,,ii  #aac? ,,congress  #b;d ,session   
,s4 #bfde  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #bc1 #bjad ,mr4  
,m>key 7= himself1 ,mrs4 ,fe9/e91 ,mr4  
,rockefell]1 ,mr4 ,br[n1 ,ms4 ,hirono1 &
 ,mr4 ,durb97 introduc$ ! foll[+ bill2  
:i* 0 read twice & ref]r$ to !          
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions  ,a ,,bill  ,to      
provide access to m$ication-assi/$      
!rapy1 & = o!r purposes4  #a4 ,%ort     
title  ,?is ,act may be cit$ z !        
,recov]y ,enhancem5t = ,addiction       
,treatm5t ,act or ! ,,treat ,act4  #b4  
,f9d+s ,congress f9ds ! foll[+3 7#a7    
,ov]doses f opioids h increas$          
dramatically 9 ! ,unit$ ,/ates4  7#b7   
,dea?s f drug ov]dose1 l>gely f         
prescription pa9 reliev]s1 h tripl$     
among m5 & increas$ five-fold among wom5
 ov] ! pa/ decade4  7#c7 ,nationwide1   
drug ov]doses n[ claim m lives ?an c>   
accid5ts4  7#d7 ,opioid addiction is a  
*ronic disease t1 untreat$1 places a    
l>ge burd5 on ! heal?c>e sy/em4 ,r\ghly 

#dge1jjj em]g5cy room visits ea* ye> are
 attributable to ! misuse & abuse (     
opioid pa9 m$ication4  7#e7 ,effective  
m$ication-assi/$ treatm5t = opioid      
addiction c decrease ov]dose dea?s1 be  
co/-effective1 r$uce transmissions (    
,,hiv & viral hepatitis1 & r$uce o!r    
social h>ms su* z crim9al activity4     
7#f7 ,effective m$ication-assi/$        
treatm5t programs = opioid addiction    
%\ld include multiple compon5ts1 includ+
 m$ications1 cognitive & behavioral     
supports & int]v5tions1 & drug te/+4    
7#g7 ,effective m$ication-assi/$        
treatm5t programs = opioid addiction may
 use a team ( /aff memb]s1 9 addition to
 a prescrib+ provid]1 to deliv]         
compreh5sive c>e4  7#h7 ,access to      
m$ication-assi/$ treatm5ts1 includ+     
(fice-bas$ bupr5orph9e opioid treatm5t1 
rema9s limit$ 9 "p due to curr5t        
practice regulations & an insuffici5t   
numb] ( provid]s4  7#i7 ,m ?an #aj ye>s 
( exp]i5ce 9 ! ,unit$ ,/ates )          
(fice-bas$ bupr5orph9e opioid treatm5t  

has in=m$ be/ practices = deliv]+       
successful1 high quality c>e4  #c4      
,expansion ( pati5t limits "u waiv]     
,section #cjc7;g77#b77;,b7 ( !          
,controll$ ,sub/ances ,act 7#ba         
,u4,s4,c4 #hbc7;g77#b77;,b77 is am5d$-- 
7#a7 9 clause 7i71 by /rik+ physician & 
ins]t+ practition]2  7#b7 9 clause      
7iii7-- 7,a7 by /rik+ #cj & ins]t+ #ajj2
 &  7,b7 by /rik+ 1 unless1 n soon] &   
all t foll[s ?r\gh ! end & ins]t+ a     
p]iod2 &  7#c7 by ins]t+ at ! end !     
foll[+ new clause3  7iv7 ,n e>li] ?an #a
 ye> aft] ! date on :i* a qualify+      
practition] obta9$ an initial waiv]     
pursuant to clause 7iii71 ! qualify+    
practition] may submit a second         
notification to ! ,secret>y ( ! ne$ &   
int5t ( ! qualify+ practition] to treat 
an unlimit$ numb] ( pati5ts1 if !       
qualify+ practition]-- 7,i7 7aa7        
satisfies ! requirem5ts ( item 7aa71    
7bb71 7cc71 or 7dd7 ( subp>agraph       
7,g77ii77,i72 &  7bb7 agrees to fully   
p>ticipate 9 ! ,prescription ,drug      

