' means a trauma-
            informed residential program primarily for substance

    [[Page 132 STAT. 4103]]

            use disorder treatment for pregnant and postpartum women and
            parents and guardians that allows children to reside with such
            women or their parents or guardians during treatment to the
            extent appropriate and applicable.
                (3) Secretary.--The term ``Secretary'' means the Secretary
            of Health and Human Services.

        (b) Support for the Development of Evidence-based Family-focused
    Residential Treatment Programs.--
                (1) Authority to award grants.--The Secretary shall award
            grants to eligible entities for purposes of developing,
            enhancing, or evaluating family-focused residential treatment
            programs to increase the availability of such programs that meet
            the requirements for promising, supported, or well-supported
            practices specified in section 471(e)(4)(C) of the Social
            Security Act (42 U.S.C. 671(e)(4)(C))) (as added by the Family
            First Prevention Services Act enacted under title VII of
            division E of Public Law 115-123).
                (2) Evaluation requirement.--The Secretary shall require any
            evaluation of a family-focused residential treatment program by
            an eligible entity that uses funds awarded under this section
            for all or part of the costs of the evaluation be designed to
            assist in the determination of whether the program may qualify
            as a promising, supported, or well-supported practice in
            accordance with the requirements of such section 471(e)(4)(C).

        (c) Authorization of Appropriations.--There is authorized to be
    appropriated to the Secretary to carry out this section, $20,000,000 for
    fiscal year 2019, which shall remain available through fiscal year 2023.

     Subtitle <<NOTE: Reauthorizing and Extending Grants for Recovery from
       Opioid Use Programs Act of 2018.>>  H--Reauthorizing and Extending
    Grants for Recovery From Opioid Use Programs
    SEC. 8091. <<NOTE: 34 USC 10101 note.>>  SHORT TITLE.

        This subtitle may be cited as the ``Reauthorizing and Extending
    Grants for Recovery from Opioid Use Programs Act of 2018'' or the
    ``REGROUP Act of 2018''.
    SEC. 8092. REAUTHORIZATION OF THE COMPREHENSIVE OPIOID ABUSE GRANT
                              PROGRAM.

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

      Subtitle <<NOTE: Fighting Opioid Abuse in Transportation Act.>>  I--
    Fighting Opioid Abuse in Transportation
    SEC. 8101. <<NOTE: 49 USC 101 note.>>  SHORT TITLE.

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

    [[Page 132 STAT. 4104]]

    SEC. 8102. <<NOTE: 49 USC 20140 note.>>  ALCOHOL AND CONTROLLED
                              SUBSTANCE TESTING OF MECHANICAL
                              EMPLOYEES.

        (a) In General.--Not later than 2 years after the date of enactment
    of this Act, the Secretary of Transportation shall publish a rule in the
    Federal Register revising the regulations promulgated under section
    20140 of title 49, United States Code, to cover all employees of
    railroad carriers who perform mechanical activities.
        (b) Definition of Mechanical Activities.--For the purposes of the
    rule under subsection (a), the Secretary shall define the term
    ``mechanical activities'' by regulation.
    SEC. 8103. <<NOTE: 49 USC 329 note.>>  DEPARTMENT OF
                              TRANSPORTATION PUBLIC DRUG AND ALCOHOL
                              TESTING DATABASE.

        (a) In General.--Subject to subsection (c), the Secretary of
    Transportation shall--
                (1) not later than March 31, 2019, establish and make
            publicly available on its website a database of the drug and
            alcohol testing data reported by employers for each mode of
            transportation; and
                (2) update the database annually.

        (b) Contents.--The database under subsection (a) shall include, for
    each mode of transportation--
                (1) the total number of drug and alcohol tests by type of
            substance tested;
                (2) the drug and alcohol test results by type of substance
            tested;
                (3) the reason for the drug or alcohol test, such as pre-
            employment, random, post-accident, reasonable suspicion or
            cause, return-to-duty, or follow-up, by type of substance
            tested; and
                (4) the number of individuals who refused testing.

        (c) Commercially Sensitive Data.--The Department of Transportation
    shall not release any commercially sensitive data or personally
    identifiable data furnished by an employer under this section unless the
    data is aggregated or otherwise in a form that does not identify the
    employer providing the data.
        (d) Savings Clause.--Nothing in this section may be construed as
    limiting or otherwise affecting the requirements of the Secretary of
    Transportation to adhere to requirements applicable to confidential
    business information and sensitive security information, consistent with
    applicable law.
    SEC. 8104. GAO REPORT ON DEPARTMENT OF TRANSPORTATION'S COLLECTION
                              AND USE OF DRUG AND ALCOHOL TESTING
                              DATA.

        (a) In General.--Not later than 2 years after the date the
    Department of Transportation public drug and alcohol testing database is
    established under section 8103, the Comptroller General of the United
    States shall--
                (1) review the Department of Transportation Drug and Alcohol
            Testing Management Information System; and
                (2) submit to the Committee on Commerce, Science, and
            Transportation of the Senate and the Committee on Transportation
            and Infrastructure of the House of Representatives a report on
            the review, including recommendations under subsection (c).

        (b) Contents.--The report under subsection (a) shall include--

    [[Page 132 STAT. 4105]]

                (1) a description of the process the Department of
            Transportation uses to collect and record drug and alcohol
            testing data submitted by employers for each mode of
            transportation;
                (2) an assessment of whether and, if so, how the Department
            of Transportation uses the data described in paragraph (1) in
            carrying out its responsibilities; and
                (3) an assessment of the Department of Transportation public
            drug and alcohol testing database under section 8103.

        (c) Recommendations.--The report under subsection (a) may include
    recommendations regarding--
                (1) how the Department of Transportation can best use the
            data described in subsection (b)(1);
                (2) any improvements that could be made to the process
            described in subsection (b)(1);
                (3) whether and, if so, how the Department of Transportation
            public drug and alcohol testing database under section 8103
            could be made more effective; and
                (4) such other recommendations as the Comptroller General
            considers appropriate.
    SEC. 8105. <<NOTE: 5 USC 7301 note.>>  TRANSPORTATION WORKPLACE
                              DRUG AND ALCOHOL TESTING PROGRAM;
                              ADDITION OF FENTANYL AND OTHER
                              SUBSTANCES.

        (a) Mandatory Guidelines for Federal Workplace Drug Testing
    Programs.--
                (1) In general.--Not later than 180 days after the date of
            enactment of this Act, the Secretary of Health and Human
            Services shall--
                        (A) determine whether a revision of the Mandatory
                    Guidelines for Federal Workplace Drug Testing Programs
                    to expand the opiate category on the list of authorized
                    substance testing to include fentanyl is justified,
                    based on the reliability and cost-effectiveness of
                    available testing; and
                        (B) consider whether to include with the
                    determination under subparagraph (A) a separate
                    determination on whether a revision of the Mandatory
                    Guidelines for Federal Workplace Drug Testing Programs
                    to expand the list of substances authorized for testing
                    to include any other drugs or other substances listed in
                    schedule I and II of section 202 of the Controlled
                    Substances Act (21 U.S.C. 812) is justified based on the
                    criteria described in subparagraph (A).
                (2) Revision of guidelines.--If an expansion of the
            substance list is determined to be justified under paragraph
            (1), the Secretary of Health and Human Services shall--
                        (A) notify the Committee on Commerce, Science, and
                    Transportation of the Senate and the Committee on
                    Transportation and Infrastructure of the House of
                    Representatives of the determination; and
                        (B) publish in the Federal Register, not later than
                    18 months after the date of the determination under that
                    paragraph, a final notice of the revision of the
                    Mandatory Guidelines for Federal Workplace Drug Testing
                    Programs to expand the list of substances authorized to
                    be tested to include the substance or substances
                    determined to be justified for inclusion.

    [[Page 132 STAT. 4106]]

                (3) Report.--If an expansion of the substance list is
            determined not to be justified under paragraph (1), the
            Secretary of Health and Human Services shall submit to the
            Committee on Commerce, Science, and Transportation of the Senate
            and the Committee on Transportation and Infrastructure of the
            House of Representatives a report explaining, in detail, the
            reasons the expansion of the list of authorized substances is
            not justified.

        (b) Department of Transportation Drug-testing Panel.--If an
    expansion is determined to be justified under subsection (a)(1), the
    Secretary of Transportation shall publish in the Federal Register, not
    later than 18 months after the date the final notice is published under
    subsection (a)(2), a final rule revising part 40 of title 49, Code of
    Federal Regulations, to include such substances in the Department of
    Transportation's drug-testing panel, consistent with the Mandatory
    Guidelines for Federal Workplace Drug Testing Programs as revised by the
    Secretary of Health and Human Services under subsection (a).
        (c) Savings Provision.--Nothing in this section may be construed
    as--
                (1) delaying the publication of the notices described in
            sections 8106 and 8107 of this Act until the Secretary of Health
            and Human Services makes a determination or publishes a notice
            under this section; or
                (2) limiting or otherwise affecting any authority of the
            Secretary of Health and Human Services or the Secretary of
            Transportation to expand the list of authorized substance
            testing to include an additional substance.
    SEC. 8106. <<NOTE: 49 USC 31306 note.>>  STATUS REPORTS ON HAIR
                              TESTING GUIDELINES.

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

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

    [[Page 132 STAT. 4107]]

    SEC. 8107. <<NOTE: 5 USC 7301 note.>>  MANDATORY GUIDELINES FOR
                              FEDERAL WORKPLACE DRUG TESTING PROGRAMS
                              USING ORAL FLUID.

        (a) Deadline.--Not later than December 31, 2018, the Secretary of
    Health and Human Services shall publish in the Federal Register a final
    notice of the Mandatory Guidelines for Federal Workplace Drug Testing
    Programs using Oral Fluid, based on the notice of proposed mandatory
    guidelines published in the Federal Register on May 15, 2015 (94 FR
    28054).
        (b) Requirement.--To the extent practicable and consistent with the
    objective of the testing described in subsection (a) to detect illegal
    or unauthorized use of substances by the individual being tested, the
    final notice of scientific and technical guidelines under that
    subsection, as determined by the Secretary of Health and Human Services,
    shall eliminate the risk of positive test results, of the individual
    being tested, caused solely by the drug use of others and not caused by
    the drug use of the individual being tested.
        (c) Rule of Construction.--Nothing in this section may be construed
    as requiring the Secretary of Health and Human Services to reissue a
    notice of proposed mandatory guidelines to carry out subsection (a).
    SEC. 8108. <<NOTE: 5 USC 7301 note.>>  ELECTRONIC RECORDKEEPING.

        (a) Deadline.--Not later than 1 year after the date of enactment of
    this Act, the Secretary of Health and Human Services shall--
                (1) ensure that each certified laboratory that requests
            approval for the use of completely paperless electronic Federal
            Drug Testing Custody and Control Forms from the National
            Laboratory Certification Program's Electronic Custody and
            Control Form systems receives approval for those completely
            paperless electronic forms instead of forms that include any
            combination of electronic traditional handwritten signatures
            executed on paper forms; and
                (2) establish a deadline for a certified laboratory to
            request approval under paragraph (1).

        (b) Savings Clause.--Nothing in this section may be construed as
    limiting or otherwise affecting any authority of the Secretary of Health
    and Human Services to grant approval to a certified laboratory for use
    of completely paperless electronic Federal Drug Testing Custody and
    Control Forms, including to grant approval outside of the process under
    subsection (a).
        (c) <<NOTE: 49 USC 322 note.>>  Electronic Signatures.--Not later
    than 18 months after the date of the deadline under subsection (a)(2),
    the Secretary of Transportation shall issue a final rule revising part
    40 of title 49, Code of Federal Regulations, to authorize, to the extent
    practicable, the use of electronic signatures or digital signatures
    executed to electronic forms instead of traditional handwritten
    signatures executed on paper forms.
    SEC. 8109. STATUS REPORTS ON COMMERCIAL DRIVER'S LICENSE DRUG AND
                              ALCOHOL CLEARINGHOUSE.

        (a) In General.--Not later than 60 days after the date of enactment
    of this Act, and annually thereafter until the compliance date, the
    Administrator of the Federal Motor Carrier Safety Administration shall
    submit to the Committee on Commerce, Science, and Transportation of the
    Senate and the Committee on

    [[Page 132 STAT. 4108]]

    Transportation and Infrastructure of the House of Representatives a
    status report on implementation of the final rule for the Commercial
    Driver's License Drug and Alcohol Clearinghouse (81 FR 87686),
    including--
                (1) an updated schedule, including benchmarks, for
            implementing the final rule as soon as practicable, but not
            later than the compliance date; and
                (2) a description of each action the Federal Motor Carrier
            Safety Administration is taking to implement the final rule
            before the compliance date.

        (b) Definition of Compliance Date.--In this section, the term
    ``compliance date'' means the earlier of--
                (1) January 6, 2020; or
                (2) the date that the national clearinghouse required under
            section 31306a of title 49, United States Code, is operational.

     Subtitle <<NOTE: Eliminating Kickbacks in Recovery Act of 2018.>>  J--
    Eliminating Kickbacks in Recovery
    SEC. 8121. <<NOTE: 18 USC 1 note.>>  SHORT TITLE.

        This subtitle may be cited as the ``Eliminating Kickbacks in
    Recovery Act of 2018''.
    SEC. 8122. CRIMINAL PENALTIES.

        (a) In General.--Chapter 11 of title 18, United States Code, is
    amended by inserting after section 219 the following:
    ``Sec. 220. <<NOTE: 18 USC 220.>>  Illegal remunerations for
                    referrals to recovery homes, clinical treatment
                    facilities, and laboratories

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

    shall be fined not more than $200,000, imprisoned not more than 10
    years, or both, for each occurrence.
        ``(b) Applicability.--Subsection (a) shall not apply to--
                ``(1) a discount or other reduction in price obtained by a
            provider of services or other entity under a health care benefit
            program if the reduction in price is properly disclosed and
            appropriately reflected in the costs claimed or charges made by
            the provider or entity;
                ``(2) a payment made by an employer to an employee or
            independent contractor (who has a bona fide employment or

    [[Page 132 STAT. 4109]]

            contractual relationship with such employer) for employment, if
            the employee's payment is not determined by or does not vary
            by--
                        ``(A) the number of individuals referred to a
                    particular recovery home, clinical treatment facility,
                    or laboratory;
                        ``(B) the number of tests or procedures performed;
                    or
                        ``(C) the amount billed to or received from, in part
                    or in whole, the health care benefit program from the
                    individuals referred to a particular recovery home,
                    clinical treatment facility, or laboratory;
                ``(3) a discount in the price of an applicable drug of a
            manufacturer that is furnished to an applicable beneficiary
            under the Medicare coverage gap discount program under section
            1860D-14A(g) of the Social Security Act (42 U.S.C. 1395w-
            114a(g));
                ``(4) a payment made by a principal to an agent as
            compensation for the services of the agent under a personal
            services and management contract that meets the requirements of
            section 1001.952(d) of title 42, Code of Federal Regulations, as
            in effect on the date of enactment of this section;
                ``(5) a waiver or discount (as defined in section
            1001.952(h)(5) of title 42, Code of Federal Regulations, or any
            successor regulation) of any coinsurance or copayment by a
            health care benefit program if--
                        ``(A) the waiver or discount is not routinely
                    provided; and
                        ``(B) the waiver or discount is provided in good
                    faith;
                ``(6) a remuneration described in section 1128B(b)(3)(I) of
            the Social Security Act (42 U.S.C. 1320a-7b(b)(3)(I));
                ``(7) a remuneration made pursuant to an alternative payment
            model (as defined in section 1833(z)(3)(C) of the Social
            Security Act) or pursuant to a payment arrangement used by a
            State, health insurance issuer, or group health plan if the
            Secretary of Health and Human Services has determined that such
            arrangement is necessary for care coordination or value-based
            care; or
                ``(8) any other payment, remuneration, discount, or
            reduction as determined by the Attorney General, in consultation
            with the Secretary of Health and Human Services, by regulation.

        ``(c) Regulations.--The Attorney General, in consultation with the
    Secretary of Health and Human Services, may promulgate regulations to
    clarify the exceptions described in subsection (b).
        ``(d) Preemption.--
                ``(1) Federal law.--This section shall not apply to conduct
            that is prohibited under section 1128B of the Social Security
            Act (42 U.S.C. 1320a-7b).
                ``(2) State law.--Nothing in this section shall be construed
            to occupy the field in which any provisions of this section
            operate to the exclusion of State laws on the same subject
            matter.

        ``(e) Definitions.--In this section--
                ``(1) the terms `applicable beneficiary' and `applicable
            drug' have the meanings given those terms in section 1860D-
            14A(g) of the Social Security Act (42 U.S.C. 1395w-114a(g));
                ``(2) the term `clinical treatment facility' means a medical
            setting , other than a hospital, that provides detoxification,

    [[Page 132 STAT. 4110]]

            risk reduction, outpatient treatment and care, residential
            treatment, or rehabilitation for substance use, pursuant to
            licensure or certification under State law;
                ``(3) the term `health care benefit program' has the meaning
            given the term in section 24(b);
                ``(4) the term `laboratory' has the meaning given the term
            in section 353 of the Public Health Service Act (42 U.S.C.
            263a); and
                ``(5) the term `recovery home' means a shared living
            environment that is, or purports to be, free from alcohol and
            illicit drug use and centered on peer support and connection to
            services that promote sustained recovery from substance use
            disorders.''.

        (b) Clerical Amendment.--The table of sections for chapter 11 of
    title 18, United States Code, <<NOTE: 18 USC 201 prec.>>  is amended by
    inserting after the item related to section 219 the following:

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

      Subtitle <<NOTE: Substance Abuse Prevention Act of 2018. 21 USC 1701
    note.>>  K--Substance Abuse Prevention
    SEC. 8201. SHORT TITLE.

        This subtitle may be cited as the ``Substance Abuse Prevention Act
    of 2018''.
    SEC. 8202. REAUTHORIZATION OF THE OFFICE OF NATIONAL DRUG CONTROL
                              POLICY.

        (a) Office of National Drug Control Policy Reauthorization Act of
    1998.--
                (1) In general.--The Office of National Drug Control Policy
            Reauthorization Act of 1998 (21 U.S.C. 1701 et seq.), as in
            effect on September 29, 2003, and as amended by the laws
            described in paragraph (2), <<NOTE: 21 USC 1701 and note, 1702-
            1708, 1710-1712, 1714.>>  is revived and restored.
                (2) Laws described.--The laws described in this paragraph
            are:
                        (A) The Office of National Drug Control Policy
                    Reauthorization Act of 2006 (Public Law 109-469; 120
                    Stat. 3502).
                        (B) The Presidential Appointment Efficiency and
                    Streamlining Act of 2011 (Public Law 112-166; 126 Stat.
                    1283).

        (b) Reauthorization.--
                (1) In general.--Section 714 of the Office of National Drug
            Control Policy Reauthorization Act of 1998 (21 U.S.C. 1711) is
            amended by striking ``such sums as may be necessary for each of
            fiscal years 2006 through 2010'' and inserting ``$18,400,000 for
            each of fiscal years 2018 through 2023''.
                (2) Repeal of termination.--The Office of National Drug
            Control Policy Reauthorization Act of 1998 (21 U.S.C. 1701 et
            seq.) is amended by striking section 715 (21 U.S.C. 1712).
    SEC. 8203. REAUTHORIZATION OF THE DRUG-FREE COMMUNITIES PROGRAM.

        (a) Revival of National Narcotics Leadership Act of 1988.--

    [[Page 132 STAT. 4111]]

                (1) In general.--Chapter 2 of the National Narcotics
            Leadership Act of 1988 (21 U.S.C. 1521 et seq.), except for
            subchapter II (21 U.S.C. 1541 et seq.), as in effect on
            September 29, 1997, and as amended by the laws described in
            paragraph (2), is revived <<NOTE: 21 USC 1521 note. 21 USC 1521
            note.>>  and restored.
                (2) Laws described.--The laws described in this paragraph
            are:
                        (A) Public Law 107-82 (115 Stat. 814).
                        (B) The Office of National Drug Control Policy
                    Reauthorization Act of 2006 (Public Law 109-469: 120
                    Stat. 3502), as amended by paragraph (4).
                (3) Amendment to termination provision.--Section 1009 of the
            National Narcotics Leadership Act of 1988 (21 U.S.C. 1056) is
            amended <<NOTE: 21 USC 1506.>>  by inserting ``and sections 1021
            through 1035'' after ``section 1007''.
                (4) Technical correction.--
                        (A) In general.--Title VIII of the Office of
                    National Drug Control Policy Reauthorization Act of 2006
                    (Public Law 109-469; 120 Stat. 3535) <<NOTE: 21 USC
                    1524, 1532 and note.>>  is amended by striking ``Drug-
                    Free Communities Act of 1997'' each place it appears and
                    inserting ``National Narcotics Leadership Act of 1988''.
                        (B) <<NOTE: 21 USC 1524 note.>>  Effective date.--
                    The amendments made by subparagraph (A) shall take
                    effect as though enacted as part of the Office of
                    National Drug Control Policy Reauthorization Act of 2006
                    (Public Law 109-469; 120 Stat. 3502).

        (b) Amendment to National Narcotics Leadership Act of 1988.--Chapter
    2 of subtitle A of title I of the National Narcotics Leadership Act of
    1988 (21 U.S.C. 1521 et seq.) is amended--
                (1) in section 1022 (21 U.S.C. 1522), by striking
            ``substance abuse'' each place it appears and inserting
            ``substance use and misuse'';
                (2) in section 1023 (21 U.S.C. 1523), by striking paragraph
            (9) and inserting the following:
                ``(9) Substance use and misuse.--The term `substance use and
            misuse' means--
                        ``(A) the illegal use or misuse of drugs, including
                    substances for which a listing is effect under any of
                    schedules I through V under section 202 of the
                    Controlled Substances Act (21 U.S.C. 812);
                        ``(B) the misuse of inhalants or over-the-counter
                    drugs; or
                        ``(C) the use of alcohol, tobacco, or other related
                    product as such use is prohibited by State or local
                    law.'';
                (3) in section 1024 (21 U.S.C. 1524), by striking
            subsections (a) and (b) and inserting the following:

        ``(a) In General.--There is authorized to be appropriated to the
    Office of National Drug Control Policy to carry out this chapter
    $99,000,000 for each of fiscal years 2018 through 2023.
        ``(b) Administrative Costs.--Not more than 8 percent of the funds
    appropriated to carry out this chapter may be used by the Office of
    National Drug Control Policy to pay administrative costs associated with
    the responsibilities of the Office under this chapter.'';
                (4) in subchapter I (21 U.S.C. 1531 et seq.)--
                        (A) <<NOTE: 21 USC 1531-1533, 1535.>>  by striking
                    ``substance abuse'' each place it appears and inserting
                    ``substance use and misuse''; and

    [[Page 132 STAT. 4112]]

                        (B) in section 1032(b)(1)(A) (21 U.S.C.
                    1532(b)(1)(A)), by striking clause (iii) and inserting
                    the following:
                              ``(iii) Renewal grants.--Subject to clause
                          (iv), the Administrator may award a renewal grant
                          to a grant recipient under this subparagraph for
                          each fiscal year of the 4-fiscal-year period
                          following the first fiscal year for which the
                          initial additional grant is awarded in an amount
                          not to exceed the following:
                                        ``(I) For the first and second
                                    fiscal years of the 4-fiscal-year
                                    period, the amount of the non-Federal
                                    funds, including in-kind contributions,
                                    raised by the coalition for the
                                    applicable fiscal year is not less than
                                    125 percent of the amount awarded.
                                        ``(II) For the third and fourth
                                    fiscal tears of the 4-fiscal-year
                                    period, the amount of the non-Federal
                                    funds, including in-kind contributions,
                                    raised by the coalition for the
                                    applicable fiscal year is not less than
                                    150 percent of the amount awarded.'';
                                    and
                (5) <<NOTE: 21 USC 1541-1548.>>  by striking subchapter II
            (21 U.S.C. 1541 et seq.).
    SEC. 8204. REAUTHORIZATION OF THE NATIONAL COMMUNITY ANTI-DRUG
                              COALITION INSTITUTE.

