,,ii #aafth ,,congress #ast ,session ,s4 #dbe ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #g1 #bjai,mr4 ,manchin 7for himself1 ,ms4 ,klobuchar1 ,ms4 ,baldwin1 ,mr4 ,king1 ,mr4 ,whitehouse1 ,ms4 ,warren1 ,mrs4 ,shaheen1 ,ms4 ,hassan1 ,mr4 ,blumenthal1 and ,ms4 ,smith7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend the ,internal ,revenue ,code of #aihf to establish a stewardship fee on the production and importation of opioid pain relievers1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,budgeting for ,opioid ,addiction ,treatment ,act4 #b4 ,stewardship fee on opioid pain relievers 7a7 ,in general ,subchapter ,e of chapter #cb of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new section3 #daib4 ,opioid pain relievers 7a7 ,in general ,there is hereby imposed on the sale of any active opioid by the manufacturer1 producer1 or importer a fee equal to #a cent per milligram so sold4 7b7 ,active opioid ,for purposes of this section-- 7#a7 ,in general ,the term active opioid means any controlled substance 7as defined in section #ajb of the ,controlled ,substances ,act1 as in effect on the date of the enactment of this section7 which is opium1 an opiate1 or any derivative thereof4 7#b7 ,exclusion for certain prescription medications ,such term shall not include any prescribed drug which is used exclusively for the treatment of opioid addiction as part of a medically assisted treatment effort4 7#c7 ,exclusion of other ingredients ,in the case of a product that includes an active opioid and another ingredient1 subsection 7a7 shall apply only to the portion of such product that is an active opioid4 4 7b7 ,clerical amendments 7#a7 ,the heading of subchapter ,e of chapter #cb of the ,internal ,revenue ,code of #aihf is amended by striking ,medical devices and inserting ,other medical products4 7#b7 ,the table of subchapters for chapter #cb of such ,code is amended by striking the item relating to subchapter ,e and inserting the following new item3 ,subchapter ,e4 ,other medical products 4 7#c7 ,the table of sections for subchapter ,e of chapter #cb of such ,code is amended by adding at the end the following new item3 ,sec4 #daib4 ,opioid pain relievers4 4 7c7 ,effective date ,the amendments made by this section shall apply to sales on or after the date that is #a year after the date of the enactment of this ,act4 7d7 ,rebate or discount program for certain cancer and hospice patients 7#a7 ,in general ,the ,secretary of ,health and ,human ,services1 in consultation with patient advocacy groups and other relevant stakeholders as determined by such ,secretary1 shall establish a mechanism by which-- 7,a7 any amount paid by an eligible patient in connection with the stewardship fee under section #daib of the ,internal ,revenue ,code of #aihf 7as added by this section7 shall be rebated to such patient in as timely a manner as possible2 or 7,b7 amounts paid by an eligible patient for active opioids 7as defined in section #daib7;b7 of such ,code7 are discounted at time of payment or purchase to ensure that such patient does not pay any amount attributable to such fee1 with as little burden on the patient as possible4 ,the ,secretary shall choose whichever of the options described in subparagraph 7,a7 or 7,b7 is1 in the ,secretary's determination1 most effective and efficient in ensuring eligible patients face no economic burden from such fee4 7#b7 ,eligible patient ,for purposes of this section1 the term eligible patient means-- 7,a7 a patient for whom any active opioid 7as so defined7 is prescribed to treat pain relating to cancer or cancer treatment2 7,b7 a patient participating in hospice care2 and 7,c7 in the case of the death or incapacity of a patient described in subparagraph 7,a7 or 7,b7 or any similar situation as determined by the ,secretary of ,health and ,human ,services1 the appropriate family member1 medical proxy1 or similar representative or the estate of such patient4 #c4 ,block grants for prevention and treatment of substance abuse 7a7 ,grants to ,states ,section #aiba7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx-#ba7;b77 is amended by inserting 1 and1 as applicable1 for carrying out section #aibc;,a before the period4 7b7 ,nonapplicability of prevention program provision ,section #aibb7;a77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx-#bb7;a77#a77 is amended by inserting except with respect to amounts made available as described in section #aibc;,a1 before will expend4 7c7 ,opioid treatment programs ,subpart ,,ii of part ,b of title ,,xix of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx-#ba et seq47 is amended by inserting after section #aibc the following3 #aibc;,a4 ,additional substance abuse treatment programs ,a funding agreement for a grant under section #aiba is that the ,state involved shall provide that any amounts made available by any increase in revenues to the ,treasury in the previous fiscal year resulting from the enactment of section #daib of the ,internal ,revenue ,code of #aihf1 reduced by any amounts rebated or discounted under section #b7;d7 of the ,budgeting for ,opioid ,addiction ,treatment ,act 7as described in section #aicc7;a77#a77;,b77i77 be used exclusively for substance abuse 7including opioid abuse7 treatment efforts in the ,state1 including-- 7#a7 treatment programs-- 7,a7 establishing new addiction treatment facilities1 residential and outpatient1 including covering capital costs2 7,b7 establishing sober living facilities2 7,c7 recruiting and increasing reimbursement for certified mental health providers providing substance abuse treatment in medically underserved communities or communities with high rates of prescription drug abuse2 7,d7 expanding access to long-term1 residential treatment programs for opioid addicts 7including #cj-1 #fj-1 and #ij-;day programs72 7,e7 establishing or operating support programs that offer employment services1 housing1 and other support services to help recovering addicts transition back into society2 7,f7 establishing or operating housing for children whose parents are participating in substance abuse treatment programs1 including capital costs2 7,g7 establishing or operating facilities to provide care for babies born with neonatal abstinence syndrome1 including capital costs2 and 7,h7 other treatment programs1 as the ,secretary determines appropriate2 and 7#b7 recruitment and training of substance use disorder professionals to work in rural and medically underserved communities4 4 7d7 ,additional funding ,section #aicc7;a77#a77;,b77i7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx-#cc7;a77#a77;,b77i77 is amended by inserting 1 plus any increase in revenues to the ,treasury in the previous fiscal year resulting from the enactment of section #daib of the ,internal ,revenue ,code of #aihf1 reduced by any amounts rebated or discounted under section #b7;d7 of the ,budgeting for ,opioid ,addiction ,treatment ,act before the period4 #d4 ,report ,not later than #b years after the date described in section #b7;c71 the ,secretary of ,health and ,human ,services shall submit to ,congress a report on the impact of the amendments made by sections #b and #c on-- 7#a7 the retail cost of active opioids 7as defined in section #daib of the ,internal ,revenue ,code of #aihf1 as added by section #b72 7#b7 patient access to such opioids1 particularly cancer and hospice patients1 including the effect of the discount or rebate on such opioids for cancer and hospice patients under section #b7;d72 7#c7 how the increase in revenue to the ,treasury resulting from the enactment of section #daib of the ,internal ,revenue ,code of #aihf is used to improve substance abuse treatment efforts in accordance with section #aibc;,a of the ,public ,health ,service ,act 7as added by section #c72 and 7#d7 suggestions for improving-- 7,a7 access to opioids for cancer and hospice patients2 and 7,b7 substance abuse treatment efforts under such section #aibc;,a4