    [United States Statutes at Large, Volume 132, 115th Congress, 2nd Session]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    Public Law 115-271
    115th Congress

    An Act

    To provide for opioid use disorder prevention, recovery, and treatment,
    and for other purposes. <>

    Be it enacted by the Senate and House of Representatives of the
    United States of America in Congress assembled, <>
    SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

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

    Sec. 1. Short title; table of contents.

    TITLE I--MEDICAID PROVISIONS TO ADDRESS THE OPIOID CRISIS

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

    TITLE II--MEDICARE PROVISIONS TO ADDRESS THE OPIOID CRISIS

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

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    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.

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

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

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

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

    [[Page 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 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 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 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 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 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 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 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 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 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) <>  Effective date.--The
    amendments made by paragraph (1) shall take effect with respect
    to retrospective drug use reviews conducted on or after October
    1, 2020.
    SEC. 1005. GUIDANCE TO IMPROVE CARE FOR INFANTS WITH NEONATAL
    ABSTINENCE SYNDROME AND THEIR MOTHERS;
    GAO STUDY ON GAPS IN MEDICAID COVERAGE
    FOR PREGNANT AND POSTPARTUM WOMEN WITH
    SUBSTANCE USE DISORDER.

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

    [[Page 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 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 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) <>  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 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) <>  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 3917]]

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

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

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

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

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

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

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

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

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

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

    [[Page 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 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) <>  Effective Date.--The amendment
    made by subsection (a) shall apply to coverage of drugs prescribed on or
    after January 1, 2021.

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

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

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

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

    [[Page 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 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 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) <>  Effective Date.--The
    amendments made by subsection (a) shall apply beginning not later
    January 1, 2021.
    SEC. 2008. SUSPENSION OF PAYMENTS BY MEDICARE PRESCRIPTION DRUG
    PLANS AND MA-PD PLANS PENDING
    INVESTIGATIONS OF CREDIBLE ALLEGATIONS
    OF FRAUD BY PHARMACIES.

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

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

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

    (e) <>  Effective Date.--The amendments
    made by this section shall apply with respect to plan years beginning on
    or after January 1, 2020.

    [[Page 3932]]

    TITLE III--FDA AND CONTROLLED SUBSTANCE PROVISIONS

    Subtitle A--FDA Provisions

    CHAPTER 1--IN GENERAL

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

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

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

    [[Page 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 3934]]

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

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

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

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

    [[Page 3935]]

    CHAPTER 2-- <> STOP COUNTERFEIT DRUGS BY REGULATING AND
    ENHANCING ENFORCEMENT NOW
    SEC. 3011. <>  SHORT TITLE.

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

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

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

    [[Page 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) <>  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 3937]]

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

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

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

    [[Page 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-- <> STOP
    ILLICIT DRUG IMPORTATION
    SEC. 3021. <>  SHORT TITLE.

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

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

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

    [[Page 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 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 <> --SECURING OPIOIDS AND UNUSED
    NARCOTICS WITH DELIBERATE DISPOSAL AND PACKAGING
    SEC. 3031. <>  SHORT TITLE.

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

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

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

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

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

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

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

    ``Sec. 309A. <>   (a) In General.--
    Notwithstanding section 102(10), a pharmacy may deliver a controlled
    substance to a practitioner in accordance with a prescription that meets
    the requirements of this title and the regulations issued by the
    Attorney General

    [[Page 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 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-- <> EMPOWERING PHARMACISTS IN THE FIGHT AGAINST OPIOID ABUSE
    SEC. 3211. <>  SHORT TITLE.

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

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

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

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

    CHAPTER 3-- <> SAFE
    DISPOSAL OF UNUSED MEDICATION
    SEC. 3221. <>  SHORT TITLE.

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

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

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

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

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

    CHAPTER 4 <> --SPECIAL REGISTRATION FOR TELEMEDICINE CLARIFICATION
    SEC. 3231. <>  SHORT TITLE.

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

    [[Page 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 <> --
    ACCESS TO INCREASED DRUG DISPOSAL
    SEC. 3251. <>  SHORT TITLE.

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

    In this chapter--

    [[Page 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 3952]]

    SEC. 3259. <>  DURATION OF PROGRAM.