        Section 4 of Public Law 107-82 (21 U.S.C. 1521 note) is amended to
    read as follows:
    ``SEC. 4. AUTHORIZATION FOR NATIONAL COMMUNITY ANTIDRUG COALITION
                        INSTITUTE.

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

        ``(d) Authorization of Appropriations.--The Director shall, using
    amounts authorized to be appropriated by section 1032 of the National
    Narcotics Leadership Act of 1988 (15 U.S.C. 1532), make a grant of $2
    million under subsection (a), for each of the fiscal years 2018 through
    2023.''.

    [[Page 132 STAT. 4113]]

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

        Section 707 of the Office of National Drug Control Policy
    Reauthorization Act of 1998 (21 U.S.C. 1706) is amended--
                (1) in subsection (f), by striking ``no Federal'' and all
            that follows through ``programs.'' and inserting the following:
            ``not more than a total of 5 percent of Federal funds
            appropriated for the Program are expended for substance use
            disorder treatment programs and drug prevention programs.'';
                (2) in subsection (p)--
                        (A) in paragraph (4), by striking ``and'' at the
                    end;
                        (B) in paragraph (5), by striking the period at the
                    end and inserting ``; and''; and
                        (C) by adding at the end the following:
                ``(6) $280,000,000 for each of fiscal years 2018 through
            2023.''; and
                (3) in subsection (q)--
                        (A) by striking paragraph (2) and inserting the
                    following:
                ``(2) Required uses.--The funds used under paragraph (1)
            shall be used to ensure the safety of neighborhoods and the
            protection of communities, including the prevention of the
            intimidation of witnesses of illegal drug distribution and
            related activities and the establishment of, or support for,
            programs that provide protection or assistance to witnesses in
            court proceedings.''; and
                        (B) by adding at the end the following:
                ``(3) Best practice models.--The Director shall work with
            HIDTAs to develop and maintain best practice models to assist
            State, local, and Tribal governments in addressing witness
            safety, relocation, financial and housing assistance, or any
            other services related to witness protection or assistance in
            cases of illegal drug distribution and related activities. The
            Director shall ensure dissemination of the best practice models
            to each HIDTA.''.
    SEC. 8206. REAUTHORIZATION OF DRUG COURT PROGRAM.

        Section 1001(a)(25)(A) of title I of the Omnibus Crime Control and
    Safe Streets Act of 1968 (34 U.S.C. 10261(a)(25)(A)) is amended by
    striking ``Except as provided'' and all that follows and inserting the
    following: ``Except as provided in subparagraph (C), there is authorized
    to be appropriated to carry out part EE $75,000,000 for each of fiscal
    years 2018 through 2023.''.
    SEC. 8207. DRUG COURT TRAINING AND TECHNICAL ASSISTANCE.

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

    [[Page 132 STAT. 4114]]

    SEC. 8208. DRUG OVERDOSE RESPONSE STRATEGY.

        Section 707 of the Office of National Drug Control Policy
    Reauthorization Act of 1998 (21 U.S.C. 1706) is amended by adding at the
    end the following:
        ``(r) Drug Overdose Response Strategy Implementation.--The Director
    may use funds appropriated to carry out this section to implement a drug
    overdose response strategy in high intensity drug trafficking areas on a
    nationwide basis by--
                ``(1) coordinating multi-disciplinary efforts to prevent,
            reduce, and respond to drug overdoses, including the uniform
            reporting of fatal and non-fatal overdoses to public health and
            safety officials;
                ``(2) increasing data sharing among public safety and public
            health officials concerning drug-related abuse trends, including
            new psychoactive substances, and related crime; and
                ``(3) enabling collaborative deployment of prevention,
            intervention, and enforcement resources to address substance use
            addiction and narcotics trafficking.''.
    SEC. 8209. PROTECTING LAW ENFORCEMENT OFFICERS FROM ACCIDENTAL
                              EXPOSURE.

        Section 707 of the Office of National Drug Control Policy
    Reauthorization Act of 1998 (21 U.S.C. 1706), as amended by section
    8208, is amended by adding at the end the following:
        ``(s) Supplemental Grants.--The Director is authorized to use not
    more than $10,000,000 of the amounts otherwise appropriated to carry out
    this section to provide supplemental competitive grants to high
    intensity drug trafficking areas that have experienced high seizures of
    fentanyl and new psychoactive substances for the purposes of--
                ``(1) purchasing portable equipment to test for fentanyl and
            other substances;
                ``(2) training law enforcement officers and other first
            responders on best practices for handling fentanyl and other
            substances; and
                ``(3) purchasing protective equipment, including overdose
            reversal drugs.''.
    SEC. 8210. COPS ANTI-METH PROGRAM.

        Section 1701 of title I of the Omnibus Crime Control and Safe
    Streets Act of 1968 (34 U.S.C. 10381) is amended--
                (1) by redesignating subsection (k) as subsection (l); and
                (2) by inserting after subsection (j) the following:

        ``(k) COPS Anti-Meth Program.--The Attorney General shall use
    amounts otherwise appropriated to carry out this section for a fiscal
    year (beginning with fiscal year 2019) to make competitive grants, in
    amounts of not less than $1,000,000 for such fiscal year, to State law
    enforcement agencies with high seizures of precursor chemicals, finished
    methamphetamine, laboratories, and laboratory dump seizures for the
    purpose of locating or investigating illicit activities, such as
    precursor diversion, laboratories, or methamphetamine traffickers.''.
    SEC. 8211. COPS ANTI-HEROIN TASK FORCE PROGRAM.

        Section 1701 of title I of the Omnibus Crime Control and Safe
    Streets Act of 1968 (34 U.S.C. 10381) is amended--
                (1) by redesignating subsection (l), as so redesignated by
            section 8210, as subsection (m); and

    [[Page 132 STAT. 4115]]

                (2) by inserting after subsection (k), as added by section
            8210, the following:

        ``(l) Cops Anti-heroin Task Force Program.--The Attorney General
    shall use amounts otherwise appropriated to carry out this section, or
    other amounts as appropriated, for a fiscal year (beginning with fiscal
    year 2019) to make competitive grants to State law enforcement agencies
    in States with high per capita rates of primary treatment admissions,
    for the purpose of locating or investigating illicit activities, through
    Statewide collaboration, relating to the distribution of heroin,
    fentanyl, or carfentanil or relating to the unlawful distribution of
    prescription opioids.''.
    SEC. 8212. COMPREHENSIVE ADDICTION AND RECOVERY ACT EDUCATION AND
                              AWARENESS.

        Title VII of the Comprehensive Addiction and Recovery Act of 2016
    (Public Law 114-198; 130 Stat. 735) is amended by adding at the end the
    following:
    ``SEC. 709. <<NOTE: 42 USC 290ee-9.>>  SERVICES FOR FAMILIES AND
                            PATIENTS IN CRISIS.

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

    [[Page 132 STAT. 4116]]

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

        Not later than January 1, 2020, the Comptroller General of the
    United States shall submit to Congress a report examining how substance
    use disorder services are reimbursed.
    SEC. 8214. SOBRIETY TREATMENT AND RECOVERY TEAMS (START).

        Title V of the Public Health Service Act (42 U.S.C. 290dd et seq.)
    is amended by adding at the end the following:
    ``SEC. 550. <<NOTE: 42 USC 290ee-10.>>  SOBRIETY TREATMENT AND
                            RECOVERY TEAMS.

        ``(a) In General.--The Secretary may make grants to States, units of
    local government, or tribal governments to establish or expand Sobriety
    Treatment And Recovery Team (referred to in this section as `START') or
    other similar programs to determine the effectiveness of pairing social
    workers or mentors with families that are struggling with a substance
    use disorder and child abuse or neglect in order to help provide peer
    support, intensive treatment, and child welfare services to such
    families.
        ``(b) Allowable Uses.--A grant awarded under this section may be
    used for one or more of the following activities:
                ``(1) Training eligible staff, including social workers,
            social services coordinators, child welfare specialists,
            substance use disorder treatment professionals, and mentors.
                ``(2) Expanding access to substance use disorder treatment
            services and drug testing.
                ``(3) Enhancing data sharing with law enforcement agencies,
            child welfare agencies, substance use disorder treatment
            providers, judges, and court personnel.
                ``(4) Program evaluation and technical assistance.

        ``(c) Program Requirements.--A State, unit of local government, or
    tribal government receiving a grant under this section shall--
                ``(1) serve only families for which--
                        ``(A) there is an open record with the child welfare
                    agency; and
                        ``(B) substance use disorder was a reason for the
                    record or finding described in paragraph (1); and
                ``(2) coordinate any grants awarded under this section with
            any grant awarded under section 437(f) of the Social Security
            Act focused on improving outcomes for children affected by
            substance abuse.

        ``(d) Technical Assistance.--The Secretary may reserve not more than
    5 percent of funds provided under this section to provide technical
    assistance on the establishment or expansion of programs funded under
    this section from the National Center on Substance Abuse and Child
    Welfare.''.
    SEC. 8215. PROVIDER EDUCATION.

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

    [[Page 132 STAT. 4117]]

    SEC. 8216. DEFINITIONS.

        Section 702 of the Office of National Drug Control Policy
    Reauthorization Act of 1998 (21 U.S.C. 1701) is amended--
                (1) by striking paragraphs (5), (12), and (13);
                (2) by redesignating paragraph (11) as paragraph (17);
                (3) by redesignating paragraphs (9) and (10) as paragraphs
            (14) and (15), respectively;
                (4) by redesignating paragraphs (6), (7), and (8) as
            paragraphs (10), (11), and (12), respectively;
                (5) by redesignating paragraphs (1), (2), (3), and (4) as
            paragraphs (3), (4), (5), and (6), respectively;
                (6) by inserting before paragraph (3), as so redesignated,
            the following:
                ``(1) Agency.--The term `agency' has the meaning given the
            term `executive agency' in section 102 of title 31, United
            States Code.
                ``(2) Appropriate congressional committees.--
                        ``(A) In general.--The term `appropriate
                    congressional committees' means--
                              ``(i) the Committee on the Judiciary, the
                          Committee on Appropriations, and the Committee on
                          Health, Education, Labor, and Pensions of the
                          Senate; and
                              ``(ii) the Committee on Oversight and
                          Government Reform, the Committee on the Judiciary,
                          the Committee on Energy and Commerce, and the
                          Committee on Appropriations of the House of
                          Representatives.
                        ``(B) Submission to congress.--Any submission to
                    Congress shall mean submission to the appropriate
                    congressional committees.'';
                (7) by amending paragraph (3), as so redesignated, to read
            as follows:
                ``(3) Demand reduction.--The term `demand reduction' means
            any activity conducted by a National Drug Control Program
            Agency, other than an enforcement activity, that is intended to
            reduce or prevent the use of drugs or support, expand, or
            provide treatment and recovery efforts, including--
                        ``(A) education about the dangers of illicit drug
                    use;
                        ``(B) services, programs, or strategies to prevent
                    substance use disorder, including evidence-based
                    education campaigns, community-based prevention
                    programs, collection and disposal of unused prescription
                    drugs, and services to at-risk populations to prevent or
                    delay initial use of an illicit drug;
                        ``(C) substance use disorder treatment;
                        ``(D) support for long-term recovery from substance
                    use disorders;
                        ``(E) drug-free workplace programs;
                        ``(F) drug testing, including the testing of
                    employees;
                        ``(G) interventions for illicit drug use and
                    dependence;
                        ``(H) expanding availability of access to health
                    care services for the treatment of substance use
                    disorders;
                        ``(I) international drug control coordination and
                    cooperation with respect to activities described in this
                    paragraph;
                        ``(J) pre- and post-arrest criminal justice
                    interventions such as diversion programs, drug courts,
                    and the provision of evidence-based treatment to
                    individuals with substance

    [[Page 132 STAT. 4118]]

                    use disorders who are arrested or under some form of
                    criminal justice supervision, including medication
                    assisted treatment;
                        ``(K) other coordinated and joint initiatives among
                    Federal, State, local, and Tribal agencies to promote
                    comprehensive drug control strategies designed to reduce
                    the demand for, and the availability of, illegal drugs;
                        ``(L) international illicit drug use education,
                    prevention, treatment, recovery, research,
                    rehabilitation activities, and interventions for illicit
                    drug use and dependence; and
                        ``(M) research related to illicit drug use and any
                    of the activities described in this paragraph.'';
                (8) by inserting after paragraph (6), as so redesignated,
            the following:
                ``(7) Emerging drug threat.--The term `emerging drug threat'
            means the occurrence of a new and growing trend in the use of an
            illicit drug or class of drugs, including rapid expansion in the
            supply of or demand for such drug.
                ``(8) Illicit drug use; illicit drugs; illegal drugs.--The
            terms `illicit drug use', `illicit drugs', and `illegal drugs'
            include the illegal or illicit use of prescription drugs.
                ``(9) Law enforcement.--The term `law enforcement' or `drug
            law enforcement' means all efforts by a Federal, State, local,
            or Tribal government agency to enforce the drug laws of the
            United States or any State, including investigation, arrest,
            prosecution, and incarceration or other punishments or
            penalties.'';
                (9) by amending paragraph (11), as so redesignated, to read
            as follows:
                ``(11) National drug control program agency.--The term
            `National Drug Control Program Agency' means any agency (or
            bureau, office, independent agency, board, division, commission,
            subdivision, unit, or other component thereof) that is
            responsible for implementing any aspect of the National Drug
            Control Strategy, including any agency that receives Federal
            funds to implement any aspect of the National Drug Control
            Strategy, but does not include any agency that receives funds
            for drug control activity solely under the National Intelligence
            Program or the Joint Military Intelligence Program.'';
                (10) in paragraph (12), as so redesignated--
                        (A) by inserting ``or `Strategy' '' before
                    ``means''; and
                        (B) by inserting ``, including any report, plan, or
                    strategy required to be incorporated into or issued
                    concurrently with such strategy'' before the period at
                    the end;
                (11) by inserting after paragraph (12), as so redesignated,
            the following:
                ``(13) Nonprofit organization.--The term `nonprofit
            organization' means an organization that is described in section
            501(c)(3) of the Internal Revenue Code of 1986 and exempt from
            tax under section 501(a) of such Code.'';
                (12) in paragraph (14), as so redesignated, by striking
            ``Unless the context clearly indicates otherwise, the'' and
            inserting ``The'';
                (13) by inserting after paragraph (15), as so redesignated,
            the following:
                ``(16) Substance use disorder treatment.--The term
            `substance use disorder treatment' means an evidence-based,

    [[Page 132 STAT. 4119]]

            professionally directed, deliberate, and planned regimen
            including evaluation, observation, medical monitoring, and
            rehabilitative services and interventions such as
            pharmacotherapy, behavioral therapy, and individual and group
            counseling, on an inpatient or outpatient basis, to help
            patients with substance use disorder reach recovery.''; and
                (14) in paragraph (17), as so redesignated--
                        (A) by redesignating subparagraphs (B), (C), (D),
                    and (E), as subparagraphs (C), (D), (E), and (F),
                    respectively;
                        (B) by inserting after subparagraph (A) the
                    following:
                        ``(B) domestic law enforcement;'';
                        (C) in subparagraph (E), as so redesignated, by
                    striking ``and'' at the end;
                        (D) in subparagraph (F), as so redesignated, by
                    striking the period at the end and inserting a
                    semicolon; and
                        (E) by adding at the end the following:
                        ``(G) activities to prevent the diversion of drugs
                    for their illicit use; and
                        ``(H) research related to any of the activities
                    described in this paragraph.''.
    SEC. 8217. AMENDMENTS TO ADMINISTRATION OF THE OFFICE.

        (a) Responsibilities of Office.--Section 703(a) of the Office of
    National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C.
    1702(a)) is amended--
                (1) by striking paragraph (1) and inserting the following:
                ``(1) lead the national drug control effort, including
            coordinating with the National Drug Control Program Agencies;'';
                (2) in paragraph (2), by inserting before the semicolon the
            following: ``, including the National Drug Control Strategy'';
                (3) in paragraph (3), by striking ``and'' at the end; and
                (4) by striking paragraph (4) and all that follows through
            ``the National Academy of Sciences.'' and inserting the
            following:
                ``(4) evaluate the effectiveness of national drug control
            policy efforts, including the National Drug Control Program
            Agencies' program, by developing and applying specific goals and
            performance measurements and monitoring the agencies' program-
            level spending;
                ``(5) identify and respond to emerging drug threats related
            to illicit drug use;
                ``(6) administer the Drug-Free Communities Program, the
            High-Intensity Drug Trafficking Areas Program, and other grant
            programs directly authorized to be administered by the Office in
            furtherance of the National Drug Control Strategy; and
                ``(7) facilitate broad-scale information sharing and data
            standardization among Federal, State, and local entities to
            support the national drug control efforts.''.

        (b) Ethics Guidelines.--Section 703(d) of the Office of National
    Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1702(d)) is
    amended by adding at the end the following:
                ``(4) Ethics guidelines.--The Director shall establish
            written guidelines setting forth the criteria to be used in
            determining whether a gift or donation should be declined under
            this subsection because the acceptance of the gift or donation
            would--

    [[Page 132 STAT. 4120]]

                        ``(A) reflect unfavorably upon the ability of the
                    Director or the Office, or any employee of the Office,
                    to carry out responsibilities or official duties under
                    this chapter in a fair and objective manner; or
                        ``(B) compromise the integrity or the appearance of
                    integrity of programs or services provided under this
                    chapter or of any official involved in those programs or
                    services.
                ``(5) Registry of gifts.--The Director shall maintain a list
            of--
                        ``(A) the source and amount of each gift or donation
                    accepted by the Office; and
                        ``(B) the source and amount of each gift or donation
                    accepted by a contractor to be used in its performance
                    of a contract for the Office.
                ``(6) Report to congress.--The Director shall include in the
            annual assessment under section 706(g) a copy of the registry
            maintained under paragraph (5).''.

        (c) Appointment of Director and Deputy Director.--Section 704(a) of
    the Office of National Drug Control Policy Reauthorization Act of 1998
    (21 U.S.C. 1703(a)) is amended--
                (1) in paragraph (1), by striking subparagraphs (A), (B),
            and (C), and inserting the following:
                        ``(A) Director.--
                              ``(i) In general.--There shall be at the head
                          of the Office a Director who shall hold the same
                          rank and status as the head of an executive
                          department listed in section 101 of title 5,
                          United States Code.
                              ``(ii) Appointment.--The Director shall be
                          appointed by the President, by and with the advice
                          and consent of the Senate, and shall serve at the
                          pleasure of the President.
                        ``(B) Deputy director.--There shall be a Deputy
                    Director who shall report directly to the Director, and
                    who shall be appointed by the President, and shall serve
                    at the pleasure of the President.
                        ``(C) Coordinators.--The following coordinators
                    shall be appointed by the Director:
                              ``(i) Performance Budget Coordinator, as
                          described in section 704(c)(4).
                              ``(ii) Interdiction Coordinator, as described
                          in section 711.
                              ``(iii) Emerging and Continuing Threats
                          Coordinator, as described in section 709.
                              ``(iv) State, Local, and Tribal Affairs
                          Coordinator, to carry out the activities described
                          in section 704(j).
                              ``(v) Demand Reduction Coordinator, as
                          described in subparagraph (D).
                        ``(D) Demand reduction coordinator.--The Director
                    shall designate or appoint a United States Demand
                    Reduction Coordinator to be responsible for the
                    activities described in section 702(3). The Director
                    shall determine whether the coordinator position is a
                    noncareer appointee in the Senior Executive Service or a
                    career appointee in a position at level 15 of the
                    General Schedule (or equivalent).'';

    [[Page 132 STAT. 4121]]

                (2) in paragraph (5), by striking ``such official'' and
            inserting ``such officer or employee''; and
                (3) by adding at the end the following:
                ``(6) Prohibition on the use of funds for ballot
            initiatives.--No funds authorized under this title may be
            obligated for the purpose of expressly advocating the passage or
            defeat of a State or local ballot initiative.''.

        (d) Consultation.--Section 704(b) of the Office of National Drug
    Control Policy Reauthorization Act of 1998 (21 U.S.C. 1703(b)) is
    amended--
                (1) in paragraph (19), by striking ``; and'' and inserting a
            semicolon;
                (2) in paragraph (20), by striking the period at the end and
            inserting ``; and''; and
                (3) by adding at the end the following:
                ``(21) in order to formulate the national drug control
            policies, goals, objectives, and priorities--
                        ``(A) shall consult with and assist--
                              ``(i) State and local governments;
                              ``(ii) National Drug Control Program Agencies;
                              ``(iii) each committee, working group,
                          council, or other entity established under this
                          chapter, as appropriate;
                              ``(iv) the public;
                              ``(v) appropriate congressional committees;
                          and
                              ``(vi) any other person in the discretion of
                          the Director; and
                        ``(B) may--
                              ``(i) establish advisory councils;
                              ``(ii) acquire data from agencies; and
                              ``(iii) request data from any other entity.''.

        (e) National Drug Control Program Budget.--Section 704(c) of the
    Office of National Drug Control Policy Reauthorization Act of 1998 (21
    U.S.C. 1703(c)) is amended--
                (1) in paragraph (2)--
                        (A) in subparagraph (A), by striking ``paragraph
                    (1)(C);'' and inserting the following: ``paragraph
                    (1)(C) and include--
                              ``(i) the funding level for each National Drug
                          Control Program agency; and
                              ``(ii) alternative funding structures that
                          could improve progress on achieving the goals fo
                          the National Drug Control Strategy; and'';
                        (B) in subparagraph (B), strike ``the President;
                    and'' and inserting ``the President and Congress.''; and
                        (C) by striking subparagraph (C);
                (2) in paragraph (3)(E), by striking clause (ii) and
            inserting the following:
                              ``(ii) Certification.--The Director shall--
                                        ``(I) review each budget submission
                                    submitted under subparagraph (A);
                                        ``(II) based on the review under
                                    clause (i), make a determination as to
                                    whether the budget submission of a
                                    National Drug Control Program agency
                                    includes the funding levels and
                                    initiatives described in subparagraph
                                    (B); and

    [[Page 132 STAT. 4122]]

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

        (f) Powers and Responsibilities of the Director.--Section 704 of the
    Office of National Drug Control Policy Reauthorization Act of 1998 (21
    U.S.C. 1703) is amended--
                (1) in subsection (d)(8)--
                        (A) in subparagraph (D), by striking ``and'' at the
                    end;
                        (B) in subparagraph (E)--
                              (i) in clause (i)--
                                        (I) by striking ``Congress,
                                    including to the Committees on
                                    Appropriations of the Senate and the
                                    House of Representatives, the
                                    authorizing committees for the Office,''
                                    and inserting ``the appropriate
                                    congressional committees''; and
                                        (II) by striking ``or agencies'';

    [[Page 132 STAT. 4123]]

                              (ii) in clause (ii)--
                                        (I) by striking ``Congress'' and
                                    inserting ``the appropriate
                                    congressional committees''; and
                                        (II) by adding ``and'' at the end;
                                    and
                              (iii) by adding at the end the following:
                              ``(iii) funds may only be used for--
                                        ``(I) expansion of demand reduction
                                    activities;
                                        ``(II) interdiction of illicit drugs
                                    on the high seas, in United States
                                    territorial waters, and at United States
                                    ports of entry by officers and employees
                                    of National Drug Control Program
                                    Agencies and domestic and foreign law
                                    enforcement officers;
                                        ``(III) accurate assessment and
                                    monitoring of international drug
                                    production and interdiction programs and
                                    policies;
                                        ``(IV) activities to facilitate and
                                    enhance the sharing of domestic and
                                    foreign intelligence information among
                                    National Drug Control Program Agencies
                                    related to the production and
                                    trafficking of drugs in the United
                                    States and foreign countries; and
                                        ``(V) research related to any of
                                    these activities.'';
                (2) in subsection (e)(2)(A), by striking ``Notwithstanding
            any other provision of law'' and inserting ``Subject to the
            availability of appropriations''; and
                (3) by adding at the end the following:

        ``(i) Model Acts Program.--
                ``(1) In general.--The Director shall provide for or shall
            enter into an agreement with a nonprofit organization to--
                        ``(A) advise States on establishing laws and
                    policies to address illicit drug use issues; and
                        ``(B) revise such model State drug laws and draft
                    supplementary model State laws to take into
                    consideration changes in illicit drug use issues in the
                    State involved.
                ``(2) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $1,250,000 for
            each of fiscal years 2018 through 2023.

