I 

118TH CONGRESS 

2D SESSION H. R. 8323 

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 HOUSE OF REPRESENTATIVES 

MAY 8, 2024 

Mr. RASKIN (for himself, Ms. KUSTER, Mr. TRONE, Ms. PETTERSEN, Ms. 

BALINT, Ms. BARRAGA ́N, Mr. BLUMENAUER, Ms. BLUNT ROCHESTER, 

Ms. BONAMICI, Mr. BOWMAN, Ms. BROWN, Ms. BROWNLEY, Ms. BUSH, 

Mr. CA ́RDENAS, Mr. CARSON, Mr. CASAR, Ms. CHU, Mr. CONNOLLY, Ms. 

CROCKETT, Mr. CUELLAR, Mr. DAVIS of Illinois, Ms. DEAN of Pennsylvania, Ms. DEGETTE, Mrs. DINGELL, Ms. ESCOBAR, Mr. FROST, Mr. 

GARCI ́A of Illinois, Mr. ROBERT GARCIA of California, Ms. GARCIA of 

Texas, Mr. GOLDMAN of New York, Mr. GOMEZ, Mr. GRIJALVA, Mrs. 

HAYES, Mr. HUFFMAN, Ms. JACKSON LEE, Ms. JAYAPAL, Mr. JOHNSON

of Georgia, Ms. KELLY of Illinois, Mr. KHANNA, Mr. KRISHNAMOORTHI, 

Mr. LARSON of Connecticut, Ms. LEE of California, Ms. LEE of Pennsylvania, Ms. LEGER FERNANDEZ, Mr. LIEU, Mr. LYNCH, Ms. MATSUI, Ms. 

MCCOLLUM, Mr. MCGOVERN, Mr. MEEKS, Ms. MENG, Mr. MFUME, Ms. 

MOORE of Wisconsin, Mr. MORELLE, Mr. MOULTON, Mr. NADLER, Mr. 

NEGUSE, Ms. NORTON, Ms. OCASIO-CORTEZ, Ms. OMAR, Mr. PANETTA, 

Ms. PINGREE, Mr. POCAN, Ms. PORTER, Ms. PRESSLEY, Ms. ROSS, Ms. 

SA ́NCHEZ, Mr. SARBANES, Ms. SCANLON, Ms. SCHAKOWSKY, Mr. 

SCHIFF, Ms. SPANBERGER, Ms. STANSBURY, Ms. TITUS, Ms. TLAIB, Ms. 

TOKUDA, Mr. TONKO, Mr. TORRES of New York, Mrs. TRAHAN, Ms. 

UNDERWOOD, Ms. VELA ́ZQUEZ, Ms. WASSERMAN SCHULTZ, and Ms. 

WILLIAMS of Georgia) introduced the following bill; which was referred 

to the Committee on Energy and Commerce, and in addition to the Committees on Natural Resources, the Judiciary, and Oversight and Accountability, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 


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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 

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 


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‘‘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. 

‘‘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 

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1 order, including with co-occurring mental health and sub2 stance use disorders, and their families. 

3 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

4 ACT. 

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

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

7 ‘‘TITLE XXXIV—SUBSTANCE USE 

8 RESOURCES 

9 ‘‘Subtitle A—Local Substance Use 

10 Emergency Relief Grant Program 

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

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

13 grants to eligible localities for the purpose of addressing 

14 substance use within such localities. 

15 ‘‘(b) ELIGIBILITY.— 

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

17 grant under subsection (a) a locality shall— 

18 ‘‘(A) be— 

19 ‘‘(i) a county that can demonstrate 

20 that the rate of drug overdose deaths per 

21 100,000 population in the county during 

22 the most recent 3-year period for which 

23 such data are available was not less than 

24 the rate of such deaths for the county that 


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1 ranked at the 67th percentile of all coun2 ties, as determined by the Secretary; 

3 ‘‘(ii) a county that can demonstrate 

4 that the number of drug overdose deaths 

5 during the most recent 3-year period for 

6 which such data are available was not less 

7 than the number of such deaths for the 

8 county that ranked at the 90th percentile 

9 of all counties, as determined by the Sec10 retary; 

11 ‘‘(iii) a county that encompasses an 

12 undeserved area, defined as a health pro13 fessional shortage area (as defined in sec14 tion 332(a)(1)(A)) and a medically under15 served area (according to a designation 

16 under section 330(b)(3)(A)), that can dem17 onstrate a high burden of both fatal and 

18 non-fatal drug overdoses in a manner de19 termined by the Secretary; or 

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

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

22 that meets the requirements of paragraph 

23 (3); and 

24 ‘‘(B) submit to the Secretary an applica25 tion in accordance with section 3404. 


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

2 the case of an eligible county that is contiguous to 

3 one or more other eligible counties within the same 

4 State, the group of counties shall— 

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

6 county for purposes of a grant under this sec7 tion; 

8 ‘‘(B) submit a single application under sec9 tion 3404; 

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

11 purposes of section 3402); and 

12 ‘‘(D) establish, through intergovernmental 

13 agreements, an administrative mechanism to al14 locate funds and substance use disorder treat15 ment services under the grant based on— 

16 ‘‘(i) the number and rate of drug 

17 overdose deaths and nonfatal drug 

18 overdoses in each of the counties that com19 pose the eligible county; 

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

21 in each such county; and 

22 ‘‘(iii) the health and support per23 sonnel needs of each such county. 

24 ‘‘(3) CITIES AND COUNTIES WITHIN MULTIPLE

25 CONTIGUOUS COUNTIES.— 


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

2 an eligible county described in paragraph (1), 

3 or a county or group of counties that is within 

4 a group of counties determined to be an eligible 

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

6 receive a grant under this section if such city 

7 or county or group of counties meets the re8 quirements of subparagraph (B). 

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

10 meets the requirements of this subparagraph if 

11 such city or county— 

12 ‘‘(i) except as provided in subpara13 graph (C), has a population of not less 

14 than 50,000 residents; 

15 ‘‘(ii) meets the requirements of para16 graph (1)(A); 

17 ‘‘(iii) submits an application under 

18 section 3404; 

19 ‘‘(iv) establishes a planning council 

20 (for purposes of section 3402); and 

21 ‘‘(v) establishes an administrative 

22 mechanism to allocate funds and services 

23 under the grant based on— 


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1 ‘‘(I) the number and rate of drug 

2 overdose deaths and nonfatal drug 

3 overdoses in the city or county; 

4 ‘‘(II) the severity of need for sub5 stance use disorder treatment services 

6 in the city or county; and 

7 ‘‘(III) the health and support 

8 personnel needs of the city or county. 

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

10 county or group of counties that does not meet 

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

12 apply to the Secretary for a waiver of such re13 quirement. Such application shall dem14 onstrate— 

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

16 to be served are distinct or that addressing 

17 substance use in the service area would be 

18 best served by the formation of an inde19 pendent council; and 

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

21 of counties has the capacity to administer 

22 the funding received under this subtitle. 

23 ‘‘(D) MINIMUM FUNDING.—A city or coun24 ty that meets the requirement of this paragraph 

25 and receives a grant under this section shall be 


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1 entitled to an amount of funding under the 

2 grant in an amount that is not less than the 

3 amount determined under section 3403(a) with 

4 respect to such city or county. 

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

6 that are not located within the territory of a county 

7 shall be treated as eligible counties for purposes of 

8 this subtitle. 

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

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

11 governance, the Secretary shall determine the local 

12 political subdivisions within such States that are eli13 gible to receive a grant under this section and such 

14 subdivisions shall be treated as eligible counties for 

15 purposes of this subtitle. 

16 ‘‘(6) DETERMINATIONS WHERE THERE IS A

17 LACK OF DATA.—The Secretary shall establish eligi18 bility and allocation criteria related to the prevalence 

19 of drug overdose deaths, the mortality rate from 

20 drug overdoses, and that provides an equivalent 

21 measure of need for funding for cities and counties 

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

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

24 ‘‘(7) DATA FROM TRIBAL AREAS.—The Sec25 retary, acting through the Indian Health Service, 


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1 shall consult with Indian Tribes and confer with 

2 urban Indian organizations to establish eligibility 

3 and allocation criteria that provide an equivalent 

4 measure of need for Tribal and urban Indian areas 

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

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

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

8 date of enactment of this title, the Comptroller Gen9 eral shall conduct a study to determine whether the 

10 data utilized for purposes of paragraph (1)(A) pro11 vide the most precise measure of local area need re12 lated to substance use and addiction prevalence and 

13 whether additional data would provide more precise 

14 measures of substance use and addiction prevalence 

15 in local areas. Such study shall identify barriers to 

16 collecting or analyzing such data, and make rec17 ommendations for revising the indicators used under 

18 such paragraph to determine eligibility in order to 

19 direct funds to the local areas in most need of fund20 ing to provide assistance related to substance use 

21 and addiction. 

22 ‘‘(9) REFERENCE.—For purposes of this sub23 title, the term ‘eligible local area’ includes— 

24 ‘‘(A) a city or county described in para25 graph (1); 


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1 ‘‘(B) multiple contiguous counties de2 scribed in paragraph (2); 

3 ‘‘(C) cities or counties within multiple con4 tiguous counties described in paragraph (3); 

5 ‘‘(D) an independent city described in 

6 paragraph (4); and 

7 ‘‘(E) a political subdivision described in 

8 paragraph (5). 

9 ‘‘(c) ADMINISTRATION.— 

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

11 under a grant awarded under this section shall be 

12 directed to the chief elected official of the eligible 

13 local area who shall administer the grant funds. 

14 ‘‘(2) MULTIPLE CONTIGUOUS COUNTIES.— 

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

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

17 county described in subsection (b)(2), assist18 ance made available under a grant awarded 

19 under this section shall be directed to the chief 

20 elected official of the particular county des21 ignated in the application submitted for the 

22 grant under section 3404. Such chief elected of23 ficial shall be the administrator of the grant. 

24 ‘‘(B) STATE ADMINISTRATION.—Notwith25 standing subparagraph (A), the eligible county 


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1 described in subsection (b)(2) may elect to des2 ignate the chief elected State official of the 

3 State in which the eligible county is located as 

4 the administrator of the grant funds. 

5 ‘‘SEC. 3402. PLANNING COUNCIL. 

