,,ii ,calendar ,no4 #dhd #aaeth ,,congress #b;d ,session ,s4 #cabj ,report ,no4 #aae-bhd ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #be1 #bjah ,mr4 ,hatch1 from the ,committee on ,finance1 reported the following original bill2 which was read twice and placed on the calendar ,a ,,bill ,to amend titles ,,xviii and ,,xix of the ,social ,security ,act to help end addictions and lessen substance abuse disorders1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,helping to ,end ,addiction and ,lessen ,substance ,use ,disorders ,act of #bjah or the ,,heal ,act of #bjah4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,,title ,i--,medicare ,sec4 #aja4 ,medicare opioid safety education4 ,sec4 #ajb4 ,expanding the use of telehealth services for the treatment of opioid use disorder and other substance use disorders4 ,sec4 #ajc4 ,comprehensive screenings for seniors4 ,sec4 #ajd4 ,every prescription conveyed securely4 ,sec4 #aje4 ,standardizing electronic prior authorization for safe prescribing4 ,sec4 #ajf4 ,strengthening partnerships to prevent opioid abuse4 ,sec4 #ajg4 ,commit to opioid medical prescriber accountability and safety for seniors4 ,sec4 #ajh4 ,fighting the opioid epidemic with sunshine4 ,sec4 #aji4 ,demonstration testing coverage of certain services furnished by opioid treatment programs4 ,sec4 #aaj4 ,encouraging appropriate prescribing under ,medicare for victims of opioid overdose4 ,sec4 #aaa4 ,automatic escalation to external review under a ,medicare part ,d drug management program for at-risk beneficiaries4 ,sec4 #aab4 ,medicare ,improvement ,fund4 ,,title ,,ii--,medicaid ,sec4 #bja4 ,caring recovery for infants and babies4 ,sec4 #bjb4 ,peer support enhancement and evaluation review4 ,sec4 #bjc4 ,medicaid substance use disorder treatment via telehealth4 ,sec4 #bjd4 ,enhancing patient access to non-opioid treatment options4 ,sec4 #bje4 ,assessing barriers to opioid use disorder treatment4 ,sec4 #bjf4 ,help for moms and babies4 ,sec4 #bjg4 ,securing flexibility to treat substance use disorders4 ,sec4 #bjh4 ,,macpac study and report on ,,mat utilization controls under ,state ,medicaid programs4 ,sec4 #bji4 ,opioid addiction treatment programs enhancement4 ,sec4 #baj4 ,better data sharing to combat the opioid crisis4 ,sec4 #baa4 ,mandatory reporting with respect to adult behavioral health measures4 ,sec4 #bab4 ,report on innovative ,state initiatives and strategies to provide housing-related services and supports to individuals struggling with substance use disorders under ,medicaid4 ,sec4 #bac4 ,technical assistance and support for innovative ,state strategies to provide housing-related supports under ,medicaid4 ,,title ,,iii--,human ,services ,sec4 #cja4 ,supporting family-focused residential treatment4 ,sec4 #cjb4 ,improving recovery and reunifying families4 ,sec4 #cjc4 ,building capacity for family-focused residential treatment4 ,i ,medicare #aja4 ,medicare opioid safety education 7a7 ,in general ,section #ahjd of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is amended by adding at the end the following new subsection3 7d7 ,the notice provided under subsection 7a7 shall include-- 7#a7 references to educational resources regarding opioid use and pain management2 7#b7 a description of categories of alternative1 non-opioid pain management treatments covered under this title2 and 7#c7 a suggestion for the beneficiary to talk to a physician regarding opioid use and pain management4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to notices distributed prior to each ,medicare open enrollment period beginning after ,january #a1 #bjai4 #ajb4 ,expanding the use of telehealth services for the treatment of opioid use disorder and other substance use disorders ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7#a7 in paragraph 7#b77;,b7-- 7,a7 in clause 7i71 in the matter preceding subclause 7,i71 by striking clause 7ii7 and inserting clause 7ii7 and paragraph 7#f77;,c72 and 7,b7 in clause 7ii71 in the heading1 by striking for home dialysis therapy2 7#b7 in paragraph 7#d77;,c7-- 7,a7 in clause 7i71 by striking paragraph 7#f7 and inserting paragraphs 7#e71 7#f71 and 7#g72 and 7,b7 in clause 7ii77,x71 by inserting or telehealth services described in paragraph 7#g77;,a7 before the period at the end2 and 7#c7 by adding at the end the following new paragraph3 7#g7 ,treatment of substance use disorder services furnished through telehealth 7,a7 ,non-application of originating site geographic requirements ,the geographic requirements described in paragraph 7#d77;,c77i7 shall not apply with respect to telehealth services furnished on or after ,january #a1 #bjai1 to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder1 as determined by the ,secretary1 at an originating site described in paragraph 7#d77;,c77ii7 7other than an originating site described in subclause 7,,ix7 of such paragraph74 7,b7 ,implementation ,the ,secretary may implement the provisions of this paragraph by interim final rule4 7,c7 ,report ,not later than #e years after the date of the enactment of this paragraph1 the ,secretary shall submit to ,congress a report on the impact of this paragraph with respect to telehealth services on-- 7i7 the utilization of health care items and services related to substance use disorders1 including emergency department visits2 and 7ii7 health outcomes related to substance use disorders1 such as opioid overdose deaths4 4 #ajc4 ,comprehensive screenings for seniors 7a7 ,initial preventive physical examination ,section #ahfa7ww7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ww77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 by striking paragraph 7#b7 and and inserting paragraph 7#b712 and 7,b7 by inserting and the furnishing of a review of any current opioid prescriptions 7as defined in paragraph 7#d771 after #8#8upon the agreement with the individual102 and 7#b7 in paragraph 7#b7-- 7,a7 by redesignating subparagraph 7,n7 as subparagraph 7,o72 and 7,b7 by inserting after subparagraph 7,m7 the following new subparagraph3 7,n7 ,screening for potential substance use disorders4 2 and 7#c7 by adding at the end the following new paragraph3 7#d7 ,for purposes of paragraph 7#a71 the term a review of any current opioid prescriptions means1 with respect to an individual determined to have a current prescription for opioids-- 7,a7 a review of the potential risk factors to the individual for opioid use disorder2 7,b7 an evaluation of the individual's severity of pain and current treatment plan2 7,c7 the provision of information on non-opioid treatment options2 and 7,d7 a referral to a pain management specialist1 as appropriate4 4 7b7 ,annual wellness visit ,section #ahfa7;hhh77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7hhh77#b77 is amended-- 7#a7 by redesignating subparagraph 7,g7 as subparagraph 7,i72 and 7#b7 by inserting after subparagraph 7,f7 the following new subparagraphs3 7,g7 ,screening for potential substance use disorders and referral for treatment as appropriate4 7,h7 ,the furnishing of a review of any current opioid prescriptions 7as defined in subsection 7ww77#d774 4 7c7 ,effective date ,the amendments made by this section shall apply to examinations and visits furnished on or after ,january #a1 #bjai4 #ajd4 ,every prescription conveyed securely 7a7 ,in general ,section #ahfj;,d-#d7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;e77 is amended by adding at the end the following3 7#g7 ,requirement of e-prescribing for controlled substances 7,a7 ,in general ,subject to subparagraph 7,b71 a prescription for a covered part ,d drug under a prescription drug plan 7or under an ,,ma-,,pd plan7 for a schedule ,,ii1 ,,iii1 ,,iv1 or ,v controlled substance shall be transmitted by a health care practitioner electronically in accordance with an electronic prescription drug program that meets the requirements of paragraph 7#b74 7,b7 ,exception for certain circumstances ,the ,secretary shall1 through rulemaking1 specify circumstances and processes by which the ,secretary may waive the requirement under subparagraph 7,a71 with respect to a covered part ,d drug1 including in the case of-- 7i7 a prescription issued when the practitioner and dispensing pharmacy are the same entity2 7ii7 a prescription issued that cannot be transmitted electronically under the most recently implemented version of the ,national ,council for ,prescription ,drug ,programs ,,script ,standard2 7iii7 a prescription issued by a practitioner who received a waiver or a renewal thereof for a period of time as determined by the ,secretary1 not to exceed one year1 from the requirement to use electronic prescribing due to demonstrated economic hardship1 technological limitations that are not reasonably within the control of the practitioner1 or other exceptional circumstance demonstrated by the practitioner2 7iv7 a prescription issued by a practitioner under circumstances in which1 notwithstanding the practitioner's ability to submit a prescription electronically as required by this subsection1 such practitioner reasonably determines that it would be impractical for the individual involved to obtain substances prescribed by electronic prescription in a timely manner1 and such delay would adversely impact the individual's medical condition involved2 7v7 a prescription issued by a practitioner prescribing a drug under a research protocol2 7vi7 a prescription issued by a practitioner for a drug for which the ,food and ,drug ,administration requires a prescription to contain elements that are not able to be included in electronic prescribing such as1 a drug with risk evaluation and mitigation strategies that include elements to assure safe use2 7vii7 a prescription issued by a practitioner-- 7,i7 for an individual who receives hospice care under this title2 and 7,,ii7 that is not covered under the hospice benefit under this title2 and 7viii7 a prescription issued by a practitioner for an individual who is-- 7,i7 a resident of a nursing facility 7as defined in section #aiai7;a772 and 7,,ii7 dually eligible for benefits under this title and title ,,xix4 7,c7 ,dispensing 7i7 ,nothing in this paragraph shall be construed as requiring a sponsor of a prescription drug plan under this part1 ,,ma organization offering an ,,ma-,,pd plan under part ,c1 or a pharmacist to verify that a practitioner1 with respect to a prescription for a covered part ,d drug1 has a waiver 7or is otherwise exempt7 under subparagraph 7,b7 from the requirement under subparagraph 7,a74 7ii7 ,nothing in this paragraph shall be construed as affecting the ability of the plan to cover or the pharmacists' ability to continue to dispense covered part ,d drugs from otherwise valid written1 oral or fax prescriptions that are consistent with laws and regulations4 7iii7 ,nothing in this paragraph shall be construed as affecting the ability of an individual who is being prescribed a covered part ,d drug to designate a particular pharmacy to dispense the covered part ,d drug to the extent consistent with the requirements under subsection 7b77#a7 and under this paragraph4 7,d7 ,enforcement ,the ,secretary shall1 through rulemaking1 have authority to enforce and specify appropriate penalties for non-compliance with the requirement under subparagraph 7,a74 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to coverage of drugs prescribed on or after ,january #a1 #bjba4 #aje4 ,standardizing electronic prior authorization for safe prescribing ,section #ahfj;,d-#d7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;e77#b77 is amended by adding at the end the following new subparagraph3 7,e7 ,electronic prior authorization 7i7 ,in general ,not later than ,january #a1 #bjba1 the program shall provide for the secure electronic transmittal of-- 7,i7 a prior authorization request from the prescribing health care professional for coverage of a covered part ,d drug for a part ,d eligible individual enrolled in a part ,d plan 7as defined in section #ahfj;,d-#bc7;a77#e77 to the ,,pdp sponsor or ,medicare ,advantage organization offering such plan2 and 7,,ii7 a response1 in accordance with this subparagraph1 from such ,,pdp sponsor or ,medicare ,advantage organization1 respectively1 to such professional4 7ii7 ,electronic transmission 7,i7 ,exclusions ,for purposes of this subparagraph1 a facsimile1 a proprietary payer portal that does not meet standards specified by the ,secretary1 or an electronic form shall not be treated as an electronic transmission described in clause 7i74 7,,ii7 ,standards ,in order to be treated1 for purposes of this subparagraph1 as an electronic transmission described in clause 7i71 such transmission shall comply with technical standards adopted by the ,secretary in consultation with the ,national ,council for ,prescription ,drug ,programs1 other standard setting organizations determined appropriate by the ,secretary1 and stakeholders including ,,pdp sponsors1 ,medicare ,advantage organizations1 health care professionals1 and health information technology software vendors4 7,,iii7 ,application ,notwithstanding any other provision of law1 for purposes of this subparagraph1 the ,secretary may require the use of such standards adopted under subclause 7,,ii7 in lieu of any other applicable standards for an electronic transmission described in clause 7i7 for a covered part ,d drug for a part ,d eligible individual4 4 #ajf4 ,strengthening partnerships to prevent opioid abuse 7a7 ,in general ,section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 is amended by adding at the end the following new subsection3 7i7 ,program integrity transparency measures 7#a7 ,program integrity portal 7,a7 ,in general ,not later than #b years after the date of the enactment of this subsection1 the ,secretary shall1 after consultation with stakeholders1 establish a secure ,internet website portal that would allow a secure path for communication between the ,secretary1 ,,ma plans under this part1 prescription drug plans under part ,d1 and an eligible entity with a contract under section #ahic 7such as a ,medicare drug integrity contractor or any successor entity to a ,medicare drug integrity contractor71 in accordance with subsection 7j77#c7 of such section1 for the purpose of enabling through such portal-- 7i7 the referral by such plans of suspicious activities of a provider of services 7including a prescriber7 or supplier related to fraud1 waste1 and abuse for initiating or assisting investigations conducted by the eligible entity2 and 7ii7 data sharing among such ,,ma plans1 prescription drug plans1 and the ,secretary4 7,b7 ,required uses of portal ,the ,secretary shall disseminate the following information to ,,ma plans under this part and prescription drug plans under part ,d through the secure ,internet website portal established under subparagraph 7,a73 7i7 ,providers of services and suppliers that have been referred pursuant to subparagraph 7,a77i7 during the previous #ab-month period4 7ii7 ,providers of services and suppliers who are the subject of an active exclusion under section #aabh or who are subject to a suspension of payment under this title pursuant to section #ahfb7o7 or otherwise4 7iii7 ,providers of services and suppliers who are the subject of an active revocation of participation under this title1 including for not satisfying conditions of participation4 7iv7 ,in the case of such a plan that makes a referral under subparagraph 7,a77i7 through the portal with respect to suspicious activities of a provider of services 7including a prescriber7 or supplier1 if such provider 7or prescriber7 or supplier has been the subject of an administrative action under this title or title ,,xi with respect to similar activities1 a notification to such plan of such action so taken4 7,c7 ,rulemaking ,for purposes of this paragraph1 the ,secretary shall1 through rulemaking1 specify what constitutes suspicious activities related to fraud1 waste1 and abuse1 using guidance such as what is provided in the ,medicare ,program ,integrity ,manual #d4g4a4 7#b7 ,quarterly reports ,beginning not later than #b years after the date of the enactment of this subsection1 the ,secretary shall make available to ,,ma plans under this part and prescription drug plans under part ,d in a timely manner 7but no less frequently than quarterly7 and using information submitted to an entity described in paragraph 7#a7 through the portal described in such paragraph or pursuant to section #ahic1 information on fraud1 waste1 and abuse schemes and trends in identifying suspicious activity4 ,information included in each such report shall-- 7,a7 include administrative actions1 pertinent information related to opioid overprescribing1 and other data determined appropriate by the ,secretary in consultation with stakeholders2 and 7,b7 be anonymized information submitted by plans without identifying the source of such information4 7#c7 ,clarification ,nothing in this subsection shall preclude or otherwise affect referrals to the ,inspector ,general of the ,department of ,health and ,human ,services or other law enforcement entities4 4 7b7 ,contract requirement to communicate plan corrective actions against opioids over-prescribers ,section #aheg7;e77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;e77#d77;,c77 is amended by adding at the end the following new paragraph3 7#e7 ,communicating plan corrective actions against opioids over-prescribers 7,a7 ,in general ,beginning with plan years beginning on or after ,january #a1 #bjba1 a contract under this section with an ,,ma organization shall require the organization to submit to the ,secretary1 through the process established under subparagraph 7,b71 information on credible evidence of suspicious activities of a provider of services 7including a prescriber7 or supplier related to fraud and other actions taken by such plans related to inappropriate prescribing of opioids4 7,b7 ,process ,not later than ,january #a1 #bjba1 the ,secretary shall1 in consultation with stakeholders1 establish a process under which ,,ma plans and prescription drug plans shall submit to the ,secretary information described in subparagraph 7,a74 7,c7 ,regulations ,for purposes of this paragraph1 including as applied under section #ahfj;,d-#ab7;b77#c77;,d71 the ,secretary shall1 pursuant to rulemaking-- 7i7 specify a definition for the term inappropriate prescribing of opioids and a method for determining if a provider of services prescribes such a high volume2 and 7ii7 establish the process described in subparagraph 7,b7 and the types of information that may be submitted through such process4 4 7c7 ,reference under part ,d to program integrity transparency measures ,section #ahfj;,d-#d of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7 is amended by adding at the end the following new subsection3 7m7 ,program integrity transparency measures ,for program integrity transparency measures applied with respect to prescription drug plan and ,,ma plans1 see section #ahei7;i74 4 #ajg4 ,commit to opioid medical prescriber accountability and safety for seniors ,section #ahfj;,d-#d7;c77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77#d77 is amended by adding at the end the following new subparagraph3 7,d7 ,notification and additional requirements with respect to statistical outlier prescribers of opioids 7i7 ,notification ,not later than ,january #a1 #bjba1 the ,secretary shall1 in the case of a prescriber identified by the ,secretary under clause 7ii7 to be a statistical outlier prescriber of opioids1 provide1 subject to clause 7iv71 an annual notification to such prescriber that such prescriber has been so identified that includes resources on proper prescribing methods and other information as specified in accordance with clause 7iii74 7ii7 ,identification of statistical outlier prescribers of opioids 7,i7 ,in general ,the ,secretary shall1 subject to subclause 7,,iii71 using the valid prescriber ,national ,provider ,identifiers included pursuant to subparagraph 7,a7 on claims for covered part ,d drugs for part ,d eligible individuals enrolled in prescription drug plans under this part or ,,ma-,,pd plans under part ,c and based on the thresholds established under subclause 7,,ii71 identify prescribers that are statistical outlier opioids prescribers for a period of time specified by the ,secretary4 7,,ii7 ,establishment of thresholds ,for purposes of subclause 7,i7 and subject to subclause 7,,iii71 the ,secretary shall1 after consultation with stakeholders1 establish thresholds1 based on prescriber specialty and1 as determined appropriate by the ,secretary1 geographic area1 for identifying whether a prescriber in a specialty and geographic area is a statistical outlier prescriber of opioids as compared to other prescribers of opioids within such specialty and area4 7,,iii7 ,exclusions ,the following shall not be included in the analysis for identifying statistical outlier prescribers of opioids under this clause3 7aa7 ,claims for covered part ,d drugs for part ,d eligible individuals who are receiving hospice care under this title4 7bb7 ,claims for covered part ,d drugs for part ,d eligible individuals who are receiving oncology services under this title4 7cc7 ,prescribers who are the subject of an investigation by the ,centers for ,medicare ,medicaid ,services or the ,inspector ,general of the ,department of ,health and ,human ,services4 7iii7 ,contents of notification ,the ,secretary shall include the following information in the notifications provided under clause 7i73 7,i7 ,information on how such prescriber compares to other prescribers within the same specialty and1 if determined appropriate by the ,secretary1 geographic area4 7,,ii7 ,information on opioid prescribing guidelines1 based on input from stakeholders1 that may include the ,centers for ,disease ,control and ,prevention guidelines for prescribing opioids for chronic pain and guidelines developed by physician organizations4 7,,iii7 ,other information determined appropriate by the ,secretary4 7iv7 ,modifications and expansions 7,i7 ,frequency ,beginning #e years after the date of the enactment of this subparagraph1 the ,secretary may change the frequency of the notifications described in clause 7i7 based on stakeholder input and changes in opioid prescribing utilization and trends4 7,,ii7 ,expansion to other prescriptions ,the ,secretary may expand notifications under this subparagraph to include identifications and notifications with respect to concurrent prescriptions of covered ,part ,d drugs used in combination with opioids that are considered to have adverse side effects when so used in such combination1 as determined by the ,secretary4 7v7 ,additional requirements for persistent statistical outlier prescribers ,in the case of a prescriber who the ,secretary determines is persistently identified under clause 7ii7 as a statistical outlier prescriber of opioids1 the following shall apply3 7,i7 ,the ,secretary shall provide an opportunity for such prescriber to receive technical assistance or educational resources on opioid prescribing guidelines 7such as the guidelines described in clause 7iii77,,ii77 from an entity that furnishes such assistance or resources1 which may include a quality improvement organization under part ,b of title ,,xi1 as available and appropriate4 7,,ii7 ,such prescriber may be required to enroll in the program under this title under section #ahff7;j7 if such prescriber is not otherwise required to enroll4 ,the ,secretary shall determine the length of the period for which such prescriber is required to maintain such enrollment4 7,,iii7 ,not less frequently than annually 7and in a form and manner determined appropriate by the ,secretary71 the ,secretary shall communicate information on such prescribers to sponsors of a prescription drug plan and ,medicare ,advantage organizations offering an ,,ma-,,pd plan4 7vi7 ,public availability of information ,the ,secretary shall make aggregate information under this subparagraph available on the ,internet website of the ,centers for ,medicare ,medicaid ,services4 ,such information shall be in a form and manner determined appropriate by the ,secretary and shall not identify any specific prescriber4 ,in carrying out this clause1 the ,secretary shall consult with interested stakeholders4 7vii7 ,opioids defined ,for purposes of this subparagraph1 the term opioids has such meaning as specified by the ,secretary4 7viii7 ,other activities ,nothing in this subparagraph shall preclude the ,secretary from conducting activities that provide prescribers with information as to how they compare to other prescribers that are in addition to the activities under this subparagraph1 including activities that were being conducted as of the date of the enactment of this subparagraph4 4 #ajh4 ,fighting the opioid epidemic with sunshine 7a7 ,inclusion of information regarding payments to advance practice nurses 7#a7 ,in general ,section #aabh;,g7e77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;h7e77#f77 is amended-- 7,a7 in subparagraph 7,a71 by adding at the end the following new clauses3 7iii7 ,a physician assistant1 nurse practitioner1 or clinical nurse specialist 7as such terms are defined in section #ahfa7;aa77#e774 7iv7 ,a certified registered nurse anesthetist 7as defined in section #ahfa7;bb77#b774 7v7 ,a certified nurse-midwife 7as defined in section #ahfa7;gg77#b774 2 and 7,b7 in subparagraph 7,b71 by inserting 1 physician assistant1 nurse practitioner1 clinical nurse specialist1 certified nurse anesthetist1 or certified nurse-midwife after physician4 7#b7 ,effective date ,the amendments made by this subsection shall apply with respect to information required to be submitted under section #aabh;,g of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;h7 on or after ,january #a1 #bjba4 7b7 ,sunset of exclusion of ,national ,provider ,identifier of covered recipient in information made publicly available ,section #aabh;,g7c77#a77;,c77viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;h7c77#a77;,c77viii777 is amended by striking does not contain and inserting in the case of information made available under this subparagraph prior to ,january #a1 #bjba1 does not contain4 7c7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to this section or the amendments made by this section4 #aji4 ,demonstration testing coverage of certain services furnished by opioid treatment programs ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by inserting after section #ahff;,e the following3 #ahff;,f4 ,demonstration testing coverage of certain services furnished by opioid treatment programs 7a7 ,establishment 7#a7 ,in general ,the ,secretary shall conduct a demonstration 7in this section referred to as the demonstration7 to test coverage of and payment for opioid use disorder treatment services 7as defined in paragraph 7#b77;,b77 furnished by opioid treatment programs 7as defined in paragraph 7#b77;,a77 to individuals under part ,b using a bundled payment as described in paragraph 7#c74 7#b7 ,definitions ,in this section3 7,a7 ,opioid treatment program ,the term opioid treatment program means an entity that is an opioid treatment program 7as defined in section #h4b of title #db of the ,code of ,federal ,regulations1 or any successor regulation7 that-- 7i7 is selected for participation in the demonstration2 7ii7 has in effect a certification by the ,substance ,abuse and ,mental ,health ,services ,administration for such a program2 7iii7 is accredited by an accrediting body approved by the ,substance ,abuse and ,mental ,health ,services ,administration2 7iv7 submits to the ,secretary data and information needed to monitor the quality of services furnished and conduct the evaluation described in subsection 7c72 and 7v7 meets such additional requirements as the ,secretary may find necessary4 7,b7 ,opioid use disorder treatment services ,the term opioid use disorder treatment services means items and services that are furnished by an opioid treatment program for the treatment of opioid use disorder1 including-- 7i7 opioid agonist and antagonist treatment medications 7including oral1 injected1 or implanted versions7 that are approved by the ,food and ,drug ,administration under section #eje of the ,federal ,food1 ,drug and ,cosmetic ,act for use in the treatment of opioid use disorder2 7ii7 dispensing and administration of such medications1 if applicable2 7iii7 substance use counseling by a professional to the extent authorized under ,state law to furnish such services2 7iv7 individual and group therapy with a physician or psychologist 7or other mental health professional to the extent authorized under ,state law72 7v7 toxicology testing2 and 7vi7 other items and services that the ,secretary determines are appropriate 7but in no case to include meals or transportation74 7#c7 ,bundled payment under part ,b 7,a7 ,in general ,the ,secretary shall pay1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 to an opioid treatment program participating in the demonstration a bundled payment as determined by the ,secretary for opioid use disorder treatment services that are furnished by such treatment program to an individual under part ,b during an episode of care 7as defined by the ,secretary74 7,b7 ,considerations ,the ,secretary may implement this paragraph through one or more bundles based on the type of medication provided 7such as buprenorphine1 methadone1 naltrexone1 or a new innovative drug71 the frequency of services furnished1 the scope of services furnished1 characteristics of the individuals furnished such services1 or other factors as the ,secretary determine appropriate4 ,in developing such bundles1 the ,secretary may consider payment rates paid to opioid treatment programs for comparable services under ,state plans under title ,,xix or under the ,,tricare program under chapter #ee of title #aj of the ,united ,states ,code4 7b7 ,implementation 7#a7 ,duration ,the demonstration shall be conducted for a period of #e years1 beginning not later than ,january #a1 #bjba4 7#b7 ,scope ,in carrying out the demonstration1 the ,secretary shall limit the number of beneficiaries that may participate at any one time in the demonstration to #b1jjj4 7#c7 ,waiver ,the ,secretary may waive such provisions of this title and title ,,xi as the ,secretary determines necessary in order to implement the demonstration4 7#d7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to this section4 7c7 ,evaluation and report 7#a7 ,evaluation ,the ,secretary shall conduct an evaluation of the demonstration4 ,such evaluation shall include analyses of-- 7,a7 the impact of the demonstration on-- 7i7 utilization of health care items and services related to opioid use disorder1 including hospitalizations and emergency department visits2 7ii7 beneficiary health outcomes related to opioid use disorder1 including opioid overdose deaths2 and 7iii7 overall expenditures under this title2 and 7,b7 the performance of opioid treatment programs participating in the demonstration with respect to applicable quality and cost metrics1 including whether any additional quality measures related to opioid use disorder treatment are needed with respect to such programs under this title4 7#b7 ,report ,not later than #b years after the completion of the demonstration1 the ,secretary shall submit to ,congress a report containing the results of the evaluation conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 7d7 ,funding ,for purposes of administering and carrying out the demonstration1 in addition to funds otherwise appropriated1 there shall be transferred to the ,secretary for the ,center for ,medicare ,medicaid ,services ,program ,management ,account from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda #e1jjj1jjj1 to remain available until expended4 4 #aaj4 ,encouraging appropriate prescribing under ,medicare for victims of opioid overdose ,section #ahfj;,d-#d7;c77#e77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77#e77;,c77 is amended-- 7#a7 in clause 7i71 in the matter preceding subclause 7,i71 by striking ,for purposes and inserting ,except as provided in clause 7v71 for purposes2 and 7#b7 by adding at the end the following new clause3 7v7 ,treatment of enrollees with a history of opioid-related overdose 7,i7 ,in general ,for plan years beginning not later than ,january #a1 #bjba1 a part ,d eligible individual who is not an exempted individual described in clause 7ii7 and who is identified under this clause as a part ,d eligible individual with a history of opioid-related overdose 7as defined by the ,secretary7 shall be included as a potentially at-risk beneficiary for prescription drug abuse under the drug management program under this paragraph4 7,,ii7 ,identification and notice ,for purposes of this clause1 the ,secretary shall-- 7aa7 identify part ,d eligible individuals with a history of opioid-related overdose 7as so defined72 and 7bb7 notify the ,,pdp sponsor of the prescription drug plan in which such an individual is enrolled of such identification4 4 #aaa4 ,automatic escalation to external review under a ,medicare part ,d drug management program for at-risk beneficiaries 7a7 ,in general ,section #ahfj;,d-#d7;c77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww-#aj7;c77#e77 is amended-- 7#a7 in subparagraph 7,b71 in each of clauses 7ii77,,iii7 and 7iii77,,iv71 by striking and the option of an automatic escalation to external review and inserting 1 including notice that if on reconsideration a ,,pdp sponsor affirms its denial1 in whole or in part1 the case shall be automatically forwarded to the independent1 outside entity contracted with the ,secretary for review and resolution2 and 7#b7 in subparagraph 7,e71 by striking and the option and all that follows and inserting the following3 and if on reconsideration a ,,pdp sponsor affirms its denial1 in whole or in part1 the case shall be automatically forwarded to the independent1 outside entity contracted with the ,secretary for review and resolution44 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply beginning not later ,january #a1 #bjba4 #aab4 ,medicare ,improvement ,fund ,section #ahih7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;iii7b77#a77 is amended by striking fiscal year #bjba1 #j and inserting fiscal year #bjbc1 #ej1jjj1jjj4 ,,ii ,medicaid #bja4 ,caring recovery for infants and babies 7a7 ,state plan amendment ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7#a7 in paragraph 7#hb71 by striking and after the semicolon2 7#b7 in paragraph 7#hc71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after paragraph 7#hc71 the following new paragraph3 7#hd7 provide1 at the option of the ,state1 for making medical assistance available on an inpatient or outpatient basis at a residential pediatric recovery center 7as defined in subsection 7nn77 to infants with neonatal abstinence syndrome4 4 7b7 ,residential pediatric recovery center defined ,section #aijb of such ,act 7#db ,u4,s4,c4 #acif;a7 is amended by adding at the end the following new subsection3 7nn7 ,residential pediatric recovery center defined 7#a7 ,in general ,for purposes of section #aijb7;a77#hd71 the term residential pediatric recovery center means a center or facility that furnishes items and services for which medical assistance is available under the ,state plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors4 7#b7 ,counseling and services ,a residential pediatric recovery center may offer counseling and other services to mothers 7and other appropriate family members and caretakers7 of infants receiving treatment at such centers if such services are otherwise covered under the ,state plan under this title or under a waiver of such plan4 ,such other services may include the following3 7,a7 ,counseling or referrals for services4 7,b7 ,activities to encourage caregiver-infant bonding4 7,c7 ,training on caring for such infants4 4 7c7 ,effective date ,the amendments made by this section take effect on the date of enactment of this ,act and shall apply to medical assistance furnished on or after that date1 without regard to final regulations to carry out such amendments being promulgated as of such date4 #bjb4 ,peer support enhancement and evaluation review 7a7 ,in general ,not later than #b years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives1 the ,committee on ,finance of the ,senate1 and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate a report on the provision of peer support services under the ,medicaid program4 7b7 ,content of report 7#a7 ,in general ,the report required under subsection 7a7 shall include the following information3 7,a7 ,information on ,state coverage of peer support services under ,medicaid1 including-- 7i7 the mechanisms through which ,states may provide such coverage1 including through existing statutory authority or through waivers2 7ii7 the populations to which ,states have provided such coverage2 7iii7 the payment models1 including any alternative payment models1 used by ,states to pay providers of such services2 and 7iv7 where available1 information on ,federal and ,state spending under ,medicaid for peer support services4 7,b7 ,information on selected ,state experiences in providing medical assistance for peer support services under ,state ,medicaid plans and whether ,states measure the effects of providing such assistance with respect to-- 7i7 improving access to behavioral health services2 7ii7 improving early detection1 and preventing worsening1 of behavioral health disorders2 7iii7 reducing chronic and comorbid conditions2 and 7iv7 reducing overall health costs4 7#b7 ,recommendations ,the report required under subsection 7a7 shall include recommendations1 including recommendations for such legislative and administrative actions related to improving services1 including peer support services1 and access to peer support services under ,medicaid as the ,comptroller ,general of the ,united ,states determines appropriate4 #bjc4 ,medicaid substance use disorder treatment via telehealth 7a7 ,definitions ,in this section3 7#a7 ,comptroller ,general ,the term ,comptroller ,general means the ,comptroller ,general of the ,united ,states4 7#b7 ,school-based health center ,the term school-based health center has the meaning given that term in section #baaj7;c77#i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7c77#i774 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#d7 ,teleheath services ,the term telehealth services includes remote patient monitoring and other key modalities such as live video or synchronous telehealth1 store-and-forward or asynchronous telehealth1 mobile health1 telephonic consultation1 and electronic consult including provider-to-provider e-consults4 7#e7 ,underserved area ,the term underserved area means a health professional shortage area 7as defined in section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a77#a77;,a777 and a medically underserved area 7according to a designation under section #ccj7;b77#c77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c77;,a7774 7b7 ,guidance to ,states regarding ,federal reimbursement for furnishing services and treatment for substance use disorders under ,medicaid using telehealth services1 including in school-based health centers ,not later than #a year after the date of enactment of this ,act1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall issue guidance to ,states on the following3 7#a7 ,state options for ,federal reimbursement of expenditures under ,medicaid for furnishing services and treatment for substance use disorders1 including assessment1 medication-assisted treatment1 counseling1 and medication management1 using telehealth services4 ,such guidance shall also include guidance on furnishing services and treatments that address the needs of high risk individuals1 including at least the following groups3 7,a7 ,american ,indians and ,alaska ,natives4 7,b7 ,adults under the age of #dj4 7,c7 ,individuals with a history of nonfatal overdose4 7#b7 ,state options for ,federal reimbursement of expenditures under ,medicaid for education directed to providers serving ,medicaid beneficiaries with substance use disorders using the hub and spoke model1 through contracts with managed care entities1 through administrative claiming for disease management activities1 and under ,delivery ,system ,reform ,incentive ,payment 7,,dsrip7 programs4 7#c7 ,state options for ,federal reimbursement of expenditures under ,medicaid for furnishing services and treatment for substance use disorders for individuals enrolled in ,medicaid in a school-based health center using telehealth services4 7c7 ,,gao evaluation of children's access to services and treatment for substance use disorders under ,medicaid 7#a7 ,study ,the ,comptroller ,general shall evaluate children's access to services and treatment for substance use disorders under ,medicaid4 ,the evaluation shall include an analysis of ,state options for improving children's access to such services and treatment and for improving outcomes1 including by increasing the number of ,medicaid providers who offer services or treatment for substance use disorders in a school-based health center using telehealth services1 particularly in rural and underserved areas4 ,the evaluation shall include an analysis of ,medicaid provider reimbursement rates for services and treatment for substance use disorders4 7#b7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the evaluation conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7d7 ,report on reducing barriers to using telehealth services and remote patient monitoring for pediatric populations under ,medicaid 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall issue a report to the ,committee on ,finance of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representative identifying best practices and potential solutions for reducing barriers to using telehealth services to furnish services and treatment for substance use disorders among pediatric populations under ,medicaid4 ,the report shall include-- 7,a7 analyses of the best practices1 barriers1 and potential solutions for using telehealth services to diagnose and provide services and treatment for children with substance use disorders1 including opioid use disorder2 and 7,b7 identification and analysis of the differences1 if any1 in furnishing services and treatment for children with substance use disorders using telehealth services and using services delivered in person1 such as1 and to the extent feasible1 with respect to-- 7i7 utilization rates2 7ii7 costs2 7iii7 avoidable inpatient admissions and readmissions2 7iv7 quality of care2 and 7v7 patient1 family1 and provider satisfaction4 7#b7 ,publication ,the ,secretary shall publish the report required under paragraph 7#a7 on a public ,internet website of the ,department of ,health and ,human ,services4 #bjd4 ,enhancing patient access to non-opioid treatment options ,not later than ,january #a1 #bjai1 the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall issue #a or more final guidance documents1 or update existing guidance documents1 to ,states regarding mandatory and optional items and services that may be provided under a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or under a waiver of such a plan1 for non-opioid treatment and management of pain1 including1 but not limited to1 evidence-based non-opioid pharmacological therapies and non-pharmacological therapies4 #bje4 ,assessing barriers to opioid use disorder treatment 7a7 ,study 7#a7 ,in general ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study regarding the barriers to providing medication used in the treatment of substance use disorders under ,medicaid distribution models such as the buy-and-bill model1 and options for ,state ,medicaid programs to remove or reduce such barriers4 ,the study shall include analyses of each of the following models of distribution of substance use disorder treatment medications1 particularly buprenorphine1 naltrexone1 and buprenorphine-naloxone combinations3 7,a7 ,the purchasing1 storage1 and administration of substance use disorder treatment medications by providers4 7,b7 ,the dispensing of substance use disorder treatment medications by pharmacists4 7,c7 ,the ordering1 prescribing1 and obtaining substance use disorder treatment medications on demand from specialty pharmacies by providers4 7#b7 ,requirements ,for each model of distribution specified in paragraph 7#a71 the ,comptroller ,general shall evaluate how each model presents barriers or could be used by selected ,state ,medicaid programs to reduce the barriers related to the provision of substance use disorder treatment by examining what is known about the effects of the model of distribution on-- 7,a7 ,medicaid beneficiaries' access to substance use disorder treatment medications2 7,b7 the differential cost to the program between each distribution model for medication assisted treatment2 and 7,c7 provider willingness to provide or prescribe substance use disorder treatment medications4 7b7 ,report ,not later than #ae months after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #bjf4 ,help for moms and babies 7a7 ,medicaid state plan ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended by adding at the end the following new sentence3 ,in the case of a woman who is eligible for medical assistance on the basis of being pregnant 7including through the end of the month in which the #fj-;day period beginning on the last day of her pregnancy ends71 who is a patient in an institution for mental diseases for purposes of receiving treatment for a substance use disorder1 and who was enrolled for medical assistance under the ,state plan immediately before becoming a patient in an institution for mental diseases or who becomes eligible to enroll for such medical assistance while such a patient1 the exclusion from the definition of medical assistance set forth in the subdivision 7,b7 following paragraph 7#bi7 of the first sentence of this subsection shall not be construed as prohibiting ,federal financial participation for medical assistance for items or services that are provided to the woman outside of the institution44 7b7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendment made by subsection 7a7 shall take effect on the date of enactment of this ,act4 7#b7 ,rule for changes requiring state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendment made by subsection 7a71 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #bjg4 ,securing flexibility to treat substance use disorders ,section #aijc7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77 is amended by adding at the end the following new paragraph3 7#g7 ,payment shall be made under this title to a ,state for expenditures for capitation payments described in section #dch4f7;e7 of title #db1 ,code of ,federal ,regulations 7or any successor regulation74 4 #bjh4 ,,macpac study and report on ,,mat utilization controls under ,state ,medicaid programs 7a7 ,study ,the ,medicaid and ,,chip ,payment and ,access ,commission shall conduct a study and analysis of utilization control policies applied to medication-assisted treatment for substance use disorders under ,state ,medicaid programs1 including policies and procedures applied both in fee-for-service ,medicaid and in risk-based managed care ,medicaid1 which shall-- 7#a7 include an inventory of such utilization control policies and related protocols for ensuring access to medically necessary treatment2 7#b7 determine whether managed care utilization control policies and procedures for medication assisted treatment for substance use disorders are consistent with section #dch4baj7;a77#d77;ii7 of title #db1 ,code of ,federal ,regulations2 and 7#c7 identify policies that-- 7,a7 limit an individual's access to medication-assisted treatment for a substance use disorder by limiting the quantity of medication-assisted treatment prescriptions1 or the number of refills for such prescriptions1 available to the individual as part of a prior authorization process or similar utilization protocols2 and 7,b7 apply without evaluating individual instances of fraud1 waste1 or abuse4 7b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,medicaid and ,,chip ,payment and ,access ,commission shall make publicly available a report containing the results of the study conducted under subsection 7a74 #bji4 ,opioid addiction treatment programs enhancement 7a7 ,t-,,msis substance use disorder data book 7#a7 ,in general ,not later than the date that is #ab months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall publish on the public website of the ,centers for ,medicare ,medicaid ,services a report with comprehensive data on the prevalence of substance use disorders in the ,medicaid beneficiary population and services provided for the treatment of substance use disorders under ,medicaid4 7#b7 ,content of report ,the report required under paragraph 7#a7 shall include1 at a minimum1 the following data for each ,state 7including1 to the extent available1 for the ,district of ,columbia1 ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa73 7,a7 ,the number and percentage of individuals enrolled in the ,state ,medicaid plan or waiver of such plan in each of the major enrollment categories 7as defined in a public letter from the ,medicaid and ,,chip ,payment and ,access ,commission to the ,secretary7 who have been diagnosed with a substance use disorder and whether such individuals are enrolled under the ,state ,medicaid plan or a waiver of such plan1 including the specific waiver authority under which they are enrolled1 to the extent available4 7,b7 ,a list of the substance use disorder treatment services by each major type of service1 such as counseling1 medication assisted treatment1 peer support1 residential treatment1 and inpatient care1 for which beneficiaries in each ,state received at least #a service under the ,state ,medicaid plan or a waiver of such plan4 7,c7 ,the number and percentage of individuals with a substance use disorder diagnosis enrolled in the ,state ,medicaid plan or waiver of such plan who received substance use disorder treatment services under such plan or waiver by each major type of service under subparagraph 7,b7 within each major setting type1 such as outpatient1 inpatient1 residential1 and other home and community-based settings4 7,d7 ,the number of services provided under the ,state ,medicaid plan or waiver of such plan per individual with a substance use disorder diagnosis enrolled in such plan or waiver for each major type of service under subparagraph 7,b74 7,e7 ,the number and percentage of individuals enrolled in the ,state ,medicaid plan or waiver1 by major enrollment category1 who received substance use disorder treatment through-- 7i7 a medicaid managed care entity 7as defined in section #aicb7;a77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;a77#a77;,b7771 including the number of such individuals who received such assistance through a prepaid inpatient health plan or a prepaid ambulatory health plan2 7ii7 a fee-for-service payment model2 or 7iii7 an alternative payment model1 to the extent available4 7,f7 ,the number and percentage of individuals with a substance use disorder who receive substance use disorder treatment services in an outpatient or home and community-based setting after receiving treatment in an inpatient or residential setting1 and the number of services received by such individuals in the outpatient or home and community-based setting4 7#c7 ,annual updates ,the ,secretary shall issue an updated version of the report required under paragraph 7#a7 not later than ,january #a of each calendar year through #bjbd4 7#d7 ,use of ,t-,,msis data ,the report required under paragraph 7#a7 and updates required under paragraph 7#c7 shall-- 7,a7 use data and definitions from the ,transformed ,medicaid ,statistical ,information ,system 7,t-,,msis7 data set that is no more than #ab months old on the date that the report or update is published2 and 7,b7 as appropriate1 include a description with respect to each ,state of the quality and completeness of the data and caveats describing the limitations of the data reported to the ,secretary by the ,state that is sufficient to communicate the appropriate uses for the information4 7b7 ,making ,t-,,msis data on substance use disorders available to researchers 7#a7 ,in general ,the ,secretary shall publish in the ,federal ,register a system of records notice for the data specified in paragraph 7#b7 for the ,transformed ,medicaid ,statistical ,information ,system1 in accordance with section #eeb;a7e77#d7 of title #e1 ,united ,states ,code4 ,the notice shall outline policies that protect the security and privacy of the data that1 at a minimum1 meet the security and privacy policies of ,,sorn #ji-gj-jeda for the ,medicaid ,statistical ,information ,system4 7#b7 ,required data ,the data covered by the systems of records notice required under paragraph 7#a7 shall be sufficient for researchers and ,states to analyze the prevalence of substance use disorders in the ,medicaid beneficiary population and the treatment of substance use disorders under ,medicaid across all ,states 7including the ,district of ,columbia1 ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa71 forms of treatment1 and treatment settings4 7#c7 ,initiation of data-sharing activities ,not later than ,january #a1 #bjai1 the ,secretary shall initiate the data-sharing activities outlined in the notice required under paragraph 7#a74 #baj4 ,better data sharing to combat the opioid crisis 7a7 ,in general ,section #aijc7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m771 as amended by section #bjg1 is amended by adding at the end the following new paragraph3 7#h7 7,a7 ,the ,state agency administering the ,state plan under this title may have reasonable access1 as determined by the ,state1 to #a or more prescription drug monitoring program databases administered or accessed by the ,state to the extent the ,state agency is permitted to access such databases under ,state law4 7,b7 ,such ,state agency may facilitate reasonable access1 as determined by the ,state1 to #a or more prescription drug monitoring program databases administered or accessed by the ,state1 to same extent that the ,state agency is permitted under ,state law to access such databases1 for-- 7i7 any provider enrolled under the ,state plan to provide services to ,medicaid beneficiaries2 and 7ii7 any managed care entity 7as defined under section #aicb7;a77#a77;,b77 that has a contract with the ,state under this subsection or under section #aije7t77#c74 7,c7 ,such ,state agency may share information in such databases1 to the same extent that the ,state agency is permitted under ,state law to share information in such databases1 with-- 7i7 any provider enrolled under the ,state plan to provide services to ,medicaid beneficiaries2 and 7ii7 any managed care entity 7as defined under section #aicb7;a77#a77;,b77 that has a contract with the ,state under this subsection or under section #aije7t77#c74 4 7b7 ,security and privacy ,all applicable ,state and ,federal security and privacy protections and laws shall apply to any ,state agency1 individual1 or entity accessing #a or more prescription drug monitoring program databases or obtaining information in such databases in accordance with section #aijc7m77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77#h77 7as added by subsection 7a774 7c7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date of enactment of this ,act4 #baa4 ,mandatory reporting with respect to adult behavioral health measures ,section #aaci;,b of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7 is amended-- 7#a7 in subsection 7b7-- 7,a7 in paragraph 7#c7-- 7i7 by striking ,not later than ,january #a1 #bjac and inserting the following3 7,a7 ,voluntary reporting ,not later than ,january #a1 #bjac 2 and 7ii7 by adding at the end the following3 7,b7 ,mandatory reporting with respect to behavioral health measures ,beginning with the ,state report required under subsection 7d77#a7 for #bjbd1 the ,secretary shall require ,states to use all behavioral health measures included in the core set of adult health quality measures and any updates or changes to such measures to report information1 using the standardized format for reporting information and procedures developed under subparagraph 7,a71 regarding the quality of behavioral health care for ,medicaid eligible adults4 2 7,b7 in paragraph 7#e71 by adding at the end the following new subparagraph3 7,c7 ,behavioral health measures ,beginning with respect to ,state reports required under subsection 7d77#a7 for #bjbd1 the core set of adult health quality measures maintained under this paragraph 7and any updates or changes to such measures7 shall include behavioral health measures4 2 and 7#b7 in subsection 7d77#a77;,a7-- 7,a7 by striking the such plan and inserting such plan2 and 7,b7 by striking subsection 7a77#e7 and inserting subsection 7b77#e7 and1 beginning with the report for #bjbd1 all behavioral health measures included in the core set of adult health quality measures maintained under such subsection 7b77#e7 and any updates or changes to such measures 7as required under subsection 7b77#c774 #bab4 ,report on innovative ,state initiatives and strategies to provide housing-related services and supports to individuals struggling with substance use disorders under ,medicaid 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue a report to ,congress describing innovative ,state initiatives and strategies for