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

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

    CHAPTER 7-- <> USING DATA TO PREVENT OPIOID DIVERSION
    SEC. 3271. <>  SHORT TITLE.

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

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

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

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

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

    [[Page 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 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-- <> OPIOID QUOTA REFORM
    SEC. 3281. <>  SHORT TITLE.

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

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

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

    ``(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 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. <> --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 3956]]

    CHAPTER 9 <> --PREVENTING
    DRUG DIVERSION
    SEC. 3291. <>  SHORT TITLE.

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

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

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

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

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

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

    [[Page 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 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 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 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) <>  Effective Date.--The amendment
    made by subsection (a) shall apply to taxable years beginning after
    December 31, 2018.

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

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

    [[Page 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--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 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 <> --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 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 3964]]

    Subtitle C <> --CHIP Mental Health and Substance Use Disorder Parity
    SEC. 5021. <>  SHORT TITLE.

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

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

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

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

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

    Subtitle D <> --Medicaid Reentry
    SEC. 5031 <> . SHORT TITLE.

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

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

    [[Page 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 <> --Medicaid Partnership
    SEC. 5041. <>  SHORT TITLE.

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

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

    [[Page 3967]]

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

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

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

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

    [[Page 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 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 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) <>  Guidance.--Not later than
    October 1, 2019, the Administrator of the Centers for Medicare &
    Medicaid Services, in consultation with the Director of the Centers for
    Disease Control and Prevention, shall issue guidance on best practices
    on the uses of prescription drug monitoring programs required of
    prescribers and on protecting the privacy of Medicaid beneficiary
    information maintained in and accessed through prescription drug
    monitoring programs.

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

    [[Page 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. <>  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 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 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 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 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 3976]]

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

    Subtitle G--Medicaid Improvement Fund

    SEC. 5061. MEDICAID IMPROVEMENT FUND.

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

    TITLE VI--OTHER MEDICARE PROVISIONS

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

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

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

    Subtitle B <> --Abuse
    Deterrent Access
    SEC. 6011. SHORT TITLE.

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

    [[Page 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) <>  Effective Date.--The amendment
    made by subsection (a) shall apply to notices distributed prior to each
    Medicare open enrollment period beginning after January 1, 2019.

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

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

    [[Page 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 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 <> --Advancing High Quality Treatment for
    Opioid Use Disorders in Medicare
    SEC. 6041 <> . SHORT TITLE.

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

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

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

    [[Page 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 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 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 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 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 3985]]

    Subtitle F-- <> Responsible Education
    Achieves Care and Healthy Outcomes for Users' Treatment
    SEC. 6051. <>  SHORT TITLE.

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

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

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

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

    [[Page 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 <> --Preventing Addiction for Susceptible Seniors
    SEC. 6061. <>  SHORT TITLE.

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

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

    [[Page 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 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 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 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 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 3992]]

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

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

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

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

    Subtitle I <> --Dr. Todd Graham Pain Management, Treatment,
    and Recovery
    SEC. 6081. <>  SHORT TITLE.

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

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

    [[Page 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 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 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 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 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 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 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 <>  J--Combating Opioid Abuse for Care in Hospitals
    SEC. 6091. <>  SHORT TITLE.

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

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

    [[Page 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 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 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 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. <>  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 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 <>  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 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 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) <>  Effective date.--The
    amendments made by this subsection shall apply with respect to
    information required to

    [[Page 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) <>  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 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. <>  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 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. <>  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 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. <>  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 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 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. <>  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 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 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. <>  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 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 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 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. <>  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 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. <>  COMMUNICATION WITH
    FAMILIES DURING EMERGENCIES.

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

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

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

    [[Page 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. <>  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 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 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 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 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 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 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 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 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 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.) <>  is repealed.