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

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

8 eligible local area shall establish or designate a substance 

9 use disorder treatment and services planning council that 

10 shall— 

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

12 the population of individuals with substance use dis13 order in the area; 

14 ‘‘(2) include individuals with substance use dis15 order, individuals who use drugs, and individuals in 

16 recovery from substance use disorders; and 

17 ‘‘(3) include, to the maximum extent prac18 ticable, representatives of— 

19 ‘‘(A) health care providers, including Fed20 erally-qualified health centers, rural health clin21 ics, Indian health programs as defined in sec22 tion 4 of the Indian Health Care Improvement 

23 Act, urban Indian organizations as defined in 

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1 ment Act, and facilities operated by the Depart2 ment of Veterans Affairs; 

3 ‘‘(B) Native Hawaiian organizations as de4 fined in section 11 of the Native Hawaiian 

5 Health Care Act of 1988; 

6 ‘‘(C) community-based health, harm reduc7 tion, and addiction service organizations, in8 cluding, where applicable, representatives of 

9 Drug Free Communities Coalition grantees; 

10 ‘‘(D) social service providers, including 

11 providers of housing and homelessness services 

12 and recovery residence providers; 

13 ‘‘(E) mental health care providers; 

14 ‘‘(F) local public health agencies; 

15 ‘‘(G) State governments, including the 

16 State Medicaid agency and the Single State 

17 Agency for Substance Abuse Services; 

18 ‘‘(H) local governments; 

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

20 ‘‘(J) substance use disorder treatment pro21 viders, including physician addiction specialists; 

22 ‘‘(K) Indian tribes and tribal organizations 

23 as defined in section 4 of the Indian Self-Deter24 mination and Education Assistance Act; 


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

2 4 of the Indian Health Care Improvement Act; 

3 ‘‘(M) historically underserved groups and 

4 subpopulations; 

5 ‘‘(N) individuals who were formerly incar6 cerated; 

7 ‘‘(O) organizations serving individuals who 

8 are currently incarcerated or in pre-trial deten9 tion or were formerly incarcerated; 

10 ‘‘(P) Federal agencies; 

11 ‘‘(Q) organizations that provide drug pre12 vention programs and services to youth at risk 

13 of substance use; 

14 ‘‘(R) medical examiners or coroners; 

15 ‘‘(S) labor unions and the workplace com16 munity; 

17 ‘‘(T) local fire departments and emergency 

18 medical services; 

19 ‘‘(U) the lesbian, gay, bisexual, 

20 transgender, queer (LGBTQ) community; and 

21 ‘‘(V) certified or accredited addiction re22 covery community organizations. 

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

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

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1 cial of the eligible local area may establish the coun2 cil directly or designate an existing entity to serve as 

3 the council, subject to paragraph (2). 

4 ‘‘(2) CONSIDERATION REGARDING DESIGNATION

5 OF COUNCIL.—In making a determination of wheth6 er to establish or designate a council under para7 graph (1), the chief elected official shall give priority 

8 to the designation of an existing entity that has 

9 demonstrated experience in the provision of health 

10 and support services to individuals with substance 

11 use disorder within the eligible local area, that has 

12 a structure that recognizes the Federal trust respon13 sibility when spending Federal health care dollars, 

14 and that has demonstrated a commitment to re15 specting the obligation of government agencies using 

16 Federal dollars to consult with Indian tribes and 

17 confer with urban Indian organizations. 

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

19 an existing entity is designated to serve as the coun20 cil under this section, the membership of the entity 

21 shall comply with the requirements of subsection 

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

23 in subsection (e). 

24 ‘‘(4) JOINT COUNCIL.—The Secretary shall es25 tablish a process to permit an eligible local area that 


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1 is not contiguous with any other eligible local area 

2 to form a joint planning council with such other eli3 gible local area or areas, as long as such areas are 

4 located in geographical proximity to each other, as 

5 determined by the Secretary, and submit a joint ap6 plication under section 3404. 

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

8 Eligible local areas may form a joint planning coun9 cil with other eligible local areas across State lines 

10 if such areas are located in geographical proximity 

11 to each other, as determined by the Secretary, sub12 mit a joint application under section 3404, and es13 tablish intergovernmental agreements to allow the 

14 administration of the grant across State lines. 

15 ‘‘(c) MEMBERSHIP.—Members of the planning coun16 cil established or designated under subsection (a) shall— 

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

18 open process; 

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

20 and vice chair; 

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

22 Indian tribes located within any eligible local area 

23 that receives funding under the grant program es24 tablished in section 3401; 


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

2 of substance use disorder; 

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

4 nonprofit substance use disorder service provider, at 

5 least 1 representative of an urban Indian organiza6 tion, at least 1 physician addiction specialist, and at 

7 least 1 representative from an organization pro8 viding harm reduction services; 

9 ‘‘(6) include at least 1 representative of a Na10 tive Hawaiian organization (as defined in section 11 

11 of the Native Hawaiian Health Care Act of 1988) 

12 when the Native Hawaiian population exceeds 10 

13 percent; and 

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

15 the planning council. 

16 ‘‘(d) MEMBERSHIP TERMS.—Members of the plan17 ning council established or designated under subsection 

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

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

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

21 designated under subsection (a) shall— 

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

23 grant funds within the eligible local area that em24 phasize reducing drug use rates, overdose, substance 

25 use disorder, and health conditions associated with 


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1 drug use such as human immunodeficiency virus, 

2 hepatitis B, and hepatitis C through evidence-based 

3 interventions in both community and criminal justice 

4 settings and that are based on— 

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

6 use disorder prevention, intervention, treat7 ment, and recovery strategies that comply with 

8 best practices identified by the Secretary; 

9 ‘‘(B) the demonstrated or probable cost-ef10 fectiveness of proposed substance use disorder 

11 prevention, intervention, treatment, and recov12 ery services; 

13 ‘‘(C) the health priorities of the commu14 nities within the eligible local area that are af15 fected by substance use; 

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

17 with substance use disorder; and 

18 ‘‘(E) the availability of other governmental 

19 and non-governmental services; 

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

21 any existing State or local plan regarding the provi22 sion of substance use disorder treatment services to 

23 individuals with substance use disorder; 

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

25 work with local public health agencies to develop a 


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1 comprehensive plan for the organization and delivery 

2 of substance use disorder prevention and treatment 

3 services; 

4 ‘‘(4) regularly assess the efficiency of the ad5 ministrative mechanism in rapidly allocating funds 

6 to support evidence-based substance use disorder 

7 prevention and treatment services in the areas of 

8 greatest need within the eligible local area; 

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

10 determine the size and demographics of the popu11 lation of individuals with substance use disorders 

12 and the types of substance use that are most preva13 lent in the eligible local area; 

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

15 determine the needs of such population, including 

16 the need for substance use disorder prevention, 

17 intervention, treatment, harm reduction, and recov18 ery services; 

19 ‘‘(7) work with local public agencies to deter20 mine the disparities in access to services among af21 fected subpopulations and historically underserved 

22 communities, including infrastructure and capacity 

23 shortcomings of providers that contribute to these 

24 disparities; 


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

2 methods for obtaining input on community needs 

3 and priorities, including by partnering with organi4 zations that serve targeted communities experiencing 

5 high addictive substance-related health disparities to 

6 gather data using culturally attuned data collection 

7 methodologies; 

8 ‘‘(9) coordinate with Federal grantees that pro9 vide substance use disorder prevention and treat10 ment services within the eligible local area; and 

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

12 substance use disorder prevention and treatment 

13 services being supported by the grant received by the 

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

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

16 use, overdose, and death from substance use; 

17 ‘‘(B) rates of discontinuation from sub18 stance use disorder treatment services and rates 

19 of sustained recovery; 

20 ‘‘(C) long-term outcomes among individ21 uals receiving treatment for substance use dis22 orders; 

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

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1 viduals with substance use disorders over their 

2 lifetimes; and 

3 ‘‘(E) reductions in the rates of HIV, hepa4 titis C virus, and other infectious disease trans5 mission among people who use drugs. 

6 ‘‘(f) CONFLICTS OF INTEREST.— 

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

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

9 administration of a grant under section 3401. 

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

11 may serve on the planning council under subsection 

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

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

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

15 individual is a member of a public or private organi16 zation, and such entity or organization is seeking 

17 amounts from a grant under section 3401, the indi18 vidual will not, with respect to the purpose for which 

19 the entity seeks such amounts, participate (directly 

20 or in an advisory capacity) in the process of select21 ing entities to receive such amounts for such pur22 pose. 

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

24 under subsection (a) shall develop procedures for address25 ing grievances with respect to funding under this subtitle, 


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1 including procedures for submitting grievances that can2 not be resolved to binding arbitration. Such procedures 

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

4 ‘‘(h) PUBLIC DELIBERATIONS.— 

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

6 council under subsection (a), in accordance with cri7 teria established by the Secretary, the following ap8 plies: 

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

10 open to the public and shall be held only after 

11 adequate notice to the public. 

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

13 minutes, agenda, or other documents which 

14 were made available to or prepared for or by 

15 the council shall be available for public inspec16 tion and copying at a single location. 

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

18 the council shall be kept. The accuracy of all 

19 minutes shall be certified to by the chair of the 

20 council. 

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

22 apply to any disclosure of information of a personal 

23 nature that would constitute a clearly unwarranted 

24 invasion of personal privacy, including any disclosure 

25 of medical information or personnel matters. 


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

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

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

4 extent practicable, prioritize the distribution of grant 

5 funds to grantees that have— 

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

7 or 

8 ‘‘(ii) an explicit policy not to deter employ9 ees with respect to— 

10 ‘‘(I) labor organizing for the employ11 ees engaged in the covered activities; and 

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

13 and join labor organizations; and 

14 ‘‘(B) policies that require— 

15 ‘‘(i) the posting and maintenance of 

16 notices in the workplace to such employees 

17 of their rights under the National Labor 

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

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

20 beginning of their employment, provided 

21 notice and information regarding the em22 ployees’ rights under such Act; and 

23 ‘‘(iii) the employer to voluntarily rec24 ognize a union in cases where a majority 


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1 of such workers of the employer have 

2 joined and requested representation. 

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

4 apply to Indian tribes. 

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

6 FUNDING AGREEMENT. 

7 ‘‘(a) AMOUNT OF GRANT.— 

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

9 AREA.— 

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

11 subtitle, the Secretary shall make a grant for 

12 each eligible local area for which an application 

13 under section 3404 has been approved. Each 

14 such grant shall be made in an amount deter15 mined in accordance with paragraph (3). 

16 ‘‘(B) EXPEDITED DISTRIBUTION.—Not 

17 later than 90 days after an appropriation be18 comes available to carry out this subtitle for a 

19 fiscal year, the Secretary shall disburse 53 per20 cent of the amount made available under sec21 tion 3406 for carrying out this subtitle for such 

22 fiscal year through grants to eligible local areas 

23 under section 3401, in accordance with sub24 paragraphs (C) and (D). 

25 ‘‘(C) AMOUNT.— 


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1 ‘‘(i) IN GENERAL.—Subject to the ex2 tent of amounts made available in appro3 priations Acts, a grant made for purposes 

4 of this subparagraph to an eligible local 

5 area shall be made in an amount equal to 

6 the product of— 

7 ‘‘(I) an amount equal to the 

8 amount available for distribution 

9 under subparagraph (B) for the fiscal 

10 year involved; and 

11 ‘‘(II) the percentage constituted 

12 by the ratio of the distribution factor 

13 for the eligible local area to the sum 

14 of the respective distribution factors 

15 for all eligible local areas, 

16 which product shall then, as applicable, be 

17 increased under subparagraph (D). 

18 ‘‘(ii) DISTRIBUTION FACTOR.—For 

19 purposes of clause (i)(II), the term ‘dis20 tribution factor’ means— 

21 ‘‘(I) an amount equal to— 

22 ‘‘(aa) the estimated number 

23 of drug overdose deaths in the el24 igible local area, as determined 

25 under clause (iii); or 


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1 ‘‘(bb) the estimated number 

2 of non-fatal drug overdoses in the 

3 eligible local area, as determined 

4 under clause (iv), 

5 as determined by the Secretary based 

6 on which distribution factor (item (aa) 

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

8 area receiving the greatest amount of 

9 funds; or 

10 ‘‘(II) in the case of an eligible 

11 local area for which the data de12 scribed in subclause (I) are not avail13 able, an amount determined by the 

14 Secretary— 

15 ‘‘(aa) based on other data 

16 the Secretary determines appro17 priate; and 

18 ‘‘(bb) that is related to the 

19 prevalence of non-fatal drug 

20 overdoses, drug overdose deaths, 

21 and the mortality rate from drug 

22 overdoses and provides an equiv23 alent measure of need for fund24 ing. 


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1 ‘‘(iii) NUMBER OF DRUG OVERDOSE

2 DEATHS.—The number of drug overdose 

3 deaths determined under this clause for an 

4 eligible county for a fiscal year for pur5 poses of clause (ii) is the number of drug 

6 overdose deaths during the most recent 3- 

7 year period for which such data are avail8 able. 

9 ‘‘(iv) NUMBER OF NON-FATAL DRUG

10 OVERDOSES.—The number of non-fatal 

11 drug overdose deaths determined under 

12 this clause for an eligible county for a fis13 cal year for purposes of clause (ii) may be 

14 determined by using data including emer15 gency department syndromic data, visits, 

16 other emergency medical services for drug17 related causes, or Overdose Detection Map18 ping Application Program (ODMAP) data 

19 during the most recent 3-year period for 

20 which such data are available. 

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

22 after the date of enactment of this title, 

23 the Comptroller General shall conduct a 

24 study to determine whether the data uti25 lized for purposes of clause (ii) provide the 


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1 most precise measure of local area need re2 lated to substance use and addiction preva3 lence in local areas and whether additional 

4 data would provide more precise measures 

5 of substance use and addiction prevalence 

6 in local areas. Such study shall identify 

7 barriers to collecting or analyzing such 

8 data, and make recommendations for revis9 ing the distribution factors used under 

10 such clause to determine funding levels in 

11 order to direct funds to the local areas in 

12 most need of funding to provide substance 

13 use disorder treatment services. 

14 ‘‘(vi) REDUCTIONS IN AMOUNTS.—If a 

15 local area that is an eligible local area for 

16 a year loses such eligibility in a subsequent 

17 year based on the failure to meet the re18 quirements of paragraph (1)(A) or (6) of 

19 section 3401(b), such area will remain eli20 gible to receive— 

21 ‘‘(I) for such subsequent year, an 

22 amount equal to 80 percent of the 

23 amount received under the grant in 

24 the previous year; and 


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1 ‘‘(II) for the second such subse2 quent year, an amount equal to 50 

3 percent of the amount received in the 

4 previous year. 

5 ‘‘(2) SUPPLEMENTAL GRANTS.— 

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

7 disburse the remainder of amounts not dis8 bursed under paragraph (1) for such fiscal year 

9 for the purpose of making grants to cities and 

10 counties whose application under section 

11 3404— 

12 ‘‘(i) contains a report concerning the 

13 dissemination of emergency relief funds 

14 under paragraph (1) and the plan for utili15 zation of such funds, if applicable; 

16 ‘‘(ii) demonstrates the need in such 

17 local area, on an objective and quantified 

18 basis, for supplemental financial assistance 

19 to combat substance use disorder; 

20 ‘‘(iii) demonstrates the existing com21 mitment of local resources of the area, 

22 both financial and in-kind, to preventing, 

23 treating, and managing substance use dis24 order and supporting sustained recovery; 


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1 ‘‘(iv) demonstrates the ability of the 

2 area to utilize such supplemental financial 

3 resources in a manner that is immediately 

4 responsive and cost effective; 

5 ‘‘(v) demonstrates that resources will 

6 be allocated in accordance with the local 

7 demographic incidence of substance use 

8 disorders and drug overdose mortality; 

9 ‘‘(vi) demonstrates the inclusiveness of 

10 affected communities and individuals with 

11 substance use disorders, including those 

12 communities and individuals that are dis13 proportionately affected or historically un14 derserved; 

15 ‘‘(vii) demonstrates the manner in 

16 which the proposed services are consistent 

17 with the local needs assessment and the 

18 State plan approved by the Secretary pur19 suant to section 1932(b); 

20 ‘‘(viii) demonstrates success in identi21 fying individuals with substance use dis22 orders; and 

23 ‘‘(ix) demonstrates that support for 

24 substance use disorder prevention and 

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1 mize the value to the population to be 

2 served with an appropriate mix of sub3 stance use disorder prevention and treat4 ment services and attention to transition in 

5 care. 

6 ‘‘(B) AMOUNT.— 

7 ‘‘(i) IN GENERAL.—The amount of 

8 each grant made for purposes of this para9 graph shall be determined by the Sec10 retary. In making such determination, the 

11 Secretary shall consider— 

12 ‘‘(I) the rate of drug overdose 

13 deaths per 100,000 population in the 

14 eligible local area; and 

15 ‘‘(II) the increasing need for sub16 stance use disorder treatment serv17 ices, including relative rates of in18 crease in the number of drug 

19 overdoses or drug overdose deaths, or 

20 recent increases in drug overdoses or 

21 drug overdose deaths since data were 

22 provided under section 3401(b), if ap23 plicable. 

24 ‘‘(ii) DEMONSTRATED NEED.—The 

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1 termining whether a local area has a dem2 onstrated need for purposes of clause 

3 (i)(II) may include any or all of the fol4 lowing: 

5 ‘‘(I) The unmet need for sub6 stance use disorder treatment serv7 ices, including factors identified in 

8 clause (i)(II). 

9 ‘‘(II) Relative rates of increase in 

10 the number of drug overdoses or drug 

11 overdose deaths. 

12 ‘‘(III) The relative rates of in13 crease in the number of drug 

14 overdoses or drug overdose deaths 

15 within new or emerging subpopula16 tions. 

17 ‘‘(IV) The current prevalence of 

18 substance use disorders. 

19 ‘‘(V) Relevant factors related to 

20 the cost and complexity of delivering 

21 substance use disorder treatment serv22 ices to individuals in the eligible local 

23 area. 

24 ‘‘(VI) The impact of co-morbid 

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1 tions, determined relevant by the Sec2 retary. 

3 ‘‘(VII) The prevalence of home4 lessness among individuals with sub5 stance use disorders. 

6 ‘‘(VIII) The relevant factors that 

7 limit access to health care, including 

8 geographic variation, adequacy of 

9 health insurance coverage, and lan10 guage barriers. 

11 ‘‘(IX) The impact of a decline in 

12 the amount received pursuant to para13 graph (1) on substance use disorder 

14 treatment services available to all in15 dividuals with substance use disorders 

16 identified and eligible under this sub17 title. 

18 ‘‘(X) The increasing incidence in 

19 conditions related to substance use, 

20 including hepatitis C, human immuno21 deficiency virus, hepatitis B and other 

22 infections associated with injection 

23 drug use. 


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1 ‘‘(C) APPLICATION OF PROVISIONS.—A 

2 local area that receives a grant under this para3 graph— 

4 ‘‘(i) shall use amounts received in ac5 cordance with subsection (b); 

6 ‘‘(ii) shall not have to meet the eligi7 ble criteria in section 3401(b); and 

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

9 planning council under section 3402. 

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 3406 for each fiscal year to provide for20 mula funds to Indian tribes disproportionately 

21 affected by substance use, in an amount deter22 mined pursuant to a formula and eligibility cri23 teria developed by the Secretary in consultation 

24 with Indian tribes, for the purposes of address25 ing 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. An Indian tribe 

14 shall not be required to allocate funds and serv15 ices in accordance with the goals, priorities, or 

16 objectives established by a planning council 

17 under section 3402. 

18 ‘‘(b) USE OF AMOUNTS.— 

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

20 make a grant under section 3401 to an eligible local 

21 area unless the chief elected official of the area 

22 agrees that— 

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

24 within the area under the grant will be made in 


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1 accordance with the priorities established by the 

2 planning council; and 

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

4 be expended for— 

5 ‘‘(i) prevention services described in 

6 paragraph (3); 

7 ‘‘(ii) core medical services described in 

8 paragraph (4); 

9 ‘‘(iii) recovery and support services 

10 described in paragraph (5); 

11 ‘‘(iv) early intervention services de12 scribed in paragraph (6); 

13 ‘‘(v) harm reduction services described 

14 in paragraph (7); 

15 ‘‘(vi) financial assistance with health 

16 insurance described in paragraph (8); and 

17 ‘‘(vii) administrative expenses de18 scribed in paragraph (9). 

