,,ib ,union ,calendar ,no4 #egh #aaeth ,,congress #b;d ,session ,h4 ,r4 #efje ,report ,no4 #aae-gdd1 ,part ,i ,,in ,,the ,,house ,,of ,,representatives ,april #bd1 #bjah ,mr4 ,ruiz introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,june #ab1 #bjah;,additional sponsors3 ,mrs4 ,blackburn and ,mr4 ,walden ,june #ab1 #bjah ,reported from the ,committee on ,energy and ,commerce with an amendment ,strike out all after the enacting clause and insert the part printed in italic ,june #ab1 #bjah,the ,committee on ,ways and ,means discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed,for text of introduced bill1 see copy of bill as introduced on ,april #bd1 #bjah ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide for an opioid use disorder treatment demonstration program4 #a4 ,short title ,this ,act may be cited as the ,advancing ,high ,quality ,treatment for ,opioid ,use ,disorders in ,medicare ,act4 #b4 ,opioid use disorder treatment demonstration program ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by inserting after section #ahff;,e 7#db ,u4,s4,c4 #acie;cc-#e7 the following new section3 #ahff;,f4 ,opioid use disorder treatment demonstration program 7a7 ,implementation of #e-year demonstration program 7#a7 ,in general ,not later than ,january #a1 #bjba1 the ,secretary shall implement a #e-year demonstration program under this title 7in this section referred to as the ,program7 to increase access of applicable beneficiaries to opioid use disorder treatment services1 improve physical and mental health outcomes for such beneficiaries1 and to the extent possible1 reduce expenditures under this title4 ,under the ,program1 the ,secretary shall make payments under subsection 7e7 to participants 7as defined in subsection 7c77#a77;,a77 for furnishing opioid use disorder treatment services delivered through opioid use disorder care teams1 or arranging for such service to be furnished1 to applicable beneficiaries participating in the ,program4 7#b7 ,opioid use disorder treatment services ,for purposes of this section1 the term opioid use disorder treatment services-- 7,a7 means1 with respect to an applicable beneficiary1 services that are furnished for the treatment of opioid use disorders and that utilize drugs approved under section #eje of the ,federal ,food1 ,drug1 and ,cosmetic ,act for the treatment of opioid use disorders in an outpatient setting2 and 7,b7 includes-- 7i7 medication assisted treatment2 7ii7 treatment planning2 7iii7 psychiatric1 psychological1 or counseling services 7or any combination of such services71 as appropriate2 7iv7 social support services1 as appropriate2 and 7v7 care management and care coordination services1 including coordination with other providers of services and suppliers not on an opioid use disorder care team4 7b7 ,program design 7#a7 ,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 purposes3 7,a7 ,reduces hospitalizations and emergency department visits4 7,b7 ,increases use of medication-assisted treatment for opioid use disorders4 7,c7 ,improves health outcomes of individuals with opioid use disorders1 including by reducing the incidence of infectious diseases 7such as hepatitis ,c and ,,hiv74 7,d7 ,does not increase the total spending on items and services under this title4 7,e7 ,reduces deaths from opioid overdose4 7,f7 ,reduces the utilization of inpatient residential treatment4 7#b7 ,consultation ,in designing the ,program1 including the criteria under subsection 7e77#b77;,a71 the ,secretary shall1 not later than #c months after the date of the enactment of this section1 consult with specialists in the field of addiction1 clinicians in the primary care community1 and beneficiary groups4 7c7 ,participants2 opioid use disorder care teams 7#a7 ,participants 7,a7 ,definition ,in this section1 the term participant means an entity or individual-- 7i7 that is otherwise enrolled under this title and that is-- 7,i7 a physician 7as defined in section #ahfa7r77#a72 7,,ii7 a group practice comprised of physicians described in subclause 7,i72 7,,iii7 a hospital outpatient department2 7,,iv7 a federally qualified health center 7as defined in section #ahfa7;aa77#d772 7,v7 a rural health clinic 7as defined in section #ahfa7;aa77#b772 7,,vi7 a community mental health center 7as defined in section #ahfa7;ff77#c77;,b772 7,,vii7 a clinic certified as a certified community behavioral health clinic pursuant to section #bbc of the ,protecting ,access to ,medicare ,act of #bjad2 or 7,,viii7 any other individual or entity specified by the ,secretary2 7ii7 that applied for and was selected to participate in the ,program pursuant to an application and selection process established by the ,secretary2 and 7iii7 that establishes an opioid use disorder care team 7as defined in paragraph 7#b77 through employing or contracting with health care practitioners described in paragraph 