,,ib  ,union ,cal5d> ,no4 #egh  #aae?   
,,congress  #b;d ,session  ,h4 ,r4 #efje
  ,report ,no4 #aae-gdd1 ,"p ,i  ,,9 ,,!
 ,,h\se ,,( ,,repres5tatives  ,april    
#bd1 #bjah ,mr4 ,ruiz introduc$ ! foll[+
 bill2 :i* 0 ref]r$ to ! ,committee on  
,en]gy & ,comm]ce1 & 9 addition to !    
,committee on ,ways & ,means1 = a p]iod 
to be subsequ5tly det]m9$ by ! ,speak]1 
9 ea* case = consid]ation ( su*         
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,june #ab1           
#bjah;,additional sponsors3 ,mrs4       
,blackburn & ,mr4 ,wald5  ,june #ab1    
#bjah ,report$ f ! ,committee on ,en]gy 
& ,comm]ce ) an am5dm5t ,/rike out all  
aft] ! enact+ clause & ins]t ! "p pr9t$ 
9 italic  ,june #ab1 #bjah,! ,committee 
on ,ways & ,means dis*>g$2 committ$ to !
 ,committee ( ! ,:ole ,h\se on ! ,/ate (
 ! ,union & ord]$ to be printed,for text
 ( introduc$ bill1 see copy ( bill z    
introduc$ on ,april #bd1 #bjah  ,a      
,,bill  ,to am5d title ,,xviii ( !      
,social ,security ,act to provide = an  

opioid use disord] treatm5t demon/ration
 program4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,advanc+ ,high ,quality    
,treatm5t = ,opioid ,use ,disord]s 9    
,m$ic>e ,act4  #b4 ,opioid use disord]  
treatm5t demon/ration program ,title    
,,xviii ( ! ,social ,security ,act 7#db 
,u4,s4,c4 #acie et seq47 is am5d$ by    
ins]t+ aft] section #ahff;,e 7#db       
,u4,s4,c4 #acie;cc-#e7 ! foll[+ new     
section3  #ahff;,f4 ,opioid use disord] 
treatm5t demon/ration program  7a7      
,implem5tation ( #e-ye> demon/ration    
program  7#a7 ,9 g5]al ,n lat] ?an      
,janu>y #a1 #bjba1 ! ,secret>y %all     
implem5t a #e-ye> demon/ration program  
"u ?is title 79 ?is section ref]r$ to z 
! ,program7 to increase access (        
applicable b5efici>ies to opioid use    
disord] treatm5t s]vices1 improve       
physical & m5tal heal? outcomes = su*   
b5efici>ies1 & to ! ext5t possible1     
r$uce exp5ditures "u ?is title4 ,"u !   
,program1 ! ,secret>y %all make paym5ts 
"u subsection 7e7 to p>ticipants 7z     

def9$ 9 subsection 7c77#a77;,a77 =      
furni%+ opioid use disord] treatm5t     
s]vices deliv]$ ?r\gh opioid use disord]
 c>e teams1 or arrang+ = su* s]vice to  
be furni%$1 to applicable b5efici>ies   
p>ticipat+ 9 ! ,program4  7#b7 ,opioid  
use disord] treatm5t s]vices ,= purposes
 ( ?is section1 ! t]m opioid use disord]
 treatm5t s]vices-- 7,a7 means1 )       
respect to an applicable b5efici>y1     
s]vices t are furni%$ = ! treatm5t (    
opioid use disord]s & t utilize drugs   
approv$ "u section #eje ( ! ,f$]al      
,food1 ,drug1 & ,cosmetic ,act = !      
treatm5t ( opioid use disord]s 9 an     
outpati5t sett+2 &  7,b7 includes-- 7i7 
m$ication assi/$ treatm5t2  7ii7        
treatm5t plann+2  7iii7 psy*iatric1     
psy*ological1 or c\nsel+ s]vices 7or any
 comb9ation ( su* s]vices71 z           
appropriate2  7iv7 social support       
s]vices1 z appropriate2 &  7v7 c>e      
managem5t & c>e coord9ation s]vices1    
includ+ coord9ation ) o!r provid]s (    
s]vices & suppli]s n on an opioid use   

disord] c>e team4  7b7 ,program design  
7#a7 ,9 g5]al ,! ,secret>y %all design !
 ,program 9 su* a mann] to all[ = !     
evaluation ( ! ext5t to :i* ! ,program  
accompli%es ! foll[+ purposes3  7,a7    
,r$uces hospitalizations & em]g5cy      
dep>tm5t visits4  7,b7 ,increases use ( 
m$ication-assi/$ treatm5t = opioid use  
disord]s4  7,c7 ,improves heal? outcomes
 ( individuals ) opioid use disord]s1   
includ+ by r$uc+ ! incid5ce ( infecti\s 
diseases 7su* z hepatitis ,c & ,,hiv74  
7,d7 ,does n increase ! total sp5d+ on  
items & s]vices "u ?is title4  7,e7     
,r$uces dea?s f opioid ov]dose4  7,f7   
,r$uces ! utilization ( inpati5t        
resid5tial treatm5t4  7#b7 ,consultation
 ,9 design+ ! ,program1 includ+ !       
crit]ia "u subsection 7e77#b77;,a71 !   
,secret>y %all1 n lat] ?an #c mon?s aft]
 ! date ( ! enactm5t ( ?is section1     
consult ) speciali/s 9 ! field (        
addiction1 cl9icians 9 ! prim>y c>e     
community1 & b5efici>y gr\ps4  7c7      
,p>ticipants2 opioid use disord] c>e    

teams  7#a7 ,p>ticipants  7,a7          
,def9ition ,9 ?is section1 ! t]m        
p>ticipant means an entity or           
individual-- 7i7 t is o!rwise enroll$ "u
 ?is title & t is--  7,i7 a physician 7z
 def9$ 9 section #ahfa7r77#a72  7,,ii7 a
 gr\p practice compris$ ( physicians    
describ$ 9 subclause 7,i72  7,,iii7 a   
hospital outpati5t dep>tm5t2  7,,iv7 a  
f$]ally qualifi$ heal? c5t] 7z def9$ 9  
section #ahfa7;aa77#d772  7,v7 a rural  
heal? cl9ic 7z def9$ 9 section          
#ahfa7;aa77#b772  7,,vi7 a community    
m5tal heal? c5t] 7z def9$ 9 section     
#ahfa7;ff77#c77;,b772  7,,vii7 a cl9ic  
c]tifi$ z a c]tifi$ community behavioral
 heal? cl9ic pursuant to section #bbc ( 
! ,protect+ ,access to ,m$ic>e ,act (   
#bjad2 or  7,,viii7 any o!r individual  
or entity specifi$ by ! ,secret>y2  7ii7
 t appli$ = & 0 select$ to p>ticipate 9 
! ,program pursuant to an application & 
selection process e/abli%$ by !         
,secret>y2 &  7iii7 t e/abli%es an      
opioid use disord] c>e team 7z def9$ 9  

p>agraph 7#b77 ?r\gh employ+ or         
contract+ ) heal? c>e practition]s      
describ$ 9 p>agraph 7#b77;,a71 & uses   
su* team to furni% or arrange = opioid  
use disord] treatm5t s]vices 9 !        
outpati5t sett+ "u ! ,program  7,b7     
,pref]5ce ,9 select+ p>ticipants = !    
,program1 ! ,secret>y %all give pref]5ce
 to individuals & entities t are locat$ 
9 areas ) a preval5ce ( opioid use      
disord]s t is high] ?an ! national      
av]age preval5ce4  7#b7 ,opioid use     
disord] c>e teams  7,a7 ,9 g5]al ,=     
purposes ( ?is section1 ! t]m opioid use
 disord] c>e team means a team ( heal?  
c>e practition]s e/abli%$ by a          
p>ticipant describ$ 9 p>agraph 7#a77;,a7
 t--  7i7 %all include-- 7,i7 at lea/ "o
 physician 7z def9$ 9 section           
#ahfa7r77#a77 furni%+ prim>y c>e s]vices
 or addiction treatm5t s]vices to an    
applicable b5efici>y2 &  7,,ii7 at lea/ 
"o eligible practition] 7z def9$ 9      
p>agraph 7#c77;,a771 :o may be a        
physician :o meets ! crit]ion 9         