    Subtitle H--Substance Use Disorder Treatment Workforce

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

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

    ``PART F--SUBSTANCE USE DISORDER TREATMENT WORKFORCE

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

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

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

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

    [[Page 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 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. <>  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 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 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. <>  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 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 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 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. <>  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 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 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. <>  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 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. <>  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 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 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 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 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 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. <>  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 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 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 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. <>  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 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 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 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 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 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. <>  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 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 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 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 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. <>  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 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 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 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. <>  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 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. <>  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 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 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 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 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 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 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 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 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 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) <>  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 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 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. <>  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 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 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 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 <>  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 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) <>  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 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 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 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 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 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. <>  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. <>  COST RECOUPMENT.

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

    [[Page 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. <>  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 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. <>  REPORT ON VIOLATIONS OF
    ARRIVAL, REPORTING, ENTRY, AND CLEARANCE
    REQUIREMENTS AND FALSITY OR LACK OF
    MANIFEST.

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

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

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

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

    [[Page 4082]]

    Subtitle <>  B--Opioid Addiction Recovery Fraud Prevention
    SEC. 8021. <>  SHORT TITLE.

    This subtitle may be cited as the ``Opioid Addiction Recovery Fraud
    Prevention Act of 2018''.
    SEC. 8022. <>  DEFINITIONS.

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

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

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

    [[Page 4083]]

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

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

    (a) Definitions.--Except as otherwise expressly provided, in this
    section:
    (1) WIOA definitions.--The terms ``core program'',
    ``individual with a barrier to employment'', ``local area'',
    ``local board'', ``one-stop operator'', ``outlying area'',
    ``State'', ``State board'', and ``supportive services'' have the
    meanings given the terms in section 3 of the Workforce
    Innovation and Opportunity Act (29 U.S.C. 3102).
    (2) Education provider.--The term ``education provider''
    means--
    (A) an institution of higher education, as defined
    in section 101 of the Higher Education Act of 1965 (20
    U.S.C. 1001); or
    (B) a postsecondary vocational institution, as
    defined in section 102(c) of such Act (20 U.S.C.
    1002(c)).
    (3) Eligible entity.--The term ``eligible entity'' means--
    (A) a State workforce agency;
    (B) an outlying area; or
    (C) a Tribal entity.
    (4) Participating partnership.--The term ``participating
    partnership'' means a partnership--
    (A) evidenced by a written contract or agreement;
    and
    (B) including, as members of the partnership, a
    local board receiving a subgrant under subsection (d)
    and 1 or more of the following:
    (i) The eligible entity.
    (ii) A treatment provider.
    (iii) An employer or industry organization.
    (iv) An education provider.
    (v) A legal service or law enforcement
    organization.
    (vi) A faith-based or community-based
    organization.
    (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 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 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 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 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 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 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 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 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 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 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) <>  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 4094]]

    Subtitle <>  E--
    Treating Barriers to Prosperity
    SEC. 8061. <>  SHORT TITLE.

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

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

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

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

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

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

    [[Page 4095]]

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

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

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

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

    (a) Authorization of Appropriations.--There is authorized to be
    appropriated under this section such sums as may be necessary for each
    of fiscal years 2019 through 2023 for assistance to States to provide
    individuals in recovery from a substance use disorder stable, temporary
    housing for a period of not more than 2 years or until the individual
    secures permanent housing, whichever is earlier.
    (b) Allocation of Appropriated Amounts.--
    (1) In general.--The amounts appropriated or otherwise made
    available to States under this section shall be allocated based
    on a funding formula established by the Secretary of Housing and
    Urban Development (referred to in this section as the
    ``Secretary'') not later than 60 days after the date of
    enactment of this Act.
    (2) Criteria.--
    (A) In general.--The funding formula required under
    paragraph (1) shall ensure that any amounts appropriated
    or otherwise made 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 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 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. <>  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 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 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 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 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 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) <>  Effective Date.--The amendments made
    by subsection (b) shall take effect as if included in section 50711 of
    division E of Public Law 115-123.
    SEC. 8083. <>  BUILDING CAPACITY FOR
    FAMILY-FOCUSED RESIDENTIAL TREATMENT.

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

    [[Page 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 <>  H--Reauthorizing and Extending
    Grants for Recovery From Opioid Use Programs
    SEC. 8091. <>  SHORT TITLE.

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

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

    Subtitle <>  I--
    Fighting Opioid Abuse in Transportation
    SEC. 8101. <>  SHORT TITLE.

