,,ii #aadth ,,congress #ast ,session ,s4 #fcf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #c1 #bjae,mr4 ,udall introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to reduce prescription drug misuse and abuse4 #a4 ,short title ,this ,act may be cited as the ,increasing the ,safety of ,prescription ,drug ,use ,act of #bjae4 ,i ,,hhs ,programs #aja4 ,amendment to purpose ,paragraph 7#a7 of section #b of the ,national ,all ,schedules ,prescription ,electronic ,reporting ,act of #bjje 7,public ,law #aji-fj7 is amended to read as follows3 7#a7 foster the establishment of ,state-administered controlled substance monitoring systems in order to ensure that-- 7,a7 health care providers have access to the accurate1 timely prescription history information that they may use as a tool for the early identification of patients at risk for addiction in order to initiate appropriate medical interventions and avert the tragic personal1 family1 and community consequences of untreated addiction2 and 7,b7 appropriate law enforcement1 regulatory1 and ,state professional licensing authorities have access to prescription history information for the purposes of investigating drug diversion and prescribing and dispensing practices of errant prescribers or pharmacists2 and 4 #ajb4 ,prescription drug monitoring program 7a7 ,controlled substance monitoring program ,section #cii,o of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g-#c7 is amended-- 7#a7 in subsection 7a77#a7-- 7,a7 in subparagraph 7,a71 by striking or2 7,b7 in subparagraph 7,b71 by striking the period at the end and inserting 2 or2 and 7,c7 by adding at the end the following3 7,c7 to maintain and operate an existing ,state-controlled substance monitoring program4 2 7#b7 by amending subsection 7b7 to read as follows3 7b7 ,minimum requirements ,the ,secretary shall maintain and1 as appropriate1 supplement or revise 7after publishing proposed additions and revisions in the ,federal ,register and receiving public comments thereon7 minimum requirements for criteria to be used by ,states for purposes of clauses 7ii71 7v71 7vi71 and 7vii7 of subsection 7c77#a77;,a74 2 7#c7 in subsection 7c7-- 7,a7 in paragraph 7#a77;,b7-- 7i7 in the matter preceding clause 7i71 by striking 7a77#a77;,b7 and inserting 7a77#a77;,b7 or 7a77#a77;,c72 7ii7 in clause 7i71 by striking program to be improved and inserting program to be improved or maintained2 7iii7 by redesignating clauses 7iii7 and 7iv7 as clauses 7iv7 and 7v71 respectively2 7iv7 by inserting after clause 7ii71 the following3 7iii7 a plan to apply the latest advances in health information technology in order to incorporate prescription drug monitoring program data directly into the workflow of prescribers and dispensers to ensure timely access to patients' controlled prescription drug history2 2 7v7 in clause 7iv7 7as so redesignated71 by inserting before the semicolon the following3 and at least one health information technology system such as electronic health records1 health information exchanges1 and e-prescribing systems2 and 7vi7 in clause 7v7 7as so redesignated71 by striking public health and inserting public health or public safety2 7,b7 in paragraph 7#c7-- 7i7 by striking ,if a ,state that submits and inserting the following3 7,a7 ,in general ,if a ,state that submits 2 7ii7 by inserting before the period at the end and include timelines for full implementation of such interoperability4 ,the ,state shall also describe the manner in which it will achieve interoperability between its monitoring program and health information technology systems1 as allowable under ,state law1 and include timelines for the implementation of such interoperability2 and 7iii7 by adding at the end the following3 7,b7 ,monitoring of efforts ,the ,secretary shall monitor ,state efforts to achieve interoperability1 as described in subparagraph 7,a74 2 7,c7 in paragraph 7#e7-- 7i7 by striking implement or improve and inserting establish1 improve1 or maintain2 and 7ii7 by adding at the end the following3 ,the ,secretary shall redistribute any funds that are so returned among the remaining grantees under this section in accordance with the formula described in subsection 7a77#b77;,b742 7#d7 in subsection 7d7-- 7,a7 in the matter preceding paragraph 7#a7-- 7i7 by striking ,in implementing or improving and all that follows through 7a77#a77;,b7 and inserting ,in establishing1 improving1 or maintaining a controlled substance monitoring program under this section1 a ,state shall comply1 or with respect to a ,state that applies for a grant under subparagraph 7,b7 or 7,c7 of subsection 7a77#a72 and 7ii7 by striking public health and inserting public health or public safety2 and 7,b7 by adding at the end the following3 7#e7 ,the ,state shall report on interoperability with the controlled substance monitoring program of ,federal agencies1 where appropriate1 interoperability with health information technology systems such as electronic health records1 health information exchanges1 and e-prescribing1 where appropriate1 and whether or not the ,state provides automatic1 real-time or daily information about a patient when a practitioner 7or the designee of a practitioner1 where permitted7 requests information about such patient4 2 7#e7 in subsection 7e71 by adding at the end the following3 7#e7 ,the ,state shall-- 7,a7 ensure that the database-- 7i7 is interoperable with the controlled substance monitoring program of other ,states and other ,federal agencies and across appropriate ,state agencies1 including health agencies1 as determined by the ,secretary2 7ii7 is interoperable with electronic health records and e-prescribing1 where appropriate2 and 7iii7 provides automatic1 real-time or daily information about a patient when a practitioner 7or the designee of a practitioner1 where permitted7 requests information about such patient2 7,b7 require practitioners to use ,state database information to help determine whether to prescribe or renew a prescription for a controlled substance2 and 7,c7 require dispensers1 or their designees1 where permitted1 to enter data required by the ,secretary1 including the name of the patient1 the date1 and prescription dose1 into the database for a controlled substance4 7#f7 ,notwithstanding section #edc and any other provision of law1 the data required to be entered under paragraph 7#e77;,c7 shall include information with respect to methadone that is dispensed to a patient1 if applicable4 7#g7 ,the ,state shall ensure that-- 7,a7 any person who receives patient information through the database may disclose and use such information only to carry out the official duties of that person with regard to the patient2 and 7,b7 notwithstanding subsection 7f77#a77;,b71 no information kept in accordance with a database established1 improved1 or maintained through a grant under this section may be used to conduct a criminal investigation or substantiate any criminal charges against a patient or to conduct any investigation of a patient relating to methadone use of the patient4 2 7#f7 in subsections 7e71 7f77#a71 and 7g71 by striking implementing or improving each place it appears and inserting establishing1 improving1 or maintaining2 7#g7 in subsection 7f7-- 7,a7 in paragraph 7#a77;,b7 by striking misuse of a schedule ,,ii1 ,,iii1 or ,,iv substance and inserting misuse of a controlled substance included in schedule ,,ii1 ,,iii1 or ,,iv of section #bjb7;c7 of the ,controlled ,substance ,act2 and 7,b7 by adding at the end the following3 7#c7 ,evaluation and reporting ,subject to subsection 7g71 a ,state receiving a grant under subsection 7a7 shall provide the ,secretary with aggregate data and other information determined by the ,secretary to be necessary to enable the ,secretary-- 7,a7 to evaluate the success of the ,state's program in achieving its purposes2 or 7,b7 to prepare and submit the report to ,congress required by subsection 7k77#b74 7#d7 ,research by other entities ,a department1 program1 or administration receiving nonidentifiable information under paragraph 7#a77;,d7 may make such information available to other entities for research purposes4 2 7#h7 by striking subsection 7k72 7#i7 by redesignating subsections 7h7 through 7j7 as subsections 7i7 through 7k71 respectively2 7#aj7 in subsections 7c77#a77;,a77iv7 and 7d77#d71 by striking subsection 7h7 each place it appears and inserting subsection 7i72 7#aa7 by inserting after subsection 7g7 the following3 7h7 ,education and access to the monitoring system ,a ,state receiving a grant under subsection 7a7 shall take steps to-- 7#a7 facilitate prescriber and dispenser use of the ,state's controlled substance monitoring system2 and 7#b7 educate prescribers and dispenser on the benefits of the system both to them and society4 2 7#ab7 in subsection 7k77#b77;,a71 as redesignated-- 7,a7 in clause 7ii71 by striking or affected and inserting 1 established or strengthened initiatives to ensure linkages to substance use disorder services1 or affected 2 and 7,b7 in clause 7iii71 by striking including an assessment and inserting between controlled substance monitoring programs and health information technology systems1 and including an assessment 2 7#ac7 in subsection 7l77#a71 by striking establishment1 