subclause 7,i72 &  7ii7 may include o!r 
practition]s lic5s$ "u ,/ate law to     
furni% psy*iatric1 psy*ological1        
c\nsel+1 & social s]vices to applicable 
b5efici>ies4  7,b7 ,requirem5ts =       
receipt ( paym5t "u ,program ,9 ord] to 
receive paym5ts "u subsection 7e71 ea*  
p>ticipant 9 ! ,program %all-- 7i7      
furni% opioid use disord] treatm5t      
s]vices ?r\gh opioid use disord] c>e    
teams to applicable b5efici>ies :o agree
 to receive ! s]vices2  7ii7 meet m9imum
 crit]ia1 z e/abli%$ by ! ,secret>y1 =  
p>ticipation ?r\gh ! submission ( data &
 in=mation describ$ 9 clause 7iii72 &   
7iii7 submit to ! ,secret>y1 ) respect  
to ea* applicable b5efici>y = :om opioid
 use disord] treatm5t s]vices are       
furni%$ by ! opioid use disord] c>e     
team1 data ) respect to ! crit]ia       
e/abli%$ "u subsection 7e77#b77;,a7 &   
su* o!r in=mation z ! ,secret>y det]m9es
 appropriate to monitor & evaluate !    
,program1 to det]m9e if m9imum crit]ia  
are met "u clause 7ii71 & to det]m9e !  

inc5tive paym5t "u subsection 7e71 9 su*
 =m1 mann]1 & frequ5cy z specifi$ by !  
,secret>y4  7#c7 ,eligible practition]s2
 ,o!r provid]-relat$ def9itions &       
application provisions  7,a7 ,eligible  
practition]s ,= purposes ( ?is section1 
! t]m eligible practition] means a      
physician or o!r heal? c>e practition]1 
su* z a nurse practition] or advanc$    
practice nurse1 t--  7i7 is enroll$ "u  
section #ahfa7;j72  7ii7 is au?oriz$ to 
prescribe or disp5se n>cotic drugs to   
individuals = ma9t5ance treatm5t or     
detoxification treatm5t2 &  7iii7 has 9 
effect a regi/ration or waiv] 9         
accordance ) section #cjc7;g7 ( !       
,controll$ ,sub/ances ,act = su* purpose
 & is o!rwise 9 compliance ) regulations
 promulgat$ by ! ,sub/ance ,abuse &     
,m5tal ,heal? ,s]vices ,adm9i/ration to 
c>ry out su* section4  7,b7 ,addiction  
speciali/s ,= purposes ( subsection     
7e77#a77;,b77iv71 ! t]m addiction       
speciali/ means a physician t possesses 
exp]t k & skills 9 addiction m$ic9e1 z  

evid5c$ by appropriate c]tification f a 
specialty body1 a c]tificate ( advanc$  
qualification 9 addiction m$ic9e1 or    
completion ( an accr$it$ resid5cy or    
fell[%ip 9 addiction m$ic9e or addiction
 psy*iatry1 z det]m9$ by ! ,secret>y4   
7d7 ,p>ticipation ( applicable          
b5efici>ies  7#a7 ,applicable b5efici>y 
def9$ ,9 ?is section1 ! t]m applicable  
b5efici>y means an individual :o-- 7,a7 
is entitl$ to1 or enroll$ =1 b5efits "u 
"p ,a & enroll$ = b5efits "u "p ,b2     
7,b7 is n enroll$ 9 a ,m$ic>e ,advantage
 plan "u "p ,c2  7,c7 has a curr5t      
diagnosis = an opioid use disord]2 &    
7,d7 meets su* o!r crit]ia z ! ,secret>y
 det]m9es appropriate4  ,su* t]m %all   
include an individual :o is dually      
eligible = b5efits "u ?is title & title 
,,xix if su* individual satisfies !     
crit]ia describ$ 9 subp>agraphs 7,a7    
?r\gh 7,d74  7#b7 ,volunt>y             
p>ticipation2 limitation on numb] (     
p>ticipants ,an applicable b5efici>y may
 p>ticipate 9 ! ,program on a volunt>y  

