NACo Opioid Legislative Analysis, 09.07.2018

NACo OPIOID LEGISLATIVE ANALYSIS
Comparison of House and Senate

Opioid Legislative Packages
September 2018
NACo Legislative Analysis: Comparison of House and Senate Opioid Legislative Packages
Introduction
As the U.S. struggles to contain the opioid epidemic, legislators in the U.S. House of Representatives and U.S. Senate are considering comprehensive legislative
packages aimed at strengthening the nation’s response to this crisis. The House (H.R. 6) and Senate (S. 2680) bills represent the culmination of dozens of
narrowly-focused proposals introduced over the past year. Many of these proposals would impact county governments, which are at the heart of America’s
response to addiction through local health systems, human services agencies and law enforcement departments.
The following chart details major provisions put forth in the House’s and the Senate’s respective opioid legislative packages, with special focus given to items
that could strengthen the local response to the opioid epidemic. The packages each contain measures to address the epidemic via changes to the Medicaid and
Medicare programs, implementation of education and prevention activities and expansion of treatment and recovery resources, among others. Highlighted
items in the rightmost column of the chart describe potential impact of the legislation on counties.
This analysis is part of NACo’s ongoing advocacy to help strengthen federal support for county agencies on the frontlines of our nation’s response to the opioid
epidemic. NACo previously partnered with the National League of Cities (NLC) to produce a joint report, Prescription for Action: Local Leadership in Ending the
Opioid Crisis, which offers recommendations for local, state and federal responses to this national crisis.
Note: The House bill, H.R. 6, passed the full chamber on June 22, 2018, and the Senate will likely consider S. 2680 before the conclusion of the 115th Congress in
January 2019. Once both chambers have each approved legislation, any remaining differences between the bills must be resolved before the legislation can be
sent to the president for his signature. Given the ongoing consideration of these proposals in Congress, this chart will be updated to reflect the latest legislative
activity.
For questions on the content of this analysis, please contact:
Valerie Brankovic | Legislative Assistant | vbrankovic@naco.org | (202) 942-4254

Lindsey Holman | Associate Legislative Director, Justice and Public Safety |lholman@naco.org | (202) 942-4217
Eryn Hurley | Associate Legislative Director, Human Services and Education | ehurley@naco.org | (202) 942-4204
NACo Legislative Analysis: Comparison of House and Senate Opioid Legislative Packages – Last updated September 6, 2018 1
Table of Contents
Note: The House opioid legislative package is divided into eleven separate titles, whereas the Senate version contains five. Because the titles in both bills intersect
on multiple policy issues, the chart in this analysis details each of the eleven titles in H.R. 6 alongside corresponding Senate provisions.
I
Introduction……………………………………………………………………………………………………………………………………………………………………………………………………………….1
H.R. 6, Title I and related Senate provisions……………………………………………………………………………………………………………………………………………………..……....3
H.R. 6, Title II and related Senate provisions …………………………………………………………………………………………………………………………………………………………….5
H.R. 6, Title III and related Senate provisions ………….………………………………………………………………………………………………………………………………………….……6
H.R. 6, Title IV and related Senate provisions ….………………………………………………………………………………………………………………………………………………….……8
H.R. 6, Title V and related Senate provisions ….………………………………………………………………………………………………………………………………………………………..9
H.R. 6, Title VI and related Senate provisions ….………………………………………………………………………………………………………………………………………………….…10
H.R. 6, Title VII and related Senate provisions .……………………………………………………………………………………………………………………………………………….……..11

H.R. 6, Title VIII and related Senate provisions ….……………………………………………………………………………………………………………………………………………….….13
H.R. 6, Title IX and related Senate provisions .…………………………………………………………………………………………………………………………………………………...….14
H.R. 6, Title X and related Senate provisions .…………………………………………………………………………………………………………………………………………………….….15
H.R. 6, Title XI and related Senate provisions ….……………………………………………………………………………………………………………………………………………….……16
Comparison of House and Senate Versions of Opioid Legislative Packages
H.R. 6, Title I and Related Senate Provisions
Issue Description House (H.R. 6) Senate (S. 2680) Projected County Impact
Authorizes the U.S. Department of   • Legislation could enhance the resources available
Labor (DOL) to award dislocated (Section 1410) to local workforce boards to address the impacts of
worker grants to states through the the opioid epidemic on the local workforce
Workforce Innovation and Opportunity • If enacted, individuals with substance use disorders
Addressing Economic and Act (WIOA) to support local workforce could gain improved access to specialized job
Workforce Impacts of the Opioid boards and provide coordinated job training and treatment services
Epidemic training and treatment services for
individuals in affected communities
who have an opioid or substance use
disorder
Provides Medicaid protection for at-   • Legislation could help counties provide effective
risk youth by mandating that a state (Section 1001) pre- and post- release treatment and care
At-Risk Youth Medicaid cannot terminate medical assistance coordination services for justice-involved juveniles
Protection for justice-involved juveniles in public • NACo sent a letter to Congress in support of this
institutions measure
Amends the Social Security Act to   • Legislation could help reduce hospital emergency
ensure health insurance coverage (Section 1002) room visits via in-home treatment
Health Insurance for Former continuity for former foster youth • Many hospitals are county-operated
Foster Youth
Mandates that states operate drug   • Legislation could add administrative requirements
management programs for at-risk (Section 1004) for state Medicaid programs
Drug Management for At-Risk Medicaid beneficiaries beginning • In many states, counties play a major role in
Medicaid Beneficiaries January 1, 2020 financing, administering and delivering Medicaid to
residents
Expands a grant program authorized   • Legislation could better enable county first
under the Comprehensive Addiction (Section 1306) responders to address opioid overdose cases and
and Recovery Act designed to allow reduce the strain on other county-based health
first responders to administer a drug providers that administer naloxone for overdoses
First Responder Training or device, such naloxone, to treat an • Specific training around opioid analogues could
opioid overdose, and to include safety additionally improve safety conditions for first
training around fentanyl, carfentanil responders, many of whom work for local public
and other opioid analogues safety agencies
H.R. 6, Title I and Related Senate Provisions, continued
Establishes a demonstration project   • Legislation could give counties additional resources
allowing states to increase the (Section 1003) through the Medicaid program to treat substance
Increase Substance Use Provider substance abuse treatment capacity of use disorders
Capacity Under the Medicaid Medicaid providers • In many states, counties play a major role in
Program financing, administering and delivering Medicaid to
residents
Allows physicians who have recently   • Legislation could help expand medication-assisted
graduated and meet certain (Section 1406) treatment (MAT) options for county-operated
requirements to obtain a waiver to health facilities by increasing the number of health
Medication-Assisted Treatment prescribe medication-assisted care professionals permitted to administer the
(MAT) for Addiction Recovery treatment (MAT) therapies for treatment
addiction • NACo supported the expanded use of MAT in its
joint opioid report, Prescription for Action: Local
Leadership in Ending the Opioid Crisis
Extends the federal medical assistance   • Legislation could give counties more resources to
percentage (FMAP) to payments for (Section 1007) provide treatment services in states where
the provision of health home services counties play a role in administering Medicaid
Medicaid Health Homes to individuals with substance use • Medicaid health homes provide services such as
disorders comprehensive care management, individual and
family services and transitional care
Reauthorizes and improves the state-   • Legislation could give states and counties
targeted response grants from the 21st (Section 1101) additional resources and funding flexibility and
Reauthorization of Opioid Grants Century Cures Act to provide funding certainty to address the opioid epidemic in local
Under the 21st Century Cures Act to tribes and improve flexibility for communities
states in using the grants
Enables the National Health Service   • Legislation could help local behavioral health
Corps (NHSC) to provide behavioral or (Section 1416) providers – many of which are county-operated –
mental health services at a school or reach residents in underserved counties by
other community-based setting providing substance use disorder services in
National Health Service Corps located in areas with shortages of schools and community-based settings
health care professionals, and for
these services to be applied to NHSC
participants’ service requirements
H.R. 6, Title II and Related Senate Provisions
Authorizes $20 million in funding for   • Legislation could give states and counties,
the U.S. Department of Health and (Section 2303) especially those in county-administered states,
Human Services (HHS) to award to additional resources to develop family-based
states to develop, enhance and treatment programs that could qualify for funding
Building Capacity for Family- evaluate family-based treatment under the Family First Prevention Services Act
programs to increase the number of (FFPSA)
Focused Treatment
evidence-based programs that could
later qualify for funding under the
Family First Prevention Services Act
(FFPSA)
Directs the Centers for Medicare and   • Legislation could provide guidance to county-based
Medicaid (CMS) to issue guidance to (Section 2203) health providers around administering Medicaid-
states on providing telehealth services eligible telehealth services
Medicaid and Telehealth Services for substance use disorders under the • In many states, counties play a major role in
Medicaid program financing, administering and delivering Medicaid to
residents
Expands Medicare coverage to certain   • Limited direct county impact
services provided by opioid treatment (Section 2007) (Section 2109)
Medicare Coverage of Opioid programs
Addiction Treatment Programs
Allows for Medicare payment for   • Limited direct county impact

telehealth services that do not comply (Section 2001)
with some traditional requirements in
Medicare Telehealth Program the case of certain substance use
disorder treatments
Encourages the use of non-opioid   • Limited direct county impact

analgesics for the management of (Section 2002)
Opioid Alternatives for the post-surgical pain
Management of Post-Surgical
Pain
H.R. 6, Title III and Related Senate Provisions
Allows greater flexibility for health   • Legislation could expand county usage of
care providers to utilize medication- (Section 3003) (Section 1408) medication-assisted treatment (MAT) to treat
assisted treatment for opioid use opioid use disorders
Medication-Assisted Treatment disorders • NACo supported the increased use of MAT
(MAT) for Opioid Use Disorders therapies in its joint task force report, Prescription
for Action: Local Leadership in Ending the Opioid
Crisis
Reauthorizes the Drug-Free   • Legislation to reauthorize the program ensures

Communities (DFC) program through (Section 3303) funding and administrative continuity for the grant
FY 2022 program
• Drug-Free Communities (DFC) aims to reduce
Reauthorization of the Drug-Free substance use among youth and adults by
Communities (DFC) Grant strengthening collaboration across federal, state
Program and local agencies, as well as with non-profit
partners, to address the risk factors for substance
use in communities
Reauthorizes the Office of National   • Legislation to reauthorize the program ensures

Drug Control Policy’s High-Intensity (Section 3305) local law enforcement agencies have the tools
Drug Trafficking Area (HIDTA) Program needed to combat drug trafficking through
Reauthorization of the High- investigations, interdiction and prosecution
Intensity Drug Trafficking Area • The program provides funding for federal, state
(HIDTA) Program and local law enforcement task forces operating in
the nation’s most critical drug trafficking regions
Reauthorizes the Office of National   • Legislation could provide funding and

Drug Control Policy (ONDCP) at the (Section 3302) administrative continuity at the Office of National
White House, which oversees all Drug Control Policy (ONDCP)
Reauthorization of the Office of
executive branch efforts on narcotics • The office supports initiatives including the High-
control, including the development of Intensity Drug Trafficking Area (HIDTA) and Drug-
National Drug Control Policy a national drug control strategy Free Communities (DFC) programs, which facilitate
local and regional partnerships to address drug
threats in different regions across the country
H.R. 6, Title III and Related Senate Provisions, continued
Reauthorizes U.S. Department of  (Sections 3306-3307) • Legislation could enhance the use of specialized
Justice (DOJ) funding for drug courts treatment courts for justice-involved individuals
Drug Courts, Training and through FY 2022; allows non-profit with opioid or substance use disorders
Technical Assistance organizations to provide training and • NACo supports the use of specialty courts, many of
technical assistance to drug courts which are county-operated
Directs the Food and Drug   • Limited direct county impact

Administration (FDA) to develop (Section 3004)
Developing Evidence-Based evidence-based opioid-prescribing
guidelines for treatment of acute pain
Opioid-Prescribing Guidelines in treatment areas without existing
guidelines
Directs the U.S. Department of Health   • Limited direct county impact

and Human Services (HHS) to issue (Section 3006)
guidelines around prescribing the
Naloxone Prescribing Guidelines opioid overdose antidote drug
naloxone
Directs the U.S. Departments of Health   • Limited direct county impact

and Human Services (HHS), Centers for (Section 3005)
Disease Control and Prevention (CDC),
Opioid Prescribing Practices for National Institutes of Health (NIH) and
the Substance Abuse and Mental
Pregnant Women Health Services Administration
(SAMHSA) to issue opioid-prescribing
practices for pregnant women
Enlists the use of public health labs to   Limited direct county impact
test opioids for traces of fentanyl (Section 3002)
Surveillance and Testing of
Opioids to Prevent Fentanyl
Deaths
H.R. 6, Title IV and Related Senate Provisions
Requires the U.S. Department of   • Legislation could help offset Medicaid program
Health and Human Services (HHS) to (Section 4001) costs for counties by increasing federal
substitute the federal medical contribution rate
Medicaid Managed Care assistance percentage (FMAP) for • In many states, counties play a major role in
spending on Medicaid managed care financing, administering and delivering Medicaid to
plans residents
H.R. 6, Title V and Related Senate Provisions
Amends the Social Security Act so that   • Legislation could be a step toward establishing
mental health services and substance (Section 5022) behavioral health parity in the Children’s Health
Children’s Health Insurance use disorder services for children and Insurance Program (CHIP)
Program (CHIP) and Mental pregnant women are equitably • NACo has policy in support of behavioral health
Health Parity covered under the Children’s Health parity in insurance plans
Insurance Program (CHIP)
Amends the Social Security Act so that   • Legislation could improve pre- and post-release
medical assistance under Medicaid for (Section 5032) care for justice-involved individuals on Medicaid
Easing Community Reentry for justice-involved individuals is provided returning to their communities
Justice-Involved Individuals on for 30-day period prior to release from • NACo sent a letter to Congress in support of this
Medicaid a public institution legislation
Amends the Social Security Act to   • Legislation could give counties additional resources
require state Medicaid programs to (Section 5042) through the Medicaid program to treat substance
integrate prescription drug monitoring use disorders
Medicaid Providers and In-Need programs (PDMPs) into Medicaid • NACo additionally supported the use of prescription
Patients providers’ and pharmacists’ clinical drug monitoring programs (PDMPs) in its joint task
workflow to assist in-need patients force report, Prescription for Action: Local Leadership
in Ending the Opioid Crisis
Requires state Medicaid programs to   • Legislation could add reporting requirements on

report on behavioral health measures (Section 5001) (Section 2211) behavioral health for state Medicaid programs
Medicaid Reporting included as part of the Centers for • In many states, counties play a major role in
Medicare and Medicaid’s (CMS) 2018
Requirements on Adult financing, administering and delivering Medicaid to
Core Set of Adult Health Care Quality
Behavioral Health Measures residents
Measures for Medicaid
Requires the Medicaid and CHIP   • Limited direct county impact

Payment and Access Commissioner (Section 5012)
Exploratory Study on Medicaid’s (MACPAC) to conduct an exploratory
Institutions for Mental Diseases study and report on Institutions for
(IMD) Requirements and Mental Diseases (IMD) requirements
Practices and practices
H.R. 6, Title VI and Related Senate Provisions
Allows the Center for Medicare and   • Legislation could improve integration of health
Innovating with Medicare and Medicaid Innovation to test incentive (Section 6001) (Section 2112) information technologies into local health care
Medicaid Payment Models for payment models for behavioral health systems
Behavioral Health Providers providers adopting electronic health • NACo supports the use of information technologies
Adopting Electronic Health records technology to improve quality to facilitate appropriate access to health records
and coordination of care and improve the standard of care for patients
Record Technology
Requires the U.S. Department of   • Legislation could be a step toward expanding
Health and Human Services (HHS) to (Section 6031-6032) medication-assisted treatment (MAT) options for
issue recommendations under county-operated health facilities
Opioid Addiction Action Plan Medicare and Medicaid to prevent • NACo supported the expanded use of medication-
Under Medicaid and Medicare opioid addiction and enhance access assisted treatment in its joint opioid report:
to medication-assisted treatment Prescription for Action: Local Leadership in Ending
(MAT) the Opioid Crisis
Requires the U.S. Department of   • Limited direct county impact

Health and Human Services (HHS) to (Section 6051-6052) (Section 2107)
Education and Technical provide grants for eligible entities to
Assistance for Outlier Prescribers provide technical assistance to outlier
of Opioids opioid-prescribers
Amends the Social Security Act to   • Limited direct county impact

