#aae? ,,congress  #b;d ,session  ,h4 ,r4
 #ehja  ,,an ,,act  ,to am5d title ,,xix
 ( ! ,social ,security ,act to provide =
 requirem5ts "u ! ,m$icaid program      
relat+ to ! use ( qualifi$ prescription 
drug monitor+ programs & prescrib+ c]ta9
 controll$ sub/ances4  #a4 ,%ort title  
,?is ,act may be cit$ z ! ,m$icaid      
,provid]s ,are ,requir$ ,to ,note       
,exp]i5ces 9 ,record ,sy/ems to ,help   
,9-ne$ ,pati5ts ,act or ! ,m$icaid      
,,p>tn]%ip ,act4  #b4 ,m$icaid provid]s 
are requir$ to note exp]i5ces 9 record  
sy/ems to help 9-ne$ pati5ts  7a7       
,requirem5ts "u ! ,m$icaid program      
relat+ to qualifi$ prescription drug    
monitor+ programs & prescrib+ c]ta9     
controll$ sub/ances ,title ,,xix ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq47 is am5d$ by ins]t+ aft]  
section #aidc ! foll[+ new section3     
#aidd4 ,requirem5ts relat+ to qualifi$  
prescription drug monitor+ programs &   
prescrib+ c]ta9 controll$ sub/ances  7a7
 ,9 g5]al ,beg9n+ ,octob] #a1 #bjba1 a  

,/ate %all1 subject to subsection 7d71  
require ea* cov]$ provid] to *eck1 9    
accordance ) su* tim+1 mann]1 & =m z    
specifi$ by ! ,/ate1 ! prescription drug
 hi/ory ( a cov]$ individual be+ treat$ 
by ! cov]$ provid] ?r\gh a qualifi$     
prescription drug monitor+ program      
describ$ 9 subsection 7b7 be=e prescrib+
 to su* individual a controll$ sub/ance4
  7b7 ,qualifi$ prescription drug       
monitor+ program describ$ ,a qualifi$   
prescription drug monitor+ program      
describ$ 9 ?is subsection is1 ) respect 
to a ,/ate1 a prescription drug monitor+
 program adm9i/]$ by ! ,/ate t1 at a    
m9imum1 satisfies ea* ( ! foll[+        
crit]ia3  7#a7 ,! program facilitates   
access by a cov]$ provid] to1 at a      
m9imum1 ! foll[+ in=mation ) respect to 
a cov]$ individual1 9 z close to real-"t
 z possible3 7,a7 ,in=mation reg>d+ !   
prescription drug hi/ory ( a cov]$      
individual ) respect to controll$       
sub/ances4  7,b7 ,! numb] & type (      
controll$ sub/ances prescrib$ to & fill$

 = ! cov]$ individual dur+ at lea/ ! mo/
 rec5t #ab-mon? p]iod4  7,c7 ,! "n1     
location1 & contact in=mation 7or o!r   
id5tify+ numb] select$ by ! ,/ate1 su* z
 a national provid] id5tifi] issu$ by ! 
,national ,plan & ,provid] ,enum]ation  
,sy/em ( ! ,c5t]s = ,m$ic>e  ,m$icaid   
,s]vices7 ( ea* cov]$ provid] :o        
prescrib$ a controll$ sub/ance to !     
cov]$ individual dur+ at lea/ ! mo/     
rec5t #ab-mon? p]iod4  7#b7 ,! program  
facilitates ! integration ( in=mation   
describ$ 9 p>agraph 7#a7 into ! workfl[ 
( a cov]$ provid]1 :i* may include !    
electronic sy/em ! cov]$ provid] uses to
 prescribe controll$ sub/ances4  ,a     
qualifi$ prescription drug monitor+     
program describ$ 9 ?is subsection1 )    
respect to a ,/ate1 may h 9 place1 9    
accordance ) applicable ,/ate & ,f$]al  
law1 a data %>+ agreem5t ) ! ,/ate      
,m$icaid program t all[s ! m$ical       
director & ph>macy director ( su*       
program 7& any designee ( su* a director
 :o reports directly to su* director7 to

 access ! in=mation describ$ 9 p>agraph 
7#a7 9 an electronic =mat4 ,! ,/ate     
,m$icaid program "u ?is title may       
facilitate reasonable & limit$ access1 z
 det]m9$ by ! ,/ate & ensur+ docum5t$   
b5efici>y protections reg>d+ ! use ( su*
 data1 to su* qualifi$ prescription drug
 monitor+ program = ! m$ical director or
 ph>macy director ( any manag$ c>e      
entity 7z def9$ "u section              
#aicb7;a77#a77;,b77 t has a contract ) !
 ,/ate "u section #aijc7m7 or "u section
 #aije7t77#c71 or ! m$ical director or  
ph>macy director ( any entity has a     
contract to manage ! ph>maceutical      
b5efit ) respect to individuals enroll$ 
9 ! ,/ate plan 7or waiv] ( ! ,/ate      
plan74 ,all applicable ,/ate & ,f$]al   
security & privacy laws %all apply to ! 
directors or designees ( su* directors (
 any ,/ate ,m$icaid program or entity   
access+ a qualifi$ prescription drug    
monitor+ program "u ?is section4  7c7   
,application ( privacy rules            
cl>ification ,! ,secret>y %all cl>ify   

privacy requirem5ts1 includ+ requirem5ts
 "u ! regulations promulgat$ pursuant to
 section #bfd7;c7 ( ! ,heal? ,insurance 
,portability & ,acc\ntability ,act (    
#aiif 7#db ,u4,s4,c4 #acbj;d-#b note71  
relat$ to ! %>+ ( data "u subsection 7b7
 9 ! same mann] z ! ,secret>y is requir$
 "u subp>agraph 7,j7 ( section          
#ahfj;,d-#d7;c77#e7 to cl>ify privacy   
requirem5ts relat$ to ! %>+ ( data      
describ$ 9 su* subp>agraph4  7d7 ,ensur+
 access ,9 ord] to ensure reasonable    
access to heal? c>e1 ! ,secret>y %all   
waive ! application ( ! requirem5t "u   
subsection 7a71 ) 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    
7e7 ,reports  7#a7 ,/ate reports ,ea*   
,/ate %all include 9 ! annual report    
submitt$ to ! ,secret>y "u section      
#aibg7;g77#c77;,d71 beg9n+ ) su* reports
 submitt$ = #bjbc1 in=mation includ+1 at

 a m9imum1 ! foll[+ in=mation = ! mo/   
rec5t #ab-mon? p]iod3 7,a7 ,! p]c5tage (
 cov]$ provid]s 7z det]m9$ pursuant to a
 process e/abli%$ by ! ,/ate7 :o *eck$ !
 prescription drug hi/ory ( a cov]$     
individual ?r\gh a qualifi$ prescription
 drug monitor+ program describ$ 9       
subsection 7b7 be=e prescrib+ to su*    
individual a controll$ sub/ance4  7,b7  
,aggregate tr5ds ) respect to prescrib+ 
controll$ sub/ances su* z-- 7i7 !       
quantity ( daily morph9e milligram      
equival5ts prescrib$ = controll$        
sub/ances2  7ii7 ! numb] & quantity (   
daily morph9e milligram equival5ts      
prescrib$ = controll$ sub/ances p] cov]$
 individual2 &  7iii7 ! types (         
controll$ sub/ances prescrib$1 includ+ !
 dates ( su* prescriptions1 ! supplies  
au?oriz$ 7includ+ ! duration ( su*      
supplies71 & ! p]iod ( validity ( su*   
prescriptions1 9 diff]5t populations    
7su* z individuals :o are eld]ly1       
individuals ) disabilities1 &           
individuals :o are enroll$ "u bo? ?is   

title & title ,,xviii74  7,c7 ,:e!r or n
 ! ,/ate requires 7& a detail$          
explanation z to :y ! ,/ate does or does
 n require7 ph>maci/s to *eck !         
prescription drug hi/ory ( a cov]$      
individual ?r\gh a qualifi$ drug        
managem5t program be=e disp5s+ a        
controll$ sub/ance to su* individual4   
7#b7 ,report by ,,cms ,n lat] ?an       
,octob] #a1 #bjbc1 ! ,adm9i/rator ( !   
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices %all
 publi% on ! publicly available website 
( ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices 
a report includ+ ! foll[+ in=mation3    
7,a7 ,guidance = ,/ates on h[ ,/ates c  
increase ! p]c5tage ( cov]$ provid]s :o 
use qualifi$ prescription drug monitor+ 
programs describ$ 9 subsection 7b74     
7,b7 ,be/ practices = h[ ,/ates & cov]$ 
provid]s %\ld use su* qualifi$          
prescription drug monitor+ programs to  
r$uce ! occurr5ce ( abuse ( controll$   
sub/ances4  7f7 ,increase to ,f$]al     
mat*+ rate = c]ta9 exp5ditures relat+ to
 qualifi$ prescription drug managem5t   

programs ,! ,secret>y %all increase !   
,f$]al m$ical assi/ance p]c5tage or     
,f$]al mat*+ rate t w\ld o!rwise apply  
to a ,/ate "u section #aijc7;a7 = a     
cal5d> qu>t] occurr+ dur+ ! p]iod beg9n+
 ,octob] #a1 #bjah1 & end+ ,septemb]    
#cj1 #bjba1 = exp5ditures by ! ,/ate =  
activities "u ! ,/ate plan 7or waiv] ( !
 ,/ate plan7 to implem5t a prescription 
drug managem5t program t satisfies !    
crit]ia describ$ 9 p>agraphs 7#a7 & 7#b7
 ( subsection 7b7 if ! ,/ate 79 ?is     
subsection ref]r$ to z ! adm9i/]+ ,/ate7
 has 9 place agreem5ts ) all ,/ates t   
are contigu\s to su* adm9i/]+ ,/ate t1  
:5 comb9$1 enable cov]$ provid]s 9 all  
su* contigu\s ,/ates to access1 ?r\gh ! 
prescription drug managem5t program1 !  
in=mation t is describ$ 9 subsection    
7b77#a7 ( cov]$ individuals ( su*       
adm9i/]+ ,/ate & t cov]$ provid]s 9 su* 
adm9i/]+ ,/ate are able to access ?r\gh 
su* program4 ,9 no case %all an increase
 "u ?is subsection result 9 a ,f$]al    
m$ical assi/ance p]c5tage or ,f$]al     

mat*+ rate t exce$s #ajj p]c5t4  7g7    
,rule ( con/ruction ,no?+ 9 ?is section 
prev5ts a ,/ate f requir+ ph>maci/s to  
*eck ! prescription drug hi/ory ( cov]$ 
individuals ?r\gh a qualifi$ drug       
managem5t program be=e disp5s+ controll$
 sub/ances to su* individuals4  7h7     
,def9itions ,9 ?is section3 7#a7        
,controll$ sub/ance ,! t]m controll$    
sub/ance means a drug t is includ$ 9    
s*$ule ,,ii ( section #bjb7;c7 ( !      
,controll$ ,sub/ances ,act &1 at !      
option ( ! ,/ate involv$1 a drug includ$
 9 s*$ule ,,iii or ,,iv ( su* section4  
7#b7 ,cov]$ individual ,! t]m cov]$     
individual means1 ) respect to a ,/ate1 
an individual :o is enroll$ 9 ! ,/ate   
plan 7or "u a waiv] ( su* plan74 ,su*   
t]m does n include an individual :o--   
7,a7 is receiv+--  7i7 hospice or       
palliative c>e2 or  7ii7 treatm5t =     
canc]2  7,b7 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  7,c7 ! ,/ate elects to     
treat z exempt$ f su* t]m4  7#c7 ,cov]$ 
provid]  7,a7 ,9 g5]al ,! t]m cov]$     
provid] means1 subject to subp>agraph   
7,b71 ) respect to a ,/ate1 a heal? c>e 
provid] :o is p>ticipat+ "u ! ,/ate plan
 7or waiv] ( ! ,/ate plan7 & lic5s$1    
regi/]$1 or o!rwise p]mitt$ by ! ,/ate  
to prescribe a controll$ sub/ance 7or ! 
designee ( su* provid]74  7,b7          
,exceptions  7i7 ,9 g5]al ,beg9n+       
,octob] #a1 #bjba1 = purposes ( ?is     
section1 su* t]m does n include a heal? 
c>e provid] includ$ 9 any type ( heal?  
c>e provid] det]m9$ by ! ,secret>y to be
 exempt f application ( ?is section "u  
clause 7ii74  7ii7 ,exceptions process  
,n lat] ?an ,octob] #a1 #bjbj1 !        
,secret>y1 aft] consultation ) !        
,national ,association ( ,m$icaid       
,directors1 national heal? c>e provid]  
associations1 ,m$icaid b5efici>y        
advocates1 & advocates = individuals )  
r>e diseases1 %all det]m9e1 bas$ on su* 

consultations1 ! types ( heal? c>e      
provid]s 7if any7 t %\ld be exempt$ f ! 
def9ition ( ! t]m cov]$ provid] =       
purposes ( ?is section4  4  7b7         
,guidance ,n lat] ?an ,octob] #a1 #bjai1
 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices1 9 consultation ) !   
,director ( ! ,c5t]s = ,disease ,control
 & ,prev5tion1 %all issue guidance on   
be/ practices on ! uses ( prescription  
drug monitor+ programs requir$ (        
prescrib]s & on protect+ ! privacy (    
,m$icaid b5efici>y in=mation ma9ta9$ 9 &
 access$ ?r\gh prescription drug        
monitor+ programs4  7c7 ,developm5t (   
model ,/ate practices  7#a7 ,9 g5]al ,n 
lat] ?an ,octob] #a1 #bjbj1 ! ,secret>y 
( ,heal? & ,human ,s]vices %all develop 
& publi% model practices to assi/ ,/ate 
,m$icaid program op]ations 9 id5tify+ & 
implem5t+ /rategies to utilize data %>+ 
agreem5ts describ$ 9 ! matt] foll[+     
p>agraph 7#b7 ( section #aidd7;b7 ( !   
,social ,security ,act1 z add$ by       
subsection 7a71 = ! foll[+ purposes3    

7,a7 ,monitor+ & prev5t+ fraud1 wa/e1 & 
abuse4  7,b7 ,improv+ heal? c>e =       
individuals enroll$ 9 a ,/ate plan "u   
title ,,xix ( su* ,act 7or waiv] ( su*  
plan7 :o-- 7i7 transition 9 & out (     
cov]age "u su* title2  7ii7 may h s\rces
 ( heal? c>e cov]age 9 addition to      
cov]age "u su* title2 or  7iii7 pay =   
prescription drugs ) ca%4  7,c7 ,any o!r
 purposes specifi$ by ! ,secret>y4  7#b7
 ,elem5ts ( model practices ,! model    
practices describ$ 9 p>agraph 7#a7--    
7,a7 %all include /rategies = assi/+    
,/ates 9 all[+ ! m$ical director or     
ph>macy director 7or designees ( su* a  
director7 ( manag$ c>e organizations or 
ph>maceutical b5efit manag]s to access  
in=mation ) respect to all cov]$        
individuals s]v$ by su* manag$ c>e      
organizations or ph>maceutical b5efit   
manag]s to access z a s+le data set1 9  
an electronic =mat2 &  7,b7 %all include
 any appropriate b5efici>y protections &
 privacy guidel9es4  7#c7 ,consultation 
,9 develop+ model practices "u ?is      

subsection1 ! ,secret>y %all consult ) !
 ,national ,association ( ,m$icaid      
,directors1 manag$ c>e entities 7z def9$
 9 section #aicb7;a77#a77;,b7 ( !       
,social ,security ,act7 ) contracts )   
,/ates pursuant to section #aijc7m7 (   
su* ,act1 ph>maceutical b5efit manag]s1 
physicians & o!r heal? c>e provid]s1    
b5efici>y advocates1 & individuals )    
exp]tise 9 heal? c>e te*nology relat$ to
 prescription drug monitor+ programs &  
electronic heal? records4  7d7 ,report  
by ,comptroll] ,g5]al ,n lat] ?an       
,octob] #a1 #bjbj1 ! ,comptroll] ,g5]al 
( ! ,unit$ ,/ates %all issue a report   
exam9+ ! op]ation ( prescription drug   
monitor+ programs adm9i/]$ by ,/ates1   
includ+ data security & access /&>ds us$
 by su* programs4  ,pass$ ! ,h\se (     
,repres5tatives ,june #ai1 #bjah4;,cl]k4