basis & may t]m9ate p>ticipation 9 !    
,program at any "t4 ,n m ?an #bj1jjj    
applicable b5efici>ies may p>ticipate 9 
! ,program4  7#c7 ,s]vices ,9 ord] to   
p>ticipate 9 ! ,program1 an applicable  
b5efici>y %all agree to receive opioid  
use disord] treatm5t s]vices f a        
p>ticipant4 ,p>ticipation "u ! ,program 
%all n affect cov]age ( or paym5t = any 
o!r item or s]vice "u ?is title = !     
applicable b5efici>y4  7#d7 ,b5efici>y  
access to s]vices ,no?+ 9 ?is section   
%all be con/ru$ z enc\rag+ provid]s to  
limit applicable b5efici>y access to    
s]vices cov]$ "u ?is title & applicable 
b5efici>ies %all n be requir$ to        
rel9qui% access to any b5efit "u ?is    
title z a condition ( receiv+ s]vices f 
a p>ticipant 9 ! ,program4  7e7 ,paym5ts
  7#a7 ,p] applicable b5efici>y p] mon? 
c>e managem5t fee  7,a7 ,9 g5]al ,!     
,secret>y %all e/abli% a s*$ule ( p]    
applicable b5efici>y p] mon? c>e        
managem5t fees4 ,su* a p] applicable    
b5efici>y p] mon? c>e managem5t fee %all

 be paid to a p>ticipant 9 addition to  
any o!r am\nt o!rwise payable "u ?is    
title to ! heal? c>e practition]s 9 !   
p>ticipant's opioid use disord] c>e team
 or1 if applicable1 to ! p>ticipant4 ,a 
p>ticipant may use su* p] applicable    
b5efici>y p] mon? c>e managem5t fee to  
deliv] additional s]vices to applicable 
b5efici>ies1 includ+ s]vices n o!rwise  
eligible = paym5t "u ?is title4  7,b7   
,paym5t am\nts ,9 c>ry+ out subp>agraph 
7,a71 ! ,secret>y %all-- 7i7 consid]    
paym5ts o!rwise payable "u ?is title =  
opioid use disord] treatm5t s]vices & ! 
ne$s ( applicable b5efici>ies2  7ii7 pay
 a high] p] applicable b5efici>y p] mon?
 c>e managem5t fee = an applicable      
b5efici>y :o receives m int5sive        
treatm5t s]vices f a p>ticipant & = :om 
^? s]vices are appropriate bas$ on      
cl9ical guidel9es = opioid use disord]  
c>e2  7iii7 pay a high] p] applicable   
b5efici>y p] mon? c>e managem5t fee = ! 
mon? 9 :i* ! applicable b5efici>y beg9s 
treatm5t ) a p>ticipant ?an 9 subsequ5t 

mon?s1 to reflect ! great] "t & co/s    
requir$ = ! plann+ & initiation (       
treatm5t1 z comp>$ to ma9t5ance (       
treatm5t2  7iv7 pay high] p] applicable 
b5efici>y p] mon? c>e managem5t fees =  
p>ticipants t h e/abli%$ opioid use     
disord] c>e teams t include an addiction
 speciali/ 7z def9$ 9 subsection        
7c77#c77;,b772 &  7v7 take into acc\nt  
:e!r a p>ticipant's opioid use disord]  
c>e team ref]s applicable b5efici>ies to
 o!r suppli]s or provid]s = any opioid  
use disord] treatm5t s]vices4  7#b7     
,inc5tive paym5ts  7,a7 ,9 g5]al ,"u !  
,program1 ! ,secret>y %all e/abli% a    
p]=mance-bas$ inc5tive paym5t1 :i* %all 
be paid 7us+ a me?odology e/abli%$ & at 
a "t det]m9$ appropriate by ! ,secret>y7
 to p>ticipants bas$ on ! p]=mance (    
p>ticipants ) respect to crit]ia1 z     
det]m9$ appropriate by ! ,secret>y1 9   
accordance ) subp>agraph 7,b74  7,b7    
,crit]ia  7i7 ,9 g5]al ,crit]ia describ$
 9 subp>agraph 7,a7 may include         
consid]ation ( ! foll[+3 7,i7 ,pati5t   

