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H.R. 10254IntroducedHouse · nowSenatePresidentLawIn committee
Sec. 2 · H.R. 10254

Testing of elimination of Medicare cost-sharing for evidence-based opioid treatments

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Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 1315a(b)(2)) is amended— (1) in subparagraph (A), in the last sentence, by inserting, and shall include the model described in subparagraph (D) (which shall be implemented by not later than six months after the date of the enactment of the Maximizing Opioid Recovery Emergency Savings Act) before the period at the end; and (2) by adding at the end the following new subparagraph: (D) Affordable access to evidence-based opioid treatments (i) In general The model described in this subparagraph is a model that seeks to provide affordable access to evidence-based opioid treatments and community-based recovery support services by eliminating coinsurance, copayments, and deductibles otherwise applicable under parts B and D of title XVIII (including as such parts are applied under part C of such title) for the following items and services that are otherwise covered under such parts: (I) Drugs and biologicals prescribed or furnished to treat opioid use disorders or reverse overdose. (II) Behavioral health and community support services furnished for the treatment of opioid use disorders, including treatment of addiction in non-hospital residential facilities licensed to furnish such treatment. (III) Recovery support services to maintain a healthy lifestyle following opioid misuse treatment, such as peer counseling and transportation. (ii) Selection of sites The CMI shall select 15 States in which to conduct the model under this subparagraph. A State shall meet each of the following criteria in order to be selected under the preceding sentence: (I) The State has a high proportion of Medicare beneficiaries. (II) The State has a high rate of overdose deaths due to opioids. (III) The State has a significant percentage of rural areas. (iii) Termination and modification provision not applicable for first five years of the model The provisions of paragraph (3)(B) shall apply to the model under this subparagraph beginning on the date that is five years after such model is implemented, but shall not apply to such model prior to such date..