House Report 115-766 - PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 6) TO PROVIDE FOR OPIOID USE DISORDER PREVENTION, RECOVERY, AND TREATMENT, AND FOR OTHER PURPOSES; PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 5797) TO AMEND TITLE XIX OF THE SOCIAL SECURITY ACT TO ALLOW STATES TO PROVIDE UNDER MEDICAID SERVICES FOR CERTAIN INDIVIDUALS WITH OPIOID USE DISORDERS IN INSTITUTIONS FOR MENTAL DISEASES; AND PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 6082) TO AMEND THE PUBLIC HEALTH SERVICE ACT TO PROTECT THE CONFIDENTIALITY OF SUBSTANCE USE DISORDER PATIENT RECORDS

[House Report 115-766]
[From the U.S. Government Publishing Office]

115th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 115-766

======================================================================

PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 6) TO PROVIDE FOR OPIOID
USE DISORDER PREVENTION, RECOVERY, AND TREATMENT, AND FOR OTHER
PURPOSES; PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 5797) TO AMEND
TITLE XIX OF THE SOCIAL SECURITY ACT TO ALLOW STATES TO PROVIDE UNDER
MEDICAID SERVICES FOR CERTAIN INDIVIDUALS WITH OPIOID USE DISORDERS IN
INSTITUTIONS FOR MENTAL DISEASES; AND PROVIDING FOR CONSIDERATION OF
THE BILL (H.R. 6082) TO AMEND THE PUBLIC HEALTH SERVICE ACT TO PROTECT
THE CONFIDENTIALITY OF SUBSTANCE USE DISORDER PATIENT RECORDS

_______

June 19, 2018.--Referred to the House Calendar and ordered to be
printed

_______

Mr. Burgess, from the Committee on Rules,
submitted the following

R E P O R T

[To accompany H. Res. 949]

The Committee on Rules, having had under consideration
House Resolution 949, by a record vote of 7 to 3, report the
same to the House with the recommendation that the resolution
be adopted.

SUMMARY OF PROVISIONS OF THE RESOLUTION

The resolution provides for consideration of H.R. 6, the
Substance Use-Disorder Prevention that Promotes Opioid Recovery
and Treatment for Patients and Communities Act, under a
structured rule. The resolution provides one hour of general
debate equally divided and controlled by the chair and ranking
minority member of the Committee on Committee on Energy and
Commerce. The resolution waives all points of order against
consideration of the bill. The resolution provides that an
amendment in the nature of a substitute consisting of the text
of Rules Committee Print 115-76, modified by Rules Committee
Print 115-78 and the amendment printed in part A of this
report, shall be considered as adopted and the bill, as
amended, shall be considered as read. The resolution waives all
points of order against provisions in the bill, as amended. The
resolution makes in order only those further amendments printed
in part B of this report. Each such amendment may be offered
only in the order printed in this report, may be offered only
by a Member designated in this report, shall be considered as
read, shall be debatable for the time specified in this report
equally divided and controlled by the proponent and an
opponent, shall not be subject to amendment, and shall not be
subject to a demand for division of the question in the House
or in the Committee of the Whole. The resolution waives all
points of order against the amendments printed in part B of
this report. The resolution provides one motion to recommit
with or without instructions.
Section 2 of the resolution provides for consideration of
H.R. 5797, the Individuals in Medicaid Deserve Care that is
Appropriate and Responsible in its Delivery Act, under a
structured rule. The resolution provides one hour of general
debate equally divided and controlled by the chair and ranking
minority member of the Committee on Energy and Commerce. The
resolution waives all points of order against consideration of
the bill. The resolution provides that the amendment in the
nature of a substitute recommended by the Committee on Energy
and Commerce now printed in the bill, modified by the amendment
printed in part C of this report, shall be considered as
adopted and the bill, as amended, shall be considered as read.
The resolution waives all points of order against provisions in
the bill, as amended. The resolution makes in order only those
further amendments printed in part D of this report. Each such
amendment may be offered only in the order printed in this
report, may be offered only by a Member designated in this
report, shall be considered as read, shall be debatable for the
time specified in this report equally divided and controlled by
the proponent and an opponent, shall not be subject to
amendment, and shall not be subject to a demand for division of
the question in the House or in the Committee of the Whole. The
resolution waives all points of order against the amendments
printed in part D of this report. The resolution provides one
motion to recommit with or without instructions.
Section 3 of the resolution provides for consideration of
H.R. 6082, the Overdose Prevention and Patient Safety Act,
under a closed rule. The resolution provides one hour of debate
equally divided and controlled by the chair and ranking
minority member of the Committee on Energy and Commerce. The
resolution waives all points of order against consideration of
the bill. The resolution provides that an amendment in the
nature of a substitute consisting of the text of Rules
Committee Print 115-75 shall be considered as adopted, and the
bill, as amended, shall be considered as read. The resolution
waives all points of order against provisions in the bill, as
amended. The resolution provides one motion to recommit with or
without instructions.
Section 4 the resolution directs the Clerk to, in the
engrossment of H.R. 6, add the text of H.R. 2851, H.R. 5735,
and H.R. 5797 as passed by the House as a new matter at the end
of H.R. 6 and make technical and conforming modifications in
the engrossment.

EXPLANATION OF WAIVERS

The waiver of all points of order against consideration of
H.R. 6 includes a waiver of the following:
Section 302(f) of the Congressional Budget Act, which
prohibits consideration of legislation providing new budget
authority in excess of a 302(a) allocation of such authority;
and
Section 306 of the Congressional Budget Act, which
prohibits consideration of legislation within the jurisdiction
of the Committee on the Budget unless referred to or reported
by the Budget Committee; and
Section 311 of the Congressional Budget Act, which
prohibits consideration of legislation that would cause the
level of total new budget authority for the first fiscal year
to be exceeded, or would cause revenues to be less than the
level of total revenues for the first fiscal year or for the
total of that first fiscal year and the ensuing fiscal years
for which allocations are provided.
Although the resolution waives all points of order against
provisions in H.R. 6, as amended, the Committee is not aware of
any points of order. The waiver is prophylactic in nature.
Although the resolution waives all points of order against
the amendments to H.R. 6 printed in part B of this report, the
Committee is not aware of any points of order. The waiver is
prophylactic in nature.
The waiver of all points of order against consideration of
H.R. 5797 includes a waiver of the following:
Section 302(f) of the Congressional Budget Act, which
prohibits consideration of legislation providing new budget
authority in excess of a 302(a) allocation of such authority;
and
Section 311 of the Congressional Budget Act, which
prohibits consideration of legislation that would cause the
level of total new budget authority for the first fiscal year
to be exceeded.
Although the resolution waives all points of order against
provisions in H.R. 5797, as amended, the Committee is not aware
of any points of order. The waiver is prophylactic in nature.
Although the resolution waives all points of order against
the amendments to H.R. 5797 printed in Part D of this report,
the Committee is not aware of any points of order. The waiver
is prophylactic in nature.
Although the resolution waives all points of order against
consideration of the H.R. 6082, the Committee is not aware of
any points of order. The waiver is prophylactic in nature.
Although the resolution waives all points of order against
provisions in H.R. 6082, as amended, the Committee is not aware
of any points of order. The waiver is prophylactic.

Rules Committee record vote No. 236

Motion by Mr. McGovern to make in order and provide the
appropriate waivers to amendment # 7 to H.R. 5797, offered by
Rep. Kennedy (MA), which expands the eligible population to
individuals with all substance use disorders; whereas the
current bill only makes eligible those individuals with opioid
use disorder. Additionally, it would require states to provide
the full continuum of care so that patients have access to
critical services when they are discharged from IMDs. Defeated:
3-7

----------------------------------------------------------------------------------------------------------------
Majority Members Vote Minority Members Vote
----------------------------------------------------------------------------------------------------------------
Mr. Cole..................................... ............... Mr. McGovern................... Yea
Mr. Woodall.................................. Nay Mr. Hastings of Florida........ Yea
Mr. Burgess.................................. Nay Mr. Polis...................... ...............
Mr. Collins.................................. ............... Mrs. Torres.................... Yea
Mr. Byrne.................................... Nay
Mr. Newhouse................................. Nay
Mr. Buck..................................... Nay
Ms. Cheney................................... Nay
Mr. Sessions, Chairman....................... Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 237

Motion by Mr. Hastings of Florida to make in order and
provide the appropriate waivers to amendment #9 to H.R. 5797,
offered by Rep. Waters (CA), which requires states to expand
Medicaid pursuant to the Affordable Care Act as a condition for
using Medicaid funds to treat people with opioid abuse
disorders in Institutions for Mental Disease (IMDs). Defeated:
3-7

Rules Committee record vote No. 238

Motion by Mr. Woodall to report the rule. Adopted: 7-3

----------------------------------------------------------------------------------------------------------------
Majority Members Vote Minority Members Vote
----------------------------------------------------------------------------------------------------------------
Mr. Cole..................................... ............... Mr. McGovern................... Nay
Mr. Woodall.................................. Yea Mr. Hastings of Florida........ Nay
Mr. Burgess.................................. Yea Mr. Polis...................... ...............
Mr. Collins.................................. ............... Mrs. Torres.................... Nay
Mr. Byrne.................................... Yea
Mr. Newhouse................................. Yea
Mr. Buck..................................... Yea
Ms. Cheney................................... Yea
Mr. Sessions, Chairman....................... Yea
----------------------------------------------------------------------------------------------------------------

SUMMARY OF THE AMENDMENT TO H.R. 6 IN PART A CONSIDERED AS ADOPTED

1. Walden (OR): Makes a technical correction to ensure that
the matter incorporated into H.R. 6 is identical to the
legislation previously adopted by the House.

SUMMARY OF THE AMENDMENTS TO H.R. 6 IN PART B MADE IN ORDER

1. Walden (OR), Pallone (NJ), Brady, Kevin (TX), Neal (MA):
Calls for Medicaid, Medicare, and public health reforms to help
combat the opioid crisis. The policies contained in H.R. 6 were
advanced through regular order by the House Energy and Commerce
and Ways and Means Committees. (10 minutes)
2. Dunn (FL), Marshall (KS), Harris (MD), Roe (TN): Strikes
language expanding the classes of health care workers who are
authorized to dispense narcotics for narcotic treatment. (10
minutes)
3. Barton (TX), Meadows (NC), Kuster, Ann (NH): Directs the
Commissioner of Food and Drugs to develop high-quality,
evidence-based opioid analgesic prescribing guidelines for the
indication-specific treatment of acute pain. In developing such
guidelines, it would require the Commissioner of Food and Drugs
to gather input through a public workshop and comment period,
and to provide a report to Congress on how such guidelines will
be used to protect the public health. (10 minutes)
4. Curtis, John (UT): Requires a report from HHS on opioid
prescribing practices and opioid misuse during pregnancy, and
evaluating non-opiate pain management practices during
pregnancy. (10 minutes)
5. Keating (MA), Rothfus (PA): Directs HHS to issue
guidelines for prescribing naloxone in situations involving any
type of prescription or illicit opioid use. (10 minutes)
6. Meadows (NC): Requires the Government Accountability
Office to conduct a comprehensive report on health care policy
changes that may have contributed to the increase in opioid
overdoses and deaths. (10 minutes)
7. Waters (CA): Directs the Secretary of Health and Human
Services (HHS) to conduct a survey of organizations that
provide substance abuse treatment services. Under the
amendment, HHS is required to develop, and submit to Congress,
a plan to direct appropriate resources to address inadequacies
in services or funding for specific types of drug addictions
identified through the survey. (10 minutes)
8. Turner (OH), Kuster, Ann (NH): Eliminates Substance
Abuse and Mental Health Services Administration's (SAMHSA)
policy that prevents SAMHSA funding from going toward substance
abuse treatment services for individuals who are incarcerated.
(10 minutes)

SUMMARY OF THE AMENDMENT TO H.R. 5797 IN PART C CONSIDERED AS ADOPTED

1. Walters, Mimi (CA): Provides an incentive for states to
voluntarily adopt a medical loss ratio (MLR) requirement for
their Medicaid managed care organizations (MCOs) of 85 percent.

SUMMARY OF THE AMENDMENTS TO H.R. 5797 IN PART D MADE IN ORDER

1. Rush (IL): Expands treatment coverage to individuals
suffering from cocaine use disorder (which includes crack
cocaine). (10 minutes)
2. Kildee (MI): Adds two requirements to the report that
states are required to submit. The first would be information
regarding the number of individuals suffering from co-occuring
disorders and the disorders from which they suffer and the
second would be information regarding access to community care
for individuals suffering from a mental illness other than
substance use disorder. (10 minutes)
3. Fitzpatrick (PA): Provides flexibility for States to
allow the State plan amendment to include assessments to
determine level of care and length of stay recommendations
based upon criteria established or endorsed by a State agency
pursuant to 1932(b)(1)(A)(i) of the Public Health Service Act.
(10 minutes)

PART A--TEXT OF AMENDMENT TO H.R. 6 CONSIDERED AS ADOPTED

Page 49, strike line 15 and all that follows through page 50,
line 4, and insert the following:
``(1) Administrative funding.--For the purposes of
implementing, administering, and carrying out the
Program (other than for purposes described in paragraph
(2)), $5,000,000 shall be available from the Federal
Supplementary Medical Insurance Trust Fund under
section 1841.
``(2) Care management fees and incentives.--For the
purposes of making payments under subsection (e),
$10,000,000 shall be available from the Federal
Supplementary Medical Insurance Trust Fund under
section 1841 for each of fiscal years 2021 through
2024.''.
Page 53, strike lines 16 through 24, and insert the
following:
(f) Funding.--For purposes of implementing this section,
$75,000,000 shall be available from the Federal Supplementary
Medical Insurance Trust Fund under section 1841 of the Social
Security Act (42 U.S.C. 1395t), to remain available until
expended.

PART B--TEXT OF AMENDMENTS TO H.R. 6 MADE IN ORDER

1. An Amendment To Be Offered by Representative Walden of Oregon or His
Designee, Debatable for 10 Minutes

Page 65, line 18, insert ``(as described in paragraph
(4)(F))'' after ``telehealth services''.
Page 68, line 21, insert ``, as determined by the Secretary''
after ``clinical improvement''.
Page 70, line 24, strike ``certified''.
Page 70, after line 25, insert the following:
(b) Clarification.--Nothing in the amendments made by
subsection (a) shall be construed to prohibit separate payment
for structured assessment and intervention services for
substance abuse furnished to an individual on the same day as
an initial preventive physical examination.
Page 71, line 1, redesignate the subsection (b) as a
subsection (c).
Page 71, strike line 21 and all that follows through page 72,
line 2, and insert the following:
``(ii) For purposes of clause (i),
the term `targeted procedure' means a
procedure to which Healthcare Common
Procedure Coding System code 62310 (or,
for years beginning after 2016, 62321),
62311 (or, for years beginning after
2016, 62323), 62264, 64490, 64493, or
G0260, or any successor code, apply.''.
Page 95, line 1, strike ``100 or more'' and insert ``more
than 100''.
Page 95, line 2, strike ``30 or more'' and insert ``more than
30''.
Page 95, line 13, insert ``the frequency of toxicology
testing, including'' before ``the average''.
page 96, line 10, strike ``2025'' and insert ``2024''.
page 97, strike line 7, and insert ``that is at least 85
percent but not greater than the minimum medical loss ratio (as
so defined) that such State applied as of May 31, 2018; or''.
----------

2. An Amendment To Be Offered by Representative Dunn of Florida or His
Designee, Debatable for 10 Minutes

Page 93, strike lines 18 through 22 and insert the following:
(2) in subclause (II), by striking ``during the
period beginning on the date of enactment of the
Comprehensive Addiction and Recovery Act of 2016 and
ending on October 1, 2021,''.
Page 93, strike line 23 and all that follows through page 94,
line 17.
Page 94, line 18, strike ``(e)'' and insert ``(c)''.
----------

3. An Amendment To Be Offered by Representative Barton of Texas or His
Designee, Debatable for 10 Minutes

At the end of title III, insert the following new section:

SEC. 304. HIGH-QUALITY, EVIDENCE-BASED OPIOID ANALGESIC PRESCRIBING
GUIDELINES AND REPORT.

(a) Guidelines.--The Commissioner of Food and Drugs shall
develop high-quality, evidence-based opioid analgesic
prescribing guidelines for the indication-specific treatment of
acute pain in the relevant therapeutic areas where such
guidelines do not exist.
(b) Public Input.--In developing the guidelines under
subsection (a), the Commissioner of Food and Drugs shall--
(1) conduct a public workshop, open to
representatives of State medical societies and medical
boards, various medical specialties including pain
medicine specialty societies, patient groups,
pharmacists, universities, and others; and
(2) provide a period for the submission of comments
by the public.
(c) Report.--Not later than the date that is 2 years after
the date of enactment of this Act, the Commissioner of Food and
Drugs shall submit to the Committee on Energy and Commerce of
the House of Representatives and the Committee on Health,
Education, Labor, and Pensions of the Senate, and post on the
public website of the Food and Drug Administration, a report on
how the guidelines under subsection (a) will be utilized to
protect the public health.
(d) Updates.--The Commissioner of Food and Drugs shall
periodically--
(1) update the guidelines under subsection (a),
informed by public input described in subsection (b);
and
(2) submit to the committees specified in subsection
(c) and post on the public website of the Food and Drug
Administration an updated report under subsection (c).
(e) Statement To Accompany Guidelines and Recommendations.--
The Commissioner of Food and Drugs shall ensure that any opioid
analgesic prescribing guidelines and other recommendations
developed under this section are accompanied by a clear
statement that such guidelines or recommendations, as
applicable--
(1) are intended to help inform clinical
decisionmaking by prescribers and patients; and
(2) should not be used by other parties, including
pharmacy benefit management companies, retail or
community pharmacies, or public and private payors, for
the purposes of restricting, limiting, delaying, or
denying coverage for or access to a prescription issued
for a legitimate medical purpose by an individual
practitioner acting in the usual course of professional
practice.
(f) Definition.--In this section, the term ``evidence-based''
means informed by a robust and systemic review of treatment
efficacy and clinical evidence.
----------

4. An Amendment To Be Offered by Representative Curtis of Utah or His
Designee, Debatable for 10 Minutes

Add at the end of title III the following:

SEC. 304. REPORT ON OPIOIDS PRESCRIBING PRACTICES FOR PREGNANT WOMEN.

(a) In General.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Health and Human
Services, in coordination with the Centers for Disease Control
and Prevention, the National Institutes of Health, and the
Substance Abuse and Mental Health Services Administration shall
develop and submit to the Congress a report--
(1) on opioids prescribing practices for pregnant
women and recommendations for such practices;
(2) that provides recommendations for identifying and
reducing opioids misuse during pregnancy;
(3) on prescription opioid misuse during pregnancy in
urban and rural areas;
(4) on prescription opioid use during pregnancy for
the purpose of medication-assisted treatment in urban
and rural areas;
(5) evaluating current utilization of non-opiate pain
management practices in place of prescription opioids
during pregnancy;
(6) providing guidelines encouraging the use of non-
opioid pain management practices during pregnancy when
safe and effective; and
(7) that provides recommendations for increasing
public awareness and education of opioid use disorder
in pregnancy, including available treatment resources
in urban and rural areas.
(b) No Additional Funds.--No additional funds are authorized
to be appropriated for purposes of carrying out subsection (a).
----------

5. An Amendment To Be Offered by Representative Keating of
Massachusetts or His Designee, Debatable for 10 Minutes

Add at the end of title III the following:

SEC. 304. GUIDELINES FOR PRESCRIBING NALOXONE.

(a) In General.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Health and Human
Services shall issue guidelines for prescribing an opioid
overdose reversal drug.
(b) Contents.--In issuing guidelines under subsection (a),
the Secretary shall address the following:
(1) Co-prescribing an opioid overdose reversal drug
in conjunction with any prescribed opioid.
(2) Dosage safety.
(3) Prescribing an opioid overdose reversal drug to
an individual other than a patient.
(4) Standing orders.
(5) Other distribution, education, and safety
measures as determined necessary.
----------

6. An Amendment To Be Offered by Representative Meadows of North
Carolina or His Designee, Debatable for 10 Minutes

At the end of title III, insert the following new section:

SEC. 304. GAO STUDY AND REPORT ON POLICY CHANGES THAT MAY HAVE
CONTRIBUTED TO THE OPIOID EPIDEMIC.

Not later than 2 years after the date of enactment of this
Act, the Comptroller General of the United States shall
complete a study and submit a report to Congress on health care
policy changes that may have contributed to the increase in
opioid overdoses and deaths during the 10 years preceding the
date of enactment of this Act. Such study shall include--
(1) a review of health care-related legislative,
administrative, and judicial decisions by officers and
employees of the Federal Government that have affected
access to pain management strategies with an emphasis
on pharmaceuticals;
(2) an analysis of what is known about the costs and
benefits, whether financial or nonfinancial, of
reversing or revising such decisions individually or in
combination, including whether the reversals or
revisions would be expected to achieve a reduction in
abuse of, addiction to, overdose on, and death from
opioids;
(3) an analysis of the differences among State-based
prescription drug monitoring programs, including an
analysis of what is known about the effects of such
differences on monitoring for abuse of, addiction to,
overdose on, and death from opioids;
(4) an analysis of what is known about positive and
negative impacts that prescribing limitations, both
State and Federal, have on patient medical outcomes,
including for chronic pain patients; and
(5) an analysis of what is known about the costs and
benefits to payers of using abuse-deterrent
formulations of opioid pain medications, compared to
opioid pain medications without abuse-deterrent
features.
----------

7. An Amendment To Be Offered by Representative Waters of California or
Her Designee, Debatable for 10 Minutes

Add at the end of title III the following new section:

SEC. ___. REQUIRING A SURVEY OF SUBSTANCE USE DISORDER TREATMENT
PROVIDERS RECEIVING FEDERAL FUNDING.

(a) In General.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
conduct a survey of all entities that receive Federal funding
for the purpose of providing substance use disorder treatment
services. The survey shall direct such entities to provide the
following information:
(1) The length of time the entity has provided
substance use disorder treatment services.
(2) A detailed description of the patient population
served by the entity, including but not limited to the
number of patients, type of addictions, geographic area
served, as well as gender, racial, ethnic and
socioeconomic demographics of such patients.
(3) A detailed description of the types of addiction
for which the entity has the experience, capability,
and capacity to provide such services.
(4) An explanation of how the entity handles patients
requiring treatment for a substance use disorder that
the organization is not able to treat.
(5) A description of what is needed, in the opinion
of the entity, in order to improve the entity's ability
to meet the addiction treatment needs of the
communities served by that entity.
(6) Based on the identified needs of the communities
served, a description of unmet needs and inadequate
services and how such needs and services could be
better addressed through additional Federal, State, or
local government resources or funding to treat
addiction to methamphetamine, crack cocaine, other
types of cocaine, heroin, opioids, and other commonly
abused drugs.
(b) Report.--Not later than 1 year after the date of the
enactment of this Act, the Secretary shall develop and submit
to Congress a plan to direct appropriate resources to entities
that provide substance use disorder treatment services in order
to address inadequacies in services or funding identified
through the survey described in subsection (a).
----------

8. An Amendment To Be Offered by Representative Turner of Ohio or His
Designee, Debatable for 10 Minutes

Add at the end of title III the following:

SEC. 304. NO SAMSHA POLICY AGAINST SUBSTANCE ABUSE TREATMENT FOR
INCARCERATED INDIVIDUALS.

The Substance Abuse and Mental Health Services Administration
shall not establish, maintain, or implement any memorandum of
understanding or other policy that prohibits or restricts the
Administration's provision or support of substance abuse
treatment or related services for incarcerated individuals, so
long as such provision or support--
(1) is statutorily authorized (by provisions of law
other than this section) for such type of treatment or
services; and
(2) not statutorily prohibited or restricted with
respect to incarcerated individuals.
----------

PART C--TEXT OF AMENDMENT TO H.R. 5796 CONSIDERED AS ADOPTED

Add at the end the following:

SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE.

Section 1903(m) of the Social Security Act (42 U.S.C.
1396b(m)) is amended by adding at the end the following new
paragraph:
``(7)(A) With respect to expenditures described in
subparagraph (B) that are incurred by a State for any fiscal
year after fiscal year 2020 (and before fiscal year 2025), in
determining the pro rata share to which the United States is
equitably entitled under subsection (d)(3), the Secretary shall
substitute the Federal medical assistance percentage that
applies for such fiscal year to the State under section 1905(b)
(without regard to any adjustments to such percentage
applicable under such section or any other provision of law)
for the percentage that applies to such expenditures under
section 1905(y).
``(B) Expenditures described in this subparagraph, with
respect to a fiscal year to which subparagraph (A) applies, are
expenditures incurred by a State for payment for medical
assistance provided to individuals described in subclause
(VIII) of section 1902(a)(10)(A)(i) by a managed care entity,
or other specified entity (as defined in subparagraph
(D)(iii)), that are treated as remittances because the State--
``(i) has satisfied the requirement of section 438.8
of title 42, Code of Federal Regulations (or any
successor regulation), by electing--
``(I) in the case of a State described in
subparagraph (C), to apply a minimum medical
loss ratio (as defined in subparagraph (D)(ii))
that is at least 85 percent but not greater
than the minimum medical loss ratio (as so
defined) that such State applied as of May 31,
2018; or
``(II) in the case of a State not described
in subparagraph (C), to apply a minimum medical
loss ratio that is equal to 85 percent; and
``(ii) recovered all or a portion of the expenditures
as a result of the entity's failure to meet such ratio.
``(C) For purposes of subparagraph (B), a State described in
this subparagraph is a State that as of May 31, 2018, applied a
minimum medical loss ratio (as calculated under subsection (d)
of section 438.8 of title 42, Code of Federal Regulations (as
in effect on June 1, 2018)) for payment for services provided
by entities described in such subparagraph under the State plan
under this title (or a waiver of the plan) that is equal to or
greater than 85 percent.
``(D) For purposes of this paragraph:
``(i) The term `managed care entity' means a medicaid
managed care organization described in section
1932(a)(1)(B)(i).
``(ii) The term `minimum medical loss ratio' means,
with respect to a State, a minimum medical loss ratio
(as calculated under subsection (d) of section 438.8 of
title 42, Code of Federal Regulations (as in effect on
June 1, 2018)) for payment for services provided by
entities described in subparagraph (B) under the State
plan under this title (or a waiver of the plan).
``(iii) The term `other specified entity' means--
``(I) a prepaid inpatient health plan, as
defined in section 438.2 of title 42, Code of
Federal Regulations (or any successor
regulation); and
``(II) a prepaid ambulatory health plan, as
defined in such section (or any successor
regulation).''.
----------

PART D--TEXT OF AMENDMENTS TO H.R. 5797 MADE IN ORDER

1. An Amendment To Be Offered by Representative Rush of Illinois or His
Designee, Debatable for 10 Minutes

In section 2, strike ``individuals with opioid use
disorders'' and insert ``individuals with targeted suds''.
In the subsection (l) proposed to be added by section 2 of
the bill to section 1915 of the Social Security Act, strike
``eligible individuals with opioid use disorders'' each place
it appears and insert ``eligible individuals with targeted
SUDs'' each such place.
In the subsection (l) proposed to be added by section 2 of
the bill to section 1915 of the Social Security Act, strike
``eligible individual with an opioid use disorder'' each place
it appears and insert ``eligible individual with a targeted
SUD'' each such place.
Page 5, beginning on line 19, strike ``individuals with
opioid use disorder'' and insert ``eligible individuals with
targeted SUDs''.
Page 6, beginning on line 1, strike ``eligible individuals
with an opioid use disorder'' and insert ``eligible individuals
with targeted SUDs''.
Page 6, line 7, insert before the period the following: ``and
to determine the appropriate setting for such care''.
Page 7, line 12, strike ``opioid use disorder'' and insert
``targeted SUD''.
In the subsection (l)(4) proposed to be added by section 2 of
the bill to section 1915 of the Social Security Act, strike
subparagraph (D), redesignate subparagraph (E) as subparagraph
(D), and add at the end the following:
``(E) Targeted sud.--
``(i) In general.--The term `targeted
SUD' means an opioid use disorder or a
cocaine use disorder.
``(ii) Cocaine use disorder.--The
term `cocaine use disorder' means a
disorder that meets the criteria of the
Diagnostic and Statistical Manual of
Mental Disorders, 4th Edition (or a
successor edition), for either
dependence or abuse for cocaine,
including cocaine base (commonly
referred to as `crack cocaine').
``(iii) Opioid use disorder.--The
term `opioid use disorder' means a
disorder that meets the criteria of the
Diagnostic and Statistical Manual of
Mental Disorders, 4th Edition (or a
successor edition), for heroin use
disorder or pain reliever use disorder
(including with respect to opioid
prescription pain relievers).''.
Strike all that follows after section 2 and insert the
following:

SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE.

Section 1903(m) of the Social Security Act (42 U.S.C.
1396b(m)) is amended by adding at the end the following new
paragraph:
``(7)(A) With respect to expenditures described in
subparagraph (B) that are incurred by a State for any fiscal
year after fiscal year 2020 (and before fiscal year 2024), in
determining the pro rata share to which the United States is
equitably entitled under subsection (d)(3), the Secretary shall
substitute the Federal medical assistance percentage that
applies for such fiscal year to the State under section 1905(b)
(without regard to any adjustments to such percentage
applicable under such section or any other provision of law)
for the percentage that applies to such expenditures under
section 1905(y).
``(B) Expenditures described in this subparagraph, with
respect to a fiscal year to which subparagraph (A) applies, are
expenditures incurred by a State for payment for medical
assistance provided to individuals described in subclause
(VIII) of section 1902(a)(10)(A)(i) by a managed care entity,
or other specified entity (as defined in subparagraph
(D)(iii)), that are treated as remittances because the State--
``(i) has satisfied the requirement of section 438.8
of title 42, Code of Federal Regulations (or any
successor regulation), by electing--
``(I) in the case of a State described in
subparagraph (C), to apply a minimum medical
loss ratio (as defined in subparagraph (D)(ii))
that is at least 85 percent but not greater
than the minimum medical loss ratio (as so
defined) that such State applied as of May 31,
2018; or
``(II) in the case of a State not described
in subparagraph (C), to apply a minimum medical
loss ratio that is equal to 85 percent; and
``(ii) recovered all or a portion of the expenditures
as a result of the entity's failure to meet such ratio.
``(C) For purposes of subparagraph (B), a State described in
this subparagraph is a State that as of May 31, 2018, applied a
minimum medical loss ratio (as calculated under subsection (d)
of section 438.8 of title 42, Code of Federal Regulations (as
in effect on June 1, 2018)) for payment for services provided
by entities described in such subparagraph under the State plan
under this title (or a waiver of the plan) that is equal to or
greater than 85 percent.
``(D) For purposes of this paragraph:
``(i) The term `managed care entity' means a medicaid
managed care organization described in section
1932(a)(1)(B)(i).
``(ii) The term `minimum medical loss ratio' means,
with respect to a State, a minimum medical loss ratio
(as calculated under subsection (d) of section 438.8 of
title 42, Code of Federal Regulations (as in effect on
June 1, 2018)) for payment for services provided by
entities described in subparagraph (B) under the State
plan under this title (or a waiver of the plan).
``(iii) The term `other specified entity' means--
``(I) a prepaid inpatient health plan, as
defined in section 438.2 of title 42, Code of
Federal Regulations (or any successor
regulation); and
``(II) a prepaid ambulatory health plan, as
defined in such section (or any successor
regulation).''.
----------

2. An Amendment To Be Offered by Representative Kildee of Michigan or
His Designee, Debatable for 10 Minutes

Page 6, line 19, strike ``and''.
Page 6, line 23, strike the period at the end and insert ``;
and''.
Page 6, after line 23, insert the following:
``(iv) the number of eligible
individuals with any co-occuring
disorders who received services
pursuant to such State plan amendment
and the co-occuring disorders from
which they suffer; and
``(v) information regarding the
effects of a State plan amendment on
access to community care for
individuals suffering from a mental
disease other than substance use
disorder.''.
----------

3. An Amendment To Be Offered by Representative Fitzpatrick of
Pennsylvania or His Designee, Debatable for 10 Minutes

Page 6, line 7, insert before the period the following: ``or
criteria established or endorsed by the State agency identified
by the State pursuant to section 1932(b)(1)(A)(i) of the Public
Health Service Act''.

[all]