providing housing-related services and supports under a ,state ,medicaid program to individuals with substance use disorders who are experiencing or at risk of experiencing homelessness4 7b7 ,content of report ,the report required under subsection 7a7 shall describe the following3 7#a7 ,existing methods and innovative strategies developed and adopted by ,state ,medicaid programs that have achieved positive outcomes in increasing housing stability among ,medicaid beneficiaries with substance use disorders who are experiencing or at risk of experiencing homelessness1 including ,medicaid beneficiaries with substance use disorders who are-- 7,a7 receiving treatment for substance use disorders in inpatient1 residential1 outpatient1 or home and community-based settings2 7,b7 transitioning between substance use disorder treatment settings2 or 7,c7 living in supportive housing or another model of affordable housing4 7#b7 ,strategies employed by ,medicaid managed care organizations1 primary care case managers1 hospitals1 accountable care organizations1 and other care coordination providers to deliver housing-related services and supports and to coordinate services provided under ,state ,medicaid programs across different treatment settings4 7#c7 ,innovative strategies and lessons learned by ,states with ,medicaid waivers approved under section #aaae or #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae1 #acifn71 including-- 7,a7 challenges experienced by ,states in designing1 securing1 and implementing such waivers or plan amendments2 7,b7 how ,states developed partnerships with other organizations such as behavioral health agencies1 ,state housing agencies1 housing providers1 health care services agencies and providers1 community-based organizations1 and health insurance plans to implement waivers or ,state plan amendments2 and 7,c7 how and whether ,states plan to provide ,medicaid coverage for housing-related services and supports in the future1 including by covering such services and supports under ,state ,medicaid plans or waivers4 7#d7 ,existing opportunities for ,states to provide housing-related services and supports through a ,medicaid waiver under sections #aaae or #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae1 #acifn7 or through a ,state ,medicaid plan amendment1 such as the ,assistance in ,community ,integration ,service pilot program1 which promotes supportive housing and other housing-related supports under ,medicaid for individuals with substance use disorders and for which ,maryland has a waiver approved under such section #aaae to conduct the program4 7#e7 ,innovative strategies and partnerships developed and implemented by ,state ,medicaid programs or other entities to identify and enroll eligible individuals with substance use disorders who are experiencing or at risk of experiencing homelessness in ,state ,medicaid programs4 #bac4 ,technical assistance and support for innovative ,state strategies to provide housing-related supports under ,medicaid 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall provide technical assistance and support to ,states regarding the development and expansion of innovative ,state strategies 7including through ,state ,medicaid demonstration projects7 to provide housing-related supports and services and care coordination services under ,medicaid to individuals with substance use disorders4 7b7 ,report ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary shall issue a report to ,congress detailing a plan of action to carry out the requirements of subsection 7a74 ,,iii ,human ,services #cja4 ,supporting family-focused residential treatment 7a7 ,definitions ,in this section3 7#a7 ,family-focused residential treatment program ,the term family-focused residential treatment program means a trauma-informed residential program primarily for substance use disorder treatment for pregnant and postpartum women and parents and guardians that allows children to reside with such women or their parents or guardians during treatment to the extent appropriate and applicable4 7#b7 ,medicaid program ,the term ,medicaid program means the program established under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#d7 ,title ,,iv-,e program ,the term title ,,iv-,e program means the program for foster care1 prevention1 and permanency established under part ,e of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fgj et seq474 7b7 ,guidance on family-focused residential treatment programs 7#a7 ,in general ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary1 in consultation with divisions of the ,department of ,health and ,human ,services administering substance use disorder or child welfare programs1 shall develop and issue guidance to ,states identifying opportunities to support family-focused residential treatment programs for the provision of substance use disorder treatment4 ,before issuing such guidance1 the ,secretary shall solicit input from representatives of ,states1 health care providers with expertise in addiction medicine1 obstetrics and gynecology1 neonatology1 child trauma1 and child development1 health plans1 recipients of family-focused treatment services1 and other relevant stakeholders4 7#b7 ,additional requirements ,the guidance required under paragraph 7#a7 shall include descriptions of the following3 7,a7 ,existing opportunities and flexibilities under the ,medicaid program1 including under waivers authorized under section #aaae or #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae1 #acifn71 for ,states to receive ,federal ,medicaid funding for the provision of substance use disorder treatment for pregnant and postpartum women and parents and guardians and1 to the extent applicable1 their children1 in family-focused residential treatment programs4 7,b7 ,how ,states can employ and coordinate funding provided under the ,medicaid program1 the title ,,iv-,e program1 and other programs administered by the ,secretary to support the provision of treatment and services provided by a family-focused residential treatment facility such as substance use disorder treatment and services1 including medication-assisted treatment1 family1 group1 and individual counseling1 case management1 parenting education and skills development1 the provision1 assessment1 or coordination of care and services for children1 including necessary assessments and appropriate interventions1 non-emergency transportation for necessary care provided at or away from a program site1 transitional services and supports for families leaving treatment1 and other services4 7,c7 ,how ,states can employ and coordinate funding provided under the ,medicaid program and the title ,,iv-,e program 7including as amended by the ,family ,first ,prevention ,services ,act enacted under title ,,vii of division ,e of ,public ,law #aae-abc1 and particularly with respect to the authority under subsections 7a77#b77;,c7 and 7j7 of section #dgb and section #dgd7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fgb1 #fgd7;a77#a77 7as amended by section #ejgab of ,public ,law #aae-abc7 to provide foster care maintenance payments for a child placed with a parent who is receiving treatment in a licensed residential family-based treatment facility for a substance use disorder7 to support placing children with their parents in family-focused residential treatment programs4 #cjb4 ,improving recovery and reunifying families ,section #dce of the ,social ,security ,act 7#db ,u4,s4,c4 #fbi;e7 is amended by adding at the end the following3 7e7 ,family ,recovery and ,reunification ,program ,replication ,project 7#a7 ,purpose ,the purpose of this subsection is to provide resources to the ,secretary to support the conduct and evaluation of a family recovery and reunification program replication project 7referred to in this subsection as the project7 and to determine the extent to which such programs may be appropriate for use at different intervention points 7such as when a child is at risk of entering foster care or when a child is living with a guardian while a parent is in treatment74 ,the family recovery and reunification program conducted under the project shall use a recovery coach model that is designed to help reunify families and protect children by working with parents or guardians with a substance use disorder who have temporarily lost custody of their children4 7#b7 ,program components ,the family recovery and reunification program conducted under the project shall adhere closely to the elements and protocol determined to be most effective in other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children and1 consistent with such elements and protocol1 shall provide such items and services as-- 7,a7 assessments to evaluate the needs of the parent or guardian2 7,b7 assistance in receiving the appropriate benefits to aid the parent or guardian in recovery2 7,c7 services to assist the parent or guardian in prioritizing issues identified in assessments1 establishing goals for resolving such issues that are consistent with the goals of the treatment provider1 child welfare agency1 courts1 and other agencies involved with the parent or guardian or their children1 and making a coordinated plan for achieving such goals2 7,d7 home visiting services coordinated with the child welfare agency and treatment provider involved with the parent or guardian or their children2 7,e7 case management services to remove barriers for the parent or guardian to participate and continue in treatment1 as well as to re-engage a parent or guardian who is not participating or progressing in treatment2 7,f7 access to services needed to monitor the parent's or guardian's compliance with program requirements2 7,g7 frequent reporting between the treatment provider1 child welfare agency1 courts1 and other agencies involved with the parent or guardian or their children to ensure appropriate information on the parent's or guardian's status is available to inform decision-making2 and 7,h7 assessments and recommendations provided by a recovery coach to the child welfare caseworker responsible for documenting the parent's or guardian's progress in treatment and recovery as well as the status of other areas identified in the treatment plan for the parent or guardian1 including a recommendation regarding the expected safety of the child if the child is returned to the custody of the parent or guardian that can be used by the caseworker and a court to make permanency decisions regarding the child4 7#c7 ,responsibilities of the secretary 7,a7 ,in general ,the ,secretary shall1 through a grant or contract with #a or more entities1 conduct and evaluate the family recovery and reunification program under the project4 7,b7 ,requirements ,in identifying #a or more entities to conduct the evaluation of the family recovery and reunification program1 the ,secretary shall-- 7i7 determine that the area or areas in which the program will be conducted have sufficient substance use disorder treatment providers and other resources 7other than those provided with funds made available to carry out the project7 to successfully conduct the program2 7ii7 determine that the area or areas in which the program will be conducted have enough potential program participants1 and will serve a sufficient number of parents or guardians and their children1 so as to allow for the formation of a control group1 evaluation results to be adequately powered1 and preliminary results of the evaluation to be available within #d years of the program's implementation2 7iii7 provide the entity or entities with technical assistance for the program design1 including by working with #a or more entities that are or have been involved in recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children so as to make sure the program conducted under the project adheres closely to the elements and protocol determined to be most effective in such other recovery coaching programs2 7iv7 assist the entity or entities in securing adequate coaching1 treatment1 child welfare1 court1 and other resources needed to successfully conduct the family recovery and reunification program under the project2 and 7v7 ensure the entity or entities will be able to monitor the impacts of the program in the area or areas in which it is conducted for at least #e years after parents or guardians and their children are randomly assigned to participate in the program or to be part of the program's control group4 7#d7 ,evaluation requirements 7,a7 ,in general ,the ,secretary1 in consultation with the entity or entities conducting the family recovery and reunification program under the project1 shall conduct an evaluation to determine whether the program has been implemented effectively and resulted in improvements for children and families4 ,the evaluation shall have #c components3 a pilot phase1 an impact study1 and an implementation study4 7,b7 ,pilot phase ,the pilot phase component of the evaluation shall consist of the ,secretary providing technical assistance to the entity or entities conducting the family recovery and reunification program under the project to ensure-- 7i7 the program's implementation adheres closely to the elements and protocol determined to be most effective in other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children2 and 7ii7 random assignment of parents or guardians and their children to be participants in the program or to be part of the program's control group is being carried out4 7,c7 ,impact study ,the impact study component of the evaluation shall determine the impacts of the family recovery and reunification program conducted under the project on the parents and guardians and their children participating in the program4 ,the impact study component shall-- 7i7 be conducted using an experimental design that uses a random assignment research methodology2 7ii7 consistent with previous studies of other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children1 measure outcomes for parents and guardians and their children over multiple time periods1 including for a period of #e years2 and 7iii7 include measurements of family stability and parent1 guardian1 and child safety for program participants and the program control group that are consistent with measurements of such factors for participants and control groups from previous studies of other recovery coaching programs so as to allow results of the impact study to be compared with the results of such prior studies1 including with respect to comparisons between program participants and the program control group regarding-- 7,i7 safe family reunification2 7,,ii7 time to reunification2 7,,iii7 permanency 7such as through measures of reunification1 adoption1 or placement with guardians72 7,,iv7 safety 7such as through measures of subsequent maltreatment72 7,v7 parental or guardian treatment persistence and engagement2 7,,vi7 parental or guardian substance use2 7,,vii7 juvenile delinquency2 7,,viii7 cost2 and 7,,ix7 other measurements agreed upon by the ,secretary and the entity or entities operating the family recovery and reunification program under the project4 7,d7 ,implementation study ,the implementation study component of the evaluation shall be conducted concurrently with the conduct of the impact study component and shall include1 in addition to such other information as the ,secretary may determine1 descriptions and analyses of-- 7i7 the adherence of the family recovery and reunification program conducted under the project to other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children2 and 7ii7 the difference in services received or proposed to be received by the program participants and the program control group4 7,e7 ,report ,the ,secretary shall publish on an internet website maintained by the ,secretary the following information3 7i7 ,a report on the pilot phase component of the evaluation4 7ii7 ,a report on the impact study component of the evaluation4 7iii7 ,a report on the implementation study component of the evaluation4 7iv7 ,a report that includes-- 7,i7 analyses of the extent to which the program has resulted in increased reunifications1 increased permanency1 case closures1 net savings to the ,state or ,states involved 7taking into account both costs borne by ,states and the ,federal government71 or other outcomes1 or if the program did not produce such outcomes1 an analysis of why the replication of the program did not yield such results2 7,,ii7 if1 based on such analyses1 the ,secretary determines the program should be replicated1 a replication plan2 and 7,,iii7 such recommendations for legislation and administrative action as the ,secretary determines appropriate4 7#e7 ,appropriation ,in addition to any amounts otherwise made available to carry out this subpart1 out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there are appropriated #ae1jjj1jjj for fiscal year #bjai to carry out the project1 which shall remain available through fiscal year #bjbf4 4 #cjc4 ,building capacity for family-focused residential treatment 7a7 ,definitions ,in this section3 7#a7 ,eligible entity ,the term eligible entity means a ,state1 county1 local1 or tribal health or child welfare agency1 a private nonprofit organization1 a research organization1 a treatment service provider1 an institution of higher education 7as defined under section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja771 or another entity specified by the ,secretary4 7#b7 ,family-focused residential treatment program ,the term family-focused residential treatment program means a trauma-informed residential program primarily for substance use disorder treatment for pregnant and postpartum women and parents and guardians that allows children to reside with such women or their parents or guardians during treatment to the extent appropriate and applicable4 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7b7 ,support for the development of evidence-based family-focused residential treatment programs 7#a7 ,authority to award grants ,the ,secretary shall award grants to eligible entities for purposes of developing1 enhancing1 or evaluating family-focused residential treatment programs to increase the availability of such programs that meet the requirements for promising1 supported1 or well-supported practices specified in section #dga7;e77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7;e77#d77;,c777 7as added by the ,family ,first ,prevention ,services ,act enacted under title ,,vii of division ,e of ,public ,law #aae-abc74 7#b7 ,evaluation requirement ,the ,secretary shall require any evaluation of a family-focused residential treatment program by an eligible entity that uses funds awarded under this section for all or part of the costs of the evaluation be designed to assist in the determination of whether the program may qualify as a promising1 supported1 or well-supported practice in accordance with the requirements of such section #dga7;e77#d77;,c74 7c7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary to carry out this section1 #bj1jjj1jjj for fiscal year #bjai1 which shall remain available through fiscal year #bjbc4 ,june #be1 #bjah,read twice and placed on the calendar