[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5477 Reported in House (RH)]
<DOC>
Union Calendar No. 566
115th CONGRESS
2d Session
H. R. 5477
[Report No. 115-731]
To amend title XIX of the Social Security Act to provide for a
demonstration project to increase substance use provider capacity under
the Medicaid program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 11, 2018
Mr. O'Halleran introduced the following bill; which was referred to the
Committee on Energy and Commerce
June 12, 2018
Additional sponsors: Mrs. Blackburn, Mr. Walden, and Mr. Mitchell
June 12, 2018
Reported with an amendment, committed to the Committee of the Whole
House on the State of the Union, and ordered to be printed
[Strike out all after the enacting clause and insert the part printed
in italic]
[For text of introduced bill, see copy of bill as introduced on April
11, 2018]
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide for a
demonstration project to increase substance use provider capacity under
the Medicaid program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Rural Development of Opioid Capacity
Services Act'' or the ``Rural DOCS Act''.
SEC. 2. DEMONSTRATION PROJECT TO INCREASE SUBSTANCE USE PROVIDER
CAPACITY UNDER THE MEDICAID PROGRAM.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended by adding at the end the following new subsection:
``(aa) Demonstration Project to Increase Substance Use Provider
Capacity.--
``(1) In general.--Not later than the date that is 180 days
after the date of the enactment of this section, the Secretary
shall, in consultation, as appropriate, with the Director of
the Agency for Healthcare Research and Quality and the
Assistant Secretary for Mental Health and Substance Use,
conduct a 5-year demonstration project for the purpose
described in paragraph (2) under which the Secretary shall--
``(A) for the first 18-month period of such
project, award planning grants described in paragraph
(3); and
``(B) for the remaining 42-month period of such
project, provide to each State selected under paragraph
(4) payments in accordance with paragraph (5).
``(2) Purpose.--The purpose described in this paragraph is
for each State selected under paragraph (4) to increase the
treatment capacity of providers participating under the State
plan (or a waiver of such plan) to provide substance use
disorder treatment or recovery services under such plan (or
waiver) through the following activities:
``(A) For the purpose described in paragraph
(3)(C)(i), activities that support an ongoing
assessment of the behavioral health treatment needs of
the State, taking into account the matters described in
subclauses (I) through (IV) of such paragraph.
``(B) Activities that, taking into account the
results of the assessment described in subparagraph
(A), support the recruitment, training, and provision
of technical assistance for providers participating
under the State plan (or a waiver of such plan) that
offer substance use disorder treatment or recovery
services.
``(C) Improved reimbursement for and expansion of,
through the provision of education, training, and
technical assistance, the number or treatment capacity
of providers participating under the State plan (or
waiver) that--
``(i) are authorized to dispense drugs
approved by the Food and Drug Administration
for individuals with a substance use disorder
who need withdrawal management or maintenance
treatment for such disorder;
``(ii) have in effect a registration or
waiver under section 303(g) of the Controlled
Substances Act for purposes of dispensing
narcotic drugs to individuals for maintenance
treatment or detoxification treatment and are
in compliance with any regulation promulgated
by the Assistant Secretary for Mental Health
and Substance Use for purposes of carrying out
the requirements of such section 303(g); and
``(iii) are qualified under applicable
State law to provide substance use disorder
treatment or recovery services.
``(D) Improved reimbursement for and expansion of,
through the provision of education, training, and
technical assistance, the number or treatment capacity
of providers participating under the State plan (or
waiver) that have the qualifications to address the
treatment or recovery needs of--
``(i) individuals enrolled under the State
plan (or a waiver of such plan) who have
neonatal abstinence syndrome, in accordance
with guidelines issued by the American Academy
of Pediatrics and American College of
Obstetricians and Gynecologists relating to
maternal care and infant care with respect to
neonatal abstinence syndrome;
``(ii) pregnant women, postpartum women,
and infants, particularly the concurrent
treatment, as appropriate, and comprehensive
case management of pregnant women, postpartum
women and infants, enrolled under the State
plan (or a waiver of such plan);
``(iii) adolescents and young adults
between the ages of 12 and 21 enrolled under
the State plan (or a waiver of such plan); or
``(iv) American Indian and Alaska Native
individuals enrolled under the State plan (or a
waiver of such plan).
``(3) Planning grants.--
``(A) In general.--The Secretary shall, with
respect to the first 18-month period of the
demonstration project conducted under paragraph (1),
award planning grants to at least 10 States selected in
accordance with subparagraph (B) for purposes of
preparing an application described in paragraph (4)(C)
and carrying out the activities described in
subparagraph (C).
``(B) Selection.--In selecting States for purposes
of this paragraph, the Secretary shall--
``(i) select States that have a State plan
(or waiver of the State plan) approved under
this title;
``(ii) select States in a manner that
ensures geographic diversity; and
``(iii) give preference to States with a
prevalence of substance use disorders (in
particular opioid use disorders) that is
comparable to or higher than the national
average prevalence, as measured by aggregate
per capita drug overdoses, or any other measure
that the Secretary deems appropriate.
``(C) Activities described.--Activities described
in this subparagraph are, with respect to a State, each
of the following:
``(i) Activities that support the
development of an initial assessment of the
behavioral health treatment needs of the State
to determine the extent to which providers are
needed (including the types of such providers
and geographic area of need) to improve the
network of providers that treat substance use
disorders under the State plan (or waiver),
including the following:
``(I) An estimate of the number of
individuals enrolled under the State
plan (or a waiver of such plan) who
have a substance use disorder.
``(II) Information on the capacity
of providers to provide substance use
disorder treatment or recovery services
to individuals enrolled under the State
plan (or waiver), including information
on providers who provide such services
and their participation under the State
plan (or waiver).
``(III) Information on the gap in
substance use disorder treatment or
recovery services under the State plan
(or waiver) based on the information
described in subclauses (I) and (II).
``(IV) Projections regarding the
extent to which the State participating
under the demonstration project would
increase the number of providers
offering substance use disorder
treatment or recovery services under
the State plan (or waiver) during the
period of the demonstration project.
``(ii) Activities that, taking into account
the results of the assessment described in
clause (i), support the development of State
infrastructure to, with respect to the
provision of substance use disorder treatment
or recovery services under the State plan (or a
waiver of such plan), recruit prospective
providers and provide training and technical
assistance to such providers.
``(D) Funding.--For purposes of subparagraph (A),
there is appropriated, out of any funds in the Treasury
not otherwise appropriated, $50,000,000, to remain
available until expended.
``(4) Post-planning states.--
``(A) In general.--The Secretary shall, with
respect to the remaining 42-month period of the
demonstration project conducted under paragraph (1),
select not more than 5 States in accordance with
subparagraph (B) for purposes of carrying out the
activities described in paragraph (2) and receiving
payments in accordance with paragraph (5).
``(B) Selection.--In selecting States for purposes
of this paragraph, the Secretary shall--
``(i) select States that received a
planning grant under paragraph (3);
``(ii) select States that submit to the
Secretary an application in accordance with the
requirements in subparagraph (C), taking into
consideration the quality of each such
application;
``(iii) select States in a manner that
ensures geographic diversity; and
``(iv) give preference to States with a
prevalence of substance use disorders (in
particular opioid use disorders) that is
comparable to or higher than the national
average prevalence, as measured by aggregate
per capita drug overdoses, or any other measure
that the Secretary deems appropriate.
``(C) Applications.--
``(i) In general.--A State seeking to be
selected for purposes of this paragraph shall
submit to the Secretary, at such time and in
such form and manner as the Secretary requires,
an application that includes such information,
provisions, and assurances, as the Secretary
may require, in addition to the following:
``(I) A proposed process for
carrying out the ongoing assessment
described in paragraph (2)(A), taking
into account the results of the initial
assessment described in paragraph
(3)(C)(i).
``(II) A review of reimbursement
methodologies and other policies
related to substance use disorder
treatment or recovery services under
the State plan (or waiver) that may
create barriers to increasing the
number of providers delivering such
services.
``(III) The development of a plan,
taking into account activities carried
out under paragraph (3)(C)(ii), that
will result in long-term and
sustainable provider networks under the
State plan (or waiver) that will offer
a continuum of care for substance use
disorders. Such plan shall include the
following:
``(aa) Specific activities
to increase the number of
providers (including providers
that specialize in providing
substance use disorder
treatment or recovery services,
hospitals, health care systems,
Federally qualified health
centers, and, as applicable,
certified community behavioral
health clinics) that offer
substance use disorder
treatment, recovery, or support
services, including short-term
detoxification services,
outpatient substance use
disorder services, and
evidence-based peer recovery
services.
``(bb) Strategies that will
incentivize providers described
in subparagraphs (C) and (D) of
paragraph (2) to obtain the
necessary training, education,
and support to deliver
substance use disorder
treatment or recovery services
in the State.
``(cc) Milestones and
timeliness for implementing
activities set forth in the
plan.
``(dd) Specific measurable
targets for increasing the
substance use disorder
treatment and recovery provider
network under the State plan
(or a waiver of such plan).
``(IV) A proposed process for
reporting the information required
under paragraph (6)(A), including
information to assess the effectiveness
of the efforts of the State to expand
the capacity of providers to deliver
substance use disorder treatment or
recovery services during the period of
the demonstration project under this
subsection.
``(V) The expected financial impact
of the demonstration project under this
subsection on the State.
``(VI) A description of all funding
sources available to the State to
provide substance use disorder
treatment or recovery services in the
State.
``(VII) A preliminary plan for how
the State will sustain any increase in
the capacity of providers to deliver
substance use disorder treatment or
recovery services resulting from the
demonstration project under this
subsection after the termination of
such demonstration project.
``(VIII) A description of how the
State will coordinate the goals of the
demonstration project with any waiver
received pursuant to section 1115 for
the delivery of substance use services
under the State plan, as applicable.
``(ii) Consultation.--In completing an
application under clause (i), a State shall
consult with relevant stakeholders, including
Medicaid managed care plans, health care
providers, and Medicaid beneficiary advocates,
and include in such application a description
of such consultation.
``(5) Payment.--
``(A) In general.--For each quarter occurring
during the period for which the demonstration project
is conducted (after the first 18 months of such
period), the Secretary shall pay under this subsection,
subject to subparagraphs (C) and (D), to each State
selected under paragraph (4) an amount equal to 80
percent of so much of the qualified sums expended
during such quarter.
``(B) Qualified sums defined.--For purposes of
subparagraph (A), the term `qualified sums' means, with
respect to a State and a quarter, the amount equal to
the amount (if any) by which the sums expended by the
State during such quarter attributable to substance use
treatment or recovery services furnished by providers
participating under the State plan (or a waiver of such
plan) exceeds 1/4 of such sums expended by the State
during fiscal year 2018 attributable to substance use
treatment or recovery services.
``(C) Non-duplication of payment.--In the case that
payment is made under subparagraph (A) with respect to
expenditures for substance use treatment or recovery
services furnished by providers participating under the
State plan (or a waiver of such plan), payment may not
also be made under subsection (a) with respect to
expenditures for the same services so furnished.
``(D) Conditions.--In the case of a State selected
under paragraph (4) that provides substance use
disorder treatment and recovery services under a waiver
under section 1115, such State shall, as a condition of
receiving payments under subparagraph (A)--
``(i) coordinate such services under such
waiver with substance use disorder treatment
and recovery services provided under the
demonstration project under this subsection;
and
``(ii) take such actions as appropriate
under the demonstration project to expand such
services under such waiver.
``(6) Reports.--
``(A) State reports.--A State receiving payments
under paragraph (5) shall, for the period of the
demonstration project under this subsection, submit to
the Secretary a quarterly report, with respect to
expenditures for substance use treatment or recovery
services for which payment is made to the State under
this subsection, on the following:
``(i) The specific activities with respect
to which payment under this subsection was
provided.
``(ii) The number of providers that
delivered substance use disorder treatment or
recovery services in the State under the
demonstration project compared to the estimated
number of providers that would have otherwise
delivered such services in the absence of such
demonstration project.
``(iii) The number of individuals enrolled
under the State plan (or a waiver of such plan)
who received substance use disorder treatment
or recovery services under the demonstration
project compared to the estimated number of
such individuals who would have otherwise
received such services in the absence of such
demonstration project.
``(iv) Other matters as determined by the
Secretary.
``(B) CMS reports.--
``(i) Initial report.--Not later than
October 1, 2020, the Administrator of the
Centers for Medicare & Medicaid Services shall,
in consultation with the Director of the Agency
for Healthcare Research and Quality and the
Assistant Secretary for Mental Health and
Substance Use, submit to Congress an initial
report on--
``(I) the States awarded planning
grants under paragraph (3);
``(II) the criteria used in such
selection; and
``(III) the activities carried out
by such States under such planning
grants.
``(ii) Interim report.--Not later than
October 1, 2022, the Administrator of the
Centers for Medicare & Medicaid Services shall,
in consultation with the Director of the Agency
for Healthcare Research and Quality and the
Assistant Secretary for Mental Health and
Substance Use, submit to Congress an interim
report--
``(I) on activities carried out
under the demonstration project under
this subsection;
``(II) on the extent to which
States selected under paragraph (4)
have achieved the stated goals
submitted in their applications under
subparagraph (C) of such paragraph;
``(III) with a description of the
strengths and limitations of such
demonstration project; and
``(IV) with a plan for the
sustainability of such project.
``(iii) Final report.--Not later than
October 1, 2024, the Administrator of the
Centers for Medicare & Medicaid Services shall,
in consultation with the Director of the Agency
for Healthcare Research and Quality and the
Assistant Secretary for Mental Health and
Substance Use, submit to Congress a final
report--
``(I) providing updates on the
matters reported in the interim report
under clause (ii);
``(II) including a description of
any changes made with respect to the
demonstration project under this
subsection after the submission of such
interim report; and
``(III) evaluating such
demonstration project.
``(C) AHRQ report.--Not later than three years
after the date of the enactment of this subsection, the
Director of the Agency for Healthcare Research and
Quality shall submit to Congress a summary on the
experiences of States awarded planning grants under
paragraph (3) and States selected under paragraph (4).
``(7) Data sharing and best practices.--During the period
of the demonstration project under this subsection, the
Secretary shall, in collaboration with States selected under
paragraph (4), facilitate data sharing and the development of
best practices between such States and States that were not so
selected.
``(8) CMS funding.--There is appropriated, out of any funds
in the Treasury not otherwise appropriated, $5,000,000 to the
Centers for Medicare & Medicaid Services for purposes of
implementing this subsection. Such amount shall remain
available until expended.''.
Union Calendar No. 566
115th CONGRESS
2d Session
H. R. 5477
[Report No. 115-731]
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide for a
demonstration project to increase substance use provider capacity under
the Medicaid program.
_______________________________________________________________________
June 12, 2018
Reported with an amendment, committed to the Committee of the Whole
House on the State of the Union, and ordered to be printed