implementation1 or improvement and inserting establishment1 improvement1 or maintenance2 7#ad7 in subsection 7m77#h71 by striking and the ,district of ,columbia and inserting 1 the ,district of ,columbia1 and any commonwealth or territory of the ,united ,states2 and 7#ae7 by amending subsection 7n71 to read as follows3 7o7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated #g1jjj1jjj for each of fiscal years #bjaf through #bjbj4 4 7b7 ,confidentiality of records ,section #edc7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd-#b7;a77 is amended by inserting or1 with respect to methadone1 as required under section #cii,o7e77#f7 before the period at the end4 7c7 ,requirements for ,federal health care programs ,health care practitioners 7as defined in paragraph 7#g7 of section #cii,o7m7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g-#c7m777 and dispensers 7as defined in paragraph 7#d7 of such section7 who participate in or are employed by a ,federal health care program or federally funded health care program1 including the ,indian ,health ,service1 the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,federal ,bureau of ,prisons1 the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 a ,state ,medicaid plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 the ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq471 and ,federally qualified health centers1 shall use the databases of the controlled substance monitoring programs under section #cii,o of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g-#c71 if such databases are available to the practitioner or dispenser4 #ajc4 ,pilot project 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall award grants to one or more ,states to carry out a #a-year pilot project to develop a standardized peer review process and methodology to review and evaluate prescribing and pharmacy dispensing patterns1 through a review of prescription drug monitoring programs 7referred to in this section as ,,pdmp7 in the ,states receiving such grants4 7b7 ,methodology ,the recipients of a grant under this section shall develop a systematic1 standardized methodology to identify and investigate questionable or inappropriate prescribing and dispensing patterns of substances on schedule ,,ii or ,,iii under section #bjb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hab74 ,such peer review methodology and prescribing and dispensing patterns shall be shared with the appropriate ,state health profession board4 7c7 ,requirements ,a ,state receiving a grant under this section-- 7#a7 with respect to controlled substances for which a prescriber is required to have a license issued by the ,drug ,enforcement ,administration in order to prescribe such controlled substances1 shall make the information with respect to such controlled substances from the ,,pdmp available to ,state regulation and licensing boards2 and 7#b7 with respect to any other controlled substances1 may make the information with respect to such controlled substances from the ,,pdmp available to ,state regulation and licensing boards4 7d7 ,subgrantees ,a quality improvement organization with which the ,secretary has entered into a contract under part ,b of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;c et seq47 may serve as the subgrantee under this subsection to develop peer review processes as described in subsection 7a74 #ajd4 ,prescription drug and other controlled substance abuse prevention ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is amended by adding at the end the following3 #cii,v-#f4 ,prescription drug and other controlled substance abuse prevention 7a7 ,training grants 7#a7 ,in general ,the ,secretary shall award #e-year grants to eligible entities to facilitate training in order to increase the capacity of health care providers to conduct patient screening and brief interventions1 such as in health care settings1 to prevent the abuse of prescription drugs and other controlled substances4 ,the grant program under this section may be coordinated with the ,screening ,brief ,intervention and ,referral to ,treatment grant program of the ,substance ,abuse and ,mental ,health ,services ,administration1 or other appropriate program4 7#b7 ,eligible entities ,in this subsection1 the term eligible entity includes-- 7,a7 ,states2 7,b7 continuing education entities1 such as health profession boards or health accrediting bodies2 and 7,c7 other appropriate health or professional education organizations or institutions4 7b7 ,federal health care workers ,health care providers who participate in or are employed by a ,federal health care