II 

118TH CONGRESS 

2D SESSION S. 4286 

To provide emergency assistance to States, territories, Tribal nations, and 

local areas affected by substance use disorder, including the use of 

opioids and stimulants, and to make financial assistance available to 

States, territories, Tribal nations, local areas, public or private nonprofit 

entities, and certain health providers, to provide for the development, 

organization, coordination, and operation of more effective and cost efficient systems for the delivery of essential services to individuals with 

substance use disorder and their families. 

IN THE SENATE OF THE UNITED STATES 

MAY 8, 2024 

Ms. WARREN (for herself, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. BOOKER, 

Mr. MARKEY, Mr. VAN HOLLEN, Mr. CASEY, Ms. KLOBUCHAR, Mr. 

SCHATZ, Mr. PADILLA, Ms. SMITH, Mr. MERKLEY, Mr. HEINRICH, Mr. 

BROWN, Mr. WELCH, Mr. FETTERMAN, and Ms. BUTLER) introduced the 

following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

A BILL 

To provide emergency assistance to States, territories, Tribal 

nations, and local areas affected by substance use disorder, including the use of opioids and stimulants, and 

to make financial assistance available to States, territories, Tribal nations, local areas, public or private nonprofit entities, and certain health providers, to provide 

for the development, organization, coordination, and operation of more effective and cost efficient systems for 


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the delivery of essential services to individuals with substance use disorder and their families. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Comprehensive Addiction Resources Emergency Act of 

6 2024’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Purpose. 

Sec. 3. Amendment to the Public Health Service Act. 

‘‘TITLE XXXIV—SUBSTANCE USE RESOURCES 

‘‘Subtitle A—Local Substance Use Emergency Relief Grant Program 

‘‘Sec. 3401. Establishment of program of grants. 

‘‘Sec. 3402. Planning council. 

‘‘Sec. 3403. Amount of grant, use of amounts, and funding agreement. 

‘‘Sec. 3404. Application. 

‘‘Sec. 3405. Technical assistance. 

‘‘Sec. 3406. Authorization of appropriations. 

‘‘Subtitle B—State and Tribal Substance Use Disorder Prevention and 

Intervention Grant Program 

‘‘Sec. 3411. Establishment of program of grants. 

‘‘Sec. 3412. Amount of grant, use of amounts, and funding agreement. 

‘‘Sec. 3413. Application. 

‘‘Sec. 3414. Technical assistance. 

‘‘Sec. 3415. Authorization of appropriations. 

‘‘Subtitle C—Other Grant Program 

‘‘Sec. 3421. Establishment of grant program. 

‘‘Sec. 3422. Use of amounts. 

‘‘Sec. 3423. Technical assistance. 

‘‘Sec. 3424. Planning and development grants. 

‘‘Sec. 3425. Authorization of appropriations. 

‘‘Subtitle D—Innovation, Training, and Health Systems Strengthening 

‘‘Sec. 3431. Special projects of national significance. 

‘‘Sec. 3432. Education and training centers. 


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‘‘Sec. 3433. Substance use disorder treatment provider capacity under the 

Medicaid program. 

‘‘Sec. 3434. Programs to support employees. 

‘‘Sec. 3435. Improving and expanding care. 

‘‘Sec. 3436. Naloxone distribution program. 

‘‘Sec. 3437. Additional funding for the National Institutes of Health. 

‘‘Sec. 3438. Additional funding for the Centers for Disease Control and 

Prevention. 

‘‘Sec. 3439. Definitions. 

Sec. 4. Amendments to the Controlled Substances Act. 

Sec. 5. General limitation on use of funds. 

Sec. 6. Federal drug demand reduction activities. 

1 SEC. 2. PURPOSE. 

2 It is the purpose of this Act to provide emergency 

3 assistance to States, territories, Tribal nations, and local 

4 areas that are disproportionately affected by substance use 

5 disorder, including the use of opioids and stimulants, and 

6 to make financial assistance available to States, terri7 tories, Tribal nations, local areas, public or private non8 profit entities, and certain health providers, to provide for 

9 the development, organization, coordination, and operation 

10 of more effective and cost efficient systems for the delivery 

11 of essential services to individuals with substance use dis12 order, including with co-occurring mental health and sub13 stance use disorders, and their families. 

14 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

15 ACT. 

16 The Public Health Service Act (42 U.S.C. 201 et 

17 seq.) is amended by adding at the end the following: 


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1 ‘‘TITLE XXXIV—SUBSTANCE USE 

2 RESOURCES 

3 ‘‘Subtitle A—Local Substance Use 

4 Emergency Relief Grant Program 

5 ‘‘SEC. 3401. ESTABLISHMENT OF PROGRAM OF GRANTS. 

6 ‘‘(a) IN GENERAL.—The Secretary shall award 

7 grants to eligible localities for the purpose of addressing 

8 substance use within such localities. 

9 ‘‘(b) ELIGIBILITY.— 

10 ‘‘(1) IN GENERAL.—To be eligible to receive a 

11 grant under subsection (a) a locality shall— 

12 ‘‘(A) be— 

13 ‘‘(i) a county that can demonstrate 

14 that the rate of drug overdose deaths per 

15 100,000 population in the county during 

16 the most recent 3-year period for which 

17 such data are available was not less than 

18 the rate of such deaths for the county that 

19 ranked at the 67th percentile of all coun20 ties, as determined by the Secretary; 

21 ‘‘(ii) a county that can demonstrate 

22 that the number of drug overdose deaths 

23 during the most recent 3-year period for 

24 which such data are available was not less 

25 than the number of such deaths for the 


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1 county that ranked at the 90th percentile 

2 of all counties, as determined by the Sec3 retary; 

4 ‘‘(iii) a county that encompasses an 

5 undeserved area, defined as a health pro6 fessional shortage area (as defined in sec7 tion 332(a)(1)(A)) and a medically under8 served area (according to a designation 

9 under section 330(b)(3)(A)), that can dem10 onstrate a high burden of both fatal and 

11 non-fatal drug overdoses in a manner de12 termined by the Secretary; or 

13 ‘‘(iv) a city that is located within a 

14 county described in clause (i), (ii), or (iii) 

15 that meets the requirements of paragraph 

16 (3); and 

17 ‘‘(B) submit to the Secretary an applica18 tion in accordance with section 3404. 

19 ‘‘(2) MULTIPLE CONTIGUOUS COUNTIES.—In 

20 the case of an eligible county that is contiguous to 

21 one or more other eligible counties within the same 

22 State, the group of counties shall— 

23 ‘‘(A) be considered as a single eligible 

24 county for purposes of a grant under this sec25 tion; 


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1 ‘‘(B) submit a single application under sec2 tion 3404; 

3 ‘‘(C) form a joint planning council (for the 

4 purposes of section 3402); and 

5 ‘‘(D) establish, through intergovernmental 

6 agreements, an administrative mechanism to al7 locate funds and substance use disorder treat8 ment services under the grant based on— 

9 ‘‘(i) the number and rate of drug 

10 overdose deaths and nonfatal drug 

11 overdoses in each of the counties that com12 pose the eligible county; 

13 ‘‘(ii) the severity of need for services 

14 in each such county; and 

15 ‘‘(iii) the health and support per16 sonnel needs of each such county. 

17 ‘‘(3) CITIES AND COUNTIES WITHIN MULTIPLE

18 CONTIGUOUS COUNTIES.— 

19 ‘‘(A) IN GENERAL.—A city that is within 

20 an eligible county described in paragraph (1), 

21 or a county or group of counties that is within 

22 a group of counties determined to be an eligible 

23 county under paragraph (2), shall be eligible to 

24 receive a grant under this section if such city 


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1 or county or group of counties meets the re2 quirements of subparagraph (B). 

3 ‘‘(B) REQUIREMENTS.—A city or county 

4 meets the requirements of this subparagraph if 

5 such city or county— 

6 ‘‘(i) except as provided in subpara7 graph (C), has a population of not less 

8 than 50,000 residents; 

9 ‘‘(ii) meets the requirements of para10 graph (1)(A); 

11 ‘‘(iii) submits an application under 

12 section 3404; 

13 ‘‘(iv) establishes a planning council 

14 (for purposes of section 3402); and 

15 ‘‘(v) establishes an administrative 

16 mechanism to allocate funds and services 

17 under the grant based on— 

18 ‘‘(I) the number and rate of drug 

19 overdose deaths and nonfatal drug 

20 overdoses in the city or county; 

21 ‘‘(II) the severity of need for sub22 stance use disorder treatment services 

23 in the city or county; and 

24 ‘‘(III) the health and support 

25 personnel needs of the city or county. 


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1 ‘‘(C) POPULATION EXCEPTION.—A city or 

2 county or group of counties that does not meet 

3 the requirements of subparagraph (B)(i) may 

4 apply to the Secretary for a waiver of such re5 quirement. Such application shall dem6 onstrate— 

7 ‘‘(i) that the needs of the population 

8 to be served are distinct or that addressing 

9 substance use in the service area would be 

10 best served by the formation of an inde11 pendent council; and 

12 ‘‘(ii) that the city or county or group 

13 of counties has the capacity to administer 

14 the funding received under this subtitle. 

15 ‘‘(D) MINIMUM FUNDING.—A city or coun16 ty that meets the requirement of this paragraph 

17 and receives a grant under this section shall be 

18 entitled to an amount of funding under the 

19 grant in an amount that is not less than the 

20 amount determined under section 3403(a) with 

21 respect to such city or county. 

22 ‘‘(4) INDEPENDENT CITY.—Independent cities 

23 that are not located within the territory of a county 

24 shall be treated as eligible counties for purposes of 

25 this subtitle. 


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1 ‘‘(5) POLITICAL SUBDIVISIONS.—With respect 

2 to States that do not have a local county system of 

3 governance, the Secretary shall determine the local 

4 political subdivisions within such States that are eli5 gible to receive a grant under this section and such 

6 subdivisions shall be treated as eligible counties for 

7 purposes of this subtitle. 

8 ‘‘(6) DETERMINATIONS WHERE THERE IS A

9 LACK OF DATA.—The Secretary shall establish eligi10 bility and allocation criteria related to the prevalence 

11 of drug overdose deaths, the mortality rate from 

12 drug overdoses, and that provides an equivalent 

13 measure of need for funding for cities and counties 

14 for which the data described in paragraph (1)(A) or 

15 (2)(D)(i) is not available. 

16 ‘‘(7) DATA FROM TRIBAL AREAS.—The Sec17 retary, acting through the Indian Health Service, 

18 shall consult with Indian Tribes and confer with 

19 urban Indian organizations to establish eligibility 

20 and allocation criteria that provide an equivalent 

21 measure of need for Tribal and urban Indian areas 

22 for which the data described in paragraph (1)(A) or 

23 (2)(D)(i) are not available or do not apply. 

24 ‘‘(8) STUDY.—Not later than 3 years after the 

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1 eral shall conduct a study to determine whether the 

2 data utilized for purposes of paragraph (1)(A) pro3 vide the most precise measure of local area need re4 lated to substance use and addiction prevalence and 

5 whether additional data would provide more precise 

6 measures of substance use and addiction prevalence 

7 in local areas. Such study shall identify barriers to 

8 collecting or analyzing such data, and make rec9 ommendations for revising the indicators used under 

10 such paragraph to determine eligibility in order to 

11 direct funds to the local areas in most need of fund12 ing to provide assistance related to substance use 

13 and addiction. 

14 ‘‘(9) REFERENCE.—For purposes of this sub15 title, the term ‘eligible local area’ includes— 

16 ‘‘(A) a city or county described in para17 graph (1); 

18 ‘‘(B) multiple contiguous counties de19 scribed in paragraph (2); 

20 ‘‘(C) cities or counties within multiple con21 tiguous counties described in paragraph (3); 

22 ‘‘(D) an independent city described in 

23 paragraph (4); and 

24 ‘‘(E) a political subdivision described in 

25 paragraph (5). 


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1 ‘‘(c) ADMINISTRATION.— 

2 ‘‘(1) IN GENERAL.—Assistance made available 

3 under a grant awarded under this section shall be 

4 directed to the chief elected official of the eligible 

5 local area who shall administer the grant funds. 

6 ‘‘(2) MULTIPLE CONTIGUOUS COUNTIES.— 

7 ‘‘(A) IN GENERAL.—Except as provided in 

8 subparagraph (B), in the case of an eligible 

9 county described in subsection (b)(2), assist10 ance made available under a grant awarded 

11 under this section shall be directed to the chief 

12 elected official of the particular county des13 ignated in the application submitted for the 

14 grant under section 3404. Such chief elected of15 ficial shall be the administrator of the grant. 

16 ‘‘(B) STATE ADMINISTRATION.—Notwith17 standing subparagraph (A), the eligible county 

18 described in subsection (b)(2) may elect to des19 ignate the chief elected State official of the 

20 State in which the eligible county is located as 

21 the administrator of the grant funds. 

22 ‘‘SEC. 3402. PLANNING COUNCIL. 

23 ‘‘(a) ESTABLISHMENT.—To be eligible to receive a 

24 grant under section 3401, the chief elected official of the 

25 eligible local area shall establish or designate a substance 


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1 use disorder treatment and services planning council that 

2 shall— 

3 ‘‘(1) be representative of the demographics of 

4 the population of individuals with substance use dis5 order in the area; 

6 ‘‘(2) include individuals with substance use dis7 order, individuals who use drugs, and individuals in 

8 recovery from substance use disorders; and 

9 ‘‘(3) include, to the maximum extent prac10 ticable, representatives of— 

11 ‘‘(A) health care providers, including Fed12 erally-qualified health centers, rural health clin13 ics, Indian health programs as defined in sec14 tion 4 of the Indian Health Care Improvement 

15 Act, urban Indian organizations as defined in 

16 section 4 of the Indian Health Care Improve17 ment Act, and facilities operated by the Depart18 ment of Veterans Affairs; 

19 ‘‘(B) Native Hawaiian organizations as de20 fined in section 11 of the Native Hawaiian 

21 Health Care Act of 1988; 

22 ‘‘(C) community-based health, harm reduc23 tion, and addiction service organizations, in24 cluding, where applicable, representatives of 

25 Drug Free Communities Coalition grantees; 


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1 ‘‘(D) social service providers, including 

2 providers of housing and homelessness services 

3 and recovery residence providers; 

4 ‘‘(E) mental health care providers; 

5 ‘‘(F) local public health agencies; 

6 ‘‘(G) State governments, including the 

7 State Medicaid agency and the Single State 

8 Agency for Substance Abuse Services; 

9 ‘‘(H) local governments; 

10 ‘‘(I) non-elected community leaders; 

11 ‘‘(J) substance use disorder treatment pro12 viders, including physician addiction specialists; 

13 ‘‘(K) Indian tribes and tribal organizations 

14 as defined in section 4 of the Indian Self-Deter15 mination and Education Assistance Act; 

16 ‘‘(L) Urban Indians as defined in section 

17 4 of the Indian Health Care Improvement Act; 

18 ‘‘(M) historically underserved groups and 

19 subpopulations; 

20 ‘‘(N) individuals who were formerly incar21 cerated; 

22 ‘‘(O) organizations serving individuals who 

23 are currently incarcerated or in pre-trial deten24 tion or were formerly incarcerated; 

25 ‘‘(P) Federal agencies; 


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1 ‘‘(Q) organizations that provide drug pre2 vention programs and services to youth at risk 

3 of substance use; 

4 ‘‘(R) medical examiners or coroners; 

5 ‘‘(S) labor unions and the workplace com6 munity; 

7 ‘‘(T) local fire departments and emergency 

8 medical services; 

9 ‘‘(U) the lesbian, gay, bisexual, 

10 transgender, queer (LGBTQ) community; and 

11 ‘‘(V) certified or accredited addiction re12 covery community organizations. 

13 ‘‘(b) METHOD OF PROVIDING FOR COUNCIL.— 

14 ‘‘(1) IN GENERAL.—In providing for a council 

15 for purposes of subsection (a), the chief elected offi16 cial of the eligible local area may establish the coun17 cil directly or designate an existing entity to serve as 

18 the council, subject to paragraph (2). 

19 ‘‘(2) CONSIDERATION REGARDING DESIGNATION

20 OF COUNCIL.—In making a determination of wheth21 er to establish or designate a council under para22 graph (1), the chief elected official shall give priority 

23 to the designation of an existing entity that has 

24 demonstrated experience in the provision of health 

25 and support services to individuals with substance 


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1 use disorder within the eligible local area, that has 

2 a structure that recognizes the Federal trust respon3 sibility when spending Federal health care dollars, 

4 and that has demonstrated a commitment to re5 specting the obligation of government agencies using 

6 Federal dollars to consult with Indian tribes and 

7 confer with urban Indian organizations. 

8 ‘‘(3) DESIGNATION OF EXISTING ENTITY.—If 

9 an existing entity is designated to serve as the coun10 cil under this section, the membership of the entity 

11 shall comply with the requirements of subsection 

12 (a)(1) before it performs any of the duties set forth 

13 in subsection (e). 

14 ‘‘(4) JOINT COUNCIL.—The Secretary shall es15 tablish a process to permit an eligible local area that 

16 is not contiguous with any other eligible local area 

17 to form a joint planning council with such other eli18 gible local area or areas, as long as such areas are 

19 located in geographical proximity to each other, as 

20 determined by the Secretary, and submit a joint ap21 plication under section 3404. 

22 ‘‘(5) JOINT COUNCIL ACROSS STATE LINES.— 

23 Eligible local areas may form a joint planning coun24 cil with other eligible local areas across State lines 

25 if such areas are located in geographical proximity 


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1 to each other, as determined by the Secretary, sub2 mit a joint application under section 3404, and es3 tablish intergovernmental agreements to allow the 

4 administration of the grant across State lines. 

5 ‘‘(c) MEMBERSHIP.—Members of the planning coun6 cil established or designated under subsection (a) shall— 

7 ‘‘(1) be nominated and selected through an 

8 open process; 

9 ‘‘(2) elect from among their membership a chair 

10 and vice chair; 

11 ‘‘(3) include at least one representative from 

12 Indian tribes located within any eligible local area 

13 that receives funding under the grant program es14 tablished in section 3401; 

15 ‘‘(4) include at least 1 individual with a history 

16 of substance use disorder; 

17 ‘‘(5) include at least 1 representative from a 

18 nonprofit substance use disorder service provider, at 

19 least 1 representative of an urban Indian organiza20 tion, at least 1 physician addiction specialist, and at 

21 least 1 representative from an organization pro22 viding harm reduction services; 

23 ‘‘(6) include at least 1 representative of a Na24 tive Hawaiian organization (as defined in section 11 

25 of the Native Hawaiian Health Care Act of 1988) 


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1 when the Native Hawaiian population exceeds 10 

2 percent; and 

3 ‘‘(7) serve not more than 3 consecutive years on 

4 the planning council. 

5 ‘‘(d) MEMBERSHIP TERMS.—Members of the plan6 ning council established or designated under subsection 

7 (a) may serve additional terms if nominated and selected 

8 through the process established in subsection (c)(1). 

9 ‘‘(e) DUTIES.—The planning council established or 

10 designated under subsection (a) shall— 

11 ‘‘(1) establish priorities for the allocation of 

12 grant funds within the eligible local area that em13 phasize reducing drug use rates, overdose, substance 

14 use disorder, and health conditions associated with 

15 drug use such as human immunodeficiency virus, 

16 hepatitis B, and hepatitis C through evidence-based 

17 interventions in both community and criminal justice 

18 settings and that are based on— 

19 ‘‘(A) the use by the grantee of substance 

20 use disorder prevention, intervention, treat21 ment, and recovery strategies that comply with 

22 best practices identified by the Secretary; 

23 ‘‘(B) the demonstrated or probable cost-ef24 fectiveness of proposed substance use disorder 


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1 prevention, intervention, treatment, and recov2 ery services; 

3 ‘‘(C) the health priorities of the commu4 nities within the eligible local area that are af5 fected by substance use; 

6 ‘‘(D) the priorities and needs of individuals 

7 with substance use disorder; and 

8 ‘‘(E) the availability of other governmental 

9 and non-governmental services; 

10 ‘‘(2) ensure the use of grant funds will advance 

11 any existing State or local plan regarding the provi12 sion of substance use disorder treatment services to 

13 individuals with substance use disorder; 

14 ‘‘(3) in the absence of a State or local plan, 

15 work with local public health agencies to develop a 

16 comprehensive plan for the organization and delivery 

17 of substance use disorder prevention and treatment 

18 services; 

19 ‘‘(4) regularly assess the efficiency of the ad20 ministrative mechanism in rapidly allocating funds 

21 to support evidence-based substance use disorder 

22 prevention and treatment services in the areas of 

23 greatest need within the eligible local area; 

24 ‘‘(5) work with local public health agencies to 

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1 lation of individuals with substance use disorders 

2 and the types of substance use that are most preva3 lent in the eligible local area; 

4 ‘‘(6) work with local public health agencies to 

5 determine the needs of such population, including 

6 the need for substance use disorder prevention, 

7 intervention, treatment, harm reduction, and recov8 ery services; 

9 ‘‘(7) work with local public agencies to deter10 mine the disparities in access to services among af11 fected subpopulations and historically underserved 

12 communities, including infrastructure and capacity 

13 shortcomings of providers that contribute to these 

14 disparities; 

15 ‘‘(8) work with local public agencies to establish 

16 methods for obtaining input on community needs 

17 and priorities, including by partnering with organi18 zations that serve targeted communities experiencing 

19 high addictive substance-related health disparities to 

20 gather data using culturally attuned data collection 

21 methodologies; 

22 ‘‘(9) coordinate with Federal grantees that pro23 vide substance use disorder prevention and treat24 ment services within the eligible local area; and 


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1 ‘‘(10) annually assess the effectiveness of the 

2 substance use disorder prevention and treatment 

3 services being supported by the grant received by the 

4 eligible local area, including, to the extent possible— 

5 ‘‘(A) reductions in the rates of substance 

6 use, overdose, and death from substance use; 

7 ‘‘(B) rates of discontinuation from sub8 stance use disorder treatment services and rates 

9 of sustained recovery; 

10 ‘‘(C) long-term outcomes among individ11 uals receiving treatment for substance use dis12 orders; 

13 ‘‘(D) the availability and use of substance 

14 use disorder treatment services needed by indi15 viduals with substance use disorders over their 

16 lifetimes; and 

17 ‘‘(E) reductions in the rates of HIV, hepa18 titis C virus, and other infectious disease trans19 mission among people who use drugs. 

20 ‘‘(f) CONFLICTS OF INTEREST.— 

21 ‘‘(1) IN GENERAL.—The planning council under 

22 subsection (a) may not be directly involved in the 

23 administration of a grant under section 3401. 

24 ‘‘(2) REQUIRED AGREEMENTS.—An individual 

25 may serve on the planning council under subsection 


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1 (a) only if the individual agrees that if the individual 

2 has a financial interest in an entity, if the individual 

3 is an employee of a public or private entity, or if the 

4 individual is a member of a public or private organi5 zation, and such entity or organization is seeking 

6 amounts from a grant under section 3401, the indi7 vidual will not, with respect to the purpose for which 

8 the entity seeks such amounts, participate (directly 

9 or in an advisory capacity) in the process of select10 ing entities to receive such amounts for such pur11 pose. 

12 ‘‘(g) GRIEVANCE PROCEDURES.—A planning council 

13 under subsection (a) shall develop procedures for address14 ing grievances with respect to funding under this subtitle, 

15 including procedures for submitting grievances that can16 not be resolved to binding arbitration. Such procedures 

17 shall be described in the by-laws of the planning council. 

18 ‘‘(h) PUBLIC DELIBERATIONS.— 

19 ‘‘(1) IN GENERAL.—With respect to a planning 

20 council under subsection (a), in accordance with cri21 teria established by the Secretary, the following ap22 plies: 

23 ‘‘(A) The meetings of the council shall be 

24 open to the public and shall be held only after 

25 adequate notice to the public. 


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1 ‘‘(B) The records, reports, transcripts, 

2 minutes, agenda, or other documents which 

3 were made available to or prepared for or by 

4 the council shall be available for public inspec5 tion and copying at a single location. 

6 ‘‘(C) Detailed minutes of each meeting of 

7 the council shall be kept. The accuracy of all 

8 minutes shall be certified to by the chair of the 

9 council. 

10 ‘‘(2) LIMITATION.—Paragraph (1) does not 

11 apply to any disclosure of information of a personal 

12 nature that would constitute a clearly unwarranted 

13 invasion of personal privacy, including any disclosure 

14 of medical information or personnel matters. 

15 ‘‘(i) NEUTRALITY TOWARDS ORGANIZED LABOR.— 

16 ‘‘(1) IN GENERAL.—In carrying out duties 

17 under subsection (e), planning councils shall, to the 

18 extent practicable, prioritize the distribution of grant 

19 funds to grantees that have— 

20 ‘‘(A)(i) a collective bargaining agreement; 

21 or 

22 ‘‘(ii) an explicit policy not to deter employ23 ees with respect to— 

24 ‘‘(I) labor organizing for the employ25 ees engaged in the covered activities; and 


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1 ‘‘(II) such employees’ choice to form 

2 and join labor organizations; and 

3 ‘‘(B) policies that require— 

4 ‘‘(i) the posting and maintenance of 

5 notices in the workplace to such employees 

6 of their rights under the National Labor 

7 Relations Act (29 U.S.C. 151 et seq.); 

8 ‘‘(ii) that such employees are, at the 

9 beginning of their employment, provided 

10 notice and information regarding the em11 ployees’ rights under such Act; and 

12 ‘‘(iii) the employer to voluntarily rec13 ognize a union in cases where a majority 

14 of such workers of the employer have 

15 joined and requested representation. 

16 ‘‘(2) LIMITATION.—This subsection does not 

17 apply to Indian tribes. 

18 ‘‘SEC. 3403. AMOUNT OF GRANT, USE OF AMOUNTS, AND 

19 FUNDING AGREEMENT. 

20 ‘‘(a) AMOUNT OF GRANT.— 

21 ‘‘(1) GRANTS BASED ON RELATIVE NEED OF

22 AREA.— 

23 ‘‘(A) IN GENERAL.—In carrying out this 

24 subtitle, the Secretary shall make a grant for 

25 each eligible local area for which an application 


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1 under section 3404 has been approved. Each 

2 such grant shall be made in an amount deter3 mined in accordance with paragraph (3). 

4 ‘‘(B) EXPEDITED DISTRIBUTION.—Not 

5 later than 90 days after an appropriation be6 comes available to carry out this subtitle for a 

7 fiscal year, the Secretary shall disburse 53 per8 cent of the amount made available under sec9 tion 3406 for carrying out this subtitle for such 

10 fiscal year through grants to eligible local areas 

11 under section 3401, in accordance with sub12 paragraphs (C) and (D). 

13 ‘‘(C) AMOUNT.— 

14 ‘‘(i) IN GENERAL.—Subject to the ex15 tent of amounts made available in appro16 priations Acts, a grant made for purposes 

17 of this subparagraph to an eligible local 

18 area shall be made in an amount equal to 

19 the product of— 

20 ‘‘(I) an amount equal to the 

21 amount available for distribution 

22 under subparagraph (B) for the fiscal 

23 year involved; and 

24 ‘‘(II) the percentage constituted 

25 by the ratio of the distribution factor 


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1 for the eligible local area to the sum 

2 of the respective distribution factors 

3 for all eligible local areas, 

4 which product shall then, as applicable, be 

5 increased under subparagraph (D). 

6 ‘‘(ii) DISTRIBUTION FACTOR.—For 

7 purposes of clause (i)(II), the term ‘dis8 tribution factor’ means— 

9 ‘‘(I) an amount equal to— 

10 ‘‘(aa) the estimated number 

11 of drug overdose deaths in the el12 igible local area, as determined 

13 under clause (iii); or 

14 ‘‘(bb) the estimated number 

15 of non-fatal drug overdoses in the 

16 eligible local area, as determined 

17 under clause (iv), 

18 as determined by the Secretary based 

19 on which distribution factor (item (aa) 

20 or (bb)) will result in the eligible local 

21 area receiving the greatest amount of 

22 funds; or 

23 ‘‘(II) in the case of an eligible 

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1 able, an amount determined by the 

2 Secretary— 

3 ‘‘(aa) based on other data 

4 the Secretary determines appro5 priate; and 

6 ‘‘(bb) that is related to the 

7 prevalence of non-fatal drug 

8 overdoses, drug overdose deaths, 

9 and the mortality rate from drug 

10 overdoses and provides an equiv11 alent measure of need for fund12 ing. 

13 ‘‘(iii) NUMBER OF DRUG OVERDOSE

14 DEATHS.—The number of drug overdose 

15 deaths determined under this clause for an 

16 eligible county for a fiscal year for pur17 poses of clause (ii) is the number of drug 

18 overdose deaths during the most recent 3- 

19 year period for which such data are avail20 able. 

21 ‘‘(iv) NUMBER OF NON-FATAL DRUG

22 OVERDOSES.—The number of non-fatal 

23 drug overdose deaths determined under 

24 this clause for an eligible county for a fis25 cal year for purposes of clause (ii) may be 


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1 determined by using data including emer2 gency department syndromic data, visits, 

3 other emergency medical services for drug4 related causes, or Overdose Detection Map5 ping Application Program (ODMAP) data 

6 during the most recent 3-year period for 

7 which such data are available. 

8 ‘‘(v) STUDY.—Not later than 3 years 

9 after the date of enactment of this title, 

10 the Comptroller General shall conduct a 

11 study to determine whether the data uti12 lized for purposes of clause (ii) provide the 

13 most precise measure of local area need re14 lated to substance use and addiction preva15 lence in local areas and whether additional 

16 data would provide more precise measures 

17 of substance use and addiction prevalence 

18 in local areas. Such study shall identify 

19 barriers to collecting or analyzing such 

20 data, and make recommendations for revis21 ing the distribution factors used under 

22 such clause to determine funding levels in 

23 order to direct funds to the local areas in 

24 most need of funding to provide substance 

25 use disorder treatment services. 


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1 ‘‘(vi) REDUCTIONS IN AMOUNTS.—If a 

2 local area that is an eligible local area for 

3 a year loses such eligibility in a subsequent 

4 year based on the failure to meet the re5 quirements of paragraph (1)(A) or (6) of 

6 section 3401(b), such area will remain eli7 gible to receive— 

8 ‘‘(I) for such subsequent year, an 

9 amount equal to 80 percent of the 

10 amount received under the grant in 

11 the previous year; and 

12 ‘‘(II) for the second such subse13 quent year, an amount equal to 50 

14 percent of the amount received in the 

15 previous year. 

16 ‘‘(2) SUPPLEMENTAL GRANTS.— 

17 ‘‘(A) IN GENERAL.—The Secretary shall 

18 disburse the remainder of amounts not dis19 bursed under paragraph (1) for such fiscal year 

20 for the purpose of making grants to cities and 

21 counties whose application under section 

22 3404— 

23 ‘‘(i) contains a report concerning the 

24 dissemination of emergency relief funds 


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1 under paragraph (1) and the plan for utili2 zation of such funds, if applicable; 

3 ‘‘(ii) demonstrates the need in such 

4 local area, on an objective and quantified 

5 basis, for supplemental financial assistance 

6 to combat substance use disorder; 

7 ‘‘(iii) demonstrates the existing com8 mitment of local resources of the area, 

9 both financial and in-kind, to preventing, 

10 treating, and managing substance use dis11 order and supporting sustained recovery; 

12 ‘‘(iv) demonstrates the ability of the 

13 area to utilize such supplemental financial 

14 resources in a manner that is immediately 

15 responsive and cost effective; 

16 ‘‘(v) demonstrates that resources will 

17 be allocated in accordance with the local 

18 demographic incidence of substance use 

19 disorders and drug overdose mortality; 

20 ‘‘(vi) demonstrates the inclusiveness of 

21 affected communities and individuals with 

22 substance use disorders, including those 

23 communities and individuals that are dis24 proportionately affected or historically un25 derserved; 


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1 ‘‘(vii) demonstrates the manner in 

2 which the proposed services are consistent 

3 with the local needs assessment and the 

4 State plan approved by the Secretary pur5 suant to section 1932(b); 

6 ‘‘(viii) demonstrates success in identi7 fying individuals with substance use dis8 orders; and 

9 ‘‘(ix) demonstrates that support for 

10 substance use disorder prevention and 

11 treatment services is organized to maxi12 mize the value to the population to be 

13 served with an appropriate mix of sub14 stance use disorder prevention and treat15 ment services and attention to transition in 

16 care. 

17 ‘‘(B) AMOUNT.— 

18 ‘‘(i) IN GENERAL.—The amount of 

19 each grant made for purposes of this para20 graph shall be determined by the Sec21 retary. In making such determination, the 

22 Secretary shall consider— 

23 ‘‘(I) the rate of drug overdose 

24 deaths per 100,000 population in the 

25 eligible local area; and 


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1 ‘‘(II) the increasing need for sub2 stance use disorder treatment serv3 ices, including relative rates of in4 crease in the number of drug 

5 overdoses or drug overdose deaths, or 

6 recent increases in drug overdoses or 

7 drug overdose deaths since data were 

8 provided under section 3401(b), if ap9 plicable. 

10 ‘‘(ii) DEMONSTRATED NEED.—The 

11 factors considered by the Secretary in de12 termining whether a local area has a dem13 onstrated need for purposes of clause 

14 (i)(II) may include any or all of the fol15 lowing: 

16 ‘‘(I) The unmet need for sub17 stance use disorder treatment serv18 ices, including factors identified in 

19 clause (i)(II). 

20 ‘‘(II) Relative rates of increase in 

21 the number of drug overdoses or drug 

22 overdose deaths. 

23 ‘‘(III) The relative rates of in24 crease in the number of drug 

25 overdoses or drug overdose deaths 


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1 within new or emerging subpopula2 tions. 

3 ‘‘(IV) The current prevalence of 

4 substance use disorders. 

5 ‘‘(V) Relevant factors related to 

6 the cost and complexity of delivering 

7 substance use disorder treatment serv8 ices to individuals in the eligible local 

9 area. 

10 ‘‘(VI) The impact of co-morbid 

11 factors, including co-occurring condi12 tions, determined relevant by the Sec13 retary. 

14 ‘‘(VII) The prevalence of home15 lessness among individuals with sub16 stance use disorders. 

17 ‘‘(VIII) The relevant factors that 

18 limit access to health care, including 

19 geographic variation, adequacy of 

20 health insurance coverage, and lan21 guage barriers. 

22 ‘‘(IX) The impact of a decline in 

23 the amount received pursuant to para24 graph (1) on substance use disorder 

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1 dividuals with substance use disorders 

2 identified and eligible under this sub3 title. 

4 ‘‘(X) The increasing incidence in 

5 conditions related to substance use, 

6 including hepatitis C, human immuno7 deficiency virus, hepatitis B and other 

8 infections associated with injection 

9 drug use. 

10 ‘‘(C) APPLICATION OF PROVISIONS.—A 

11 local area that receives a grant under this para12 graph— 

13 ‘‘(i) shall use amounts received in ac14 cordance with subsection (b); 

15 ‘‘(ii) shall not have to meet the eligi16 ble criteria in section 3401(b); and 

17 ‘‘(iii) shall not have to establish a 

18 planning council under section 3402. 

19 ‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN20 MENTS.— 

21 ‘‘(A) INDIAN TRIBES.—In this section, the 

22 term ‘Indian tribe’ has the meaning given such 

23 term in section 4 of the Indian Self-Determina24 tion and Education Assistance Act. 


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1 ‘‘(B) FORMULA FUNDS.—The Secretary, 

2 acting through the Indian Health Service, shall 

3 use 10 percent of the amount available under 

4 section 3406 for each fiscal year to provide for5 mula funds to Indian tribes disproportionately 

6 affected by substance use, in an amount deter7 mined pursuant to a formula and eligibility cri8 teria developed by the Secretary in consultation 

9 with Indian tribes, for the purposes of address10 ing substance use. 

11 ‘‘(C) PAYMENT OF FUNDS.—At the option 

12 of an Indian tribe the Secretary shall pay funds 

13 under this section through a contract, coopera14 tive agreement, or compact under, as applicable, 

15 title I or V of the Indian Self-Determination 

16 and Education Assistance Act. 

17 ‘‘(D) USE OF AMOUNTS.—Notwithstanding 

18 any requirements in this section, an Indian 

19 tribe may use amounts provided under funds 

20 awarded under this paragraph for the uses 

21 identified in subsection (b) and any other activi22 ties determined appropriate by the Secretary, in 

23 consultation with Indian tribes. An Indian tribe 

24 shall not be required to allocate funds and serv25 ices in accordance with the goals, priorities, or 


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1 objectives established by a planning council 

2 under section 3402. 

3 ‘‘(b) USE OF AMOUNTS.— 

4 ‘‘(1) REQUIREMENTS.—The Secretary may not 

5 make a grant under section 3401 to an eligible local 

6 area unless the chief elected official of the area 

7 agrees that— 

8 ‘‘(A) the allocation of funds and services 

9 within the area under the grant will be made in 

10 accordance with the priorities established by the 

11 planning council; and 

12 ‘‘(B) funds provided under this grant will 

13 be expended for— 

14 ‘‘(i) prevention services described in 

15 paragraph (3); 

16 ‘‘(ii) core medical services described in 

17 paragraph (4); 

18 ‘‘(iii) recovery and support services 

19 described in paragraph (5); 

20 ‘‘(iv) early intervention services de21 scribed in paragraph (6); 

22 ‘‘(v) harm reduction services described 

23 in paragraph (7); 

24 ‘‘(vi) financial assistance with health 

25 insurance described in paragraph (8); and 


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1 ‘‘(vii) administrative expenses de2 scribed in paragraph (9). 

3 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 

4 ‘‘(A) IN GENERAL.—An eligible local area 

5 shall use amounts received under a grant under 

6 section 3401 to provide direct financial assist7 ance to eligible entities or providers for the pur8 pose of providing prevention services, core med9 ical services, recovery and support services, 

10 early intervention services, and harm reduction 

11 services. 

12 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi13 nancial assistance may be provided under sub14 paragraph (A) to public or nonprofit entities, 

15 other eligible Medicaid providers if more than 

16 half of their patients are diagnosed with a sub17 stance use disorder and covered by Medicaid, or 

18 other private for-profit entities if such entities 

19 are the only available provider of quality sub20 stance use disorder treatment services in the 

21 area. 

22 ‘‘(C) LIMITATION.—An eligible local area 

23 (not including tribal areas) may not provide di24 rect financial assistance to any entity or pro25 vider that provides medication for addiction 


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1 treatment if that entity or provider does not 

2 also offer mental health services or psycho3 therapy by licensed clinicians through a referral 

4 or onsite. 

5 ‘‘(D) NEUTRALITY TOWARDS ORGANIZED

6 LABOR.— 

7 ‘‘(i) IN GENERAL.—In carrying out 

8 duties under this section, eligible local 

9 areas shall, to the extent practicable, 

10 prioritize the distribution of grant funds to 

11 grantees that have— 

12 ‘‘(I)(aa) a collective bargaining 

13 agreement; or 

14 ‘‘(bb) an explicit policy not to 

15 deter employees with respect to— 

16 ‘‘(AA) labor organizing for 

17 the employees engaged in the 

18 covered activities; and 

19 ‘‘(BB) such employees’ 

20 choice to form and join labor or21 ganizations; and 

22 ‘‘(II) policies that require— 

23 ‘‘(aa) the posting and main24 tenance of notices in the work25 place to such employees of their 


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1 rights under the National Labor 

2 Relations Act (29 U.S.C. 151 et 

3 seq.); 

4 ‘‘(bb) that such employees 

5 are, at the beginning of their em6 ployment, provided notice and in7 formation regarding the employ8 ees’ rights under such Act; and 

9 ‘‘(cc) the employer to volun10 tarily recognize a union in cases 

11 where a majority of such workers 

12 of the employer have joined and 

13 requested representation. 

14 ‘‘(ii) LIMITATION.—This subsection 

15 does not apply to Indian tribes. 

16 ‘‘(3) PREVENTION SERVICES.— 

17 ‘‘(A) IN GENERAL.—For purposes of this 

18 section, the term ‘prevention services’ means 

19 evidence-based services, programs, or multi-sec20 tor strategies to prevent substance use disorder 

21 (including education campaigns, community22 based prevention programs, risk identification 

23 programs, opioid diversion, collection and dis24 posal of unused opioids, services to at-risk pop25 ulations, and trauma support services). 


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1 ‘‘(B) LIMIT.—An eligible local area may 

2 use not to exceed 20 percent of the amount of 

3 the grant under section 3401 for prevention 

4 services. An eligible local area may apply to the 

5 Secretary for a waiver of this subparagraph. 

6 ‘‘(4) CORE MEDICAL SERVICES.—For purposes 

7 of this section, the term ‘core medical services’ 

8 means the following evidence-based services provided 

9 to individuals with substance use disorder or at risk 

10 for developing substance use disorder, including 

11 through the use of telemedicine or a hub and spoke 

12 model: 

13 ‘‘(A) Substance use disorder treatments, as 

14 more fully described in section 3439, including 

15 assessment of disease presence, severity, and 

16 co-occurring conditions, treatment planning, 

17 clinical stabilization services, withdrawal man18 agement and detoxification, the provision of 

19 medication for substance use disorder, intensive 

20 inpatient treatment, intensive outpatient treat21 ment, outpatient treatment, residential inpa22 tient services, treatment for co-occurring mental 

23 health and substance use disorders, and all 

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1 tration for the treatment of substance use dis2 order. 

3 ‘‘(B) Outpatient and ambulatory health 

4 services, including those administered by Feder5 ally-qualified health centers, rural health clinics, 

6 tribal clinics and hospitals, urban Indian orga7 nizations, certified community behavioral health 

8 clinics (as described in section 223 of the Pro9 tecting Access to Medicare Act), HIV services 

10 organizations, Native Hawaiian organizations 

11 (as defined in section 11 of the Native Hawai12 ian Health Care Act of 1988), and comprehen13 sive opioid recovery centers (as described in sec14 tion 552 of this Act). 

15 ‘‘(C) Hospice services. 

16 ‘‘(D) Mental health services. 

17 ‘‘(E) Opioid overdose reversal drug prod18 ucts procurement, distribution, and training. 

19 ‘‘(F) Pharmaceutical assistance and diag20 nostic testing related to the management of 

21 substance use disorders and co-morbid condi22 tions. 

23 ‘‘(G) Home- and community-based health 

24 services. 


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1 ‘‘(H) Comprehensive Case Management 

2 and care coordination, including substance use 

3 disorder treatment adherence services. 

4 ‘‘(I) Health insurance enrollment and cost5 sharing assistance in accordance with para6 graph (8). 

7 ‘‘(J) Programs that hire, employ, train, 

8 and dispatch licensed health care professionals, 

9 mental health professionals, harm reduction 

10 providers, or community health workers to re11 spond in lieu of law enforcement officers in 

12 emergencies and that ensure a licensed health 

13 care professional is a member of the team that 

14 responds in lieu of law enforcement officers in 

15 emergencies in which— 

16 ‘‘(i) an individual calling 911, the Na17 tional Suicide Hotline, or another emer18 gency hotlines states that a person is expe19 riencing a drug overdose or is otherwise 

20 under the influence of a legal or illegal 

21 substance; or 

22 ‘‘(ii) a law enforcement officer, other 

23 first responder, or other individual identi24 fies a person as being (or possibly being) 


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1 under the influence of a legal or illegal 

2 substance. 

3 ‘‘(5) RECOVERY AND SUPPORT SERVICES.—For 

4 purposes of this section, the term ‘recovery and sup5 port services’ means services that are provided to in6 dividuals with substance use disorder, including resi7 dential recovery housing, mental health services, 

8 long term recovery services, 24/7 hotline crisis center 

9 support, medical transportation services, respite care 

10 for persons caring for individuals with substance use 

11 disorder, child care and family services while an in12 dividual is receiving inpatient treatment services or 

13 at the time of outpatient services, outreach services, 

14 peer recovery services, nutrition services, and refer15 rals for job training and career services, housing, 

16 legal services, and child care and family services. 

17 The entities through which such services may be 

18 provided include local and tribal authorities that 

19 provide child care, housing, community development, 

20 and other recovery and support services, so long as 

21 they do not exclude individuals on the basis that 

22 such individuals receive medication for addiction 

23 treatment. 

24 ‘‘(6) EARLY INTERVENTION SERVICES.—For 

25 purposes of this section, the term ‘early intervention 


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1 services’ means services to provide screening and 

2 connection to the appropriate level of substance use 

3 disorder and mental health treatment (including 

4 same-day connection), counseling provided to indi5 viduals who have misused substances, who have ex6 perienced an overdose, or are at risk of developing 

7 substance use disorder, the provision of referrals to 

8 facilitate the access of such individuals to core med9 ical services or recovery and support services for 

10 substance use disorder, and rapid access to medica11 tion for addiction treatment in the setting of recent 

12 overdose. The entities through which such services 

13 may be provided include emergency rooms, fire de14 partments and emergency medical services, detention 

15 facilities, prisons and jails, homeless shelters, health 

16 care points of entry specified by eligible local areas, 

17 Federally-qualified health centers, workforce agen18 cies and job centers, youth development centers, 

19 tribal clinics and hospitals, urban Indian organiza20 tions, and rural health clinics. 

