II 

117TH CONGRESS 

2D SESSION S. 4482 

To help persons in the United States experiencing homelessness and significant behavioral health issues, including substance use disorders, by authorizing a grant program within the Department of Housing and Urban 

Development to assist State and local governments, Continuums of Care, 

community-based organizations that administer both health and homelessness services, and providers of services to people experiencing homelessness, better coordinate health care and homelessness services, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 23, 2022 

Mr. PADILLA (for himself and Mrs. FEINSTEIN) introduced the following bill; 

which was read twice and referred to the Committee on Banking, Housing, and Urban Affairs 

A BILL 

To help persons in the United States experiencing homelessness and significant behavioral health issues, including 

substance use disorders, by authorizing a grant program 

within the Department of Housing and Urban Development to assist State and local governments, Continuums 

of Care, community-based organizations that administer 

both health and homelessness services, and providers of 

services to people experiencing homelessness, better coordinate health care and homelessness services, and for 

other purposes. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Coordinating Sub5 stance Use and Homelessness Care Act of 2022’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) The United States has a homelessness cri9 sis, with more than 580,000 people experiencing 

10 homelessness on a single night according to the De11 partment of Housing and Urban Development’s 

12 2020 Annual Homeless Assessment Report to Con13 gress. 

14 (2) While the lack of affordable housing is the 

15 primary driver of homelessness, behavioral health 

16 conditions, including substance use disorders, can 

17 exacerbate homelessness and can also be a con18 sequence of homelessness. 

19 (3) Research shows that people experiencing 

20 homelessness have higher rates of substance use dis21 order than people with housing stability. Some peo22 ple who experience homelessness use substances to 

23 cope with the trauma and deprivations of their cir24 cumstances, but substance use disorders frequently 


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1 make it more difficult for people experiencing home2 lessness to secure permanent housing. 

3 (4) Many individuals with substance use dis4 order who experience homelessness have co-occurring 

5 illnesses. The combined effect of physical illness, 

6 mental illness, and lack of housing results in higher 

7 mortality rates for individuals experiencing home8 lessness. 

9 (5) Safely and securely housing individuals who 

10 are experiencing both homelessness and behavioral 

11 health issues, including substance use disorders, 

12 often requires supportive services and close coordina13 tion between housing and social service providers, in 

14 addition to low-barrier, affordable housing. Sub15 sidized housing is critical, but not enough—access to 

16 additional voluntary person-centered supportive serv17 ices is needed. 

18 (6) Nevertheless, it is imperative that when 

19 people experiencing homelessness, including those 

20 with a behavioral health condition such as substance 

21 use disorder, choose to seek help that housing as 

22 well as health care and person-centered supportive 

23 services be coordinated, particularly given their 

24 acute needs and the significant costs incurred by 


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1 communities for law enforcement, correctional, and 

2 emergency department care for failing to do so. 

3 (7) Providing access to health care and vol4 untary person-centered supportive services can be 

5 beneficial in securing and successfully maintaining 

6 stable housing. 

7 (8) Integration of health and homelessness serv8 ices to achieve optimal outcomes for people experi9 encing homelessness, significant behavioral health 

10 conditions such as substance use disorder, and other 

11 health conditions can be challenging for State and 

12 local governments, continuums of care, and commu13 nity-based organizations that administer both health 

14 and homelessness services and providers of homeless15 ness services. 

16 (9) Capacity-building is needed to create sys17 tems-level linkages between the 2 sets of services to 

18 allow for smoother pathways and simpler navigation. 

19 (10) Black, Hispanic, and Indigenous people 

20 are disproportionately underserved by person-cen21 tered supportive services. In order to address critical 

22 services deficits and affirmatively serve protected 

23 classes of people with significant behavioral health 

24 conditions, including substance use disorders, who 

25 are experiencing homelessness, the grant program 


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1 established under this Act can be used to build the 

2 capacities of homelessness services providers that 

3 have demonstrated cultural competencies in service 

4 provision and a record of serving Black, Hispanic, 

5 and Indigenous people and other underserved popu6 lations experiencing homelessness that also suffer 

7 from substance use disorders. 

8 SEC. 3. DEFINITIONS. 

9 In this Act: 

10 (1) INDIAN TRIBE; TRIBAL ORGANIZATION.— 

11 The terms ‘‘Indian Tribe’’ and ‘‘Tribal organiza12 tion’’— 

13 (A) have the meanings given those terms 

14 in section 4 of the Indian Self-Determination 

15 and Education Assistance Act (25 U.S.C. 

16 5304); and 

17 (B) include entities that serve Native Ha18 waiians, as defined in section 338K(c) of the 

19 Public Health Service Act (42 U.S.C. 254s(c)). 

20 (2) PERSON EXPERIENCING HOMELESSNESS.— 

21 The term ‘‘person experiencing homelessness’’ has 

22 the same meaning as the terms ‘‘homeless’’, ‘‘home23 less individual’’, and ‘‘homeless person’’, as those 

24 terms are defined in the McKinney-Vento Homeless 

25 Assistance Act (42 U.S.C. 11302). 


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1 (3) PUBLIC HOUSING AGENCY.—The term 

2 ‘‘public housing agency’’ has the meaning given the 

3 term in section 3(b) of the United States Housing 

4 Act of 1937 (42 U.S.C. 1437a(b)). 

5 (4) SECRETARY.—The term ‘‘Secretary’’ means 

6 the Secretary of Housing and Urban Development. 

7 (5) SUBSTANCE USE DISORDER.—The term 

8 ‘‘substance use disorder’’ means the disorder that 

9 occurs when the recurrent use of alcohol or drugs, 

10 or both, causes clinically significant impairment, in11 cluding health problems, disability, and failure to 

12 meet major responsibilities at work, school, or home. 

13 (6) TRIBALLY DESIGNATED HOUSING ENTI14 TY.—The term ‘‘tribally designated housing entity’’ 

15 has the meaning given the term in section 4 of the 

16 Native American Housing Assistance and Self-De17 termination Act of 1996. 

18 SEC. 4. ESTABLISHMENT OF GRANT PROGRAM. 

19 (a) IN GENERAL.—The Secretary, in consultation 

20 with the working group established pursuant to subsection 

21 (b), shall establish a grant program to award competitive 

22 grants to eligible entities described in subsection (c)(4) to 

23 build or increase their capacities for the better coordina24 tion of health care and homelessness services for people 

25 who are experiencing homelessness and significant behavVerDate Sep 11 2014 00:49 Jun 30, 2022 Jkt 029200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4482.IS S4482

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1 ioral health issues, including substance use disorders, and 

2 are voluntarily seeking assistance. 

3 (b) WORKING GROUP.— 

4 (1) ESTABLISHMENT.—The Secretary shall es5 tablish an interagency working group to provide ad6 vice to the Secretary in carrying out the program 

7 under subsection (a). 

8 (2) COMPOSITION.—The working group estab9 lished under paragraph (1) shall include representa10 tives from the Department of Housing and Urban 

11 Development, the United States Interagency Council 

12 on Homelessness, the Department of Health and 

13 Human Services, the Department of Agriculture, 

14 and the Bureau of Indian Affairs, to be appointed 

15 by the heads of those agencies. 

16 (3) DEVELOPMENT OF ASSISTANCE TOOLS.— 

17 Not later than 1 year after the date of enactment 

18 of this Act, the working group established under 

19 paragraph (1) shall— 

20 (A) develop training, tools, and other tech21 nical assistance materials that simplify home22 lessness services for providers of health care 

23 and simplify health care services for providers 

24 of homelessness services by identifying the basic 


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1 elements the health and homelessness sectors 

2 need to understand about the other; and 

3 (B) circulate the materials described in 

4 subparagraph (A) to interested entities, particu5 larly those that apply for grants awarded under 

6 this section. 

7 (c) CAPACITY-BUILDING GRANTS.— 

8 (1) IN GENERAL.—The Secretary shall award 

9 5-year grants to eligible entities described in para10 graph (4), which shall be used only to build or in11 crease their capacities to coordinate health care and 

12 homelessness services. 

13 (2) PROHIBITION.—None of the proceeds from 

14 the grants awarded pursuant to this Act may be 

15 used to pay for— 

16 (A) health care, with the exception of ef17 forts to increase the availability of Naloxone 

18 and provide training for its administration; or 

19 (B) rent. 

20 (3) AMOUNT.—The amount awarded to an enti21 ty under a grant under this section shall not exceed 

22 $500,000. 

23 (4) ELIGIBILITY.—To be eligible to receive a 

24 grant under this subsection an entity shall— 

25 (A) be— 


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1 (i) a governmental entity at the coun2 ty, city, regional, or locality level; 

3 (ii) an Indian Tribe, a tribally des4 ignated housing entity, or a Tribal organi5 zation; 

6 (iii) a public housing agency admin7 istering housing choice vouchers; or 

8 (iv) a continuum of care or nonprofit 

9 organization designated by the continuum 

10 of care; 

11 (B) be responsible for homelessness serv12 ices; 

13 (C) provide such assurances as the Sec14 retary shall require that, in carrying out activi15 ties with amounts from the grant, the entity 

16 will ensure that services are culturally com17 petent, meet the needs of the people being 

18 served, and follow trauma-informed best prac19 tices to address those needs using a harm re20 duction approach; and 

21 (D) demonstrate how the capacity of the 

22 entity to coordinate health care and homeless23 ness services to better serve people experiencing 

24 homelessness and significant behavioral health 


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1 issues, including substance use disorders, can 

2 be increased through— 

3 (i) the designation of a governmental 

4 official as a coordinator for making con5 nections between health and homelessness 

6 services and developing a strategy for 

7 using those services in a holistic way to 

8 help people experiencing homelessness and 

9 behavioral health conditions such as sub10 stance use disorders, including those with 

11 cooccurring conditions; 

12 (ii) improvements in infrastructure at 

13 the systems level; 

14 (iii) improvements in technology for 

15 voluntary remote monitoring capabilities, 

16 including internet and video, which can 

17 allow for more home- and community18 based behavioral health care services and 

19 ensure those improvements maintain effec20 tive communication requirements for per21 sons with disabilities and program access 

22 for persons with limited English pro23 ficiency; 

24 (iv) improvements in connections to 

25 health care services delivered by providers 


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1 experienced in behavioral health care and 

2 people experiencing homelessness; 

3 (v) efforts to increase the availability 

4 of Naloxone and provide training for its 

5 administration; and 

6 (vi) any additional activities identified 

7 by the Secretary that will advance the co8 ordination of homelessness assistance, 

9 housing, and substance use services and 

10 other health care services. 

11 (5) ELIGIBLE ACTIVITIES.—An eligible entity 

12 receiving a grant under this section may use the 

13 grant to cover costs related to— 

14 (A) hiring system coordinators; and 

15 (B) administrative costs, including staffing 

16 costs, technology costs, and other such costs 

17 identified by the Secretary. 

18 (6) DISTRIBUTION OF FUNDS.—An eligible enti19 ty receiving a grant under this section may dis20 tribute all or a portion of the grant amounts to pri21 vate nonprofit organizations, other government enti22 ties, public housing agencies, tribally designated 

23 housing entities, or other entities as determined by 

24 the Secretary to carry out programs and activities in 

25 accordance with this section. 


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1 (7) OVERSIGHT REQUIREMENTS.— 

2 (A) ANNUAL REPORTS.—Not later than 6 

3 years after the date on which grant amounts 

4 are first received by an eligible entity under this 

5 section, the entity shall submit to the Secretary 

6 a report on the activities carried out under the 

7 grant, which shall include, with respect to ac8 tivities carried out with grant amounts in the 

9 community served— 

10 (i) measures of outcomes relating to 

11 whether people experiencing homelessness 

12 and significant behavioral health issues, in13 cluding substance use disorders, who 

14 sought help from the entity— 

15 (I) were housed and did not ex16 perience intermittent periods of home17 lessness; 

18 (II) were voluntarily enrolled in 

19 treatment and recovery programs; 

20 (III) experienced improvements 

21 in their health; 

22 (IV) obtained access to specific 

23 primary care providers; and 

24 (V) have health care plans that 

25 meet their individual needs, including 


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1 access to mental health and substance 

2 use disorder treatment and recovery 

3 services; 

4 (ii) how grant funds were used; and 

5 (iii) any other matters determined ap6 propriate by the Secretary. 

7 (B) RULE OF CONSTRUCTION.—Nothing in 

8 this subsection may be construed to condition 

9 the receipt of future housing and other services 

10 by individuals assisted with activities and serv11 ices provided with grant amounts on the out12 comes detailed in the reports submitted under 

13 this paragraph. 

14 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to carry out this section 

16 $20,000,000 for each of fiscal years 2022 through 2027, 

17 of which not less than 5 percent of such funds shall be 

18 awarded to Indian Tribes, tribally designated housing en19 tities, and Tribal organizations. 

Æ 


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