,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #faaj  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,june #ad1 #bjah,mrs4 
,walorski 7= h]self1 ,ms4 ,judy ,*u (   
,cali=nia1 ,mrs4 ,noem1 ,mr4 ,m>*ant1   
,ms4 ,sn*ez1 ,mr4 ,blum5au]1 ,mr4       
,ro?fus1 ,mr4 ,roskam1 ,mr4 ,mac,arthur1
 & ,mr4 ,danny ,k4 ,davis ( ,ill9ois7   
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to provide = !   
review & adju/m5t ( paym5ts "u ! ,m$ic>e
 outpati5t prospective paym5t sy/em to  
avoid f9ancial inc5tives to use opioids 
in/ead ( non-opioid alt]native          
treatm5ts1 & = o!r purposes4  #a4 ,%ort 
title ,?is ,act may be cit$ z ! ,dr4    
,todd ,graham ,pa9 ,managem5t1          
,treatm5t1 & ,recov]y ,act ( #bjah4  #b4

 ,review & adju/m5t ( paym5ts "u !      
,m$ic>e outpati5t prospective paym5t    
sy/em to avoid f9ancial inc5tives to use
 opioids in/ead ( non-opioid alt]native 
treatm5ts  7a7 ,outpati5t prospective   
paym5t sy/em ,section #ahcc7t7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7t77 is am5d$ by add+ at ! end !  
foll[+ new p>agraph3  7#bb7 ,review &   
revisions ( paym5ts = non-opioid        
alt]native treatm5ts  7,a7 ,9 g5]al ,)  
respect to paym5ts made "u ?is          
subsection = cov]$ ,,opd s]vices 7or    
gr\ps ( s]vices71 includ+ cov]$ ,,opd   
s]vices assign$ to a compreh5sive       
ambulatory paym5t classification1 !     
,secret>y--  7i7 %all1 z soon z         
practicable1 conduct a review 7"p ( :i* 
may include a reque/ = in=mation7 (     
paym5ts = opioids & evid5ce-bas$        
non-opioid alt]natives = pa9 managem5t  
7includ+ drugs & devices1 n]ve blocks1  
surgical injections1 & neuromodulation7 
) a goal ( ensur+ t !re are n f9ancial  
inc5tives to use opioids in/ead (       

non-opioid alt]natives2  7ii7 may1 z !  
,secret>y det]m9es appropriate1 conduct 
subsequ5t reviews ( su* paym5ts2 &      
7iii7 %all consid] ! ext5t to :i*       
revisions "u ?is subsection to su*      
paym5ts 7su* z ! creation ( additional  
gr\ps ( cov]$ ,,opd s]vices to classify 
sep>ately ^? proc$ures t utilize opioids
 & non-opioid alt]natives = pa9         
managem5t7 w\ld r$uce paym5t inc5tives  
to use opioids in/ead ( non-opioid      
alt]natives = pa9 managem5t4  7,b7      
,priority ,9 conduct+ ! review "u clause
 7i7 ( subp>agraph 7,a7 & consid]+      
revisions "u clause 7iii7 ( su*         
subp>agraph1 ! ,secret>y %all focus on  
cov]$ ,,opd s]vices 7or gr\ps ( s]vices7
 assign$ to a compreh5sive ambulatory   
paym5t classification1 ambulatory paym5t
 classifications t prim>ily include     
surgical s]vices1 & o!r s]vices det]m9$ 
by ! ,secret>y :i* g5]ally involve      
treatm5t = pa9 managem5t4  7,c7         
,revisions ,if ! ,secret>y id5tifies    
revisions to paym5ts pursuant to        