program1 including the ,indian ,health ,service1 the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,federal ,bureau of ,prisons1 the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 a ,state ,medicaid plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 the ,state ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq471 and ,federally qualified health centers1 shall screen patients for abuse of prescription drugs or other controlled substances1 conduct brief interventions1 and provide referrals for known or suspected abuse of prescription drugs or other controlled substances1 as appropriate4 7c7 ,expansion of prescribing authority ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants to ,states for the purpose of evaluating the prospect of the health professions board of such ,states reviewing and expanding prescribing authorities of providers1 such as advance practice nurses and physician assistants1 in order to control the abuse of prescription drugs or other controlled substances with respect to specific drugs and other controlled substances1 as appropriate4 4 #aje4 ,prescription drug abuse training and screening programs 7a7 ,continuing education grants ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall award grants to ,states to develop continuing education criteria and review processes that allow ,state health profession boards or ,state agencies to certify appropriate education and training for informed and safe prescribing of opioids and other drugs on schedule ,,ii and ,,iii under section #bjb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hab74 7b7 ,registration with ,,dea ,a practitioner who registers or renews a registration under section #cjc7;f7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;f77 shall1 at the time of registering1 certify to the ,attorney ,general that such practitioner has completed continuing medical education or nursing continuing education1 as applicable-- 7#a7 in the case of a practitioner registering for the first time1 with respect to prescription drug abuse2 and 7#b7 in the case of a practitioner renewing a registration1 with respect to medical understanding of the proper use of all drugs listed in the schedules under section #bjb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hab74 7c7 ,screening program ,the ,attorney ,general shall require that a practitioner registered under section #cjc7;f7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;f77 conduct patient screening for potential drug misuse or abuse before prescribing a drug listed on schedule ,,ii or ,,iii under section #bjb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hab71 according to standards established by the applicable ,state licensing body4 #ajf4 ,,fda review of naloxone ,the ,secretary of ,health and ,human ,services1 acting through the ,commissioner of ,food and ,drugs1 shall conduct a review of naloxone to consider whether naloxone should cease to be subject to section #ejc7;b77#a7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cec7;b77#a77 and be available as a behind-the-counter drug1 in order to increase access of such drug to community-based organizations and street outreach organizations4 #ajg4 ,prescription drug disposal ,the ,secretary of ,health and ,human ,services shall convene or coordinate with an existing entity an interagency working group to encourage ,states and local governments to increase opportunities for disposal of opiates1 such as frequent take-back programs and fixed medicine disposal sites at law enforcement public buildings1 and to reduce opportunities for abuse of opiates1 such as establishing opioid dispensing limits at hospital emergency departments4 #ajh4 ,,gao report ,the ,comptroller ,general of the ,united ,states shall review prescription drug abuse programs and policies in ,federal agencies and best practices with respect to prescription drug abuse programs of the ,states and1 not later than #ah months after the date of enactment of this ,act1 shall issue a report to ,congress on its findings and recommendations on ways to reduce prescription drug abuse4 ,,ii ,,treat ,act #bja4 ,short title ,this title may be cited as the ,recovery ,enhancement for ,addiction ,treatment ,act or the ,,treat ,act4 #bjb4 ,expansion of patient limits under waiver ,section #cjc7;g77#b77;,b7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,b77 is amended-- 7#a7 in clause 7i71 by striking physician and inserting practitioner2 7#b7 in clause 7iii7-- 7,a7 by striking #cj and inserting #ajj2 and 7,b7 by striking 1 unless1 not sooner and all that follows through the end and inserting a