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
To amend title XIX of the Social Security Act to encourage appropriate prescribing under Medicaid for victims of opioid overdose.
This Act may be cited as the
Improving Medicaid Programs' Response to Overdose Victims and Enhancing Addiction Care Act or the
IMPROVE Addiction Care Act.
Encouraging appropriate prescribing under medicaid for victims of opioid overdose
Section 1927(g)(2) of the Social Security Act (42 U.S.C. 1396r–8(g)(2)) is amended by adding at the end the following new subparagraph:
Additional drug use review requirements
As part of a State’s prospective and retrospective drug use review under subparagraphs (A) and (B), as applicable, the State shall, not later than 24 months after the date of enactment of this subparagraph, develop and implement, or review and update, protocols to, subject to any applicable State or Federal privacy or confidentiality protections that could preclude such protocols—
identify individuals receiving benefits under this title who have experienced a nonfatal opioid-related overdose within a look-back period (to be determined by the Secretary except that such period shall not be less than 1 year and shall not exceed 5 years), to the extent that such data is available, and make a good faith effort to connect these individuals to treatment options and recovery support services that have been determined appropriate by the Secretary;
if an individual receiving benefits under this title experiences a fatal overdose that is opioid-related (without regard to whether such overdose was related to a covered outpatient drug), or, if specified by the Secretary, related to any other drug (including a drug that is not a covered outpatient drug), not later than 6 months after the date of such overdose—
provide notice of such overdose to each provider that, during the period (to be established by the Secretary) preceding such overdose, prescribed opioids (or such other specified drug, if applicable) to such individual, to the extent that such data is available; and
provide each such provider with educational materials on prescribing opioids (or such other specified drugs, if applicable);
ensure that a provider who is treating an individual receiving benefits under this title has notice of the individual's diagnosis or history of opioid use disorder, opioid poisoning diagnosis, history of nonfatal opioid-related overdose, or a diagnosis or history of a substance use disorder or overdose for such other specified drug, if applicable, to the extent such data is available; and
perform ongoing retrospective drug utilization reviews and offer provider education that is informed by such reviews (which may include education provided under an educational outreach program established under subparagraph (D) or through an intervention described in paragraph (3)(C)(iii)) regarding appropriate prescribing practices for individuals receiving benefits under this title with a diagnosis or history of opioid use disorder, a history of nonfatal opioid-related overdose, an opioid poisoning diagnosis, or a diagnosis or history of a substance use disorder or overdose for such other specified drug, if applicable.
Section 1932(i) of the Social Security Act (42 U.S.C. 1396u–2(i)) is amended—
section 483.3(s)(4) and inserting
section 438.3(s)(4); and
483.3(s)(5) and inserting