subp>agraph 7,a77iii71 ! ,secret>y %all1
 z det]m9$ appropriate1 beg9 mak+ su*   
revisions = s]vices furni%$ on or aft]  
,janu>y #a1 #bjbj4 ,revisions "u !      
previ\s s5t5ce %all be treat$ z         
adju/m5ts = purposes ( application (    
p>agraph 7#i77;,b74  7,d7 ,rules (      
con/ruction ,no?+ 9 ?is p>agraph %all be
 con/ru$ to preclude ! ,secret>y-- 7i7 f
 conduct+ a demon/ration be=e mak+ !    
revisions describ$ 9 subp>agraph 7,c72  
or  7ii7 prior to implem5tation ( ?is   
p>agraph1 f *ang+ paym5ts "u ?is        
subsection = cov]$ ,,opd s]vices 7or    
gr\ps ( s]vices7 :i* include opioids or 
non-opioid alt]natives = pa9 managem5t4 
4  7b7 ,ambulatory surgical c5t]s       
,section #ahcc7;i7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciel7i77 is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#h7 ,! ,secret>y %all conduct a      
simil> type ( review z requir$ "u       
p>agraph 7#bb7 ( section #ahcc7t71      
includ+ ! second s5t5ce ( subp>agraph   
7,c7 ( su* p>agraph1 to paym5t = s]vices

 "u ?is subsection1 & make su* revisions
 "u ?is p>agraph1 9 an appropriate mann]
 7z det]m9$ by ! ,secret>y74  4  #c4    
,exp&+ access "u ! ,m$ic>e program to   
addiction treatm5t 9 ,f$]ally qualifi$  
heal? c5t]s & rural heal? cl9ics  7a7   
,f$]ally qualifi$ heal? c5t]s ,section  
#ahcd7o7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciem7o77 is am5d$ by add+  
at ! end ! foll[+ new p>agraph3  7#c7   
,additional paym5ts = c]ta9 ,f,q,h,cs ) 
physicians or o!r practition]s receiv+  
,,data #bjjj waiv]s  7,a7 ,9 g5]al ,9 ! 
case ( a ,f$]ally qualifi$ heal? c5t] ) 
respect to :i*1 beg9n+ on or aft]       
,janu>y #a1 #bjai1 ,f$]ally qualifi$    
heal? c5t] s]vices 7z def9$ 9 section   
#ahfa7;aa77#c77 are furni%$ = ! treatm5t
 ( opioid use disord] by a physician or 
practition] :o meets ! requirem5ts      
describ$ 9 subp>agraph 7,c7 ! ,secret>y 
%all1 subject to availability ( funds "u
 subp>agraph 7,d71 make a paym5t 7at su*
 "t & 9 su* mann] z specifi$ by !       
,secret>y7 to su* ,f$]ally qualifi$     

heal? c5t] aft] receiv+ & approv+ an    
application submitt$ by su* ,f$]ally    
qualifi$ heal? c5t] "u subp>agraph 7,b74
 ,su* a paym5t %all be 9 an am\nt       
det]m9$ by ! ,secret>y1 bas$ on an      
e/imate ( ! av]age co/s ( tra9+ =       
purposes ( receiv+ a waiv] describ$ 9   
subp>agraph 7,c77ii74 ,su* a paym5t may 
be made only "o "t ) respect to ea* su* 
physician or practition]4  7,b7         
,application ,9 ord] to receive a paym5t
 describ$ 9 subp>agraph 7,a71 a ,f$]ally
 qualifi$ heal? c5t] %all submit to !   
,secret>y an application = su* a paym5t 
at su* "t1 9 su* mann]1 & conta9+ su*   
in=mation z specifi$ by ! ,secret>y4 ,a 
,f$]ally qualifi$ heal? c5t] may apply =
 su* a paym5t = ea* physician or        
practition] describ$ 9 subp>agraph 7,a7 
furni%+ s]vices describ$ 9 su*          
subp>agraph at su* c5t]4  7,c7          
,requirem5ts ,= purposes ( subp>agraph  
7,a71 ! requirem5ts describ$ 9 ?is      
subp>agraph1 ) respect to a physician or
 practition]1 are ! foll[+3  7i7 ,!     

physician or practition] is employ$ by  
or work+ "u contract ) a ,f$]ally       
qualifi$ heal? c5t] describ$ 9          
subp>agraph 7,a7 t submits an           
application "u subp>agraph 7,b74  7ii7  
,! physician or practition] fir/        
receives a waiv] "u section #cjc7;g7 ( !
 ,controll$ ,sub/ances ,act on or aft]  
,janu>y #a1 #bjai4  7,d7 ,fund+ ,=      
purposes ( mak+ paym5ts "u ?is p>agraph1
 !re are appropriat$1 out ( am\nts 9 !  
,treasury n o!rwise appropriat$1        
#f1jjj1jjj1 :i* %all rema9 available    
until exp5d$4  4  7b7 ,rural heal? cl9ic
 ,section #ahcc ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciel7 is am5d$--  
7#a7 by r$esignat+ ! subsection 7z7     
relat+ to m$ical review ( sp9al         
subluxation s]vices z subsection 7aa72 &
  7#b7 by add+ at ! end ! foll[+ new    
subsection3  7bb7 ,additional paym5ts = 
c]ta9 rural heal? cl9ics ) physicians or
 practition]s receiv+ ,,data #bjjj      
waiv]s  7#a7 ,9 g5]al ,9 ! case ( a     
rural heal? cl9ic ) respect to :i*1     

beg9n+ on or aft] ,janu>y #a1 #bjai1    
rural heal? cl9ic s]vices 7z def9$ 9    
section #ahfa7;aa77#a77 are furni%$ = ! 
treatm5t ( opioid use disord] by a      
physician or practition] :o meets !     
requirem5ts describ$ 9 p>agraph 7#c71 ! 
,secret>y %all1 subject to availability 
( funds "u p>agraph 7#d71 make a paym5t 
7at su* "t & 9 su* mann] z specifi$ by !
 ,secret>y7 to su* rural heal? cl9ic    
aft] receiv+ & approv+ an application   
describ$ 9 p>agraph 7#b74 ,su* paym5t   
%all be 9 an am\nt det]m9$ by !         
,secret>y1 bas$ on an e/imate ( ! av]age
 co/s ( tra9+ = purposes ( receiv+ a    
waiv] describ$ 9 p>agraph 7#c77;,b74    
,su* paym5t may be made only "o "t )    
respect to ea* su* physician or         
practition]4  7#b7 ,application ,9 ord] 
to receive a paym5t describ$ 9 p>agraph 
7#a71 a rural heal? cl9ic %all submit to
 ! ,secret>y an application = su* a     
paym5t at su* "t1 9 su* mann]1 & conta9+
 su* in=mation z specifi$ by !          
,secret>y4 ,a rural heal? cl9ic may     

apply = su* a paym5t = ea* physician or 
practition] describ$ 9 p>agraph 7#a7    
furni%+ s]vices describ$ 9 su* p>agraph 
at su* cl9ic4  7#c7 ,requirem5ts ,=     
purposes ( p>agraph 7#a71 ! requirem5ts 
describ$ 9 ?is p>agraph1 ) respect to a 
physician or practition]1 are ! foll[+3 
7,a7 ,! physician or practition] is     
employ$ by or work+ "u contract ) a     
rural heal? cl9ic describ$ 9 p>agraph   
7#a7 t submits an application "u        
p>agraph 7#b74  7,b7 ,! physician or    
practition] fir/ receives a waiv] "u    
section #cjc7;g7 ( ! ,controll$         
,sub/ances ,act on or aft] ,janu>y #a1  
#bjai4  7#d7 ,fund+ ,= purposes ( mak+  
paym5ts "u ?is subsection1 !re are      
appropriat$1 out ( am\nts 9 ! ,treasury 
n o!rwise appropriat$1 #b1jjj1jjj1 :i*  
%all rema9 available until exp5d$4  4   
#d4 ,/udy+ ! availability ( supplem5tal 
b5efits design$ to treat or prev5t      
sub/ance use disord]s "u ,m$ic>e        
,advantage plans  7a7 ,9 g5]al ,n lat]  
?an #b ye>s aft] ! date ( ! enactm5t (  

?is ,act1 ! ,secret>y ( ,heal? & ,human 
,s]vices 79 ?is section ref]r$ to z !   
,secret>y7 %all submit to ,congress a   
report on ! availability ( supplem5tal  
heal? c>e b5efits 7z describ$ 9 section 
#aheb7;a77#c77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#bb7;a77#c77;,a777 design$ to    
treat or prev5t sub/ance use disord]s "u
 ,m$ic>e ,advantage plans (f]$ "u "p ,c 
( title ,,xviii ( su* ,act4 ,su* report 
%all include ! analysis describ$ 9      
subsection 7c7 & any diff]5ces 9 !      
availability ( su* b5efits "u specializ$
 ,,ma plans = special ne$s individuals  
7z def9$ 9 section #ahei7;b77#f7 ( su*  
,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f777
 (f]$ to individuals entitl$ to m$ical  
assi/ance "u title ,,xix ( su* ,act &   
o!r su* ,m$ic>e ,advantage plans4  7b7  
,consultation ,! ,secret>y %all develop 
! report describ$ 9 subsection 7a7 9    
consultation ) relevant /akehold]s1     
includ+--  7#a7 individuals entitl$ to  
b5efits "u "p ,a or enroll$ "u "p ,b (  

title ,,xviii ( ! ,social ,security     
,act2  7#b7 entities :o advocate on     
behalf ( su* individuals2  7#c7 ,m$ic>e 
,advantage organizations2  7#d7 ph>macy 
b5efit manag]s2 &  7#e7 provid]s (      
s]vices & suppli]s 7z su* t]ms are def9$
 9 section #ahfa ( su* ,act 7#db        
,u4,s4,c4 #aciex774  7c7 ,cont5ts ,!    
report describ$ 9 subsection 7a7 %all   
include an analysis on ! foll[+3 7#a7 ,!
 ext5t to :i* plans describ$ 9 su*      
subsection (f] supplem5tal heal? c>e    
b5efits relat+ to cov]age (--  7,a7     
m$ication-assi/$ treatm5ts = opioid use1
 sub/ance use disord] c\nsel+1 pe]      
recov]y support s]vices1 or o!r =ms (   
sub/ance use disord] treatm5ts 7:e!r    
furni%$ 9 an inpati5t or outpati5t      
sett+72 &  7,b7 non-opioid alt]natives =
 ! treatm5t ( pa94  7#b7 ,*all5ges      
associat$ ) su* plans (f]+ supplem5tal  
heal? c>e b5efits relat+ to cov]age (   
items & s]vices describ$ 9 subp>agraph  
7,a7 or 7,b7 ( p>agraph 7#a74  7#c7 ,!  
impact1 if any1 ( increas+ ! applicable 

rebate p]c5tage det]m9$ "u section      
#ahed7;b77#a77;,c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#bd7;b77#a77;,c77 = plans (f]+   
su* b5efits relat+ to su* cov]age w\ld h
 on ! availability ( su* b5efits relat+ 
to su* cov]age (f]$ "u ,m$ic>e          
,advantage plans4  7#d7 ,pot5tial ways  
to improve ^u su* cov]age or to         
inc5tivize su* plans to (f] additional  
supplem5tal heal? c>e b5efits relat+ to 
su* cov]age4  #e4 ,cl9ical psy*ologi/   
s]vices models "u ! ,c5t] = ,m$ic>e &   
,m$icaid ,innovation2 ,,gao /udy &      
report  7a7 ,,cmi models ,section       
#aaae;,a7b77#b77;,b7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acae;a7b77#b77;,b77 is am5d$ by add+ at
 ! end ! foll[+ new clauses3  7xxv7     
,support+ ways to famili>ize individuals
 ) ! availability ( cov]age "u "p ,b (  
title ,,xviii = qualifi$ psy*ologi/     
s]vices 7z def9$ 9 section #ahfa7;ii774 
7xxvi7 ,explor+ ways to avoid unnecess>y
 hospitalizations or em]g5cy dep>tm5t   

visits = m5tal & behavioral heal?       
s]vices 7su* z = treat+ depression7     
?r\gh use ( a #bd-;h\r1 #g-;day a week  
help l9e t may in=m individuals ab\t !  
availability ( treatm5t options1 includ+
 ! availability ( qualifi$ psy*ologi/   
s]vices 7z def9$ 9 section #ahfa7;ii774 
4  7b7 ,,gao /udy & report ,n lat] ?an  
#ah mon?s aft] ! date ( ! enactm5t ( ?is
 ,act1 ! ,comptroll] ,g5]al ( ! ,unit$  
,/ates %all conduct a /udy1 & submit to 
,congress a report1 on m5tal &          
behavioral heal? s]vices "u ! ,m$ic>e   
program "u title ,,xviii ( ! ,social    
,security ,act1 includ+ an exam9ation ( 
! foll[+3  7#a7 ,in=mation ab\t s]vices 
furni%$ by psy*iatri/s1 cl9ical         
psy*ologi/s1 & o!r pr(essionals4  7#b7  
,in=mation ab\t ways t ,m$ic>e          
b5efici>ies famili>ize !mselves ab\t !  
availability ( ,m$ic>e paym5t = qualifi$
 psy*ologi/ s]vices 7z def9$ 9 section  
#ahfa7;ii7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #aciex7ii77 & ways t !   
provision ( su* in=mation c\ld be       