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

    [[Page 4104]]

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

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

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

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

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

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

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

    [[Page 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. <>  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 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. <>  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 4107]]

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

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

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

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

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

    [[Page 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 <>  J--
    Eliminating Kickbacks in Recovery
    SEC. 8121. <>  SHORT TITLE.

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

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

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

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

    [[Page 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 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, <>  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 <>  K--Substance Abuse Prevention
    SEC. 8201. SHORT TITLE.

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

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

    (b) Reauthorization.--
    (1) In general.--Section 714 of the Office of National Drug
    Control Policy Reauthorization Act of 1998 (21 U.S.C. 1711) is
    amended by striking ``such sums as may be necessary for each of
    fiscal years 2006 through 2010'' and inserting ``$18,400,000 for
    each of fiscal years 2018 through 2023''.
    (2) Repeal of termination.--The Office of National Drug
    Control Policy Reauthorization Act of 1998 (21 U.S.C. 1701 et
    seq.) is amended by striking section 715 (21 U.S.C. 1712).
    SEC. 8203. REAUTHORIZATION OF THE DRUG-FREE COMMUNITIES PROGRAM.

    (a) Revival of National Narcotics Leadership Act of 1988.--

    [[Page 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 <>  and restored.
    (2) Laws described.--The laws described in this paragraph
    are:
    (A) Public Law 107-82 (115 Stat. 814).
    (B) The Office of National Drug Control Policy
    Reauthorization Act of 2006 (Public Law 109-469: 120
    Stat. 3502), as amended by paragraph (4).
    (3) Amendment to termination provision.--Section 1009 of the
    National Narcotics Leadership Act of 1988 (21 U.S.C. 1056) is
    amended <>  by inserting ``and sections 1021
    through 1035'' after ``section 1007''.
    (4) Technical correction.--
    (A) In general.--Title VIII of the Office of
    National Drug Control Policy Reauthorization Act of 2006
    (Public Law 109-469; 120 Stat. 3535) <>  is amended by striking ``Drug-
    Free Communities Act of 1997'' each place it appears and
    inserting ``National Narcotics Leadership Act of 1988''.
    (B) <>  Effective date.--
    The amendments made by subparagraph (A) shall take
    effect as though enacted as part of the Office of
    National Drug Control Policy Reauthorization Act of 2006
    (Public Law 109-469; 120 Stat. 3502).

    (b) Amendment to National Narcotics Leadership Act of 1988.--Chapter
    2 of subtitle A of title I of the National Narcotics Leadership Act of
    1988 (21 U.S.C. 1521 et seq.) is amended--
    (1) in section 1022 (21 U.S.C. 1522), by striking
    ``substance abuse'' each place it appears and inserting
    ``substance use and misuse'';
    (2) in section 1023 (21 U.S.C. 1523), by striking paragraph
    (9) and inserting the following:
    ``(9) Substance use and misuse.--The term `substance use and
    misuse' means--
    ``(A) the illegal use or misuse of drugs, including
    substances for which a listing is effect under any of
    schedules I through V under section 202 of the
    Controlled Substances Act (21 U.S.C. 812);
    ``(B) the misuse of inhalants or over-the-counter
    drugs; or
    ``(C) the use of alcohol, tobacco, or other related
    product as such use is prohibited by State or local
    law.'';
    (3) in section 1024 (21 U.S.C. 1524), by striking
    subsections (a) and (b) and inserting the following:

    ``(a) In General.--There is authorized to be appropriated to the
    Office of National Drug Control Policy to carry out this chapter
    $99,000,000 for each of fiscal years 2018 through 2023.
    ``(b) Administrative Costs.--Not more than 8 percent of the funds
    appropriated to carry out this chapter may be used by the Office of
    National Drug Control Policy to pay administrative costs associated with
    the responsibilities of the Office under this chapter.'';
    (4) in subchapter I (21 U.S.C. 1531 et seq.)--
    (A) <>  by striking
    ``substance abuse'' each place it appears and inserting
    ``substance use and misuse''; and

    [[Page 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) <>  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 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 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 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. <>  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 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. <>  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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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. <>  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 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 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 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 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 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 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 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 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) <>  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 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.