,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #egii  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #ae1 #bjah,mrs4  
,blackburn 7= h]self1 ,mr4 ,b>r1 & ,mr4 
,knight7 introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce  ,a ,,bill  ,to am5d title     
,,xix ( ! ,social ,security ,act to     
require z a condition ( receipt ( full  
,f$]al m$ical assi/ance p]c5tage "u     
,m$icaid t ,/ate ,m$icaid plans h 9     
place c]ta9 drug utilization review     
activities4  #a4 ,%ort title ,?is ,act  
may be cit$ z ! ,m$icaid ,drug ,review1 
,utilization1 ,good ,gov]nance          
,improvem5t ,act or ! ,m$icaid ,,drug   
,improvem5t ,act4  #b4 ,m$icaid drug    
utilization review  7a7 ,/ate plan      
requirem5t ,section #aijb7;a7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77 is am5d$--  7#a7 9 p>agraph 
7#hb71 at ! end1 by /rik+ &2  7#b7 9    
p>agraph 7#hc71 at ! end1 by /rik+ !    
p]iod & ins]t+ 2 &2 &  7#c7 by ins]t+   
aft] p>agraph 7#hc7 ! foll[+ new        

p>agraph3  7#hd7 provide t ! ,/ate is 9 
compliance ) ! drug review & utilization
 requirem5ts "u subsection 7nn77#a74  4 
7b7 ,drug review & utilization          
requirem5ts ,section #aijb ( ! ,social  
,security ,act 7#db ,u4,s4,c4 #acif;a7  
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7nn7 ,drug review &        
utilization requirem5ts  7#a7 ,9 g5]al  
,= purposes ( subsection 7a77#hd71 !    
drug review & utilization requirem5ts "u
 ?is subsection are1 subject to p>agraph
 7#c7 & beg9n+ ,octob] #a1 #bjai1 !     
foll[+3  7,a7 ,claims review limitations
  7i7 ,9 g5]al ,! ,/ate has 9 place--   
7,i7 safety edits 7z specifi$ by !      
,/ate7 = subsequ5t fills = opioids & a  
claims review automat$ process 7z       
design$ & implem5t$ by ! ,/ate7 t       
indicates :5 an individual enroll$ "u ! 
,/ate plan 7or "u a waiv] ( ! ,/ate     
plan7 is prescrib$ a subsequ5t fill (   
opioids 9 excess ( any limitation t may 
be id5tifi$ by ! ,/ate2  7,,ii7 safety  
edits 7z specifi$ by ! ,/ate7 on !      

maximum daily morph9e equival5t t c be  
prescrib$ to an individual enroll$ "u ! 
,/ate plan 7or "u a waiv] ( ! ,/ate     
plan7 = treatm5t ( *ronic pa9 & a claims
 review automat$ process 7z design$ &   
implem5t$ by ! ,/ate7 t indicates :5 an 
individual enroll$ "u ! plan 7or waiv]7 
is prescrib$ ! morph9e equival5t = su*  
treatm5t 9 excess ( any limitation t may
 be id5tifi$ by ! ,/ate2 &  7,,iii7 a   
claims review automat$ process 7z       
design$ & implem5t$ by ! ,/ate7 t       
monitors :5 an individual enroll$ "u !  
,/ate plan 7or "u a waiv] ( ! ,/ate     
plan7 is concurr5tly prescrib$ opioids  
&--  7aa7 b5zodiazep9es2 or  7bb7       
antipsy*otics4  7ii7 ,manag$ c>e        
entities ,! ,/ate requires ea* manag$   
c>e entity 7z def9$ 9 section           
#aicb7;a77#a77;,b77 ) respect to :i* !  
,/ate has a contract "u section #aijc7m7
 or "u section #aije7t77#c7 to h 9      
place1 subject to p>agraph 7#c71 )      
respect to individuals :o are eligible =
 m$ical assi/ance "u ! ,/ate plan 7or "u

 a waiv] ( ! ,/ate plan7 & :o are       
enroll$ ) ! entity1 ! limitations       
describ$ 9 subclauses 7,i7 & 7,,ii7 (   
clause 7i7 & a claims review automat$   
process describ$ 9 subclause 7,,iii7 (  
su* clause4  7iii7 ,rules ( con/ruction 
,no?+ 9 ?is subp>agraph may be con/ru$ z
 prohibit+ a ,/ate or manag$ c>e entity 
f design+ & implem5t+ a claims review   
automat$ process "u ?is subp>agraph t   
provides = prospective or retrospective 
reviews ( claims4 ,no?+ 9 ?is           
subp>agraph %all be und]/ood z prohibit+
 ! ex]cise ( cl9ical judgm5t f a provid]
 enroll$ z a p>ticipat+ provid] 9 a     
,/ate plan 7or waiv] ( ! ,/ate plan7 or 
contract+ ) a manag$ c>e entity reg>d+ !
 be/ items & s]vices = an individual    
enroll$ "u su* ,/ate plan 7or waiv]74   
7,b7 ,program to monitor antipsy*otic   
m$ications by *ildr5 ,! ,/ate has 9     
place a program 7z design$ & implem5t$  
by ! ,/ate71 includ+ su* a program t !  
,/ate _h 9 place be=e ! date ( !        
enactm5t ( ?is subsection1 to monitor & 

manage ! appropriate use ( antipsy*otic 
m$ications by *ildr5 enroll$ "u ! ,/ate 
plan 7or "u a waiv] ( ! ,/ate plan7 &   
submits annually to ! ,secret>y su*     
in=mation z ! ,secret>y may require on  
activities c>ri$ out "u su* program =   
individuals n m ?an ! age ( #ah ye>s    
g5]ally & *ildr5 9 fo/] c>e             
specifically4  7,c7 ,fraud & abuse      
id5tification ,! ,/ate has 9 place a    
process 7z design$ & implem5t$ by !     
,/ate71 includ+ su* a process t ! ,/ate 
_h 9 place be=e ! date ( ! enactm5t (   
?is subsection1 t id5tifies pot5tial    
fraud or abuse ( controll$ sub/ances by 
individuals enroll$ "u ! ,/ate plan 7or 
"u a waiv] ( ! ,/ate plan71 heal? c>e   
provid]s prescrib+ drugs to individuals 
s enroll$1 & ph>macies disp5s+ drugs to 
individuals s enroll$4  7,d7 ,reports ,!
 ,/ate %all include 9 ! annual report   
submitt$ to ! ,secret>y "u section      
#aibg7;g77#c77;,d7 in=mation on !       
limitations1 requirem5t1 program1 &     
processes appli$ by ! ,/ate "u          

subp>agraphs 7,a7 ?r\gh 7,c7 9          
accordance ) su* mann] & "t z specifi$  
by ! ,secret>y4  7#b7 ,annual report by 
,secret>y ,= ea* fiscal ye> beg9n+ )    
fiscal ye> #bjbj1 ! ,secret>y %all      
submit to ,congress a report on ! mo/   
rec5t in=mation submitt$ by ,/ates "u   
p>agraph 7#a77;,d74  7#c7 ,exceptions   
7,a7 ,c]ta9 individuals exempt$ ,! drug 
review & utilization requirem5ts "u ?is 
subsection %all n apply ) respect to an 
individual :o--  7i7 is receiv+-- 7,i7  
hospice or palliative c>e2 or  7,,ii7   
treatm5t = canc]2  7ii7 is a resid5t ( a
 long-t]m c>e facility1 ( a facility    
describ$ 9 section #aije7;d71 or ( ano!r
 facility = :i* frequ5tly abus$ drugs   
are disp5s$ = resid5ts ?r\gh a contract 
) a s+le ph>macy2 or  7iii7 ! ,/ate     
elects to treat z exempt$ f su*         
requirem5ts4  7,b7 ,exception relat+ to 
ensur+ access ,9 ord] to ensure         
reasonable access to heal? c>e1 !       
,secret>y may waive ! drug review &     
utilization requirem5ts "u ?is          

subsection1 ) respect to a ,/ate1 9 !   
case ( natural disa/]s & simil>         
situations1 & 9 ! case ( ! provision (  
em]g5cy s]vices 7z def9$ = purposes (   
section                                 
#ahfj;,d-#d7;c77#e77;,d77ii77,,ii774  4 
7c7 ,manag$ c>e entities ,section #aicb 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acifu-#b7 is am5d$ by add+ at
 ! end ! foll[+ new subsection3  7i7    
,drug utilization review activities &   
requirem5ts ,beg9n+ n lat] ?an ,octob]  
#a1 #bjai1 ea* contract "u a ,/ate plan 
) a manag$ c>e entity 7o!r ?an a prim>y 
c>e case manag]7 "u section #aijc7m7    
%all provide t ! entity is 9 compliance 
) ! applicable provisions ( section     
#dch4c7s77#b7 ( title #db ( ! ,code (   
,f$]al ,regulations1 section            
#dhc4c7s77#d7 ( su* title1 & section    
#dhc4c7s77#e7 ( su* title1 z su*        
provisions 7 9 effect on ,m>* #ca1      
#bjah4  4