,,ib ,union ,calendar ,no4 #eff #aaeth ,,congress #b;d ,session ,h4 ,r4 #edgg ,report ,no4 #aae-gca ,,in ,,the ,,house ,,of ,,representatives ,april #aa1 #bjah ,mr4 ,o',halleran introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,june #ab1 #bjah;,additional sponsors3 ,mrs4 ,blackburn1 ,mr4 ,walden1 and ,mr4 ,mitchell ,june #ab1 #bjah ,reported with an amendment1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed ,strike out all after the enacting clause and insert the part printed in italic ,for text of introduced bill1 see copy of bill as introduced on ,april #aa1 #bjah ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to provide for a demonstration project to increase substance use provider capacity under the ,medicaid program4 #a4 ,short title ,this ,act may be cited as the ,rural ,development of ,opioid ,capacity ,services ,act or the ,rural ,,docs ,act4 #b4 ,demonstration project to increase substance use provider capacity under the ,medicaid program ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by adding at the end the following new subsection3 7aa7 ,demonstration project to increase substance use provider capacity 7#a7 ,in general ,not later than the date that is #ahj days after the date of the enactment of this section1 the ,secretary shall1 in consultation1 as appropriate1 with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 conduct a #e-year demonstration project for the purpose described in paragraph 7#b7 under which the ,secretary shall-- 7,a7 for the first #ah-month period of such project1 award planning grants described in paragraph 7#c72 and 7,b7 for the remaining #db-month period of such project1 provide to each ,state selected under paragraph 7#d7 payments in accordance with paragraph 7#e74 7#b7 ,purpose ,the purpose described in this paragraph is for each ,state selected under paragraph 7#d7 to increase the treatment capacity of providers participating under the ,state plan 7or a waiver of such plan7 to provide substance use disorder treatment or recovery services under such plan 7or waiver7 through the following activities3 7,a7 ,for the purpose described in paragraph 7#c77;,c77i71 activities that support an ongoing assessment of the behavioral health treatment needs of the ,state1 taking into account the matters described in subclauses 7,i7 through 7,,iv7 of such paragraph4 7,b7 ,activities that1 taking into account the results of the assessment described in subparagraph 7,a71 support the recruitment1 training1 and provision of technical assistance for providers participating under the ,state plan 7or a waiver of such plan7 that offer substance use disorder treatment or recovery services4 7,c7 ,improved reimbursement for and expansion of1 through the provision of education1 training1 and technical assistance1 the number or treatment capacity of providers participating under the ,state plan 7or waiver7 that-- 7i7 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 disorder2 7ii7 have in effect a registration or waiver under section #cjc7;g7 of the ,controlled ,substances ,act for purposes of dispensing narcotic drugs to individuals for maintenance treatment or detoxification treatment and are in compliance with any regulation promulgated by the ,assistant ,secretary for ,mental ,health and ,substance ,use for purposes of carrying out the requirements of such section #cjc7;g72 and 7iii7 are qualified under applicable ,state law to provide substance use disorder treatment or recovery services4 7,d7 ,improved reimbursement for and expansion of1 through the provision of education1 training1 and technical assistance1 the number or treatment capacity of providers participating under the ,state plan 7or waiver7 that have the qualifications to address the treatment or recovery needs of-- 7i7 individuals enrolled under the ,state plan 7or a waiver of such plan7 who have neonatal abstinence syndrome1 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 syndrome2 7ii7 pregnant women1 postpartum women1 and infants1 particularly the concurrent treatment1 as appropriate1 and comprehensive case management of pregnant women1 postpartum women and infants1 enrolled under the ,state plan 7or a waiver of such plan72 7iii7 adolescents and young adults between the ages of #ab and #ba enrolled under the ,state plan 7or a waiver of such plan72 or 7iv7 ,american ,indian and ,alaska ,native individuals enrolled under the ,state plan 7or a waiver of such plan74 7#c7 ,planning grants 7,a7 ,in general ,the ,secretary shall1 with respect to the first #ah-month period of the demonstration project conducted under paragraph 7#a71 award planning grants to at least #aj ,states selected in accordance with subparagraph 7,b7 for purposes of preparing an application described in paragraph 7#d77;,c7 and carrying out the activities described in subparagraph 7,c74 7,b7 ,selection ,in selecting ,states for purposes of this paragraph1 the ,secretary shall-- 7i7 select ,states that have a ,state plan 7or waiver of the ,state plan7 approved under this title2 7ii7 select ,states in a manner that ensures geographic diversity2 and 7iii7 give preference to ,states with a prevalence of substance use disorders 7in particular opioid use disorders7 that is comparable to or higher than the national average prevalence1 as measured by aggregate per capita drug overdoses1 or any other measure that the ,secretary deems appropriate4 7,c7 ,activities