period2 and 7#c7 by inserting at the end the following new clause3 7iv7 ,not earlier than #a year after the date on which a qualifying practitioner obtained an initial waiver pursuant to clause 7iii71 the qualifying practitioner may submit a second notification to the ,secretary of the need and intent of the qualifying practitioner to treat an unlimited number of patients1 if the qualifying practitioner-- 7,i7 7aa7 satisfies the requirements of item 7aa71 7bb71 7cc71 or 7dd7 of subparagraph 7,g77ii77,i72 and 7bb7 agrees to fully participate in the ,prescription ,drug ,monitoring ,program of the ,state in which the qualifying practitioner is licensed1 pursuant to applicable ,state guidelines2 or 7,,ii7 7aa7 satisfies the requirements of item 7ee71 7ff71 or 7gg7 of subparagraph 7,g77ii77,i72 7bb7 agrees to fully participate in the ,prescription ,drug ,monitoring ,program of the ,state in which the qualifying practitioner is licensed1 pursuant to applicable ,state guidelines2 7cc7 practices in a qualified practice setting2 and 7dd7 has completed not less than #bd hours of training 7through classroom situations1 seminars at professional society meetings1 electronic communications1 or otherwise7 with respect to the treatment and management of opiate-dependent patients for substance use disorders provided by the ,american ,society of ,addiction ,medicine1 the ,american ,academy of ,addiction ,psychiatry1 the ,american ,medical ,association1 the ,american ,osteopathic ,association1 the ,american ,psychiatric ,association1 or any other organization that the ,secretary determines is appropriate for purposes of this subclause4 4 #bjc4 ,definitions ,section #cjc7;g77#b77;,g7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,g77 is amended-- 7#a7 by striking clause 7ii7 and inserting the following3 7ii7 ,the term qualifying practitioner means the following3 7,i7 ,a physician who is licensed under ,state law and who meets #a or more of the following conditions3 7aa7 ,the physician holds a board certification in addiction psychiatry from the ,american ,board of ,medical ,specialties4 7bb7 ,the physician holds an addiction certification from the ,american ,society of ,addiction ,medicine4 7cc7 ,the physician holds a board certification in addiction medicine from the ,american ,osteopathic ,association4 7dd7 ,the physician holds a board certification from the ,american ,board of ,addiction ,medicine4 7ee7 ,the physician has completed not less than #h hours of training 7through classroom situations1 seminar at professional society meetings1 electronic communications1 or otherwise7 with respect to the treatment and management of opiate-dependent patients for substance use disorders provided by the ,american ,society of ,addiction ,medicine1 the ,american ,academy of ,addiction ,psychiatry1 the ,american ,medical ,association1 the ,american ,osteopathic ,association1 the ,american ,psychiatric ,association1 or any other organization that the ,secretary determines is appropriate for purposes of this subclause4 7ff7 ,the physician has participated as an investigator in #a or more clinical trials leading to the approval of a narcotic drug in schedule ,,iii1 ,,iv1 or ,v for maintenance or detoxification treatment1 as demonstrated by a statement submitted to the ,secretary by this sponsor of such approved drug4 7gg7 ,the physician has such other training or experience as the ,secretary determines will demonstrate the ability of the physician to treat and manage opiate-dependent patients4 7,,ii7 ,a nurse practitioner or physician assistant who is licensed under ,state law and meets all of the following conditions3 7aa7 ,the nurse practitioner or physician assistant is licensed under ,state law to prescribe schedule ,,iii1 ,,iv1 or ,v medications for pain4 7bb7 ,the nurse practitioner or physician assistant satisfies #a or more of the following3 7,,aa7 ,has completed not fewer than #bd hours of training 7through classroom situations1 seminar at professional society meetings1 electronic communications1 or otherwise7 with respect to the treatment and management of opiate-dependent patients for substance use disorders provided by the ,american ,society of ,addiction ,medicine1 the ,american ,academy of ,addiction ,psychiatry1 the ,american ,medical ,association1 the ,american ,osteopathic ,association1 the ,american ,psychiatric ,association1 or any other organization that the ,secretary determines is appropriate for purposes of this subclause4 7,,bb7 ,has such other training or experience as the ,secretary determines will demonstrate the ability of the nurse practitioner or physician