,monitor+ ,program ( ! ,/ate 9 :i* !    
qualify+ practition] is lic5s$1 pursuant
 to applicable ,/ate guidel9es2 or      
7,,ii7 7aa7 satisfies ! requirem5ts (   
item 7ee71 7ff71 or 7gg7 ( subp>agraph  
7,g77ii77,i72  7bb7 agrees to fully     
p>ticipate 9 ! ,prescription ,drug      
,monitor+ ,program ( ! ,/ate 9 :i* !    
qualify+ practition] is lic5s$1 pursuant
 to applicable ,/ate guidel9es2  7cc7   
practices 9 a qualifi$ practice sett+2 &
  7dd7 has complet$ n less ?an #bd h\rs 
( tra9+ 7?r\gh classroom situations1    
sem9>s at pr(essional society meet+s1   
electronic communications1 or o!rwise7 )
 respect to ! treatm5t & managem5t (    
opiate-dep5d5t pati5ts = sub/ance use   
disord]s provid$ by ! ,am]ican ,society 
( ,addiction ,m$ic9e1 ! ,am]ican        
,academy ( ,addiction ,psy*iatry1 !     
,am]ican ,m$ical ,association1 !        
,am]ican ,o/eopa?ic ,association1 !     
,am]ican ,psy*iatric ,association1 or   
any o!r organization t ! ,secret>y      
det]m9es is appropriate = purposes ( ?is

 subclause4  4  #d4 ,def9itions ,section
 #cjc7;g77#b77;,g7 ( ! ,controll$       
,sub/ances ,act 7#ba ,u4,s4,c4          
#hbc7;g77#b77;,g77 is am5d$-- 7#a7 by   
/rik+ clause 7ii7 & ins]t+ ! foll[+3    
7ii7 ,! t]m qualify+ practition] means !
 foll[+3 7,i7 ,a physician :o is lic5s$ 
"u ,/ate law & :o meets #a or m ( !     
foll[+ conditions3 7aa7 ,! physician    
holds a bo>d c]tification 9 addiction   
psy*iatry f ! ,am]ican ,bo>d ( ,m$ical  
,specialties4  7bb7 ,! physician holds  
an addiction c]tification f ! ,am]ican  
,society ( ,addiction ,m$ic9e4  7cc7 ,! 
physician holds a bo>d c]tification 9   
addiction m$ic9e f ! ,am]ican ,o/eopa?ic
 ,association4  7dd7 ,! physician holds 
a bo>d c]tification f ! ,am]ican ,bo>d (
 ,addiction ,m$ic9e4  7ee7 ,! physician 
has complet$ n less ?an #h h\rs ( tra9+ 
7?r\gh classroom situations1 sem9> at   
pr(essional society meet+s1 electronic  
communications1 or o!rwise7 ) respect to
 ! treatm5t & managem5t ( opiate-dep5d5t
 pati5ts = sub/ance use disord]s provid$

 by ! ,am]ican ,society ( ,addiction    
,m$ic9e1 ! ,am]ican ,academy (          
,addiction ,psy*iatry1 ! ,am]ican       
,m$ical ,association1 ! ,am]ican        
,o/eopa?ic ,association1 ! ,am]ican     
,psy*iatric ,association1 or any o!r    
organization t ! ,secret>y det]m9es is  
appropriate = purposes ( ?is subclause4 
7ff7 ,! physician has p>ticipat$ z an   
inve/igator 9 #a or m cl9ical trials    
lead+ to ! approval ( a n>cotic drug 9  
s*$ule ,,iii1 ,,iv1 or ,v = ma9t5ance or
 detoxification treatm5t1 z demon/rat$  
by a /atem5t submitt$ to ! ,secret>y by 
?is sponsor ( su* approv$ drug4  7gg7 ,!
 physician has su* o!r tra9+ or exp]i5ce
 z ! ,secret>y det]m9es w demon/rate !  
ability ( ! physician to treat & manage 
opiate-dep5d5t pati5ts4  7,,ii7 ,a nurse
 practition] or physician assi/ant :o is
 lic5s$ "u ,/ate law & meets all ( !    
foll[+ conditions3 7aa7 ,! nurse        
practition] or physician assi/ant is    
lic5s$ "u ,/ate law to prescribe s*$ule 
,,iii1 ,,iv1 or ,v m$ications = pa94    

7bb7 ,! nurse practition] or physician  
assi/ant satisfies #a or m ( ! foll[+3  
7,,aa7 ,has complet$ n few] ?an #bd h\rs
 ( tra9+ 7?r\gh classroom situations1   
sem9> at pr(essional society meet+s1    
electronic communications1 or o!rwise7 )
 respect to ! treatm5t & managem5t (    
opiate-dep5d5t pati5ts = sub/ance use   
disord]s provid$ by ! ,am]ican ,society 
( ,addiction ,m$ic9e1 ! ,am]ican        
,academy ( ,addiction ,psy*iatry1 !     
,am]ican ,m$ical ,association1 !        
,am]ican ,o/eopa?ic ,association1 !     
,am]ican ,psy*iatric ,association1 or   
any o!r organization t ! ,secret>y      
det]m9es is appropriate = purposes ( ?is
 subclause4 7,,bb7 ,has su* o!r tra9+ or
 exp]i5ce z ! ,secret>y det]m9es w      
demon/rate ! ability ( ! nurse          
practition] or physician assi/ant to    
treat & manage opiate-dep5d5t pati5ts4  
7cc7 ,! nurse practition] or physician  
assi/ant practices "u ! sup]vision ( a  
lic5s$ physician :o holds an active     
waiv] to prescribe s*$ule ,,iii1 ,,iv1  

or ,v n>cotic m$ications = opioid       
addiction !rapy1 &-- 7,,aa7 ! sup]vis+  
physician satisfies ! conditions ( item 
7aa71 7bb71 7cc71 or 7dd7 ( subclause   
7,i72 or 7,,bb7 bo? ! sup]vis+ physician
 & ! nurse practition] or physician     
assi/ant practice 9 a qualifi$ practice 
sett+4  7,,iii7 ,a nurse practition] :o 
is lic5s$ "u ,/ate law & meets all ( !  
foll[+ conditions3 7aa7 ,! nurse        
practition] is lic5s$ "u ,/ate law to   
prescribe s*$ule ,,iii1 ,,iv1 or ,v     
m$ications = pa94  7bb7 ,! nurse        
practition] has tra9+ or exp]i5ce t !   
,secret>y det]m9es demon/rates          
specialization 9 ! ability to treat     
opiate-dep5d5t pati5ts1 su* z a         
c]tification 9 addiction specialty      
accr$it$ by ! ,am]ican ,bo>d ( ,nurs+   
,specialties or ! ,national ,commission 
= ,c]tify+ ,ag5cies1 or a c]tification 9
 addiction nurs+ z a ,c]tifi$ ,addiction
 ,regi/]$ ,nurse--,advanc$ ,practice4   
7cc7 ,9 accordance ) ,/ate law1 ! nurse 
practition] prescribes opioid addiction 

!rapy 9 collaboration ) a physician :o  
holds an active waiv] to prescribe      
s*$ule ,,iii1 ,,iv1 or ,v n>cotic       
m$ications = opioid addiction !rapy4    
7dd7 ,! nurse practition] practices 9 a 
qualifi$ practice sett+4  2 &  7#b7 by  
add+ at ! end ! foll[+3  7iii7 ,! t]m   
qualifi$ practice sett+ means #a or m ( 
! foll[+ treatm5t sett+s3 7,i7 ,a       
,national ,committee = ,quality         
,assurance-recogniz$ ,pati5t-,c5t]$     
,m$ical ,home or ,pati5t-,c5t]$         
,specialty ,practice4  7,,ii7 ,a ,c5t]s 
= ,m$icaid  ,m$ic>e ,s]vices-recogniz$  
,acc\ntable ,c>e ,organization4  7,,iii7
 ,a cl9ical facility adm9i/]$ by !      
,dep>tm5t ( ,vet]ans ,affairs1 ,dep>tm5t
 ( ,def5se1 or ,indian ,heal? ,s]vice4  
7,,iv7 ,a ,behavioral ,heal? ,home      
accr$it$ by ! ,jo9t ,commission4  7,v7  
,a ,f$]ally-qualifi$ heal? c5t] 7z def9$
 9 section #aije7l77#b77;,b7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acif;d7l77#b77;,b777 or a              
,f$]ally-qualifi$ heal? c5t] look-alike4

  7,,vi7 ,a ,sub/ance ,abuse & ,m5tal   
,heal? ,s]vices-c]tifi$ ,opioid         
,treatm5t ,program4  7,,vii7 ,a cl9ical 
program ( a ,/ate or ,f$]al jail1       
prison1 or o!r facility :]e individuals 
are inc>c]at$4  7,,viii7 ,a cl9ic t     
demon/rates compliance ) ! ,model       
,policy on ,,data #bjjj & ,treatm5t (   
,opioid ,addiction 9 ! ,m$ical ,(fice   
issu$ by ! ,f$]ation ( ,/ate ,m$ical    
,bo>ds4  7,,ix7 ,a treatm5t sett+ t is  
"p ( an ,accr$itation ,c\ncil =         
,graduate ,m$ical ,education1 ,am]ican  
,association ( ,colleges ( ,o/eopa?ic   
,m$ic9e1 or ,am]ican ,o/eopa?ic         
,association-accr$it$ resid5cy or       
fell[%ip tra9+ program4  7,x7 ,any o!r  
practice sett+ approv$ by a ,/ate       
regulatory bo>d or ,/ate ,m$icaid ,plan 
to provide addiction treatm5t s]vices4  
7,,xi7 ,any o!r practice sett+ approv$  
by ! ,secret>y4  4  #e4 ,,gao           
,evaluation ,two ye>s aft] ! date on :i*
 ! fir/ notification "u clause 7iv7 (   
section #cjc7;g77#b77;,b7 ( ! ,controll$

 ,sub/ances ,act 7#ba ,u4,s4,c4         
#hbc7;g77#b77;,b771 z add$ by ?is ,act1 
is receiv$ by ! ,secret>y ( ,heal? &    
,human ,s]vices1 ! ,comptroll] ,g5]al ( 
! ,unit$ ,/ates %all initiate an        
evaluation ( ! effectiv5ess ( ! am5dm5ts
 made by ?is ,act1 :i* %all include an  
evaluation (-- 7#a7 any *anges 9 !      
availability & use ( m$ication-assi/$   
treatm5t = opioid addiction2  7#b7 !    
quality ( m$ication-assi/$ treatm5t     
programs2  7#c7 ! integration (         
m$ication-assi/$ treatm5t ) r\t9e       
heal?c>e s]vices2  7#d7 div]sion (      
opioid addiction treatm5t m$ication2    
7#e7 *anges 9 ,/ate or local policies & 
legislation relat+ to opioid addiction  
treatm5t2  7#f7 ! use ( nurse           
practition]s & physician assi/ants :o   
prescribe opioid addiction m$ication2   
7#g7 ! use ( ,prescription ,drug        
,monitor+ ,programs by waiv$            
practition]s to maximize safety ( pati5t
 c>e & prev5t div]sion ( opioid         
addiction m$ication2  7#h7 ! f9d+s (    

,drug ,en=cem5t ,ag5cy inspections (    
waiv$ practition]s1 includ+ ! frequ5cy )
 :i* ! ,drug ,en=cem5t ,ag5cy f9ds no   
docum5tation ( access to behavioral     
heal? s]vices2 &  7#i7 ! effectiv5ess ( 
cross-ag5cy collaboration betwe5        
,dep>tm5t ( ,heal? & ,human ,s]vices & !
 ,drug ,en=cem5t ,ag5cy = exp&+         
effective opioid addiction treatm5t4