,i #aae? ,,congress #b;d ,session ,h4 ,r4 #egae ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #i1 #bjah,mr4 ,r5acci 7= himself1 ,ms4 ,sewell ( ,alabama1 ,mr4 ,gu?rie1 & ,mr4 ,pet]s7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,ways & ,means1 & 9 addition to ! ,committee on ,en]gy & ,comm]ce1 = 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$ ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to provide = c]ta9 program integrity transp>5cy measures "u ,m$ic>e p>ts ,c & ,d4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,/r5g!n+ ,p>tn]%ips to ,prev5t ,opioid ,abuse ,act4 #b4 ,program integrity transp>5cy measures "u ,m$ic>e p>ts ,c & ,d 7a7 ,9 g5]al ,section #ahei ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7i7 ,program integrity transp>5cy measures 7#a7 ,program integrity portal 7,a7 ,9 g5]al ,n lat] ?an two ye>s aft] ! date ( ! enactm5t ( ?is subsection1 ! ,secret>y %all1 aft] consultation ) /akehold]s1 e/abli% a secure ,int]net website portal 7or o!r successor te*nology7 t w\ld all[ a secure pa? = communication betwe5 ! ,secret>y1 ,,ma plans "u ?is "p1 prescription drug plans "u "p ,d1 & an eligible entity ) a contract "u section #ahic 7su* z a ,m$ic>e drug integrity contractor or an entity responsible = c>ry+ out program integrity activities "u ?is "p & "p ,d7 = ! purpose ( enabl+ ?r\gh su* portal 7or o!r successor te*nology7-- 7i7 ! ref]ral by su* plans ( sub/antiat$ fraud1 wa/e1 & abuse = initiat+ or assi/+ inve/igations conduct$ by ! eligible entity2 & 7ii7 data %>+ among su* ,,ma plans1 prescription drug plans1 & ! ,secret>y4 7,b7 ,requir$ uses ( portal ,! ,secret>y %all dissem9ate ! foll[+ in=mation to ,,ma plans "u ?is "p & prescription drug plans "u "p ,d ?r\gh ! secure ,int]net website portal 7or o!r successor te*nology7 e/abli%$ "u subp>agraph 7,a73 7i7 ,provid]s ( s]vices & suppli]s t h be5 ref]r$ pursuant to subp>agraph 7,a77i7 dur+ ! previ\s #ab-mon? p]iod4 7ii7 ,provid]s ( s]vices & suppli]s :o are ! subject ( an active exclusion "u section #aabh or :o are subject to a susp5sion ( paym5t "u ?is title pursuant to section #ahfb7o7 or o!rwise4 7iii7 ,provid]s ( s]vices & suppli]s :o are ! subject ( an active revocation ( p>ticipation "u ?is title1 includ+ = n satisfy+ conditions ( p>ticipation4 7iv7 ,9 ! case ( su* a plan t makes a ref]ral "u subp>agraph 7,a77i7 ?r\gh ! portal 7or o!r successor te*nology7 ) respect to activities ( sub/antiat$ fraud1 wa/e1 or abuse ( a provid] ( s]vices or suppli]1 if su* provid] or suppli] has be5 ! subject ( an adm9i/rative action "u ?is title or title ,,xi ) respect to simil> activities1 a notification to su* plan ( su* action s tak54 7,c7 ,rulemak+ ,= purposes ( ?is p>agraph1 ! ,secret>y %all1 ?r\gh rulemak+1 specify :at con/itutes sub/antiat$ fraud1 wa/e1 & abuse1 us+ guidance su* z :at is provid$ 9 ! ,m$ic>e ,program ,integrity ,manual #d4g4a4 7,d7 ,,hipaa compliant in=mation only ,= purposes ( ?is subsection1 communications may only occur if ! communications are p]mitt$ "u ! ,f$]al regulations 7conc]n+ ! privacy ( individually id5tifiable heal? in=mation7 promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif4 7#b7 ,qu>t]ly reports ,beg9n+ two ye>s aft] ! date ( enactm5t ( ?is subsection1 ! ,secret>y %all make available to ,,ma plans "u ?is "p & prescription drug plans "u "p ,d 9 a timely mann] 7b no less frequ5tly ?an qu>t]ly7 & us+ in=mation submitt$ to an entity describ$ 9 p>agraph 7#a7 ?r\gh ! portal 7or o!r successor te*nology7 describ$ 9 su* p>agraph or pursuant to section #ahic1 in=mation on fraud1 wa/e1 & abuse s*emes & tr5ds 9 id5tify+ suspici\s activity4 ,in=mation includ$ 9 ea* su* report %all-- 7,a7 include adm9i/rative actions1 p]t95t in=mation relat$ to opioid ov]prescrib+1 & o!r data det]m9$ appropriate by ! ,secret>y 9 consultation ) /akehold]s2 & 7,b7 be anonymiz$ in=mation submitt$ by plans )\t id5tify+ ! s\rce ( su* in=mation4 7#c7 ,cl>ification ,no?+ 9 ?is subsection %all be con/ru$ z preclud+ or o!rwise affect+ ref]rals describ$ 9 subp>agraph 7,a7 t may o!rwise be made to law en=cem5t entities or to ! ,secret>y4 4 7b7 ,contract requirem5t ,to communicate plan corrective actions aga9/ opioids ov]-prescrib]s ,section #aheg7;e77#d77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;e77#d77;,c77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,communicat+ plan corrective actions aga9/ opioids ov]-prescrib]s 7,a7 ,9 g5]al ,beg9n+ ) plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjba1 a contract "u ?is section ) an ,,ma organization %all require ! organization to submit to ! ,secret>y1 ?r\gh ! process e/abli%$ "u subp>agraph 7,b71 in=mation on ! inve/igations & o!r actions tak5 by su* plans relat$ to provid]s ( s]vices :o prescribe a high volume ( opioids4 7,b7 ,process ,n lat] ?an ,janu>y #a1 #bjba1 ! ,secret>y %all1 9 consultation ) /akehold]s1 e/abli% a process "u :i* ,,ma plans & prescription drug plans %all submit to ! ,secret>y in=mation describ$ 9 subp>agraph 7,a74 7,c7 ,regulations ,= purposes ( ?is p>agraph1 includ+ z appli$ "u section #ahfj;,d-#ab7;b77#c77;,d71 ! ,secret>y %all1 pursuant to rulemak+-- 7i7 specify a def9ition = ! t]m high volume ( opioids & a me?od = det]m9+ if a provid] ( s]vices prescribes su* a high volume2 & 7ii7 e/abli% ! process describ$ 9 subp>agraph 7,b7 & ! types ( in=mation t %all be submitt$ ?r\gh su* process4 4 7c7 ,ref]5ce "u "p ,d to program integrity transp>5cy measures ,section #ahfj;,d-#d ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7m7 ,program integrity transp>5cy measures ,= program integrity transp>5cy measures appli$ ) respect to prescription drug plan & ,,ma plans1 see section #ahei7;i74 4