,,ii  #aae? ,,congress  #b;d ,session   
,s4 #bije  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #bb1 #bjah ,mr4   
,toomey 7= himself & ,mrs4 ,mc,caskill7 
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = c]ta9 program integrity       
transp>5cy measures "u ,m$ic>e p>ts ,c &
 ,d4  #a4 ,%ort title ,?is ,act may be  
cit$ z ! ,/r5g!n+ ,p>tn]%ips to ,prev5t 
,opioid ,abuse ,act ( #bjah4  #b4       
,program integrity transp>5cy measures  
"u ,m$ic>e p>ts ,c & ,d  7a7 ,9 g5]al   
,section #ahei ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciew-#bh7 is am5d$
 by add+ at ! end ! foll[+ new          
subsection3  7i7 ,program integrity     
transp>5cy measures  7#a7 ,program      
integrity portal  7,a7 ,9 g5]al ,n lat] 
?an #b ye>s aft] ! date ( ! enactm5t (  
?is subsection1 ! ,secret>y %all1 aft]  
consultation ) /akehold]s1 e/abli% a    
secure ,int]net website portal t w\ld   

all[ a secure pa? = communication betwe5
 ! ,secret>y1 ,,ma plans "u ?is "p1     
prescription drug plans "u "p ,d1 & an  
eligible entity ) a contract "u section 
#ahic 7su* z a ,m$ic>e drug integrity   
contractor or any successor entity to a 
,m$ic>e drug integrity contractor71 9   
accordance ) subsection 7j77#c7 ( su*   
section1 = ! purpose ( enabl+ ?r\gh su* 
portal-- 7i7 ! ref]ral by su* plans (   
suspici\s activities ( a provid] (      
s]vices 7includ+ a prescrib]7 or suppli]
 relat$ to fraud1 wa/e1 & abuse =       
initiat+ or assi/+ inve/igations        
conduct$ by ! eligible entity2 &  7ii7  
data %>+ among su* ,,ma plans1          
prescription drug plans1 & ! ,secret>y  
7includ+ ) respect to in=mation =       
activities "u section #ahic7;j774  7,b7 
,requir$ uses ( portal ,! ,secret>y %all
 dissem9ate ! foll[+ in=mation to ,,ma  
plans "u ?is "p & prescription drug     
plans "u "p ,d ?r\gh ! secure ,int]net  
website portal e/abli%$ "u subp>agraph  
7,a73  7i7 ,provid]s ( s]vices &        

suppli]s t h be5 ref]r$ pursuant to     
subp>agraph 7,a77i7 dur+ ! previ\s      
#ab-mon? p]iod4  7ii7 ,provid]s (       
s]vices & suppli]s :o are ! subject ( an
 active exclusion "u section #aabh or :o
 are subject to a susp5sion ( paym5t "u 
?is title pursuant to section #ahfb7o7  
or o!rwise4  7iii7 ,provid]s ( s]vices &
 suppli]s :o are ! subject ( an active  
revocation ( p>ticipation "u ?is title1 
includ+ = n satisfy+ conditions (       
p>ticipation4  7iv7 ,9 ! case ( su* a   
plan t makes a ref]ral "u subp>agraph   
7,a77i7 ?r\gh ! portal ) respect to     
suspici\s activities ( a provid] (      
s]vices 7includ+ a prescrib]7 or        
suppli]1 if su* provid] 7or prescrib]7  
or suppli] has be5 ! subject ( an       
adm9i/rative action "u ?is title or     
title ,,xi ) respect to simil>          
activities1 a notification to su* plan (
 su* action s tak54  7,c7 ,rulemak+ ,=  
purposes ( ?is p>agraph1 ! ,secret>y    
%all1 ?r\gh rulemak+1 specify :at       
con/itutes sub/antiat$ fraud1 wa/e1 &   

abuse1 us+ guidance su* z :at is provid$
 9 ! ,m$ic>e ,program ,integrity ,manual
 #d4g4a4  7#b7 ,qu>t]ly reports ,beg9n+ 
n lat] ?an #b ye>s aft] ! date ( !      
enactm5t ( ?is subsection1 ! ,secret>y  
%all make available to ,,ma plans "u ?is
 "p & prescription drug plans "u "p ,d 9
 a timely mann] 7b no less frequ5tly ?an
 qu>t]ly7 & us+ in=mation submitt$ to an
 entity describ$ 9 p>agraph 7#a7 ?r\gh !
 portal describ$ 9 su* p>agraph or      
pursuant to section #ahic1 in=mation on 
fraud1 wa/e1 & abuse s*emes & tr5ds 9   
id5tify+ suspici\s activity4 ,in=mation 
includ$ 9 ea* su* report %all--  7,a7   
include adm9i/rative actions1 p]t95t    
in=mation relat$ to opioid ov]prescrib+1
 & o!r data det]m9$ appropriate by !    
,secret>y 9 consultation ) /akehold]s2 &
  7,b7 be anonymiz$ in=mation submitt$  
by plans )\t id5tify+ ! s\rce ( su*     
in=mation4  7#c7 ,cl>ification ,no?+ 9  
?is subsection %all preclude ref]rals to
 ! ,inspector ,g5]al ( ! ,dep>tm5t (    
,heal? & ,human ,s]vices or o!r law     

en=cem5t entities4  4  7b7 ,contract    
requirem5t ,to communicate plan         
corrective actions aga9/ opioids        
ov]-prescrib]s ,section                 
#aheg7;e77#d77;,c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#bg7;e77#d77;,c77 is am5d$ by    
add+ at ! end ! foll[+ new p>agraph3    
7#e7 ,communicat+ plan corrective       
actions aga9/ opioids ov]-prescrib]s    
7,a7 ,9 g5]al ,beg9n+ ) plan ye>s beg9n+
 on or aft] ,janu>y #a1 #bjba1 a        
contract "u ?is section ) an ,,ma       
organization %all require ! organization
 to submit to ! ,secret>y1 ?r\gh !      
process e/abli%$ "u subp>agraph 7,b71   
in=mation on cr$ible evid5ce ( suspect$ 
fraud & o!r actions tak5 by su* plans   
relat$ to inappropriate prescrib+ (     
opioids4  7,b7 ,process ,n lat] ?an     
,janu>y #a1 #bjba1 ! ,secret>y %all1 9  
consultation ) /akehold]s1 e/abli% a    
process "u :i* ,,ma plans & prescription
 drug plans %all submit to ! ,secret>y  
in=mation describ$ 9 subp>agraph 7,a74  

7,c7 ,regulations ,= purposes ( ?is     
p>agraph1 includ+ z appli$ "u section   
#ahfj;,d-#ab7;b77#c77;,d71 ! ,secret>y  
%all1 pursuant to rulemak+-- 7i7 specify
 a def9ition = ! t]m inappropriate      
prescrib+ ( opioids & a me?od = det]m9+ 
if a provid] ( s]vices prescribes su* a 
high volume2 &  7ii7 e/abli% ! process  
describ$ 9 subp>agraph 7,b7 & ! types ( 
in=mation t may be submitt$ ?r\gh su*   
process4  4  7c7 ,ref]5ce "u "p ,d to   
program integrity transp>5cy measures   
,section #ahfj;,d-#d ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajd7 is am5d$ by add+ at ! end !
 foll[+ new subsection3  7m7 ,program   
integrity transp>5cy measures ,= program
 integrity transp>5cy measures appli$ ) 
respect to prescription drug plan & ,,ma
 plans1 see section #ahei7;i74  4