        ``(j) State, Local, and Tribal Affairs Coordinator.--The Director
    shall designate or appoint a United States State, Local, and Tribal
    Affairs Coordinator to perform the duties of the Office outlined in this
    section and 706 and such other duties as may be determined by the
    Director with respect to coordination of drug control efforts between
    agencies and State, local, and Tribal governments. The Director shall
    determine whether the coordinator position is a noncareer appointee in
    the Senior Executive Service or a career appointee in a position at
    level 15 of the General Schedule (or equivalent).
        ``(k) Harm Reduction Programs.--When developing the national drug
    control policy, any policy of the Director, including policies relating
    to syringe exchange programs for intravenous drug users, shall be based
    on the best available medical and scientific evidence regarding the
    effectiveness of such policy in promoting individual health and
    preventing the spread of infectious disease and the impact of such
    policy on drug addiction and use. In making any policy relating to harm
    reduction programs, the Director shall

    [[Page 132 STAT. 4124]]

    consult with the National Institutes of Health and the National Academy
    of Sciences.''.
        (g) Accounting of Funds Expended.--Section 705 of the Office of
    National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C.
    1704(d)), as amended by section 8207 is further amended--
                (1) by amending subsection (d) to read as follows:

        ``(d) Accounting of Funds Expended.--
                ``(1) In general.--Not later than February 1 of each year,
            in accordance with guidance issued by the Director, the head of
            each National Drug Control Program Agency shall submit to the
            Director a detailed accounting of all funds expended by the
            agency for National Drug Control Program activities during the
            previous fiscal year and shall ensure such detailed accounting
            is authenticated for the previous fiscal year by the Inspector
            General for such agency prior to the submission to the Director
            as frequently as determined by the Inspector General but not
            less frequently that every 3 years.
                ``(2) Submission to congress.--The Director shall submit to
            Congress not later than April 1 of each year the information
            submitted to the Director under paragraph (1).''; and
                (2) by adding at the end the following:

        ``(f) Tracking System for Federally Funded Grant Programs.--
                ``(1) Establishment.--The Director, or the head of an agency
            designated by the Director, in coordination with the Secretary
            of Health and Human Services, shall track federally-funded grant
            programs to--
                        ``(A) ensure the public has electronic access to
                    information identifying:
                              ``(i) all drug control grants and pertinent
                          identifying information for each grant;
                              ``(ii) any available performance metrics,
                          evaluations, or other information indicating the
                          effectiveness of such programs;
                        ``(B) facilitate efforts to identify duplication,
                    overlap, or gaps in funding to provide increased
                    accountability of Federally-funded grants for substance
                    use disorder treatment, prevention, and enforcement; and
                        ``(C) identify barriers in the grant application
                    process impediments that applicants currently have in
                    the grant application process with applicable agencies.
                ``(2) National drug control agencies.--The head of each
            National Drug Control Program Agency shall provide to the
            Director a complete list of all drug control program grant
            programs and any other relevant information for inclusion in the
            system developed under paragraph (1) and annually update such
            list.
                ``(3) Updating existing systems.--The Director may meet the
            requirements of this subsection by utilizing, updating, or
            improving existing Federal information systems to ensure they
            meet the requirements of this subsection.
                ``(4) Report.--Not later than 3 years after the date of
            enactment of this subsection, the Comptroller General of the
            United States shall submit to Congress a report examining
            implementation of this subsection.''.

    [[Page 132 STAT. 4125]]

        (h) Technical and Conforming Amendment.--Section 1105 of the Office
    of National Drug Control Policy Reauthorization Act of 2006 (21 U.S.C.
    1701 note) is repealed.
    SEC. 8218. EMERGING THREATS COMMITTEE, PLAN, AND MEDIA CAMPAIGN.

        (a) In General.--Section 709 of the Office of National Drug Control
    Policy Reauthorization Act of 1998 (21 U.S.C. 1708) is amended to read
    as follows:
    ``SEC. 709. EMERGING THREATS COMMITTEE, PLAN, AND MEDIA CAMPAIGN.

        ``(a) Emerging Threats Coordinator.--The Director shall designate or
    appoint a United States Emerging and Continuing Threats Coordinator to
    perform the duties of that position described in this section and such
    other duties as may be determined by the Director. The Director shall
    determine whether the coordinator position is a noncareer appointee in
    the Senior Executive Service or a career appointee in a position at
    level 15 of the General Schedule (or equivalent).
        ``(b) Emerging Threats Committee.--
                ``(1) In general.--The Emerging Threats Committee shall--
                        ``(A) monitor evolving and emerging drug threats in
                    the United States;
                        ``(B) identify and discuss evolving and emerging
                    drug trends in the United States using the criteria
                    required to be established under paragraph (6);
                        ``(C) assist in the formulation of and oversee
                    implementation of any plan described in subsection (d);
                        ``(D) provide such other advice to the Coordinator
                    and Director concerning strategy and policies for
                    emerging drug threats and trends as the Committee
                    determines to be appropriate; and
                        ``(E) disseminate and facilitate the sharing with
                    Federal, State, local, and Tribal officials and other
                    entities as determined by the Director of pertinent
                    information and data relating to--
                              ``(i) recent trends in drug supply and demand;
                              ``(ii) fatal and nonfatal overdoses;
                              ``(iii) demand for and availability of
                          evidence-based substance use disorder treatment,
                          including the extent of the unmet treatment need,
                          and treatment admission trends;
                              ``(iv) recent trends in drug interdiction,
                          supply, and demand from State, local, and Tribal
                          law enforcement agencies; and
                              ``(v) other subject matter as determined
                          necessary by the Director.
                ``(2) Chairperson.--The Director shall designate one of the
            members of the Emerging Threats Committee to serve as
            Chairperson.
                ``(3) Members.--The Director shall appoint other members of
            the Committee, which shall include--
                        ``(A) representatives from National Drug Control
                    Program Agencies or other agencies;
                        ``(B) representatives from State, local, and Tribal
                    governments; and

    [[Page 132 STAT. 4126]]

                        ``(C) representatives from other entities as
                    designated by the Director.
                ``(4) Meetings.--The members of the Emerging Threats
            Committee shall meet, in person and not through any delegate or
            representative, not less frequently than once per calendar year,
            before June 1. At the call of the Director or the Chairperson,
            the Emerging Threats Committee may hold additional meetings as
            the members may choose.
                ``(5) Contract, agreement, and other authority.--The
            Director may award contracts, enter into interagency agreements,
            manage individual projects, and conduct other activities in
            support of the identification of emerging drug threats and in
            support of the development, implementation, and assessment of
            any Emerging Threat Response Plan.
                ``(6) Criteria to identify emerging drug threats.--Not later
            than 180 days after the date on which the Committee first meets,
            the Committee shall develop and recommend to the Director
            criteria to be used to identify an emerging drug threat or the
            termination of an emerging drug threat designation based on
            information gathered by the Committee, statistical data, and
            other evidence.

        ``(c) Designation.--
                ``(1) In general.--The Director, in consultation with the
            Coordinator, the Committee, and the head of each National Drug
            Control Program Agency, may designate an emerging drug threat in
            the United States.
                ``(2) Standards for designation.--The Director, in
            consultation with the Coordinator, shall promulgate and make
            publicly available standards by which a designation under
            paragraph (1) and the termination of such designation may be
            made. In developing such standards, the Director shall consider
            the recommendations of the committee and other criteria the
            Director considers to be appropriate.
                ``(3) Public statement required.--The Director shall publish
            a public written statement on the portal of the Office
            explaining the designation of an emerging drug threat or the
            termination of such designation and shall notify the appropriate
            congressional committees of the availability of such statement
            when a designation or termination of such designation has been
            made.

        ``(d) Plan.--
                ``(1) Public availability of plan.--Not later than 90 days
            after making a designation under subsection (c), the Director
            shall publish and make publicly available an Emerging Threat
            Response Plan and notify the President and the appropriate
            congressional committees of such plan's availability.
                ``(2) Timing.--Concurrently with the annual submissions
            under section 706(g), the Director shall update the plan and
            report on implementation of the plan, until the Director issues
            the public statement required under subsection (c)(3) to
            terminate the emerging drug threat designation.
                ``(3) Contents of an emerging threat response plan.--The
            Director shall include in the plan required under this
            subsection--
                        ``(A) a comprehensive strategic assessment of the
                    emerging drug threat, including the current availability

    [[Page 132 STAT. 4127]]

                    of, demand for, and effectiveness of evidence-based
                    prevention, treatment, and enforcement programs and
                    efforts to respond to the emerging drug threat;
                        ``(B) comprehensive, research-based, short- and
                    long-term, quantifiable goals for addressing the
                    emerging drug threat, including for reducing the supply
                    of the drug designated as the emerging drug threat and
                    for expanding the availability and effectiveness of
                    evidence-based substance use disorder treatment and
                    prevention programs to reduce the demand for the
                    emerging drug threat;
                        ``(C) performance measures pertaining to the plan's
                    goals, including quantifiable and measurable objectives
                    and specific targets;
                        ``(D) the level of funding needed to implement the
                    plan, including whether funding is available to be
                    reprogrammed or transferred to support implementation of
                    the plan or whether additional appropriations are
                    necessary to implement the plan;
                        ``(E) an implementation strategy for the media
                    campaign under subsection (f), including goals as
                    described under subparagraph (B) of this paragraph and
                    performance measures, objectives, and targets, as
                    described under subparagraph (C) of this paragraph; and
                        ``(F) any other information necessary to inform the
                    public of the status, progress, or response of an
                    emerging drug threat.
                ``(4) Implementation.--
                        ``(A) In general.--Not later than 120 days after the
                    date on which a designation is made under subsection
                    (c), the Director, in consultation with the President,
                    the appropriate congressional committees, and the head
                    of each National Drug Control Program Agency, shall
                    issue guidance on implementation of the plan described
                    in this subsection to the National Drug Control Program
                    Agencies and any other relevant agency determined to be
                    necessary by the Director.
                        ``(B) Coordinator's responsibilities.--The
                    Coordinator shall--
                              ``(i) direct the implementation of the plan
                          among the agencies identified in the plan, State,
                          local, and Tribal governments, and other relevant
                          entities;
                              ``(ii) facilitate information-sharing between
                          agencies identified in the plan, State, local, and
                          Tribal governments, and other relevant entities;
                          and
                              ``(iii) monitor implementation of the plan by
                          coordinating the development and implementation of
                          collection and reporting systems to support
                          performance measurement and adherence to the plan
                          by agencies identified in plan, where appropriate.
                        ``(C) Reporting.--Not later than 180 days after the
                    date on which a designation is made under subsection (c)
                    and in accordance with subparagraph (A), the head of
                    each agency identified in the plan shall submit to the
                    Coordinator a report on implementation of the plan.

        ``(e) Evaluation of Media Campaign.--Upon designation of an emerging
    drug threat, the Director shall evaluate whether a media campaign would
    be appropriate to address that threat.