21 ‘‘(7) HARM REDUCTION SERVICES.—For pur22 poses of this section, the term ‘harm reduction serv23 ices’ means services provided to individuals engaging 

24 in substance use scientifically accepted to reduce the 

25 risk of infectious disease transmission, overdose, or 


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1 death, including syringe services programs and other 

2 safe use services, such as utilization of a device, kit, 

3 or chemical agent that tests or analyzes a substance 

4 to determine its composition or that detects sub5 stances. 

6 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV7 ERAGE.—An eligible local area may use amounts 

8 provided under a grant awarded under section 3401 

9 to establish a program of financial assistance to as10 sist eligible individuals with substance use disorder 

11 in— 

12 ‘‘(A) enrolling in health insurance cov13 erage; or 

14 ‘‘(B) affording health care services, includ15 ing assistance paying cost-sharing amounts, in16 cluding premiums. 

17 ‘‘(9) ADMINISTRATION AND PLANNING.—An eli18 gible local area (not including tribal areas) shall not 

19 use in excess of 15 percent of amounts received 

20 under a grant under section 3401 for administra21 tion, accounting, reporting, and program oversight 

22 functions, including the development of systems to 

23 improve data collection and data sharing, in the first 

24 year of receiving the grant, and shall not use in ex25 cess of 10 percent of amounts received under a 


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1 grant under section 3401 for such activities in sub2 sequent years. 

3 ‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 

4 received under a grant under section 3401 may be 

5 used to provide substance use disorder treatment 

6 services, including medication for addiction treat7 ment, to individuals who are currently incarcerated 

8 or in pre-trial detention. 

9 ‘‘(c) REQUIRED TERMS.— 

10 ‘‘(1) REQUIREMENT OF STATUS AS MEDICAID

11 PROVIDER.— 

12 ‘‘(A) PROVISION OF SERVICE.—Subject to 

13 subparagraph (B), the Secretary may not make 

14 a grant under section 3401 for the provision of 

15 substance use disorder treatment services under 

16 this section in an eligible local area unless, in 

17 the case of any such service that is available 

18 pursuant to the State plan approved under title 

19 XIX of the Social Security Act for the State— 

20 ‘‘(i) the political subdivision involved 

21 will provide the service directly, and the 

22 political subdivision has entered into a par23 ticipation agreement under the State plan 

24 and is qualified to receive payments under 

25 such plan; or 


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1 ‘‘(ii) the eligible local area involved— 

2 ‘‘(I) will enter into agreements 

3 with public or nonprofit entities, or 

4 other Medicaid providers if more than 

5 half of their patients are diagnosed 

6 with a substance use disorder and 

7 covered by Medicaid, under which 

8 such entities and other providers will 

9 provide the service, and such entities 

10 and other providers have entered into 

11 such a participation agreement and 

12 are qualified to receive such pay13 ments; and 

14 ‘‘(II) demonstrates that it will 

15 ensure that such entities and other 

16 providers providing the service will 

17 seek payment for each such service 

18 rendered in accordance with the usual 

19 payment schedule under the State 

20 plan. 

21 ‘‘(B) WAIVER.— 

22 ‘‘(i) IN GENERAL.—In the case of an 

23 entity making an agreement pursuant to 

24 subparagraph (A)(ii) regarding the provi25 sion of substance use disorder treatment 


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1 services, the requirement established in 

2 such subparagraph shall be waived by the 

3 substance use planning council for the area 

4 involved if the entity does not, in providing 

5 health care services, impose a charge or ac6 cept reimbursement available from any 

7 third-party payor, including reimbursement 

8 under any insurance policy or under any 

9 Federal or State health benefits program. 

10 A waiver under this subparagraph shall 

11 not be longer than 2 years in duration and 

12 shall not be renewed. 

13 ‘‘(ii) DETERMINATION.—A determina14 tion by the substance use planning council 

15 of whether an entity referred to in clause 

16 (i) meets the criteria for a waiver under 

17 such clause shall be made without regard 

18 to whether the entity accepts voluntary do19 nations for the purpose of providing serv20 ices to the public. 

21 ‘‘(2) REQUIRED TERMS FOR EXPANDING AND

22 IMPROVING CARE.—A funding agreement for a grant 

23 under this section shall— 

24 ‘‘(A) ensure that funds received under the 

25 grant will not be utilized to make payments for 


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1 any item or service to the extent that payment 

2 has been made, or can reasonably be expected 

3 to be made, with respect to that item or service 

4 under a State compensation program, under an 

5 insurance policy, or under any Federal or State 

6 health benefits program (except for a program 

7 administered by, or providing the services of, 

8 the Indian Health Service); and 

9 ‘‘(B) ensure that all entities providing sub10 stance use disorder treatment services with as11 sistance made available under the grant offer 

12 all drugs approved by the Food and Drug Ad13 ministration for the treatment of substance use 

14 disorder for which the applicant offers treat15 ment, in accordance with section 3435. 

16 ‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund17 ing agreement for a grant under this section is 

18 that— 

19 ‘‘(A) funds received under the grant will be 

20 utilized to supplement not supplant other Fed21 eral, State, or local funds made available in the 

22 year for which the grant is awarded to provide 

23 substance use disorder treatment services to in24 dividuals with substance use disorder, including 

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1 ical services, recovery and support services, 

2 early intervention services, harm reduction serv3 ices, mental health services, and administrative 

4 expenses; 

5 ‘‘(B) political subdivisions within the eligi6 ble local area will maintain the level of expendi7 tures by such political subdivisions for sub8 stance use disorder treatment services at a level 

9 that is at least equal to the level of such ex10 penditures by such political subdivisions for the 

11 preceding fiscal year, including expenditures for 

12 each of prevention services, core medical serv13 ices, recovery and support services, early inter14 vention services, harm reduction services, men15 tal health services, and administrative expenses; 

16 ‘‘(C) political subdivisions within the eligi17 ble local area will not use funds received under 

18 a grant awarded under section 3401 in main19 taining the level of substance use disorder treat20 ment services as required in subparagraph (B); 

21 ‘‘(D) substance use disorder treatment 

22 services provided with assistance made available 

23 under the grant will be provided without re24 gard— 


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1 ‘‘(i) to the ability of the individual to 

2 pay for such services; and 

3 ‘‘(ii) to the current or past health con4 dition of the individual to be served; 

5 ‘‘(E) substance use disorder treatment 

6 services will be provided in a setting that is ac7 cessible to low-income individuals with sub8 stance use disorders and to individuals with 

9 substance use disorders residing in rural areas; 

10 ‘‘(F) a program of outreach will be pro11 vided to low-income individuals with substance 

12 use disorders to inform such individuals of sub13 stance use disorder treatment services and to 

14 individuals with substance use disorders resid15 ing in rural areas; 

16 ‘‘(G) Indian tribes are included in planning 

17 for the use of grant funds and the Federal trust 

18 responsibility is upheld at all levels of program 

19 administration; and 

20 ‘‘(H) the confidentiality of individuals re21 ceiving substance use disorder treatment serv22 ices will be maintained in a manner not incon23 sistent with applicable law. 


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1 ‘‘SEC. 3404. APPLICATION. 

2 ‘‘(a) APPLICATION.—To be eligible to receive a grant 

3 under section 3401, an eligible local area shall prepare and 

4 submit to the Secretary an application in such form, and 

5 containing such information, as the Secretary shall re6 quire, including— 

7 ‘‘(1) a complete accounting of the disbursement 

8 of any prior grants received under this subtitle by 

9 the applicant and the results achieved by these ex10 penditures and a demonstration that funds received 

11 from a grant under this subtitle in the prior year 

12 were expended in accordance with local priorities de13 veloped by the local planning council established 

14 under section 3402, except that the planning council 

15 requirement shall not apply with respect to areas re16 ceiving supplemental grant funds under section 

17 3403(a)(2); 

18 ‘‘(2) establishment of goals and objectives to be 

19 achieved with grant funds provided under this sub20 title, including targets and milestones that are in21 tended to be met, the activities that will be under22 taken to achieve those targets, the number of indi23 viduals likely to be served by the funds sought, in24 cluding demographic data on the populations to be 

25 served, and an explanation of how these goals and 


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1 objectives advance the State plan approved by the 

2 Secretary pursuant to section 1932(b); 

3 ‘‘(3) a demonstration that the local area will 

4 use funds in a manner that provides substance use 

5 disorder treatment services in compliance with the 

6 evidence-based standards developed in accordance 

7 with section 3435, including providing all drugs ap8 proved by the Food and Drug Administration for the 

9 treatment of substance use disorder; 

10 ‘‘(4) a demonstration that resources provided 

11 under the grant will be allocated in accordance with 

12 the local demographic incidence of substance use, in13 cluding allocations for services for children, youths, 

14 and women; 

15 ‘‘(5) an explanation of how income, asset, and 

16 medical expense criteria will be established and ap17 plied to those who qualify for assistance under the 

18 program; 

19 ‘‘(6) an explanation of how an eligible local area 

20 will support, through distribution of resources and 

21 by other means, increased access to harm reduction 

22 services within the eligible local area; 

23 ‘‘(7) where practical, an explanation of how an 

24 eligible local area shall coordinate with local public 


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1 health departments in the distribution of funding; 

2 and 

3 ‘‘(8) for any prior funding received under this 

4 section, data provided in such form as the Secretary 

5 shall require detailing, at a minimum, the extent to 

6 which the activities supported by the funding met 

7 the goals and objectives specified in the application 

8 for the funding, the number of individuals who 

9 accessed medication for treatment by age, gender, 

10 sexual orientation, race, disability status, and other 

11 demographic criteria relevant to the program, and 

12 the effect of the program on overdose rates and 

13 rates of death due to overdose in the local area 

14 served by the program. 

15 ‘‘(b) REQUIREMENTS REGARDING IMPOSITION OF

16 CHARGES FOR SERVICES.— 

17 ‘‘(1) IN GENERAL.—The Secretary may not 

18 make a grant under section 3401 to an eligible local 

19 area unless the eligible local area provides assur20 ances that in the provision of substance use disorder 

21 treatment services with assistance provided under 

22 the grant— 

23 ‘‘(A) in the case of individuals with an in24 come less than or equal to 150 percent of the 

25 official poverty level, the provider will not imVerDate Sep 11 2014 20:19 May 31, 2024 Jkt 049200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\S4286.IS S4286

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1 pose charges on any such individual for the 

2 services provided under the grant; 

3 ‘‘(B) in the case of individuals with an in4 come greater than 150 percent of the official 

5 poverty level, the provider will impose a charge 

6 on each such individual according to a schedule 

7 of charges made available to the public; 

8 ‘‘(C) in the case of individuals with an in9 come greater than 150 percent of the official 

10 poverty level but not exceeding 200 percent of 

11 such poverty level, the provider will not, for any 

12 calendar year, impose charges in an amount ex13 ceeding 2 percent of the annual gross income of 

14 the individual; 

15 ‘‘(D) in the case of individuals with an in16 come greater than 200 percent of the official 

17 poverty level but not exceeding 250 percent of 

18 such poverty level, the provider will not, for any 

19 calendar year, impose charges in an amount ex20 ceeding 4 percent of the annual gross income of 

21 the individual involved; 

22 ‘‘(E) in the case of individuals with an in23 come greater than 250 percent of the official 

24 poverty level but not exceeding 300 percent of 

25 such poverty level, the provider will not, for any 


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1 calendar year, impose charges in an amount ex2 ceeding 6 percent of the annual gross income of 

3 the individual involved; 

4 ‘‘(F) in the case of individuals with an in5 come greater than 300 percent of the official 

6 poverty level but not exceeding 400 percent of 

7 such poverty level, the provider will not, for any 

8 calendar year, impose charges in an amount ex9 ceeding 8.5 percent of the annual gross income 

10 of the individual involved; 

11 ‘‘(G) in the case of individuals with an in12 come greater than 400 percent of the official 

13 poverty level, the provider will not, for any cal14 endar year, impose charges in an amount ex15 ceeding 8.5 percent of the annual gross income 

16 of the individual involved; and 

17 ‘‘(H) in the case of eligible American In18 dian and Alaska Native individuals as defined 

19 by section 447.50 of title 42, Code of Federal 

20 Regulations (as in effect on July 1, 2010), the 

21 provider will not impose any charges for sub22 stance use disorder treatment services, includ23 ing any charges or cost-sharing prohibited by 

24 section 1402(d) of the Patient Protection and 

25 Affordable Care Act. 


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1 ‘‘(2) CHARGES.—With respect to compliance 

2 with the assurances made under paragraph (1), an 

3 eligible local area may, in the case of individuals 

4 subject to a charge— 

5 ‘‘(A) assess the amount of the charge in 

6 the discretion of the area, including imposing 

7 only a nominal charge for the provision of sub8 stance use disorder treatment services, subject 

9 to the provisions of the paragraph regarding 

10 public schedules and regarding limitations on 

11 the maximum amount of charges; and 

12 ‘‘(B) take into consideration the total med13 ical expenses of individuals in assessing the 

14 amount of the charge, subject to such provi15 sions. 

16 ‘‘(3) AGGREGATE CHARGES.—The Secretary 

17 may not make a grant under section 3401 to an eli18 gible local area unless the area agrees that the limi19 tations on charges for substance use disorder treat20 ment services under this subsection applies to the 

21 annual aggregate of charges imposed for such serv22 ices, however the charges are characterized, includes 

23 enrollment fees, premiums, deductibles, cost sharing, 

24 co-payments, co-insurance costs, or any other 

25 charges. 


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1 ‘‘(c) INDIAN TRIBES.—Any application requirements 

2 for grants distributed in accordance with section 

3 3403(a)(3) shall be developed by the Secretary in con4 sultation with Indian tribes. 

5 ‘‘SEC. 3405. TECHNICAL ASSISTANCE. 

6 ‘‘The Secretary shall, beginning on the date of enact7 ment of this title, provide technical assistance, including 

8 assistance from other grantees, contractors or subcontrac9 tors under this title to assist newly eligible local areas in 

10 the establishment of planning councils and, to assist enti11 ties in complying with the requirements of this subtitle 

12 in order to make such areas eligible to receive a grant 

13 under this subtitle. The Secretary may make planning 

14 grants available to eligible local areas, in an amount not 

15 to exceed $75,000, for any area that is projected to be 

16 eligible for funding under section 3401 in the following 

17 fiscal year. Such grant amounts shall be deducted from 

18 the first year formula award to eligible local areas accept19 ing such grants. 

20 ‘‘SEC. 3406. AUTHORIZATION OF APPROPRIATIONS. 

21 ‘‘There is authorized to be appropriated to carry out 

22 this subtitle— 

23 ‘‘(1) $3,300,000,000 for fiscal year 2024; 

24 ‘‘(2) $3,300,000,000 for fiscal year 2025; 

25 ‘‘(3) $3,300,000,000 for fiscal year 2026; 


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1 ‘‘(4) $3,300,000,000 for fiscal year 2027; 

2 ‘‘(5) $3,300,000,000 for fiscal year 2028; 

3 ‘‘(6) $3,300,000,000 for fiscal year 2029; 

4 ‘‘(7) $3,300,000,000 for fiscal year 2030; 

5 ‘‘(8) $3,300,000,000 for fiscal year 2031; 

6 ‘‘(9) $3,300,000,000 for fiscal year 2032; and 

7 ‘‘(10) $3,300,000,000 for fiscal year 2033. 

8 ‘‘Subtitle B—State and Tribal Sub9 stance Use Disorder Prevention 

10 and Intervention Grant Pro11 gram 

12 ‘‘SEC. 3411. ESTABLISHMENT OF PROGRAM OF GRANTS. 

13 ‘‘The Secretary shall award grants to States, terri14 tories, and Tribal governments for the purpose of address15 ing substance use within such States. 

16 ‘‘SEC. 3412. AMOUNT OF GRANT, USE OF AMOUNTS, AND 

17 FUNDING AGREEMENT. 

18 ‘‘(a) AMOUNT OF GRANT TO STATES AND TERRI19 TORIES.— 

20 ‘‘(1) IN GENERAL.— 

21 ‘‘(A) EXPEDITED DISTRIBUTION.—Not 

22 later than 90 days after an appropriation be23 comes available, the Secretary shall disburse 50 

24 percent of the amount made available under 

25 section 3415 for carrying out this subtitle for 


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1 such fiscal year through grants to States under 

2 section 3411, in accordance with subparagraphs 

3 (B) and (C). 

4 ‘‘(B) MINIMUM ALLOTMENT.—Subject to 

5 the amount made available under section 3415, 

6 the amount of a grant under section 3411 for— 

7 ‘‘(i) each of the 50 States, the District 

8 of Columbia, and Puerto Rico for a fiscal 

9 year shall be the greater of— 

10 ‘‘(I) $2,000,000; or 

11 ‘‘(II) an amount determined 

12 under the subparagraph (C); and 

13 ‘‘(ii) each territory other than Puerto 

14 Rico for a fiscal year shall be the greater 

15 of— 

16 ‘‘(I) $500,000; or 

17 ‘‘(II) an amount determined 

18 under the subparagraph (C). 

19 ‘‘(C) DETERMINATION.— 

20 ‘‘(i) FORMULA.—For purposes of sub21 paragraph (B), the amount referred to in 

22 this subparagraph for a State (including a 

23 territory) for a fiscal year is— 

24 ‘‘(I) an amount equal to the 

25 amount made available under section 


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1 3415 for the fiscal year involved for 

2 grants pursuant to subparagraph (B); 

3 and 

4 ‘‘(II) the percentage constituted 

5 by the sum of— 

6 ‘‘(aa) the product of 0.85 

7 and the ratio of the State dis8 tribution factor for the State or 

9 territory to the sum of the re10 spective distribution factors for 

11 all States; and 

12 ‘‘(bb) the product of 0.15 

13 and the ratio of the non-local dis14 tribution factor for the State or 

15 territory (as determined under 

16 clause (iv)) to the sum of the re17 spective non-local distribution 

18 factors for all States or terri19 tories. 

20 ‘‘(ii) STATE DISTRIBUTION FACTOR.— 

21 For purposes of clause (i)(II)(aa), the term 

22 ‘State distribution factor’ means an 

23 amount equal to— 


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1 ‘‘(I) the estimated number of 

2 drug overdose deaths in the State, as 

3 determined under clause (iii); or 

4 ‘‘(II) the number of non-fatal 

5 drug overdoses in the State, as deter6 mined under clause (iv), 

7 as determined by the Secretary based on 

8 which distribution factor (subclause (I) or 

9 (II)) will result in the State receiving the 

10 greatest amount of funds. 

11 ‘‘(iii) NUMBER OF DRUG

12 OVERDOSES.—For purposes of clause (ii), 

13 the number of drug overdose deaths deter14 mined under this clause for a State for a 

15 fiscal year is the number of drug overdose 

16 deaths during the most recent 3-year pe17 riod for which such data are available. 

18 ‘‘(iv) NUMBER OF NON-FATAL DRUG

19 OVERDOSES.—The number of non-fatal 

20 drug overdose deaths determined under 

21 this clause for a State for a fiscal year for 

22 purposes of clause (ii) may be determined 

23 by using data including emergency depart24 ment syndromic data, visits, other emer25 gency medical services for drug-related 


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1 causes, or Overdose Detection Mapping 

2 Application Program (ODMAP) data dur3 ing the most recent 3-year period for which 

4 such data are available. 

5 ‘‘(v) NON-LOCAL DISTRIBUTION FAC6 TORS.—For purposes of clause (i)(II)(bb), 

7 the term ‘non-local distribution factor’ 

8 means an amount equal to the sum of— 

9 ‘‘(I) the number of drug overdose 

10 deaths in the State involved, as deter11 mined under clause (iii), or the num12 ber of non-fatal drug overdoses in the 

13 State, based on the criteria used by 

14 the State under clause (ii); less 

15 ‘‘(II) the total number of drug 

16 overdose deaths or non-fatal drug 

17 overdoses that are within areas in 

18 such State or territory that are eligi19 ble counties under section 3401. 

20 ‘‘(vi) STUDY.—Not later than 3 years 

21 after the date of enactment of this title, 

22 the Comptroller General shall conduct a 

23 study to determine whether the data uti24 lized for purposes of clause (ii) provide the 

25 most precise measure of State need related 


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1 to substance use and addiction prevalence 

2 and whether additional data would provide 

3 more precise measures the levels of sub4 stance use and addiction prevalent in 

5 States. Such study shall identify barriers 

6 to collecting or analyzing such data, and 

7 make recommendations for revising the 

8 distribution factors used under such clause 

9 to determine funding levels in order to di10 rect funds to the States in most need of 

11 funding to provide substance use disorder 

12 treatment services. 

13 ‘‘(2) SUPPLEMENTAL GRANTS.— 

14 ‘‘(A) IN GENERAL.—Subject to subpara15 graph (C), the Secretary shall disburse the re16 mainder of amounts not disbursed under para17 graph (1) for such fiscal year for the purpose 

18 of making grants to States whose application— 

19 ‘‘(i) contains a report concerning the 

20 dissemination of emergency relief funds 

21 under paragraph (1) and the plan for utili22 zation of such funds, if applicable; 

23 ‘‘(ii) demonstrates the need in such 

24 State, on an objective and quantified basis, 


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1 for supplemental financial assistance to 

2 combat substance use disorder; 

3 ‘‘(iii) demonstrates the existing com4 mitment of local resources of the State, 

5 both financial and in-kind, to preventing, 

6 treating, and managing substance use dis7 order and supporting sustained recovery; 

8 ‘‘(iv) demonstrates the ability of the 

9 State to utilize such supplemental financial 

10 resources in a manner that is immediately 

11 responsive and cost effective; 

12 ‘‘(v) demonstrates that resources will 

13 be allocated in accordance with the local 

14 demographic incidence of substance use 

15 disorders and drug overdose mortality; 

16 ‘‘(vi) demonstrates the inclusiveness of 

17 affected communities and individuals with 

18 substance use disorders, including those 

19 communities and individuals that are dis20 proportionately affected or historically un21 derserved; 

22 ‘‘(vii) demonstrates the manner in 

23 which the proposed services are consistent 

24 with the local needs assessment and the 


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1 State plan approved by the Secretary pur2 suant to section 1932(b); 

3 ‘‘(viii) demonstrates success in identi4 fying individuals with substance use dis5 orders; and 

6 ‘‘(ix) demonstrates that support for 

7 substance use disorder prevention and 

8 treatment services is organized to maxi9 mize the value to the population to be 

10 served with an appropriate mix of sub11 stance use disorder treatment services and 

12 attention to transition in care. 

13 ‘‘(B) AMOUNT.— 

14 ‘‘(i) IN GENERAL.—The amount of 

15 each grant made for purposes of this para16 graph shall be determined by the Sec17 retary. In making such determination, the 

18 Secretary shall consider— 

19 ‘‘(I) the rate of drug overdose 

20 deaths per 100,000 population in the 

21 State; and 

22 ‘‘(II) the increasing need for sub23 stance use disorder treatment serv24 ices, including relative rates of in25 crease in the number of drug 


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1 overdoses or drug overdose deaths, or 

2 recent increases in drug overdoses or 

3 drug overdose deaths since the data 

4 were reported under section 3413, if 

5 applicable. 

6 ‘‘(ii) DEMONSTRATED NEED.—The 

7 factors considered by the Secretary in de8 termining whether a State has a dem9 onstrated need for purposes of subpara10 graph (A)(ii) may include any or all of the 

11 following: 

12 ‘‘(I) The unmet need for such 

13 services, including the factors identi14 fied in clause (i)(II). 

15 ‘‘(II) Relative rates of increase in 

16 the number of drug overdoses or drug 

17 overdose deaths. 

18 ‘‘(III) The relative rates of in19 crease in the number of drug 

20 overdoses or drug overdose deaths 

21 within new or emerging subpopula22 tions. 

23 ‘‘(IV) The current prevalence of 

24 substance use disorders. 


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1 ‘‘(V) Relevant factors related to 

2 the cost and complexity of delivering 

3 substance use disorder treatment serv4 ices to individuals in the State. 

5 ‘‘(VI) The impact of co-morbid 

6 factors, including co-occurring condi7 tions, determined relevant by the Sec8 retary. 

9 ‘‘(VII) The prevalence of home10 lessness among individuals with sub11 stance use disorder. 

12 ‘‘(VIII) The relevant factors that 

13 limit access to health care, including 

14 geographic variation, adequacy of 

15 health insurance coverage, and lan16 guage barriers. 

17 ‘‘(IX) The impact of a decline in 

18 the amount received pursuant to para19 graph (1) on substance use disorder 

20 treatment services available to all in21 dividuals with substance use disorders 

22 identified and eligible under this sub23 title. 

24 ‘‘(X) The increasing incidence in 

25 conditions related to substance use, 


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1 including hepatitis C, human immuno2 deficiency virus, hepatitis B and other 

3 infections associated with injection 

4 drug use. 

5 ‘‘(C) MODEL STANDARDS.— 

6 ‘‘(i) PREFERENCE.—In determining 

7 whether a State will receive funds under 

8 this paragraph, except as provided in 

9 clause (ii), the Secretary shall give pref10 erence to States that have adopted the 

11 model standards for each substance use 

12 disorder treatment service and recovery 

13 residence developed in accordance with 

14 subsections (a) and (b) of section 3435. 

15 ‘‘(ii) REQUIREMENT.—Effective begin16 ning in fiscal year 2026, the Secretary 

17 shall not award a grant under this para18 graph to a State unless that State has 

19 adopted the model standards for each of 

20 substance use disorder treatment services 

21 and recovery residences developed in ac22 cordance with subsections (a) and (b) of 

23 section 3435. 

24 ‘‘(D) CONTINUUM OF CARE.— 


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1 ‘‘(i) PREFERENCE.—In determining 

2 whether a State will receive funds under 

3 this paragraph, except as provided in 

4 clause (ii), the Secretary shall give pref5 erence to States that have carried out the 

6 requirements to ensure a continuum of 

7 services in accordance with section 

8 3435(d). 

9 ‘‘(ii) REQUIREMENT.—Effective begin10 ning in fiscal year 2026, the Secretary 

11 shall not award a grant under this para12 graph to a State unless that State has car13 ried out the requirements to ensure a con14 tinuum of services in accordance with sec15 tion 3435(d). 

16 ‘‘(E) UTILIZATION MANAGEMENT FOR

17 MEDICATION FOR ADDICTION TREATMENT.— 

18 ‘‘(i) PREFERENCE.—In determining 

19 whether a State will receive funds under 

20 this paragraph, the Secretary shall give 

21 preference to States that have prohibited 

22 prior authorization and step therapy re23 quirements for at least 1 drug in each 

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1 ministration for the treatment of substance 

2 use disorder. 

3 ‘‘(ii) ADDITIONAL PREFERENCES.— 

4 Additional preference shall be given to 

5 States that have prohibited prior author6 ization and step therapy requirements for 

7 2 or more drugs in each class approved by 

8 the Food and Drug Administration for the 

9 treatment of substance use disorder. 

10 ‘‘(iii) DEFINITIONS.—In this subpara11 graph: 

12 ‘‘(I) PRIOR AUTHORIZATION.— 

13 The term ‘prior authorization’ means 

14 the process by which a health insur15 ance issuer or pharmacy benefit man16 agement company determines the 

17 medical necessity of otherwise covered 

18 health care services prior to the ren19 dering of such health care services. 

20 Such term includes any health insur21 ance issuer’s or utilization review enti22 ty’s requirement that a subscriber or 

23 health care provider notify the issuer 

24 or entity prior to providing a health 

25 care service. 


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1 ‘‘(II) STEP THERAPY.—The term 

2 ‘step therapy’ means a protocol or 

3 program that establishes the specific 

4 sequence in which prescription drugs 

5 for a medical condition that are medi6 cally appropriate for a particular pa7 tient are authorized by a health insur8 ance issuer or prescription drug man9 agement company. 

10 ‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN11 MENTS.— 

12 ‘‘(A) INDIAN TRIBES.—In this section, the 

13 term ‘Indian tribe’ has the meaning given such 

14 term in section 4 of the Indian Self-Determina15 tion and Education Assistance Act. 

16 ‘‘(B) FORMULA FUNDS.—The Secretary, 

17 acting through the Indian Health Service, shall 

18 use 10 percent of the amount available under 

19 section 3415 for each fiscal year to provide for20 mula funds to Indian tribes in an amount de21 termined pursuant to a formula and eligibility 

22 criteria developed by the Secretary in consulta23 tion with Indian tribes, for the purposes of ad24 dressing substance use. 


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1 ‘‘(C) PAYMENT OF FUNDS.—At the option 

2 of an Indian tribe the Secretary shall pay funds 

3 under this section through a contract, coopera4 tive agreement, or compact under, as applicable, 

5 title I or V of the Indian Self-Determination 

6 and Education Assistance Act. 

7 ‘‘(D) USE OF AMOUNTS.—Notwithstanding 

8 any requirements in this section, an Indian 

9 tribe may use amounts provided under funds 

10 awarded under this paragraph for the uses 

11 identified in subsection (b) and any other activi12 ties determined appropriate by the Secretary, in 

13 consultation with Indian tribes. 

14 ‘‘(b) USE OF AMOUNTS.— 

15 ‘‘(1) IN GENERAL.—A State or tribe may use 

16 amounts provided under grants awarded under sec17 tion 3411 for— 

18 ‘‘(A) prevention services described in para19 graph (3); 

20 ‘‘(B) core medical services described in 

21 paragraph (4); 

22 ‘‘(C) recovery and support services de23 scribed in paragraph (5); 

24 ‘‘(D) early intervention services described 

25 in paragraph (6); 


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1 ‘‘(E) harm reduction services described in 

2 paragraph (7); 

3 ‘‘(F) financial assistance with health insur4 ance as described in paragraph (8); and 

5 ‘‘(G) administrative expenses described in 

6 paragraph (9). 

7 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 

8 ‘‘(A) IN GENERAL.—A State or tribe may 

9 use amounts received under a grant under sec10 tion 3411 to provide direct financial assistance 

11 to eligible entities or other eligible Medicaid 

12 providers for the purpose of providing preven13 tion services, core medical services, recovery 

14 and support services, early intervention services, 

15 and harm reduction services. 

16 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi17 nancial assistance may be provided under sub18 paragraph (A) to public or nonprofit entities, 

19 other Medicaid providers if more than half of 

20 their patients are diagnosed with a substance 

21 use disorder and covered by Medicaid, or other 

22 private for-profit entities if such entities are the 

23 only available provider of quality substance use 

24 disorder treatment services in the area. 


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1 ‘‘(C) LIMITATION.—A State may not pro2 vide direct financial assistance to any entity or 

3 provider that provides medication for addiction 

4 treatment if that entity or provider does not 

5 also offer mental health services or psycho6 therapy by licensed clinicians through a referral 

7 or onsite. 

8 ‘‘(D) NEUTRALITY TOWARDS ORGANIZED

9 LABOR.— 

10 ‘‘(i) IN GENERAL.—In carrying out 

11 duties under this section, States shall, to 

12 the extent practicable, prioritize the dis13 tribution of grant funds to grantees that 

14 have— 

15 ‘‘(I)(aa) a collective bargaining 

16 agreement; or 

17 ‘‘(bb) an explicit policy not to 

18 deter employees with respect to— 

19 ‘‘(AA) labor organizing for 

20 the employees engaged in the 

21 covered activities; and 

22 ‘‘(BB) such employees’ 

23 choice to form and join labor or24 ganizations; and 

25 ‘‘(II) policies that require— 


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1 ‘‘(aa) the posting and main2 tenance of notices in the work3 place to such employees of their 

4 rights under the National Labor 

5 Relations Act (29 U.S.C. 151 et 

6 seq.); 

7 ‘‘(bb) that such employees 

8 are, at the beginning of their em9 ployment, provided notice and in10 formation regarding the employ11 ees’ rights under such Act; and 

12 ‘‘(cc) the employer to volun13 tarily recognize a union in cases 

14 where a majority of such workers 

15 of the employer have joined and 

16 requested representation. 

17 ‘‘(ii) LIMITATION.—This subsection 

18 does not apply to Indian tribes. 

19 ‘‘(3) PREVENTION SERVICES.— 

20 ‘‘(A) IN GENERAL.—For purposes of this 

21 section, the term ‘prevention services’ means 

22 evidence-based services, programs, or multi-sec23 tor strategies to prevent substance use disorder 

24 (including education campaigns, community25 based prevention programs, risk-identification 


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1 programs, opioid diversion, collection and dis2 posal of unused opioids, services to at-risk pop3 ulations, and trauma support services). 

4 ‘‘(B) LIMIT.—A State may use not to ex5 ceed 20 percent of the amount of the grant 

6 under section 3411 for prevention services. A 

7 State may apply to the Secretary for a waiver 

8 of this subparagraph. 

9 ‘‘(4) CORE MEDICAL SERVICES.—For purposes 

10 of this section, the term ‘core medical services’ 

11 means the following evidence-based services when 

12 provided to individuals with substance use disorder 

13 or at risk for developing substance use disorder, in14 cluding through the use of telemedicine or a hub and 

15 spoke model: 

16 ‘‘(A) Substance use disorder treatment, as 

17 described in section 3439(4), including assess18 ment of disease presence, severity, and co-oc19 curring conditions, treatment planning, clinical 

20 stabilization services, withdrawal management 

21 and detoxification, the provision of medication 

22 for substance use disorder, intensive inpatient 

23 treatment, intensive outpatient treatment, out24 patient treatment, residential inpatient services, 

25 treatment for co-occurring mental health and 


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1 substance use disorders, and all drugs approved 

2 by the Food and Drug Administration for the 

3 treatment of substance use disorder. 

4 ‘‘(B) Outpatient and ambulatory health 

5 services, including those administered by Feder6 ally-qualified health centers, rural health clinics, 

7 tribal clinics and hospitals, urban Indian orga8 nizations, certified community behavioral health 

9 clinics (as described in section 223 of the Pro10 tecting Access to Medicare Act), HIV services 

11 organizations, Native Hawaiian organizations 

12 (as defined in section 11 of the Native Hawai13 ian Health Care Act of 1988), and comprehen14 sive opioid recovery centers (as described in sec15 tion 552 of this Act). 

16 ‘‘(C) Hospice services. 

17 ‘‘(D) Mental health services. 

18 ‘‘(E) Opioid overdose reversal drug prod19 ucts procurement, distribution, and training. 

20 ‘‘(F) Pharmaceutical assistance related to 

21 the management of substance-use disorders and 

22 co-morbid conditions. 

23 ‘‘(G) Home- and community-based health 

24 services. 


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1 ‘‘(H) Comprehensive Case Management 

2 and care coordination, including substance use 

3 disorder treatment adherence services. 

4 ‘‘(I) Health insurance enrollment and cost5 sharing assistance in accordance with para6 graph (8). 

7 ‘‘(J) Programs that hire, employ, train, 

8 and dispatch licensed health care professionals, 

9 mental health professionals, harm reduction 

10 providers, or community health workers to re11 spond in lieu of law enforcement officers in 

12 emergencies and that ensure a licensed health 

13 care professional is a member of the team that 

14 responds in lieu of law enforcement officers in 

15 emergencies in which— 

16 ‘‘(i) an individual calling 911, the Na17 tional Suicide Hotline, or another emer18 gency hotlines states that a person is expe19 riencing a drug overdose or is otherwise 

20 under the influence of a legal or illegal 

21 substance; or 

22 ‘‘(ii) a law enforcement officer, other 

23 first responder, or other individual identi24 fies a person as being (or possibly being) 


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1 under the influence of a legal or illegal 

2 substance. 

3 ‘‘(5) RECOVERY AND SUPPORT SERVICES.—For 

4 purposes of this section, the term ‘recovery and sup5 port services’ means services including residential re6 covery housing, mental health services, long term re7 covery services, 24/7 hotline crisis center services, 

8 medical transportation services, respite care for per9 sons caring for individuals with substance use dis10 order, child care and family services while an indi11 vidual is receiving inpatient treatment services or at 

12 the time of outpatient services, outreach services, 

13 peer recovery services, nutrition services, and refer14 rals for job training and career services, housing, 

15 legal services, and child care and family services. 

16 The entities through which such services may be 

17 provided include State, local, and Tribal authorities 

18 that provide child care, housing, community develop19 ment, and other recovery and support services, so 

20 long as they do not exclude individuals on the basis 

21 that such individuals receive medication for addic22 tion treatment. 

23 ‘‘(6) EARLY INTERVENTION SERVICES.—For 

24 purposes of this section, the term ‘early intervention 

25 services’ means services to provide screening and 


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1 connection to the appropriate level of substance use 

2 disorder and mental health treatment (including 

3 same-day connection), counseling provided to indi4 viduals who have misused substances, who have ex5 perienced an overdose, or are at risk of developing 

6 substance use disorder, the provision of referrals to 

7 facilitate the access of such individuals to core med8 ical services or recovery and support services for 

9 substance use disorder, and rapid access to medica10 tion for addiction treatment in the setting of recent 

11 overdose. The entities through which such services 

12 may be provided include emergency rooms, fire de13 partments and emergency medical services, detention 

14 facilities, , homeless shelters, health care points of 

15 entry specified by eligible local areas, Federally16 qualified health centers, workforce agencies and job 

17 centers, youth development centers, tribal clinics and 

18 hospitals, urban Indian organizations, and rural 

19 health clinics. 

20 ‘‘(7) HARM REDUCTION SERVICES.—For pur21 poses of this section, the term ‘harm reduction serv22 ices’ means services provided to individuals engaging 

23 in substance use scientifically accepted to reduce the 

24 risk of infectious disease transmission, overdose, or 

25 death, including syringe services programs and other 


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1 safe use services, such as utilization of a device, kit, 

2 or chemical agent that tests or analyzes a substance 

3 to determine its composition or that detects sub4 stances. 

5 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV6 ERAGE.—A State may use amounts provided under 

7 a grant awarded under section 3411 to establish a 

8 program of financial assistance to assist eligible indi9 viduals with substance use disorder in— 

10 ‘‘(A) enrolling in health insurance cov11 erage; or 

12 ‘‘(B) affording health care services, includ13 ing assistance paying cost-sharing amounts, in14 cluding premiums. 

15 ‘‘(9) ADMINISTRATION AND PLANNING.—A 

16 State shall not use in excess of 10 percent of 

17 amounts received under a grant under section 3411 

18 for administration, accounting, reporting, and pro19 gram oversight functions, including the development 

20 of systems to improve data collection and data shar21 ing. 

22 ‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 

23 received under a grant under section 3411 may be 

24 used to provide substance use disorder treatment 

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1 ment, to individuals who are currently incarcerated 

2 or in pre-trial detention. 

3 ‘‘(c) REQUIRED TERMS.— 

4 ‘‘(1) REQUIREMENT OF STATUS AS MEDICAID

5 PROVIDER.— 

6 ‘‘(A) PROVISION OF SERVICE.—Subject to 

7 subparagraph (B), the Secretary may not make 

8 a grant under section 3411 for the provision of 

9 substance use disorder treatment services under 

10 this section in a State unless, in the case of any 

11 such service that is available pursuant to the 

12 State plan approved under title XIX of the So13 cial Security Act for the State— 

14 ‘‘(i)(I) the State will enter into an 

15 agreement with a political subdivision, 

16 under which the political subdivision will 

17 provide the service directly, and the polit18 ical subdivision has entered into a partici19 pation agreement under the State plan and 

20 is qualified to receive payments under such 

21 plan; or 

22 ‘‘(II) the State will enter into agree23 ments with public or nonprofit entities, or 

24 other Medicaid providers if more than half 

25 of their patients are diagnosed with a subVerDate Sep 11 2014 20:19 May 31, 2024 Jkt 049200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\S4286.IS S4286

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1 stance use disorder and covered by Med2 icaid, under which such entities and other 

3 providers will provide the service, and such 

4 entities and other providers have entered 

5 into such a participation agreement and 

6 are qualified to receive such payments; and 

7 ‘‘(III) the State ensures the political 

8 subdivision under clause (i)(I) or the pub9 lic or nonprofit private entities and other 

10 providers under clause (i)(II) will seek pay11 ment for each such service rendered in ac12 cordance with the usual payment schedule 

13 under the State plan. 

14 ‘‘(B) WAIVER.— 

15 ‘‘(i) IN GENERAL.—In the case of an 

16 entity making an agreement pursuant to 

17 subparagraph (A)(ii) regarding the provi18 sion of substance use disorder treatment 

19 services, the requirement established in 

20 such subparagraph shall be waived by the 

21 State if the entity does not, in providing 

22 health care services, impose a charge or ac23 cept reimbursement available from any 

24 third-party payor, including reimbursement 

25 under any insurance policy or under any 


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1 Federal or State health benefits program. 

2 A waiver under this subparagraph shall 

3 not be longer than 2 years in duration and 

4 shall not be renewed. 

5 ‘‘(ii) DETERMINATION.—A determina6 tion by the State of whether an entity re7 ferred to in clause (i) meets the criteria for 

8 a waiver under such clause shall be made 

9 without regard to whether the entity ac10 cepts voluntary donations for the purpose 

11 of providing services to the public. 

12 ‘‘(2) REQUIRED TERMS FOR EXPANDING AND

13 IMPROVING CARE.—A funding agreement for a grant 

14 under this section shall— 

15 ‘‘(A) ensure that funds received under the 

16 grant will not be utilized to make payments for 

17 any item or service to the extent that payment 

18 has been made, or can reasonably be expected 

19 to be made, with respect to that item or service 

20 under a State compensation program, under an 

21 insurance policy, or under any Federal or State 

22 health benefits program (except for a program 

23 administered by, or providing the services of, 

24 the Indian Health Service); and 


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1 ‘‘(B) ensure that all entities providing sub2 stance use disorder treatment services with as3 sistance made available under the grant shall 

4 offer all drugs approved by the Food and Drug 

5 Administration for the treatment of substance 

6 use disorder for which the applicant offers 

7 treatment, in accordance with section 3435. 

8 ‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund9 ing agreement for a grant under this section is 

10 that— 

11 ‘‘(A) funds received under the grant will be 

12 utilized to supplement not supplant other Fed13 eral, State, or local funds made available in the 

14 year for which the grant is awarded to provide 

15 substance use disorder treatment services to in16 dividuals with substance use disorder, including 

17 funds for each of prevention services, core med18 ical services, recovery and support services, 

19 early intervention services, harm reduction serv20 ices, mental health services, and administrative 

21 expenses; 

22 ‘‘(B) political subdivisions within the State 

23 will maintain the level of expenditures by such 

24 political subdivisions for substance use disorder 

25 treatment services at a level that is at least 


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1 equal to the level of such expenditures by such 

2 political subdivisions for the preceding fiscal 

3 year including expenditures for each of preven4 tion services, core medical services, recovery 

5 and support services, early intervention services, 

6 harm reduction services, mental health services, 

7 and administrative expenses; 

8 ‘‘(C) political subdivisions within the State 

9 will not use funds received under a grant 

10 awarded under section 3411 in maintaining the 

11 level of substance use disorder treatment serv12 ices as required in subparagraph (B); 

13 ‘‘(D) substance use disorder treatment 

14 services provided with assistance made available 

15 under the grant will be provided without re16 gard— 

17 ‘‘(i) to the ability of the individual to 

18 pay for such services; and 

19 ‘‘(ii) to the current or past health con20 dition of the individual to be served; 

21 ‘‘(E) substance use disorder treatment 

22 services will be provided in a setting that is ac23 cessible to low-income individuals with sub24 stance use disorders and to individuals with 

25 substance use disorders residing in rural areas; 


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1 ‘‘(F) a program of outreach will be pro2 vided to low-income individuals with substance 

3 use disorders to inform such individuals of sub4 stance use disorder treatment services and to 

5 individuals with substance use disorders resid6 ing in rural areas; 

7 ‘‘(G) Indian tribes are included in planning 

8 for the use of grant funds and the Federal trust 

9 responsibility is upheld at all levels of program 

10 administration; and 

11 ‘‘(H) the confidentiality of individuals re12 ceiving substance use disorder treatment serv13 ices will be maintained in a manner not incon14 sistent with applicable law. 

15 ‘‘SEC. 3413. APPLICATION. 

16 ‘‘(a) APPLICATION.—To be eligible to receive a grant 

17 under section 3411, a State shall have in effect a State 

18 plan approved by the Secretary pursuant to section 

19 1932(b), and shall prepare and submit to the Secretary 

20 an application in such form, and containing such informa21 tion, as the Secretary shall require, including— 

22 ‘‘(1) a complete accounting of the disbursement 

23 of any prior grants received under this subtitle by 

24 the applicant and the results achieved by these ex25 penditures and a demonstration that funds received 


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1 from a grant under this subtitle in the prior year 

2 were expended in accordance with State priorities; 

3 ‘‘(2) establishment of goals and objectives to be 

4 achieved with grant funds provided under this sub5 title, including targets and milestones that are in6 tended to be met, the activities that will be under7 taken to achieve those targets, and the number of 

8 individuals likely to be served by the funds sought, 

9 including demographic data on the populations to be 

10 served; 

11 ‘‘(3) a demonstration that the State will use 

12 funds in a manner that provides substance use dis13 order treatment services in compliance with the evi14 dence-based standards developed in accordance with 

15 section 3435, including all drugs approved by the 

16 Food and Drug Administration for the treatment of 

17 substance use disorder; 

18 ‘‘(4) a demonstration that resources provided 

19 under the grant will be allocated in accordance with 

20 the local demographic incidence of substance use, in21 cluding allocations for services for children, youths, 

22 and women; 

23 ‘‘(5) an explanation of how income, asset, and 

24 medical expense criteria will be established and apVerDate Sep 11 2014 20:19 May 31, 2024 Jkt 049200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\S4286.IS S4286

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1 plied to those who qualify for assistance under the 

2 program; 

3 ‘‘(6) an explanation of how the State will sup4 port, through distribution of resources and by other 

5 means, increased access to harm reduction services 

6 resources within the State; and 

7 ‘‘(7) for any prior funding received under this 

8 section, data provided in such form as the Secretary 

9 shall require detailing, at a minimum, the extent to 

10 which the activities supported by the funding met 

11 the goals and objectives specified in the application 

12 for the funding, the number of individuals who 

13 accessed medication for addiction treatment by age, 

14 gender, sexual orientation, race, disability status, 

15 and other demographic criteria relevant to the pro16 gram, and the effect of the program on overdose 

17 rates and rates of death due to overdose in the re18 gion served by the program. 

19 ‘‘(b) REQUIREMENTS REGARDING IMPOSITION OF

20 CHARGES FOR SERVICES.— 

21 ‘‘(1) IN GENERAL.—The Secretary may not 

22 make a grant under section 3411 to a State unless 

23 the State provides assurances that in the provision 

24 of services with assistance provided under the 

25 grant— 


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1 ‘‘(A) in the case of individuals with an in2 come less than or equal to 150 percent of the 

3 official poverty level, the provider will not im4 pose charges on any such individual for the 

5 services provided under the grant; 

6 ‘‘(B) in the case of individuals with an in7 come greater than 150 percent of the official 

8 poverty level, the provider will impose a charge 

9 on each such individual according to a schedule 

10 of charges made available to the public; 

11 ‘‘(C) in the case of individuals with an in12 come greater than 150 percent of the official 

13 poverty level but not exceeding 200 percent of 

14 such poverty level, the provider will not, for any 

15 calendar year, impose charges in an amount ex16 ceeding 2 percent of the annual gross income of 

17 the individual; 

18 ‘‘(D) in the case of individuals with an in19 come greater than 200 percent of the official 

20 poverty level but not exceeding 250 percent of 

21 such poverty level, the provider will not, for any 

22 calendar year, impose charges in an amount ex23 ceeding 4 percent of the annual gross income of 

24 the individual involved; 


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1 ‘‘(E) in the case of individuals with an in2 come greater than 250 percent of the official 

3 poverty level but not exceeding 300 percent of 

4 such poverty level, the provider will not, for any 

5 calendar year, impose charges in an amount ex6 ceeding 6 percent of the annual gross income of 

7 the individual involved; 

8 ‘‘(F) in the case of individuals with an in9 come greater than 300 percent of the official 

10 poverty level but not exceeding 400 percent of 

11 such poverty level, the provider will not, for any 

12 calendar year, impose charges in an amount ex13 ceeding 8.5 percent of the annual gross income 

14 of the individual involved; 

15 ‘‘(G) in the case of individuals with an in16 come greater than 400 percent of the official 

17 poverty level, the provider will not, for any cal18 endar year, impose charges in an amount ex19 ceeding 8.5 percent of the annual gross income 

20 of the individual involved; and 

21 ‘‘(H) in the case of eligible American In22 dian and Alaska Native and urban Indian indi23 viduals as defined by section 447.50 of title 42, 

24 Code of Federal Regulations (as in effect on 

25 July 1, 2010), the provider will not impose any 


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1 charges for substance use disorder treatment 

2 services, including any charges or cost-sharing 

3 prohibited by section 1402(d) of the Patient 

4 Protection and Affordable Care Act. 

5 ‘‘(2) CHARGES.—With respect to compliance 

6 with the assurances made under paragraph (1), a 

7 State may, in the case of individuals subject to a 

8 charge— 

9 ‘‘(A) assess the amount of the charge in 

10 the discretion of the State, including imposing 

11 only a nominal charge for the provision of serv12 ices, subject to the provisions of the paragraph 

13 regarding public schedules and regarding limi14 tations on the maximum amount of charges; 

15 and 

16 ‘‘(B) take into consideration the total med17 ical expenses of individuals in assessing the 

18 amount of the charge, subject to such provi19 sions. 

20 ‘‘(3) AGGREGATE CHARGES.—The Secretary 

21 may not make a grant under section 3411 to a State 

22 unless the State agrees that the limitations on 

23 charges for substance use disorder treatment serv24 ices under this subsection applies to the annual ag25 gregate of charges imposed for such services, howVerDate Sep 11 2014 20:19 May 31, 2024 Jkt 049200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\S4286.IS S4286

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1 ever the charges are characterized, includes enroll2 ment fees, premiums, deductibles, cost sharing, co3 payments, co-insurance costs, or any other charges. 

4 ‘‘(c) INDIAN TRIBES.—Any application requirements 

5 applying to grants distributed in accordance with section 

6 3412(b) shall be developed by the Secretary in consulta7 tion with Indian tribes. 

8 ‘‘SEC. 3414. TECHNICAL ASSISTANCE. 

9 ‘‘The Secretary shall, directly or through grants or 

10 contracts, provide technical assistance in administering 

11 and coordinating the activities authorized under section 

12 3412, including technical assistance for the development 

13 of State applications for supplementary grants authorized 

14 in section 3412(a)(2). 

15 ‘‘SEC. 3415. AUTHORIZATION OF APPROPRIATIONS. 

16 ‘‘There is authorized to be appropriated to carry out 

17 this subtitle— 

18 ‘‘(1) $4,600,000,000 for fiscal year 2024; 

19 ‘‘(2) $4,600,000,000 for fiscal year 2025; 

20 ‘‘(3) $4,600,000,000 for fiscal year 2026; 

21 ‘‘(4) $4,600,000,000 for fiscal year 2027; 

22 ‘‘(5) $4,600,000,000 for fiscal year 2028; 

23 ‘‘(6) $4,600,000,000 for fiscal year 2029; 

24 ‘‘(7) $4,600,000,000 for fiscal year 2030; 

25 ‘‘(8) $4,600,000,000 for fiscal year 2031; 


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1 ‘‘(9) $4,600,000,000 for fiscal year 2032; and 

2 ‘‘(10) $4,600,000,000 for fiscal year 2033. 

3 ‘‘Subtitle C—Other Grant Program 

4 ‘‘SEC. 3421. ESTABLISHMENT OF GRANT PROGRAM. 

5 ‘‘(a) GRANTS.— 

6 ‘‘(1) IN GENERAL.—The Secretary shall award 

7 grants to public entities, nonprofit entities, Indian 

8 entities, and other eligible Medicaid providers for the 

9 purpose of funding prevention services, core medical 

10 services, recovery and support services, early inter11 vention services, harm reduction services, and ad12 ministrative expenses in accordance with this sec13 tion. 

14 ‘‘(2) PRIORITIZATION.— 

15 ‘‘(A) IN GENERAL.—In awarding grants 

16 under this section, the Secretary shall, to the 

17 extent practicable, prioritize the distribution of 

18 grant funds to grantees that have— 

19 ‘‘(i) an explicit policy not to deter em20 ployees with respect to— 

21 ‘‘(I) labor organizing for the em22 ployees engaged in the covered activi23 ties; and 

24 ‘‘(II) such employees’ choice to 

25 form and join labor organizations; or 


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1 ‘‘(ii) policies that require— 

2 ‘‘(I) the posting and maintenance 

3 of notices in the workplace to such 

4 employees of their rights under the 

5 National Labor Relations Act (29 

6 U.S.C. 151 et seq.); 

7 ‘‘(II) that such employees are, at 

8 the beginning of their employment, 

9 provided notice and information re10 garding the employees’ rights under 

11 such Act; and 

12 ‘‘(III) the employer to voluntarily 

13 recognize a union in cases where such 

14 workers of the employer have joined 

15 and requested representation. 

16 ‘‘(B) EXCEPTION.—This paragraph shall 

17 not apply to Indian tribes. 

18 ‘‘(b) ELIGIBILITY.— 

19 ‘‘(1) ENTITIES.—Public entities, nonprofit enti20 ties, urban Indian organizations, and other Medicaid 

21 providers eligible to receive a grant under subsection 

22 (a) may include— 

23 ‘‘(A) Federally-qualified health centers 

24 under section 1905(l)(2)(B) of the Social Secu25 rity Act; 


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1 ‘‘(B) family planning clinics; 

2 ‘‘(C) rural health clinics; 

3 ‘‘(D) Indian entities, including Indian 

4 health programs as defined in section 4 of the 

5 Indian Health Care Improvement Act, urban 

6 Indian organizations as defined in section 4 of 

7 the Indian Health Care Improvement Act, and 

8 Native Hawaiian organizations as defined in 

9 section 11 of the Native Hawaiian Health Care 

10 Act of 1988; 

11 ‘‘(E) community-based organizations, clin12 ics, hospitals, and other health facilities that 

13 provide substance use disorder treatment serv14 ices; 

15 ‘‘(F) other nonprofit entities that provide 

16 substance use disorder treatment services; 

17 ‘‘(G) certified community behavioral health 

18 clinics and certified community behavioral 

19 health clinic expansion grant recipients, under 

20 section 223 of the Protecting Access to Medi21 care Act (42 U.S.C. 1396a note); and 

22 ‘‘(H) other Medicaid providers if more 

23 than half of their patients are diagnosed with a 

24 substance use disorder and covered by Med25 icaid. 


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1 ‘‘(2) UNDERSERVED POPULATIONS.—Entities 

2 described in paragraph (1) shall serve underserved 

3 populations which may include— 

4 ‘‘(A) minority populations and Indian pop5 ulations; 

6 ‘‘(B) formerly incarcerated individuals; 

7 ‘‘(C) individuals with comorbidities includ8 ing human immunodeficiency virus, hepatitis B, 

9 hepatitis C, mental health disorder or other be10 havioral health disorders; 

11 ‘‘(D) low-income populations; 

12 ‘‘(E) people with disabilities; 

13 ‘‘(F) urban populations; 

14 ‘‘(G) rural populations; 

15 ‘‘(H) the lesbian, gay, bisexual, 

16 transgender, queer (LGBTQ) community; and 

17 ‘‘(I) pregnant individuals with, or at risk 

18 of developing, substance use disorder and in19 fants with neonatal abstinence syndrome. 

20 ‘‘(3) APPLICATION.—To be eligible to receive a 

21 grant under this section, public entities, nonprofit 

22 entities, and other Medicaid providers described in 

23 this subsection shall prepare and submit to the Sec24 retary an application in such form, and containing 


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1 such information, as the Secretary shall require, in2 cluding— 

3 ‘‘(A) a complete accounting of the dis4 bursement of any prior grants received under 

5 this subtitle by the applicant and the results 

6 achieved by these expenditures; 

7 ‘‘(B) a comprehensive plan for the use of 

8 the grant, including— 

9 ‘‘(i) a demonstration of the extent of 

10 local need for the funds sought; 

11 ‘‘(ii) a plan for providing substance 

12 use disorder treatment services that is con13 sistent with local needs; and 

14 ‘‘(iii) goals and objectives to be 

15 achieved with grant funds provided under 

16 this section, including targets and mile17 stones that are intended to be met and a 

18 description of the activities that will be un19 dertaken to achieve those targets; 

20 ‘‘(C) a demonstration that the grantee will 

21 use funds in a manner that provides substance 

22 use disorder treatment services compliant with 

23 the evidence-based standards developed in ac24 cordance with section 3435, including all drugs 

25 approved by the Food and Drug Administration 


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1 for the treatment of substance use disorder for 

2 which the applicant offers treatment, in accord3 ance with section 3435(c); 

4 ‘‘(D) information on the number of individ5 uals to be served by the funds sought, including 

6 demographic data on the populations to be 

7 served; 

8 ‘‘(E) a demonstration that resources pro9 vided under the grant will be allocated in ac10 cordance with the local demographic incidence 

11 of substance use, including allocations for serv12 ices for children, youths, and women; 

13 ‘‘(F) an explanation of how income, asset, 

14 and medical expense criteria will be established 

15 and applied to those who qualify for assistance 

16 under the program; and 

17 ‘‘(G) for any prior funding received under 

18 this section, data provided in such form as the 

19 Secretary shall require detailing, at a minimum, 

20 the extent to which the activities supported by 

21 the funding met the goals and objectives speci22 fied in the application for the funding, the num23 ber of individuals who accessed medication for 

24 addiction treatment by age, gender, race, sexual 

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1 graphic criteria relevant to the program, and 

2 the effect of the program on overdose rates and 

3 rates of death due to overdose in the region 

4 served by the program. 

5 ‘‘(4) REQUIREMENT OF STATUS AS MEDICAID

6 PROVIDER.— 

7 ‘‘(A) PROVISION OF SERVICE.—Subject to 

8 subparagraph (B), the Secretary may not make 

9 a grant under this section for the provision of 

10 substance use disorder treatment services under 

11 this section in a State unless, in the case of any 

12 such service that is available pursuant to the 

13 State plan approved under title XIX of the So14 cial Security Act for the State— 

15 ‘‘(i)(I) the applicant for the grant will 

16 provide the service directly, and the appli17 cant has entered into a participation agree18 ment under the State plan and is qualified 

19 to receive payments under such plan; or 

20 ‘‘(II) the applicant for the grant will 

21 enter into an agreement with public or 

22 nonprofit entities, Indian entities, or other 

23 Medicaid providers if more than half of 

24 their patients are diagnosed with a sub25 stance use disorder and covered by MedVerDate Sep 11 2014 20:19 May 31, 2024 Jkt 049200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\S4286.IS S4286

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1 icaid, under which such entities and other 

2 providers will provide the substance use 

3 disorder treatment service, and such enti4 ties and other providers have entered into 

5 such a participation agreement and are 

6 qualified to receive such payments; and 

7 ‘‘(ii) the applicant ensures that pay8 ment will be sought for each such service 

9 rendered in accordance with the usual pay10 ment schedule under the State plan. 

11 ‘‘(B) WAIVER.—In the case of an entity 

12 making an agreement pursuant to subpara13 graph (A) regarding the provision of substance 

14 use disorder treatment services, the require15 ment established in such paragraph shall be 

16 waived by the State if the entity does not, in 

17 providing such services, impose a charge or ac18 cept reimbursement available from any third19 party payor, including reimbursement under 

20 any insurance policy or under any Federal or 

21 State health benefits program. A waiver under 

22 this subparagraph shall not be longer than 2 

23 years in duration and shall not be renewed. 

24 ‘‘(C) DETERMINATION.—A determination 

25 by the State of whether an entity referred to in 


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1 subparagraph (A) meets the criteria for a waiv2 er under such subparagraph shall be made 

3 without regard to whether the entity accepts 

4 voluntary donations for the purpose of pro5 viding services to the public. 

6 ‘‘(5) REQUIRED TERMS FOR EXPANDING AND

7 IMPROVING CARE.—A funding agreement for a grant 

8 under this section is that— 

9 ‘‘(A) funds received under the grant will 

10 not be utilized to make payments for any item 

11 or service to the extent that payment has been 

12 made, or can reasonably be expected to be 

13 made, with respect to that item or service under 

14 a State compensation program, under an insur15 ance policy, or under any Federal or State 

16 health benefits program (except for a program 

17 administered by, or providing the services of, 

18 the Indian Health Service); 

19 ‘‘(B) entities providing substance use dis20 order treatment services with assistance made 

21 available under the grant shall offer all drugs 

22 approved by the Food and Drug Administration 

23 for the treatment of substance use disorder for 

24 which the applicant offers treatment, in accord25 ance with section 3435(c); 


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1 ‘‘(C) substance use disorder treatment 

2 services provided with assistance made available 

3 under the grant will be provided without re4 gard— 

5 ‘‘(i) to the ability of the individual to 

6 pay for such services; and 

7 ‘‘(ii) to the current or past health con8 dition of the individual to be served; 

9 ‘‘(D) substance use disorder treatment 

10 services will be provided in a setting that is ac11 cessible to low-income individuals with sub12 stance use disorders and to individuals with 

13 substance use disorders residing in rural areas; 

14 and 

15 ‘‘(E) the confidentiality of individuals re16 ceiving substance use disorder treatment serv17 ices will be maintained in a manner not incon18 sistent with applicable law. 

19 ‘‘(c) AMOUNT OF GRANT TO INDIAN ENTITIES.— 

20 ‘‘(1) INDIAN TRIBES.—In this section, the term 

21 ‘Indian tribe’ has the meaning given such term in 

22 section 4 of the Indian Self-Determination and Edu23 cation Assistance Act. 

24 ‘‘(2) FORMULA GRANTS.—The Secretary, acting 

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1 cent of the amount available under section 3425 for 

2 each fiscal year to provide grants to Indian entities 

3 in an amount determined pursuant to criteria devel4 oped by the Secretary in consultation with Indian 

5 tribes and after conferring with urban Indian orga6 nizations, for the purposes of addressing substance 

7 use. 

8 ‘‘(3) USE OF AMOUNTS.—Notwithstanding any 

9 requirements in this section, Native entities may use 

10 amounts provided under grants awarded under this 

11 section for the uses identified in section 3422 and 

12 any other activities determined appropriate by the 

13 Secretary, in consultation with Indian tribes. 

14 ‘‘SEC. 3422. USE OF AMOUNTS. 

15 ‘‘(a) USE OF FUNDS.—An entity shall use amounts 

16 received under a grant under section 3421 to provide di17 rect financial assistance to eligible entities for the purpose 

18 of delivering or enhancing— 

19 ‘‘(1) prevention services described in subsection 

20 (b); 

21 ‘‘(2) core medical services described in sub22 section (c); 

23 ‘‘(3) recovery and support services described in 

24 subsection (d); 


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1 ‘‘(4) early intervention and engagement services 

2 described in subsection (e); 

3 ‘‘(5) harm reduction services described in sub4 section (f); and 

5 ‘‘(6) administrative expenses described in sub6 section (g). 

7 ‘‘(b) PREVENTION SERVICES.—For purposes of this 

8 section, the term ‘prevention services’ means evidence9 based services, programs, or multi-sector strategies to pre10 vent substance use disorder (including education cam11 paigns, community-based prevention programs, risk iden12 tification programs, opioid diversion, collection and dis13 posal of unused opioids, services to at-risk populations, 

14 and trauma support services). 

15 ‘‘(c) CORE MEDICAL SERVICES.—For purposes of 

16 this section, the term ‘core medical services’ means the 

17 following evidence-based services provided to individuals 

18 with substance use disorder or at risk for developing sub19 stance use disorder, including through the use of telemedi20 cine or a hub and spoke model: 

21 ‘‘(1) Substance use disorder treatment, as more 

22 fully described in section 3439(4), including assess23 ment of disease presence, severity, and co-occurring 

24 conditions, treatment planning, clinical stabilization 

25 services, withdrawal management and detoxification, 


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1 intensive inpatient treatment, intensive outpatient 

2 treatment, outpatient treatment, residential inpa3 tient services, treatment for co-occurring mental 

4 health and substance use disorders, and all drugs 

5 approved by the Food and Drug Administration for 

6 the treatment of substance use disorder. 

7 ‘‘(2) Outpatient and ambulatory health services, 

8 including those administered by Federally-qualified 

9 health centers, rural health clinics, tribal clinics and 

10 hospitals, urban Indian organizations, certified com11 munity behavioral health clinics (as described in sec12 tion 223 of the Protecting Access to Medicare Act), 

13 HIV services organizations, Native Hawaiian organi14 zations (as defined in section 11 of the Native Ha15 waiian Health Care Act of 1988), and comprehen16 sive opioid recovery centers (as described in section 

17 552 of this Act). 

18 ‘‘(3) Hospice services. 

19 ‘‘(4) Mental health services. 

20 ‘‘(5) Opioid overdose reversal drug products 

21 procurement, distribution, and training. 

22 ‘‘(6) Pharmaceutical assistance related to the 

23 management of substance-use disorder and co-mor24 bid conditions. 


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1 ‘‘(7) Home- and community-based health serv2 ices. 

3 ‘‘(8) Comprehensive Case Management and care 

4 coordination, including substance use disorder treat5 ment adherence services. 

6 ‘‘(9) Health insurance enrollment and cost7 sharing assistance in accordance with section 3412. 

8 ‘‘(10) Programs that hire, employ, train, and 

9 dispatch mental health professionals, harm reduction 

10 providers, or community health workers to respond 

11 in lieu of law enforcement officers in emergencies in 

12 which— 

13 ‘‘(A) an individual calling 911, the Na14 tional Suicide Hotline, or another emergency 

15 hotlines states that a person is experiencing a 

16 drug overdose or is otherwise under the influ17 ence of a legal or illegal substance; and 

18 ‘‘(B) a law enforcement officer, other first 

19 responder, or other individual identifies a per20 son as being (or possibly being) under the influ21 ence of a legal or illegal substance. 

22 ‘‘(d) RECOVERY AND SUPPORT SERVICES.—For pur23 poses of this section, the term ‘recovery and support serv24 ices’ means services that are provided to individuals with 

25 substance use disorder, including residential recovery 


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1 housing, mental health services, long term recovery serv2 ices, 24/7 hotline crisis center support, medical transpor3 tation services, respite care for persons caring for individ4 uals with substance use disorder, child care and family 

5 services while an individual is receiving inpatient treat6 ment services or at the time of outpatient services, out7 reach services, peer recovery services, nutrition services, 

8 and referrals for job training and career services, housing, 

9 legal services, and child care and family services. The enti10 ties through which such services may be provided include 

11 local and Tribal authorities that provide child care, hous12 ing, community development, and other recovery and sup13 port services, so long as they do not exclude individuals 

14 on the basis that such individuals receive medication for 

15 addiction treatment. 

16 ‘‘(e) EARLY INTERVENTION SERVICES.—For pur17 poses of this section, the term ‘early intervention services’ 

18 means services to provide screening and connection to the 

19 appropriate level of substance use disorder and mental 

20 health treatment (including same-day connection), coun21 seling provided to individuals who have misused sub22 stances, who have experienced an overdose, or are at risk 

23 of developing substance use disorder, the provision of re24 ferrals to facilitate the access of such individuals to core 

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1 stance use disorder, and rapid access to medication for 

2 addiction treatment in the setting of recent overdose. The 

3 entities through which such services may be provided in4 clude emergency rooms, fire departments and emergency 

5 medical services, detention facilities, prisons and jails, 

6 homeless shelters, health care points of entry specified by 

7 eligible local areas, Federally-qualified health centers, 

8 workforce agencies and job centers, youth development 

9 centers, tribal clinics and hospitals, urban Indian organi10 zations, and rural health clinics. 

11 ‘‘(f) HARM REDUCTION SERVICES.—For purposes of 

12 this section, the term ‘harm reduction services’ means 

13 services provided to individuals engaging in substance use 

14 that are scientifically accepted to reduce the risk of infec15 tious disease transmission, overdose, or death, including 

16 syringe services programs and other safe use services, such 

17 as utilization of a device, kit, or chemical agent that tests 

18 or analyzes a substance to determine its composition or 

19 that detects substances. 

20 ‘‘(g) ADMINISTRATION AND PLANNING.—An entity 

21 (not including tribal entities) shall not use in excess of 

22 10 percent of amounts received under a grant under sec23 tion 3421 for administration, accounting, reporting, and 

24 program oversight functions, including for the purposes of 


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1 developing systems to improve data collection and data 

2 sharing. 

3 ‘‘(h) RELATION TO EXISTING EMERGENCY MEDICAL

4 SERVICES.—Nothing in this section shall be construed to 

5 diminish or alter the rights, privileges, remedies, or obliga6 tions of any provider or any Federal, State, or local gov7 ernment to provide emergency medical services. 

8 ‘‘SEC. 3423. TECHNICAL ASSISTANCE. 

9 ‘‘The Secretary may, directly or through grants or 

10 contracts, provide technical assistance to public or non11 profit entities, Indian entities, and other eligible Medicaid 

12 providers regarding the process of submitting to the Sec13 retary applications for grants under section 3421, and 

14 may provide technical assistance with respect to the plan15 ning, development, and operation of any program or serv16 ice carried out pursuant to such section. 

17 ‘‘SEC. 3424. PLANNING AND DEVELOPMENT GRANTS. 

18 ‘‘(a) IN GENERAL.—The Secretary may provide plan19 ning grants to public or nonprofit entities, Indian entities, 

20 and other eligible Medicaid providers for purposes of as21 sisting such entities and providers in expanding their ca22 pacity to provide substance use disorder treatment services 

23 in low-income communities and affected subpopulations 

24 that are underserviced with respect to such services. 


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1 ‘‘(b) AMOUNT.—A grant under this section may be 

2 made in an amount not to exceed $150,000. 

3 ‘‘SEC. 3425. AUTHORIZATION OF APPROPRIATIONS. 

4 ‘‘There is authorized to be appropriated to carry out 

5 this subtitle— 

6 ‘‘(1) $1,000,000,000 for fiscal year 2024; 

7 ‘‘(2) $1,000,000,000 for fiscal year 2025; 

8 ‘‘(3) $1,000,000,000 for fiscal year 2026; 

9 ‘‘(4) $1,000,000,000 for fiscal year 2027; 

10 ‘‘(5) $1,000,000,000 for fiscal year 2028; 

11 ‘‘(6) $1,000,000,000 for fiscal year 2029; 

12 ‘‘(7) $1,000,000,000 for fiscal year 2030; 

13 ‘‘(8) $1,000,000,000 for fiscal year 2031; 

14 ‘‘(9) $1,000,000,000 for fiscal year 2032; and 

15 ‘‘(10) $1,000,000,000 for fiscal year 2033. 

16 ‘‘Subtitle D—Innovation, Training, 

17 and Health Systems Strengthening 

18 ‘‘SEC. 3431. SPECIAL PROJECTS OF NATIONAL SIGNIFI19 CANCE. 

20 ‘‘(a) IN GENERAL.—The Secretary shall award 

21 grants to entities to administer special projects of national 

22 significance to support the development of innovative and 

23 original models for the delivery of substance use disorder 

24 treatment and harm reduction services. 


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1 ‘‘(b) GRANTS.—The Secretary shall award grants 

2 under a project under subsection (a) to entities eligible 

3 for grants under subtitles A, B, and C based on newly 

4 emerging needs of individuals receiving assistance under 

5 this title. 

6 ‘‘(c) REPLICATION.—The Secretary shall make infor7 mation concerning successful models or programs devel8 oped under this section available to grantees under this 

9 title for the purpose of coordination, replication, and inte10 gration. To facilitate efforts under this section, the Sec11 retary may provide for peer-based technical assistance for 

12 grantees funded under this section. 

13 ‘‘(d) GRANTS TO TRIBAL GOVERNMENTS.— 

14 ‘‘(1) INDIAN TRIBES.—In this section, the term 

15 ‘Indian tribe’ has the meaning given such term in 

16 section 4 of the Indian Self-Determination and Edu17 cation Assistance Act. 

18 ‘‘(2) USE OF FUNDS.—The Secretary, acting 

19 through the Indian Health Service, shall use 10 per20 cent of the amount available under this section for 

21 each fiscal year to provide grants to Indian tribes 

22 for the purposes of supporting the development of 

23 innovative and original models for the delivery of 

24 substance use disorder treatment services, including 

25 the development of culturally informed care models. 


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1 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section— 

3 ‘‘(1) $500,000,000 for fiscal year 2024; 

4 ‘‘(2) $500,000,000 for fiscal year 2025; 

5 ‘‘(3) $500,000,000 for fiscal year 2026; 

6 ‘‘(4) $500,000,000 for fiscal year 2027; 

7 ‘‘(5) $500,000,000 for fiscal year 2028; 

8 ‘‘(6) $500,000,000 for fiscal year 2029; 

9 ‘‘(7) $500,000,000 for fiscal year 2030; 

10 ‘‘(8) $500,000,000 for fiscal year 2031; 

11 ‘‘(9) $500,000,000 for fiscal year 2032; and 

12 ‘‘(10) $500,000,000 for fiscal year 2033. 

13 ‘‘SEC. 3432. EDUCATION AND TRAINING CENTERS. 

14 ‘‘(a) IN GENERAL.—The Secretary may make grants 

15 and enter into contracts to assist public or nonprofit enti16 ties, public or nonprofit schools, and academic health cen17 ters in meeting the cost of projects— 

18 ‘‘(1) to train health professionals, including 

19 practitioners in programs under this title and other 

20 community providers, including physician addiction 

21 specialists, psychologists, counselors, case managers, 

22 social workers, peer recovery coaches, harm reduc23 tion workers, public health workers, and community 

24 health workers, and paraprofessionals, such as peer 

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1 nosis, treatment, and prevention of substance use 

2 disorders and drug use-related health issues, includ3 ing measures for the prevention and treatment of co4 occurring infectious diseases, mental health dis5 orders, and other conditions, and including (as appli6 cable to the type of health professional involved), 

7 care for women, pregnant women, and children; 

8 ‘‘(2) to train the faculty of schools of medicine, 

9 nursing, public health, osteopathic medicine, den10 tistry, allied health, social work, and mental health 

11 practice to teach health professions students to 

12 screen for and provide for the needs of individuals 

13 with substance use disorders or at risk of substance 

14 use; and 

15 ‘‘(3) to develop and disseminate curricula and 

16 resource materials relating to evidence-based prac17 tices for the screening, prevention, and treatment of 

18 substance use disorders and drug use-related health 

19 issues, including information about combating stig20 ma, prescribing best practices, overdose reversal, al21 ternative pain therapies, and all drugs approved by 

22 the Food and Drug Administration for the treat23 ment of substance use disorders, including for the 

24 purposes authorized under the amendments made by 


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1 section 3203 of the SUPPORT for Patients and 

2 Communities Act. 

3 ‘‘(b) PREFERENCE IN MAKING GRANTS.—In making 

4 grants under subsection (a), the Secretary shall give pref5 erence to qualified projects that will— 

6 ‘‘(1) train, or result in the training of, health 

7 professionals and other community providers de8 scribed in subsection (a)(1), to provide substance 

9 use disorder treatments for underserved groups, in10 cluding minority individuals and Indians with sub11 stance use disorder and other individuals who are at 

12 a high risk of substance use; 

13 ‘‘(2) train, or result in the training of, minority 

14 health professionals and minority allied health pro15 fessionals, to provide substance use disorder treat16 ment for individuals with such disease; 

17 ‘‘(3) train or result in the training of individ18 uals who will provide substance use disorder treat19 ment in rural or other areas that are underserved by 

20 current treatment structures; 

21 ‘‘(4) train or result in the training of health 

22 professionals and allied health professionals, includ23 ing counselors, case managers, social workers, peer 

24 recovery coaches, and harm reduction workers, pub25 lic health workers, and community health workers, 


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1 to provide treatment for infectious diseases and 

2 mental health disorders co-occurring with substance 

3 use disorder; and 

4 ‘‘(5) train or result in the training of health 

5 professionals and other community providers to pro6 vide substance use disorder treatments for pregnant 

7 women, children, and adolescents. 

8 ‘‘(c) NATIVE EDUCATION AND TRAINING CEN9 TERS.—The Secretary shall use 10 percent of the amount 

10 available under subsection (d) for each fiscal year to pro11 vide grants authorized under this subtitle to— 

12 ‘‘(1) tribal colleges and universities; 

13 ‘‘(2) Indian Health Service grant funded insti14 tutions; and 

15 ‘‘(3) Native partner institutions, including insti16 tutions of higher education with medical training 

17 programs that partner with one or more Indian 

18 tribes, tribal organizations, Native Hawaiian organi19 zations, or tribal colleges and universities to train 

20 Native health professionals that will provide sub21 stance use disorder treatment services in Native 

22 communities. 

23 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

24 is authorized to be appropriated to carry out this section— 

25 ‘‘(1) $500,000,000 for fiscal year 2024; 


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1 ‘‘(2) $500,000,000 for fiscal year 2025; 

2 ‘‘(3) $500,000,000 for fiscal year 2026; 

3 ‘‘(4) $500,000,000 for fiscal year 2027; 

4 ‘‘(5) $500,000,000 for fiscal year 2028; 

5 ‘‘(6) $500,000,000 for fiscal year 2029; 

6 ‘‘(7) $500,000,000 for fiscal year 2030; 

7 ‘‘(8) $500,000,000 for fiscal year 2031; 

8 ‘‘(9) $500,000,000 for fiscal year 2032; and 

9 ‘‘(10) $500,000,000 for fiscal year 2033. 

10 ‘‘SEC. 3433. SUBSTANCE USE DISORDER TREATMENT PRO11 VIDER CAPACITY UNDER THE MEDICAID PRO12 GRAM. 

13 ‘‘(a) PROJECTS.— 

14 ‘‘(1) IN GENERAL.—The Secretary shall use 

15 amounts appropriated under this section to provide 

16 funding for projects in any State or territory to in17 crease substance use provider capacity, as provided 

18 for in section 1903(aa) of the Social Security Act. 

19 ‘‘(2) PRIORITIZATIONS.— 

20 ‘‘(A) IN GENERAL.—In awarding grants 

21 under this section, the Secretary shall, to the 

22 extent practicable, prioritize the distribution of 

23 grant funds to grantees that have— 

24 ‘‘(i) an explicit policy not to deter em25 ployees with respect to— 


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1 ‘‘(I) labor organizing for the em2 ployees engaged in the covered activi3 ties; and 

4 ‘‘(II) such employees’ choice to 

5 form and join labor organizations; and 

6 ‘‘(ii) policies that require— 

7 ‘‘(I) the posting and maintenance 

8 of notices in the workplace to such 

9 employees of their rights under the 

10 National Labor Relations Act (29 

11 U.S.C. 151 et seq.); 

12 ‘‘(II) that such employees are, at 

13 the beginning of their employment, 

14 provided notice and information re15 garding the employees’ rights under 

16 such Act; and 

17 ‘‘(III) the employer to voluntarily 

18 recognize a union in cases where such 

19 workers of the employer have joined 

20 and requested representation. 

21 ‘‘(B) EXCEPTION.—This paragraph shall 

22 not apply to Indian tribes. 

23 ‘‘(b) AMOUNT OF GRANT TO INDIAN ENTITIES.— 

24 ‘‘(1) INDIAN TRIBES.—In this section, the term 

25 ‘Indian tribe’ has the meaning given such term in 


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1 section 4 of the Indian Self-Determination and Edu2 cation Assistance Act. 

3 ‘‘(2) URBAN INDIAN ORGANIZATION.—In this 

4 section, the term ‘urban Indian organization’ has the 

5 meaning given such term in section 4 of the Indian 

6 Health Care Improvement Act. 

7 ‘‘(3) GRANTS.—The Secretary, acting through 

8 the Indian Health Service, shall use 10 percent of 

9 the amount appropriated under this section for each 

10 fiscal year to award grants to Indian tribes and 

11 urban Indian organizations in an amount deter12 mined pursuant to criteria developed by the Sec13 retary in consultation with Indian tribes and in con14 ference with urban Indian organizations. 

15 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

16 is authorized to be appropriated to carry out this section— 

17 ‘‘(1) $50,000,000 for fiscal year 2024; 

18 ‘‘(2) $50,000,000 for fiscal year 2025; 

19 ‘‘(3) $50,000,000 for fiscal year 2026; 

20 ‘‘(4) $50,000,000 for fiscal year 2027; 

21 ‘‘(5) $50,000,000 for fiscal year 2028; 

22 ‘‘(6) $50,000,000 for fiscal year 2029; 

23 ‘‘(7) $50,000,000 for fiscal year 2030; 

24 ‘‘(8) $50,000,000 for fiscal year 2031; 

25 ‘‘(9) $50,000,000 for fiscal year 2032; and 


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1 ‘‘(10) $50,000,000 for fiscal year 2033. 

2 ‘‘SEC. 3434. PROGRAMS TO SUPPORT EMPLOYEES. 

3 ‘‘(a) GRANT PROGRAM FOR WORKERS.— 

4 ‘‘(1) IN GENERAL.—The Secretary, acting 

5 through the Director of the National Institute for 

6 Occupational Safety and Health, shall award grants 

7 to non-profit entities that meet the requirements of 

8 this section to fund programs and projects to assist 

9 workers who are at risk of substance use disorder, 

10 who have substance use disorder, or who are recov11 ering from substance use disorder to maintain or 

12 gain employment. 

13 ‘‘(2) GRANTS FOR WORKERS.— 

14 ‘‘(A) IN GENERAL.—The Secretary shall, 

15 on a competitive basis, award grants for a pe16 riod of not more than 3 years to non-profit en17 tities that submit an application under para18 graph (3) to enable such entities to implement, 

19 conduct, continue, and expand evidence-based 

20 programs and projects to assist individuals de21 scribed in subparagraph (G). 

22 ‘‘(B) USE OF AMOUNTS.—An entity may 

23 use amounts provided under this subsection 

24 for— 


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1 ‘‘(i) prevention services described in 

2 subparagraph (C), including providing edu3 cation and information to workers regard4 ing the dangers of illicit and licit drug use, 

5 non-opioid pain management and non-drug 

6 pain management, or occupational injury 

7 and illness prevention; 

8 ‘‘(ii) early intervention services de9 scribed in subparagraph (D) to enable in10 dividuals to maintain or gain employment; 

11 ‘‘(iii) recovery and support services 

12 described in subparagraph (E) to enable 

13 individuals to maintain or gain employ14 ment; 

15 ‘‘(iv) harm reduction services de16 scribed in subparagraph (F) to enable indi17 viduals to maintain or gain employment; 

18 ‘‘(v) hiring case managers, care coor19 dinators, and peer support specialists to 

20 assist employed individuals who are experi21 encing substance use disorder, or who are 

22 recovering from substance use disorder, in 

23 accessing substance use disorder treatment 

24 services; or 


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1 ‘‘(vi) providing vocational, life skills, 

2 and other forms of job training to workers 

3 who are receiving substance use disorder 

4 treatment services to enable such workers 

5 to maintain or gain employment. 

6 ‘‘(C) PREVENTION SERVICES.—For pur7 poses of this section, the term ‘prevention serv8 ices’ means evidence-based services, programs, 

9 or multi-sector strategies to prevent substance 

10 use disorder (including education campaigns, 

11 community-based prevention programs, risk 

12 identification programs, opioid diversion, collec13 tion and disposal of unused opioids, services to 

14 at-risk populations, and trauma support serv15 ices). 

16 ‘‘(D) RECOVERY AND SUPPORT SERV17 ICES.—For purposes of this section, the term 

18 ‘recovery and support services’ means services 

19 including residential recovery housing, mental 

20 health services, long term recovery services, 24/ 

21 7 hotline crisis center services, medical trans22 portation services, respite care for persons car23 ing for individuals with substance use disorder, 

24 child care and family services while an indi25 vidual is receiving inpatient treatment services 


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1 or at the time of outpatient services, outreach 

2 services, peer recovery services, nutrition serv3 ices, and referrals for job training and career 

4 services, housing, legal services, and child care 

5 and family services so long as they do not ex6 clude individuals on the basis that such individ7 uals receive medication for addiction treatment. 

8 ‘‘(E) EARLY INTERVENTION SERVICES.— 

9 For purposes of this section, the term ‘early 

10 intervention services’ means services to provide 

11 screening and connection to the appropriate 

12 level of substance use disorder and mental 

13 health treatment (including same-day connec14 tion), counseling provided to individuals who 

15 have misused substances, who have experienced 

16 an overdose, or are at risk of developing sub17 stance use disorder, the provision of referrals to 

18 facilitate the access of such individuals to core 

19 medical services or recovery and support serv20 ices for substance use disorder, and rapid ac21 cess to medication for addiction treatment in 

22 the setting of recent overdose. 

23 ‘‘(F) HARM REDUCTION SERVICES.—For 

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1 viduals engaging in substance use scientifically 

2 accepted to reduce the risk of infectious disease 

3 transmission, overdose, or death, including sy4 ringe services programs and other safe use serv5 ices, such as utilization of a device, kit, or 

6 chemical agent that tests or analyzes a sub7 stance to determine its composition or that de8 tects substances. 

9 ‘‘(G) INDIVIDUALS DESCRIBED.—Individ10 uals described in this subparagraph are individ11 uals who— 

12 ‘‘(i)(I) have been employed in the 12- 

13 month period immediately preceding the 

14 date on which the determination is being 

15 made, or who are participating in an em16 ployee training or apprenticeship program; 

17 and 

18 ‘‘(II) are at high risk of developing 

19 substance use disorder, including as a re20 sult of employment in industries that expe21 rience high rates of occupational injuries 

22 and illness; or 

23 ‘‘(ii) are experiencing a substance use 

24 disorder or are in recovery from a sub25 stance use disorder. 


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1 ‘‘(3) APPLICATIONS.—To be eligible for a grant 

2 under this subsection, an entity shall submit to the 

3 Secretary an application at such time, in such man4 ner, and containing such information as the Sec5 retary may require, including— 

6 ‘‘(A) a complete accounting of the dis7 bursement of any prior grants received under 

8 this title by the applicant and the results 

9 achieved by such expenditures; 

10 ‘‘(B) a description of the population to be 

11 served with grant funds provided under this 

12 section, including a description of the unique 

13 risks the population faces for experiencing occu14 pational injuries or exposure to illicit sub15 stances; 

16 ‘‘(C) the goals and objectives to be 

17 achieved with grant funds provided under this 

18 section, including targets and milestones that 

19 are intended to be met, the activities that will 

20 be undertaken to achieve those targets, and the 

21 number of individuals likely to be served by the 

22 grant funds, including demographic data on the 

23 populations to be served; 

24 ‘‘(D) a demonstration of the ability of the 

25 applicant to reach the individuals described in 


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1 paragraph (2)(G) and to provide services de2 scribed in paragraph (2)(B) included in the ap3 plicant’s grant application, including by 

4 partnering with local stakeholders; 

5 ‘‘(E) for any prior funding received under 

6 this subsection, data provided in such form as 

7 the Secretary shall require detailing, at a min8 imum, the extent to which the activities sup9 ported by the funding met the goals, objectives, 

10 targets, and milestones specified in the applica11 tion for the funding, and the number of individ12 uals with and without substance use disorder 

13 who received services supported by the funding, 

14 including the services provided to these individ15 uals, the industries in which the individuals 

16 were employed when they received services, and 

17 whether the individuals were still employed in 

18 that same industry or in any industry when the 

19 individuals ceased receiving services supported 

20 by the funding; and 

21 ‘‘(F) any other information the Secretary 

22 shall require. 

23 ‘‘(4) DATA REPORTING AND OVERSIGHT.—An 

24 entity awarded a grant under this subsection shall 

25 submit to the Secretary an annual report at such 


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1 time and in such manner as the Secretary shall re2 quire. Such report shall include, at a minimum, a 

3 description of— 

4 ‘‘(A) the activities funded by the grant; 

5 ‘‘(B) the number of individuals with and 

6 without substance use disorder served through 

7 activities funded by the grant, including the 

8 services provided to those individuals and the 

9 industries in which those individuals were em10 ployed at the time they received services sup11 ported by the grant; 

12 ‘‘(C) for workers experiencing substance 

13 use disorder or recovering from substance use 

14 disorder served by activities funded by the 

15 grant, the number of individuals who main16 tained employment, the number of individuals 

17 who gained employment, and the number of in18 dividuals who failed to maintain employment 

19 over the course of the reporting period; and 

20 ‘‘(D) any other information required by the 

21 Secretary. 

22 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

23 There is authorized to be appropriated to carry out 

24 this subsection— 

25 ‘‘(A) $40,000,000 for fiscal year 2024; 


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1 ‘‘(B) $40,000,000 for fiscal year 2025; 

2 ‘‘(C) $40,000,000 for fiscal year 2026; 

3 ‘‘(D) $40,000,000 for fiscal year 2027; 

4 ‘‘(E) $40,000,000 for fiscal year 2028; 

5 ‘‘(F) $40,000,000 for fiscal year 2029; 

6 ‘‘(G) $40,000,000 for fiscal year 2030; 

7 ‘‘(H) $40,000,000 for fiscal year 2031; 

8 ‘‘(I) $40,000,000 for fiscal year 2032; and 

9 ‘‘(J) $40,000,000 for fiscal year 2033. 

10 ‘‘(b) RESEARCH ON THE IMPACT OF SUBSTANCE USE

11 DISORDER IN THE WORKPLACE AND ON DIRECT SERVICE

12 PROVIDERS.— 

13 ‘‘(1) RISKS OF SUBSTANCE USE DISORDER.— 

14 The Secretary, in consultation with the Director of 

15 the National Institute for Occupational Safety and 

16 Health, shall conduct (directly or through grants or 

17 contracts) research, experiments, and demonstra18 tions, and publish studies relating to— 

19 ‘‘(A) the risks faced by employees in var20 ious occupations of developing substance use 

21 disorder and of drug overdose deaths and non22 fatal drug overdoses, and the formulation of 

23 prevention activities tailored to the risks identi24 fied in these occupations, including occupational 

25 injury and illness prevention; 


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1 ‘‘(B) the prevalence of substance use dis2 order among employees in various occupations; 

3 ‘‘(C) efforts that employers may undertake 

4 to assist employees who are undergoing sub5 stance use disorder treatment services in main6 taining employment while ensuring workplaces 

7 are safe and healthful; 

8 ‘‘(D) risks of occupational exposure to 

9 opioids and other illicit substances and the for10 mulation of prevention activities tailored to the 

11 risks identified; and 

12 ‘‘(E) other subjects related to substance 

13 use disorder in the workplace as the Secretary 

14 determines. 

15 ‘‘(2) DIRECT SERVICE PROVIDERS.—The Sec16 retary shall conduct (directly or through grants or 

17 contracts) research, experiments, and demonstra18 tions, and publish studies relating to the occupa19 tional health and safety, recruitment, and retention 

20 of behavioral health providers who, as part of their 

21 job responsibilities, provide direct services to individ22 uals who are at risk of experiencing substance use 

23 disorder or who are experiencing or recovering from 

24 substance use disorder, including— 


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1 ‘‘(A) identifying factors that the Secretary 

2 believes may endanger the health or safety of 

3 such workers, including factors that affect the 

4 risks such workers face of developing substance 

5 use disorder; 

6 ‘‘(B) motivational and behavioral factors 

7 relating to the field of behavioral health pro8 viders; 

9 ‘‘(C) strategies to support the recruitment 

10 and retention of behavioral health providers; 

11 and 

12 ‘‘(D) other subjects related to behavioral 

13 health providers engaged in direct provision of 

14 substance use disorder prevention and treat15 ment services as the Secretary determines ap16 propriate. 

17 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

18 There is authorized to be appropriated to carry out 

19 this subsection— 

20 ‘‘(A) $10,000,000 for fiscal year 2024; 

21 ‘‘(B) $10,000,000 for fiscal year 2025; 

22 ‘‘(C) $10,000,000 for fiscal year 2026; 

23 ‘‘(D) $10,000,000 for fiscal year 2027; 

24 ‘‘(E) $10,000,000 for fiscal year 2028; 

25 ‘‘(F) $10,000,000 for fiscal year 2029; 


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1 ‘‘(G) $10,000,000 for fiscal year 2030; 

2 ‘‘(H) $10,000,000 for fiscal year 2031; 

3 ‘‘(I) $10,000,000 for fiscal year 2032; and 

4 ‘‘(J) $10,000,000 for fiscal year 2033. 

5 ‘‘SEC. 3435. IMPROVING AND EXPANDING CARE. 

6 ‘‘(a) LEVEL OF CARE STANDARDS FOR SUBSTANCE

7 USE DISORDER TREATMENT SERVICES.— 

8 ‘‘(1) IN GENERAL.—Not later than 1 year after 

9 the date of enactment of this title, the Secretary, in 

10 consultation with the American Society of Addiction 

11 Medicine, State and Tribal officials selected by the 

12 Secretary, and other stakeholders as the Secretary 

13 determines necessary, and after seeking public input, 

14 shall promulgate model standards for the regulation 

15 of substance use disorder treatment services. 

16 ‘‘(2) SUBSTANCE USE DISORDER TREATMENT

17 SERVICES.—The model standards promulgated 

18 under paragraph (1) shall, at a minimum— 

19 ‘‘(A) identify the types of substance use 

20 disorder treatment services intended to be cov21 ered without regard to whether they participate 

22 in any Federal health care program (as defined 

23 in section 1128B(f) of the Social Security Act) 

24 and shall not include— 


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1 ‘‘(i) a private practitioner who is al2 ready licensed by a State licensing board 

3 and whose practice is limited to non-inten4 sive outpatient care; or 

5 ‘‘(ii) any substance use disorder treat6 ment service provided on a non-intensive 

7 outpatient basis in the office of a private 

8 practitioner who is licensed by a State li9 censing board; 

10 ‘‘(B) require the designation of a single 

11 State agency to serve as the primary regulator 

12 in the State for substance use disorder treat13 ment services; 

14 ‘‘(C) subject to paragraph (3), require that 

15 substance use disorder treatment services iden16 tified in accordance with subparagraph (A), be 

17 licensed by the respective States according to 

18 the standards for levels of care set forth by the 

19 American Society of Addiction Medicine in 

20 2013 or an equivalent set of standards; 

21 ‘‘(D) require implementation of a process 

22 to ensure that substance use disorder treatment 

23 program qualifications are verified by means of 

24 an onsite inspection not less frequently than 

25 every 3 years by the State agency serving as 


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1 the primary regulator in the State for substance 

2 use disorder treatment services or by an inde3 pendent third party that is approved by the 

4 State’s primary regulator; and 

5 ‘‘(E) require that all patients leaving a res6 idential treatment program receive a written 

7 transition plan prior to discharge from that 

8 level of care. 

9 ‘‘(3) ANNUAL ASSESSMENT.—Beginning with 

10 respect to fiscal year 2024, the Secretary shall make 

11 a determination with respect to each State on 

12 whether the State has adopted, for each of the sub13 stance use disorder treatment services identified in 

14 accordance with paragraph (2)(A), licensure stand15 ards that are in compliance in all material respects 

16 with the model standards promulgated in accordance 

17 with this subsection. In the event the American Soci18 ety of Addiction Medicine revises its criteria, the 

19 Secretary shall revise the national model level of 

20 care standards accordingly and disseminate any such 

21 update to the States, and the States may adopt any 

22 such updates to be in compliance with this sub23 section. 


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1 ‘‘(b) STANDARDS FOR OTHER SPECIFIED MATTERS

2 RELATED TO SUBSTANCE USE DISORDER TREATMENT

3 SERVICES AND RECOVERY RESIDENCES.— 

4 ‘‘(1) IN GENERAL.—Not later than 2 years 

5 after the date of enactment of this title, the Sec6 retary, in consultation with representatives of non7 profit service providers and State and Tribal officials 

8 as the Secretary determines necessary, shall promul9 gate model standards for the regulation of— 

10 ‘‘(A) other specified matters related to sub11 stance use disorder treatment services; and 

12 ‘‘(B) recovery residences. 

13 ‘‘(2) OTHER SPECIFIED MATTERS RELATED TO

14 SUBSTANCE USE DISORDER TREATMENT SERV15 ICES.—The model standards promulgated under 

16 paragraph (1)(A) shall, at a minimum— 

17 ‘‘(A) identify the professional credentials 

18 needed by each type of substance use disorder 

19 treatment professional; 

20 ‘‘(B) include standards for data reporting 

21 and require compilation of statewide reports; 

22 ‘‘(C) require the establishment and mainte23 nance within each State of a toll-free telephone 

24 number to receive complaints from the public 


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1 regarding substance use disorder treatment 

2 service providers; and 

3 ‘‘(D) require the establishment and main4 tenance on a publicly accessible internet website 

5 of a list of all substance use disorder treatment 

6 services in the State that have a certification in 

7 effect in accordance with this section. 

8 ‘‘(3) RECOVERY RESIDENCES.— 

9 ‘‘(A) ECONOMIC RELATIONSHIP.—The 

10 model standards promulgated under paragraph 

11 (1)(B) shall, at a minimum, be applied to recov12 ery residences that have an ongoing economic 

13 relationship with any commercial substance use 

14 disorder treatment service. 

15 ‘‘(B) MINIMUM REQUIREMENTS.—The 

16 model standards promulgated under paragraph 

17 (1)(B), which may include any model laws de18 veloped under section 550(a) shall, at a min19 imum, identify requirements for— 

20 ‘‘(i) the designation of a single State 

21 agency to certify recovery residences; 

22 ‘‘(ii) the implementation of a process 

23 to ensure that the qualifications of recov24 ery residences in which not fewer than 10 

25 individuals may lawfully reside are verified 


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1 by means of an onsite inspection not less 

2 frequently than every 3 years by the State 

3 agency serving as the primary regulator in 

4 the State or by an independent third party 

5 that is approved by the State’s primary 

6 regulator; 

7 ‘‘(iii) fire, safety, and health stand8 ards; 

9 ‘‘(iv) equipping residences with opioid 

10 overdose reversal drug products, such as 

11 naloxone and training residence owners, 

12 operators, and employees in the adminis13 tration of naloxone; 

14 ‘‘(v) recovery residence owners and 

15 operators; 

16 ‘‘(vi) a written policy that prohibits 

17 the exclusion of individuals on the basis 

18 that such individuals receive drugs ap19 proved by the Food and Drug Administra20 tion for the treatment of substance use dis21 order; 

22 ‘‘(vii) the establishment and mainte23 nance within each State of a toll-free tele24 phone number to receive complaints from 


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1 the public regarding recovery residences; 

2 and 

3 ‘‘(viii) the establishment and mainte4 nance on a publicly accessible internet 

5 website of a list of all recovery residences 

6 in the State that have a certification in ef7 fect in accordance with this section. 

8 ‘‘(4) ANNUAL ASSESSMENT.—Beginning with 

9 respect to fiscal year 2025, the Secretary shall make 

10 a determination with respect to each State on 

11 whether the State has adopted, for each of the other 

12 specified substance use disorder treatment services 

13 identified in this section and for recovery residences, 

14 standards that are in compliance in all material re15 spects with the model standards promulgated in ac16 cordance with this subsection. 

17 ‘‘(c) ENSURING ACCESS TO MEDICATION FOR SUB18 STANCE USE DISORDER TREATMENT.— 

19 ‘‘(1) MEDICATION FOR ADDICTION TREAT20 MENT.—The Secretary may not make a grant under 

21 this section unless the applicant for the grant agrees 

22 to require all entities offering substance use disorder 

23 treatment services under the grant to offer all drugs 

24 approved by the Food and Drug Administration for 


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1 the treatment of substance use disorder for which 

2 the applicant offers treatment. 

3 ‘‘(2) WAIVER.—The Secretary may grant a 

4 waiver with respect to any requirement of this sec5 tion if the grant applicant involved— 

6 ‘‘(A) submits to the Secretary a justifica7 tion for such waiver containing such informa8 tion as the Secretary shall require; and 

9 ‘‘(B) agrees to require all entities offering 

10 substance use disorder treatment services under 

11 the grant to— 

12 ‘‘(i) offer, on site, at least 2 drugs ap13 proved by the Food and Drug Administra14 tion for the treatment of substance use dis15 order; 

16 ‘‘(ii) provide counseling to patients on 

17 the benefits and risks of all drugs ap18 proved by the Food and Drug Administra19 tion for the treatment of substance use dis20 order; and 

21 ‘‘(iii) maintain an affiliation agree22 ment with a provider that can prescribe or 

23 otherwise dispense all other forms of drugs 

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1 tration for the treatment of substance use 

2 disorder. 

3 ‘‘(3) GAO STUDY.—Not later than 1 year after 

4 the date of enactment of this title, the Comptroller 

5 General of the United States shall submit to Con6 gress a comprehensive report describing any rela7 tionship between substance use rates, pain manage8 ment practices of the Indian Health Service, and pa9 tient request denials through the purchased/referred 

10 care program of the Indian Health Service. 

11 ‘‘(d) ENSURING A FULL CONTINUUM OF SERV12 ICES.— 

13 ‘‘(1) IN GENERAL.—Not later than 6 months 

14 after the date of the enactment of this title, the Ad15 ministrator of the Centers for Medicare & Medicaid 

16 Services shall issue a State Medicaid Director letter 

17 and Tribal leader letter explaining how States and 

18 tribes can ensure access to a continuum of services 

19 for adults with substance use disorders who are re20 ceiving medical assistance under title XIX of the So21 cial Security Act. Such letter shall describe how 

22 States can cover the continuum of community-based, 

23 residential, and inpatient substance use disorder 

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1 tion 1905(a) of such Act, including through section 

2 1915 of such Act and through demonstration 

3 projects under section 1115 of such Act. 

4 ‘‘(2) MACPAC ANALYSIS.—Not later than 1 

5 year after the date of the enactment of this title, the 

6 Medicaid and CHIP Payment and Access Commis7 sion shall conduct an analysis, and make publicly 

8 available a report containing the results of such 

9 analysis, of States’ coverage of substance use serv10 ices for Medicaid beneficiaries. Such report shall in11 clude examples of promising strategies States use to 

12 cover a continuum of community-based substance 

13 use services. 

14 ‘‘(3) ANNUAL ASSESSMENT.—Beginning with 

15 respect to fiscal year 2026, the Secretary shall make 

16 a determination with respect to each State on 

17 whether the State has carried out the requirements 

18 to ensure a continuum of services as described in 

19 section 1915(l)(4)(C) of the Social Security Act. 

20 ‘‘SEC. 3436. NALOXONE DISTRIBUTION PROGRAM. 

21 ‘‘(a) ESTABLISHMENT OF PROGRAM.— 

22 ‘‘(1) IN GENERAL.—The Secretary shall provide 

23 for the purchase and delivery of federally approved 

24 opioid overdose reversal drug products on behalf of 

25 each State (or Indian tribe as defined in section 4 


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1 of the Indian Health Care Improvement Act) that 

2 receives a grant under subtitle B. This paragraph 

3 constitutes budget authority in advance of appro4 priations Acts, and represents the obligation of the 

5 Federal Government to provide for the purchase and 

6 delivery to States and Indian tribes of the opioid 

7 overdose reversal drug products in accordance with 

8 this paragraph. 

9 ‘‘(2) SPECIAL RULES WHERE OPIOID OVERDOSE

10 REVERSAL DRUG PRODUCTS ARE UNAVAILABLE.—To 

11 the extent that a sufficient quantity of opioid over12 dose reversal drug products are not available for 

13 purchase or delivery under paragraph (1), the Sec14 retary shall provide for the purchase and delivery of 

15 the available opioid overdose reversal drug products 

16 in accordance with priorities established by the Sec17 retary, with priority given to States with at least one 

18 local area eligible for funding under section 3401(a). 

19 ‘‘(b) NEGOTIATION OF CONTRACTS WITH MANUFAC20 TURERS.— 

21 ‘‘(1) IN GENERAL.—For the purpose of car22 rying out this section, the Secretary shall negotiate 

23 and enter into contracts with manufacturers of 

24 opioid overdose reversal drug products consistent 

25 with the requirements of this subsection and, to the 


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1 maximum extent practicable, consolidate such con2 tracting with any other contracting activities con3 ducted by the Secretary to purchase opioid overdose 

4 reversal drug products. The Secretary may enter 

5 into such contracts under which the Federal Govern6 ment is obligated to make outlays, the budget au7 thority for which is not provided for in advance in 

8 appropriations Acts, for the purchase and delivery of 

9 opioid overdose reversal drug products under sub10 section (a). 

11 ‘‘(2) AUTHORITY TO DECLINE CONTRACTS.— 

12 The Secretary may decline to enter into contracts 

13 under this subsection and may modify or extend 

14 such contracts. 

15 ‘‘(3) CONTRACT PRICE.— 

16 ‘‘(A) IN GENERAL.—The Secretary, in ne17 gotiating the prices at which opioid overdose re18 versal drug products will be purchased and de19 livered from a manufacturer under this sub20 section, shall take into account quantities of 

21 opioid overdose reversal drug products to be 

22 purchased by States under the option under 

23 paragraph (4)(B). 

24 ‘‘(B) NEGOTIATION OF DISCOUNTED PRICE

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1 UCTS.—With respect to contracts entered into 

2 for the purchase of opioid overdose reversal 

3 drug products on behalf of States under this 

4 subsection, the price for the purchase of such 

5 drug product shall be a discounted price nego6 tiated by the Secretary. 

7 ‘‘(4) QUANTITIES AND TERMS OF DELIVERY.— 

8 Under contracts under this subsection— 

9 ‘‘(A) the Secretary shall provide, consistent 

10 with paragraph (6), for the purchase and deliv11 ery on behalf of States and Indian tribes of 

12 quantities of opioid overdose reversal drug 

13 products; and 

14 ‘‘(B) each State and Indian tribe, at the 

15 option of the State or tribe, shall be permitted 

16 to obtain additional quantities of opioid over17 dose reversal drug products (subject to amounts 

18 specified to the Secretary by the State or tribe 

19 in advance of negotiations) through purchasing 

20 the opioid overdose reversal drug products from 

21 the manufacturers at the applicable price nego22 tiated by the Secretary consistent with para23 graph (3), if the State or tribe provides to the 

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1 vance of negotiations under paragraph (1)) as 

2 the Secretary determines to be necessary, to 

3 provide for quantities of opioid overdose rever4 sal drug products for the State or tribe to pur5 chase pursuant to this subsection and to deter6 mine annually the percentage of the opioid over7 dose reversal drug market that is purchased 

8 pursuant to this section and this subparagraph. 

9 The Secretary shall enter into the initial negotia10 tions not later than 180 days after the date of the 

11 enactment of this title. 

12 ‘‘(5) CHARGES FOR SHIPPING AND HAN13 DLING.—The Secretary may enter into a contract 

14 referred to in paragraph (1) only if the manufac15 turer involved agrees to submit to the Secretary 

16 such reports as the Secretary determines to be ap17 propriate to assure compliance with the contract and 

18 if, with respect to a State program under this sec19 tion that does not provide for the direct delivery of 

20 qualified opioid overdose reversal drug products, the 

21 manufacturer involved agrees that the manufacturer 

22 will provide for the delivery of the opioid overdose 

23 reversal drug products on behalf of the State in ac24 cordance with such program and will not impose any 

25 charges for the costs of such delivery (except to the 


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1 extent such costs are provided for in the price estab2 lished under paragraph (3)). 

3 ‘‘(6) MULTIPLE SUPPLIERS.—In the case of the 

4 opioid overdose reversal drug product involved, the 

5 Secretary may, as appropriate, enter into a contract 

6 referred to in paragraph (1) with each manufacturer 

7 of the opioid overdose reversal drug product that 

8 meets the terms and conditions of the Secretary for 

9 an award of such a contract (including terms and 

10 conditions regarding safety and quality). With re11 spect to multiple contracts entered into pursuant to 

12 this paragraph, the Secretary may have in effect dif13 ferent prices under each of such contracts and, with 

14 respect to a purchase by States pursuant to para15 graph (4)(B), each eligible State may choose which 

16 of such contracts will be applicable to the purchase. 

17 ‘‘(c) USE OF OPIOID OVERDOSE REVERSAL DRUG

18 PRODUCT LIST.—Beginning not later than one year after 

19 the first contract has been entered into under this section, 

20 the Secretary shall use, for the purpose of the purchase, 

21 delivery, and administration of opioid overdose reversal 

22 drug products under this section, the list established (and 

23 periodically reviewed and, as appropriate, revised) by an 

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1 tion, which considers the cost effectiveness of each opioid 

2 overdose reversal drug product. 

3 ‘‘(d) STATE DISTRIBUTION OF OPIOID OVERDOSE

4 REVERSAL DRUG PRODUCTS.—States shall distribute 

5 opioid overdose reversal drug products received under this 

6 section to the following: 

7 ‘‘(1) First responders and local emergency med8 ical services organizations, including volunteer emer9 gency medical services organizations. 

10 ‘‘(2) Public entities with authority to administer 

11 local public health services, including all local health 

12 departments; 

13 ‘‘(3) Nonprofit entities, including— 

14 ‘‘(A) community-based organizations that 

15 provide substance use disorder treatments or 

16 harm reduction services; 

17 ‘‘(B) nonprofit entities that provide sub18 stance use disorder treatments or harm reduc19 tion services; and 

20 ‘‘(C) faith based organizations that provide 

21 substance use disorder treatments or harm re22 duction services; 

23 ‘‘(4) Other entities in areas of high need. 

24 ‘‘(5) The general public. 


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1 ‘‘(e) STATE REQUIREMENTS.—To be eligible to re2 ceive opioid overdose reversal drugs under this section, 

3 each State shall— 

4 ‘‘(1) establish a program for distributing opioid 

5 overdose reversal drug products to first responders, 

6 nonprofit entities, the general public, and entities 

7 with authority to administer local public health serv8 ices, including local health departments; 

9 ‘‘(2) beginning in the second year of the pro10 gram, demonstrate a distribution rate of a minimum 

11 of 90 percent of the opioid overdose reversal drug 

12 products received under this program; 

13 ‘‘(3) certify to the Secretary that the State has 

14 in place a Good Samaritan Law that ensures immu15 nity from arrest and prosecution, including from pa16 role and probation violations, except that the State 

17 may apply to the Secretary for a waiver of the re18 quirement of this paragraph, and such waiver if 

19 granted shall not be longer than 3 years in duration 

20 and may not be renewed unless the State can show 

21 progress being made towards instituting a Good Sa22 maritan Law; and 

23 ‘‘(4) certify to the Secretary that the State has 

24 in place additional measures that enhance access to 

25 opioid overdose reversal drug products, such as laws 


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1 that provide civil or disciplinary immunity for med2 ical personnel who prescribe an opioid overdose re3 versal drug product, Third Party Prescription Laws, 

4 Collaborative Practice Agreements, and Standing 

5 Orders. 

6 ‘‘(f) INDIAN TRIBE REQUIREMENTS.—The Indian 

7 Health Service, in consultation with Indian tribes, shall 

8 determine any requirements that shall apply to Indian 

9 tribes receiving opioid overdose reversal drug products 

10 made available under this section. 

11 ‘‘(g) DEFINITIONS.—For purposes of this section: 

12 ‘‘(1) COLLABORATIVE PRACTICE AGREEMENT.— 

13 The term ‘Collaborative Practice Agreement’ means 

14 an agreement under which a pharmacist operates 

15 under authority delegated by another licensed practi16 tioner with prescribing authority. 

17 ‘‘(2) EMERGENCY MEDICAL SERVICE.—The 

18 term ‘emergency medical service’ means resources 

19 used by a public or private licensed entity to deliver 

20 medical care outside of a medical facility under 

21 emergency conditions that occur as a result of the 

22 condition of the patient and includes services deliv23 ered (either on a compensated or volunteer basis) by 

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1 volved as an emergency medical technician, a para2 medic, or an equivalent professional (as determined 

3 by the State). 

4 ‘‘(3) GOOD SAMARITAN LAW.—The term ‘Good 

5 Samaritan Law’ means a law that provides criminal 

6 immunity for a person who administers an opioid 

7 overdose reversal drug product, a person who, in 

8 good faith, seeks medical assistance for someone ex9 periencing a drug-related overdose, or a person who 

10 experiences a drug-related overdose and is in need of 

11 medical assistance and, in good faith, seeks such 

12 medical assistance, or is the subject of such a good 

13 faith request for medical assistance. 

14 ‘‘(4) INDIANS.—The terms ‘Indian’, ‘Indian 

15 tribe’, ‘tribal organization’, and ‘urban Indian orga16 nization’ have the meanings given such terms in sec17 tion 4 of the Indian Health Care Improvement Act. 

18 ‘‘(5) MANUFACTURER.—The term ‘manufac19 turer’ means any corporation, organization, or insti20 tution, whether public or private (including Federal, 

21 State, and local departments, agencies, and instru22 mentalities), which manufactures, imports, proc23 esses, or distributes under its label any opioid over24 dose reversal drug product. The term ‘manufacture’ 


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1 means to manufacture, import, process, or distribute 

2 an opioid overdose reversal drug. 

3 ‘‘(6) OPIOID OVERDOSE REVERSAL DRUG PROD4 UCT.—The term ‘opioid overdose reversal drug prod5 uct’ means a finished dosage form that has been ap6 proved by the Food and Drug Administration and 

7 that contains an active pharmaceutical ingredient 

8 that acts as an opioid receptor antagonist. The term 

9 ‘opioid overdose reversal drug product’ includes a 

10 combination product, as defined in section 3.2(e) of 

11 title 21, Code of Federal Regulations. 

12 ‘‘(7) STANDING ORDER.—The term ‘standing 

13 order’ means a non-patient-specific order covering 

14 administration of medication by others to a patient 

15 who may be unknown to the prescriber at the time 

16 of the order. 

17 ‘‘(8) THIRD PARTY PRESCRIPTION.—The term 

18 ‘third party prescription’ means an order written for 

19 medication dispensed to one person with the inten20 tion that it will be administered to another person. 

21 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

22 is authorized to be appropriated to carry out this suc23 tion— 

24 ‘‘(1) $1,000,000,000 for fiscal year 2024; 

25 ‘‘(2) $1,000,000,000 for fiscal year 2025; 


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1 ‘‘(3) $1,000,000,000 for fiscal year 2026; 

2 ‘‘(4) $1,000,000,000 for fiscal year 2027; 

3 ‘‘(5) $1,000,000,000 for fiscal year 2028; 

4 ‘‘(6) $1,000,000,000 for fiscal year 2029; 

5 ‘‘(7) $1,000,000,000 for fiscal year 2030; 

6 ‘‘(8) $1,000,000,000 for fiscal year 2031; 

7 ‘‘(9) $1,000,000,000 for fiscal year 2032; and 

8 ‘‘(10) $1,000,000,000 for fiscal year 2033. 

9 ‘‘SEC. 3437. ADDITIONAL FUNDING FOR THE NATIONAL IN10 STITUTES OF HEALTH. 

11 ‘‘There is authorized to be appropriated to the Na12 tional Institutes of Health for the purpose of conducting 

13 research on addiction and pain, including research to de14 velop overdose reversal drug products, non-opioid drug 

15 products and non-pharmacological treatments for address16 ing pain and substance use disorder, and drug products 

17 used to treat substance use disorder— 

18 ‘‘(1) $1,000,000,000 for fiscal year 2024; 

19 ‘‘(2) $1,000,000,000 for fiscal year 2025; 

20 ‘‘(3) $1,000,000,000 for fiscal year 2026; 

21 ‘‘(4) $1,000,000,000 for fiscal year 2027; 

22 ‘‘(5) $1,000,000,000 for fiscal year 2028; 

23 ‘‘(6) $1,000,000,000 for fiscal year 2029; 

24 ‘‘(7) $1,000,000,000 for fiscal year 2030; 

25 ‘‘(8) $1,000,000,000 for fiscal year 2031; 


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1 ‘‘(9) $1,000,000,000 for fiscal year 2032; and 

2 ‘‘(10) $1,000,000,000 for fiscal year 2033. 

3 ‘‘SEC. 3438. ADDITIONAL FUNDING FOR THE CENTERS FOR 

4 DISEASE CONTROL AND PREVENTION. 

5 ‘‘(a) IMPROVED DATA COLLECTION AND PREVEN6 TION OF INFECTIOUS DISEASE TRANSMISSION.— 

7 ‘‘(1) DATA COLLECTION.—The Centers for Dis8 ease Control and Prevention shall use a portion of 

9 the funding appropriated under this section to en10 sure that all States participate in the Enhanced 

11 State Opioid Overdose Surveillance program and to 

12 provide technical assistance to medical examiners 

13 and coroners to facilitate improved data collection on 

14 fatal overdoses through such program. 

15 ‘‘(2) CENTERS FOR DISEASE CONTROL AND

16 PREVENTION.—The Centers for Disease Control and 

17 Prevention shall use amounts appropriated under 

18 this section for the purpose of improving data on 

19 drug overdose deaths and non-fatal drug overdoses, 

20 surveillance related to addiction and substance use 

21 disorder, and the prevention of transmission of infec22 tious diseases related to substance use. 

23 ‘‘(3) TRIBAL DATA.—Not later than 6 months 

24 after the date of enactment of this title, the Director 

25 of the Centers for Disease Control and Prevention 


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1 shall consult with Indian tribes and confer with 

2 urban Indian organizations to develop and imple3 ment strategies that improve surveillance and re4 porting of fatal overdose deaths among American In5 dians and Alaska Natives, including strategies that 

6 reduce the underestimation of fatal overdose deaths 

7 among American Indians and Alaska Natives due to 

8 undersampling or racial misclassification in State 

9 and Federal public health surveillance systems. 

10 ‘‘(b) CHILDHOOD TRAUMA.—The Centers for Disease 

11 Control and Prevention shall use a portion of the funding 

12 appropriated under this section to fund the surveillance 

13 and data collection activities described in section 7131 of 

14 the SUPPORT for Patients and Communities Act, includ15 ing to encourage all States to participate in collecting and 

16 reporting data on adverse childhood experiences through 

17 the Behavioral Risk Factor Surveillance System, the 

18 Youth Risk Behavior Surveillance System, and other rel19 evant public health surveys or questionnaires. 

20 ‘‘(c) WORKER HEALTH RISKS.—The Centers for Dis21 ease Control and Prevention shall use a portion of the 

22 funding appropriated under this section for data collection 

23 and surveillance activities on substance use, substance use 

24 disorders, drug overdose deaths, and non-fatal drug 

25 overdoses among workers, and the factors and practices 


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1 that contribute to such use, disorders, and overdoses, in2 cluding occupational injuries and illness as well as occupa3 tional exposure to opioids and other illicit and licit drugs. 

4 ‘‘(d) TRIBAL EPIDEMIOLOGY CENTERS.—There shall 

5 be made available to the Indian Health Service for the 

6 purpose of funding efforts by Indian tribes and tribal epi7 demiology centers to improve data on drug overdose 

8 deaths and non-fatal drug overdoses, surveillance related 

9 to addiction and substance use disorder, and prevention 

10 of childhood trauma, not less than 1.5 percent of the total 

11 amount appropriated under this section for each fiscal 

12 year. 

13 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

14 is authorized to be appropriated to carry out this section— 

15 ‘‘(1) $500,000,000 for fiscal year 2024; 

16 ‘‘(2) $500,000,000 for fiscal year 2025; 

17 ‘‘(3) $500,000,000 for fiscal year 2026; 

18 ‘‘(4) $500,000,000 for fiscal year 2027; 

19 ‘‘(5) $500,000,000 for fiscal year 2028; 

20 ‘‘(6) $500,000,000 for fiscal year 2029; 

21 ‘‘(7) $500,000,000 for fiscal year 2030; 

22 ‘‘(8) $500,000,000 for fiscal year 2031; 

23 ‘‘(9) $500,000,000 for fiscal year 2032; and 

24 ‘‘(10) $500,000,000 for fiscal year 2033. 


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1 ‘‘SEC. 3439. DEFINITIONS. 

2 ‘‘In this title: 

3 ‘‘(1) PLANNING COUNCIL.—The term ‘planning 

4 council’ means the substance use planning council 

5 established under section 3402. 

6 ‘‘(2) RECOVERY RESIDENCE.—The term ‘recov7 ery residence’ means a residential dwelling unit, or 

8 other form of group housing, that is offered or ad9 vertised through any means, including oral, written, 

10 electronic, or printed means, by any individual or en11 tity as a residence that provides an evidence-based, 

12 peer-supported living environment for individuals un13 dergoing any type of substance use disorder treat14 ment or who have received any type of substance use 

15 disorder treatment in the past 3 years, including 

16 medication for addiction treatment. 

17 ‘‘(3) STATE.— 

18 ‘‘(A) IN GENERAL.—The term ‘State’ 

19 means each of the 50 States, the District of Co20 lumbia, and each of the territories. 

21 ‘‘(B) TERRITORIES.—The term ‘territory’ 

22 means each of American Samoa, Guam, the 

23 Commonwealth of Puerto Rico, the Common24 wealth of the Northern Mariana Islands, the 

25 Virgin Islands, the Republic of the Marshall IsVerDate Sep 11 2014 20:19 May 31, 2024 Jkt 049200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\S4286.IS S4286

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1 lands, the Federated States of Micronesia, and 

2 Palau. 

3 ‘‘(4) SUBSTANCE USE DISORDER TREAT4 MENT.— 

5 ‘‘(A) IN GENERAL.—The term ‘substance 

6 use disorder treatment’ means an evidence7 based, professionally directed, deliberate, and 

8 planned regimen including evaluation, observa9 tion, medical monitoring, and rehabilitative 

10 services and interventions such as 

11 pharmacotherapy, mental health services, and 

12 individual and group counseling, on an inpa13 tient or outpatient basis, to help patients with 

14 substance use disorder reach remission and 

15 maintain recovery. 

16 ‘‘(B) TYPES OF TREATMENT.—Substance 

17 use disorder treatments shall include the fol18 lowing: 

19 ‘‘(i) Clinical stabilization services, 

20 which are evidence-based services provided 

21 in secure, acute care facilities (which may 

22 be referred to as ‘addictions receiving fa23 cilities’) that, at a minimum— 

24 ‘‘(I) provide intoxication manage25 ment and stabilization services; 


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1 ‘‘(II) are operated 24 hours per 

2 day, 7 days per week; and 

3 ‘‘(III) that serve individuals 

4 found to be substance use impaired. 

5 These can also be referred to as ‘Ad6 dictions receiving facilities’. 

7 ‘‘(ii) Withdrawal management and de8 toxification, which is a medical service that 

9 is provided on an inpatient or an out10 patient basis to assist an individual in 

11 managing the process of withdrawal from 

12 the physiological and psychological effects 

13 of substance use disorder. 

14 ‘‘(iii) All outpatient, residential, and 

15 inpatient services described in section 

16 1915(l)(4)(C) of the Social Security Act. 

17 ‘‘(C) LIMITATION.—Substance use disorder 

18 treatment providers shall not include— 

19 ‘‘(i) prevention only providers; and 

20 ‘‘(ii) a private practitioner who is li21 censed by a State licensing board and 

22 whose practice is limited to non-intensive 

23 outpatient care. 

24 ‘‘(5) SUBSTANCE USE DISORDER TREATMENT

25 SERVICES.—The term ‘substance use disorder treatVerDate Sep 11 2014 20:19 May 31, 2024 Jkt 049200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\S4286.IS S4286

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1 ment services’ means any prevention services, core 

2 medical services, recovery and support services, early 

3 intervention services, and harm reduction services 

4 authorized under this title.’’. 

5 SEC. 4. AMENDMENTS TO THE CONTROLLED SUBSTANCES 

6 ACT. 

7 (a) CERTIFICATIONS.—Part C of the Controlled Sub8 stances Act (21 U.S.C. 821 et seq.) is amended by adding 

9 at the end the following: 

10 ‘‘CERTIFICATIONS RELATING TO DIVERSION CONTROLS

11 AND MISBRANDING

12 ‘‘SEC. 313. (a) DEFINITIONS.—In this section— 

13 ‘‘(1) the term ‘covered dispenser’— 

14 ‘‘(A) means a dispenser— 

15 ‘‘(i) that is required to register under 

16 section 302(a)(2); and 

17 ‘‘(ii) dispenses a controlled substance 

18 in schedule II; and 

19 ‘‘(B) does not include a dispenser that is— 

20 ‘‘(i) registered to dispense opioid 

21 agonist treatment medication under section 

22 303(h)(1); and 

23 ‘‘(ii) operating in that capacity; 

24 ‘‘(2) the term ‘covered distributor’ means a dis25 tributor— 


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1 ‘‘(A) that is required to register under sec2 tion 302(a)(1); and 

3 ‘‘(B) distributes a controlled substance in 

4 schedule II; 

5 ‘‘(3) the term ‘covered manufacturer’ means a 

6 manufacturer— 

7 ‘‘(A) that is required to register under sec8 tion 302(a)(1); and 

9 ‘‘(B) manufactures a controlled substance 

10 in schedule II; 

11 ‘‘(4) the term ‘covered officer’, with respect to 

12 a covered person means— 

13 ‘‘(A) in the case of a covered person that 

14 is not an individual— 

15 ‘‘(i) the chief executive officer of the 

16 covered person; 

17 ‘‘(ii) the president of the covered per18 son; 

19 ‘‘(iii) the chief medical officer of the 

20 covered person; or 

21 ‘‘(iv) the chief counsel of the covered 

22 person; and 

23 ‘‘(B) in the case of a covered person that 

24 is an individual, that individual; and 

25 ‘‘(5) the term ‘covered person’ means— 


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1 ‘‘(A) a covered dispenser; 

2 ‘‘(B) a covered distributor; or 

3 ‘‘(C) a covered manufacturer. 

4 ‘‘(b) CERTIFICATIONS RELATING TO DIVERSION

5 CONTROLS.—Not later than 180 days after the date of 

6 enactment of this section, and each year thereafter, each 

7 covered officer of a covered person shall submit to the At8 torney General, for each controlled substance in schedule 

9 II dispensed, distributed, or manufactured by the covered 

10 person, a certification— 

11 ‘‘(1) signed by the covered officer; and 

12 ‘‘(2) certifying that— 

13 ‘‘(A) the covered person maintains effective 

14 controls against diversion of the controlled sub15 stance into channels other than legitimate med16 ical, scientific, research, or industrial channels; 

17 ‘‘(B) all information contained in any 

18 record, inventory, or report required to be kept 

19 or submitted to the Attorney General by the 

20 covered person under section 307, or under any 

21 regulation issued under that section, is accu22 rate; and 

23 ‘‘(C) the covered person is in compliance 

24 with all applicable requirements under Federal 


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1 law relating to reporting suspicious orders for 

2 controlled substances. 

3 ‘‘(c) CERTIFICATIONS RELATING TO MIS4 BRANDING.— 

5 ‘‘(1) IN GENERAL.—Not later than 180 days 

6 after the date of enactment of this section, and each 

7 year thereafter, each covered officer of a covered 

8 manufacturer shall submit to the Secretary, for each 

9 controlled substance in schedule II manufactured by 

10 the covered manufacturer, a certification— 

11 ‘‘(A) signed by the covered officer; and 

12 ‘‘(B) certifying that the controlled sub13 stance is not misbranded, as described in sec14 tion 502 of the Federal Food, Drug, and Cos15 metic Act (21 U.S.C. 352). 

16 ‘‘(2) NOTIFICATION TO THE ATTORNEY GEN17 ERAL.— 

18 ‘‘(A) FAILURE TO SUBMIT CERTIFI19 CATIONS.—Not later than 30 days after the 

20 date on which a covered officer of a covered 

21 manufacturer is required to submit a certifi22 cation under paragraph (1) and fails to do so, 

23 the Secretary shall notify the Attorney General 

24 of the failure by the covered officer to submit 

25 the certification. 


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1 ‘‘(B) FALSE CERTIFICATIONS RELATING

2 TO MISBRANDING.—Not later than 30 days 

3 after the date on which the Secretary becomes 

4 aware that a certification submitted under 

5 paragraph (1) contains a materially false state6 ment or representation relating to the mis7 branding of a controlled substance with respect 

8 to the year for which the certification is sub9 mitted, the Secretary shall notify the Attorney 

10 General that the certification contains the ma11 terially false statement or representation.’’. 

12 (b) OFFENSES.—Part D of title II of the Controlled 

13 Substances Act (21 U.S.C. 841 et seq.) is amended by 

14 adding at the end the following: 

15 ‘‘CERTIFICATIONS BY COVERED OFFICERS

16 ‘‘SEC. 424. (a) DEFINITIONS.—In this section, the 

17 terms ‘covered dispenser’, ‘covered distributor’, ‘covered 

18 manufacturer’, ‘covered officer’, and ‘covered person’ have 

19 the meanings given those terms in section 313. 

20 ‘‘(b) OFFENSES.— 

21 ‘‘(1) FAILURE TO SUBMIT CERTIFICATIONS.— 

22 ‘‘(A) CERTIFICATIONS RELATING TO DI23 VERSION CONTROLS.—It shall be unlawful for a 

24 covered officer of a covered person to fail to 

25 submit a certification required under section 


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1 313(b), without regard to the state of mind of 

2 the covered officer. 

3 ‘‘(B) CERTIFICATIONS RELATING TO MIS4 BRANDING.—It shall be unlawful for a covered 

5 officer of a covered manufacturer to fail to sub6 mit a certification required under section 

7 313(c)(1), without regard to the state of mind 

8 of the covered officer. 

9 ‘‘(2) SUBMISSION OF FALSE CERTIFICATIONS.— 

10 ‘‘(A) FALSE CERTIFICATIONS RELATING TO

11 DIVERSION CONTROLS.—It shall be unlawful for 

12 a covered officer of a covered person to submit 

13 a certification required under section 313(b), 

14 without regard to the state of mind of the cov15 ered officer, that contains a materially false 

16 statement or representation relating to the in17 formation required to be certified under that 

18 section for the year for which the certification 

19 is submitted. 

20 ‘‘(B) FALSE CERTIFICATIONS RELATING

21 TO MISBRANDING.—It shall be unlawful for a 

22 covered officer of a covered manufacturer to 

23 submit a certification required under section 

24 313(c)(1), without regard to the state of mind 

25 of the covered officer, that contains a materially 


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1 false statement or representation relating to the 

2 misbranding of a controlled substance with re3 spect to the year for which the certification is 

4 submitted. 

5 ‘‘(c) PENALTIES.— 

6 ‘‘(1) CIVIL PENALTIES.—Except as provided in 

7 paragraph (2), a covered officer who violates sub8 section (b) shall be subject to a civil penalty of not 

9 more than $25,000. 

10 ‘‘(2) CRIMINAL PENALTIES.—A covered officer 

11 who knowingly violates subsection (b)(2) shall be 

12 subject to criminal penalties under section 403(d). 

13 ‘‘(d) COMPREHENSIVE ADDICTION RESOURCES

14 FUND.— 

15 ‘‘(1) ESTABLISHMENT.—There is established in 

16 the Treasury a fund to be known as the ‘Com17 prehensive Addiction Resources Fund’. 

18 ‘‘(2) TRANSFER OF AMOUNTS.—There shall be 

19 transferred to the Comprehensive Addiction Re20 sources Fund 100 percent of— 

21 ‘‘(A) any civil penalty paid to the United 

22 States under this section; and 

23 ‘‘(B) any fine paid to the United States 

24 under section 403(d) for a knowing violation of 

25 subsection (b)(2) of this section. 


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1 ‘‘(3) AVAILABILITY AND USE OF FUNDS.— 

2 Amounts transferred to the Comprehensive Addic3 tion Fund under paragraph (2) shall— 

4 ‘‘(A) remain available until expended; and 

5 ‘‘(B) be made available to supplement 

6 amounts appropriated to carry out title XXXIV 

7 of the Public Health Service Act.’’. 

8 (c) CRIMINAL PENALTIES.—Section 403 of the Con9 trolled Substances Act (21 U.S.C. 843) is amended— 

10 (1) in subsection (d)(1)— 

11 (A) by inserting ‘‘or knowingly violates sec12 tion 424(b)(2)’’ after ‘‘any person who violates 

13 this section’’; and 

14 (B) by striking ‘‘violation of this section’’ 

15 and inserting ‘‘such a violation’’; and 

16 (2) in subsection (f)— 

17 (A) in paragraph (1), by striking ‘‘or 416’’ 

18 and inserting ‘‘or section 416, or knowing viola19 tions of section 424(b)(2)’’; and 

20 (B) in paragraph (3), by inserting ‘‘or 

21 knowing violations of section 424(b)(2)’’ before 

22 the period at the end. 

23 (d) TECHNICAL AND CONFORMING AMENDMENTS.— 

24 The table of contents for the Comprehensive Drug Abuse 


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1 Prevention and Control Act of 1970 (Public Law 91–513; 

2 84 Stat. 1236) is amended— 

3 (1) by inserting after the item relating to sec4 tion 311 the following: 

‘‘Sec. 312. Suspicious orders. 

‘‘Sec. 313. Certifications relating to diversion controls and misbranding.’’; 

5 and 

6 (2) by inserting after the item relating to sec7 tion 423 the following: 

‘‘Sec. 424. Certifications by covered officers.’’. 

8 (e) EFFECTIVE DATE.—The amendments made by 

9 subsections (b) and (c) of this section shall take effect on 

10 the date that is 180 days after the date of enactment of 

11 this Act. 

12 SEC. 5. GENERAL LIMITATION ON USE OF FUNDS. 

13 Amounts appropriated or provided under this Act, or 

14 an amendment made by this Act— 

15 (1) shall be used only for the public health pur16 poses described in this Act (including the amend17 ments made by this Act); and 

18 (2) shall not be used to— 

19 (A) fund the incarceration, institutionaliza20 tion, or involuntary treatment of individuals to 

21 address the illicit use of substances; or 

22 (B) procure equipment or support activi23 ties inconsistent with the public health purposes 


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1 described in this Act (including the amend2 ments made by this Act). 

3 SEC. 6. FEDERAL DRUG DEMAND REDUCTION ACTIVITIES. 

4 (a) PUBLICATION OF LIST.— 

5 (1) AMENDMENT.—Section 705(f) of the Office 

6 of National Drug Control Policy Reauthorization Act 

7 of 1998 (21 U.S.C. 1704(f)) is amended by inserting 

8 at the end the following new paragraph: 

9 ‘‘(5) PUBLICATION OF LIST.—The Director 

10 shall publish online a complete list of all drug con11 trol program grant programs and any other relevant 

12 information included in the system developed under 

13 paragraph (1).’’. 

14 (2) DEADLINE AND FREQUENCY.—Not later 

15 than one year after the date of the enactment of this 

16 Act, and annually thereafter, the Director of Na17 tional Drug Control Policy shall publish the list re18 quired under section 705(f)(5) of the National Drug 

19 Control Act of 1998, as added by paragraph (1). 

20 (b) NATIONAL DRUG CONTROL STRATEGY.—Section 

21 706(c)(1) of the National Drug Control Act of 1998 (21 

22 U.S.C. 1705(c)(1)) is amended by adding at the end the 

23 following new subparagraph: 


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1 ‘‘(O) A review of all federally funded de2 mand reduction activities, including an evalua3 tion of— 

4 ‘‘(i) the effectiveness of those activi5 ties; 

6 ‘‘(ii) the contribution of those activi7 ties to demand reduction activities funded 

8 by State, local, and Tribal governments; 

9 and 

10 ‘‘(iii) whether any duplication or inef11 ficiency in federally funded demand reduc12 tion activities needs to be addressed.’’. 

Æ 


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