engagem5t & ret5tion 9 treatm5t4  7,,ii7
 ,evid5ce-bas$ m$ication-assi/$         
treatm5t4  7,,iii7 ,o!r crit]ia e/abli%$
 by ! ,secret>y4  7ii7 ,requir$         
consultation & consid]ation ,9 det]m9+  
crit]ia describ$ 9 subp>agraph 7,a71 !  
,secret>y %all-- 7,i7 consult )         
/akehold]s1 includ+ cl9icians 9 ! prim>y
 c>e community & 9 ! field ( addiction  
m$ic9e2 &  7,,ii7 consid] exi/+ cl9ical 
guidel9es = ! treatm5t ( opioid use     
disord]s4  7,c7 ,submission ( data ,ea* 
p>ticipant %all submit to ! ,secret>y1 9
 su* =m1 mann]1 & frequ5cy specifi$ by !
 ,secret>y1 data ) respect to su*       
crit]ia describ$ 9 subp>agraph 7,a7 &   
su* o!r in=mation z ! ,secret>y det]m9es
 appropriate to evaluate & monitor !    
effectiv5ess ( ! ,program1 to det]m9e ! 
p]=mance ( ! p>ticipants = purposes ( ! 
inc5tive paym5t "u subp>agraph 7,a71 &  
to ensure ! p>ticipants meet m9imum     
crit]ia = program p>ticipation describ$ 
9 subsection 7c77#b77;,b77ii74  7#c7    
,non-duplication ( paym5ts ,9 ! case if 

an applicable b5efici>y receiv+ s]vices 
support$ by ! ,program f m ?an "o       
p>ticipant dur+ any "o cal5d> mon?1 or f
 a p>ticipant & a provid] :o is n a     
p>ticipant dur+ any "o cal5d> mon?1 !   
,secret>y %all adju/ 7su* z pro-rate7   
paym5t "u p>agraph 7#a7 & any paym5t "u 
p>agraph 7#b7 to ea* su* p>ticipant1 )  
respect to su* applicable b5efici>y &   
mon? to avoid any duplication ( paym5t4 
7f7 ,multipay] /rategy ,9 c>ry+ out !   
,program1 ! ,secret>y %all enc\rage o!r 
pay]s to provide simil> paym5ts & to use
 simil> crit]ia z appli$ "u ! ,program  
"u subsection 7e77#b77;,c74 ,! ,secret>y
 may ent] into a memor&um ( und]/&+ )   
o!r pay]s to align ! me?odology = paym5t
 provid$ by su* a pay] relat$ to opioid 
use disord] treatm5t s]vices ) su*      
me?odology = paym5t "u ! ,program4  7g7 
,evaluation  7#a7 ,9 g5]al ,! ,secret>y 
%all conduct an int]m$iate & f9al       
evaluation ( ! program4 ,ea* su*        
evaluation %all det]m9e ! ext5t to :i*  
ea* ( ! purposes describ$ 9 subsection  

7b7 h be5 accompli%$ "u ! ,program4     
7#b7 ,reports ,! ,secret>y %all submit  
to ! ,secret>y & ,congress-- 7,a7 a     
report ) respect to ! int]m$iate        
evaluation "u p>agraph 7#a7 n lat] ?an  
#c ye>s aft] ! date ( ! implem5tation ( 
! ,program2 &  7,b7 a report ) respect  
to ! f9al evaluation "u p>agraph 7#a7 n 
lat] ?an #f ye>s aft] su* date4  7h7    
,fund+  7#a7 ,adm9i/rative fund+ ,= !   
purposes ( implem5t+1 adm9i/]+1 & c>ry+ 
out ! ,program 7o!r ?an = purposes      
describ$ 9 p>agraph 7#b771 ! ,secret>y  
%all provide = ! transf] f ! ,f$]al     
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund "u section #ahda ( #e1jjj1jjj to !
 ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices    
,program ,managem5t ,acc\nt4  7#b7 ,c>e 
managem5t fees & inc5tives ,= ! purposes
 ( mak+ paym5ts "u subsection 7e71 !    
,secret>y %all provide = ! transf] f !  
,f$]al ,supplem5t>y ,m$ical ,insurance  
,tru/ ,fund "u section #ahda (          
#aj1jjj1jjj = ea* ( fiscal ye>s #bjba   
?r\gh #bjbe4  7#c7 ,availability ,am\nts

 transf]r$ "u ?is subsection = a fiscal 
ye> %all be available until exp5d$4  7i7
 ,waiv]s ,! ,secret>y may waive any     
provision ( ?is title z may be necess>y 
to c>ry out ! ,program "u ?is section4  
4  ,june #ab1 #bjah ,report$ f !        
,committee on ,en]gy & ,comm]ce ) an    
amendment,june #ab1 #bjah,! ,committee  
on ,ways & ,means dis*>g$2 committ$ to !
 ,committee ( ! ,:ole ,h\se on ! ,/ate (
 ! ,union & ord]$ to be pr9t$