    [[Page 132 STAT. 4128]]

        ``(f) National Anti-drug Media Campaign.--
                ``(1) In general.--The Director shall, to the extent
            feasible and appropriate, conduct a national anti-drug media
            campaign (referred to in this subtitle as the `national media
            campaign') in accordance with this subsection for the purposes
            of--
                        ``(A) preventing substance abuse among people in the
                    United States;
                        ``(B) educating the public about the dangers and
                    negative consequences of substance use and abuse,
                    including patient and family education about the
                    characteristics and hazards of substance abuse and
                    methods to safeguard against substance use, to include
                    the safe disposal of prescription medications;
                        ``(C) supporting evidence-based prevention programs
                    targeting the attitudes, perception, and beliefs of
                    persons concerning substance use and intentions to
                    initiate or continue such use;
                        ``(D) encouraging individuals affected by substance
                    use disorders to seek treatment and providing such
                    individuals with information on--
                              ``(i) how to recognize addiction issues;
                              ``(ii) what forms of evidence-based treatment
                          options are available; and
                              ``(iii) how to access such treatment;
                        ``(E) combating the stigma of addiction and
                    substance use disorders, including the stigma of
                    treating such disorders with medication-assisted
                    treatment therapies; and
                        ``(F) informing the public about the dangers of any
                    drug identified by the Director as an emerging drug
                    threat as appropriate.
                ``(2) Use of funds.--
                        ``(A) In general.--Amounts made available to carry
                    out this subsection for the national media campaign may
                    only be used for the following:
                              ``(i) The purchase of media time and space,
                          including the strategic planning for, tracking,
                          and accounting of, such purchases.
                              ``(ii) Creative and talent costs, consistent
                          with subparagraph (B)(i).
                              ``(iii) Advertising production costs, which
                          may include television, radio, internet, social
                          media, and other commercial marketing venues.
                              ``(iv) Testing and evaluation of advertising.
                              ``(v) Evaluation of the effectiveness of the
                          national media campaign.
                              ``(vi) Costs of contracts to carry out
                          activities authorized by this subsection.
                              ``(vii) Partnerships with professional and
                          civic groups, community-based organizations,
                          including faith-based organizations, and
                          government organizations related to the national
                          media campaign.
                              ``(viii) Entertainment industry outreach,
                          interactive outreach, media projects and
                          activities, public information, news media
                          outreach, and corporate sponsorship and
                          participation.
                              ``(ix) Operational and management expenses.
                        ``(B) Specific requirements.--

    [[Page 132 STAT. 4129]]

                              ``(i) Creative services.--In using amounts for
                          creative and talent costs under subparagraph
                          (A)(ii), the Director shall use creative services
                          donated at no cost to the Government wherever
                          feasible and may only procure creative services
                          for advertising--
                                        ``(I) responding to high-priority or
                                    emergent campaign needs that cannot
                                    timely be obtained at no cost; or
                                        ``(II) intended to reach a minority,
                                    ethnic, or other special audience that
                                    cannot reasonably be obtained at no
                                    cost.
                              ``(ii) Testing and evaluation of
                          advertising.--In using amounts for testing and
                          evaluation of advertising under subparagraph
                          (A)(iv), the Director shall test all
                          advertisements prior to use in the national media
                          campaign to ensure that the advertisements are
                          effective with the target audience and meet
                          industry-accepted standards. The Director may
                          waive this requirement for advertisements using no
                          more than 10 percent of the purchase of
                          advertising time purchased under this subsection
                          in a fiscal year and no more than 10 percent of
                          the advertising space purchased under this
                          subsection in a fiscal year, if the advertisements
                          respond to emergent and time-sensitive campaign
                          needs or the advertisements will not be widely
                          utilized in the national media campaign.
                              ``(iii) Consultation.--For the planning of the
                          campaign under paragraph (1), the Director may
                          consult with--
                                        ``(I) the head of any appropriate
                                    National Drug Control Program Agency;
                                        ``(II) experts on the designated
                                    drug;
                                        ``(III) State, local, and Tribal
                                    government officials and relevant
                                    agencies;
                                        ``(IV) communications professionals;
                                        ``(V) the public; and
                                        ``(VI) appropriate congressional
                                    committees.
                              ``(iv) Evaluation of effectiveness of national
                          media campaign.--In using amounts for the
                          evaluation of the effectiveness of the national
                          media campaign under subparagraph (A)(v), the
                          Director shall--
                                        ``(I) designate an independent
                                    entity to evaluate by April 20 of each
                                    year the effectiveness of the national
                                    media campaign based on data from--
                                                ``(aa) the Monitoring the
                                            Future Study published by the
                                            Department of Health and Human
                                            Services;
                                                ``(bb) the National Survey
                                            on Drug Use and Health; and
                                                ``(cc) other relevant
                                            studies or publications, as
                                            determined by the Director,
                                            including tracking and
                                            evaluation data collected
                                            according to marketing and
                                            advertising industry standards;
                                            and
                                        ``(II) ensure that the effectiveness
                                    of the national media campaign is
                                    evaluated in a manner

    [[Page 132 STAT. 4130]]

                                    that enables consideration of whether
                                    the national media campaign has
                                    contributed to changes in attitude or
                                    behaviors among the target audience with
                                    respect to substance use and such other
                                    measures of evaluation as the Director
                                    determines are appropriate.
                ``(3) Advertising.--In carrying out this subsection, the
            Director shall ensure that sufficient funds are allocated to
            meet the stated goals of the national media campaign.
                ``(4) Responsibilities and functions under the program.--
                        ``(A) In general.--The Director shall determine the
                    overall purposes and strategy of the national media
                    campaign.
                        ``(B) Director.--
                              ``(i) In general.--The Director shall
                          approve--
                                        ``(I) the strategy of the national
                                    media campaign;
                                        ``(II) all advertising and
                                    promotional material used in the
                                    national media campaign; and
                                        ``(III) the plan for the purchase of
                                    advertising time and space for the
                                    national media campaign.
                              ``(ii) Implementation.--The Director shall be
                          responsible for implementing a focused national
                          media campaign to meet the purposes set forth in
                          paragraph (1) and shall ensure--
                                        ``(I) information disseminated
                                    through the campaign is accurate and
                                    scientifically valid; and
                                        ``(II) the campaign is designed
                                    using strategies demonstrated to be the
                                    most effective at achieving the goals
                                    and requirements of paragraph (1), which
                                    may include--
                                                ``(aa) a media campaign, as
                                            described in paragraph (2);
                                                ``(bb) local, regional, or
                                            population specific messaging;
                                                ``(cc) the development of
                                            websites to publicize and
                                            disseminate information;
                                                ``(dd) conducting outreach
                                            and providing educational
                                            resources for parents;
                                                ``(ee) collaborating with
                                            law enforcement agencies; and
                                                ``(ff) providing support for
                                            school-based public health
                                            education classes to improve
                                            teen knowledge about the effects
                                            of substance use.
                ``(5) Prohibitions.--None of the amounts made available
            under paragraph (2) may be obligated or expended for any of the
            following:
                        ``(A) To supplant current anti-drug community-based
                    coalitions.
                        ``(B) To supplant pro bono public service time
                    donated by national and local broadcasting networks for
                    other public service campaigns.
                        ``(C) For partisan political purposes, or to express
                    advocacy in support of or to defeat any clearly
                    identified candidate, clearly identified ballot
                    initiative, or clearly identified legislative or
                    regulatory proposal.

    [[Page 132 STAT. 4131]]

                        ``(D) To fund advertising that features any elected
                    officials, persons seeking elected office, cabinet level
                    officials, or other Federal officials employed pursuant
                    to section 213 of Schedule C of title 5, Code of Federal
                    Regulations.
                        ``(E) To fund advertising that does not contain a
                    primary message intended to reduce or prevent substance
                    use.
                        ``(F) To fund advertising containing a primary
                    message intended to promote support for the national
                    media campaign or private sector contributions to the
                    national media campaign.
                ``(6) Matching requirement.--
                        ``(A) In general.--Amounts made available under
                    paragraph (2) for media time and space shall be matched
                    by an equal amount of non-Federal funds for the national
                    media campaign, or be matched with in-kind contributions
                    of the same value.
                        ``(B) No-cost match advertising direct relationship
                    requirement.--The Director shall ensure that not less
                    than 85 percent of no-cost match advertising directly
                    relates to substance abuse prevention consistent with
                    the specific purposes of the national media campaign.
                        ``(C) No-cost match advertising not directly
                    related.--The Director shall ensure that no-cost match
                    advertising that does not directly relate to substance
                    abuse prevention consistent with the purposes of the
                    national media campaign includes a clear anti-drug
                    message. Such message is not required to be the primary
                    message of the match advertising.
                ``(7) Financial and performance accountability.--The
            Director shall cause to be performed--
                        ``(A) audits and reviews of costs of the national
                    media campaign pursuant to section 4706 of title 41,
                    United States Code; and
                        ``(B) an audit to determine whether the costs of the
                    national media campaign are allowable under chapter 43
                    of title 41, United States Code.
                ``(8) Report to congress.--The Director shall submit on an
            annual basis a report to Congress that describes--
                        ``(A) the strategy of the national media campaign
                    and whether specific objectives of the national media
                    campaign were accomplished;
                        ``(B) steps taken to ensure that the national media
                    campaign operates in an effective and efficient manner
                    consistent with the overall strategy and focus of the
                    national media campaign;
                        ``(C) plans to purchase advertising time and space;
                        ``(D) policies and practices implemented to ensure
                    that Federal funds are used responsibly to purchase
                    advertising time and space and eliminate the potential
                    for waste, fraud, and abuse;
                        ``(E) all contracts entered into with a corporation,
                    partnership, or individual working on behalf of the
                    national media campaign;
                        ``(F) the results of any financial audit of the
                    national media campaign;

    [[Page 132 STAT. 4132]]

                        ``(G) a description of any evidence used to develop
                    the national media campaign;
                        ``(H) specific policies and steps implemented to
                    ensure compliance with this section;
                        ``(I) a detailed accounting of the amount of funds
                    obligated during the previous fiscal year for carrying
                    out the national media campaign, including each
                    recipient of funds, the purpose of each expenditure, the
                    amount of each expenditure, any available outcome
                    information, and any other information necessary to
                    provide a complete accounting of the funds expended; and
                        ``(J) a review and evaluation of the effectiveness
                    of the national media campaign strategy for the past
                    year.
                ``(9) Required notice for communication from the office.--
            Any communication, including an advertisement, paid for or
            otherwise disseminated by the Office directly or through a
            contract awarded by the Office shall include a prominent notice
            informing the audience that the communication was paid for by
            the Office.

        ``(g) Authorization of Appropriations.--There is authorized to be
    appropriated to the Office to carry out this section, $25,000,000 for
    each of fiscal years 2018 through 2023.''.
        (b) Technical and Conforming Amendment.--Subsection (a) of section
    203 of the Office of National Drug Control Policy Reauthorization Act of
    2006 (21 U.S.C. 1708a) is repealed.
    SEC. 8219. DRUG INTERDICTION.

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

    [[Page 132 STAT. 4133]]

                              (iii) by redesignating subparagraph (D) as
                          subparagraph (C);
                              (iv) in subparagraph (C), as so redesignated--
                                        (I) in the matter preceding clause
                                    (i)--
                                                (aa) by striking ``March 1''
                                            and inserting ``September 1'';
                                                (bb) by inserting ``the
                                            Director, acting through''
                                            before ``the United States'';
                                                (cc) by inserting a comma
                                            after ``Coordinator'';
                                                (dd) by striking ``a report
                                            on behalf of the Director''; and
                                                (ee) by striking ``, which
                                            shall include'' and inserting
                                            ``a report that'';
                                        (II) by redesignating clauses (i),
                                    (ii), and (iii) as subclauses (I), (II),
                                    and (III), and adjusting the margins
                                    accordingly;
                                        (III) by inserting before subclause
                                    (I), as so redesignated, the following:
                              ``(i) includes--'';
                                        (IV) in clause (i), as so
                                    redesignated--
                                                (aa) in subclause (I), as so
                                            redesignated, by inserting ``,
                                            including information about how
                                            each National Drug Control
                                            Program agency conducting drug
                                            interdiction activities is
                                            engaging with relevant
                                            international partners'' after
                                            ``Plan'';
                                                (bb) in subclause (II), as
                                            so redesignated, by striking ``,
                                            as well as'' and inserting
                                            ``and'';
                                                (cc) in subclause III, as so
                                            redesignated--
                                                    (AA) by striking ``, as
                                                well as'' and inserting
                                                ``and''; and
                                                    (BB) by striking the
                                                period at the end and
                                                inserting ``; and''; and
                                        (V) by adding at the end the
                                    following:
                              ``(ii) may include recommendations for changes
                          to existing agency authorities or laws governing
                          interagency relationships.''; and
                              (v) by adding at the end the following:
                        ``(D) Classified annex.--Each report required to be
                    submitted under subparagraph (C) shall be in
                    unclassified form, but may include a classified
                    annex.'';
                (2) in subsection (b)--
                        (A) in paragraph (1)(B), by inserting ``and how to
                    strengthen international partnerships to better achieve
                    the goals of that plan'' after ``that plan'';
                        (B) in paragraph (2)--
                              (i) in the paragraph heading, by striking
                          ``Chairman'' and inserting ``Chairperson''; and
                              (ii) by striking ``chairman'' and inserting
                          ``Chairperson'';
                        (C) in paragraph (3)--
                              (i) by striking ``prior to March 1'' and
                          inserting ``before June 1'';
                              (ii) by striking ``either'' each place it
                          appears;
                              (iii) by striking ``current chairman'' and
                          inserting ``Chairperson''; and

    [[Page 132 STAT. 4134]]

                              (iv) by striking ``they'' and inserting ``the
                          members''; and
                        (D) in paragraph (4)--
                              (i) by striking ``chairman'' each place it
                          appears and inserting ``Chairperson'';
                              (ii) in the first sentence, by striking ``a
                          report'';
                              (iii) by inserting ``a report'' after
                          ``committees''; and
                              (iv) by striking the second sentence and
                          inserting the following: ``The report required
                          under this paragraph shall be in unclassified
                          form, but may include a classified annex.''; and
                (3) by adding at the end the following:

        ``(c) International Coordination.--The Director may facilitate
    international drug control coordination efforts.''.
    SEC. 8220. <<NOTE: 21 USC 1715.>>  GAO AUDIT.

