text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Responsible Education Achieves Care 
  and Healthy Outcomes for Users' Treatment Act of 2018'' or the ``REACH 
  OUT Act of 2018''.
  
  SEC. 2. GRANTS TO PROVIDE TECHNICAL ASSISTANCE TO OUTLIER PRESCRIBERS 
                OF OPIOIDS.
  
      (a) Grants Authorized.--The Secretary of Health and Human Services 
  (in this section referred to as the ``Secretary'') shall, through the 
  Centers for Medicare & Medicaid Services, award grants, contracts, or 
  cooperative agreements to eligible entities for the purposes described 
  in subsection (b).
      (b) Use of Funds.--Grants, contracts, and cooperative agreements 
  awarded under subsection (a) shall be used to support eligible entities 
  through technical assistance--
              (1) to educate and provide outreach to outlier prescribers 
          of opioids about best practices for prescribing opioids;
              (2) to educate and provide outreach to outlier prescribers 
          of opioids about non-opioid pain management therapies; and
              (3) to reduce the amount of opioid prescriptions prescribed 
          by outlier prescribers of opioids.
      (c) Application.--Each eligible entity seeking to receive a grant, 
  contract, or cooperative agreement under subsection (a) shall submit to 
  the Secretary an application, at such time, in such manner, and 
  containing such information as the Secretary may require.
      (d) Geographic Distribution.--In awarding grants, contracts, and 
  cooperative agreements under this section, the Secretary shall 
  prioritize establishing technical assistance resources in each State.
      (e) Definitions.--In this section:
              (1) Eligible entity.--The term ``eligible entity'' means--
                      (A) an organization--
                              (i) that has demonstrated experience 
                          providing technical assistance to health care 
                          professionals on a State or regional basis; and
                              (ii) that has at least--
                                      (I) one individual who is a 
                                  representative of consumers on its 
                                  governing body; and
                                      (II) one individual who is a 
                                  representative of health care providers 
                                  on its governing body; or
                      (B) an entity that is a quality improvement entity 
                  with a contract under part B of title XI of the Social 
                  Security Act (42 U.S.C. 1320c et seq.).
              (2) Outlier prescriber of opioids.--The term ``outlier 
          prescriber of opioids'' means a prescriber, identified by the 
          Secretary of Health and Human Services (through use of 
          prescriber information provided by prescriber National Provider 
          Identifiers included pursuant to section 1860D-4(c)(4)(A) of 
          the Social Security Act (42 U.S.C. 1395w-104(c)(4)(A)) on 
          claims for covered part D drugs for part D eligible individuals 
          enrolled in prescription drug plans under part D of title XVIII 
          of such Act (42 U.S.C. 1395w-101 et seq.) and MA-PD plans under 
          part C of such title (42 U.S.C. 1395w-21 et seq.)) as 
          prescribing, as compared to other prescribers in the specialty 
          of the prescriber and geographic area, amounts of opioids in 
          excess of a threshold (and other criteria) specified by the 
          Secretary, after consultation with stakeholders.
              (3) Prescribers.--The term ``prescriber'' means any health 
          care professional, including a nurse practitioner or physician 
          assistant, who is licensed to prescribe opioids by the State or 
          territory in which such professional practices.
      (f) Funding.--For purposes of implementing this section, $75 
  million 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.
  
  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 2025 
  (and before fiscal year 2029), 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).''.
  
              Passed the House of Representatives June 19, 2018.
  
              Attest:
  
                                                   KAREN L. HAAS,
  
                                                                   Clerk.
target: Responsible Education Achieves Care and Healthy Outcomes for Users&rsquo; Treatment Act of 2018 or the REACH OUT Act of 2018 (Sec. 2) This bill requires the Centers for Medicare &amp; Medicaid Services to award grants, contracts, or cooperative agreements to qualifying organizations in order to support efforts to curb outlier prescribers of opioids under the Medicare prescription drug benefit and Medicare Advantage prescription drug plans. (Sec. 3) Additionally, the bill temporarily eliminates the enhanced federal matching rate for Medicaid expenditures regarding specified medical services provided by certain managed care organizations.
feat_title: Responsible Education Achieves Care and Healthy Outcomes for Users’ Treatment Act of 2018