improv$4  #f4 ,pa9 managem5t /udy  7a7  
,9 g5]al ,n lat] ?an #a ye> aft] ! date 
( enactm5t ( ?is ,act1 ! ,secret>y (    
,heal? & ,human ,s]vices 7ref]r$ to 9   
?is section z ! 8,secret>y07 %all       
conduct a /udy analyz+ be/ practices z  
well z paym5t & cov]age = pa9 managem5t 
s]vices "u title ,,xviii ( ! ,social    
,security ,act & submit to ! ,committee 
on ,ways & ,means & ! ,committee on     
,en]gy & ,comm]ce ( ! ,h\se (           
,repres5tatives & ! ,committee on       
,f9ance ( ! ,s5ate a report conta9+     
options = revis+ paym5t to provid]s &   
suppli]s ( s]vices & cov]age relat$ to !
 use ( multi-discipl9>y1 evid5ce-bas$1  
non-opioid treatm5ts = acute & *ronic   
pa9 managem5t = individuals entitl$ to  
b5efits "u "p ,a or enroll$ "u "p ,b (  
title ,,xviii ( ! ,social ,security     
,act4 ,! ,secret>y %all make su* report 
available on ! public website ( ! ,c5t]s
 = ,m$ic>e  ,m$icaid ,s]vices4  7b7     
,consultation ,9 develop+ ! report      
describ$ 9 subsection 7a71 ! ,secret>y  

%all consult )-- 7#a7 relevant ag5cies  
)9 ! ,dep>tm5t ( ,heal? & ,human        
,s]vices2  7#b7 lic5s$ & practic+       
o/eopa?ic & allopa?ic physicians1       
behavioral heal? practition]s1 physician
 assi/ants1 nurse practition]s1 d5ti/s1 
ph>maci/s1 & o!r provid]s ( heal?       
s]vices2  7#c7 provid]s & suppli]s (    
s]vices 7z su* t]ms are def9$ 9 section 
#ahfa ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #aciex772  7#d7 sub/ance abuse
 & m5tal heal? pr(essional              
organizations2  7#e7 pa9 managem5t      
pr(essional organizations & advocacy    
entities1 includ+ individuals :o        
p]sonally suff] *ronic pa92  7#f7 m$ical
 pr(essional organizations & m$ical     
specialty organizations2  7#g7 lic5s$   
heal? c>e provid]s :o furni% alt]native 
pa9 managem5t s]vices2  7#h7            
organizations ) exp]tise 9 ! developm5t 
( innovative m$ical te*nologies = pa9   
managem5t2  7#i7 b5efici>y advocacy     
organizations2 &  7#aj7 o!r             
organizations ) exp]tise 9 ! assessm5t1 

diagnosis1 treatm5t1 & managem5t ( pa91 
z det]m9$ appropriate by ! ,secret>y4   
7c7 ,cont5ts ,! report describ$ 9       
subsection 7a7 %all include ! foll[+3   
7#a7 ,an analysis ( paym5t & cov]age "u 
title ,,xviii ( ! ,social ,security ,act
 ) respect to ! foll[+3  7,a7           
,evid5ce-bas$ treatm5ts & te*nologies = 
*ronic or acute pa91 includ+ su*        
treatm5ts t are cov]$1 n cov]$1 or h    
limit$ cov]age "u su* title4  7,b7      
,evid5ce-bas$ treatm5ts & te*nologies t 
monitor sub/ance use )drawal & prev5t   
ov]doses ( opioids4  7,c7 ,evid5ce-bas$ 
treatm5ts & te*nologies t treat sub/ance
 use disord]s4  7,d7 ,items & s]vices   
furni%$ by practition]s ?r\gh a         
multi-discipl9>y treatm5t model = pa9   
managem5t1 includ+ ! pati5t-c5t]$ m$ical
 home4  7,e7 ,m$ical devices1 non-opioid
 bas$ drugs1 & o!r !rapies 7includ+     
int]v5tional & integrative pa9 !rapies7 
approv$ or cle>$ by ! ,food & ,drug     
,adm9i/ration = ! treatm5t ( pa94  7,f7 
,items & s]vices furni%$ to b5efici>ies 

) psy*iatric disord]s1 sub/ance use     
disord]s1 or :o are at risk ( suicide1  
or h comorbidities & require            
consultation or managem5t ( pa9 ) "o or 
m speciali/s 9 pa9 managem5t1 m5tal     
heal?1 or addiction treatm5t4  7#b7 ,an 
evaluation ( ! foll[+3 7,a7 ,b>ri]s     
inhibit+ individuals entitl$ to b5efits 
"u "p ,a or enroll$ "u "p ,b ( su* title
 f access+ treatm5ts & te*nologies      
describ$ 9 subp>agraphs 7,a7 ?r\gh 7,f7 
( p>agraph 7#a74  7,b7 ,co/s & b5efits  
associat$ ) pot5tial expansion ( cov]age
 "u su* title to include items & s]vices
 n cov]$ "u su* title t may be us$ = !  
treatm5t ( pa91 su* z acupuncture1      
!rapeutic massage1 & items & s]vices    
furni%$ by integrat$ pa9 managem5t      
programs4  7,c7 ,pa9 managem5t guidance 
publi%$ by ! ,f$]al ,gov]nm5t t may be  
relevant to cov]age det]m9ations or o!r 
cov]age requirem5ts "u title ,,xviii ( !
 ,social ,security ,act4  7#c7 ,an      
assessm5t ( all guidance publi%$ by !   
,dep>tm5t ( ,heal? & ,human ,s]vices on 

or aft] ,janu>y #a1 #bjaf1 relat+ to !  
prescrib+ ( opioids4 ,su* assessm5t %all
 consid] incorporat+ into su* guidance  
relevant elem5ts ( ! ,va_/,do,d ,cl9ical
 ,practice ,guidel9e = ,opioid ,!rapy = 
,*ronic ,pa9 publi%$ 9 ,febru>y #bjag by
 ! ,dep>tm5t ( ,vet]ans ,affairs &      
,dep>tm5t ( ,def5se1 includ+ adoption ( 
elem5ts ( ! ,dep>tm5t ( ,def5se &       
,vet]ans ,adm9i/ration pa9 rat+ scale4  
7#d7 ,! options describ$ 9 subsection   
7d74  7#e7 ,! impact analysis describ$ 9
 subsection 7e74  7d7 ,options ,!       
options describ$ 9 ?is subsection are1 )
 respect to individuals entitl$ to      
b5efits "u "p ,a or enroll$ "u "p ,b (  
title ,,xviii ( ! ,social ,security     
,act1 legislative & adm9i/rative options
 = accompli%+ ! foll[+3  7#a7 ,improv+  
cov]age ( & paym5t = pa9 managem5t      
!rapies )\t ! use ( opioids1 includ+    
int]v5tional pa9 !rapies1 & options to  
augm5t opioid !rapy ) o!r cl9ical &     
complem5t>y1 integrative heal? s]vices  
to m9imize ! risk ( sub/ance use        

disord]1 includ+ 9 a hospital sett+4    
7#b7 ,improv+ cov]age ( & paym5t =      
m$ical devices & non-opioid bas$        
ph>macological & non-ph>macological     
!rapies approv$ or cle>$ by ! ,food &   
,drug ,adm9i/ration = ! treatm5t ( pa9 z
 an alt]native or augm5t to opioid      
!rapy4  7#c7 ,improv+ & dissem9at+      
treatm5t /rategies = b5efici>ies )      
psy*iatric disord]s1 sub/ance use       
disord]s1 or :o are at risk ( suicide1 &
 treatm5t /rategies to address heal?    
disp>ities relat$ to opioid use & opioid
 abuse treatm5t4  7#d7 ,improv+ &       
dissem9at+ treatm5t /rategies =         
b5efici>ies ) comorbidities :o require a
 consultation or comanagem5t ( pa9 ) "o 
or m speciali/s 9 pa9 managem5t1 m5tal  
heal?1 or addiction treatm5t1 includ+ 9 
a hospital sett+4  7#e7 ,educat+        
provid]s on risks ( coadm9i/ration (    
opioids & o!r drugs1 p>ticul>ly         
b5zodiazep9es4  7#f7 ,ensur+ appropriate
 case managem5t = b5efici>ies :o        
transition betwe5 inpati5t & outpati5t  

hospital sett+s1 or betwe5 opioid !rapy 
to non-opioid !rapy1 :i* may include !  
use ( c>e transition plans4  7#g7 ,exp&+
 outrea* activities design$ to educate  
provid]s ( s]vices & suppli]s "u !      
,m$ic>e program & individuals entitl$ to
 b5efits "u "p ,a or "u "p ,b ( su*     
title on alt]native1 non-opioid !rapies 
to manage & treat acute & *ronic pa94   
7#h7 ,creat+ a b5efici>y education tool 
on alt]natives to opioids = *ronic pa9  
managem5t4  7e7 ,impact analysis ,!     
impact analysis describ$ 9 ?is          
subsection consi/s ( an analysis ( any  
pot5tial effects implem5t+ ! options    
describ$ 9 subsection 7d7 w\ld h--  7#a7
 on exp5ditures "u ! ,m$ic>e program2 & 
7#b7 on prev5t+ or r$uc+ opioid         
addiction = individuals receiv+ b5efits 
"u ! ,m$ic>e program4  #g4 ,susp5sion ( 
paym5ts by ,m$ic>e prescription drug    
plans & ,,ma-,,pd plans p5d+            
inve/igations ( cr$ible allegations (   
fraud by ph>macies  7a7 ,9 g5]al        
,section #ahfj;,d-#ab7;b7 ( ! ,social   

,security ,act 7#db ,u4,s4,c4           
#aciew-#aab7;b77 is am5d$ by add+ at !  
end ! foll[+ new p>agraph3  7#g7        
,susp5sion ( paym5ts p5d+ inve/igation (
 cr$ible allegations ( fraud by         
ph>macies  7,a7 ,9 g5]al ,! provisions (
 section #ahfb7o7 %all apply ) respect  
to a ,,pdp sponsor ) a contract "u ?is  
"p1 a ph>macy1 & paym5ts to su* ph>macy 
"u ?is "p 9 ! same mann] z su*          
provisions apply ) respect to !         
,secret>y1 a provid] ( s]vices or       
suppli]1 & paym5ts to su* provid] (     
s]vices or suppli] "u ?is title4  7,b7  
,rule ( con/ruction ,no?+ 9 ?is p>agraph
 %all be con/ru$ z limit+ ! au?ority ( a
 ,,pdp sponsor to conduct po/paym5t     
review4  4  7b7 ,application to         
,,ma-,,pd plans ,section #aheg7;f77#c7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciew-#bg7;f77#c77 is am5d$ by add+ at
 ! end ! foll[+ new subp>agraph3  7,d7  
,susp5sion ( paym5ts p5d+ inve/igation (
 cr$ible allegations ( fraud by         
ph>macies ,section #ahfj;,d-#ab7;b77#g74

  4  7c7 ,con=m+ am5dm5t ,section       
#ahfb7o77#c7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciey7o77#c77 is am5d$  
by ins]t+ 1 section #ahfj;,d-#ab7;b77#g7
 7includ+ z appli$ pursuant to section  
#aheg7;f77#c77;,d771 aft] ?is           
subsection4  7d7 ,cl>ification relat+ to
 cr$ible allegation ( fraud ,section    
#ahfb7o7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciey7o77 is am5d$ by add+  
at ! end ! foll[+ new p>agraph3  7#d7   
,cr$ible allegation ( fraud ,9 c>ry+ out
 ?is subsection1 section                
#ahfj;,d-#ab7;b77#g7 7includ+ z appli$  
pursuant to section #aheg7;f77#c77;,d771
 & section #aijc7;i77#b77;,c71 a fraud  
hotl9e tip 7z def9$ by ! ,secret>y7 )\t 
fur!r evid5ce %all n be treat$ z        
suffici5t evid5ce = a cr$ible allegation
 ( fraud4  4  7e7 ,effective date ,!    
am5dm5ts made by ?is section %all apply 
) respect to plan ye>s beg9n+ on or aft]
 ,janu>y #a1 #bjbj4