        Not later than 4 years after the date of enactment of this Act, and
    every 4 years thereafter, the Comptroller General of the United States
    shall--
                (1) conduct an audit relating to the programs and operations
            of--
                        (A) the Office; and
                        (B) certain programs within the Office, including--
                              (i) the High Intensity Drug Trafficking Areas
                          Program;
                              (ii) the Drug-Free Communities Program; and
                              (iii) the campaign under section 709(f) of the
                          Office of National Drug Control Policy
                          Reauthorization Act of 1998 (21 U.S.C. 1708(f));
                          and
                (2) submit to the Director and the appropriate congressional
            committees a report containing an evaluation of and
            recommendations on the--
                        (A) policies and activities of the programs and
                    operations subject to the audit;
                        (B) economy, efficiency, and effectiveness in the
                    administration of the reviewed programs and operations;
                    and
                        (C) policy or management changes needed to prevent
                    and detect fraud and abuse in such programs and
                    operations.
    SEC. 8221. NATIONAL DRUG CONTROL STRATEGY.

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

        ``(a) In General.--
                ``(1) Statement of drug policy priorities.--The Director
            shall release a statement of drug control policy priorities in
            the calendar year of a Presidential inauguration following the
            inauguration, but not later than April 1.
                ``(2) National drug control strategy submitted by the
            president.--Not later than the first Monday in February
            following the year in which the term of the President commences,
            and every 2 years thereafter, the President shall submit to
            Congress a National Drug Control Strategy.

    [[Page 132 STAT. 4135]]

        ``(b) Development of the National Drug Control Strategy.--
                ``(1) Promulgation.--The Director shall promulgate the
            National Drug Control Strategy, which shall set forth a
            comprehensive plan to reduce illicit drug use and the
            consequences of such illicit drug use in the United States by
            limiting the availability of and reducing the demand for illegal
            drugs and promoting prevention, early intervention, treatment,
            and recovery support for individuals with substance use
            disorders.
                ``(2) State and local commitment.--The Director shall seek
            the support and commitment of State, local, and Tribal officials
            in the formulation and implementation of the National Drug
            Control Strategy.
                ``(3) Strategy based on evidence.--The Director shall ensure
            the National Drug Control Strategy is based on the best
            available evidence regarding the policies that are most
            effective in reducing the demand for and supply of illegal
            drugs.
                ``(4) Process for development and submission of national
            drug control strategy.--In developing and effectively
            implementing the National Drug Control Strategy, the Director--
                        ``(A) shall consult with--
                              ``(i) the heads of the National Drug Control
                          Program Agencies;
                              ``(ii) each Coordinator listed in section 704;
                              ``(iii) the Interdiction Committee and the
                          Emerging Threats Committee;
                              ``(iv) the appropriate congressional
                          committees and any other committee of
                          jurisdiction;
                              ``(v) State, local, and Tribal officials;
                              ``(vi) private citizens and organizations,
                          including community and faith-based organizations,
                          with experience and expertise in demand reduction;
                              ``(vii) private citizens and organizations
                          with experience and expertise in supply reduction;
                          and
                              ``(viii) appropriate representatives of
                          foreign governments; and
                        ``(B) in satisfying the requirements of subparagraph
                    (A), shall ensure, to the maximum extent possible, that
                    State, local, and Tribal officials and relevant private
                    organizations commit to support and take steps to
                    achieve the goals and objectives of the National Drug
                    Control Strategy.

        ``(c) Contents of the National Drug Control Strategy.--
                ``(1) In general.--The National Drug Control Strategy
            submitted under subsection (a)(2) shall include the following:
                        ``(A) A mission statement detailing the major
                    functions of the National Drug Control Program.
                        ``(B) Comprehensive, research-based, long-range,
                    quantifiable goals for reducing illicit drug use, and
                    the consequences of illicit drug use in the United
                    States.
                        ``(C) Annual quantifiable and measurable objectives
                    and specific targets to accomplish long-term
                    quantifiable goals that the Director determines may be
                    achieved during each year beginning on the date on which
                    the National Drug Control Strategy is submitted.

    [[Page 132 STAT. 4136]]

                        ``(D) A 5-year projection for the National Drug
                    Control Program and budget priorities.
                        ``(E) A review of international, State, local, and
                    private sector drug control activities to ensure that
                    the United States pursues coordinated and effective drug
                    control at all levels of government.
                        ``(F) A description of how each goal established
                    under subparagraph (B) will be achieved, including for
                    each goal--
                              ``(i) a list of each relevant National Drug
                          Control Program Agency and each such agency's
                          related programs, activities, and available assets
                          and the role of each such program, activity, and
                          asset in achieving such goal;
                              ``(ii) a list of relevant stakeholders and
                          each such stakeholder's role in achieving such
                          goal;
                              ``(iii) an estimate of Federal funding and
                          other resources needed to achieve such goal;
                              ``(iv) a list of each existing or new
                          coordinating mechanism needed to achieve such
                          goal; and
                              ``(v) a description of the Office's role in
                          facilitating the achievement of such goal.
                        ``(G) For each year covered by the Strategy, a
                    performance evaluation plan for each goal established
                    under subparagraph (B) for each National Drug Control
                    Program Agency, including--
                              ``(i) specific performance measures for each
                          National Drug Control Program Agency;
                              ``(ii) annual and, to the extent practicable,
                          quarterly objectives and targets for each
                          performance measure; and
                              ``(iii) an estimate of Federal funding and
                          other resources needed to achieve each performance
                          objective and target.
                        ``(H) A list identifying existing data sources or a
                    description of data collection needed to evaluate
                    performance, including a description of how the Director
                    will obtain such data.
                        ``(I) A list of any anticipated challenges to
                    achieving the National Drug Control Strategy goals and
                    planned actions to address such challenges.
                        ``(J) A description of how each goal established
                    under subparagraph (B) was determined, including--
                              ``(i) a description of each required
                          consultation and a description of how such
                          consultation was incorporated; and
                              ``(ii) data, research, or other information
                          used to inform the determination to establish the
                          goal.
                        ``(K) A description of the current prevalence of
                    illicit drug use in the United States, including both
                    the availability of illicit drugs and the prevalence of
                    substance use disorders.
                        ``(L) Such other statistical data and information as
                    the Director considers appropriate to demonstrate and
                    assess trends relating to illicit drug use, the effects
                    and consequences of illicit drug use (including the
                    effects on children), supply reduction, demand
                    reduction, drug-related

    [[Page 132 STAT. 4137]]

                    law enforcement, and the implementation of the National
                    Drug Control Strategy.
                        ``(M) A systematic plan for increasing data
                    collection to enable real time surveillance of drug
                    control threats, developing analysis and monitoring
                    capabilities, and identifying and addressing policy
                    questions related to the National Drug Control Strategy
                    and Program, which shall include--
                              ``(i) a list of policy-relevant questions for
                          which the Director and each National Drug Control
                          Program Agency intends to develop evidence to
                          support the National Drug Control Program and
                          Strategy;
                              ``(ii) a list of data the Director and each
                          National Drug Control Program Agency intends to
                          collect, use, or acquire to facilitate the use of
                          evidence in drug control policymaking and
                          monitoring;
                              ``(iii) a list of methods and analytical
                          approaches that may be used to develop evidence to
                          support the National Drug Control Program and
                          Strategy and related policy;
                              ``(iv) a list of any challenges to developing
                          evidence to support policymaking, including any
                          barriers to accessing, collecting, or using
                          relevant data;
                              ``(v) a description of the steps the Director
                          and the head of each National Drug Control Program
                          Agency will take to effectuate the plan; and
                              ``(vi) any other relevant information as
                          determined by the Director.
                        ``(N) A plan to expand treatment of substance use
                    disorders, which shall--
                              ``(i) identify unmet needs for treatment for
                          substance use disorders and a strategy for closing
                          the gap between available and needed treatment;
                              ``(ii) describe the specific roles and
                          responsibilities of the relevant National Drug
                          Control Programs for implementing the plan;
                              ``(iii) identify the specific resources
                          required to enable the relevant National Drug
                          Control Agencies to implement that strategy; and
                              ``(iv) identify the resources, including
                          private sources, required to eliminate the unmet
                          need for evidence-based substance use disorder
                          treatment.
                ``(2) Consultation.--In developing the plan required under
            paragraph (1), the Director shall consult with the following:
                        ``(A) The public.
                        ``(B) Any evaluation or analysis units and personnel
                    of the Office.
                        ``(C) Office officials responsible for implementing
                    privacy policy.
                        ``(D) Office officials responsible for data
                    governance.
                        ``(E) The appropriate congressional committees.
                        ``(F) Any other individual or entity as determined
                    by the Director.
                ``(3) Additional strategies.--
                        ``(A) In general.--The Director shall include in the
                    National Drug Control Strategy the additional strategies

    [[Page 132 STAT. 4138]]

                    described under this paragraph and shall comply with the
                    following:
                              ``(i) Provide a copy of the additional
                          strategies to the appropriate congressional
                          committees and to the Committee on Armed Services
                          and the Committee on Homeland Security of the
                          House of Representatives, and the Committee on
                          Homeland Security and Governmental Affairs and the
                          Committee on Armed Services of the Senate.
                              ``(ii) Issue the additional strategies in
                          consultation with the head of each relevant
                          National Drug Control Program Agency, any relevant
                          official of a State, local, or Tribal government,
                          and the government of other relevant countries.
                              ``(iii) Not change any existing agency
                          authority or construe any strategy described under
                          this paragraph to amend or modify any law
                          governing interagency relationship but may include
                          recommendations about changes to such authority or
                          law.
                              ``(iv) Present separately from the rest of any
                          strategy described under this paragraph any
                          information classified under criteria established
                          by an Executive order, or whose public disclosure,
                          as determined by the Director or the head of any
                          relevant National Drug Control Program Agency,
                          would be detrimental to the law enforcement or
                          national security activities of any Federal,
                          State, local, or Tribal agency.
                        ``(B) Requirement for southwest border
                    counternarcotics strategy.--
                              ``(i) Purposes.--The Southwest Border
                          Counternarcotics Strategy shall--
                                        ``(I) set forth the Government's
                                    strategy for preventing the illegal
                                    trafficking of drugs across the
                                    international border between the United
                                    States and Mexico, including through
                                    ports of entry and between ports of
                                    entry on that border;
                                        ``(II) state the specific roles and
                                    responsibilities of the relevant
                                    National Drug Control Program Agencies
                                    for implementing that strategy; and
                                        ``(III) identify the specific
                                    resources required to enable the
                                    relevant National Drug Control Program
                                    Agencies to implement that strategy.
                              ``(ii) Specific content related to drug
                          tunnels between the united states and mexico.--The
                          Southwest Border Counternarcotics Strategy shall
                          include--
                                        ``(I) a strategy to end the
                                    construction and use of tunnels and
                                    subterranean passages that cross the
                                    international border between the United
                                    States and Mexico for the purpose of
                                    illegal trafficking of drugs across such
                                    border; and
                                        ``(II) recommendations for criminal
                                    penalties for persons who construct or
                                    use such a tunnel or subterranean
                                    passage for such a purpose.
                        ``(C) Requirement for northern border
                    counternarcotics strategy.--
                              ``(i) Purposes.--The Northern Border
                          Counternarcotics Strategy shall--

    [[Page 132 STAT. 4139]]

                                        ``(I) set forth the strategy of the
                                    Federal Government for preventing the
                                    illegal trafficking of drugs across the
                                    international border between the United
                                    States and Canada, including through
                                    ports of entry and between ports of
                                    entry on the border;
                                        ``(II) state the specific roles and
                                    responsibilities of each relevant
                                    National Drug Control Program Agency for
                                    implementing the strategy;
                                        ``(III) identify the specific
                                    resources required to enable the
                                    relevant National Drug Control Program
                                    Agencies to implement the strategy;
                                        ``(IV) be designed to promote, and
                                    not hinder, legitimate trade and travel;
                                    and
                                        ``(V) reflect the unique nature of
                                    small communities along the
                                    international border between the United
                                    States and Canada, ongoing cooperation
                                    and coordination with Canadian law,
                                    enforcement authorities, and variations
                                    in the volumes of vehicles and
                                    pedestrians crossing through ports of
                                    entry along the international border
                                    between the United States and Canada.
                              ``(ii) Specific content related to cross-
                          border indian reservations.--The Northern Border
                          Counternarcotics Strategy shall include--
                                        ``(I) a strategy to end the illegal
                                    trafficking of drugs to or through
                                    Indian reservations on or near the
                                    international border between the United
                                    States and Canada; and
                                        ``(II) recommendations for
                                    additional assistance, if any, needed by
                                    Tribal law enforcement agencies relating
                                    to the strategy, including an evaluation
                                    of Federal technical and financial
                                    assistance, infrastructure capacity
                                    building, and interoperability
                                    deficiencies.
                ``(4) Classified information.--Any contents of the National
            Drug Control Strategy that involve information properly
            classified under criteria established by an Executive order
            shall be presented to Congress separately from the rest of the
            National Drug Control Strategy.
                ``(5) Selection of data and information.--In selecting data
            and information for inclusion in the Strategy, the Director
            shall ensure--
                        ``(A) the inclusion of data and information that
                    will permit analysis of current trends against
                    previously compiled data and information where the
                    Director believes such analysis enhances long-term
                    assessment of the National Drug Control Strategy; and
                        ``(B) the inclusion of data and information to
                    permit a standardized and uniform assessment of the
                    effectiveness of drug treatment programs in the United
                    States.

        ``(d) Submission of Revised Strategy.--The President may submit to
    Congress a revised National Drug Control Strategy that meets the
    requirements of this section--
                ``(1) at any time, upon a determination of the President, in
            consultation with the Director, that the National Drug Control
            Strategy in effect is not sufficiently effective; or

    [[Page 132 STAT. 4140]]

                ``(2) if a new President or Director takes office.

        ``(e) Failure of Director to Submit National Drug Control
    Strategy.--If the Director does not submit a National Drug Control
    Strategy to Congress in accordance with subsection (a)(2), not later
    than five days after the first Monday in February following the year in
    which the term of the President commences, the Director shall send a
    notification to the appropriate congressional committees--
                ``(1) explaining why the Strategy was not submitted; and
                ``(2) specifying the date by which the Strategy will be
            submitted.

        ``(f) Drug Control Data Dashboard.--
                ``(1) In general.--The Director shall collect and
            disseminate, as appropriate, such information as the Director
            determines is appropriate, but not less than the information
            described in this subsection. The data shall be publicly
            available in a machine-readable format on the online portal of
            the Office, and to the extent practicable on the Drug Control
            Data Dashboard.
                ``(2) Establishment.--The Director shall publish to the
            online portal of the office in a machine-readable, sortable, and
            searchable format, or to the extent practicable, establish and
            maintain a data dashboard on the online portal of the Office to
            be known as the `Drug Control Data Dashboard'. To the extent
            practicable, when establishing the Drug Control Dashboard, the
            Director shall ensure the user interface of the dashboard is
            constructed with modern design standards. To the extent
            practicable, the data made available on the dashboard shall be
            publicly available in a machine-readable format and searchable
            by year, agency, drug, and location.
                ``(3) Data.--The data included in the Drug Control Data
            Dashboard shall be updated quarterly to the extent practicable,
            but not less frequently than annually and shall include, at a
            minimum, the following:
                        ``(A) For each substance identified by the Director
                    as having a significant impact on the prevalence of
                    illicit drug use--
                              ``(i) data sufficient to show the quantities
                          of such substance available in the United States,
                          including--
                                        ``(I) the total amount seized and
                                    disrupted in the calendar year and each
                                    of the previous 3 calendar years,
                                    including to the extent practicable the
                                    amount seized by State, local, and
                                    Tribal governments;
                                        ``(II) the known and estimated flows
                                    into the United States from all sources
                                    in the calendar year and each of the
                                    previous 3 calendar years;
                                        ``(III) the total amount of known
                                    flows that could not be interdicted or
                                    disrupted in the calendar year and each
                                    of the previous 3 calendar years;
                                        ``(IV) the known and estimated
                                    levels of domestic production in the
                                    calendar year and each of the previous
                                    three calendar years, including the
                                    levels of domestic production if the
                                    drug is a prescription drug, as
                                    determined under the Federal Food, Drug,
                                    and Cosmetic Act, for which a listing

    [[Page 132 STAT. 4141]]

                                    is in effect under section 202 of the
                                    Controlled Substances Act (21 U.S.C.
                                    812);
                                        ``(V) the average street price for
                                    the calendar year and the highest known
                                    street price during the preceding 10-
                                    year period; and
                                        ``(VI) to the extent practicable,
                                    related prosecutions by State, local,
                                    and Tribal governments;
                              ``(ii) data sufficient to show the frequency
                          of use of such substance, including--
                                        ``(I) use of such substance in the
                                    workplace and productivity lost by such
                                    use;
                                        ``(II) use of such substance by
                                    arrestees, probationers, and parolees;
                                        ``(III) crime and criminal activity
                                    related to such substance;
                                        ``(IV) to the extent practicable,
                                    related prosecutions by State, local,
                                    and Tribal governments;
                        ``(B) For the calendar year and each of the previous
                    three years data sufficient to show, disaggregated by
                    State and, to the extent feasible, by region within a
                    State, county, or city, the following:
                              ``(i) The number of fatal and non-fatal
                          overdoses caused by each drug identified under
                          subparagraph (A)(i).
                              ``(ii) The prevalence of substance use
                          disorders.
                              ``(iii) The number of individuals who have
                          received substance use disorder treatment,
                          including medication assisted treatment, for a
                          substance use disorder, including treatment
                          provided through publicly-financed health care
                          programs.
                              ``(iv) The extent of the unmet need for
                          substance use disorder treatment, including the
                          unmet need for medication-assisted treatment.
                        ``(C) Data sufficient to show the extent of
                    prescription drug diversion, trafficking, and misuse in
                    the calendar year and each of the previous 3 calendar
                    years.
                        ``(D) Any quantifiable measures the Director
                    determines to be appropriate to detail progress toward
                    the achievement of the goals of the National Drug
                    Control Strategy.

        ``(g) Development of an Annual National Drug Control Assessment.--
                ``(1) Timing.--Not later than the first Monday in February
            of each year, the Director shall submit to the President,
            Congress, and the appropriate congressional committees, a report
            assessing the progress of each National Drug Control Program
            Agency toward achieving each goal, objective, and target
            contained in the National Drug Control Strategy applicable to
            the prior fiscal year.
                ``(2) Process for development of the annual assessment.--Not
            later than November 1 of each year, the head of each National
            Drug Control Program Agency shall submit, in accordance with
            guidance issued by the Director, to the Director an evaluation
            of progress by the agency with respect to the National Drug
            Control Strategy goals using the performance measures for the
            agency developed under this title, including progress with
            respect to--

    [[Page 132 STAT. 4142]]

                        ``(A) success in achieving the goals of the National
                    Drug Control Strategy;
                        ``(B) success in reducing domestic and foreign
                    sources of illegal drugs;
                        ``(C) success in expanding access to and increasing
                    the effectiveness of substance use disorder treatment;
                        ``(D) success in protecting the borders of the
                    United States (and in particular the Southwestern border
                    of the United States) from penetration by illegal
                    narcotics;
                        ``(E) success in reducing crime associated with drug
                    use in the United States;
                        ``(F) success in reducing the negative health and
                    social consequences of drug use in the United States;
                        ``(G) implementation of evidence-based substance use
                    disorder treatment and prevention programs in the United
                    States and improvements in the adequacy and
                    effectiveness of such programs; and
                        ``(H) success in increasing the prevention of
                    illicit drug use.
                ``(3) Contents of the annual assessment.--The Director shall
            include in the annual assessment required under paragraph (1)--
                        ``(A) a summary of each evaluation received by the
                    Director under paragraph (2);
                        ``(B) a summary of the progress of each National
                    Drug Control Program Agency toward the National Drug
                    Control Strategy goals of the agency using the
                    performance measures for the agency developed under this
                    chapter;
                        ``(C) an assessment of the effectiveness of each
                    National Drug Control Program Agency and program in
                    achieving the National Drug Control Strategy for the
                    previous year, including a specific evaluation of
                    whether the applicable goals, measures, objectives, and
                    targets for the previous year were met; and
                        ``(D) the assessments required under this subsection
                    shall be based on the Performance Measurement System.''.

        (b) Technical and Conforming Amendments.--
                (1) Section 704(b) of the Office of National Drug Control
            Policy Reauthorization Act of 1998 (21 U.S.C. 1703(b)) is
            amended--
                        (A) by striking paragraphs (13) and (17); and
                        (B) in paragraph (14)(A), by striking ``paragraph
                    (13)'' and inserting ``section 706(g)(2)''.
                (2) The Office of National Drug Control Policy
            Reauthorization Act of 2006 (Public Law 109-469; 120 Stat.
            3502) <<NOTE: 21 USC 1705 notes.>>  is amended by striking
            sections 1110 and 1110A.
    SEC. 8222. TECHNICAL AND CONFORMING AMENDMENTS TO THE OFFICE OF
                              NATIONAL DRUG CONTROL POLICY
                              REAUTHORIZATION ACT OF 1998.

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

    [[Page 132 STAT. 4143]]

                                        (I) in the matter before clause (i),
                                    by inserting ``requests a level of
                                    funding that will not enable achievement
                                    of the goals of the National Drug
                                    Control Strategy, including'' after
                                    ``request that'';
                                        (II) in clause (iii)--
                                                (aa) by striking ``drug
                                            treatment'' and inserting
                                            ``substance use disorder
                                            prevention and treatment''; and
                                                (bb) by striking the
                                            semicolon at the end and
                                            inserting ``; and'';
                                        (III) by striking clauses (iv),
                                    (vi), and (vii);
                                        (IV) by redesignating clause (v) as
                                    clause (iv); and
                                        (V) in clause (iv), as so
                                    redesignated, by striking the semicolon
                                    and inserting a period;
                              (ii) in paragraph (4)(A), by striking
                          ``$1,000,000'' and inserting ``$5,000,000 or 10
                          percent of a specific program or account''; and
                        (B) in subsection (f)--
                              (i) by striking the first paragraph (5); and
                              (ii) by striking the second paragraph (4); and
                (3) by striking section 708 (21 U.S.C. 1707).

                          Subtitle L--Budgetary Effects

    SEC. 8231. BUDGETARY EFFECT.

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

        Approved October 24, 2018.

    LEGISLATIVE HISTORY--H.R. 6:
    ---------------------------------------------------------------------------

    CONGRESSIONAL RECORD, Vol. 164 (2018):
                June 22, considered and passed House.
                Sept. 17, considered and passed Senate, amended.
                Sept. 28, House concurred in Senate amendment with an
                    amendment pursuant to H. Res. 1099.
                Oct. 3, Senate concurred in House amendment.
    DAILY COMPILATION OF PRESIDENTIAL DOCUMENTS (2018):
                Oct. 24, Presidential remarks and statement.

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