IMPROVE Addiction Care Act

II 117TH CONGRESS 1ST SESSION S. 1575 To amend title XIX of the Social Security Act to encourage appropriate prescribing under Medicaid for victims of opioid overdose. IN THE SENATE OF THE UNITED STATES MAY 12, 2021 Mr. TOOMEY (for himself and Mr. MANCHIN) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XIX of the Social Security Act to encourage appropriate prescribing under Medicaid for victims of opioid overdose. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Improving Medicaid 4 Programs’ Response to Overdose Victims and Enhancing 5 Addiction Care Act’’ or the ‘‘IMPROVE Addiction Care 6 Act’’. 7 VerDate Sep 11 2014 23:34 May 26, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1575.IS S1575 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1575 IS SEC. 2. ENCOURAGING APPROPRIATE PRESCRIBING 1 UNDER MEDICAID FOR VICTIMS OF OPIOID 2 OVERDOSE. 3 (a) IN GENERAL.—Section 1927(g)(2) of the Social 4 Security Act (42 U.S.C. 1396r–8(g)(2)) is amended by 5 adding at the end the following new subparagraph: 6 ‘‘(E) ADDITIONAL DRUG USE REVIEW RE- 7 QUIREMENTS.—As part of a State’s prospective 8 and retrospective drug use review under sub- 9 paragraphs (A) and (B), as applicable, the 10 State shall, not later than 24 months after the 11 date of enactment of this subparagraph, develop 12 and implement, or review and update, protocols 13 to, subject to any applicable State or Federal 14 privacy or confidentiality protections that could 15 preclude such protocols— 16 ‘‘(i) identify individuals receiving ben- 17 efits under this title who have experienced 18 a nonfatal opioid-related overdose within a 19 look-back period (to be determined by the 20 Secretary except that such period shall not 21 be less than 1 year and shall not exceed 5 22 years), to the extent that such data is 23 available, and make a good faith effort to 24 connect these individuals to treatment op- 25 tions and recovery support services that 26 VerDate Sep 11 2014 23:34 May 26, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1575.IS S1575 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1575 IS have been determined appropriate by the 1 Secretary; 2 ‘‘(ii) if an individual receiving benefits 3 under this title experiences a fatal overdose 4 that is opioid-related (without regard to 5 whether such overdose was related to a 6 covered outpatient drug), or, if specified by 7 the Secretary, related to any other drug 8 (including a drug that is not a covered out- 9 patient drug), not later than 6 months 10 after the date of such overdose— 11 ‘‘(I) provide notice of such over- 12 dose to each provider that, during the 13 period (to be established by the Sec- 14 retary) preceding such overdose, pre- 15 scribed opioids (or such other speci- 16 fied drug, if applicable) to such indi- 17 vidual, to the extent that such data is 18 available; and 19 ‘‘(II) provide each such provider 20 with educational materials on pre- 21 scribing opioids (or such other speci- 22 fied drugs, if applicable); 23 ‘‘(iii) ensure that a provider who is 24 treating an individual receiving benefits 25 VerDate Sep 11 2014 23:34 May 26, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1575.IS S1575 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1575 IS under this title has notice of the individ- 1 ual’s diagnosis or history of opioid use dis- 2 order, opioid poisoning diagnosis, history 3 of nonfatal opioid-related overdose, or a di- 4 agnosis or history of a substance use dis- 5 order or overdose for such other specified 6 drug, if applicable, to the extent such data 7 is available; and 8 ‘‘(iv) perform ongoing retrospective 9 drug utilization reviews and offer provider 10 education that is informed by such reviews 11 (which may include education provided 12 under an educational outreach program es- 13 tablished under subparagraph (D) or 14 through an intervention described in para- 15 graph (3)(C)(iii)) regarding appropriate 16 prescribing practices for individuals receiv- 17 ing benefits under this title with a diag- 18 nosis or history of opioid use disorder, a 19 history of nonfatal opioid-related overdose, 20 an opioid poisoning diagnosis, or a diag- 21 nosis or history of a substance use disorder 22 or overdose for such other specified drug, 23 if applicable. 24 VerDate Sep 11 2014 23:34 May 26, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1575.IS S1575 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1575 IS Nothing in this subparagraph shall be con- 1 strued as requiring a State to develop and im- 2 plement additional protocols if the State estab- 3 lishes to the satisfaction of the Secretary that 4 the State has in place existing protocols meet- 5 ing or exceeding the standards set forth in this 6 subparagraph.’’. 7 (b) TECHNICAL AMENDMENTS.—Section 1932(i) of 8 the Social Security Act (42 U.S.C. 1396u–2(i)) is amend- 9 ed— 10 (1) by striking ‘‘section 483.3(s)(4)’’ and in- 11 serting ‘‘section 438.3(s)(4)’’; and 12 (2) by striking ‘‘483.3(s)(5)’’ and inserting 13 ‘‘438.3(s)(5)’’. 14 Æ VerDate Sep 11 2014 23:34 May 26, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S1575.IS S1575 kjohnson on DSK79L0C42PROD with BILLS