assistant to treat and manage opiate-dependent patients4 7cc7 ,the nurse practitioner or physician assistant practices under the supervision of a licensed physician who holds an active waiver to prescribe schedule ,,iii1 ,,iv1 or ,v narcotic medications for opioid addiction therapy1 and-- 7,,aa7 the supervising physician satisfies the conditions of item 7aa71 7bb71 7cc71 or 7dd7 of subclause 7,i72 or 7,,bb7 both the supervising physician and the nurse practitioner or physician assistant practice in a qualified practice setting4 7,,iii7 ,a nurse practitioner who is licensed under ,state law and meets all of the following conditions3 7aa7 ,the nurse practitioner is licensed under ,state law to prescribe schedule ,,iii1 ,,iv1 or ,v medications for pain4 7bb7 ,the nurse practitioner has training or experience that the ,secretary determines demonstrates specialization in the ability to treat opiate-dependent patients1 such as a certification in addiction specialty accredited by the ,american ,board of ,nursing ,specialties or the ,national ,commission for ,certifying ,agencies1 or a certification in addiction nursing as a ,certified ,addiction ,registered ,nurse--,advanced ,practice4 7cc7 ,in accordance with ,state law1 the nurse practitioner prescribes opioid addiction therapy in collaboration with a physician who holds an active waiver to prescribe schedule ,,iii1 ,,iv1 or ,v narcotic medications for opioid addiction therapy4 7dd7 ,the nurse practitioner practices in a qualified practice setting4 2 and 7#b7 by adding at the end the following3 7iii7 ,the term qualified practice setting means #a or more of the following treatment settings3 7,i7 ,a ,national ,committee for ,quality ,assurance-recognized ,patient-,centered ,medical ,home or ,patient-,centered ,specialty ,practice4 7,,ii7 ,a ,centers for ,medicaid ,medicare ,services-recognized ,accountable ,care ,organization4 7,,iii7 ,a clinical facility administered by the ,department of ,veterans ,affairs1 ,department of ,defense1 or ,indian ,health ,service4 7,,iv7 ,a ,behavioral ,health ,home accredited by the ,joint ,commission4 7,v7 ,a ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b777 or a ,federally-qualified health center look-alike4 7,,vi7 ,a ,substance ,abuse and ,mental ,health ,services-certified ,opioid ,treatment ,program4 7,,vii7 ,a clinical program of a ,state or ,federal jail1 prison1 or other facility where individuals are incarcerated4 7,,viii7 ,a clinic that demonstrates compliance with the ,model ,policy on ,,data #bjjj and ,treatment of ,opioid ,addiction in the ,medical ,office issued by the ,federation of ,state ,medical ,boards4 7,,ix7 ,a treatment setting that is part of an ,accreditation ,council for ,graduate ,medical ,education1 ,american ,association of ,colleges of ,osteopathic ,medicine1 or ,american ,osteopathic ,association-accredited residency or fellowship training program4 7,x7 ,any other practice setting approved by a ,state regulatory board or ,state ,medicaid ,plan to provide addiction treatment services4 7,,xi7 ,any other practice setting approved by the ,secretary4 4 #bjd4 ,,gao ,evaluation ,two years after the date on which the first notification under clause 7iv7 of section #cjc7;g77#b77;,b7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,b771 as added by this title1 is received by the ,secretary of ,health and ,human ,services1 the ,comptroller ,general of the ,united ,states shall initiate an evaluation of the effectiveness of the amendments made by this title1 which shall include an evaluation of-- 7#a7 any changes in the availability and use of medication-assisted treatment for opioid addiction2 7#b7 the quality of medication-assisted treatment programs2 7#c7 the integration of medication-assisted treatment with routine healthcare services2 7#d7 diversion of opioid addiction treatment medication2 7#e7 changes in ,state or local policies and legislation relating to opioid addiction treatment2 7#f7 the use of nurse practitioners and physician assistants who prescribe opioid addiction medication2 7#g7 the use of ,prescription ,drug ,monitoring ,programs by waived practitioners to maximize safety of patient care and prevent diversion of opioid addiction medication2 7#h7 the findings of ,drug ,enforcement ,agency inspections of waived practitioners1 including the frequency with which the ,drug ,enforcement ,agency finds no documentation of access to behavioral health services2 and 7#i7 the effectiveness of cross-agency collaboration between ,department of ,health and ,human ,services and the ,drug ,enforcement ,agency for expanding effective opioid addiction treatment4