described ,activities described in this subparagraph are1 with respect to a ,state1 each of the following3 7i7 ,activities that support the development of an initial assessment of the behavioral health treatment needs of the ,state to determine the extent to which providers are needed 7including the types of such providers and geographic area of need7 to improve the network of providers that treat substance use disorders under the ,state plan 7or waiver71 including the following3 7,i7 ,an estimate of the number of individuals enrolled under the ,state plan 7or a waiver of such plan7 who have a substance use disorder4 7,,ii7 ,information on the capacity of providers to provide substance use disorder treatment or recovery services to individuals enrolled under the ,state plan 7or waiver71 including information on providers who provide such services and their participation under the ,state plan 7or waiver74 7,,iii7 ,information on the gap in substance use disorder treatment or recovery services under the ,state plan 7or waiver7 based on the information described in subclauses 7,i7 and 7,,ii74 7,,iv7 ,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 7or waiver7 during the period of the demonstration project4 7ii7 ,activities that1 taking into account the results of the assessment described in clause 7i71 support the development of ,state infrastructure to1 with respect to the provision of substance use disorder treatment or recovery services under the ,state plan 7or a waiver of such plan71 recruit prospective providers and provide training and technical assistance to such providers4 7,d7 ,funding ,for purposes of subparagraph 7,a71 there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #ej1jjj1jjj1 to remain available until expended4 7#d7 ,post-planning ,states 7,a7 ,in general ,the ,secretary shall1 with respect to the remaining #db-month period of the demonstration project conducted under paragraph 7#a71 select not more than #e ,states in accordance with subparagraph 7,b7 for purposes of carrying out the activities described in paragraph 7#b7 and receiving payments in accordance with paragraph 7#e74 7,b7 ,selection ,in selecting ,states for purposes of this paragraph1 the ,secretary shall-- 7i7 select ,states that received a planning grant under paragraph 7#c72 7ii7 select ,states that submit to the ,secretary an application in accordance with the requirements in subparagraph 7,c71 taking into consideration the quality of each such application2 7iii7 select ,states in a manner that ensures geographic diversity2 and 7iv7 give preference to ,states with a prevalence of substance use disorders 7in particular opioid use disorders7 that is comparable to or higher than the national average prevalence1 as measured by aggregate per capita drug overdoses1 or any other measure that the ,secretary deems appropriate4 7,c7 ,applications 7i7 ,in general ,a ,state seeking to be selected for purposes of this paragraph shall submit to the ,secretary1 at such time and in such form and manner as the ,secretary requires1 an application that includes such information1 provisions1 and assurances1 as the ,secretary may require1 in addition to the following3 7,i7 ,a proposed process for carrying out the ongoing assessment described in paragraph 7#b77;,a71 taking into account the results of the initial assessment described in paragraph 7#c77;,c77i74 7,,ii7 ,a review of reimbursement methodologies and other policies related to substance use disorder treatment or recovery services under the ,state plan 7or waiver7 that may create barriers to increasing the number of providers delivering such services4 7,,iii7 ,the development of a plan1 taking into account activities carried out under paragraph 7#c77;,c77ii71 that will result in long-term and sustainable provider networks under the ,state plan 7or waiver7 that will offer a continuum of care for substance use disorders4 ,such plan shall include the following3 7aa7 ,specific activities to increase the number of providers 7including providers that specialize in providing substance use disorder treatment or recovery services1 hospitals1 health care systems1 ,federally qualified health centers1 and1 as applicable1 certified community behavioral health clinics7 that offer substance use disorder treatment1 recovery1 or support services1 including short-term detoxification services1 outpatient substance use disorder services1 and evidence-based peer recovery services4 7bb7 ,strategies that will incentivize providers described in subparagraphs 7,c7 and 7,d7 of paragraph 7#b7 to obtain the necessary training1 education1 and support to deliver substance use disorder treatment or recovery services in the ,state4 7cc7 ,milestones and timeliness for implementing activities set forth in the plan4 7dd7 ,specific measurable targets for increasing the substance use disorder treatment and recovery provider network under the ,state plan 7or a waiver of such plan74 7,,iv7 ,a proposed process for reporting the information required under paragraph 7#f77;,a71 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 subsection4 7,v7 ,the expected financial impact of the demonstration project under this subsection on the ,state4 7,,vi7 ,a description of all funding sources available to the ,state to provide substance use disorder treatment or recovery services in the ,state4 7,,vii7 ,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 