,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #f  ,,9 ,,! ,,h\se ,,(             
,,repres5tatives  ,june #ac1 #bjah,mr4  
,wald5 7= himself1 ,mr4 ,pallone1 ,mr4  
,brady ( ,texas1 ,mr4 ,neal1 ,mr4 ,roe (
 ,t5nessee1 ,mr4 ,%u/]1 ,ms4 ,foxx1 ,mr4
 ,goodlatte1 ,mr4 ,walz1 ,mr4 ,de,fazio1
 & ,mr4 ,burgess7 introduc$ ! foll[+    
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committees on ,ways & ,means1 & !      
,judici>y1 = 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 provide = opioid use       
disord] prev5tion1 recov]y1 & treatm5t1 
& = o!r purposes4  #a4 ,%ort title2     
table ( cont5ts  7a7 ,%ort title ,?is   
,act may be cit$ z ! ,sub/ance          
,use-,disord] ,prev5tion t ,promotes    
,opioid ,recov]y & ,treatm5t = ,pati5ts 
& ,communities ,act or ! ,,support =    
,pati5ts & ,communities ,act4  7b7      
,table ( cont5ts ,! table ( cont5ts = ! 

,act is z foll[s3 ,sec4 #a4 ,%ort title2
 table ( cont5ts4 ,title ,i--,m$icaid   
,provisions to ,address ! ,opioid       
,crisis ,sec4 #aja4 ,at-risk y\?        
,m$icaid protection4 ,sec4 #ajb4 ,heal? 
,insurance = ,=m] ,fo/] ,y\?4 ,sec4     
#ajc4 ,demon/ration project to increase 
sub/ance use provid] capacity "u !      
,m$icaid program4 ,sec4 #ajd4 ,drug     
managem5t program = at-risk b5efici>ies4
 ,sec4 #aje4 ,m$icaid drug review &     
utilization4 ,sec4 #ajf4 ,guidance to   
improve c>e = infants ) neonatal ab/95ce
 syndrome & _! mo!rs2 ,,gao /udy on gaps
 9 ,m$icaid cov]age = pregnant &        
po/p>tum wom5 ) sub/ance use disord]4   
,sec4 #ajg4 ,m$icaid heal? homes =      
opioid-use-disord] ,m$icaid enrollees4  
,title ,,ii--,m$ic>e ,provisions to     
,address ! ,opioid ,crisis ,sec4 #bja4  
,au?ority n to apply c]ta9 ,m$ic>e      
teleheal? requirem5ts 9 ! case ( c]ta9  
treatm5t ( a sub/ance use disord] or    
co-occurr+ m5tal heal? disord]4 ,sec4   
#bjb4 ,enc\rag+ ! use ( non-opioid      

analgesics = ! managem5t ( po/-surgical 
pa94 ,sec4 #bjc4 ,requir+ a review (    
curr5t opioid prescriptions = *ronic pa9
 & scre5+ = opioid use disord] to be    
includ$ 9 ! ,welcome to ,m$ic>e initial 
prev5tive physical exam9ation4 ,sec4    
#bjd4 ,modification ( paym5t = c]ta9    
outpati5t surgical s]vices4 ,sec4 #bje4 
,requir+ e-prescrib+ = cov]age ( cov]$  
"p ,d controll$ sub/ances4 ,sec4 #bjf4  
,requir+ prescription drug plan sponsors
 "u ,m$ic>e to e/abli% drug managem5t   
programs = at-risk b5efici>ies4 ,sec4   
#bjg4 ,m$ic>e cov]age ( c]ta9 s]vices   
furni%$ by opioid treatm5t programs4    
,title ,,iii--,o!r ,heal? ,provisions to
 ,address ! ,opioid ,crisis ,sec4 #cja4 
,cl>ify+ ,,fda regulation (             
non-addictive pa9 & addiction !rapies4  
,sec4 #cjb4 ,surveillance & ,te/+ (     
,opioids to ,prev5t ,f5tanyl ,dea?s4    
,sec4 #cjc4 ,all[+ = m flexibility )    
respect to m$ication-assi/$ treatm5t =  
opioid use disord]s4 ,title             
,,iv--,(fsets ,sec4 #dja4 ,promot+ value

 9 ,m$icaid manag$ c>e4 ,sec4 #djb4     
,ext5d+ p]iod ( application ( ,m$ic>e   
second>y pay] rules = individuals ) end 
/age r5al disease4 ,sec4 #djc4 ,requir+ 
report+ by gr\p heal? plans (           
prescription drug cov]age in=mation =   
purposes ( id5tify+ prim>y pay]         
situations "u ! ,m$ic>e program4  ,i    
,m$icaid ,provisions to ,address !      
,opioid ,crisis  #aja4 ,at-risk y\?     
,m$icaid protection  7a7 ,9 g5]al       
,section #aijb ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 
7#a7 9 subsection 7a7-- 7,a7 by /rik+ & 
at ! end ( p>agraph 7#hb72  7,b7 by     
/rik+ ! p]iod at ! end ( p>agraph 7#hc7 
& ins]t+ 2 &2 &  7,c7 by ins]t+ aft]    
p>agraph 7#hc7 ! foll[+ new p>agraph3   
7#hd7 provide t-- 7,a7 ! ,/ate %all n   
t]m9ate eligibility = m$ical assi/ance  
"u ! ,/ate plan = an individual :o is an
 eligible juv5ile 7z def9$ 9 subsection 
7nn77#b77 because ! juv5ile is an inmate
 ( a public in/itution 7z def9$ 9       
subsection 7nn77#c771 b may susp5d      

cov]age dur+ ! p]iod ! juv5ile is su* an
 inmate2  7,b7 9 ! case ( an individual 
:o is an eligible juv5ile describ$ 9    
p>agraph 7#b77;,a7 ( subsection 7nn71 ! 
,/ate %all1 prior to ! individual's     
release f su* a public in/itution1      
conduct a r$et]m9ation ( eligibility =  
su* individual ) respect to su* m$ical  
assi/ance 7)\t requir+ a new application
 f ! individual7 &1 if ! ,/ate det]m9es 
pursuant to su* r$et]m9ation t !        
individual cont9ues to meet !           
eligibility requirem5ts = su* m$ical    
assi/ance1 ! ,/ate %all re/ore cov]age =
 su* m$ical assi/ance to su* an         
individual ^u ! individual's release f  
su* public in/itution2 &  7,c7 9 ! case 
( an individual :o is an eligible       
juv5ile describ$ 9 p>agraph 7#b77;,b7 ( 
subsection 7nn71 ! ,/ate %all process   
any application = m$ical assi/ance      
submitt$ by1 or on behalf (1 su*        
individual su* t ! ,/ate makes a        
det]m9ation ( eligibility = su*         
individual ) respect to su* m$ical      

assi/ance ^u release ( su* individual f 
su* public in/itution4  2 &  7#b7 by    
add+ at ! end ! foll[+ new subsection3  
7nn7 ,juv5ile2 eligible juv5ile2 public 
in/itution ,= purposes ( subsection     
7a77#hd7 & ?is subsection3  7#a7        
,juv5ile ,! t]m juv5ile means an        
individual :o is-- 7,a7 "u #ba ye>s (   
age2 or  7,b7 describ$ 9 subsection     
7a77#aj77;,a77i77,,ix74  7#b7 ,eligible 
juv5ile ,! t]m eligible juv5ile means a 
juv5ile :o is an inmate ( a public      
in/itution & :o--  7,a7 0 det]m9$       
eligible = m$ical assi/ance "u ! ,/ate  
plan imm$iately be=e becom+ an inmate ( 
su* a public in/itution2 or  7,b7 is    
det]m9$ eligible = su* m$ical assi/ance 
:ile an inmate ( a public in/itution4   
7#c7 ,inmate ( a public in/itution ,!   
t]m inmate ( a public in/itution has !  
mean+ giv5 su* t]m = purposes ( apply+ !
 subdivision 7,a7 foll[+ p>agraph 7#bi7 
( section #aije7;a71 tak+ into acc\nt ! 
exception 9 su* subdivision = a pati5t (
 a m$ical in/itution4  4  7b7 ,no *ange 

9 exclusion f m$ical assi/ance = inmates
 ( public in/itutions ,no?+ 9 ?is       
section %all be con/ru$ z *ang+ !       
exclusion f m$ical assi/ance "u !       
subdivision 7,a7 foll[+ p>agraph 7#bi7 (
 section #aije7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif;d7a771       
includ+ any applicable re/rictions on a 
,/ate submitt+ claims = ,f$]al f9ancial 
p>ticipation "u title ,,xix ( su* ,act =
 su* assi/ance4  7c7 ,no *ange 9        
cont9uity ( eligibility be=e            
adjudication or s5t5c+ ,no?+ 9 ?is      
section %all be con/ru$ to m&ate1       
enc\rage1 or sugge/ t a ,/ate susp5d or 
t]m9ate cov]age = individuals be=e !y h 
be5 adjudicat$ or s5t5c$4  7d7          
,effective date  7#a7 ,9 g5]al ,except z
 provid$ 9 p>agraph 7#b71 ! am5dm5ts    
made by subsection 7a7 %all apply to    
eligibility ( juv5iles :o become inmates
 ( public in/itutions on or aft] ! date 
t is #a ye> aft] ! date ( ! enactm5t (  
?is ,act4  7#b7 ,rule = *anges requir+  
/ate legislation ,9 ! case ( a ,/ate    

plan = m$ical assi/ance "u title ,,xix (
 ! ,social ,security ,act :i* !         
,secret>y ( ,heal? & ,human ,s]vices    
det]m9es requires ,/ate legislation 7o!r
 ?an legislation appropriat+ funds7 9   
ord] = ! plan to meet ! additional      
requirem5ts impos$ by ! am5dm5ts made by
 subsection 7a71 ! ,/ate plan %all n be 
reg>d$ z fail+ to comply ) ! requirem5ts
 ( su* title solely on ! basis ( its    
failure to meet ^! additional           
requirem5ts be=e ! fir/ day ( ! fir/    
cal5d> qu>t] beg9n+ aft] ! close ( !    
fir/ regul> session ( ! ,/ate           
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      
sep>ate regul> session ( ! ,/ate        
legislature4  #ajb4 ,heal? ,insurance = 
,=m] ,fo/] ,y\?  7a7 ,cov]age cont9uity 
= =m] fo/] c>e *ildr5 up to age #bf     
7#a7 ,9 g5]al ,section                  
#aijb7;a77#aj77;,a77i77,,ix7 ( ! ,social

 ,security ,act 7#db ,u4,s4,c4          
#acif;a7a77#aj77;,a77i77,,ix77 is       
am5d$--  7,a7 9 item 7bb71 by /rik+ are 
n describ$ 9 or enroll$ "u & ins]t+ are 
n describ$ 9 & are n enroll$ "u2  7,b7 9
 item 7cc71 by /rik+ responsibility ( ! 
,/ate & ins]t+ responsibility ( a ,/ate2
 &  7,c7 9 item 7dd71 by /rik+ ! ,/ate  
plan "u ?is title or "u a waiv] ( ! &   
ins]t+ a ,/ate plan "u ?is title or "u a
 waiv] ( su* a4  7#b7 ,effective date ,!
 am5dm5ts made by ?is subsection %all   
take effect ) respect to fo/] y\? :o    
atta9 #ah ye>s ( age on or aft] ,janu>y 
#a1 #bjbc4  7b7 ,guidance ,n lat] ?an "o
 ye> aft] ! date ( ! enactm5t ( ?is     
,act1 ! ,secret>y ( ,heal? & ,human     
,s]vices %all issue guidance to ,/ates1 
) respect to ! ,/ate ,m$icaid programs (
 su* ,/ates--  7#a7 on be/ practices =--
 7,a7 remov+ b>ri]s & ensur+ /reaml9$1  
timely access to ,m$icaid cov]age = =m] 
fo/] y\? up to age #bf2 &  7,b7 conduct+
 outrea* & rais+ aw>5ess among su* y\?  
reg>d+ ,m$icaid cov]age options = su*   

y\?2 &  7#b7 :i* %all include examples (
 ,/ates t h successfully ext5d$ ,m$icaid
 cov]age to =m] fo/] y\? up to age #bf4 
#ajc4 ,demon/ration project to increase 
sub/ance use provid] capacity "u !      
,m$icaid program ,section #aijc ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7 is am5d$ by add+ at ! end !    
foll[+ new subsection3  7aa7            
,demon/ration project ,to increase      
sub/ance use provid] capacity  7#a7 ,9  
g5]al ,n lat] ?an ! date t is #ahj days 
aft] ! date ( ! enactm5t ( ?is section1 
! ,secret>y %all1 9 consultation1 z     
appropriate1 ) ! ,director ( ! ,ag5cy = 
,heal?c>e ,rese>* & ,quality & !        
,assi/ant ,secret>y = ,m5tal ,heal? &   
,sub/ance ,use1 conduct a #ed-mon?      
demon/ration project = ! purpose        
describ$ 9 p>agraph 7#b7 "u :i* !       
,secret>y %all--  7,a7 = ! fir/ #ah-mon?
 p]iod ( su* project1 aw>d plann+ grants
 describ$ 9 p>agraph 7#c72 &  7,b7 = !  
rema9+ #cf-mon? p]iod ( su* project1    
provide to ea* ,/ate select$ "u p>agraph

 7#d7 paym5ts 9 accordance ) p>agraph   
7#e74  7#b7 ,purpose ,! purpose describ$
 9 ?is p>agraph is = ea* ,/ate select$  
"u p>agraph 7#d7 to increase ! treatm5t 
capacity ( provid]s p>ticipat+ "u !     
,/ate plan 7or a waiv] ( su* plan7 to   
provide sub/ance use disord] treatm5t or
 recov]y s]vices "u su* plan 7or waiv]7 
?r\gh ! foll[+ activities3  7,a7 ,= !   
purpose describ$ 9 p>agraph             
7#c77;,c77i71 activities t support an   
ongo+ assessm5t ( ! behavioral heal?    
treatm5t ne$s ( ! ,/ate1 tak+ into      
acc\nt ! matt]s describ$ 9 subclauses   
7,i7 ?r\gh 7,,iv7 ( su* p>agraph4  7,b7 
,activities t1 tak+ into acc\nt !       
results ( ! assessm5t describ$ 9        
subp>agraph 7,a71 support ! recruitm5t1 
tra9+1 & provision ( te*nical assi/ance 
= provid]s p>ticipat+ "u ! ,/ate plan   
7or a waiv] ( su* plan7 t (f] sub/ance  
use disord] treatm5t or recov]y s]vices4
  7,c7 ,improv$ reimbursem5t = &        
expansion (1 ?r\gh ! provision (        
education1 tra9+1 & te*nical assi/ance1 

! numb] or treatm5t capacity ( provid]s 
p>ticipat+ "u ! ,/ate plan 7or waiv]7   
t--  7i7 are au?oriz$ to disp5se drugs  
approv$ by ! ,food & ,drug ,adm9i/ration
 = individuals ) a sub/ance use disord] 
:o ne$ )drawal managem5t or ma9t5ance   
treatm5t = su* disord]2  7ii7 h 9 effect
 a regi/ration or waiv] "u section      
#cjc7;g7 ( ! ,controll$ ,sub/ances ,act 
= purposes ( disp5s+ n>cotic drugs to   
individuals = ma9t5ance treatm5t or     
detoxification treatm5t & are 9         
compliance ) any regulation promulgat$  
by ! ,assi/ant ,secret>y = ,m5tal ,heal?
 & ,sub/ance ,use = purposes ( c>ry+ out
 ! requirem5ts ( su* section #cjc7;g72 &
  7iii7 are qualifi$ "u applicable ,/ate
 law to provide sub/ance use disord]    
treatm5t or recov]y s]vices4  7,d7      
,improv$ reimbursem5t = & expansion (1  
?r\gh ! provision ( education1 tra9+1 & 
te*nical assi/ance1 ! numb] or treatm5t 
capacity ( provid]s p>ticipat+ "u !     
,/ate plan 7or waiv]7 t h !             
qualifications to address ! treatm5t or 

recov]y ne$s (--  7i7 individuals       
enroll$ "u ! ,/ate plan 7or a waiv] (   
su* plan7 :o h neonatal ab/95ce         
syndrome1 9 accordance ) guidel9es issu$
 by ! ,am]ican ,academy ( ,p$iatrics &  
,am]ican ,college ( ,ob/etricians &     
,gynecologi/s relat+ to mat]nal c>e &   
infant c>e ) respect to neonatal ab/95ce
 syndrome2  7ii7 pregnant wom51 po/p>tum
 wom51 & infants1 p>ticul>ly ! concurr5t
 treatm5t1 z appropriate1 & compreh5sive
 case managem5t ( pregnant wom51        
po/p>tum wom5 & infants1 enroll$ "u !   
,/ate plan 7or a waiv] ( su* plan72     
7iii7 adolesc5ts & "y adults betwe5 !   
ages ( #ab & #ba enroll$ "u ! ,/ate plan
 7or a waiv] ( su* plan72 or  7iv7      
,am]ican ,indian & ,alaska ,native      
individuals enroll$ "u ! ,/ate plan 7or 
a waiv] ( su* plan74  7#c7 ,plann+      
grants  7,a7 ,9 g5]al ,! ,secret>y %all1
 ) respect to ! fir/ #ah-mon? p]iod ( ! 
demon/ration project conduct$ "u        
p>agraph 7#a71 aw>d plann+ grants to at 
lea/ #aj ,/ates select$ 9 accordance )  

subp>agraph 7,b7 = purposes ( prep>+ an 
application describ$ 9 p>agraph         
7#d77;,c7 & c>ry+ out ! activities      
describ$ 9 subp>agraph 7,c74  7,b7      
,selection ,9 select+ ,/ates = purposes 
( ?is p>agraph1 ! ,secret>y %all-- 7i7  
select ,/ates t h a ,/ate plan 7or waiv]
 ( ! ,/ate plan7 approv$ "u ?is title2  
7ii7 select ,/ates 9 a mann] t ensures  
geographic div]sity2 &  7iii7 give      
pref]5ce to ,/ates ) a preval5ce (      
sub/ance use disord]s 79 p>ticul> opioid
 use disord]s7 t is comp>able to or     
high] ?an ! national av]age preval5ce1 z
 measur$ by aggregate p] capita drug    
ov]doses1 or any o!r measure t !        
,secret>y deems appropriate4  7,c7      
,activities describ$ ,activities        
describ$ 9 ?is subp>agraph are1 )       
respect to a ,/ate1 ea* ( ! foll[+3 7i7 
,activities t support ! developm5t ( an 
initial assessm5t ( ! behavioral heal?  
treatm5t ne$s ( ! ,/ate to det]m9e !    
ext5t to :i* provid]s are ne$$ 7includ+ 
! types ( su* provid]s & geographic area

 ( ne$7 to improve ! network ( provid]s 
t treat sub/ance use disord]s "u ! ,/ate
 plan 7or waiv]71 includ+ ! foll[+3     
7,i7 ,an e/imate ( ! numb] ( individuals
 enroll$ "u ! ,/ate plan 7or a waiv] (  
su* plan7 :o h a sub/ance use disord]4  
7,,ii7 ,in=mation on ! capacity (       
provid]s to provide sub/ance use disord]
 treatm5t or recov]y s]vices to         
individuals enroll$ "u ! ,/ate plan 7or 
waiv]71 includ+ in=mation on provid]s :o
 provide su* s]vices & _! p>ticipation  
"u ! ,/ate plan 7or waiv]74  7,,iii7    
,in=mation on ! gap 9 sub/ance use      
disord] treatm5t or recov]y s]vices "u !
 ,/ate plan 7or waiv]7 bas$ on !        
in=mation describ$ 9 subclauses 7,i7 &  
7,,ii74  7,,iv7 ,projections reg>d+ !   
ext5t to :i* ! ,/ate p>ticipat+ "u !    
demon/ration project w\ld increase !    
numb] ( provid]s (f]+ sub/ance use      
disord] treatm5t or recov]y s]vices "u !
 ,/ate plan 7or waiv]7 dur+ ! p]iod ( ! 
demon/ration project4  7ii7 ,activities 
t1 tak+ into acc\nt ! results ( !       

assessm5t describ$ 9 clause 7i71 support
 ! developm5t ( ,/ate infra/ructure to1 
) respect to ! provision ( sub/ance use 
disord] treatm5t or recov]y s]vices "u !
 ,/ate plan 7or a waiv] ( su* plan71    
recruit prospective provid]s & provide  
tra9+ & te*nical assi/ance to su*       
provid]s4  7,d7 ,fund+ ,= purposes (    
subp>agraph 7,a71 !re is appropriat$1   
out ( any funds 9 ! ,treasury n o!rwise 
appropriat$1 #ej1jjj1jjj1 to rema9      
available until exp5d$4  7#d7           
,po/-plann+ ,/ates  7,a7 ,9 g5]al ,!    
,secret>y %all1 ) respect to ! rema9+   
#cf-mon? p]iod ( ! demon/ration project 
conduct$ "u p>agraph 7#a71 select n m   
?an #e ,/ates 9 accordance ) subp>agraph
 7,b7 = purposes ( c>ry+ out !          
activities describ$ 9 p>agraph 7#b7 &   
receiv+ paym5ts 9 accordance ) p>agraph 
7#e74  7,b7 ,selection ,9 select+ ,/ates
 = purposes ( ?is p>agraph1 ! ,secret>y 
%all-- 7i7 select ,/ates t receiv$ a    
plann+ grant "u p>agraph 7#c72  7ii7    
select ,/ates t submit to ! ,secret>y an

 application 9 accordance ) !           
requirem5ts 9 subp>agraph 7,c71 tak+    
into consid]ation ! quality ( ea* su*   
application2  7iii7 select ,/ates 9 a   
mann] t ensures geographic div]sity2 &  
7iv7 give pref]5ce to ,/ates ) a        
preval5ce ( sub/ance use disord]s 79    
p>ticul> opioid use disord]s7 t is      
comp>able to or high] ?an ! national    
av]age preval5ce1 z measur$ by aggregate
 p] capita drug ov]doses1 or any o!r    
measure t ! ,secret>y deems appropriate4
  7,c7 ,applications  7i7 ,9 g5]al ,a   
,/ate seek+ to be select$ = purposes (  
?is p>agraph %all submit to ! ,secret>y1
 at su* "t & 9 su* =m & mann] z !       
,secret>y requires1 an application t    
includes su* in=mation1 provisions1 &   
assurances1 z ! ,secret>y may require1 9
 addition to ! foll[+3  7,i7 ,a propos$ 
process = c>ry+ out ! ongo+ assessm5t   
describ$ 9 p>agraph 7#b77;,a71 tak+ into
 acc\nt ! results ( ! initial assessm5t 
describ$ 9 p>agraph 7#c77;,c77i74       
7,,ii7 ,a review ( reimbursem5t         

me?odologies & o!r policies relat$ to   
sub/ance use disord] treatm5t or recov]y
 s]vices "u ! ,/ate plan 7or waiv]7 t   
may create b>ri]s to increas+ ! numb] ( 
provid]s deliv]+ su* s]vices4  7,,iii7  
,! developm5t ( a plan1 tak+ into acc\nt
 activities c>ri$ out "u p>agraph       
7#c77;,c77ii71 t w result 9 long-t]m &  
su/a9able provid] networks "u ! ,/ate   
plan 7or waiv]7 t w (f] a cont9uum ( c>e
 = sub/ance use disord]s4 ,su* plan %all
 include ! foll[+3  7aa7 ,specific      
activities to increase ! numb] (        
provid]s 7includ+ provid]s t specialize 
9 provid+ sub/ance use disord] treatm5t 
or recov]y s]vices1 hospitals1 heal? c>e
 sy/ems1 ,f$]ally qualifi$ heal? c5t]s1 
&1 z applicable1 c]tifi$ community      
behavioral heal? cl9ics7 t (f] sub/ance 
use disord] treatm5t1 recov]y1 or       
support s]vices1 includ+ %ort-t]m       
detoxification s]vices1 outpati5t       
sub/ance use disord] s]vices1 &         
evid5ce-bas$ pe] recov]y s]vices4  7bb7 
,/rategies t w inc5tivize provid]s      

describ$ 9 subp>agraphs 7,c7 & 7,d7 (   
p>agraph 7#b7 to obta9 ! necess>y tra9+1
 education1 & support to deliv] sub/ance
 use disord] treatm5t or recov]y s]vices
 9 ! ,/ate4  7cc7 ,mile/ones & timel9ess
 = implem5t+ activities set =? 9 ! plan4
  7dd7 ,specific measurable t>gets =    
increas+ ! sub/ance use disord] treatm5t
 & recov]y provid] network "u ! ,/ate   
plan 7or a waiv] ( su* plan74  7,,iv7 ,a
 propos$ process = report+ ! in=mation  
requir$ "u p>agraph 7#f77;,a71 includ+  
in=mation to assess ! effectiv5ess ( !  
ef=ts ( ! ,/ate to exp& ! capacity (    
provid]s to deliv] sub/ance use disord] 
treatm5t or recov]y s]vices dur+ ! p]iod
 ( ! demon/ration project "u ?is        
subsection4  7,v7 ,! expect$ f9ancial   
impact ( ! demon/ration project "u ?is  
subsection on ! ,/ate4  7,,vi7 ,a       
description ( all fund+ s\rces available
 to ! ,/ate to provide sub/ance use     
disord] treatm5t or recov]y s]vices 9 ! 
,/ate4  7,,vii7 ,a prelim9>y plan = h[ !
 ,/ate w su/a9 any increase 9 ! capacity

 ( provid]s to deliv] sub/ance use      
disord] treatm5t or recov]y s]vices     
result+ f ! demon/ration project "u ?is 
subsection aft] ! t]m9ation ( su*       
demon/ration project4  7,,viii7 ,a      
description ( h[ ! ,/ate w coord9ate !  
goals ( ! demon/ration project ) any    
waiv] grant$ 7or submitt$ by ! ,/ate &  
p5d+7 pursuant to section #aaae = !     
deliv]y ( sub/ance use s]vices "u !     
,/ate plan1 z applicable4  7ii7         
,consultation ,9 complet+ an application
 "u clause 7i71 a ,/ate %all consult )  
relevant /akehold]s1 includ+ ,m$icaid   
manag$ c>e plans1 heal? c>e provid]s1 & 
,m$icaid b5efici>y advocates1 & include 
9 su* application a description ( su*   
consultation4  7#e7 ,paym5t  7,a7 ,9    
g5]al ,= ea* qu>t] occurr+ dur+ ! p]iod 
= :i* ! demon/ration project is conduct$
 7aft] ! fir/ #ah mon?s ( su* p]iod71 ! 
,secret>y %all pay "u ?is subsection1   
subject to subp>agraph 7,c71 to ea*     
,/ate select$ "u p>agraph 7#d7 an am\nt 
equal to #hj p]c5t ( s mu* ( ! qualifi$ 

sums exp5d$ dur+ su* qu>t]4  7,b7       
,qualifi$ sums def9$ ,= purposes (      
subp>agraph 7,a71 ! t]m qualifi$ sums   
means1 ) respect to a ,/ate & a qu>t]1 !
 am\nt equal to ! am\nt 7if any7 by :i* 
! sums exp5d$ by ! ,/ate dur+ su* qu>t] 
attributable to sub/ance use treatm5t or
 recov]y s]vices furni%$ by provid]s    
p>ticipat+ "u ! ,/ate plan 7or a waiv] (
 su* plan7 exce$s #a_/d ( su* sums      
exp5d$ by ! ,/ate dur+ fiscal ye> #bjah 
attributable to sub/ance use treatm5t or
 recov]y s]vices4  7,c7 ,non-duplication
 ( paym5t ,9 ! case t paym5t is made "u 
subp>agraph 7,a7 ) respect to           
exp5ditures = sub/ance use treatm5t or  
recov]y s]vices furni%$ by provid]s     
p>ticipat+ "u ! ,/ate plan 7or a waiv] (
 su* plan71 paym5t may n also be made "u
 subsection 7a7 ) respect to exp5ditures
 = ! same s]vices s furni%$4  7#f7      
,reports  7,a7 ,/ate reports ,a ,/ate   
receiv+ paym5ts "u p>agraph 7#e7 %all1 =
 ! p]iod ( ! demon/ration project "u ?is
 subsection1 submit to ! ,secret>y a    

qu>t]ly report1 ) respect to exp5ditures
 = sub/ance use treatm5t or recov]y     
s]vices = :i* paym5t is made to ! ,/ate 
"u ?is subsection1 on ! foll[+3  7i7 ,! 
specific activities ) respect to :i*    
paym5t "u ?is subsection 0 provid$4     
7ii7 ,! numb] ( provid]s t deliv]$      
sub/ance use disord] treatm5t or recov]y
 s]vices 9 ! ,/ate "u ! demon/ration    
project comp>$ to ! e/imat$ numb] (     
provid]s t w\ld h o!rwise deliv]$ su*   
s]vices 9 ! abs5ce ( su* demon/ration   
project4  7iii7 ,! numb] ( individuals  
enroll$ "u ! ,/ate plan 7or a waiv] (   
su* plan7 :o receiv$ sub/ance use       
disord] treatm5t or recov]y s]vices "u !
 demon/ration project comp>$ to !       
e/imat$ numb] ( su* individuals :o w\ld 
h o!rwise receiv$ su* s]vices 9 ! abs5ce
 ( su* demon/ration project4  7iv7 ,o!r 
matt]s z det]m9$ by ! ,secret>y4  7,b7  
,,cms reports  7i7 ,initial report ,n   
lat] ?an ,octob] #a1 #bjbj1 !           
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all1 9 consultation )

 ! ,director ( ! ,ag5cy = ,heal?c>e     
,rese>* & ,quality & ! ,assi/ant        
,secret>y = ,m5tal ,heal? & ,sub/ance   
,use1 submit to ,congress an initial    
report on--  7,i7 ! ,/ates aw>d$ plann+ 
grants "u p>agraph 7#c72  7,,ii7 !      
crit]ia us$ 9 su* selection2 &  7,,iii7 
! activities c>ri$ out by su* ,/ates "u 
su* plann+ grants4  7ii7 ,int]im report 
,n lat] ?an ,octob] #a1 #bjbb1 !        
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all1 9 consultation )
 ! ,director ( ! ,ag5cy = ,heal?c>e     
,rese>* & ,quality & ! ,assi/ant        
,secret>y = ,m5tal ,heal? & ,sub/ance   
,use1 submit to ,congress an int]im     
report--  7,i7 on activities c>ri$ out  
"u ! demon/ration project "u ?is        
subsection2  7,,ii7 on ! ext5t to :i*   
,/ates select$ "u p>agraph 7#d7 h a*iev$
 ! /at$ goals submitt$ 9 _! applications
 "u subp>agraph 7,c7 ( su* p>agraph2    
7,,iii7 ) a description ( ! /r5g?s &    
limitations ( su* demon/ration project2 
&  7,,iv7 ) a plan = ! su/a9ability (   

su* project4  7iii7 ,f9al report ,n lat]
 ?an ,octob] #a1 #bjbd1 ! ,adm9i/rator (
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices  
%all1 9 consultation ) ! ,director ( !  
,ag5cy = ,heal?c>e ,rese>* & ,quality & 
! ,assi/ant ,secret>y = ,m5tal ,heal? & 
,sub/ance ,use1 submit to ,congress a   
f9al report--  7,i7 provid+ updates on !
 matt]s report$ 9 ! int]im report "u    
clause 7ii72  7,,ii7 includ+ a          
description ( any *anges made ) respect 
to ! demon/ration project "u ?is        
subsection aft] ! submission ( su*      
int]im report2 &  7,,iii7 evaluat+ su*  
demon/ration project4  7,c7 ,,ahrq      
report ,n lat] ?an ?ree ye>s aft] ! date
 ( ! enactm5t ( ?is subsection1 !       
,director ( ! ,ag5cy = ,heal?c>e ,rese>*
 & ,quality1 on consultation ) !        
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices1 %all submit to       
,congress a summ>y on ! exp]i5ces (     
,/ates aw>d$ plann+ grants "u p>agraph  
7#c7 & ,/ates select$ "u p>agraph 7#d74 
7#g7 ,data %>+ & be/ practices ,dur+ !  

p]iod ( ! demon/ration project "u ?is   
subsection1 ! ,secret>y %all1 9         
collaboration ) ,/ates select$ "u       
p>agraph 7#d71 facilitate data %>+ & !  
developm5t ( be/ practices betwe5 su*   
,/ates & ,/ates t 7 n s select$4  7#h7  
,,cms fund+ ,!re is appropriat$1 out (  
any funds 9 ! ,treasury n o!rwise       
appropriat$1 #e1jjj1jjj to ! ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices = purposes ( 
implem5t+ ?is subsection4 ,su* am\nt    
%all rema9 available until exp5d$4  4   
#ajd4 ,drug managem5t program = at-risk 
b5efici>ies  7a7 ,9 g5]al ,title ,,xix (
 ! ,social ,security ,act is am5d$ by   
ins]t+ aft] section #aibg 7#db ,u4,s4,c4
 #acifr-#h7 ! foll[+ new section3       
#aibg;,a4 ,drug managem5t program =     
at-risk b5efici>ies  7a7 ,9 g5]al       
,beg9n+ ,janu>y #a1 #bjbj1 a ,/ate %all 
op]ate a qualifi$ drug managem5t program
 "u :i* a ,/ate may enroll c]ta9 at-risk
 b5efici>ies id5tifi$ by ! ,/ate "u !   
program4  7b7 ,qualifi$ drug managem5t  
program ,= purposes ( ?is section1 ! t]m

 qualifi$ drug managem5t program means1 
) respect to a ,/ate1 a program c>ri$   
out by ! ,/ate 7includ+ ?r\gh a contract
 ) a ph>macy b5efit manag]7 t provides  
at lea/ = ! foll[+3  7#a7 ,id5tification
 ( at-risk individuals ,"u ! program1 ! 
,/ate id5tifies1 9 accordance )         
subsection 7c71 individuals enroll$ "u !
 ,/ate plan 7or waiv] ( ! ,/ate plan7 :o
 are at-risk b5efici>ies4  7#b7 ,elem5ts
 ( program  7,a7 ,9 g5]al ,"u ! program1
 ! ,/ate1 ) respect to ea* individual   
id5tifi$ "u p>agraph 7#a7 & enroll$ "u !
 program "u p>agraph 7#e7--  7i7 subject
 to subp>agraphs 7,b7 & 7,c71 selects at
 lea/ "o1 b n m ?an ?ree1 heal? c>e     
provid]s & at lea/ "o1 b n m ?an ?ree1  
ph>macies = ea* su* individual =        
purposes ( clause 7ii71 9 accordance ) a
 selection process t takes into acc\nt  
reasonable factors su* z ! individual's 
previ\s utilization ( items & s]vices f 
heal? c>e provid]s & ph>macies1         
geographic proximity ( ! individual to  
su* heal? c>e provid]s & ph>macies1     

access ( ! individual to heal? c>e1     
reasonable travel "t1 in=mation reg>d+  
h\s+ /atus1 & any kn[n pref]5ce ( !     
individual = a c]ta9 heal? c>e provid]  
or ph>macy2 &  7ii7 requires t any      
controll$ sub/ance furni%$ to su*       
individual dur+ ! p]iod = :i* su*       
individual is enroll$ "u ! program be   
prescrib$ by a heal? c>e provid] select$
 "u clause 7i7 = su* individual &       
disp5s$ by a ph>macy select$ "u clause  
7i7 = su* individual 9 ord] = su*       
controll$ sub/ance to be cov]$ "u !     
,/ate plan 7or waiv]74  7,b7 ,b5efici>y 
pref]5ce ,9 ! case ( an individual      
receiv+ a notice "u p>agraph 7#c77;,a7 (
 be+ id5tifi$ z pot5tially be+ an       
at-risk b5efici>y describ$ 9 su*        
p>agraph1 su* individual may submit1    
dur+ ! #cj-;day p]iod foll[+ receipt (  
su* notice1 pref]5ces = :i* heal? c>e   
provid]s & ph>macies ! individual w\ld  
pref] ! ,/ate to select "u subp>agraph  
7,a74 ,! ,/ate %all select or *ange !   
selection ( heal? c>e provid]s &        

ph>macies "u subp>agraph 7,a7 = !       
individuals bas$ on su* pref]5ces1      
except t 9 ! case t ,/ate det]m9es t su*
 selection 7or *ange ( selection7 ( a   
heal? c>e provid] or ph>macy "u         
subp>agraph 7,a7 is contribut+ or w\ld  
contribute to prescription drug abuse or
 drug div]sion by ! individual1 ! ,/ate 
may select or *ange ! selection ( heal? 
c>e provid] or ph>macy = ! individual   
)\t reg>d to ! pref]5ces ( ! individual 
describ$ 9 ?is subp>agraph4 ,if ! ,/ate 
selects or *anges ! selection pursuant  
to ! prec$+ s5t5ce )\t reg>d to !       
pref]5ces ( ! individual1 ! ,/ate %all  
provide ! individual ) at lea/ #cj days 
writt5 notice ( ! selection or *ange (  
selection & a rationale = ! selection or
 *ange4  7,c7 ,treatm5t ( ph>macy )     
multiple locations ,= purposes (        
subp>agraph 7,a77i71 9 ! case ( a       
ph>macy t has multiple locations t %>e  
real-"t electronic prescription data1   
all su* locations ( ! ph>macy %all      
collectively be treat$ z "o ph>macy4    

7,d7 ,treatm5t ( exi/+ ,,ffs drug       
managem5t programs ,9 ! case ( a pati5t 
review & re/riction program 7z id5tifi$ 
9 ! annual report submitt$ to !         
,secret>y "u section #aibg7;g77#c77;,d77
 op]at$ by a ,/ate pursuant to section  
#aiae7;a77#b7 be=e ! date ( ! enactm5t (
 ?is section1 su* program %all be treat$
 z a qualifi$ drug managem5t program4   
7,e7 ,reasonable access ,! program %all 
ensure1 includ+ ?r\gh waiv] ( elem5ts ( 
! program 7includ+ "u subp>agraph       
7,a77ii771 reasonable access to heal?   
c>e 7includ+ access to heal? c>e        
provid]s & ph>macies ) respect to       
prescription drugs describ$ 9           
subp>agraph 7,a77 9 ! case ( individuals
 ) multiple resid5ces1 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    
7#c7 ,notification to id5tifi$          
individuals ,"u ! program1 ! ,/ate      
provides ea* individual :o is id5tifi$  

"u p>agraph 7#a71 prior to enroll+ su*  
individual "u ! program1 at lea/ "o     
notification ( ea* ( ! foll[+3  7,a7    
,notice t ! ,/ate has id5tifi$ !        
individual z pot5tially be+ an at-risk  
b5efici>y = abuse or misuse ( a         
controll$ sub/ance4  7,b7 ,! "n1        
address1 & contact in=mation ( ea* heal?
 c>e provid] & ph>macy t may be select$ 
= ! individual "u p>agraph 7#b77;,a74   
7,c7 ,in=mation describ+ all ,/ate &    
,f$]al public heal? res\rces t are      
design$ to address su* abuse or misuse  
to :i* ! individual has access1 includ+ 
m5tal heal? s]vices1 sub/ance use       
disord] & recov]y s]vices1 & o!r c\nsel+
 s]vices4  7,d7 ,notice (1 & in=mation  
ab\t1 ! "r ( ! individual to-- 7i7      
submit pref]5ces ( ! individual = heal? 
c>e provid]s & ph>macies to be select$  
"u p>agraph 7#b77;,a71 includ+ z        
describ$ 9 p>agraph 7#b77;,b72  7ii7    
appeal "u p>agraph 7#d7-- 7,i7 su*      
id5tification describ$ 9 subp>agraph    
7,a72 &  7,,ii7 ! selection ( heal? c>e 

provid]s & ph>macies "u p>agraph        
7#b77;,a74  7,e7 ,an explanation ( !    
mean+ & consequ5ces ( ! id5tification ( 
! individual z pot5tially be+ an at-risk
 b5efici>y = abuse or misuse ( a        
controll$ sub/ance1 includ+ an          
explanation ( ! program4  7,f7          
,in=mation1 includ+ a contact li/ & cle>
 in/ructions1 t expla9 h[ ! individual c
 contact ! appropriate entities adm9i/]+
 ! program 9 ord] to submit pref]5ces   
describ$ 9 p>agraph 7#b77;,b7 & any o!r 
communications relat+ to ! program4     
7#d7 ,appeals process ,"u ! program1 !  
,/ate provides = an appeals process "u  
:i*1 ) respect to an individual id5tifi$
 "u p>agraph 7#a7--  7,a7 su* individual
 may appeal-- 7i7 su* id5tification2 &  
7ii7 ! selection ( a heal? c>e provid]  
or ph>macy "u p>agraph 7#b77;,a72  7,b7 
9 ! case ( an appeal describ$ 9         
subp>agraph 7,a77ii71 ! ,/ate %all      
accommodate ! heal? c>e provid] or      
ph>macy pref]r$ by ! individual =       
selection = purposes ( p>agraph         

7#b77;,a71 unless ! ,/ate det]m9es t a  
*ange to ! selection ( heal? c>e provid]
 or ph>macy "u su* p>agraph is          
contribut+ or w\ld contribute to        
prescription drug abuse or drug div]sion
 by ! individual2  7,c7 su* individual  
is provid$ a p]iod ( n less ?an #cj days
 foll[+ ! date ( receipt ( ! notice     
describ$ 9 p>agraph 7#c7 to submit su*  
appeal2 &  7,d7 ! ,/ate mu/ make a      
det]m9ation ) respect to an appeal      
describ$ 9 subp>agraph 7,a71 & notify ! 
individual ( su* det]m9ation1 prior to  
enrollm5t ( su* individual 9 ! program4 
7#e7 ,enrollm5t ,"u ! program1 ! ,/ate  
initially enrolls individuals :o are    
id5tifi$ "u p>agraph 7#a7 9 ! program = 
a #ab-mon? p]iod--  7,a7 9 ! case ( su* 
an individual :o does n submit an appeal
 "u p>agraph 7#d7 )9 ! p]iod appli$ by !
 ,/ate pursuant to subp>agraph 7,c7 (   
su* p>agraph1 beg9n+ on ! day aft] ! la/
 day ( su* p]iod2 &  7,b7 9 ! case ( su*
 an individual :o does submit an appeal 
"u p>agraph 7#d7 )9 ! p]iod appli$ by ! 

,/ate pursuant to subp>agraph 7,c7 ( su*
 p>agraph b su* appeal is d5i$1 beg9n+ n
 lat] ?an #cj days aft] ! date ( su*    
d5ial4  7#f7 ,notification ( heal? c>e  
provid]s & ph>macies ,"u ! program1 !   
,/ate provides to ea* heal? c>e provid] 
& ph>macy select$ = an individual "u    
p>agraph 7#b7--  7,a7 notification t !  
individual is an at-risk b5efici>y      
enroll$ "u ! program & t ! provid] or   
ph>macy has be5 select$ = ! individual  
"u p>agraph 7#b72  7,b7 in=mation on su*
 program & ! role ( be+ s select$2 &    
7,c7 a process ?r\gh :i* ! provid] or   
ph>macy c submit a conc]n or compla9t ) 
respect to be+ s select$4  7#g7         
,cont9uation ( enrollm5t ,"u ! program1 
! ,/ate1 ) respect to an individual     
enroll$ "u ! program1 provides = a      
process to--  7,a7 n lat] ?an #cj days  
be=e ! end ( ! #ab-mon? p]iod = :i* !   
individual is s enroll$ pursuant to     
p>agraph 7#e7--  7i7 assess1 9          
accordance ) publicly available         
evid5ce-bas$ guidel9es1 :e!r or n su*   

individual %\ld cont9ue to be enroll$ "u
 ! program2 &  7ii7 notify su*          
individual ( ! results ( ! assessm5t "u 
clause 7i72  7,b7 cont9ue1 subject to   
subp>agraph 7,c71 enrollm5t ( su*       
individual if su* assessm5t recomm5ds   
su* cont9uation2 &  7,c7 appeal !       
cont9uation ( enrollm5t 9 accordance ) !
 appeals process describ$ 9 p>agraph    
7#d74  7c7 ,at-,risk b5efici>y  7#a7    
,id5tification ,= purposes ( ?is        
section1 a ,/ate %all id5tify an        
individual enroll$ "u ! ,/ate plan 7or  
waiv] ( ! ,/ate plan7 z an at-risk      
b5efici>y if ! individual is n an       
exempt$ individual describ$ 9 p>agraph  
7#b7 &--  7,a7 is id5tifi$ z su* an     
at-risk b5efici>y ?r\gh ! use ( publicly
 available evid5ce-bas$ guidel9es t     
indicate misuse or abuse ( a controll$  
sub/ance2 or  7,b7 ! ,/ate receiv$      
notification f a ,,pdp sponsor or       
,m$ic>e ,advantage organization t su*   
individual 0 id5tifi$ z be+ an at-risk  
b5efici>y = prescription drug abuse =   

enrollm5t 9 a drug managem5t program    
e/abli%$ by ! sponsor or organization   
pursuant to section #ahfj;,d-#d7;c77#e7 
& su* id5tification has n be5 t]m9at$ "u
 subp>agraph 7,f7 ( su* section4  7#b7  
,exempt$ individual describ$ ,= purposes
 ( p>agraph 7#a71 an exempt$ individual 
describ$ 9 ?is p>agraph is 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 an exempt$ individual = purposes
 ( p>agraph 7#a74  7d7 ,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 7b77#f7 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  7e7        
,reports  7#a7 ,annual reports ,a ,/ate 
op]at+ a qualifi$ drug managem5t program
 %all include 9 ! annual report submitt$
 to ! ,secret>y "u section              
#aibg7;g77#c77;,d71 beg9n+ ) su* reports
 submitt$ = #bjba1 ! foll[+ in=mation3  
7,a7 ,! numb] ( individuals enroll$ "u !
 ,/ate plan 7or waiv] ( ! ,/ate plan7 :o
 are enroll$ "u ! program & ! p]c5tage (
 individuals enroll$ "u ! ,/ate plan 7or
 waiv]7 :o are enroll$ "u su* program4  
7,b7 ,! numb] ( prescriptions =         
controll$ sub/ances t 7 disp5s$ p] mon? 
dur+ ea* su* ye> p] individual enroll$  
"u ! program1 includ+ ! daily morph9e   
milligram equival5ts & ! quantity       
prescrib$ = ea* su* prescription4  7,c7 
,! numb] ( ph>macies fill+ prescriptions
 = controll$ sub/ances = individuals    

enroll$ "u su* program4  7,d7 ,! numb] (
 heal? c>e provid]s writ+ prescriptions 
= controll$ sub/ances 7o!r ?an          
prescriptions = a refill7 = individuals 
enroll$ "u su* program4  7,e7 ,any o!r  
data t ! ,secret>y may require4  7,f7   
,any report submitt$ by a manag$ c>e    
entity "u subsection 7f77#a77;,b7 )     
respect to ! ye> involv$4  ,= ea* su*   
report = a ye> aft] #bjba1 ! in=mation  
describ$ 9 ?is p>agraph %all be provid$ 
9 a mann] t comp>es su* in=mation )     
respect to ! prior cal5d> ye> to su*    
in=mation ) respect to ! second prior   
cal5d> ye>4  7#b7 ,,macpac reports &    
review ,n lat] ?an two ye>s aft] ! date 
( ! enactm5t ( ?is section1 ! ,m$icaid &
 ,,*ip ,paym5t & ,access ,commission 79 
?is section ref]r$ to z ,,macpac71 9    
consultation ) ! ,national ,association 
( ,m$icaid ,directors1 ph>macy b5efit   
manag]s1 manag$ c>e organizations1 heal?
 c>e provid]s 7includ+ ph>maci/s71      
b5efici>y advocates1 & o!r /akehold]s1  
%all publi% a report t includes--  7,a7 

be/ practices = op]at+ drug managem5t   
programs1 bas$ on a review ( a          
repres5tative sample ( ,/ates adm9i/]+  
su* a program2  7,b7 a summ>y ( !       
exp]i5ce ( ! appeals process "u drug    
managem5t programs op]at$ by sev]al     
,/ates1 su* z ! frequ5cy at :i*         
individuals appeal$ ! id5tification (   
be+ an at-risk individual1 ! frequ5cy at
 :i* individuals appeal$ ! selection ( a
 heal? c>e provid] or ph>macy "u su* a  
program1 ! timeframes = su* appeals1 a  
summ>y ( ! reasons = su* appeals1 & !   
design ( su* appeals processes2  7,c7 a 
summ>y ( tr5ds & ! effectiv5ess (       
qualifi$ drug managem5t programs op]at$ 
"u ?is section2 &  7,d7 recomm5dations  
to ,/ates on h[ improvem5ts c be made ) 
respect to ! op]ation ( su* programs4   
,9 report+ on ,/ate practices1 !        
,,macpac %all consid] h[ su* programs h 
be5 implem5t$ 9 rural areas1 "u         
fee-=-s]vice z well z manag$ c>e        
arrangem5ts1 & ! ext5t to :i* su*       
programs h result$ 9 increas$           

effici5cies to su* ,/ates or to ! ,f$]al
 ,gov]nm5t "u ?is title4  7#c7 ,report  
on plan = coord9at$ c>e ,n lat] ?an     
,janu>y #a1 #bjba1 ea* ,/ate op]at+ a   
qualifi$ drug managem5t program %all    
submit to ! ,adm9i/rator ( ! ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices a report on  
h[ su* ,/ate plans to provide coord9at$ 
c>e = individuals enroll$ "u ! ,/ate    
plan 7or waiv] ( ! ,/ate plan7 &--  7,a7
 :o are enroll$ "u ! program2 or  7,b7  
:o are enroll$ ) a manag$ c>e entity &  
enroll$ "u su* a qualifi$ drug managem5t
 program op]at$ by su* entity4  7f7     
,applicability to manag$ c>e entities   
7#a7 ,9 g5]al ,) respect to any contract
 t a ,/ate ent]s into on or aft] ,janu>y
 #a1 #bjbj1 ) a manag$ c>e entity 7z    
def9$ 9 section #aicb7;a77#a77;,b77     
pursuant to section #aijc7m71 ! ,/ate   
%all1 z a condition ( ! contract1       
require ! manag$ c>e entity--  7,a7 to  
op]ate a qualifi$ drug managem5t program
 7z def9$ 9 subsection 7b77 = at-risk   
b5efici>ies :o are enroll$ ) su* entity 

& id5tifi$ by ! manag$ c>e entity by    
means ( application ( p>agraph 7#b72    
7,b7 to submit to ! ,/ate an annual     
report on ! matt]s describ$ 9           
subp>agraphs 7,a7 ?r\gh 7,e7 (          
subsection 7e77#a72 &  7,c7 to submit to
 ! ,/ate a li/ 7& z necess>y update su* 
li/7 ( individuals enroll$ ) su* entity 
"u ! qualifi$ drug managem5t program    
op]at$ by su* entity "u subp>agraph 7,a7
 = purposes ( all[+ ,/ate plans = :i*   
m$ical assi/ance is paid on a           
fee-=-s]vice basis to h access to su*   
in=mation4  7#b7 ,application ,=        
purposes ( apply+1 ) respect to a manag$
 c>e entity-- 7,a7 "u p>agraph          
7#a77;,a7--  7i7 ! def9ition ( ! t]m    
qualifi$ drug managem5t program "u      
subsection 7b71 o!r ?an p>agraph        
7#b77;,d7 ( su* subsection2 &  7ii7 !   
provisions ( p>agraphs 7#a7 & 7#b7 (    
subsection 7c72 &  7,b7 "u p>agraph     
7#a77;,b71 ! report requirem5ts describ$
 9 subp>agraphs 7,a7 ?r\gh 7,e7 (       
subsection 7e77#a72  ea* ref]5ce 9 su*  

subsection 7b7 & p>agraphs ( subsection 
7c7 to a ,/ate or ! ,/ate 7o!r ?an to a 
,/ate plan or ! ,/ate plan7 %all be     
deem$ a ref]5ce to ! manag$ c>e entity1 
ea* ref]5ce "u su* subsection1          
p>agraphs1 or subp>agraphs to           
individuals enroll$ "u ! ,/ate plan 7or 
waiv] ( ! ,/ate plan7 %all be deem$ a   
ref]5ce to individuals enroll$ ) su*    
entity1 & ea* ref]5ce "u su* subsection1
 p>agraphs1 or subp>agraphs to          
individuals enroll$ "u ! qualifi$ drug  
managem5t program op]at$ by ! ,/ate %all
 be deem$ a ref]5ce to individuals      
enroll$ "u ! qualifi$ drug managem5t    
program op]at$ by ! manag$ c>e entity4  
7g7 ,controll$ sub/ance def9$ ,=        
purposes ( ?is section1 ! t]m controll$ 
sub/ance means a drug t is includ$ 9    
s*$ule ,,ii1 ,,iii1 or ,,iv ( section   
#bjb7;c7 ( ! ,controll$ ,sub/ances ,act1
 or any comb9ation !re(1 z specifi$ by !
 ,/ate4  4  7b7 ,guidance on at-,risk   
population transition+ betwe5 ,m$icaid  
,,ffs & manag$ c>e ,n lat] ?an ,octob]  

#a1 #bjai1 ! ,secret>y ( ,heal? & ,human
 ,s]vices %all issue guidance = ,/ate   
,m$icaid programs1 ) respect to         
individuals :o are enroll$ "u a ,/ate   
plan 7or waiv] ( su* plan7 "u title     
,,xix ( ! ,social ,security ,act & "u a 
drug managem5t program1 = purposes (    
provid+ be/ practices--  7#a7 =         
transition+1 z applicable1 su*          
individuals f fee-=-s]vice ,m$icaid 7&  
su* a program op]at$ by ! ,/ate7 to     
receiv+ m$ical assi/ance "u su* title   
?r\gh a manag$ c>e entity 7z def9$ 9    
section #aicb7;a77#a77;,b7 ( ! ,social  
,security ,act7 ) a contract t ) ! ,/ate
 pursuant to section #aijc7m7 ( su* ,act
 7& su* a program op]at$ by su* entity72
 &  7#b7 = transition+1 z applicable1   
su* individuals f receiv+ m$ical        
assi/ance "u su* title ?r\gh a manag$   
c>e entity 7z def9$ 9 section           
#aicb7;a77#a77;,b7 ( ! ,social ,security
 ,act7 ) a contract t ) ! ,/ate pursuant
 to section #aijc7m7 ( su* ,act 7& su* a
 program op]at$ by su* entity7 to       

fee-=-s]vice ,m$icaid 7& su* a program  
op]at$ by ! ,/ate74  7c7 ,guidance on   
at-,risk population transition+ to      
,m$ic>e  7#a7 ,9 g5]al ,n lat] ?an      
,janu>y #a1 #bjbj1 ! ,secret>y ( ,heal? 
& ,human ,s]vices1 aft] consultation ) !
 ,f$]al ,coord9at$ ,heal? ,c>e ,(fice   
e/abli%$ "u section #bfjb ( ! ,pati5t   
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #acae;b71 %all issue guidance 
= ,/ate ,m$icaid programs1 ) respect to 
transition+ individuals1 provid+ =--    
7,a7 notification to be submitt$ by !   
,/ate to ! ,c5t]s = ,m$ic>e  ,m$icaid   
,s]vices & su* individuals ( ! /atus (  
su* individuals z transition+           
individuals2  7,b7 notification to su*  
individuals ab\t enrollm5t "u a         
prescription drug plan "u "p ,d ( su*   
title or "u a ,,ma-,,pd plan "u "p ,c ( 
su* title2  7,c7 be/ practices =        
transition+ su* individuals to su* a    
plan2 &  7,d7 be/ practices =           
coord9ation betwe5 ! qualifi$ drug      
managem5t program 7z describ$ 9 section 

#aibg;,a7b7 ( ! ,social ,security ,act1 
z add$ by subsection 7a77 c>ri$ out by !
 ,/ate & a drug managem5t program c>ri$ 
out "u su* a plan pursuant to section   
#ahfj;,d-#d7;c77#e7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#aj7;c77#e774  7#b7 ,transition+ 
individuals ,= purposes ( p>agraph 7#a71
 a transition+ individual is an         
individual :o1 ) respect to a mon?--    
7,a7 is enroll$ "u ! ,/ate plan 7or     
waiv] ( ! ,/ate plan7 & "u ! qualifi$   
drug managem5t program 7z describ$ 9    
section #aibg;,a7b7 ( ! ,social         
,security ,act1 z add$ by subsection    
7a77 c>ri$ out by ! ,/ate2 &  7,b7 is   
expect$ to become eligible = ! ,m$ic>e  
program "u title ,,xviii ( su* ,act dur+
 ! subsequ5t #ab-mon? p]iod4  #aje4     
,m$icaid drug review & utilization  7a7 
,m$icaid drug utilization review  7#a7  
,/ate plan requirem5t ,section #aijb7;a7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acif;a7a771 z am5d$ by       
section #aja1 is fur!r am5d$--  7,a7 9  

p>agraph 7#hc71 at ! end1 by /rik+ &2   
7,b7 9 p>agraph 7#hd71 at ! end1 by     
/rik+ ! p]iod & ins]t+ 2 &2 &  7,c7 by  
ins]t+ aft] p>agraph 7#hd7 ! foll[+ new 
p>agraph3  7#he7 provide t ! ,/ate is 9 
compliance ) ! drug review & utilization
 requirem5ts "u subsection 7oo77#a74  4 
7#b7 ,drug review & utilization         
requirem5ts ,section #aijb ( ! ,social  
,security ,act 7#db ,u4,s4,c4 #acif;a71 
z am5d$ by section #aja1 is fur!r am5d$ 
by add+ at ! end ! foll[+ new           
subsection3  7oo7 ,drug review &        
utilization requirem5ts  7#a7 ,9 g5]al  
,= purposes ( subsection 7a77#he71 !    
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 ! ,/ate7 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 !     
,/ate7 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,e7 ,cl>ification     
,no?+ %all prev5t a ,/ate f satisfy+ !  
requirem5t-- 7i7 describ$ 9 subp>agraph 
7,a7 by hav+ safety edits or a claims   
review automat$ process describ$ 9 su*  
subp>agraph t 0 9 place be=e ,octob] #a1
 #bjai2  7ii7 describ$ 9 subp>agraph    
7,b7 by hav+ a program describ$ 9 su*   
subp>agraph t 0 9 place be=e su* date2  
or  7iii7 describ$ 9 subp>agraph 7,c7 by
 hav+ a process describ$ 9 su*          
subp>agraph t 0 9 place be=e su* date4  
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 %all 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 
7#c7 ,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$]al ,regulations1 section            
#dhc4c7s77#d77 ( su* title1 & section   
#dhc4c7s77#e7 ( su* title1 z su*        
provisions 7 9 effect on ,m>* #ca1      
#bjah4  4  7b7 ,id5tify+ & address+     
inappropriate prescrib+ & bill+         
practices "u ,m$icaid  7#a7 ,9 g5]al    
,section #aibg7;g7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr-#h7;g77 is  
am5d$-- 7,a7 9 p>agraph 7#a77;,a7--  7i7
 by /rik+ ( section #aijc7;i77#aj77;,b7 
& ins]t+ ( section #aijb7;a77#ed72  7ii7
 by /rik+ 1 by n lat] ?an ,janu>y #a1   
#aiic12  7iii7 by ins]t+ aft] gross     
ov]use1 ! foll[+3 excessive             
utilization12 &  7iv7 by /rik+ or       
inappropriate or m$ically unnecess>y c>e
 & ins]t+ inappropriate or m$ically     
unnecess>y c>e1 or prescrib+ or bill+   
practices t indicate abuse or excessive 

utilization2 &  7,b7 9 p>agraph         
7#b77;,b7-- 7i7 by ins]t+ aft] gross    
ov]use1 ! foll[+3 excessive             
utilization12 &  7ii7 by /rik+ or       
inappropriate or m$ically unnecess>y c>e
 & ins]t+ inappropriate or m$ically     
unnecess>y c>e1 or prescrib+ or bill+   
practices t indicate abuse or excessive 
utilization4  7#b7 ,effective date ,!   
am5dm5ts made by p>agraph 7#a7 %all take
 effect ) respect to retrospective drug 
use reviews conduct$ on or aft] ,octob] 
#a1 #bjbj4  #ajf4 ,guidance to improve  
c>e = infants ) neonatal ab/95ce        
syndrome & _! mo!rs2 ,,gao /udy on gaps 
9 ,m$icaid cov]age = pregnant & po/p>tum
 wom5 ) sub/ance use disord]  7a7       
,guidance ,n lat] ?an "o ye> aft] ! date
 ( ! enactm5t ( ?is ,act1 ! ,secret>y ( 
,heal? & ,human ,s]vices %all issue     
guidance to improve c>e = infants )     
neonatal ab/95ce syndrome & _! families4
 ,su* guidance %all include--  7#a7 !   
types ( s]vices1 includ+ po/-dis*>ge    
s]vices & p>5t+ supports1 = families (  

babies ) neonatal ab/95ce syndrome t    
,/ates may cov] "u ! ,m$icaid program "u
 title ,,xix ( ! ,social ,security ,act2
  7#b7 be/ practices f ,/ates ) respect 
to innovative or evid5c$-bas$ paym5t    
models t focus on prev5tion1 scre5+1    
treatm5t1 plans ( safe c>e1 &           
po/-dis*>ge s]vices = mo!rs & fa!rs )   
sub/ance use disord]s & babies )        
neonatal ab/95ce syndrome t improve c>e 
& cl9ical outcomes2  7#c7 recomm5dations
 = ,/ates on available f9anc+ options "u
 ! ,m$icaid program "u title ,,xix ( su*
 ,act & "u ! ,*ildr5's ,heal? ,insurance
 ,program "u title ,,xxi ( su* ,act =   
,*ildr5's ,heal? ,insurance ,program    
,heal? ,s]vices ,initiative funds =     
p>5ts ) sub/ance use disord]s1 infants )
 neonatal ab/95ce syndrome1 & home      
visit+ s]vices2 &  7#d7 guidance &      
te*nical assi/ance to ,/ate ,m$icaid    
ag5cies reg>d+ additional flexibilities 
& inc5tives relat$ to scre5+1 prev5tion1
 & po/-dis*>ge s]vices1 includ+ p>5t+   
supports4  7b7 ,,gao /udy ,n lat] ?an "o

 ye> aft] ! date ( ! enactm5t ( ?is     
,act1 ! ,comptroll] ,g5]al ( ! ,unit$   
,/ates %all conduct a /udy1 & submit to 
,congress a report1 address+ gaps 9     
cov]age = pregnant wom5 ) sub/ance use  
disord] "u ! ,m$icaid program "u title  
,,xix ( ! ,social ,security ,act1 & gaps
 9 cov]age = po/p>tum wom5 ) sub/ance   
use disord] :o _h cov]age dur+ _!       
pregnancy "u ! ,m$icaid program "u su*  
title4  #ajg4 ,m$icaid heal? homes =    
opioid-use-disord] ,m$icaid enrollees   
7a7 ,ext5sion ( enhanc$ ,,fmap = c]ta9  
heal? homes = individuals ) sub/ance use
 disord]s ,section #aide ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acifw-#d7
 is am5d$-- 7#a7 9 subsection 7c7--     
7,a7 9 p>agraph 7#a71 by ins]t+ subject 
to p>agraph 7#d71 aft] except t12 &     
7,b7 by add+ at ! end ! foll[+ new      
p>agraph3  7#d7 ,special rule relat+ to 
sub/ance use disord] heal? homes  7,a7  
,9 g5]al ,9 ! case ( a ,/ate ) an       
,,sud-focus$ ,/ate plan am5dm5t approv$ 
by ! ,secret>y on or aft] ,octob] #a1   

#bjah1 ! ,secret>y may1 at ! reque/ ( ! 
,/ate1 ext5d ! application ( ! ,f$]al   
m$ical assi/ance p]c5tage describ$ 9    
p>agraph 7#a7 to paym5ts = ! provision (
 heal? home s]vices to ,,sud-eligible   
individuals "u su* ,/ate plan am5dm5t1 9
 addition to ! fir/ #h fiscal ye> qu>t]s
 ! ,/ate plan am5dm5t is 9 effect1 = !  
subsequ5t #b fiscal ye> qu>t]s t ! ,/ate
 plan am5dm5t is 9 effect4 ,no?+ 9 ?is  
section %all be con/ru$ z prohibit+ a   
,/ate ) a ,/ate plan am5dm5t t is       
approv$ "u ?is section & t is n an      
,,sud-focus$ ,/ate plan am5dm5t f       
additionally hav+ approv$ on or aft] su*
 date an ,,sud-focus$ ,/ate plan am5dm5t
 "u ?is section1 includ+ = purposes (   
application ( ?is p>agraph4  7,b7       
,report requirem5ts ,9 ! case ( a ,/ate 
) an ,,sud-focus$ ,/ate plan am5dm5t =  
:i* ! application ( ! ,f$]al m$ical     
assi/ance p]c5tage has be5 ext5d$ "u    
subp>agraph 7,a71 su* ,/ate %all1 at !  
end ( ! p]iod ( su* ,/ate plan am5dm5t1 
submit to ! ,secret>y a report on !     

foll[+1 ) respect to ,,sud-eligible     
individuals provid$ heal? home s]vices  
"u su* ,/ate plan am5dm5t3  7i7 ,!      
quality ( heal? c>e provid$ to su*      
individuals1 ) a focus on outcomes      
relevant to ! recov]y ( ea* su*         
individual4  7ii7 ,! access ( su*       
individuals to heal? c>e4  7iii7 ,!     
total exp5ditures ( su* individuals =   
heal? c>e4  ,= purposes ( ?is           
subp>agraph1 ! ,secret>y %all specify   
all applicable measures = det]m9+       
quality1 access1 & exp5ditures4  7,c7   
,be/ practices ,n lat] ?an ,octob] #a1  
#bjbj1 ! ,secret>y %all make publicly   
available on ! ,int]net website ( !     
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices be/ 
practices = design+ & implem5t+ an      
,,sud-focus$ ,/ate plan am5dm5t1 bas$ on
 ! exp]i5ces ( ,/ates t h ,/ate plan    
am5dm5ts approv$ "u ?is section t       
include ,,sud-eligible individuals4     
7,d7 ,def9itions ,= purposes ( ?is      
p>agraph3 7i7 ,,sud-eligible individuals
 ,! t]m ,,sud-eligible individual means1

 ) respect to a ,/ate1 an individual :o 
satisfies all ( ! foll[+3  7,i7 ,!      
individual is an eligible individual )  
*ronic conditions4  7,,ii7 ,! individual
 is an individual ) a sub/ance use      
disord]4  7,,iii7 ,! individual has n   
previ\sly receiv$ heal? home s]vices "u 
any o!r ,/ate plan am5dm5t approv$ = !  
,/ate "u ?is section by ! ,secret>y4    
7ii7 ,,sud-focus$ ,/ate plan am5dm5t ,! 
t]m ,,sud-focus$ ,/ate plan am5dm5t     
means a ,/ate plan am5dm5t "u ?is       
section t is design$ to provide heal?   
home s]vices prim>ily to ,,sud-eligible 
individuals4  4  7b7 ,requirem5t = ,/ate
 ,m$icaid plans ,to provide cov]age =   
m$ication-,assi/$ treatm5t  7#a7        
,requirem5t = ,/ate ,m$icaid plans to   
provide cov]age = m$ication-assi/$      
treatm5t ,section #aijb7;a77#aj77;,a7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acif;a7a77#aj77;,a77 is am5d$1 9 !     
matt] prec$+ clause 7i71 by /rik+ &     
7#bh7 & ins]t+ 7#bh71 & 7#bi74  7#b7    
,inclusion ( m$ication-assi/$ treatm5t z

 m$ical assi/ance ,section #aije7;a7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acif;d7a77 is am5d$-- 7,a7 9 p>agraph  
7#bh71 by /rik+ & at ! end2  7,b7 by    
r$esignat+ p>agraph 7#bi7 z p>agraph    
7#cj72 &  7,c7 by ins]t+ aft] p>agraph  
7#bh7 ! foll[+ new p>agraph3  7#bi7     
subject to p>agraph 7#b7 ( subsection   
7ee71 = ! p]iod beg9n+ ,octob] #a1      
#bjbj1 & end+ ,septemb] #cj1 #bjbe1     
m$ication-assi/$ treatm5t 7z def9$ 9    
p>agraph 7#a7 ( su* subsection72 &  4   
7#c7 ,m$ication-assi/$ treatm5t def9$2  
,waiv]s ,section #aije ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acif;d7  
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7ee7 ,m$ication-,assi/$    
treatm5t  7#a7 ,def9ition ,= purposes ( 
subsection 7a77#bi71 ! t]m              
m$ication-assi/$ treatm5t-- 7,a7 means  
all drugs approv$ "u section #eje ( !   
,f$]al ,food1 ,drug1 & ,cosmetic ,act   
7#ba ,u4,s4,c4 #cee71 includ+ me?adone1 
& all biological products lic5s$ "u     
section #cea ( ! ,public ,heal? ,s]vice 

,act 7#db ,u4,s4,c4 #bfb7 to treat      
opioid use disord]s2 &  7,b7 includes1 )
 respect to ! provision ( su* drugs &   
biological products1 c\nsel+ s]vices &  
behavioral !rapy4  7#b7 ,exception ,!   
provisions ( p>agraph 7#bi7 ( subsection
 7a7 %all n apply ) respect to a ,/ate =
 ! p]iod specifi$ 9 su* p>agraph1 if    
be=e ! beg9n+ ( su* p]iod ! ,/ate       
c]tifies to ! satisfaction ( ! ,secret>y
 t implem5t+ su* provisions /atewide =  
all individuals eligible to enroll 9 !  
,/ate plan 7or waiv] ( ! ,/ate plan7    
w\ld n be feasible by reason ( a %ortage
 ( qualifi$ provid]s ( m$ication-assi/$ 
treatm5t1 or facilities provid+ su*     
treatm5t1 t w contract ) ! ,/ate or a   
manag$ c>e entity ) :i* ! ,/ate has a   
contract "u section #aijc7m7 or "u      
section #aije7t77#c74  4  7#d7          
,effective date  7,a7 ,9 g5]al ,subject 
to subp>agraph 7,b71 ! am5dm5ts made by 
?is subsection %all apply ) respect to  
m$ical assi/ance provid$ on or aft]     
,octob] #a1 #bjbj1 & be=e ,octob] #a1   

#bjbe4  7,b7 ,exception = ,/ate         
legislation ,9 ! case ( a ,/ate plan "u 
title ,,xix ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acif et seq47 t !       
,secret>y ( ,heal? & ,human ,s]vices    
det]m9es requires ,/ate legislation 9   
ord] = ! respective plan to meet any    
requirem5t impos$ by ! am5dm5ts made by 
?is subsection1 ! respective plan %all n
 be reg>d$ z fail+ to comply ) !        
requirem5ts ( su* title solely on !     
basis ( its failure to meet su* an      
additional requirem5t be=e ! fir/ day ( 
! fir/ cal5d> qu>t] beg9n+ aft] ! close 
( ! fir/ regul> session ( ! ,/ate       
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session %all be consid]$ to be a     
sep>ate regul> session ( ! ,/ate        
legislature4  ,,ii ,m$ic>e ,provisions  
to ,address ! ,opioid ,crisis  #bja4    
,au?ority n to apply c]ta9 ,m$ic>e      
teleheal? requirem5ts 9 ! case ( c]ta9  

treatm5t ( a sub/ance use disord] or    
co-occurr+ m5tal heal? disord] ,section 
#ahcd7m7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciem7m77 is am5d$-- 7#a7 9 
p>agraph 7#b77;,b77i71 by ins]t+ &      
p>agraph 7#g77;,e7 aft] ,subject to     
clause 7ii72 &  7#b7 by add+ at ! end ! 
foll[+ new p>agraphs3  7#g7 ,au?ority n 
to apply c]ta9 requirem5ts 9 ! case (   
c]ta9 treatm5t ( sub/ance use disord] or
 co-occurr+ m5tal heal? disord]  7,a7 ,9
 g5]al ,= purposes ( paym5t "u ?is      
subsection1 9 ! case ( teleheal? s]vices
 describ$ 9 subp>agraph 7,c7 furni%$ on 
or aft] ,janu>y #a1 #bjbj1 to an        
eligible b5efici>y 7z def9$ 9           
subp>agraph 7,f77 = ! treatm5t ( a      
sub/ance use disord] or a m5tal heal?   
disord] t is co-occurr+ ) a sub/ance use
 disord]1 ! ,secret>y is au?oriz$ to1   
?r\gh rulemak+1 n apply any ( !         
requirem5ts describ$ 9 subp>agraph 7,b74
  7,b7 ,requirem5ts describ$ ,= purposes
 ( ?is p>agraph1 ! requirem5ts describ$ 
9 ?is subp>agraph are any ( ! foll[+3   

7i7 ,qualifications = an orig9at+ site  
"u p>agraph 7#d77;,c77ii74  7ii7        
,geographic limitations "u p>agraph     
7#d77;,c77i74  7,c7 ,teleheal? s]vices  
describ$ ,= purposes ( ?is p>agraph1 !  
teleheal? s]vices describ$ 9 ?is        
subp>agraph are s]vices t are bo?       
teleheal? s]vices & id5tifi$ by !       
,secret>y1 ?r\gh rulemak+1 z s]vices t  
are ! mo/ commonly furni%$ 7z def9$ by !
 ,secret>y7 "u ?is "p to individuals    
diagnos$ ) a sub/ance use disord] or a  
m5tal heal? disord] t is co-occurr+ ) a 
sub/ance use disord]4  7,d7             
,cl>ification ,no?+ 9 ?is p>agraph %all 
be con/ru$ z limit+ or o!rwise affect+ !
 au?ority ( ! ,secret>y to limit or     
elim9ate ! non-application pursuant to  
?is p>agraph ( any ( ! requirem5ts "u   
subp>agraph 7,b74  7,e7 ,treatm5t (     
orig9at+ site facility fee ,no facility 
fee %all be paid "u p>agraph 7#b77;,b7  
to an orig9at+ site ) respect to a      
teleheal? s]vice describ$ 9 subp>agraph 
7,b7 = :i* paym5t is made "u ?is        

subsection by reason ( ! non-application
 ( a requirem5t describ$ 9 subp>agraph  
7,b7 pursuant to ?is p>agraph if paym5t 
= su* s]vice w\ld n o!rwise be p]mitt$  
"u ?is subsection if su* requirem5t 7   
appli$4  7,f7 ,eligible b5efici>y def9$ 
,= purposes ( ?is p>agraph1 ! t]m       
eligible b5efici>y means an individual  
:o-- 7i7 is entitl$ to1 or enroll$ =1   
b5efits "u "p ,a & enroll$ = b5efits "u 
?is "p2  7ii7 has a diagnosis = a       
sub/ance use disord]2 &  7iii7 meets su*
 o!r crit]ia z ! ,secret>y det]m9es     
appropriate4  7,g7 ,report ,n lat] ?an  
#e ye>s aft] ! date ( ! enactm5t ( ?is  
p>agraph1 ! ,secret>y %all submit to    
,congress a report on ! impact ( any    
non-application "u ?is p>agraph ( any ( 
! requirem5ts describ$ 9 subp>agraph    
7,b7 on  7i7 ! utilization ( heal? c>e  
s]vices relat$ to sub/ance use disord]1 
su* z behavioral heal? s]vices & em]g5cy
 dep>tm5t visits2 &  7ii7 heal? outcomes
 relat$ to sub/ance use disord]1 su* z  
sub/ance use ov]dose dea?s4  7,h7 ,fund+

 ,= purposes ( c>ry+ out ?is p>agraph1 9
 addition to funds o!rwise available1 ! 
,secret>y %all provide = ! transf]1 f ! 
,f$]al ,supplem5t>y ,m$ical ,insurance  
,tru/ ,fund "u section #ahda1 (         
#c1jjj1jjj to ! ,c5t]s = ,m$ic>e        
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt to rema9 available until exp5d$4
  7#h7 ,rule ( con/ruction ,no?+ 9 ?is  
subsection may be con/ru$ z waiv+       
requirem5ts "u ?is title to comply )    
applicable ,/ate law1 includ+ ,/ate     
lic5sure requirem5ts4  4  #bjb4         
,enc\rag+ ! use ( non-opioid analgesics 
= ! managem5t ( po/-surgical pa9        
,section #ahcc7t77#f7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciel7t77#f77 is am5d$-- 7#a7 9        
subp>agraph 7,c77i71 by ins]t+ or1 9 !  
case ( an eligible non-opioid analgesic 
7z def9$ 9 subp>agraph 7,j771 dur+ a    
p]iod ( #e ye>s1 aft] #c ye>s12 &  7#b7 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,j7 ,eligible non-opioid 
analgesic def9$ ,9 ?is p>agraph1 ! t]m  

eligible non-opioid analgesic means a   
drug or biological--  7i7 t is an       
analgesic t is n an opioid2  7ii7 t     
demon/rat$ sub/antial cl9ical           
improvem5t2 &  7iii7 = :i* paym5t-- 7,i7
 z an outpati5t hospital s]vice "u ?is  
"p 0 n be+ made z ( ! date ( ! enactm5t 
( ?is subp>agraph2 or  7,,ii7 0 be+ made
 "u ?is p>agraph z ( su* date4  4  #bjc4
 ,requir+ a review ( curr5t opioid      
prescriptions = *ronic pa9 & scre5+ =   
opioid use disord] to be includ$ 9 !    
,welcome to ,m$ic>e initial prev5tive   
physical exam9ation  7a7 ,9 g5]al       
,section #ahfa7ww7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciex7ww77 is     
am5d$--  7#a7 9 p>agraph 7#a71 by ins]t+
 & a review ( curr5t opioid             
prescriptions & scre5+ = opioid use     
disord] 7z def9$ 9 p>agraph 7#d771 be=e 
b does n include2 &  7#b7 by add+ at !  
end ! foll[+ new p>agraph3  7#d7 7,a7 ,=
 purposes ( p>agraph 7#a71 ! t]m a      
review ( curr5t opioid prescriptions &  
scre5+ = opioid use disord] means1 )    

respect to an individual--  7i7 a review
 by a physician or qualifi$             
non-physician practition] ( all curr5t  
prescriptions ( ! individual2 &  7ii7 9 
! case ( an individual det]m9$ by !     
review ( a physician or qualifi$        
non-physician practition] "u subp>agraph
 7,a7 to h a curr5t prescription =      
opioids = *ronic pa9 t has be5 prescrib$
 = a m9imum p]iod ( "t 7z specifi$ by ! 
,secret>y7--  7,i7 a review by !        
physician or practition] ( ! pot5tial   
risk factors to ! individual = opioid   
use disord]2  7,,ii7 an evaluation by ! 
physician or practition] ( pa9 ( !      
individual2  7,,iii7 ! provision (      
in=mation reg>d+ non-opioid treatm5t    
options = ! treatm5t & managem5t ( any  
*ronic pa9 ( ! individual2 &  7,,iv7 if 
det]m9$ necess>y by ! physician or      
practition] bas$ on ! results ( ! review
 & evaluation conduct$ z describ$ 9 ?is 
p>agraph1 an appropriate ref]ral by !   
physician or practition] = additional   
treatm5t4  7,b7 ,= purposes ( ?is       

p>agraph1 ! t]m qualifi$ non-physician  
practition] means a physician assi/ant1 
nurse practition]1 or c]tifi$ cl9ical   
nurse speciali/4  4  7b7 ,effective date
 ,! am5dm5ts made by subsection 7a7 %all
 apply ) respect to initial prev5tive   
physical exam9ations furni%$ on or aft] 
,janu>y #a1 #bjbj4  #bjd4 ,modification 
( paym5t = c]ta9 outpati5t surgical     
s]vices  7a7 ,freeze ( paym5t = c]ta9   
s]vices furni%$ 9 ambulatory surgical   
c5t]s ,section #ahcc7;i77#b7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciel7i77#b77 is am5d$ by add+ at ! end
 ! foll[+ new subp>agraph3  7,f7  7i7 ,)
 respect to a t>get$ proc$ure 7z def9$ 9
 clause 7ii77 furni%$ dur+ #bjbj or a   
subsequ5t ye> 7be=e #bjbd7 to an        
individual 9 an ambulatory surgical     
c5t]1 ! paym5t am\nt = su* proc$ure t   
w\ld o!rwise be det]m9$ "u ! revis$     
paym5t sy/em "u subp>agraph 7,d71 )\t   
application ( ?is subp>agraph1 %all be  
equal to ! paym5t am\nt = su* proc$ure  
furni%$ 9 #bjaf4  7ii7 ,= purposes (    

clause 7i71 ! t]m t>get$ proc$ure means 
a proc$ure to :i* ,heal?c>e ,common     
,proc$ure ,cod+ ,sy/em #fbcaj 7or1 =    
ye>s beg9n+ aft] #bjaf1 #fbcba71 #fbcaa 
7or1 = ye>s beg9n+ aft] #bjaf1 #fbcbc71 
#fbbfd1 #fddij1 #fddic1 or ,g#jbfj 7or  
any successor code7 applies4  7iii7 ,?is
 subp>agraph %all n be appli$ 9 a       
budget-neutral mann]4  4  7b7 ,data     
collection  7#a7 ,9 g5]al ,! ,comptroll]
 ,g5]al %all collect data relat+ to !   
co/ diff]5tial betwe5 t>get$ proc$ures  
7z def9$ 9 section                      
#ahcc7;i77#b77;,f77ii7 ( ! ,social      
,security ,act1 z add$ by subsection    
7a77 t are p]=m$ 9 a hospital op]at+    
room & su* proc$ures t are p]=m$ 9 an   
(fice sett+ )9 a hospital 9 ord] to     
det]m9e :e!r su* proc$ures are be+      
prop]ly cod$ = claims1 bas$ on sett+1 = 
paym5t "u section #ahcc7;i77#b77;,d7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciel7i77#b77;,d77 & to det]m9e if     
fur!r *anges are ne$$ 9 ! classification
 sy/em = cov]$ outpati5t dep>tm5t       

s]vices 7z describ$ 9 section           
#ahcc7t77#b77;,a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciel7t77#b77;,a774
  7#b7 ,report ,n lat] ?an #d ye>s aft] 
! date ( ! enactm5t ( ?is ,act1 !       
,comptroll] ,g5]al %all submit a report 
to ! ,committee on ,en]gy & ,comm]ce & !
 ,committee on ,ways & ,means ( ! ,h\se 
( ,repres5tatives & ! ,committee on     
,f9ance ( ! ,s5ate conta9+--  7,a7 a    
det]m9ation ( :e!r proc$ures describ$ 9 
p>agraph 7#a7 are be+ prop]ly cod$ =    
claims1 bas$ on sett+1 = paym5t "u      
section #ahcc7;i77#b77;,d7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciel7i77#b77;,d772 &  7,b7            
recomm5dations on any *anges !          
,comptroll] ,g5]al det]m9es are ne$$ 9 !
 classification sy/em = cov]$ outpati5t 
dep>tm5t s]vices 7z describ$ 9 section  
#ahcc7t77#b77;,a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciel7t77#b77;,a774
  7c7 ,/udy ,n lat] ?an #c ye>s aft] !  
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,heal? & ,human ,s]vices    

%all conduct a /udy & submit to         
,congress a report on ! ext5t to :i*    
proc$ures describ$ 9 section            
#ahcc7;i77#b77;,f77ii7 ( ! ,social      
,security ,act1 z add$ by subsection    
7a71 are effective at prev5t+ ! ne$ =   
opioids = individuals furni%$ su*       
proc$ures4  #bje4 ,requir+ e-prescrib+ =
 cov]age ( cov]$ "p ,d controll$        
sub/ances  7a7 ,9 g5]al ,section        
#ahfj;,d-#d7;e7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciew-#ajd7;e77 is 
am5d$ by add+ at ! end ! foll[+3  7#g7  
,requirem5t ( e-prescrib+ = controll$   
sub/ances  7,a7 ,9 g5]al ,subject to    
subp>agraph 7,b71 a prescription = a    
cov]$ "p ,d drug "u a prescription drug 
plan 7or "u an ,,ma-,,pd plan7 = a      
s*$ule ,,ii1 ,,iii1 ,,iv1 or ,v         
controll$ sub/ance %all be transmitt$ by
 a heal? c>e practition] electronically 
9 accordance ) an electronic            
prescription drug program t meets !     
requirem5ts ( p>agraph 7#b74  7,b7      
,exception = c]ta9 circum/ances ,!      

,secret>y %all1 pursuant to rulemak+1   
specify circum/ances ) respect to :i* ! 
,secret>y may waive ! requirem5t "u     
subp>agraph 7,a71 ) respect to a cov]$  
"p ,d drug1 includ+ 9 ! case (--  7i7 a 
prescription issu$ :5 ! practition] &   
disp5s] are ! same entity2  7ii7 a      
prescription issu$ t _c be transmitt$   
electronically "u ! mo/ rec5tly         
implem5t$ v]sion ( ! ,national ,c\ncil =
 ,prescription ,drug ,programs ,,script 
,/&>d2  7iii7 a prescription issu$ by a 
practition] :o has receiv$ a waiv] or a 
r5ewal !re( = a specifi$ p]iod det]m9$  
by ! ,secret>y1 n to exce$ "o ye>1 f !  
requirem5t to use electronic prescrib+1 
pursuant to a process e/abli%$ by       
regulation by ! ,secret>y1 due to       
demon/rat$ economic h>d%ip1 te*nological
 limitations t are n reasonably )9 !    
control ( ! practition]1 or o!r         
exceptional circum/ance demon/rat$ by ! 
practition]2  7iv7 a prescription issu$ 
by a practition] "u circum/ances 9 :i*1 
not)/&+ ! practition]'s ability to      

submit a prescription electronically z  
requir$ by ?is subsection1 su*          
practition] reasonably det]m9es t x w\ld
 be impractical = ! individual involv$  
to obta9 sub/ances prescrib$ by         
electronic prescription 9 a timely      
mann]1 & su* delay w\ld adv]sely impact 
! individual's m$ical condition involv$2
  7v7 a prescription issu$ by a         
practition] all[+ = ! disp5s+ ( a       
non-pati5t specific prescription        
pursuant to a /&+ ord]1 approv$ protocol
 = drug !rapy1 collaborative drug       
managem5t1 or compreh5sive m$ication    
managem5t1 9 response to a public heal? 
em]g5cy1 or o!r circum/ances :]e !      
practition] may issue a non-pati5t      
specific prescription2  7vi7 a          
prescription issu$ by a practition]     
prescrib+ a drug "u a rese>* protocol2  
7vii7 a prescription issu$ by a         
practition] = a drug = :i* ! ,food &    
,drug ,adm9i/ration requires a          
prescription to conta9 elem5ts t are n  
able to be includ$ 9 electronic         

prescrib+1 su* z a drug ) risk          
evaluation & mitigation /rategies t     
include elem5ts to assure safe use2 &   
7viii7 a prescription issu$ by a        
practition] = an individual :o-- 7,i7   
receives hospice c>e "u ?is title2 or   
7,,ii7 is a resid5t ( a skill$ nurs+    
facility 7z def9$ 9 section #ahai7;a771 
or a m$ical in/itution or nurs+ facility
 = :i* paym5t is made = an              
in/itutionaliz$ individual "u section   
#aijb7q77#a77;,b71 = :i* frequ5tly abus$
 drugs are disp5s$ = resid5ts ?r\gh a   
contract ) a s+le ph>macy1 z det]m9$ by 
! ,secret>y 9 accordance ) ?is p>agraph4
  7,c7 ,disp5s+ ,no?+ 9 ?is p>agraph    
%all be con/ru$ z requir+ a sponsor ( a 
prescription drug plan "u ?is "p1 ,,ma  
organization (f]+ an ,,ma-,,pd plan "u  
"p ,c1 or a ph>maci/ to v]ify t a       
practition]1 ) respect to a prescription
 = a cov]$ "p ,d drug1 has a waiv] 7or  
is o!rwise exempt7 "u subp>agraph 7,b7 f
 ! requirem5t "u subp>agraph 7,a74 ,no?+
 9 ?is p>agraph %all be con/ru$ z       

affect+ ! ability ( ! plan to cov] or ! 
ph>maci/s' ability to cont9ue to disp5se
 cov]$ "p ,d drugs f o!rwise valid      
writt51 oral or fax prescriptions t are 
consi/5t ) laws & regulations4 ,no?+ 9  
?is p>agraph %all be con/ru$ z affect+ !
 ability ( ! b5efici>y involv$ to       
designate a p>ticul> ph>macy to disp5se 
a prescrib$ drug to ! ext5t consi/5t ) !
 requirem5ts "u subsection 7b77#a7 & "u 
?is p>agraph4  7,d7 ,en=cem5t ,!        
,secret>y %all1 pursuant to rulemak+1 h 
au?ority to en=ce & specify appropriate 
p5alties = non-compliance ) ! requirem5t
 "u subp>agraph 7,a74  4  7b7 ,effective
 date ,! am5dm5t made by subsection 7a7 
%all apply to cov]age ( drugs prescrib$ 
on or aft] ,janu>y #a1 #bjba4  #bjf4    
,requir+ prescription drug plan sponsors
 "u ,m$ic>e to e/abli% drug managem5t   
programs = at-risk b5efici>ies ,section 
#ahfj;,d-#d7;c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77 is 
am5d$-- 7#a7 9 p>agraph 7#a71 by ins]t+ 
aft] subp>agraph 7,e7 ! foll[+ new      

subp>agraph3  7,f7 ,) respect to plan   
ye>s beg9n+ on or aft] ,janu>y #a1      
#bjba1 a drug managem5t program =       
at-risk b5efici>ies describ$ 9 p>agraph 
7#e74  2 &  7#b7 9 p>agraph 7#e77;,a71  
by ins]t+ 7& = plan ye>s beg9n+ on or   
aft] ,janu>y #a1 #bjba1 a ,,pdp sponsor 
%all7 aft] ,a ,,pdp sponsor may4  #bjg4 
,m$ic>e cov]age ( c]ta9 s]vices furni%$ 
by opioid treatm5t programs  7a7        
,cov]age ,section #ahfa7s77#b7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7s77#b77 is am5d$--  7#a7 9       
subp>agraph 7,,ff71 by /rik+ at ! end &2
  7#b7 9 subp>agraph 7,,gg71 by ins]t+  
at ! end 2 &2 &  7#c7 by add+ at ! end !
 foll[+ new subp>agraph3  7,,hh7 opioid 
use disord] treatm5t s]vices 7z def9$ 9 
subsection 7jjj774  4  7b7 ,opioid use  
disord] treatm5t s]vices & opioid       
treatm5t program def9$ ,section #ahfa ( 
! ,social ,security ,act is am5d$ by    
add+ at ! end ! foll[+ new subsection3  
7jjj7 ,opioid use disord] treatm5t      
s]vices2 opioid treatm5t program  7#a7  

,opioid use disord] treatm5t s]vices ,! 
t]m opioid use disord] treatm5t s]vices 
means items & s]vices t are furni%$ by  
an opioid treatm5t program = ! treatm5t 
( opioid use disord]1 includ+--  7,a7   
opioid agoni/ & antagoni/ treatm5t      
m$ications 7includ+ oral1 inject$1 or   
implant$ v]sions7 t are approv$ by !    
,food & ,drug ,adm9i/ration "u section  
#eje ( ! ,f$]al ,food1 ,drug & ,cosmetic
 ,act = use 9 ! treatm5t ( opioid use   
disord]2  7,b7 disp5s+ & adm9i/ration ( 
su* m$ications1 if applicable2  7,c7    
sub/ance use c\nsel+ by a pr(essional to
 ! ext5t au?oriz$ "u ,/ate law to furni%
 su* s]vices2  7,d7 individual & gr\p   
!rapy ) a physician or psy*ologi/ 7or   
o!r m5tal heal? pr(essional to ! ext5t  
au?oriz$ "u ,/ate law72  7,e7 toxicology
 te/+1 &  7,f7 o!r items & s]vices t !  
,secret>y det]m9es are appropriate 7b 9 
no ev5t to include meals or             
transportation74  7#b7 ,opioid treatm5t 
program ,! t]m opioid treatm5t program  
means an entity t is opioid treatm5t    

program 7z def9$ 9 section #h4b ( title 
#db ( ! ,code ( ,f$]al ,regulations1 or 
any successor regulation7 t--  7,a7 is  
enroll$ "u section #ahff7;j72  7,b7 has 
9 effect a c]tification by ! ,sub/ance  
,abuse & ,m5tal ,heal? ,s]vices         
,adm9i/ration = su* a program2  7,c7 is 
accr$it$ by an accr$it+ body approv$ by 
! ,sub/ance ,abuse & ,m5tal ,heal?      
,s]vices ,adm9i/ration2 &  7,d7 meets   
su* additional conditions z ! ,secret>y 
may f9d necess>y to ensure-- 7i7 ! heal?
 & safety ( individuals be+ furni%$     
s]vices "u su* program2 &  7ii7 !       
effective & effici5t furni%+ ( su*      
s]vices4  4  7c7 ,paym5t  7#a7 ,9 g5]al 
,section #ahcc7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciel7a77#a77 is am5d$--  7,a7 by /rik+
 & 7,,bb7 & ins]t+ 7,,bb72 &  7,b7 by   
ins]t+ be=e ! semicolon at ! end !      
foll[+ 1 & 7,,cc7 ) respect to opioid   
use disord] treatm5t s]vices furni%$    
dur+ an episode ( c>e1 ! am\nt paid %all
 be equal to ! am\nt payable "u section 

#ahcd7w7 less any copaym5t requir$ z    
specifi$ by ! ,secret>y4  7#b7 ,paym5t  
det]m9ation ,section #ahcd ( ! ,social  
,security ,act 7#db ,u4,s4,c4 #aciem7 is
 am5d$ by add+ at ! end ! foll[+ new    
subsection3  7w7 ,opioid use disord]    
treatm5t s]vices  7#a7 ,9 g5]al ,!      
,secret>y %all pay to an opioid treatm5t
 program 7z def9$ 9 p>agraph 7#b7 (     
section #ahfa7;jjj77 an am\nt t is equal
 to #ajj p]c5t ( a bundl$ paym5t "u ?is 
"p = opioid use disord] treatm5t s]vices
 7z def9$ 9 p>agraph 7#a7 ( su* section7
 t are furni%$ by su* program to an     
individual dur+ an episode ( c>e 7z     
def9$ by ! ,secret>y7 beg9n+ on or aft] 
,janu>y #a1 #bjbj4 ,! ,secret>y %all    
ensure1 z det]m9$ appropriate by !      
,secret>y1 t no duplicative paym5ts are 
made "u ?is "p or "p ,d = items &       
s]vices furni%$ by an opioid treatm5t   
program4  7#b7 ,consid]ations ,!        
,secret>y may implem5t ?is subsection   
?r\gh "o or m bundles bas$ on ! type (  
m$ication provid$ 7su* z bupr5orph9e1   

me?adone1 naltrexone1 or a new          
innovative drug71 ! frequ5cy ( s]vices1 
! scope ( s]vices furni%$1 *>act]i/ics (
 ! individuals furni%$ su* s]vices1 or  
o!r factors z ! ,secret>y det]m9e       
appropriate4 ,9 develop+ su* bundles1 ! 
,secret>y may consid] paym5t rates paid 
to opioid treatm5t programs = comp>able 
s]vices "u ,/ate plans "u title ,,xix or
 "u ! ,,tric>e program "u *apt] #ee (   
title #aj ( ! ,unit$ ,/ates ,code4  7#c7
 ,annual updates ,! ,secret>y %all      
provide an update ea* ye> to ! bundl$   
paym5t am\nts "u ?is subsection4  4  7d7
 ,includ+ opioid treatm5t programs z    
,m$ic>e provid]s ,section #ahff7;e7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7e77 is am5d$-- 7#a7 9 p>agraph 
7#a71 by /rik+ at ! end &2  7#b7 9      
p>agraph 7#b71 by /rik+ ! p]iod at ! end
 & ins]t+ 2 &2 &  7#c7 by add+ at ! end 
! foll[+ new p>agraph3  7#c7 opioid     
treatm5t programs 7z def9$ 9 p>agraph   
7#b7 ( section #ahfa7;jjj771 b only )   
respect to ! furni%+ ( opioid use       

disord] treatm5t s]vices 7z def9$ 9     
p>agraph 7#a7 ( su* section74  4  ,,iii 
,o!r ,heal? ,provisions to ,address !   
,opioid ,crisis  #cja4 ,cl>ify+ ,,fda   
regulation ( non-addictive pa9 &        
addiction !rapies  7a7 ,public meet+s ,n
 lat] ?an #a ye> aft] ! date ( enactm5t 
( ?is ,act1 ! ,secret>y ( ,heal? &      
,human ,s]vices1 act+ ?r\gh !           
,commission] ( ,food & ,drugs1 %all hold
 n less ?an "o public meet+ to address !
 *all5ges & b>ri]s ( develop+           
non-addictive m$ical products int5d$ to 
treat pa9 or addiction1 :i* may         
include--  7#a7 ! application ( novel   
cl9ical trial designs 7consi/5t )       
section #cjba ( ! #ba/ ,c5tury ,cures   
,act 7,public ,law #aad-bee771 use (    
real _w evid5ce 7consi/5t ) section     
#eje;,f ( ! ,f$]al ,food1 ,drug1 &      
,cosmetic ,act 7#ba ,u4,s4,c4 #cee;g771 
& use ( pati5t exp]i5ce data 7consi/5t )
 section #efi;,c ( ! ,f$]al ,food1      
,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4  
#cfj;bbb-#h;c77 = ! developm5t (        

non-addictive m$ical products int5d$ to 
treat pa9 or addiction2 &  7#b7 !       
application ( eligibility crit]ia "u    
sections #ejf & #eae;,b ( ! ,f$]al      
,food1 ,drug1 & ,cosmetic ,act 7#ba     
,u4,s4,c4 #cef1 #cfj;e-#c7 =            
non-addictive m$ical products int5d$ to 
treat pa9 or addiction4  7b7 ,guidance  
,n lat] ?an "o ye> aft] ! public meet+s 
are conduct$ "u subsection 7a7 !        
,secret>y %all issue "o or m f9al       
guidance docum5ts1 or update exi/+      
guidance docum5ts1 to help address      
*all5ges to develop+ non-addictive      
m$ical products to treat pa9 or         
addiction4 ,su* guidance docum5ts %all  
include in=mation reg>d+--  7#a7 h[ !   
,food & ,drug ,adm9i/ration may apply   
sections #ejf & #eae;,b ( ! ,f$]al      
,food1 ,drug1 & ,cosmetic ,act 7#ba     
,u4,s4,c4 #cef1 #cfj;e-#c7 to           
non-addictive m$ical products int5d$ to 
treat pa9 or addiction1 includ+ !       
circum/ances "u :i* ! ,secret>y--  7,a7 
may apply ! eligibility crit]ia "u su*  

sections #ejf & #eae;,b to non-opioid or
 non-addictive m$ical products int5d$ to
 treat pa9 or addiction2  7,b7 consid]s 
! risk ( addiction ( controll$ sub/ances
 approv$ to treat pa9 :5 e/abli%+ unmet 
m$ical ne$2 &  7,c7 consid]s pa91 pa9   
control1 or pa9 managem5t 9 assess+ :e!r
 a disease or condition is a s]i\s or   
life-?reat5+ disease or condition2 &    
7#b7 ! me?ods by :i* sponsors may       
evaluate acute & *ronic pa91 endpo9ts = 
non-addictive m$ical products int5d$ to 
treat pa91 ! mann] 9 :i* endpo9ts &     
evaluations ( efficacy w be appli$      
across & )9 review divisions1 tak+ into 
consid]ation ! etiology ( ! und]ly+     
disease1 & ! mann] 9 :i* sponsors may   
use surrogate endpo9ts1 int]m$iate      
endpo9ts1 & real _w evid5ce4  7c7       
,m$ical product def9$ ,9 ?is section1 ! 
t]m m$ical product means a drug 7z def9$
 9 section #bja7;g77#a7 ( ! ,f$]al      
,food1 ,drug1 & ,cosmetic ,act 7#ba     
,u4,s4,c4 #cba7;g77#a7771 biological    
product 7z def9$ 9 section #cea7;i7 ( ! 

,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bfb7;i7771 or device 7z def9$
 9 section #bja7;h7 ( ! ,f$]al ,food1   
,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4  
#cba7;h7774  #cjb4 ,surveillance & ,te/+
 ( ,opioids to ,prev5t ,f5tanyl ,dea?s  
7a7 ,public heal? laboratories ,to      
detect f5tanyl ,"p ,f ( title ,,iii ( ! 
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bfb et seq47 is am5d$-- 7#a7 
9 ! head+ ( "p ,f1 by /rik+ & cl9ical   
laboratories & ins]t+ 1 cl9ical         
laboratories1 & public heal?            
laboratories2 &  7#b7 by add+ at ! end !
 foll[+ new subp>t3  #d ,public ,heal?  
,laboratories  #cee4 ,public heal?      
laboratories to detect f5tanyl  7a7 ,9  
g5]al ,! ,secret>y %all e/abli% a       
program to aw>d grants to ,f$]al1 ,/ate1
 & local ag5cies to support ! e/abli%m5t
 or op]ation ( public heal? laboratories
 to detect f5tanyl1 its analogues1 & o!r
 syn!tic opioids1 z describ$ 9          
subsection 7b74  7b7 ,/&>ds ,!          
,secret>y1 9 consultation ) ! ,director 

( ! ,national ,in/itute ( ,/&>ds &      
,te*nology1 %all--  7#a7 develop /&>ds =
 safely & effectively h&l+ & te/+       
f5tanyl1 its analogues1 & o!r syn!tic   
opioids2  7#b7 develop f5tanyl & f5tanyl
 analog ref]5ce mat]ials & quality      
control /&>ds & protocols to calibrate  
in/rum5tation = cl9ical diagno/ics &    
po/mortem surveillance2 &  7#c7 include 
9 ! /&>ds develop$ pursuant to p>agraph 
7#a7 proc$ures = enc\nt]+ new & em]g+   
syn!tic opioid =mulations & report+ ^?  
f9d+s to o!r ,f$]al1 ,/ate1 & local     
public heal? laboratories4  7c7         
,laboratories ,! ,secret>y %all require 
grantees "u subsection 7a7 to-- 7#a7    
foll[ ! /&>ds e/abli%$ "u subsection 7b7
 & be capable ( provid+ sy/ematic &     
r\t9e laboratory te/+ ( drugs = !       
purposes ( obta9+ & dissem9at+ public   
heal? in=mation to ,f$]al1 ,/ate1 &     
local public heal? (ficials1            
laboratories1 & o!r entities ! ,secret>y
 deems appropriate2  7#b7 "w ) law      
en=cem5t ag5cies & public heal?         

au?orities1 z feasible1 to develop      
real-"t in=mation on ! purity & movem5t 
( f5tanyl1 its analogues1 & o!r syn!tic 
opioids2  7#c7 assi/ ,/ate & local law  
en=cem5t ag5cies 9 te/+ seiz$ drugs :5  
,/ate & local =5sic laboratories reque/ 
additional assi/ance2  7#d7 provide e>ly
 w>n+ in=mation & advice to ,f$]al1     
,/ate1 & local law en=cem5t ag5cies &   
public heal? au?orities reg>d+ pot5tial 
significant *anges 9 ! supply ( f5tanyl1
 its analogues1 & o!r syn!tic opioids2  
7#e7 provide biosurveillance = non-fatal
 exposures2 &  7#f7 provide diagno/ic   
te/+ = non-fatal exposures ( em]g5cy    
p]sonnel4  7d7 ,au?orization (          
appropriations ,to c>ry out ?is section1
 !re is au?oriz$ to be appropriat$      
#ae1jjj1jjj = ea* ( fiscal ye>s #bjai   
?r\gh #bjbc4  4  7b7 ,enhanc$ f5tanyl   
surveillance ,title ,,iii ( ! ,public   
,heal? ,s]vice ,act is am5d$ by ins]t+  
aft] section #cag,t ( su* ,act 7#db     
,u4,s4,c4 #bdg;b-#bb7 ! foll[+ new      
section3  #cag,u4 ,enhanc$ f5tanyl      

surveillance  7a7 ,9 g5]al ,! ,director 
( ! ,c5t]s = ,disease ,control &        
,prev5tion %all enhance its drug        
surveillance program by--  7#a7 exp&+   
its surveillance program to include all 
#ej ,/ates & ! t]ritories ( ! ,unit$    
,/ates2  7#b7 increas+ & accel]at+ !    
collection ( data on f5tanyl1 its       
analogues1 & o!r syn!tic opioids & new  
em]g+ drugs ( abuse1 includ+ relat$     
ov]dose data f m$ical exam9]s & drug    
treatm5t admissions2 &  7#c7 utiliz+    
available & em]g+ in=mation on f5tanyl1 
its analogues1 & o!r syn!tic opioids &  
new em]g+ drugs ( abuse1 includ+        
in=mation f--  7,a7 ! ,national ,drug   
,e>ly ,w>n+ ,sy/em2  7,b7 ,/ate & local 
public heal? au?orities2 &  7,c7 ,f$]al1
 ,/ate1 & local public heal?            
laboratories4  7b7 ,au?orization (      
appropriations ,to c>ry out ?is section1
 !re is au?oriz$ to be appropriat$      
#aj1jjj1jjj = ea* ( fiscal ye>s #bjai   
?r\gh #bjbc4  4  7c7 ,pilot program =   
po9t-(-,use te/+ ( illicit drugs =      

dang]\s contam9ants ,"p ,p ( title ,,iii
 ( ! ,public ,heal? ,s]vice ,act 7#db   
,u4,s4,c4 #bhj;g et seq47 is am5d$ by   
add+ at ! end ! foll[+ new section3     
#cii,v-#g4 ,pilot program = po9t-(-use  
te/+ ( illicit drugs = dang]\s          
contam9ants  7a7 ,9 g5]al ,! ,secret>y  
%all-- 7#a7 e/abli% a pilot program     
?r\gh :i* #e ,/ate or local ag5cies     
conduct1 9 #e ,/ates1 po9t-(-use te/+ ( 
illicit drugs = dang]\s contam9ants2    
7#b7 e/abli% metrics to evaluate !      
success ( ! pilot program 9 r$uc+ drug  
ov]dose rates2 &  7#c7 bas$ on su*      
metrics1 conduct an annual evaluation ( 
! pilot program & submit an annual      
report to ! ,congress conta9+ ! results 
( su* evaluation4  7b7 ,au?orization (  
appropriations ,to c>ry out ?is section1
 !re is au?oriz$ to be appropriat$      
#e1jjj1jjj = ea* ( fiscal ye>s #bjai    
?r\gh #bjbc4  4  #cjc4 ,all[+ = m       
flexibility ) respect to                
m$ication-assi/$ treatm5t = opioid use  
disord]s  7a7 ,con=m+ applicable numb]  

,subclause 7,,ii7 ( section             
#cjc7;g77#b77;,b77iii7 ( ! ,controll$   
,sub/ances ,act 7#ba ,u4,s4,c4          
#hbc7;g77#b77;,b77iii77 is am5d$ to read
 z foll[s3  7,,ii7 ,! applicable numb]  
is-- 7aa7 #ajj if1 n soon] ?an #a ye>   
aft] ! date on :i* ! practition]        
submitt$ ! initial notification1 !      
practition] submits a second            
notification to ! ,secret>y ( ! ne$ &   
int5t ( ! practition] to treat up to    
#ajj pati5ts2  7bb7 #ajj if !           
practition] holds additional cr$5tial+1 
z def9$ 9 section #h4b ( title #db1     
,code ( ,f$]al ,regulations 7or         
successor regulations72 or  7cc7 #ajj if
 ! practition] provides m$ication-assi/$
 treatm5t 7,,mat7 us+ cov]$ m$ications  
7z su* t]ms are def9$ 9 section #h4b (  
title #db1 ,code ( ,f$]al ,regulations  
7or successor regulations77 9 a qualifi$
 practice sett+ 7z describ$ 9 section   
#h4fae ( title #db1 ,code ( ,f$]al      
,regulations 7or successor              
regulations774  4  7b7 ,elim9at+ any "t 

limitation = nurse practition]s &       
physician assi/ants ,to become qualify+ 
practition]s ,clause 7iii7 ( section    
#cjc7;g77#b77;,g7 ( ! ,controll$        
,sub/ances ,act 7#ba ,u4,s4,c4          
#hbc7;g77#b77;,g77 is am5d$--  7#a7 9   
subclause 7,i71 by /rik+ or at ! end2 & 
7#b7 by am5d+ subclause 7,,ii7 to read z
 foll[s3  7,,ii7 a qualify+ o!r         
practition]1 z def9$ 9 clause 7iv71 :o  
is a nurse practition] or physician     
assi/ant2 or  4  7c7 ,impos+ a "t       
limitation = cl9ical nurse speciali/s1  
c]tifi$ regi/]$ nurse ane/heti/s1 &     
c]tifi$ nurse midwifes ,to become       
qualify+ practition]s ,clause 7iii7 (   
section #cjc7;g77#b77;,g7 ( ! ,controll$
 ,sub/ances ,act 7#ba ,u4,s4,c4         
#hbc7;g77#b77;,g771 z am5d$ by          
subsection 7b71 is fur!r am5d$ by add+  
at ! end ! foll[+3  7,,iii7 = ! p]iod   
beg9n+ on ,octob] #a1 #bjah1 & end+ on  
,octob] #a1 #bjbc1 a qualify+ o!r       
practition]1 z def9$ 9 clause 7iv71 :o  
is a cl9ical nurse speciali/1 c]tifi$   

regi/]$ nurse ane/heti/1 or c]tifi$     
nurse midwife4  4  7d7 ,def9ition (     
qualify+ o!r practition] ,section       
#cjc7;g77#b77;,g77iv7 ( ! ,controll$    
,sub/ances ,act 7#ba ,u4,s4,c4          
#hbc7;g77#b77;,g77iv77 is am5d$ by /rik+
 nurse practition] or physician assi/ant
 ea* place x appe>s & ins]t+ nurse      
practition]1 cl9ical nurse speciali/1   
c]tifi$ regi/]$ nurse ane/heti/1 c]tifi$
 nurse midwife1 or physician assi/ant4  
7e7 ,report by ,secret>y ,n lat] ?an two
 ye>s aft] ! date ( ! enactm5t ( ?is    
,act1 ! ,secret>y ( ,heal? & ,human     
,s]vices1 9 consultation ) ! ,drug      
,en=cem5t ,adm9i/ration1 %all submit to 
,congress a report t assesses ! c>e     
provid$ by qualify+ practition]s 7z     
def9$ 9 section #cjc7;g77#b77;,g77iii7 (
 ! ,controll$ ,sub/ances ,act 7#ba      
,u4,s4,c4 #hbc7;g77#b77;,g77iii777 :o   
are treat+1 9 ! case ( physicians1 #ajj 
or m pati5ts1 & 9 ! case ( qualify+     
practition]s :o are n physicians1 #cj or
 m pati5ts4 ,su* report %all include    

recomm5dations on future applicable     
pati5t numb] levels & limits4 ,9 prep>+ 
su* report1 ! ,secret>y %all /udy1 )    
respect to opioid use disord] treatm5t--
  7#a7 ! av]age frequ5cy ) :i* qualify+ 
practition]s see _! pati5ts2  7#b7 !    
av]age frequ5cy ) :i* pati5ts receive   
c\nsel+1 includ+ ! rates by :i* su*     
c\nsel+ is provid$ by su* a qualify+    
practition] directly1 or by ref]ral2    
7#c7 ! av]age frequ5cy ) :i* r&om       
toxicology te/+ is adm9i/]$2  7#d7 !    
av]age mon?ly pati5t caseload = ea* type
 ( qualify+ practition]2  7#e7 !        
treatm5t ret5tion rates = pati5ts2  7#f7
 ov]dose & mortality rates2 &  7#g7 any 
available in=mation reg>d+ ! div]sion ( 
drugs by pati5ts receiv+ su* treatm5t f 
su* a qualify+ practition]4  ,,iv       
,(fsets  #dja4 ,promot+ value 9 ,m$icaid
 manag$ c>e  ,section #aijc7m7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7m77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#g7  7,a7 ,)     
respect to exp5ditures describ$ 9       

subp>agraph 7,b7 t are incurr$ by a     
,/ate = any fiscal ye> aft] fiscal ye>  
#bjbj 7& be=e fiscal ye> #bjbe71 9      
det]m9+ ! pro rata %>e to :i* ! ,unit$  
,/ates is equitably entitl$ "u          
subsection 7d77#c71 ! ,secret>y %all    
sub/itute ! ,f$]al m$ical assi/ance     
p]c5tage t applies = su* fiscal ye> to !
 ,/ate "u section #aije7;b7 7)\t reg>d  
to any adju/m5ts to su* p]c5tage        
applicable "u su* section or any o!r    
provision ( law7 = ! p]c5tage t applies 
to su* exp5ditures "u section #aije7y74 
7,b7 ,exp5ditures describ$ 9 ?is        
subp>agraph1 ) respect to a fiscal ye>  
to :i* subp>agraph 7,a7 applies1 are    
exp5ditures incurr$ by a ,/ate = paym5t 
= m$ical assi/ance provid$ to           
individuals describ$ 9 subclause        
7,,viii7 ( section                      
#aijb7;a77#aj77;,a77i7 by a manag$ c>e  
entity1 or o!r specifi$ entity 7z def9$ 
9 subp>agraph 7,d77iii771 t are treat$ z
 remittances because ! ,/ate--  7i7 has 
satisfi$ ! requirem5t ( section #dch4h (

 title #db1 ,code ( ,f$]al ,regulations 
7or any successor regulation71 by       
elect+--  7,i7 9 ! case ( a ,/ate       
describ$ 9 subp>agraph 7,c71 to apply a 
m9imum m$ical loss ratio 7z def9$ 9     
subp>agraph 7,d77ii77 t is equal to or  
great] ?an #he p]c5t2 or  7,,ii7 9 !    
case ( a ,/ate n describ$ 9 subp>agraph 
7,c71 to apply a m9imum m$ical loss     
ratio t is equal to #he p]c5t2 &  7ii7  
recov]$ all or a portion ( ! exp5ditures
 z a result ( ! entity's failure to meet
 su* ratio4  7,c7 ,= purposes (         
subp>agraph 7,b71 a ,/ate describ$ 9 ?is
 subp>agraph is a ,/ate t z ( ,may #ca1 
#bjah1 appli$ a m9imum m$ical loss ratio
 7z calculat$ "u subsection 7d7 (       
section #dch4h ( title #db1 ,code (     
,f$]al ,regulations 7z 9 effect on ,june
 #a1 #bjah77 = paym5t = s]vices provid$ 
by entities describ$ 9 su* subp>agraph  
"u ! ,/ate plan "u ?is title 7or a waiv]
 ( ! plan7 t is equal to or great] ?an  
#he p]c5t4  7,d7 ,= purposes ( ?is      
p>agraph3 7i7 ,! t]m manag$ c>e entity  

means a m$icaid manag$ c>e organization 
describ$ 9 section                      
#aicb7;a77#a77;,b77i74  7ii7 ,! t]m     
m9imum m$ical loss ratio means1 )       
respect to a ,/ate1 a m9imum m$ical loss
 ratio 7z calculat$ "u subsection 7d7 ( 
section #dch4h ( title #db1 ,code (     
,f$]al ,regulations 7z 9 effect on ,june
 #a1 #bjah77 = paym5t = s]vices provid$ 
by entities describ$ 9 subp>agraph 7,b7 
"u ! ,/ate plan "u ?is title 7or a waiv]
 ( ! plan74  7iii7 ,! t]m o!r specifi$  
entity means-- 7,i7 a prepaid inpati5t  
heal? plan1 z def9$ 9 section #dch4b (  
title #db1 ,code ( ,f$]al ,regulations  
7or any successor regulation72 &  7,,ii7
 a prepaid ambulatory heal? plan1 z     
def9$ 9 su* section 7or any successor   
regulation74  4  #djb4 ,ext5d+ p]iod (  
application ( ,m$ic>e second>y pay]     
rules = individuals ) end /age r5al     
disease ,section #ahfb7;b77#a77;,c7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciey7b77#a77;,c77 is am5d$--  7#a7 9 !
 la/ s5t5ce1 by ins]t+ & be=e ,janu>y   

#a1 #bjbj aft] date ( enactm5t ( !      
,balanc$ ,budget ,act ( #aiig2 &  7#b7  
by add+ at ! end ! foll[+ new s5t5ce3   
,effective = items & s]vices furni%$ on 
or aft] ,janu>y #a1 #bjbj 7) respect to 
p]iods beg9n+ on or aft] ,july #a1      
#bjah71 clauses 7i7 & 7ii7 %all be      
appli$ by sub/itut+ #cc-mon? = #ab-mon? 
ea* place x appe>s44  #djc4 ,requir+    
report+ by gr\p heal? plans (           
prescription drug cov]age in=mation =   
purposes ( id5tify+ prim>y pay]         
situations "u ! ,m$ic>e program ,clause 
7i7 ( section #ahfb7;b77#g77;,a7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciey7b77#g77;,a77 is am5d$ to read z  
foll[s3  7i7 secure f ! plan sponsor &  
plan p>ticipants su* in=mation z !      
,secret>y %all specify = ! purpose (    
id5tify+ situations :]e ! gr\p heal?    
plan is or has be5--  7,i7 a prim>y plan
 to ! program "u ?is title2 or  7,,ii7 =
 cal5d> qu>t]s beg9n+ on or aft] ,janu>y
 #a1 #bjbj1 a prim>y pay] ) respect to  
b5efits relat+ to prescription drug     

cov]age "u "p ,d2 &  4