provide a five-year demonstration (Section 6041-6042) (Section 2109)
Expanding Treatment Options for program on opioid use disorder
Opioid Use Disorders Under treatment under Medicare that
Medicare expands the number of beneficiaries
eligible for treatment
Amends the Social Security Act to   • Limited direct county impact
provide for the adjustment of (Section 6081-6086)
payments under Medicare to avoid
Pain Management, Treatment, financial incentives to use opioids
and Recovery instead of non-opioid alternative
treatments
H.R. 6, Title VII and Related Senate Provisions
Directs the U.S. Department of Health   • Legislation could clarify current regulations around
and Human Services (HHS) to (Section 7053) (Section 1510) disclosing a patient’s medical history across
disseminate information to health care medical providers and with their families and
Communicating Health providers on permitted disclosures of caregivers
Information to Patients’ Families
a patient’s health information to their • The clarification resulting from this measure could
families, caregivers and other health help counties differentiate when substance use
care providers in case of emergency records can be shared under existing law, which
NACo supports
Establishes grants under the U.S.   • Legislation would create a pilot program that, if
Department of Health and Human (Section 7132) (Section 1401) counties were eligible to apply, could provide
Services (HHS) for eligible entities to additional resources for counties to help
Comprehensive Opioid Recovery establish and operate comprehensive coordinate services for people with substance use
Centers opioid recovery centers disorders
Allows employees of qualified hospice   • Legislation could help reduce the diversion of
programs to dispose of a deceased (Section 7062) (Section 1307) unused controlled substances (such as pills) by
patient’s controlled substances onsite allowing hospice workers the legal authority to
Disposal of Controlled Substances in accordance with federal, state and dispose of medications
in Hospice Settings local laws • Some hospices are county-operated and receive
Medicaid funding
Creates a loan repayment program for   • NACo supports measures such as low-interest loan
Loan Repayment Program for substance use disorder treatment (Section 7072) (Section 1417) repayment, loan forgiveness and scholarships that
employees help health care providers retain and attract
Employees of Substance Use
employees to the profession and meet growing
Disorder Treatment Facilities
demand in the health care sector
Directs the U.S. Department of Health   • NACo supported the use of prescription drug
and Human Services (HHS) to support (Section 7203) monitoring programs (PDMPs) in its joint task force
states in the establishment and report, Prescription for Action: Local Leadership in
Prescription Drug Monitoring improvement of prescription drug Ending the Opioid Crisis
Programs (PDMPs) monitoring programs (PDMPs)
H.R. 6, Title VII and Related Senate Provisions, continued
Calls on the U.S. Department of Health   • Legislation could strengthen childcare providers’
and Human Services to disseminate (Subtitle B, Sections ability to recognize signs of trauma in children,
information, resources and technical 8011 and 8012) thereby working to improve the quality of care
Recognizing Early Childhood assistance to early childhood care and • NACo supports the use of high-quality childcare
Trauma Related to Substance Use education providers working with services to ensure the developmental needs of
young children on recognizing and children are met
Disorders
responding to children impacted by
trauma related to a caretaker’s
substance use disorder
Directs the U.S. Department of Health   • Legislation could help counties better provide and
and Human Services to identify best (Section 7032) (Section 1409) regulate housing options for residents with
Recovery Housing for Individuals practices for operating recovery substance use disorders
with Substance Use Disorders housing for individuals with substance • NACo has policy in support of best practices and
use disorders patient protections for sober homes
Calls on the U.S. Department of Health   • Legislation could help state and local agencies
and Human Services (HHS) to assist (Subtitle C, Sections (Section 1414) enact programs for infants impacted by a family
States’ Implementation of Plans states in complying with the Child 8021-8022) member’s substance use disorder
of Safe Care Abuse Prevention and Treatment Act
to promote better protections for
young children and families
Establishes a program to develop   • Legislation could be a step toward enhancing care
procedures for discharging drug (Section 7082) coordination across health care providers treating
Supporting Emergency Room overdose patients and enhancing the substance use disorders
Discharge and Care Coordination coordination of care and treatment • NACo supports increased information-sharing
for Drug Overdose Patients options for substance use disorders across health care providers that could ease the
provision of addiction treatment services across
different health care providers
Establishes grants that the U.S.   • Limited direct county impact, although counties
Department of Health and Human (Section 7092) (Section 1403) operate over 900 hospitals nationwide
Services (HHS) may award to hospitals • Additional grant funding for hospitals and
Hospital Emergency Department and emergency departments to emergency departments could ease the financial
Alternatives develop and enhance pain burden for county-supported hospitals and help
management techniques limiting the ensure positive health outcomes for patients
use and prescription of opioids in
emergency departments
H.R. 6, Title VIII and Related Senate Provisions
Issue Description House (H.R. 6) Senate (S. 2680) • Projected County Impact
Amends the Omnibus Crime Control   • Legislation could give counties additional resources
and Safe Streets Act (P.L. 90-351) to (Section Subtitle J, to combat the opioid epidemic in local
reauthorize the comprehensive opioid Section 8901-8902) communities
Reauthorizing Grants for abuse grant program, allocating • The grant program enhances prevention,
Recovery From Opioid Use $330,000,000 for FY 2019-FY 2023 education, treatment and recovery activities and
aims to improve the overall response to individuals
with substance use disorders
Addresses the impact of drug use on   • Legislation could provide targeted assistance to
economic development in the (Section Subtitle J, counties in the Appalachian region affected by the
Appalachian region by providing Section 8071-8072) opioid epidemic
Treating Opioid Use Disorders in technical assistance, establishing • NACo supports regional economic development
Appalachia grants and engaging in projects and efforts in distressed areas that facilitate
activities in the region that combat cooperative approaches to economic development
opioid use disorders
Calls on the U.S. Department of   • Legislation could expand the personnel resources
Veterans Affairs (VA) to hire additional (Section Subtitle F, available to veterans treatment courts that
Veterans Justice Outreach Specialists Section 8051-8052) connect justice-involved veterans with programs
Veterans Treatment Court to provide treatment court services to and benefits earned through their service
Improvement justice-involved veterans • NACo is supportive of specialty treatment courts,
and veterans treatment courts allow communities
to serve justice-involved veterans in ways
specifically tailored to their needs
Calls on the U.S. Department of   • Limited direct county impact
Veterans Affairs (VA) to enhance peer- (Section Subtitle G,
Peer Counseling for Female to-peer counseling for women Section 8601)
Veterans veterans, and to recruit female peer
support counselors with expertise in
gender-specific issues and services
Establishes an advisory council to   • Limited direct county impact
support grandparents raising (Section Subtitle I,
Supporting Grandparents Raising grandchildren Section 8081-8084)
Grandchildren
H.R. 6, Title IX and Related Senate Provisions
Amends the Controlled Substances Act   • Legislation could give local law enforcement
to establish a new schedule of drugs (Sections 9002-9006) agencies additional resources to prevent the flow
Stopping the Importation and for synthetic opioid analogues of synthetic opioids, such as fentanyl, into local
(Schedule A), as well as criminal communities
Trafficking of Synthetic Opioid
penalties for individuals who import,
Analogues export, manufacture or distribute
Schedule A drugs
H.R. 6, Title X and Related Senate Provisions
Establishes a demonstration program   • Legislation could help counties better provide
to study the impact of using rental (Sections 10001- housing options for residents with substance use
Demonstration Program for vouchers for supportive and 10005) disorders
Supportive Housing Vouchers for transitional housing for individuals • NACo has policy language in support of best
Individuals Recovering From recovering from opioid or other practices and patient protections for supportive
Opioid Use Disorders substance use disorders housing and sober homes
H.R. 6, Title XI and Related Senate Provisions
Amends the Social Security Act to   • Legislation could provide greater flexibility around
provide a Medicaid state plan option (Sections 11001- Medicaid’s Institutions for Mental Disease (IMD)
for services for individuals with opioid 11003) exclusion, a longtime NACo policy priority
Institutions for Mental Diseases
use disorders in Institutions for Mental
(IMD) Care Diseases (IMD) facilities

NACo Opioid Legislative Analysis, 09.07.2018

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NACo OPIOID LEGISLATIVE ANALYSIS

Comparison of House and Senate

For questions on the content of this analysis, please contact:

Valerie Brankovic | Legislative Assistant | vbrankovic@naco.org | (202) 942-4254

H.R. 6, Title VI and related Senate provisions ….………………………………………………………………………………………………………………………………………………….…10

H.R. 6, Title VII and related Senate provisions .……………………………………………………………………………………………………………………………………………….……..11

Allows for Medicare payment for   • Limited direct county impact

Encourages the use of non-opioid   • Limited direct county impact

Reauthorizes the Drug-Free   • Legislation to reauthorize the program ensures

Reauthorizes the Office of National   • Legislation to reauthorize the program ensures

Reauthorizes the Office of National   • Legislation could provide funding and

Directs the Food and Drug   • Limited direct county impact

Directs the U.S. Department of Health   • Limited direct county impact

Directs the U.S. Departments of Health   • Limited direct county impact

Requires state Medicaid programs to   • Legislation could add reporting requirements on

Requires the Medicaid and CHIP   • Limited direct county impact

Requires the U.S. Department of   • Limited direct county impact

Amends the Social Security Act to   • Limited direct county impact

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