project4 7,,viii7 ,a description of how the ,state will coordinate the goals of the demonstration project with any waiver received pursuant to section #aaae for the delivery of substance use services under the ,state plan1 as applicable4 7ii7 ,consultation ,in completing an application under clause 7i71 a ,state shall consult with relevant stakeholders1 including ,medicaid managed care plans1 health care providers1 and ,medicaid beneficiary advocates1 and include in such application a description of such consultation4 7#e7 ,payment 7,a7 ,in general ,for each quarter occurring during the period for which the demonstration project is conducted 7after the first #ah months of such period71 the ,secretary shall pay under this subsection1 subject to subparagraphs 7,c7 and 7,d71 to each ,state selected under paragraph 7#d7 an amount equal to #hj percent of so much of the qualified sums expended during such quarter4 7,b7 ,qualified sums defined ,for purposes of subparagraph 7,a71 the term qualified sums means1 with respect to a ,state and a quarter1 the amount equal to the amount 7if any7 by which the sums expended by the ,state during such quarter attributable to substance use treatment or recovery services furnished by providers participating under the ,state plan 7or a waiver of such plan7 exceeds #a_/d of such sums expended by the ,state during fiscal year #bjah attributable to substance use treatment or recovery services4 7,c7 ,non-duplication of payment ,in the case that payment is made under subparagraph 7,a7 with respect to expenditures for substance use treatment or recovery services furnished by providers participating under the ,state plan 7or a waiver of such plan71 payment may not also be made under subsection 7a7 with respect to expenditures for the same services so furnished4 7,d7 ,conditions ,in the case of a ,state selected under paragraph 7#d7 that provides substance use disorder treatment and recovery services under a waiver under section #aaae1 such ,state shall1 as a condition of receiving payments under subparagraph 7,a7-- 7i7 coordinate such services under such waiver with substance use disorder treatment and recovery services provided under the demonstration project under this subsection2 and 7ii7 take such actions as appropriate under the demonstration project to expand such services under such waiver4 7#f7 ,reports 7,a7 ,state reports ,a ,state receiving payments under paragraph 7#e7 shall1 for the period of the demonstration project under this subsection1 submit to the ,secretary a quarterly report1 with respect to expenditures for substance use treatment or recovery services for which payment is made to the ,state under this subsection1 on the following3 7i7 ,the specific activities with respect to which payment under this subsection was provided4 7ii7 ,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 project4 7iii7 ,the number of individuals enrolled under the ,state plan 7or a waiver of such plan7 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 project4 7iv7 ,other matters as determined by the ,secretary4 7,b7 ,,cms reports 7i7 ,initial report ,not later than ,october #a1 #bjbj1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 submit to ,congress an initial report on-- 7,i7 the ,states awarded planning grants under paragraph 7#c72 7,,ii7 the criteria used in such selection2 and 7,,iii7 the activities carried out by such ,states under such planning grants4 7ii7 ,interim report ,not later than ,october #a1 #bjbb1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 submit to ,congress an interim report-- 7,i7 on activities carried out under the demonstration project under this subsection2 7,,ii7 on the extent to which ,states selected under paragraph 7#d7 have achieved the stated goals submitted in their applications under subparagraph 7,c7 of such paragraph2 7,,iii7 with a description of the strengths and limitations of such demonstration project2 and 7,,iv7 with a plan for the sustainability of such project4 7iii7 ,final report ,not later than ,october #a1 #bjbd1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 submit to ,congress a final report-- 7,i7 providing updates on the matters reported in the interim report under clause 7ii72 7,,ii7 including a description of any changes made with respect to the demonstration project under this subsection after the submission of such interim report2 and 7,,iii7 evaluating such demonstration project4 7,c7 ,,ahrq report ,not later than three years after the date of the enactment of this subsection1 the ,director of the ,agency for ,healthcare ,research and ,quality shall submit to ,congress a summary on the experiences of ,states awarded planning grants under paragraph 7#c7 and ,states selected under paragraph 7#d74 7#g7 ,data sharing and best practices ,during the period of the demonstration project under this subsection1 the ,secretary shall1 in collaboration with ,states selected under paragraph 7#d71 facilitate data sharing and the development of best practices between such ,states and ,states that were not so selected4 7#h7 ,,cms funding ,there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #e1jjj1jjj to the ,centers for ,medicare ,medicaid ,services for purposes of implementing this subsection4 ,such amount shall remain available until expended4 4 ,june #ab1 #bjah ,reported with an amendment1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed