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Title II — Treatment

S. 987 · 117th Congress · Mar 25, 2021 · Lineage

II Treatment

Sec. 201 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; 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; and offering peer-based interventions in the emergency room and other health care environments to connect people to clinical and community-based supports for substance use disorder.”

(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. 202 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 “that agrees to use” and inserting

“(1) to use”

(B)
by striking the period at the end and inserting “; or”; and
(C)
by adding at the end the following:

“(2) 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 as a medication for addiction 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. 203 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. 204 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) overdose prevention and response, including the administration of naloxone;

“(x) 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;

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

“(xii) 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. 205 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. 206 Medication-assisted treatment for recovery from substance use disorder

(a)
In general— Section 303(g) of the Controlled Substances Act (21 U.S.C. 823(g)) is amended—
(1)
by striking paragraph (2);
(2)
by striking “(g)(1) Except as provided in paragraph (2), practitioners who dispense narcotic drugs to individuals for maintenance treatment or detoxification treatment” and inserting “(g) Practitioners who dispense narcotic drugs (other than narcotic drugs in schedule III, IV, or V) to individuals for maintenance treatment or detoxification treatment”;
(3)
by redesignating subparagraphs (A), (B), and (C) as paragraphs (1), (2), and (3), respectively; and
(4)
in paragraph (2), as redesignated, by redesignating clauses (i) and (ii) as subparagraphs (A) and (B), respectively.
(b)
Technical and conforming edits—
(1)
In general—
(A)
Section 304 of the Controlled Substances Act (21 U.S.C. 824) is amended—
(i)
in subsection (a), by striking “303(g)(1)” each place it appears and inserting “303(g)”; and
(ii)
in subsection (d)(1), by striking “303(g)(1)” and inserting “303(g)”.
(B)
Section 309A(a) of the Controlled Substances Act (21 U.S.C. 829a(a)) is amended by striking paragraph (2) and inserting the following:

“(2) the controlled substance—

“(A) is a narcotic drug in schedule III, IV, or V to be administered for the purpose of maintenance or detoxification treatment; and

“(B) is to be administered by injection or implantation;”

(C)
Section 520E–4(c) of the Public Health Service Act (42 U.S.C. 290bb–36d(c)) is amended, in the matter preceding paragraph (1), by striking “information on any qualified practitioner that is certified to prescribe medication for opioid dependency under section 303(g)(2)(B) of the Controlled Substances Act” and inserting “information on any practitioner who prescribes narcotic drugs in schedule III, IV, or V of section 202 of the Controlled Substances Act for the purpose of maintenance or detoxification treatment”.
(D)
Section 544(a)(3) of the Public Health Service Act (42 U.S.C. 290dd–3) is amended by striking “any practitioner dispensing narcotic drugs pursuant to section 303(g) of the Controlled Substances Act” and inserting “any practitioner dispensing narcotic drugs for the purpose of maintenance or detoxification treatment”.
(E)
Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended by striking subsection (bb).
(F)
Section 1834(o) of the Social Security Act (42 U.S.C. 1395m(o)) is amended by striking paragraph (3).
(G)
Section 1866F(c)(3) of the Social Security Act (42 U.S.C. 1395cc–6(c)(3)) is amended—
(i)
in subparagraph (A), by inserting “and” at the end;
(ii)
in subparagraph (B), by striking “; and” and inserting a period; and
(iii)
by striking subparagraph (C).
(H)
Section 1903(aa)(2)(C) of the Social Security Act (42 U.S.C. 1396b(aa)(2)(C)) is amended—
(i)
in clause (i), by inserting “and” at the end;
(ii)
by striking clause (ii); and
(iii)
by redesignating clause (iii) as clause (ii).
(2)
Effective date of Medicare amendments— The amendments made by subparagraphs (E) and (F) of paragraph (1) shall take effect one year after the date of enactment of this Act.

Sec. 207 Telehealth response for e-prescribing addiction therapy services

(a)
Funding for the testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology— In addition to amounts appropriated under subsection (f) of section 1135A of the Social Security Act (42 U.S.C. 13951315a), there are authorized to be appropriated to the Center for Medicare and Medicaid Innovation such sums as may be necessary for fiscal year 2021 to design, implement, and evaluate the model under subsection (b)(2)(B)(xxv) of such section. Amounts appropriated under the preceding sentence shall remain available until expended.
(b)
Telehealth for substance use disorder treatment—
(1)
Substance use disorder services furnished through telehealth under Medicare— Section 1834(m)(7) of the Social Security Act (42 U.S.C. 1395m(m)(7)) is amended by adding at the end the following: “With respect to telehealth services described in the preceding sentence that are furnished on or after January 1, 2020, nothing shall preclude the furnishing of such services through audio or telephone only technologies in the case where a physician or practitioner has already conducted an in-person medical evaluation or a telehealth evaluation that utilizes both audio and visual capabilities with the eligible telehealth individual.”.
(2)
Controlled substances dispensed by means of the internet— Section 309(e)(2) of the Controlled Substances Act (21 U.S.C. 829(e)(2)) is amended—
(A)
in subparagraph (A)(i)—
(i)
by striking “at least 1 in-person medical evaluation” and inserting the following:

“(I) 1 in-person medical evaluation”

(ii)
by adding at the end the following:

“(II) for purposes of prescribing a controlled substance in schedule III or IV, 1 telehealth evaluation; or”

(B)
by adding at the end the following:

“(D)

“(i) The term telehealth evaluation means a medical evaluation that is conducted in accordance with applicable Federal and State laws by a practitioner (other than a pharmacist) who is at a location remote from the patient and is communicating with the patient using a telecommunications system referred to in section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site practitioner.

“(ii) Nothing in clause (i) shall be construed to imply that 1 telehealth evaluation demonstrates that a prescription has been issued for a legitimate medical purpose within the usual course of professional practice.

“(iii) A practitioner who prescribes the drugs or combination of drugs that are covered under section 303(g)(2)(C) using the authority under subparagraph (A)(i)(II) of this paragraph shall adhere to nationally recognized evidence-based guidelines for the treatment of patients with opioid use disorders and a diversion control plan, as those terms are defined in section 8.2 of title 42, Code of Federal Regulations, as in effect on the date of enactment of this subparagraph.”

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.

Sec. 210 GAO study on parity

The Comptroller General of the United States shall conduct a study examining the reimbursement parity between substance use disorder services and other health care services, and the effect of any inequity in reimbursement with respect to substance use disorder services on the substance use disorder workforce, and not later than December 31, 2023, submit a report to Congress on the findings of such study.

Sec. 211 Improving substance use disorder prevention workforce act

Subpart 2 of part B of title V of the Public Health Service Act (42 U.S.C. 290bb–21 et seq), as amended by section 105, is further amended by adding at the end the following:

“519F. Pilot program to help enhance substance use disorder prevention workforce

“(a) In general—The Director of the Prevention Center (referred to in this section as the “Director”) shall develop a pilot program to assist State alcohol and drug agencies in addressing the substance use disorder prevention workforce needs in the States.

“(b) Definitions—In this section, the term State alcohol and drug agency means the State agency responsible for administering the substance abuse prevention and treatment block grant under subpart II of part B of title XIX.

“(c) Application—A State alcohol and drug agency may apply to the Director for approval of a grant authorized in this section. Such application shall include a description of the proposed workforce activities that will be carried out using grant funds, which may include, with respect to substance use disorder prevention—

“(1) enhancing or developing training curricula;

“(2) supporting or coordinating with institutes of higher education regarding curricula development;

“(3) partnering with elementary schools, middle schools, high schools or institutions of higher education to generate early student interest in avoiding misuse of substances;

“(4) enhancing or establishing initiatives related to credentialing or other certification processes recognized by the State alcohol and drug agency, including scholarships or support for certification costs and testing;

“(5) establishing or enhancing initiatives that promote recruitment, professional development, and access to education and training that increase the State’s ability to address diversity, equity, and inclusion in the workforce, including communication initiatives or campaigns designed to draw interest in a career in substance use disorder prevention;

“(6) supporting loan repayment programs for individuals in the substance use disorder prevention workforce;

“(7) establishing or enhancing internships, fellowships and other career opportunities; and

“(8) retention initiatives that may include training, leadership development or other educational opportunities.

“(d) Authorization of appropriations—To carry out this section, there are authorized to be appropriated such sums as may be necessary.

“519G. National study on substance use disorder workforce

“(a) In general—The Director shall conduct a comprehensive national study regarding the substance use disorder prevention workforce. Such study shall include—

“(1) an environmental assessment regarding the existing workforce, including demographics, salaries, settings, current or anticipated workforce shortages and other relevant information;

“(2) challenges in maintaining support for an adequate substance use disorder prevention workforce and a plan to address such challenges; and

“(3) potential programming to help implement the plan.

“(b) Consultation—The Director shall ensure the study under this section is developed in consultation with key substance use disorder prevention workforce stakeholders, including organizations representing State alcohol and drug agencies, community anti-drug coalitions, workforce credentialing bodies, researchers, and others.

“(c) Authorization of appropriation—To carry out this section, there are authorized to be appropriated such sums as may be necessary.”