,,ib ,union ,calendar ,no4 #efj #aaeth ,,congress #b;d ,session ,h4 ,r4 #ehja ,report ,no4 #aae-gbe ,,in ,,the ,,house ,,of ,,representatives ,may #ae1 #bjah ,mr4 ,griffith 7for himself and ,mr4 ,fitzpatrick7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,june #ab1 #bjah;,additional sponsor3 ,mrs4 ,blackburn and ,mr4 ,walden ,june #ab1 #bjah ,reported with an amendment1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed ,strike out all after the enacting clause and insert the part printed in italic ,for text of introduced bill1 see copy of bill as introduced on ,may #ae1 #bjah ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to provide for requirements under the ,medicaid program relating to the use of qualified prescription drug monitoring programs and prescribing certain controlled substances4 #a4 ,short title ,this ,act may be cited as the ,medicaid ,providers ,are ,required ,to ,note ,experiences in ,record ,systems to ,help ,in-need ,patients ,act or the ,medicaid ,,partnership ,act4 #b4 ,requirements under the ,medicaid program relating to qualified prescription drug monitoring programs and prescribing certain controlled substances ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended by inserting after section #aidc the following new section3 #aidd4 ,requirements relating to qualified prescription drug monitoring programs and prescribing certain controlled substances 7a7 ,in general ,beginning ,october #a1 #bjba1 a ,state shall1 subject to subsection 7d71 require each covered provider to check the prescription drug history of a covered individual being treated by the covered provider through a qualified prescription drug monitoring program described in subsection 7b7 before prescribing to such individual a controlled substance4 7b7 ,qualified prescription drug monitoring program described ,a qualified prescription drug monitoring program described in this subsection is1 with respect to a ,state1 a prescription drug monitoring program administered by the ,state that1 at a minimum1 satisfies each of the following criteria3 7#a7 ,the program facilitates access by a covered provider to1 at a minimum1 the following information with respect to a covered individual1 in as close to real-time as possible3 7,a7 ,information regarding the prescription drug history of a covered individual with respect to controlled substances4 7,b7 ,the number and type of controlled substances prescribed to and filled for the covered individual during at least the most recent #ab-month period4 7,c7 ,the name1 location1 and contact information 7or other identifying number selected by the ,state1 such as a national provider identifier issued by the ,national ,plan and ,provider ,enumeration ,system of the ,centers for ,medicare ,medicaid ,services7 of each covered provider who prescribed a controlled substance to the covered individual during at least the most recent #ab-month period4 7#b7 ,the program facilitates the integration of information described in paragraph 7#a7 into the workflow of a covered provider1 which may include the electronic system the covered provider uses to prescribe controlled substances4 ,a qualified prescription drug monitoring program described in this subsection1 with respect to a ,state1 may have in place1 in accordance with applicable ,state and ,federal law1 a data sharing agreement with the ,state ,medicaid program that allows the medical director and pharmacy director of such program 7and any designee of such a director who reports directly to such director7 to access the information described in paragraph 7#a7 in an electronic format4 ,the ,state ,medicaid program under this title may facilitate reasonable and limited access1 as determined by the ,state and ensuring documented beneficiary protections regarding the use of such data1 to such qualified prescription drug monitoring program for the medical director or pharmacy director of any managed care entity 7as defined under section #aicb7;a77#a77;,b77 that has a contract with the ,state under section #aijc7m7 or under section #aije7t77#c71 or the medical director or pharmacy director of any entity has a contract to manage the pharmaceutical benefit with respect to individuals enrolled in the ,state plan 7or waiver of the ,state plan74 ,all applicable ,state and ,federal security and privacy laws shall apply to the directors or designees of such directors of any ,state ,medicaid program or entity accessing a qualified prescription drug monitoring program under this section4 7c7 ,application of privacy rules clarification ,the ,secretary shall clarify privacy requirements1 including requirements under the regulations promulgated pursuant to section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note71 related to the sharing of data under subsection 7b7 in the same manner as the ,secretary is required under subparagraph 7,j7 of section #ahfj;,d-#d7;c77#e7 to clarify privacy requirements related to the sharing of data described in such subparagraph4 7d7 ,ensuring access ,in order to ensure reasonable access to health care1 the ,secretary may waive the application of the requirement under subsection 7a71 with respect to a ,state1 in the case of natural disasters and similar situations1 and in the case of the provision of emergency services 7as defined for purposes of section #ahfj;,d-#d7;c77#e77;,d77ii77,,ii774 7e7 ,reports 7#a7 ,state reports ,each ,state shall include in the annual report submitted to the ,secretary under section #aibg7;g77#c77;,d71 beginning with such reports submitted for #bjbc1 information including1 at a minimum1 the following information for the most recent #ab-month period3 7,a7 ,the percentage of covered providers 7as determined pursuant to a process established by the ,state7 who checked the prescription drug history of a covered individual through a qualified prescription drug monitoring program described in subsection 7b7 before prescribing to such individual a controlled substance4 7,b7 ,aggregate trends with respect to prescribing controlled substances such as-- 7i7 the number of pill counts and dosage for controlled substances2 7ii7 the number and dosage of controlled substances prescribed per covered individual2 and 7iii7 the types of controlled substances prescribed1 including the dates of such prescriptions1 the supplies authorized 7including the duration of such supplies71 and the period of validity of such prescriptions1 in different populations 7such as individuals who are elderly1 individuals with disabilities1 and individuals who are enrolled under both this title and title ,,xviii74 7,c7 ,whether or not the ,state requires 7and a detailed explanation as to why the ,state does or does not require7 pharmacists to check the prescription drug history of a covered individual through a qualified drug management program before dispensing a controlled substance to such individual4 7#b7 ,report by ,,cms ,not later than ,october #a1 #bjbc1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall publish on the publicly available website of the ,centers for ,medicare ,medicaid ,services a report including the following information3 7,a7 ,guidance for ,states on how ,states can increase the percentage of covered providers who use qualified prescription drug monitoring programs described in subsection 7b74 7,b7 ,best practices for how ,states and covered providers should use such qualified prescription drug monitoring programs to reduce the occurrence of abuse of controlled substances4 7f7 ,increase to ,federal matching rate for certain expenditures relating to qualified prescription drug management programs ,the ,secretary shall increase the ,federal medical assistance percentage or ,federal matching rate that would otherwise apply to a ,state under section #aijc7;a7 for a calendar quarter occurring during the period beginning ,october #a1 #bjah1 and ending ,september #cj1 #bjba1 for expenditures by the ,state for activities under the ,state plan 7or waiver of the ,state plan7 to implement a prescription drug management program that satisfies the criteria described in paragraphs 7#a7 and 7#b7 of subsection 7b7 if the ,state 7in this subsection referred to as the administering ,state7 has in place agreements with all ,states that are contiguous to such administering ,state that1 when combined1 enable covered providers in all such contiguous ,states to access1 through the prescription drug management program1 the information that is described in subsection 7b77#a7 of covered individuals of such administering ,state and that covered providers in such administering ,state are able to access through such program4 ,in no case shall an increase under this subsection result in a ,federal medical assistance percentage or ,federal matching rate that exceeds #ajj percent4 7g7 ,rule of construction ,nothing in this section prevents a ,state from requiring pharmacists to check the prescription drug history of covered individuals through a qualified drug management program before dispensing controlled substances to such individuals4 7h7 ,definitions ,in this section3 7#a7 ,controlled substance ,the term controlled substance means a drug that is included in schedule ,,ii of section #bjb7;c7 of the ,controlled ,substances ,act and1 at the option of the ,state involved1 a drug included in schedule ,,iii or ,,iv of such section4 7#b7 ,covered individual ,the term covered individual means1 with respect to a ,state1 an individual who is enrolled in the ,state plan 7or under a waiver of such plan74 ,such term does not include an individual who-- 7,a7 is receiving-- 7i7 hospice or palliative care2 or 7ii7 treatment for cancer2 7,b7 is a resident of a long-term care facility1 of a facility described in section #aije7;d71 or of another facility for which frequently abused drugs are dispensed for residents through a contract with a single pharmacy2 or 7,c7 the ,state elects to treat as exempted from such term4 7#c7 ,covered provider 7,a7 ,in general ,the term covered provider means1 subject to subparagraph 7,b71 with respect to a ,state1 a health care provider who is participating under the ,state plan 7or waiver of the ,state plan7 and licensed1 registered1 or otherwise permitted by the ,state to prescribe a controlled substance 7or the designee of such provider74 7,b7 ,exceptions 7i7 ,in general ,beginning ,october #a1 #bjba1 for purposes of this section1 such term does not include a health care provider included in any type of health care provider determined by the ,secretary to be exempt from application of this section under clause 7ii74 7ii7 ,exceptions process ,not later than ,october #a1 #bjbj1 the ,secretary1 after consultation with the ,national ,association of ,medicaid ,directors1 national health care provider associations1 ,medicaid beneficiary advocates1 and advocates for individuals with rare diseases1 shall determine1 based on such consultations1 the types of health care providers 7if any7 that should be exempted from the definition of the term covered provider for purposes of this section4 4 #c4 ,guidance ,not later than ,october #a1 #bjai1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 shall issue guidance on best practices on the uses of prescription drug monitoring programs required of prescribers and on protecting the privacy of ,medicaid beneficiary information maintained in and accessed through prescription drug monitoring programs4 #d4 ,development of model state practices 7a7 ,in general ,not later than ,october #a1 #bjbj1 the ,secretary of ,health and ,human ,services shall develop and publish model practices to assist ,state ,medicaid program operations in identifying and implementing strategies to utilize data sharing agreements described in the matter following paragraph 7#b7 of section #aidd7;b7 of the ,social ,security ,act1 as added by section #b1 for the following purposes3 7#a7 ,monitoring and preventing fraud1 waste1 and abuse4 7#b7 ,improving health care for individuals enrolled in a ,state plan under title ,,xix of such ,act 7or waiver of such plan7 who-- 7,a7 transition in and out of coverage under such title2 7,b7 may have sources of health care coverage in addition to coverage under such title2 or 7,c7 pay for prescription drugs with cash4 7#c7 ,any other purposes specified by the ,secretary4 7b7 ,elements of model practices ,the model practices described in subsection 7a7-- 7#a7 may include strategies for assisting ,states in allowing the medical director or pharmacy director 7or designees of such a director7 of managed care organizations or pharmaceutical benefit managers to access information with respect to all covered individuals served by such managed care organizations or pharmaceutical benefit managers to access as a single data set1 in an electronic format2 and 7#b7 shall include any appropriate beneficiary protections and privacy guidelines4 7c7 ,consultation ,in developing model practices under this section1 the ,secretary shall consult with the ,national ,association of ,medicaid ,directors1 managed care entities 7as defined in section #aicb7;a77#a77;,b7 of the ,social ,security ,act7 with contracts with ,states pursuant to section #aijc7m7 of such ,act1 pharmaceutical benefit managers1 physicians and other health care providers1 beneficiary advocates1 and individuals with expertise in health care technology related to prescription drug monitoring programs and electronic health records4 #e4 ,report by ,comptroller ,general ,not later than ,october #a1 #bjbj1 the ,comptroller ,general of the ,united ,states shall issue a report examining the operation of prescription drug monitoring programs administered by ,states1 including data security and access standards used by such programs4 ,june #ab1 #bjah ,reported with an amendment1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed