Title II — S. 5000 (Introduced in Senate)

Sec. 201 Three-day limit on opioid prescriptions

Section 303 of the Controlled Substances Act (21 U.S.C. 823) is amended by adding at the end the following:

“(l) Three-Day limit on opioid prescriptions

“(1) Definitions—In this subsection—

“(A) the term acute pain—

“(i) means pain with abrupt onset and caused by an injury or other process that is not ongoing; and

“(ii) does not include—

“(I) chronic pain;

“(II) pain being treated as part of cancer care;

“(III) hospice or other end-of-life care; or

“(IV) pain being treated as part of palliative care; and

“(B) the term substance use treatment opioid prescription means a prescription—

“(i) for an opioid drug in schedule II, III, or IV approved by the Food and Drug Administration for an indication for the treatment of substance use disorder; and

“(ii) that is for the treatment of substance use disorder.

“(2) Three-day limit—The Attorney General may not register, or renew the registration of, a practitioner under subsection (f) who is licensed under State law to prescribe controlled substances in schedule II, III, or IV, unless the practitioner submits to the Attorney General, for each such registration or renewal request, a certification that the practitioner, during the applicable registration period, will not prescribe any opioid in schedule II, III, or IV, other than a substance use disorder treatment opioid prescription, for the initial treatment of acute pain in an amount in excess of a 3-day supply.”

Sec. 202 Evidence-based substance use disorder treatment and intervention demonstrations

Section 514B of the Public Health Service Act (42 U.S.C. 290bb–10) is amended—

(1)

in subsection (a), by adding at the end the following:

“(3) Use of funds for training—Funds awarded under paragraph (1) may be used by a recipient for training emergency room technicians, physicians, nurses, or other health care professionals on identifying the presence of substance use disorders, and how effectively to engage with, intervene with respect to, and refer patients for assessment and specialized substance use disorder care, including medication-assisted treatment and care for co-occurring disorders.”

(2)

in subsection (d), by inserting “, and Indian tribes and tribal organizations (as defined in section 4 of the Indian Self-Determination and Education Assistance Act)” before the period of the first sentence; and

(3)

in subsection (f), by inserting before the period the following: “, and $300,000,000 for each of fiscal years 2021 through 2026”.

Sec. 203 National youth and young adult recovery initiative

(a)

Definitions— In this section:

(1)

Eligible entity— The term eligible entity means—

(A)

a high school that has been accredited as a substance use recovery high school or that is seeking to establish or expand substance use recovery support services;

(B)

an institution of higher education;

(C)

a recovery program at an institution of higher education;

(D)

a nonprofit organization; or

(E)

a technical assistance center that can help grantees install recovery support service programs aimed at youth and young adults which include recovery coaching, job training, transportation, linkages to community-based services and supports, regularly scheduled alternative peer group activities, life-skills education, mentoring, and leadership development.

(2)

High school— The term high school has the meaning given the term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).

(3)

Institution of higher education— The term institution of higher education has the meaning given the term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001).

(4)

Recovery program— The term recovery program means a program—

(A)

to help youth or young adults who are recovering from substance use disorders to initiate, stabilize, and maintain healthy and productive lives in the community; and

(B)

that includes peer-to-peer support delivered by individuals with lived experience in recovery, and communal activities to build recovery skills and supportive social networks.

(b)

Grants authorized— The Assistant Secretary for Mental Health and Substance Use, in consultation with the Secretary of Education, shall award grants, on a competitive basis, to eligible entities to enable the eligible entities to—

(1)

provide culturally competent (as defined in section 102 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C. 15002)) substance use recovery support services to youth and young adults enrolled in high school or an institution of higher education;

(2)

help build communities of support for youth and young adults in substance use recovery through a spectrum of activities such as counseling, job training, recovery coaching, alternative peer groups, life-skills workshops, family support groups, and health and wellness-oriented social activities; and

(3)

encourage initiatives designed to help youth and young adults achieve and sustain recovery from substance use disorders.

(c)

Application— An eligible entity desiring a grant under this section shall submit to the Assistant Secretary for Mental Health and Substance Use an application at such time, in such manner, and containing such information as the Assistant Secretary may require.

(d)

Preference— In awarding grants under subsection (b), the Assistant Secretary for Mental Health and Substance Use shall give preference to eligible entities that propose to serve students from areas with schools serving a high percentage of children who are counted under section 1124(c) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6333(c)).

(e)

Use of funds— Grants awarded under subsection (b) may be used for activities to develop, support, or maintain substance use recovery support services for youth or young adults, including—

(1)

the development and maintenance of a dedicated physical space for recovery programs;

(2)

hiring dedicated staff for the provision of recovery programs;

(3)

providing health and wellness-oriented social activities and community engagement;

(4)

the establishment of a substance use recovery high school;

(5)

the coordination of a peer delivered substance use recovery program with—

(A)

substance use disorder treatment programs and systems that utilize culturally competent (as defined in section 102 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C. 15002)) services that reflect the communities they serve;

(B)

providers of mental health services;

(C)

primary care providers;

(D)

the criminal justice system, including the juvenile justice system;

(E)

employers;

(F)

recovery housing services;

(G)

child welfare services;

(H)

high schools; and

(I)

institutions of higher education;

(6)

the development of peer-to-peer support programs or services delivered by individuals with lived experience in substance use disorder recovery; and

(7)

any additional activity that helps youth or young adults achieve recovery from substance use disorders.

(f)

Resource center— The Assistant Secretary for Mental Health and Substance Use shall establish a resource center to provide technical support to recipients of grants under this section.

(g)

Authorization of appropriations— There are authorized to be appropriated $10,000,000 for each of fiscal years 2021 through 2026.

Sec. 204 Improving treatment for pregnant, postpartum, and parenting women

Section 508 of the Public Health Service Act (42 U.S.C. 290bb–1) is amended—

(1)

in subsection (m)—

(A)

by striking “shall give priority” and inserting

“(1) priority”

(B)

by striking the period at the end and inserting “; and”; and

(C)

by adding at the end the following:

“(2) preference to an applicant that agrees to—

“(A) allow participation in the program supported by the award by individuals taking a drug or combination of drugs approved by the Food and Drug Administration for medication-assisted treatment, including such individuals taking an opioid agonist;

“(B) provide culturally competent services (as defined in section 102 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000);

“(C) ensure flexible lengths of stay in the treatment program; and

“(D) use peer recovery advocates in the program supported by the award.”

(2)

in subsection (p), by inserting “, and demographic data on the individuals served by programs funded under this section and case outcomes, as reported to the Director by award recipients” before the period at the end of the third sentence; and

(3)

in subsection (s), by striking “$29,931,000 for each of fiscal years 2019 through 2023” and inserting “100,000,000 for each of fiscal years 2021 through 2026”.

Sec. 205 Require the use of prescription drug monitoring programs

(a)

Definitions— In this section:

(1)

Controlled substance— The term controlled substance has the meaning given the term in section 102 of the Controlled Substances Act (21 U.S.C. 802).

(2)

Covered State— The term covered State means a State that receives funding under the Harold Rogers Prescription Drug Monitoring Program established under the Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2002 (Public Law 107–77; 115 Stat. 748), under this Act (or an amendment made by this Act), or under the controlled substance monitoring program under section 399O of the Public Health Service Act (42 U.S.C. 280g–3).

(3)

Dispenser— The term dispenser—

(A)

means a person licensed or otherwise authorized by a State to deliver a prescription drug product to a patient or an agent of the patient; and

(B)

does not include a person involved in oversight or payment for prescription drugs.

(4)

PDMP— The term PDMP means a prescription drug monitoring program.

(5)

Practitioner— The term practitioner means a practitioner registered under section 303(f) of the Controlled Substances Act (21 U.S.C. 823(f)) to prescribe, administer, or dispense controlled substances.

(6)

State— The term State means each of the several States and the District of Columbia.

(b)

In general— Beginning 1 year after the date of enactment of this Act, each covered State shall require—

(1)

each prescribing practitioner within the covered State or their designee, who shall be licensed or registered healthcare professionals or other employees who report directly to the practitioner, to consult the PDMP of the covered State before initiating treatment with a prescription for a controlled substance listed in schedule II, III, or IV of section 202(c) of the Controlled Substances Act (21 U.S.C. 812(c)), and every 3 months thereafter as long as the treatment continues;

(2)

the PDMP of the covered State to provide proactive notification to a practitioner when patterns indicative of controlled substance misuse, including opioid misuse, are detected;

(3)

each dispenser within the covered State to report each prescription for a controlled substance dispensed by the dispenser to the PDMP not later than 24 hours after the controlled substance is dispensed to the patient;

(4)

that the PDMP make available a quarterly de-identified data set and an annual report for public and private use, including use by healthcare providers, health plans and health benefits administrators, State agencies, and researchers, which shall, at a minimum, meet requirements established by the Attorney General, in coordination with the Secretary of Health and Human Services;

(5)

each State agency that administers the PDMP to—

(A)

proactively analyze data available through the PDMP; and

(B)

provide reports to prescriber licensing boards describing any prescribing practitioner that repeatedly fall outside of expected norms or standard practices for the prescribing practitioner’s field; and

(6)

that the data contained in the PDMP of the covered State be made available to other States.

(c)

Noncompliance— If a covered State fails to comply with subsection (a), the Attorney General or the Secretary of Health and Human Services may withhold grant funds from being awarded to the covered State under the Harold Rogers Prescription Drug Monitoring Program established under the Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2002 (Public Law 107–77; 115 Stat. 748), under this Act (or an amendment made by this Act), or under the controlled substance monitoring program under section 399O of the Public Health Service Act (42 U.S.C. 280g–3).

Sec. 206 Prescriber education

(a)

In general— Section 303 of the Controlled Substances Act (21 U.S.C. 823), as amended by section 201, is amended—

(1)

in subsection (f), in the matter preceding paragraph (1), by striking “The Attorney General shall register” and inserting “Subject to subsection (m), the Attorney General shall register”; and

(2)

by adding at the end the following:

“(m) Prescriber education

“(1) Definitions—In this subsection—

“(A) the term covered agent or employee means an agent or employee of a covered facility who—

“(i) prescribes controlled substances for humans under the registration of the facility under this part; and

“(ii) is a medical resident;

“(B) the term covered facility means a practitioner—

“(i) that is a hospital or other institution;

“(ii) that is licensed under State law to prescribe controlled substances; and

“(iii) under whose registration under this part agents or employees of the practitioner prescribe controlled substances;

“(C) the term covered individual practitioner means a practitioner who—

“(i) is an individual;

“(ii) is not a veterinarian; and

“(iii) is licensed under State law to prescribe controlled substances; and

“(D) the term specified continuing education topics means—

“(i) alternatives to opioids for pain management;

“(ii) palliative care;

“(iii) substance use disorder;

“(iv) adverse events;

“(v) potential for dependence;

“(vi) tolerance;

“(vii) prescribing contraindicated substances;

“(viii) medication-assisted treatment;

“(ix) culturally competent (as defined in section 102 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C. 15002)) services;

“(x) bias and stigma in prescribing trends; and

“(xi) any other topic that the Attorney General determines appropriate.

“(2) Certification of continuing education

“(A) Individual practitioners—As a condition of granting or renewing the registration of a covered individual practitioner under this part to dispense controlled substances in schedule II, III, IV, or V, the Attorney General shall require the practitioner to certify that, during the 3-year period preceding the date of the grant or renewal of registration, the practitioner completed course work or training from an organization accredited by the Accreditation Council for Continuing Medical Education (commonly known as the “ACCME”), or by a State medical society accreditor recognized by the ACCME, that included not fewer than 3 hours of content on the specified continuing education topics.

“(B) Facilities—As a condition of granting or renewing the registration of a covered facility under this part to dispense controlled substances in schedule II, III, IV, or V, the Attorney General shall require the covered facility to certify that the facility does not allow a covered agent or employee to prescribe controlled substances for humans under the registration of the facility unless, during the preceding 3-year period, the covered agent or employee completed course work or training from an organization accredited by the Accreditation Council for Continuing Medical Education (commonly known as the “ACCME”), or a State medical society accreditor recognized by the ACCME, that included not fewer than 3 hours of content on the specified continuing education topics.”

(b)

Effective date— Subsection (m) of section 303 of the Controlled Substances Act (21 U.S.C. 823), as added by subsection (a), shall apply to any grant or renewal of registration described in such subsection (m) that occurs on or after the date that is 2 years after the date of enactment of this Act.

Sec. 207 Prohibition of utilization control policies or procedures for medication-assisted treatment under Medicaid

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—

(1)

in subsection (a)—

(A)

in the matter preceding paragraph (1), by moving the margin of clause (xvi) 4 ems to the left; and

(B)

in paragraph (29), by inserting “and to the extent allowed in paragraph (3) of such subsection” after “paragraph (1) of such subsection”; and

(2)

in subsection (ee), by adding at the end the following new paragraph:

“(3) Prohibition of utilization control policies or procedures for medication-assisted treatment—As a condition for a State receiving payments under section 1903(a) for medical assistance for medication-assisted treatment, a State may not impose any utilization control policies or procedures (as defined by the Secretary), including prior authorization requirements, with respect to such treatment.”

Sec. 208 Pilot program on expanding access to treatment

The Secretary of Health and Human Services (referred to in this section as the “Secretary”) shall establish a 5-year pilot program in not less than 5 diverse regions to study the use of mobile methadone clinics in rural and underserved environments. At the end of the pilot program, the Secretary shall report to Congress on the program outcomes, including the number of people served and the demographics of people served, including race and income.

Sec. 209 Reauthorization of PRAC Ed grant program

To carry out the Practitioner Education grant program established by the Substance Abuse and Mental Health Services Administration, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2021 through 2026.

Title II — Treatment

II Treatment