7#b77;,a71 and uses such team to furnish or arrange for opioid use disorder treatment services in the outpatient setting under the ,program 7,b7 ,preference ,in selecting participants for the ,program1 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 prevalence4 7#b7 ,opioid use disorder care teams 7,a7 ,in general ,for purposes of this section1 the term opioid use disorder care team means a team of health care practitioners established by a participant described in paragraph 7#a77;,a7 that-- 7i7 shall include-- 7,i7 at least one physician 7as defined in section #ahfa7r77#a77 furnishing primary care services or addiction treatment services to an applicable beneficiary2 and 7,,ii7 at least one eligible practitioner 7as defined in paragraph 7#c77;,a771 who may be a physician who meets the criterion in subclause 7,i72 and 7ii7 may include other practitioners licensed under ,state law to furnish psychiatric1 psychological1 counseling1 and social services to applicable beneficiaries4 7,b7 ,requirements for receipt of payment under ,program ,in order to receive payments under subsection 7e71 each participant in the ,program shall-- 7i7 furnish opioid use disorder treatment services through opioid use disorder care teams to applicable beneficiaries who agree to receive the services2 7ii7 meet minimum criteria1 as established by the ,secretary1 for participation through the submission of data and information described in clause 7iii72 and 7iii7 submit to the ,secretary1 with respect to each applicable beneficiary for whom opioid use disorder treatment services are furnished by the opioid use disorder care team1 data with respect to the criteria established under subsection 7e77#b77;,a7 and such other information as the ,secretary determines appropriate to monitor and evaluate the ,program1 to determine if minimum criteria are met under clause 7ii71 and to determine the incentive payment under subsection 7e71 in such form1 manner1 and frequency as specified by the ,secretary4 7#c7 ,eligible practitioners2 ,other provider-related definitions and application provisions 7,a7 ,eligible practitioners ,for purposes of this section1 the term eligible practitioner means a physician or other health care practitioner1 such as a nurse practitioner or advanced practice nurse1 that-- 7i7 is enrolled under section #ahfa7;j72 7ii7 is authorized to prescribe or dispense narcotic drugs to individuals for maintenance treatment or detoxification treatment2 and 7iii7 has in effect a registration or waiver in accordance with section #cjc7;g7 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 section4 7,b7 ,addiction specialists ,for purposes of subsection 7e77#a77;,b77iv71 the term addiction specialist means a physician that possesses expert knowledge and skills in addiction medicine1 as evidenced by appropriate certification from a specialty body1 a certificate of advanced qualification in addiction medicine1 or completion of an accredited residency or fellowship in addiction medicine or addiction psychiatry1 as determined by the ,secretary4 7d7 ,participation of applicable beneficiaries 7#a7 ,applicable beneficiary defined ,in this section1 the term applicable beneficiary means an individual who-- 7,a7 is entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under part ,b2 7,b7 is not enrolled in a ,medicare ,advantage plan under part ,c2 7,c7 has a current diagnosis for an opioid use disorder2 and 7,d7 meets such other criteria as the ,secretary determines appropriate4 ,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 7,a7 through 7,d74 7#b7 ,voluntary participation2 limitation on number of participants ,an applicable beneficiary may participate in the ,program on a voluntary basis and may terminate participation in the ,program at any time4 ,not more than #bj1jjj applicable beneficiaries may participate in the ,program4 7#c7 ,services ,in order to participate in the ,program1 an applicable beneficiary shall agree to receive opioid use disorder treatment services from a participant4 ,participation under the ,program shall not affect coverage of or payment for any other item or service under this title for the applicable beneficiary4 7#d7 ,beneficiary access to services ,nothing in this section shall be construed as encouraging providers to limit applicable beneficiary access to services covered under this 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 ,program4 7e7 ,payments 7#a7 ,per applicable beneficiary per month care management fee 7,a7 ,in general ,the ,secretary shall establish a schedule of per applicable beneficiary per month care management fees4 ,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 or1 if applicable1 to the participant4 ,a participant may use such per applicable beneficiary per month care management fee to deliver additional services to applicable beneficiaries1 including services not otherwise eligible for payment under this title4 7,b7 ,payment amounts ,in carrying out subparagraph 7,a71 the ,secretary shall-- 7i7 consider payments otherwise payable under this title for opioid use disorder treatment services and the needs of applicable beneficiaries2 7ii7 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 care2 7iii7 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 months1 to reflect the greater time and costs required for the planning and initiation of treatment1 as compared to maintenance of treatment2 7iv7 pay higher per applicable beneficiary per month care management fees for participants that have established opioid use disorder care teams that include an addiction specialist 7as defined in subsection 7c77#c77;,b772 and 7v7 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 services4 7#b7 ,incentive payments 7,a7 ,in general ,under the ,program1 the ,secretary shall establish a performance-based incentive payment1 which shall be paid 7using a methodology established and at a time determined appropriate by the ,secretary7 to participants based on the performance of participants with respect to criteria1 as determined appropriate by the ,secretary1 in accordance with subparagraph 7,b74 7,b7 ,criteria 7i7 ,in general ,criteria described in subparagraph 7,a7 may include consideration of the following3 7,i7 ,patient engagement and retention in treatment4 7,,ii7 ,evidence-based medication-assisted treatment4 7,,iii7 ,other criteria established by the ,secretary4 7ii7 ,required consultation and consideration ,in determining criteria described in subparagraph 7,a71 the ,secretary shall-- 7,i7 consult with stakeholders1 including clinicians in the primary care community and in the field of addiction medicine2 and 7,,ii7 consider existing clinical guidelines for the treatment of opioid use disorders4 7,c7 ,submission of data ,each participant shall submit to the ,secretary1 in such form1 manner1 and frequency specified by the ,secretary1 data with respect to such criteria described in subparagraph 7,a7 and such other information as the ,secretary determines appropriate to evaluate and monitor the effectiveness of the ,program1 to determine the performance of the participants for purposes of the incentive payment under subparagraph 7,a71 and to ensure the participants meet minimum criteria for program participation described in subsection 7c77#b77;,b77ii74 7#c7 ,non-duplication of payments ,in the case if an applicable beneficiary receiving services supported by the ,program from more than one participant during any one calendar month1 or from a participant and a provider who is not a participant during any one calendar month1 the ,secretary shall adjust 7such as pro-rate7 payment under paragraph 7#a7 and any payment under paragraph 7#b7 to each such participant1 with respect to such applicable beneficiary and month to avoid any duplication of payment4 7f7 ,multipayer strategy ,in carrying out the ,program1 the ,secretary shall encourage other payers to provide similar payments and to use similar criteria as applied under the ,program under subsection 7e77#b77;,c74 ,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 ,program4 7g7 ,evaluation 7#a7 ,in general ,the ,secretary shall conduct an intermediate and final evaluation of the program4 ,each such evaluation shall determine the extent to which each of the purposes described in subsection 7b7 have been accomplished under the ,program4 7#b7 ,reports ,the ,secretary shall submit to the ,secretary and ,congress-- 7,a7 a report with respect to the intermediate evaluation under paragraph 7#a7 not later than #c years after the date of the implementation of the ,program2 and 7,b7 a report with respect to the final evaluation under paragraph 7#a7 not later than #f years after such date4 7h7 ,funding 7#a7 ,administrative funding ,for the purposes of implementing1 administering1 and carrying out the ,program 7other than for purposes described in paragraph 7#b771 the ,secretary shall provide for the transfer from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of #e1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account4 7#b7 ,care management fees and incentives ,for the purposes of making payments under subsection 7e71 the ,secretary shall provide for the transfer from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of #aj1jjj1jjj for each of fiscal years #bjba through #bjbe4 7#c7 ,availability ,amounts transferred under this subsection for a fiscal year shall be available until expended4 7i7 ,waivers ,the ,secretary may waive any provision of this title as may be necessary to carry out the ,program under this section4 4 ,june #ab1 #bjah ,reported from the ,committee on ,energy and ,commerce with an amendment,june #ab1 #bjah,the ,committee on ,ways and ,means discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed