II 

118TH CONGRESS 

2D SESSION S. 4430 

To amend title XIX of the Social Security Act to establish a Health Engagement Hub demonstration program to increase access to treatment for 

opiate use disorder and other drug use treatment, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 23, 2024 

Ms. CANTWELL (for herself and Mr. CASSIDY) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to establish 

a Health Engagement Hub demonstration program to 

increase access to treatment for opiate use disorder and 

other drug use treatment, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Fatal Overdose Reduc5 tion Act of 2024’’. 


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1 SEC. 2. HEALTH ENGAGEMENT HUB DEMONSTRATION PRO2 GRAM UNDER MEDICAID. 

3 Section 1903 of the Social Security Act (42 U.S.C. 

4 1396b) is amended by adding at the end the following new 

5 subsection: 

6 ‘‘(cc) HEALTH ENGAGEMENT HUB DEMONSTRATION

7 PROGRAM.— 

8 ‘‘(1) AUTHORITY.—The Secretary shall conduct 

9 a demonstration program (referred to in this sub10 section as the ‘demonstration program’) for the pur11 pose of increasing access to treatment for opiate use 

12 disorder and other drug use treatment through the 

13 establishment of Health Engagement Hubs that 

14 meet the criteria published by the Secretary under 

15 paragraph (2)(A). 

16 ‘‘(2) PUBLICATION OF GUIDANCE.—Not later 

17 than 6 months after the date of enactment of this 

18 subsection, the Secretary shall publish the following: 

19 ‘‘(A) CERTIFICATION CRITERIA.—The cri20 teria described in paragraph (3) for an organi21 zation to be certified by a State as a Health 

22 Engagement Hub for purposes of participating 

23 in the demonstration program. 

24 ‘‘(B) PROSPECTIVE PAYMENT SYSTEM.— 

25 Guidance for States selected to participate in 

26 the demonstration program to use to establish 


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1 a prospective payment system for services per2 mitted under paragraph (3)(B) that are pro3 vided by a certified Health Engagement Hub 

4 participating in the demonstration program. 

5 ‘‘(3) CRITERIA FOR CERTIFICATION OF HEALTH

6 ENGAGEMENT HUBS.— 

7 ‘‘(A) GENERAL REQUIREMENTS.—In order 

8 to be certified as a Health Engagement Hub, 

9 an organization shall— 

10 ‘‘(i) demonstrate that the organization 

11 is able to serve as an all-in-one location 

12 where individuals who are eligible for med13 ical assistance under a State plan under 

14 this title or under a waiver of such plan 

15 who seek treatment for opiate use disorder 

16 or other drug use may access a range of 

17 social and medical services, in a drop-in 

18 manner and without prior appointment or 

19 proof of payment; 

20 ‘‘(ii) provide the services specified in 

21 subparagraph (B) (in a manner reflecting 

22 person-centered care) which, if not avail23 able directly through the organization, 

24 shall be provided through formal relation25 ships with other providers; 


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1 ‘‘(iii) demonstrate that in selecting 

2 the location for the Health Engagement 

3 Hub, the organization prioritized place4 ment in communities disproportionately 

5 impacted by overdose, health issues, and 

6 other harms related to drug use, as well as 

7 areas that are medically underserved, 

8 rural, geographically isolated areas, tribal 

9 areas, or urban centers with under10 resourced behavioral health infrastructure, 

11 including disadvantaged communities 

12 based on race, individuals experiencing 

13 homelessness, and communities negatively 

14 impacted by the criminal-legal system; 

15 ‘‘(iv) give priority to establishing or 

16 adopting evidence-based models to increase 

17 engagement or improve outcomes for indi18 viduals with active, ongoing substance use, 

19 such as social work empowerment models 

20 approved by the Secretary, motivational 

21 interviewing models approved by the Sec22 retary, or shared decision making models 

23 approved by the Secretary; and 

24 ‘‘(v) meet— 


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1 ‘‘(I) the minimum staffing re2 quirements described in subparagraph 

3 (C); 

4 ‘‘(II) the experience requirement 

5 described in subparagraph (D); and 

6 ‘‘(III) the community advisory 

7 board requirement described in sub8 paragraph (E). 

9 ‘‘(B) SCOPE OF SERVICES.—The services 

10 specified in this subparagraph are the following: 

11 ‘‘(i) REQUIRED SERVICES.— 

12 ‘‘(I) Harm reduction services and 

13 supplies provided directly by the orga14 nization or under an arrangement 

15 with an organization that offers harm 

16 reduction services (which may include 

17 a syringe service program, a Feder18 ally-qualified health center, a commu19 nity health center, a Tribal health 

20 program, or an opioid treatment pro21 gram that offers such services), that 

22 include— 

23 ‘‘(aa) overdose education 

24 and naloxone distribution; 


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1 ‘‘(bb) safer drug use edu2 cation and supplies; 

3 ‘‘(cc) safer-sex supplies; 

4 ‘‘(dd) emotional support and 

5 counseling services to reduce 

6 harms associated with substance 

7 use, including trauma-informed 

8 care; and 

9 ‘‘(ee) access or referral to 

10 medications and drugs approved 

11 by the Food and Drug Adminis12 tration for treatment of opioid 

13 use disorder with a strong evi14 dence base of significantly reduc15 ing mortality (such as methadone 

16 and buprenorphine) and other 

17 substances, including stimulants, 

18 within 4 hours. 

19 ‘‘(II) Substance use disorder 

20 screening and brief intervention. 

21 ‘‘(III) Patient-centered and pa22 tient-driven physical and behavioral 

23 health care that has walk-in avail24 ability, is offered during non-tradiVerDate Sep 11 2014 20:52 Jul 16, 2024 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4430.IS S4430

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1 tional hours, including evenings and 

2 weekends, and includes— 

3 ‘‘(aa) shared decision mak4 ing for patients and providers for 

5 opioid use disorder, stimulant use 

6 disorder, or both, under which a 

7 patient and provider discuss the 

8 patient’s diagnosis and condition 

9 together and evaluate treatment 

10 options together; 

11 ‘‘(bb) primary mental health 

12 and substance use disorder serv13 ices, including screening, assess14 ment, and referrals to higher lev15 els of care; 

16 ‘‘(cc) wound care; 

17 ‘‘(dd) infectious disease vac18 cination, screening, testing, and, 

19 to the extent practicable, treat20 ment (including for HIV, sexually 

21 transmitted infections, and hepa22 titis testing and treatment); 

23 ‘‘(ee) access or referral to 

24 sexual and reproductive health 

25 services; 


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1 ‘‘(ff) assessment and linkage 

2 or referrals to psychiatric serv3 ices and other specialty care; and 

4 ‘‘(gg) secure medication 

5 storage and inventory policies 

6 and procedures for patients expe7 riencing homelessness or housing 

8 insecurity. 

9 ‘‘(IV) Care coordination, complex 

10 case management, and other case 

11 management, care navigation, and 

12 care coordination services that may 

13 include— 

14 ‘‘(aa) education and assist15 ance with obtaining housing, 

16 transportation, and other public 

17 assistance benefits, including en18 rollment in the State plan under 

19 this title or under a waiver of 

20 such plan; 

21 ‘‘(bb) identification services 

22 (such as assistance with obtain23 ing a government-recognized 

24 form of identification); 


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1 ‘‘(cc) employment coun2 seling; 

3 ‘‘(dd) recovery support coun4 seling; 

5 ‘‘(ee) family reunification 

6 services; and 

7 ‘‘(ff) criminal-legal services. 

8 ‘‘(V) All services that may be 

9 provided under the Outreach Site/ 

10 Street Place of Service code (POS 

11 Code 27 as of October 1, 2023) (or a 

12 successor place of service code). 

13 ‘‘(VI) Community health out14 reach and navigation services to en15 gage with and conduct outreach to 

16 community members that is provided 

17 by outreach and engagement staff de18 scribed in subparagraph (C)(i)(IV). 

19 ‘‘(ii) OPTIONAL SERVICES.— 

20 ‘‘(I) Services and supplies to 

21 meet basic needs, including food, 

22 clothing, and hygiene supplies. 

23 ‘‘(II) Evidence-based and cul24 turally appropriate behavioral health 

25 services. 


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1 ‘‘(III) Medication management 

2 for physical and mental health condi3 tions. 

4 ‘‘(C) MINIMUM STAFFING REQUIRE5 MENTS.— 

6 ‘‘(i) IN GENERAL.—The minimum 

7 staffing requirements specified in this sub8 paragraph are the following: 

9 ‘‘(I) At least 1 part-time or full10 time health care provider who is li11 censed to practice in the State and is 

12 licensed, registered, or otherwise per13 mitted, by the United States to pre14 scribe controlled substances (as de15 fined in section 102 of the Controlled 

16 Substances Act) in the course of pro17 fessional practice. 

18 ‘‘(II) At least 1 part-time or full19 time registered professional nurse or 

20 licensed practical nurse who can pro21 vide medication management, medical 

22 case management, care coordination, 

23 wound care, vaccine administration, 

24 and community-based outreach. 


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1 ‘‘(III) At least 1 part-time or 

2 full-time licensed behavioral health 

3 staff who is qualified to assess and 

4 provide counseling and treatment rec5 ommendations for substance use and 

6 mental health diagnoses. 

7 ‘‘(IV) Full-time outreach, en8 gagement, and ongoing care naviga9 tion staff, including peer counselors, 

10 community health workers, and recov11 ery coaches. At least 50 percent of 

12 such staff shall be individuals with a 

13 personal history of drug use. 

14 ‘‘(ii) STAFFING THROUGH ARRANGE15 MENTS WITH PARTNER AGENCIES.—An or16 ganization may enter into an arrangement 

17 with a partner agency, such as a Feder18 ally-qualified health center, to satisfy the 

19 minimum staffing requirements specified 

20 in clause (i). 

21 ‘‘(D) EXPERIENCE.—An organization shall 

22 have a demonstrated history of at least 12 

23 months of service provision to individuals who 

24 use drugs, including those who continue with 


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1 substance use while receiving health and social 

2 services. 

3 ‘‘(E) COMMUNITY ADVISORY BOARD.—An 

4 organization shall have a community advisory 

5 board composed of individuals with a history of 

6 substance use, or who continue with substance 

7 use, that meets, at a minimum, on— 

8 ‘‘(i) a monthly basis, to review pro9 gram utilization data and provide feedback 

10 to the organization; and 

11 ‘‘(ii) on a quarterly basis, with the ex12 ecutives or board of directors of the orga13 nization to provide input on service deliv14 ery and receive feedback on actions taken 

15 based on previous feedback provided by the 

16 community advisory board. 

17 ‘‘(4) PLANNING GRANTS.— 

18 ‘‘(A) IN GENERAL.—Not later than 1 year 

19 after the date of enactment of this subsection, 

20 the Secretary shall award planning grants to 

21 States for the purpose of developing proposals 

22 to participate in the demonstration program. 

23 ‘‘(B) AMOUNT OF GRANT.—The amount of 

24 a grant awarded to a State under this para25 graph shall be sufficient to pay 100 percent of 


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1 the actual costs expended by a State to carry 

2 out the activities required under subparagraph 

3 (C). 

4 ‘‘(C) USE OF FUNDS.—A State awarded a 

5 planning grant under this paragraph shall so6 licit input on the development of a proposal to 

7 participate in the demonstration program from 

8 patients, providers, harm reduction service pro9 viders, social service providers, and other stake10 holders, with respect to— 

11 ‘‘(i) identifying and certifying organi12 zations as Health Engagement Hubs for 

13 purposes of participating in the demonstra14 tion program; and 

15 ‘‘(ii) establishing a prospective pay16 ment system for services provided by a cer17 tified Health Engagement Hub partici18 pating in the demonstration program, in 

19 accordance with the guidance issued under 

20 paragraph (2)(B). 

21 ‘‘(D) FUNDING.—Out of any funds in the 

22 Treasury not otherwise appropriated, there are 

23 appropriated to the Secretary such sums as are 

24 necessary to carry out this paragraph, to re25 main available until expended. 


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1 ‘‘(5) STATE DEMONSTRATION PROGRAMS.— 

2 ‘‘(A) IN GENERAL.—Not later than 2 years 

3 after the date of enactment of this subsection, 

4 the Secretary shall solicit applications solely 

5 from the States awarded a planning grant 

6 under paragraph (4) to participate in the dem7 onstration program. 

8 ‘‘(B) APPLICATION REQUIREMENTS.—An 

9 application to participate in the demonstration 

10 program shall include the following: 

11 ‘‘(i) A description of, including the es12 timated number of individuals in, the tar13 get population to be served by the State 

14 under the demonstration program. 

‘‘(ii) An assurance that at least 1 15 ⁄2 of 

16 the Health Engagement Hubs in the State 

17 shall be located in— 

18 ‘‘(I) a county (or a municipality, 

19 if not contained within any county) 

20 where the mean drug overdose death 

21 rate per 100,000 people over the past 

22 3 years for which official data is avail23 able from the State, is higher than 

24 the most recent available national av25 erage overdose death rate per 100,000 


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1 people, as reported by the Centers for 

2 Disease Control and Prevention; or 

3 ‘‘(II) an area of the State that is 

4 designated under section 332(a)(1)(A) 

5 of the Public Health Service Act as a 

6 mental health professional shortage 

7 area. 

8 ‘‘(iii) A description of the prospective 

9 payment system that is to be tested under 

10 the demonstration program. 

11 ‘‘(iv) A list of the certified Health En12 gagement Hubs located in the State that 

13 will participate in the demonstration pro14 gram. 

15 ‘‘(v) Verification that each such cer16 tified Health Engagement Hub satisfies 

17 the requirements described in paragraph 

18 (3)(A). 

19 ‘‘(vi) A description of the scope of the 

20 services that will be paid for under the 

21 prospective payment system (which in22 cludes at a minimum the required services 

23 described in paragraph (3)(B)(i)) that is to 

24 be tested under the demonstration pro25 gram. 


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1 ‘‘(vii) Verification that the State has 

2 agreed to pay for such services at the at 

3 the rate established under the prospective 

4 payment system. 

5 ‘‘(viii) Any other information that the 

6 Secretary may require relating to the dem7 onstration program with respect to deter8 mining the soundness of the proposed pro9 spective payment system. 

10 ‘‘(C) SELECTION CRITERIA.— 

11 ‘‘(i) IN GENERAL.—The Secretary 

12 shall select from among the applications 

13 submitted at least 10 States to participate 

14 in the demonstration program based on ge15 ographic and demographic diversity. 

16 ‘‘(ii) PRIORITY.—In addition to the 

17 criteria specified in clause (i), the Sec18 retary shall prioritize selecting States with 

19 the highest rates of opioid- or stimulant-in20 volved overdose death rates. 

21 ‘‘(D) LENGTH OF DEMONSTRATION PRO22 GRAMS.—A State selected to participate in the 

23 demonstration program shall participate in the 

24 program for a 2-year period. 


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1 ‘‘(E) WAIVER OF CERTAIN REQUIRE2 MENTS.—The Secretary shall waive section 

3 1902(a)(1) (relating to statewideness), section 

4 1902(a)(10)(B) (relating to comparability), and 

5 any other provision of this title which would be 

6 directly contrary to the authority under this 

7 subsection as may be necessary for a State to 

8 participate in the demonstration program in ac9 cordance with this paragraph. 

10 ‘‘(F) PAYMENTS TO STATES.— 

11 ‘‘(i) IN GENERAL.—The Secretary 

12 shall pay a State participating in the dem13 onstration program the Federal matching 

14 percentage specified in clause (ii) for 

15 amounts expended by the State for medical 

16 assistance for services provided through 

17 certified Health Engagement Hubs to indi18 viduals enrolled under the State plan (or 

19 under a waiver of such plan) consisting of 

20 medications and drugs approved by the 

21 Food and Drug Administration for treat22 ment of opioid use disorder and other sub23 stances, including stimulants, and the serv24 ices specified by the State in its application 

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1 tablished under the prospective payment 

2 system established by the State for pur3 poses of the demonstration program. 

4 ‘‘(ii) FEDERAL MATCHING PERCENT5 AGE.—The Federal matching percentage 

6 specified in this clause is— 

7 ‘‘(I) with respect to medical as8 sistance described in clause (i) that is 

9 furnished to a newly eligible individual 

10 described in paragraph (2) of section 

11 1905(y), the matching rate applicable 

12 under paragraph (1) of that section; 

13 and 

14 ‘‘(II) with respect to medical as15 sistance described in clause (i) that is 

16 furnished to an individual who is not 

17 a newly eligible individual (as so de18 scribed), but who is eligible for med19 ical assistance under the State plan 

20 under this title or under a waiver of 

21 such plan, the enhanced FMAP appli22 cable to the State under section 

23 2105(b). 

24 ‘‘(iii) APPLICATION.—Payments to 

25 States made under this subparagraph shall 


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1 be considered to have been made under, 

2 and are subject to, the requirements of this 

3 section. 

4 ‘‘(6) REPORTS.— 

5 ‘‘(A) ANNUAL STATE REPORTS.— 

6 ‘‘(i) IN GENERAL.—Each State se7 lected to participate in the demonstration 

8 program under paragraph (5) shall submit 

9 an annual report to the Secretary on the 

10 demonstration program that includes the 

11 following: 

12 ‘‘(I) An assessment of the extent 

13 to which Health Engagement Hubs 

14 funded under the demonstration pro15 gram have increased access to treat16 ment for opiate use disorder and other 

17 drug use treatment, health services 

18 for individuals who use drugs, and 

19 other social services under State plans 

20 under this title or under waivers of 

21 such plans in the area or areas of 

22 States targeted by the demonstration 

23 program compared to other areas of 

24 the State. 


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1 ‘‘(II) An assessment on the im2 pact of Health Engagement Hubs on 

3 reducing opioid and stimulant over4 dose mortality rates and the rate of 

5 adherence to prescribed medication 

6 for opioid use, hospitalization rates, 

7 and housing status for the population 

8 served by a Health Engagement Hub 

9 as compared to populations that are 

10 not served by a Health Engagement 

11 Hub. 

12 ‘‘(III) A description of the suc13 cesses of the demonstration program. 

14 ‘‘(IV) Recommendations for im15 provements to the demonstration pro16 gram, including whether the dem17 onstration program should be contin18 ued, expanded, modified, or termi19 nated. 

20 ‘‘(ii) FUNDING.—Out of any funds in 

21 the Treasury not otherwise appropriated, 

22 there are appropriated such sums as are 

23 necessary, to remain available until ex24 pended, for purposes of making payments 

25 to States for expenditures attributable to 


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1 collecting and reporting the information re2 quired under this subparagraph. 

3 ‘‘(B) REPORTS TO CONGRESS.— 

4 ‘‘(i) IN GENERAL.—The Secretary 

5 shall submit an annual report to Congress 

6 that describes the information, findings, 

7 and recommendations in the annual State 

8 reports submitted to the Secretary under 

9 subparagraph (A). 

10 ‘‘(ii) IMPLEMENTATION EVALUATION

11 RESULTS.—The Secretary shall include 

12 with the first 3 annual reports submitted 

13 by the Secretary under this subparagraph 

14 the findings and conclusions of the imple15 mentation evaluation required by para16 graph (7). 

17 ‘‘(7) IMPLEMENTATION EVALUATION.— 

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

19 solicit public input and fund an implementation 

20 evaluation of the planning grants awarded 

21 under paragraph (4) and the initial set of 

22 States selected for the demonstration program 

23 under paragraph (5) to determine the reach, ef24 fectiveness, adoption, and implementation of the 

25 demonstration program in each such State to 


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1 document the degree to which the services were 

2 implemented as intended and allow for a com3 plete assessment of the impact of the Health 

4 Engagement Hubs in each such State. 

5 ‘‘(B) REQUIREMENTS.— 

6 ‘‘(i) INFORMATION.—The evaluation 

7 shall include information on the character8 istics of the individuals who receive serv9 ices, service utilization metrics over time 

10 (including by staff role), and input from 

11 interviews with such individuals and staff. 

12 ‘‘(ii) ELIGIBLE ENTITIES.—In order 

13 to be eligible to conduct the evaluation, an 

14 entity shall have documented experience 

15 conducting implementation evaluations of 

16 health and social services programs for in17 dividuals who use drugs. 

18 ‘‘(C) FUNDING.—Out of any funds in the 

19 Treasury not otherwise appropriated, there are 

20 appropriated to the Secretary such sums as are 

21 necessary to carry out this paragraph, to re22 main available until expended.’’. 

23 SEC. 3. GOVERNMENT ACCOUNTABILITY OFFICE REPORT. 

24 (a) IN GENERAL.—Not later than 6 months after the 

25 conclusion of the demonstration program established 


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1 under subsection (cc) of section 1903 of the Social Secu2 rity Act (42 U.S.C. 1396b), as added by section 2, the 

3 Comptroller General of the United States shall conduct 

4 and publish a comparative analysis on the impacts of the 

5 health engagement hubs certified under such program (in 

6 this section referred to as ‘‘health engagement hubs’’) 

7 compared to the impacts of other opioid treatment pro8 grams and health care organizations that offer behavioral 

9 health care or substance use disorder services. 

10 (b) CONTENT OF ANALYSIS.—The analysis required 

11 under this section shall include the following: 

12 (1) Data and information analyzing differences 

13 in rates among individuals who receive behavioral 

14 health care or substance use disorder services 

15 through a health engagement hub and among indi16 viduals who receive such care or services through a 

17 program or organization referred to in subsection (a) 

18 for each of the following factors: 

19 (A) Changes in rates of mortality. 

20 (B) Changes in rates of recidivism. 

21 (C) Rates of relapse. 

22 (D) Rates of hospital and emergency de23 partment utilization. 

24 (E) Frequency of visits for care or serv25 ices. 


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1 (F) Rates of successful intervention 

2 through the administration of buprenorphine or 

3 other medication approved by the Food and 

4 Drug Administration for the treatment of sub5 stance use disorder. 

6 (2) Data and information comparing the racial 

7 and socioeconomic demographics, housing status, 

8 employment, and other metrics, as recommended by 

9 the Secretary of Health and Human Services, of the 

10 population groups that receive behavioral health care 

11 or substance use disorder services through a health 

12 engagement hub or through a program or organiza13 tion referred to in subsection (a). 

Æ 


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