19 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 

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

21 shall use amounts received under a grant under 

22 section 3401 to provide direct financial assist23 ance to eligible entities or providers for the pur24 pose of providing prevention services, core med25 ical services, recovery and support services, 


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1 early intervention services, and harm reduction 

2 services. 

3 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi4 nancial assistance may be provided under sub5 paragraph (A) to public or nonprofit entities, 

6 other eligible Medicaid providers if more than 

7 half of their patients are diagnosed with a sub8 stance use disorder and covered by Medicaid, or 

9 other private for-profit entities if such entities 

10 are the only available provider of quality sub11 stance use disorder treatment services in the 

12 area. 

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

14 (not including tribal areas) may not provide di15 rect financial assistance to any entity or pro16 vider that provides medication for addiction 

17 treatment if that entity or provider does not 

18 also offer mental health services or psycho19 therapy by licensed clinicians through a referral 

20 or onsite. 

21 ‘‘(D) NEUTRALITY TOWARDS ORGANIZED

22 LABOR.— 

23 ‘‘(i) IN GENERAL.—In carrying out 

24 duties under this section, eligible local 

25 areas shall, to the extent practicable, 


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1 prioritize the distribution of grant funds to 

2 grantees that have— 

3 ‘‘(I)(aa) a collective bargaining 

4 agreement; or 

5 ‘‘(bb) an explicit policy not to 

6 deter employees with respect to— 

7 ‘‘(AA) labor organizing for 

8 the employees engaged in the 

9 covered activities; and 

10 ‘‘(BB) such employees’ 

11 choice to form and join labor or12 ganizations; and 

13 ‘‘(II) policies that require— 

14 ‘‘(aa) the posting and main15 tenance of notices in the work16 place to such employees of their 

17 rights under the National Labor 

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

19 seq.); 

20 ‘‘(bb) that such employees 

21 are, at the beginning of their em22 ployment, provided notice and in23 formation regarding the employ24 ees’ rights under such Act; and 


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1 ‘‘(cc) the employer to volun2 tarily recognize a union in cases 

3 where a majority of such workers 

4 of the employer have joined and 

5 requested representation. 

6 ‘‘(ii) LIMITATION.—This subsection 

7 does not apply to Indian tribes. 

8 ‘‘(3) PREVENTION SERVICES.— 

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

10 section, the term ‘prevention services’ means 

11 evidence-based services, programs, or multi-sec12 tor strategies to prevent substance use disorder 

13 (including education campaigns, community14 based prevention programs, risk identification 

15 programs, opioid diversion, collection and dis16 posal of unused opioids, services to at-risk pop17 ulations, and trauma support services). 

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

19 use not to exceed 20 percent of the amount of 

20 the grant under section 3401 for prevention 

21 services. An eligible local area may apply to the 

22 Secretary for a waiver of this subparagraph. 

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

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

25 means the following evidence-based services provided 


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1 to individuals with substance use disorder or at risk 

2 for developing substance use disorder, including 

3 through the use of telemedicine or a hub and spoke 

4 model: 

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

6 more fully described in section 3439, including 

7 assessment of disease presence, severity, and 

8 co-occurring conditions, treatment planning, 

9 clinical stabilization services, withdrawal man10 agement and detoxification, the provision of 

11 medication for substance use disorder, intensive 

12 inpatient treatment, intensive outpatient treat13 ment, outpatient treatment, residential inpa14 tient services, treatment for co-occurring mental 

15 health and substance use disorders, and all 

16 drugs approved by the Food and Drug Adminis17 tration for the treatment of substance use dis18 order. 

19 ‘‘(B) Outpatient and ambulatory health 

20 services, including those administered by Feder21 ally-qualified health centers, rural health clinics, 

22 tribal clinics and hospitals, urban Indian orga23 nizations, certified community behavioral health 

24 clinics (as described in section 223 of the Pro25 tecting Access to Medicare Act), HIV services 


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1 organizations, Native Hawaiian organizations 

2 (as defined in section 11 of the Native Hawai3 ian Health Care Act of 1988), and comprehen4 sive opioid recovery centers (as described in sec5 tion 552 of this Act). 

6 ‘‘(C) Hospice services. 

7 ‘‘(D) Mental health services. 

8 ‘‘(E) Opioid overdose reversal drug prod9 ucts procurement, distribution, and training. 

10 ‘‘(F) Pharmaceutical assistance and diag11 nostic testing related to the management of 

12 substance use disorders and co-morbid condi13 tions. 

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

15 services. 

16 ‘‘(H) Comprehensive Case Management 

17 and care coordination, including substance use 

18 disorder treatment adherence services. 

19 ‘‘(I) Health insurance enrollment and cost20 sharing assistance in accordance with para21 graph (8). 

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

23 and dispatch licensed health care professionals, 

24 mental health professionals, harm reduction 

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1 spond in lieu of law enforcement officers in 

2 emergencies and that ensure a licensed health 

3 care professional is a member of the team that 

4 responds in lieu of law enforcement officers in 

5 emergencies in which— 

6 ‘‘(i) an individual calling 911, the Na7 tional Suicide Hotline, or another emer8 gency hotline states that a person is expe9 riencing a drug overdose or is otherwise 

10 under the influence of a legal or illegal 

11 substance; or 

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

13 first responder, or other individual identi14 fies a person as being (or possibly being) 

15 under the influence of a legal or illegal 

16 substance. 

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

18 purposes of this section, the term ‘recovery and sup19 port services’ means services that are provided to in20 dividuals with substance use disorder, including resi21 dential recovery housing, mental health services, 

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

23 support, medical transportation services, respite care 

24 for persons caring for individuals with substance use 

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1 dividual is receiving inpatient treatment services or 

2 at the time of outpatient services, outreach services, 

3 peer recovery services, nutrition services, and refer4 rals for job training and career services, housing, 

5 legal services, and child care and family services. 

6 The entities through which such services may be 

7 provided include local and tribal authorities that 

8 provide child care, housing, community development, 

9 and other recovery and support services, so long as 

10 they do not exclude individuals on the basis that 

11 such individuals receive medication for addiction 

12 treatment. 

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

14 purposes of this section, the term ‘early intervention 

15 services’ means services to provide screening and 

16 connection to the appropriate level of substance use 

17 disorder and mental health treatment (including 

18 same-day connection), counseling provided to indi19 viduals who have misused substances, who have ex20 perienced an overdose, or are at risk of developing 

21 substance use disorder, the provision of referrals to 

22 facilitate the access of such individuals to core med23 ical services or recovery and support services for 

24 substance use disorder, and rapid access to medica25 tion for addiction treatment in the setting of recent 


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1 overdose. The entities through which such services 

2 may be provided include emergency rooms, fire de3 partments and emergency medical services, detention 

4 facilities, prisons and jails, homeless shelters, health 

5 care points of entry specified by eligible local areas, 

6 Federally-qualified health centers, workforce agen7 cies and job centers, youth development centers, 

8 tribal clinics and hospitals, urban Indian organiza9 tions, and rural health clinics. 

10 ‘‘(7) HARM REDUCTION SERVICES.—For pur11 poses of this section, the term ‘harm reduction serv12 ices’ means services provided to individuals engaging 

13 in substance use scientifically accepted to reduce the 

14 risk of infectious disease transmission, overdose, or 

15 death, including syringe services programs and other 

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

17 or chemical agent that tests or analyzes a substance 

18 to determine its composition or that detects sub19 stances. 

20 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV21 ERAGE.—An eligible local area may use amounts 

22 provided under a grant awarded under section 3401 

23 to establish a program of financial assistance to as24 sist eligible individuals with substance use disorder 

25 in— 


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1 ‘‘(A) enrolling in health insurance cov2 erage; or 

3 ‘‘(B) affording health care services, includ4 ing assistance paying cost-sharing amounts, in5 cluding premiums. 

6 ‘‘(9) ADMINISTRATION AND PLANNING.—An eli7 gible local area (not including tribal areas) shall not 

8 use in excess of 15 percent of amounts received 

9 under a grant under section 3401 for administra10 tion, accounting, reporting, and program oversight 

11 functions, including the development of systems to 

12 improve data collection and data sharing, in the first 

13 year of receiving the grant, and shall not use in ex14 cess of 10 percent of amounts received under a 

15 grant under section 3401 for such activities in sub16 sequent years. 

17 ‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 

18 received under a grant under section 3401 may be 

19 used to provide substance use disorder treatment 

20 services, including medication for addiction treat21 ment, to individuals who are currently incarcerated 

22 or in pre-trial detention. 

23 ‘‘(c) REQUIRED TERMS.— 

24 ‘‘(1) REQUIREMENT OF STATUS AS MEDICAID

25 PROVIDER.— 


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

2 subparagraph (B), the Secretary may not make 

3 a grant under section 3401 for the provision of 

4 substance use disorder treatment services under 

5 this section in an eligible local area unless, in 

6 the case of any such service that is available 

7 pursuant to the State plan approved under title 

8 XIX of the Social Security Act for the State— 

9 ‘‘(i) the political subdivision involved 

10 will provide the service directly, and the 

11 political subdivision has entered into a par12 ticipation agreement under the State plan 

13 and is qualified to receive payments under 

14 such plan; or 

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

16 ‘‘(I) will enter into agreements 

17 with public or nonprofit entities, or 

18 other Medicaid providers if more than 

19 half of their patients are diagnosed 

20 with a substance use disorder and 

21 covered by Medicaid, under which 

22 such entities and other providers will 

23 provide the service, and such entities 

24 and other providers have entered into 

25 such a participation agreement and 


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1 are qualified to receive such pay2 ments; and 

3 ‘‘(II) demonstrates that it will 

4 ensure that such entities and other 

5 providers providing the service will 

6 seek payment for each such service 

7 rendered in accordance with the usual 

8 payment schedule under the State 

9 plan. 

10 ‘‘(B) WAIVER.— 

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

12 entity making an agreement pursuant to 

13 subparagraph (A)(ii) regarding the provi14 sion of substance use disorder treatment 

15 services, the requirement established in 

16 such subparagraph shall be waived by the 

17 substance use planning council for the area 

18 involved if the entity does not, in providing 

19 health care services, impose a charge or ac20 cept reimbursement available from any 

21 third-party payor, including reimbursement 

22 under any insurance policy or under any 

23 Federal or State health benefits program. 

24 A waiver under this subparagraph shall 


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1 not be longer than 2 years in duration and 

2 shall not be renewed. 

3 ‘‘(ii) DETERMINATION.—A determina4 tion by the substance use planning council 

5 of whether an entity referred to in clause 

6 (i) meets the criteria for a waiver under 

7 such clause shall be made without regard 

8 to whether the entity accepts voluntary do9 nations for the purpose of providing serv10 ices to the public. 

11 ‘‘(2) REQUIRED TERMS FOR EXPANDING AND

12 IMPROVING CARE.—A funding agreement for a grant 

13 under this section shall— 

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

15 grant will not be utilized to make payments for 

16 any item or service to the extent that payment 

17 has been made, or can reasonably be expected 

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

19 under a State compensation program, under an 

20 insurance policy, or under any Federal or State 

21 health benefits program (except for a program 

22 administered by, or providing the services of, 

23 the Indian Health Service); and 

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1 sistance made available under the grant offer 

2 all drugs approved by the Food and Drug Ad3 ministration for the treatment of substance use 

4 disorder for which the applicant offers treat5 ment, in accordance with section 3435. 

6 ‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund7 ing agreement for a grant under this section is 

8 that— 

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

10 utilized to supplement not supplant other Fed11 eral, State, or local funds made available in the 

12 year for which the grant is awarded to provide 

13 substance use disorder treatment services to in14 dividuals with substance use disorder, including 

15 funds for each of prevention services, core med16 ical services, recovery and support services, 

17 early intervention services, harm reduction serv18 ices, mental health services, and administrative 

19 expenses; 

20 ‘‘(B) political subdivisions within the eligi21 ble local area will maintain the level of expendi22 tures by such political subdivisions for sub23 stance use disorder treatment services at a level 

24 that is at least equal to the level of such ex25 penditures by such political subdivisions for the 


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1 preceding fiscal year, including expenditures for 

2 each of prevention services, core medical serv3 ices, recovery and support services, early inter4 vention services, harm reduction services, men5 tal health services, and administrative expenses; 

6 ‘‘(C) political subdivisions within the eligi7 ble local area will not use funds received under 

8 a grant awarded under section 3401 in main9 taining the level of substance use disorder treat10 ment services as required in subparagraph (B); 

11 ‘‘(D) substance use disorder treatment 

12 services provided with assistance made available 

13 under the grant will be provided without re14 gard— 

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

16 pay for such services; and 

17 ‘‘(ii) to the current or past health con18 dition of the individual to be served; 

19 ‘‘(E) substance use disorder treatment 

20 services will be provided in a setting that is ac21 cessible to low-income individuals with sub22 stance use disorders and to individuals with 

23 substance use disorders residing in rural areas; 

24 ‘‘(F) a program of outreach will be pro25 vided to low-income individuals with substance 


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1 use disorders to inform such individuals of sub2 stance use disorder treatment services and to 

3 individuals with substance use disorders resid4 ing in rural areas; 

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

6 for the use of grant funds and the Federal trust 

7 responsibility is upheld at all levels of program 

8 administration; and 

9 ‘‘(H) the confidentiality of individuals re10 ceiving substance use disorder treatment serv11 ices will be maintained in a manner not incon12 sistent with applicable law. 

13 ‘‘SEC. 3404. APPLICATION. 

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

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

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

17 containing such information, as the Secretary shall re18 quire, including— 

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

20 of any prior grants received under this subtitle by 

21 the applicant and the results achieved by these ex22 penditures and a demonstration that funds received 

23 from a grant under this subtitle in the prior year 

24 were expended in accordance with local priorities de25 veloped by the local planning council established 


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1 under section 3402, except that the planning council 

2 requirement shall not apply with respect to areas re3 ceiving supplemental grant funds under section 

4 3403(a)(2); 

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

6 achieved with grant funds provided under this sub7 title, including targets and milestones that are in8 tended to be met, the activities that will be under9 taken to achieve those targets, the number of indi10 viduals likely to be served by the funds sought, in11 cluding demographic data on the populations to be 

12 served, and an explanation of how these goals and 

13 objectives advance the State plan approved by the 

14 Secretary pursuant to section 1932(b); 

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

16 use funds in a manner that provides substance use 

17 disorder treatment services in compliance with the 

18 evidence-based standards developed in accordance 

19 with section 3435, including providing all drugs ap20 proved by the Food and Drug Administration for the 

21 treatment of substance use disorder; 

22 ‘‘(4) a demonstration that resources provided 

23 under the grant will be allocated in accordance with 

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1 cluding allocations for services for children, youths, 

2 and women; 

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

4 medical expense criteria will be established and ap5 plied to those who qualify for assistance under the 

6 program; 

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

8 will support, through distribution of resources and 

9 by other means, increased access to harm reduction 

10 services within the eligible local area; 

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

12 eligible local area shall coordinate with local public 

13 health departments in the distribution of funding; 

14 and 

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

16 section, data provided in such form as the Secretary 

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

18 which the activities supported by the funding met 

19 the goals and objectives specified in the application 

20 for the funding, the number of individuals who 

21 accessed medication for treatment by age, gender, 

22 sexual orientation, race, disability status, and other 

23 demographic criteria relevant to the program, and 

24 the effect of the program on overdose rates and 


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1 rates of death due to overdose in the local area 

2 served by the program. 

3 ‘‘(b) REQUIREMENTS REGARDING IMPOSITION OF

4 CHARGES FOR SERVICES.— 

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

6 make a grant under section 3401 to an eligible local 

7 area unless the eligible local area provides assur8 ances that in the provision of substance use disorder 

9 treatment services with assistance provided under 

10 the grant— 

11 ‘‘(A) in the case of individuals with an in12 come less than or equal to 150 percent of the 

13 official poverty level, the provider will not im14 pose charges on any such individual for the 

15 services provided under the grant; 

16 ‘‘(B) in the case of individuals with an in17 come greater than 150 percent of the official 

18 poverty level, the provider will impose a charge 

19 on each such individual according to a schedule 

20 of charges made available to the public; 

21 ‘‘(C) in the case of individuals with an in22 come greater than 150 percent of the official 

23 poverty level but not exceeding 200 percent of 

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

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1 ceeding 2 percent of the annual gross income of 

2 the individual; 

3 ‘‘(D) in the case of individuals with an in4 come greater than 200 percent of the official 

5 poverty level but not exceeding 250 percent of 

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

7 calendar year, impose charges in an amount ex8 ceeding 4 percent of the annual gross income of 

9 the individual involved; 

10 ‘‘(E) in the case of individuals with an in11 come greater than 250 percent of the official 

12 poverty level but not exceeding 300 percent of 

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

14 calendar year, impose charges in an amount ex15 ceeding 6 percent of the annual gross income of 

16 the individual involved; 

17 ‘‘(F) in the case of individuals with an in18 come greater than 300 percent of the official 

19 poverty level but not exceeding 400 percent of 

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

21 calendar year, impose charges in an amount ex22 ceeding 8.5 percent of the annual gross income 

23 of the individual involved; 

24 ‘‘(G) in the case of individuals with an in25 come greater than 400 percent of the official 


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1 poverty level, the provider will not, for any cal2 endar year, impose charges in an amount ex3 ceeding 8.5 percent of the annual gross income 

4 of the individual involved; and 

5 ‘‘(H) in the case of eligible American In6 dian and Alaska Native individuals as defined 

7 by section 447.50 of title 42, Code of Federal 

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

9 provider will not impose any charges for sub10 stance use disorder treatment services, includ11 ing any charges or cost-sharing prohibited by 

12 section 1402(d) of the Patient Protection and 

13 Affordable Care Act. 

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

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

16 eligible local area may, in the case of individuals 

17 subject to a charge— 

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

19 the discretion of the area, including imposing 

20 only a nominal charge for the provision of sub21 stance use disorder treatment services, subject 

22 to the provisions of the paragraph regarding 

23 public schedules and regarding limitations on 

24 the maximum amount of charges; and 


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1 ‘‘(B) take into consideration the total med2 ical expenses of individuals in assessing the 

3 amount of the charge, subject to such provi4 sions. 

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

6 may not make a grant under section 3401 to an eli7 gible local area unless the area agrees that the limi8 tations on charges for substance use disorder treat9 ment services under this subsection applies to the 

10 annual aggregate of charges imposed for such serv11 ices, however the charges are characterized, includes 

12 enrollment fees, premiums, deductibles, cost sharing, 

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

14 charges. 

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

16 for grants distributed in accordance with section 

17 3403(a)(3) shall be developed by the Secretary in con18 sultation with Indian tribes. 

19 ‘‘SEC. 3405. TECHNICAL ASSISTANCE. 

20 ‘‘The Secretary shall, beginning on the date of enact21 ment of this title, provide technical assistance, including 

22 assistance from other grantees, contractors or subcontrac23 tors under this title to assist newly eligible local areas in 

24 the establishment of planning councils and, to assist enti25 ties in complying with the requirements of this subtitle 


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

2 under this subtitle. The Secretary may make planning 

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

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

5 eligible for funding under section 3401 in the following 

6 fiscal year. Such grant amounts shall be deducted from 

7 the first year formula award to eligible local areas accept8 ing such grants. 

9 ‘‘SEC. 3406. AUTHORIZATION OF APPROPRIATIONS. 

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

11 this subtitle— 

12 ‘‘(1) $3,300,000,000 for fiscal year 2024; 

13 ‘‘(2) $3,300,000,000 for fiscal year 2025; 

14 ‘‘(3) $3,300,000,000 for fiscal year 2026; 

15 ‘‘(4) $3,300,000,000 for fiscal year 2027; 

16 ‘‘(5) $3,300,000,000 for fiscal year 2028; 

17 ‘‘(6) $3,300,000,000 for fiscal year 2029; 

18 ‘‘(7) $3,300,000,000 for fiscal year 2030; 

19 ‘‘(8) $3,300,000,000 for fiscal year 2031; 

20 ‘‘(9) $3,300,000,000 for fiscal year 2032; and 

21 ‘‘(10) $3,300,000,000 for fiscal year 2033. 


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1 ‘‘Subtitle B—State and Tribal Sub2 stance Use Disorder Prevention 

3 and Intervention Grant Pro4 gram 

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

6 ‘‘The Secretary shall award grants to States, terri7 tories, and Tribal governments for the purpose of address8 ing substance use within such States. 

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

10 FUNDING AGREEMENT. 

11 ‘‘(a) AMOUNT OF GRANT TO STATES AND TERRI12 TORIES.— 

13 ‘‘(1) IN GENERAL.— 

14 ‘‘(A) EXPEDITED DISTRIBUTION.—Not 

15 later than 90 days after an appropriation be16 comes available, the Secretary shall disburse 50 

17 percent of the amount made available under 

18 section 3415 for carrying out this subtitle for 

19 such fiscal year through grants to States under 

20 section 3411, in accordance with subparagraphs 

21 (B) and (C). 

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

23 the amount made available under section 3415, 

24 the amount of a grant under section 3411 for— 


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

2 of Columbia, and Puerto Rico for a fiscal 

3 year shall be the greater of— 

4 ‘‘(I) $2,000,000; or 

5 ‘‘(II) an amount determined 

6 under the subparagraph (C); and 

7 ‘‘(ii) each territory other than Puerto 

8 Rico for a fiscal year shall be the greater 

9 of— 

10 ‘‘(I) $500,000; or 

11 ‘‘(II) an amount determined 

12 under the subparagraph (C). 

13 ‘‘(C) DETERMINATION.— 

14 ‘‘(i) FORMULA.—For purposes of sub15 paragraph (B), the amount referred to in 

16 this subparagraph for a State (including a 

17 territory) for a fiscal year is— 

18 ‘‘(I) an amount equal to the 

19 amount made available under section 

20 3415 for the fiscal year involved for 

21 grants pursuant to subparagraph (B); 

22 and 

23 ‘‘(II) the percentage constituted 

24 by the sum of— 


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1 ‘‘(aa) the product of 0.85 

2 and the ratio of the State dis3 tribution factor for the State or 

4 territory to the sum of the re5 spective distribution factors for 

6 all States; and 

7 ‘‘(bb) the product of 0.15 

8 and the ratio of the non-local dis9 tribution factor for the State or 

10 territory (as determined under 

11 clause (iv)) to the sum of the re12 spective non-local distribution 

13 factors for all States or terri14 tories. 

15 ‘‘(ii) STATE DISTRIBUTION FACTOR.— 

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

17 ‘State distribution factor’ means an 

18 amount equal to— 

19 ‘‘(I) the estimated number of 

20 drug overdose deaths in the State, as 

21 determined under clause (iii); or 

22 ‘‘(II) the number of non-fatal 

23 drug overdoses in the State, as deter24 mined under clause (iv), 


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1 as determined by the Secretary based on 

2 which distribution factor (subclause (I) or 

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

4 greatest amount of funds. 

5 ‘‘(iii) NUMBER OF DRUG

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

7 the number of drug overdose deaths deter8 mined under this clause for a State for a 

9 fiscal year is the number of drug overdose 

10 deaths during the most recent 3-year pe11 riod for which such data are available. 

12 ‘‘(iv) NUMBER OF NON-FATAL DRUG

13 OVERDOSES.—The number of non-fatal 

14 drug overdose deaths determined under 

15 this clause for a State for a fiscal year for 

16 purposes of clause (ii) may be determined 

17 by using data including emergency depart18 ment syndromic data, visits, other emer19 gency medical services for drug-related 

20 causes, or Overdose Detection Mapping 

21 Application Program (ODMAP) data dur22 ing the most recent 3-year period for which 

23 such data are available. 

24 ‘‘(v) NON-LOCAL DISTRIBUTION FAC25 TORS.—For purposes of clause (i)(II)(bb), 


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1 the term ‘non-local distribution factor’ 

2 means an amount equal to the sum of— 

3 ‘‘(I) the number of drug overdose 

4 deaths in the State involved, as deter5 mined under clause (iii), or the num6 ber of non-fatal drug overdoses in the 

7 State, based on the criteria used by 

8 the State under clause (ii); less 

9 ‘‘(II) the total number of drug 

10 overdose deaths or non-fatal drug 

11 overdoses that are within areas in 

12 such State or territory that are eligi13 ble counties under section 3401. 

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

15 after the date of enactment of this title, 

16 the Comptroller General shall conduct a 

17 study to determine whether the data uti18 lized for purposes of clause (ii) provide the 

19 most precise measure of State need related 

20 to substance use and addiction prevalence 

21 and whether additional data would provide 

22 more precise measures of the levels of sub23 stance use and addiction prevalent in 

24 States. Such study shall identify barriers 

25 to collecting or analyzing such data, and 


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1 make recommendations for revising the 

2 distribution factors used under such clause 

3 to determine funding levels in order to di4 rect funds to the States in most need of 

5 funding to provide substance use disorder 

6 treatment services. 

7 ‘‘(2) SUPPLEMENTAL GRANTS.— 

8 ‘‘(A) IN GENERAL.—Subject to subpara9 graph (C), the Secretary shall disburse the re10 mainder of amounts not disbursed under para11 graph (1) for such fiscal year for the purpose 

12 of making grants to States whose application— 

13 ‘‘(i) contains a report concerning the 

14 dissemination of emergency relief funds 

15 under paragraph (1) and the plan for utili16 zation of such funds, if applicable; 

17 ‘‘(ii) demonstrates the need in such 

18 State, on an objective and quantified basis, 

19 for supplemental financial assistance to 

20 combat substance use disorder; 

21 ‘‘(iii) demonstrates the existing com22 mitment of local resources of the State, 

23 both financial and in-kind, to preventing, 

24 treating, and managing substance use dis25 order and supporting sustained recovery; 


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1 ‘‘(iv) demonstrates the ability of the 

2 State to utilize such supplemental financial 

3 resources in a manner that is immediately 

4 responsive and cost effective; 

5 ‘‘(v) demonstrates that resources will 

6 be allocated in accordance with the local 

7 demographic incidence of substance use 

8 disorders and drug overdose mortality; 

9 ‘‘(vi) demonstrates the inclusiveness of 

10 affected communities and individuals with 

11 substance use disorders, including those 

12 communities and individuals that are dis13 proportionately affected or historically un14 derserved; 

15 ‘‘(vii) demonstrates the manner in 

16 which the proposed services are consistent 

17 with the local needs assessment and the 

18 State plan approved by the Secretary pur19 suant to section 1932(b); 

20 ‘‘(viii) demonstrates success in identi21 fying individuals with substance use dis22 orders; and 

23 ‘‘(ix) demonstrates that support for 

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1 mize the value to the population to be 

2 served with an appropriate mix of sub3 stance use disorder treatment services and 

4 attention to transition in care. 

5 ‘‘(B) AMOUNT.— 

6 ‘‘(i) IN GENERAL.—The amount of 

7 each grant made for purposes of this para8 graph shall be determined by the Sec9 retary. In making such determination, the 

10 Secretary shall consider— 

11 ‘‘(I) the rate of drug overdose 

12 deaths per 100,000 population in the 

13 State; and 

14 ‘‘(II) the increasing need for sub15 stance use disorder treatment serv16 ices, including relative rates of in17 crease in the number of drug 

18 overdoses or drug overdose deaths, or 

19 recent increases in drug overdoses or 

20 drug overdose deaths since the data 

21 were reported under section 3413, if 

22 applicable. 

23 ‘‘(ii) DEMONSTRATED NEED.—The 

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1 onstrated need for purposes of subpara2 graph (A)(ii) may include any or all of the 

3 following: 

4 ‘‘(I) The unmet need for such 

5 services, including the factors identi6 fied in clause (i)(II). 

7 ‘‘(II) Relative rates of increase in 

8 the number of drug overdoses or drug 

9 overdose deaths. 

10 ‘‘(III) The relative rates of in11 crease in the number of drug 

12 overdoses or drug overdose deaths 

13 within new or emerging subpopula14 tions. 

15 ‘‘(IV) The current prevalence of 

16 substance use disorders. 

17 ‘‘(V) Relevant factors related to 

18 the cost and complexity of delivering 

19 substance use disorder treatment serv20 ices to individuals in the State. 

21 ‘‘(VI) The impact of co-morbid 

22 factors, including co-occurring condi23 tions, determined relevant by the Sec24 retary. 


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1 ‘‘(VII) The prevalence of home2 lessness among individuals with sub3 stance use disorder. 

4 ‘‘(VIII) The relevant factors that 

5 limit access to health care, including 

6 geographic variation, adequacy of 

7 health insurance coverage, and lan8 guage barriers. 

9 ‘‘(IX) The impact of a decline in 

10 the amount received pursuant to para11 graph (1) on substance use disorder 

12 treatment services available to all in13 dividuals with substance use disorders 

14 identified and eligible under this sub15 title. 

16 ‘‘(X) The increasing incidence in 

17 conditions related to substance use, 

18 including hepatitis C, human immuno19 deficiency virus, hepatitis B and other 

20 infections associated with injection 

21 drug use. 

22 ‘‘(C) MODEL STANDARDS.— 

23 ‘‘(i) PREFERENCE.—In determining 

24 whether a State will receive funds under 

25 this paragraph, except as provided in 


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1 clause (ii), the Secretary shall give pref2 erence to States that have adopted the 

3 model standards for each substance use 

4 disorder treatment service and recovery 

5 residence developed in accordance with 

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

7 ‘‘(ii) REQUIREMENT.—Effective begin8 ning in fiscal year 2026, the Secretary 

9 shall not award a grant under this para10 graph to a State unless that State has 

11 adopted the model standards for each of 

12 substance use disorder treatment services 

13 and recovery residences developed in ac14 cordance with subsections (a) and (b) of 

15 section 3435. 

16 ‘‘(D) CONTINUUM OF CARE.— 

17 ‘‘(i) PREFERENCE.—In determining 

18 whether a State will receive funds under 

19 this paragraph, except as provided in 

20 clause (ii), the Secretary shall give pref21 erence to States that have carried out the 

22 requirements to ensure a continuum of 

23 services in accordance with section 

24 3435(d). 


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1 ‘‘(ii) REQUIREMENT.—Effective begin2 ning in fiscal year 2026, the Secretary 

3 shall not award a grant under this para4 graph to a State unless that State has car5 ried out the requirements to ensure a con6 tinuum of services in accordance with sec7 tion 3435(d). 

8 ‘‘(E) UTILIZATION MANAGEMENT FOR

9 MEDICATION FOR ADDICTION TREATMENT.— 

10 ‘‘(i) PREFERENCE.—In determining 

11 whether a State will receive funds under 

12 this paragraph, the Secretary shall give 

13 preference to States that have prohibited 

14 prior authorization and step therapy re15 quirements for at least 1 drug in each 

16 class approved by the Food and Drug Ad17 ministration for the treatment of substance 

18 use disorder. 

19 ‘‘(ii) ADDITIONAL PREFERENCES.— 

20 Additional preference shall be given to 

21 States that have prohibited prior author22 ization and step therapy requirements for 

23 2 or more drugs in each class approved by 

24 the Food and Drug Administration for the 

25 treatment of substance use disorder. 


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1 ‘‘(iii) DEFINITIONS.—In this subpara2 graph: 

3 ‘‘(I) PRIOR AUTHORIZATION.— 

4 The term ‘prior authorization’ means 

5 the process by which a health insur6 ance issuer or pharmacy benefit man7 agement company determines the 

8 medical necessity of otherwise covered 

9 health care services prior to the ren10 dering of such health care services. 

11 Such term includes any health insur12 ance issuer’s or utilization review enti13 ty’s requirement that a subscriber or 

14 health care provider notify the issuer 

15 or entity prior to providing a health 

16 care service. 

17 ‘‘(II) STEP THERAPY.—The term 

18 ‘step therapy’ means a protocol or 

19 program that establishes the specific 

20 sequence in which prescription drugs 

21 for a medical condition that are medi22 cally appropriate for a particular pa23 tient are authorized by a health insur24 ance issuer or prescription drug man25 agement company. 


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1 ‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN2 MENTS.— 

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

4 term ‘Indian tribe’ has the meaning given such 

5 term in section 4 of the Indian Self-Determina6 tion and Education Assistance Act. 

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

8 acting through the Indian Health Service, shall 

9 use 10 percent of the amount available under 

10 section 3415 for each fiscal year to provide for11 mula funds to Indian tribes in an amount de12 termined pursuant to a formula and eligibility 

13 criteria developed by the Secretary in consulta14 tion with Indian tribes, for the purposes of ad15 dressing substance use. 

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

17 of an Indian tribe the Secretary shall pay funds 

18 under this section through a contract, coopera19 tive agreement, or compact under, as applicable, 

20 title I or V of the Indian Self-Determination 

21 and Education Assistance Act. 

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

23 any requirements in this section, an Indian 

24 tribe may use amounts provided under funds 

25 awarded under this paragraph for the uses 


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1 identified in subsection (b) and any other activi2 ties determined appropriate by the Secretary, in 

3 consultation with Indian tribes. 

4 ‘‘(b) USE OF AMOUNTS.— 

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

6 amounts provided under grants awarded under sec7 tion 3411 for— 

8 ‘‘(A) prevention services described in para9 graph (3); 

10 ‘‘(B) core medical services described in 

11 paragraph (4); 

12 ‘‘(C) recovery and support services de13 scribed in paragraph (5); 

14 ‘‘(D) early intervention services described 

15 in paragraph (6); 

16 ‘‘(E) harm reduction services described in 

17 paragraph (7); 

18 ‘‘(F) financial assistance with health insur19 ance as described in paragraph (8); and 

20 ‘‘(G) administrative expenses described in 

21 paragraph (9). 

22 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 

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

24 use amounts received under a grant under sec25 tion 3411 to provide direct financial assistance 


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1 to eligible entities or other eligible Medicaid 

2 providers for the purpose of providing preven3 tion services, core medical services, recovery 

4 and support services, early intervention services, 

5 and harm reduction services. 

6 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi7 nancial assistance may be provided under sub8 paragraph (A) to public or nonprofit entities, 

9 other Medicaid providers if more than half of 

10 their patients are diagnosed with a substance 

11 use disorder and covered by Medicaid, or other 

12 private for-profit entities if such entities are the 

13 only available provider of quality substance use 

14 disorder treatment services in the area. 

15 ‘‘(C) LIMITATION.—A State may not pro16 vide direct financial assistance to any entity or 

17 provider that provides medication for addiction 

18 treatment if that entity or provider does not 

19 also offer mental health services or psycho20 therapy by licensed clinicians through a referral 

21 or onsite. 

22 ‘‘(D) NEUTRALITY TOWARDS ORGANIZED

23 LABOR.— 

24 ‘‘(i) IN GENERAL.—In carrying out 

25 duties under this section, States shall, to 


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1 the extent practicable, prioritize the dis2 tribution of grant funds to grantees that 

3 have— 

4 ‘‘(I)(aa) a collective bargaining 

5 agreement; or 

6 ‘‘(bb) an explicit policy not to 

7 deter employees with respect to— 

8 ‘‘(AA) labor organizing for 

9 the employees engaged in the 

10 covered activities; and 

11 ‘‘(BB) such employees’ 

12 choice to form and join labor or13 ganizations; and 

14 ‘‘(II) policies that require— 

15 ‘‘(aa) the posting and main16 tenance of notices in the work17 place to such employees of their 

18 rights under the National Labor 

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

20 seq.); 

21 ‘‘(bb) that such employees 

22 are, at the beginning of their em23 ployment, provided notice and in24 formation regarding the employ25 ees’ rights under such Act; and 


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1 ‘‘(cc) the employer to volun2 tarily recognize a union in cases 

3 where a majority of such workers 

4 of the employer have joined and 

5 requested representation. 

6 ‘‘(ii) LIMITATION.—This subsection 

7 does not apply to Indian tribes. 

8 ‘‘(3) PREVENTION SERVICES.— 

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

10 section, the term ‘prevention services’ means 

11 evidence-based services, programs, or multi-sec12 tor strategies to prevent substance use disorder 

13 (including education campaigns, community14 based prevention programs, risk-identification 

15 programs, opioid diversion, collection and dis16 posal of unused opioids, services to at-risk pop17 ulations, and trauma support services). 

18 ‘‘(B) LIMIT.—A State may use not to ex19 ceed 20 percent of the amount of the grant 

20 under section 3411 for prevention services. A 

21 State may apply to the Secretary for a waiver 

22 of this subparagraph. 

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

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

25 means the following evidence-based services when 


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1 provided to individuals with substance use disorder 

2 or at risk for developing substance use disorder, in3 cluding through the use of telemedicine or a hub and 

4 spoke model: 

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

6 described in section 3439(4), including assess7 ment of disease presence, severity, and co-oc8 curring conditions, treatment planning, clinical 

9 stabilization services, withdrawal management 

10 and detoxification, the provision of medication 

11 for substance use disorder, intensive inpatient 

12 treatment, intensive outpatient treatment, out13 patient treatment, residential inpatient services, 

14 treatment for co-occurring mental health and 

15 substance use disorders, and all drugs approved 

16 by the Food and Drug Administration for the 

17 treatment of substance use disorder. 

18 ‘‘(B) Outpatient and ambulatory health 

19 services, including those administered by Feder20 ally-qualified health centers, rural health clinics, 

21 tribal clinics and hospitals, urban Indian orga22 nizations, certified community behavioral health 

23 clinics (as described in section 223 of the Pro24 tecting Access to Medicare Act), HIV services 

25 organizations, Native Hawaiian organizations 


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1 (as defined in section 11 of the Native Hawai2 ian Health Care Act of 1988), and comprehen3 sive opioid recovery centers (as described in sec4 tion 552 of this Act). 

5 ‘‘(C) Hospice services. 

6 ‘‘(D) Mental health services. 

7 ‘‘(E) Opioid overdose reversal drug prod8 ucts procurement, distribution, and training. 

9 ‘‘(F) Pharmaceutical assistance related to 

10 the management of substance use disorders and 

11 co-morbid conditions. 

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

13 services. 

14 ‘‘(H) Comprehensive Case Management 

15 and care coordination, including substance use 

16 disorder treatment adherence services. 

17 ‘‘(I) Health insurance enrollment and cost18 sharing assistance in accordance with para19 graph (8). 

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

21 and dispatch licensed health care professionals, 

22 mental health professionals, harm reduction 

23 providers, or community health workers to re24 spond in lieu of law enforcement officers in 

25 emergencies and that ensure a licensed health 


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1 care professional is a member of the team that 

2 responds in lieu of law enforcement officers in 

3 emergencies in which— 

4 ‘‘(i) an individual calling 911, the Na5 tional Suicide Hotline, or another emer6 gency hotline states that a person is expe7 riencing a drug overdose or is otherwise 

8 under the influence of a legal or illegal 

9 substance; or 

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

11 first responder, or other individual identi12 fies a person as being (or possibly being) 

13 under the influence of a legal or illegal 

14 substance. 

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

16 purposes of this section, the term ‘recovery and sup17 port services’ means services including residential re18 covery housing, mental health services, long term re19 covery services, 24/7 hotline crisis center services, 

20 medical transportation services, respite care for per21 sons caring for individuals with substance use dis22 order, child care and family services while an indi23 vidual is receiving inpatient treatment services or at 

24 the time of outpatient services, outreach services, 

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1 rals for job training and career services, housing, 

2 legal services, and child care and family services. 

3 The entities through which such services may be 

4 provided include State, local, and Tribal authorities 

5 that provide child care, housing, community develop6 ment, and other recovery and support services, so 

7 long as they do not exclude individuals on the basis 

8 that such individuals receive medication for addic9 tion treatment. 

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

11 purposes of this section, the term ‘early intervention 

12 services’ means services to provide screening and 

13 connection to the appropriate level of substance use 

14 disorder and mental health treatment (including 

15 same-day connection), counseling provided to indi16 viduals who have misused substances, who have ex17 perienced an overdose, or are at risk of developing 

18 substance use disorder, the provision of referrals to 

19 facilitate the access of such individuals to core med20 ical services or recovery and support services for 

21 substance use disorder, and rapid access to medica22 tion for addiction treatment in the setting of recent 

23 overdose. The entities through which such services 

24 may be provided include emergency rooms, fire de25 partments and emergency medical services, detention 


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1 facilities, prisons and jails, homeless shelters, health 

2 care points of entry specified by eligible local areas, 

3 Federally-qualified health centers, workforce agen4 cies and job centers, youth development centers, 

5 tribal clinics and hospitals, urban Indian organiza6 tions, and rural health clinics. 

7 ‘‘(7) HARM REDUCTION SERVICES.—For pur8 poses of this section, the term ‘harm reduction serv9 ices’ means services provided to individuals engaging 

10 in substance use scientifically accepted to reduce the 

11 risk of infectious disease transmission, overdose, or 

12 death, including syringe services programs and other 

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

14 or chemical agent that tests or analyzes a substance 

15 to determine its composition or that detects sub16 stances. 

17 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV18 ERAGE.—A State may use amounts provided under 

19 a grant awarded under section 3411 to establish a 

20 program of financial assistance to assist eligible indi21 viduals with substance use disorder in— 

22 ‘‘(A) enrolling in health insurance cov23 erage; or 


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1 ‘‘(B) affording health care services, includ2 ing assistance paying cost-sharing amounts, in3 cluding premiums. 

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

5 State shall not use in excess of 10 percent of 

6 amounts received under a grant under section 3411 

7 for administration, accounting, reporting, and pro8 gram oversight functions, including the development 

9 of systems to improve data collection and data shar10 ing. 

11 ‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 

12 received under a grant under section 3411 may be 

13 used to provide substance use disorder treatment 

14 services, including medication for addiction treat15 ment, to individuals who are currently incarcerated 

16 or in pre-trial detention. 

17 ‘‘(c) REQUIRED TERMS.— 

18 ‘‘(1) REQUIREMENT OF STATUS AS MEDICAID

19 PROVIDER.— 

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

21 subparagraph (B), the Secretary may not make 

22 a grant under section 3411 for the provision of 

23 substance use disorder treatment services under 

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

25 such service that is available pursuant to the 


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1 State plan approved under title XIX of the So2 cial Security Act for the State— 

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

4 agreement with a political subdivision, 

5 under which the political subdivision will 

6 provide the service directly, and the polit7 ical subdivision has entered into a partici8 pation agreement under the State plan and 

9 is qualified to receive payments under such 

10 plan; or 

11 ‘‘(II) the State will enter into agree12 ments with public or nonprofit entities, or 

13 other Medicaid providers if more than half 

14 of their patients are diagnosed with a sub15 stance use disorder and covered by Med16 icaid, under which such entities and other 

17 providers will provide the service, and such 

18 entities and other providers have entered 

19 into such a participation agreement and 

20 are qualified to receive such payments; and 

21 ‘‘(III) the State ensures the political 

22 subdivision under clause (i)(I) or the pub23 lic or nonprofit private entities and other 

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1 cordance with the usual payment schedule 

2 under the State plan. 

3 ‘‘(B) WAIVER.— 

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

5 entity making an agreement pursuant to 

6 subparagraph (A)(ii) regarding the provi7 sion of substance use disorder treatment 

8 services, the requirement established in 

9 such subparagraph shall be waived by the 

10 State if the entity does not, in providing 

11 health care services, impose a charge or ac12 cept reimbursement available from any 

13 third-party payor, including reimbursement 

14 under any insurance policy or under any 

15 Federal or State health benefits program. 

16 A waiver under this subparagraph shall 

17 not be longer than 2 years in duration and 

18 shall not be renewed. 

19 ‘‘(ii) DETERMINATION.—A determina20 tion by the State of whether an entity re21 ferred to in clause (i) meets the criteria for 

22 a waiver under such clause shall be made 

23 without regard to whether the entity ac24 cepts voluntary donations for the purpose 

25 of providing services to the public. 


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1 ‘‘(2) REQUIRED TERMS FOR EXPANDING AND

2 IMPROVING CARE.—A funding agreement for a grant 

3 under this section shall— 

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

5 grant will not be utilized to make payments for 

6 any item or service to the extent that payment 

7 has been made, or can reasonably be expected 

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

9 under a State compensation program, under an 

10 insurance policy, or under any Federal or State 

11 health benefits program (except for a program 

12 administered by, or providing the services of, 

13 the Indian Health Service); and 

14 ‘‘(B) ensure that all entities providing sub15 stance use disorder treatment services with as16 sistance made available under the grant shall 

17 offer all drugs approved by the Food and Drug 

18 Administration for the treatment of substance 

19 use disorder for which the applicant offers 

20 treatment, in accordance with section 3435. 

21 ‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund22 ing agreement for a grant under this section is 

23 that— 

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

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1 eral, State, or local funds made available in the 

2 year for which the grant is awarded to provide 

3 substance use disorder treatment services to in4 dividuals with substance use disorder, including 

5 funds for each of prevention services, core med6 ical services, recovery and support services, 

7 early intervention services, harm reduction serv8 ices, mental health services, and administrative 

9 expenses; 

10 ‘‘(B) political subdivisions within the State 

11 will maintain the level of expenditures by such 

12 political subdivisions for substance use disorder 

13 treatment services at a level that is at least 

14 equal to the level of such expenditures by such 

15 political subdivisions for the preceding fiscal 

16 year including expenditures for each of preven17 tion services, core medical services, recovery 

18 and support services, early intervention services, 

19 harm reduction services, mental health services, 

20 and administrative expenses; 

21 ‘‘(C) political subdivisions within the State 

22 will not use funds received under a grant 

23 awarded under section 3411 in maintaining the 

24 level of substance use disorder treatment serv25 ices as required in subparagraph (B); 


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1 ‘‘(D) 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 ‘‘(E) 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 ‘‘(F) a program of outreach will be pro15 vided to low-income individuals with substance 

16 use disorders to inform such individuals of sub17 stance use disorder treatment services and to 

18 individuals with substance use disorders resid19 ing in rural areas; 

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

21 for the use of grant funds and the Federal trust 

22 responsibility is upheld at all levels of program 

23 administration; and 

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1 ices will be maintained in a manner not incon2 sistent with applicable law. 

3 ‘‘SEC. 3413. APPLICATION. 

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

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

6 plan approved by the Secretary pursuant to section 

7 1932(b), and shall prepare and submit to the Secretary 

8 an application in such form, and containing such informa9 tion, as the Secretary shall require, including— 

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

11 of any prior grants received under this subtitle by 

12 the applicant and the results achieved by these ex13 penditures and a demonstration that funds received 

14 from a grant under this subtitle in the prior year 

15 were expended in accordance with State priorities; 

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

17 achieved with grant funds provided under this sub18 title, including targets and milestones that are in19 tended to be met, the activities that will be under20 taken to achieve those targets, and the number of 

21 individuals likely to be served by the funds sought, 

22 including demographic data on the populations to be 

23 served; 

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

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1 order treatment services in compliance with the evi2 dence-based standards developed in accordance with 

3 section 3435, including all drugs approved by the 

4 Food and Drug Administration for the treatment of 

5 substance use disorder; 

6 ‘‘(4) a demonstration that resources provided 

7 under the grant will be allocated in accordance with 

8 the local demographic incidence of substance use, in9 cluding allocations for services for children, youths, 

10 and women; 

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

12 medical expense criteria will be established and ap13 plied to those who qualify for assistance under the 

14 program; 

15 ‘‘(6) an explanation of how the State will sup16 port, through distribution of resources and by other 

17 means, increased access to harm reduction services 

18 resources within the State; and 

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

20 section, data provided in such form as the Secretary 

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

22 which the activities supported by the funding met 

23 the goals and objectives specified in the application 

24 for the funding, the number of individuals who 

25 accessed medication for addiction treatment by age, 


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1 gender, sexual orientation, race, disability status, 

2 and other demographic criteria relevant to the pro3 gram, and the effect of the program on overdose 

4 rates and rates of death due to overdose in the re5 gion served by the program. 

6 ‘‘(b) REQUIREMENTS REGARDING IMPOSITION OF

7 CHARGES FOR SERVICES.— 

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

9 make a grant under section 3411 to a State unless 

10 the State provides assurances that in the provision 

11 of services with assistance provided under the 

12 grant— 

13 ‘‘(A) in the case of individuals with an in14 come less than or equal to 150 percent of the 

15 official poverty level, the provider will not im16 pose charges on any such individual for the 

17 services provided under the grant; 

18 ‘‘(B) in the case of individuals with an in19 come greater than 150 percent of the official 

20 poverty level, the provider will impose a charge 

21 on each such individual according to a schedule 

22 of charges made available to the public; 

23 ‘‘(C) in the case of individuals with an in24 come greater than 150 percent of the official 

25 poverty level but not exceeding 200 percent of 


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

2 calendar year, impose charges in an amount ex3 ceeding 2 percent of the annual gross income of 

4 the individual; 

5 ‘‘(D) in the case of individuals with an in6 come greater than 200 percent of the official 

7 poverty level but not exceeding 250 percent of 

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

9 calendar year, impose charges in an amount ex10 ceeding 4 percent of the annual gross income of 

11 the individual involved; 

12 ‘‘(E) in the case of individuals with an in13 come greater than 250 percent of the official 

14 poverty level but not exceeding 300 percent of 

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

16 calendar year, impose charges in an amount ex17 ceeding 6 percent of the annual gross income of 

18 the individual involved; 

19 ‘‘(F) in the case of individuals with an in20 come greater than 300 percent of the official 

21 poverty level but not exceeding 400 percent of 

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

23 calendar year, impose charges in an amount ex24 ceeding 8.5 percent of the annual gross income 

25 of the individual involved; 


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1 ‘‘(G) in the case of individuals with an in2 come greater than 400 percent of the official 

3 poverty level, the provider will not, for any cal4 endar year, impose charges in an amount ex5 ceeding 8.5 percent of the annual gross income 

6 of the individual involved; and 

7 ‘‘(H) in the case of eligible American In8 dian and Alaska Native and urban Indian indi9 viduals as defined by section 447.50 of title 42, 

10 Code of Federal Regulations (as in effect on 

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

12 charges for substance use disorder treatment 

13 services, including any charges or cost-sharing 

14 prohibited by section 1402(d) of the Patient 

15 Protection and Affordable Care Act. 

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

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

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

19 charge— 

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

21 the discretion of the State, including imposing 

22 only a nominal charge for the provision of serv23 ices, subject to the provisions of the paragraph 

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1 tations on the maximum amount of charges; 

2 and 

3 ‘‘(B) take into consideration the total med4 ical expenses of individuals in assessing the 

5 amount of the charge, subject to such provi6 sions. 

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

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

9 unless the State agrees that the limitations on 

10 charges for substance use disorder treatment serv11 ices under this subsection applies to the annual ag12 gregate of charges imposed for such services, how13 ever the charges are characterized, includes enroll14 ment fees, premiums, deductibles, cost sharing, co15 payments, co-insurance costs, or any other charges. 

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

17 applying to grants distributed in accordance with section 

18 3412(b) shall be developed by the Secretary in consulta19 tion with Indian tribes. 

20 ‘‘SEC. 3414. TECHNICAL ASSISTANCE. 

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

22 contracts, provide technical assistance in administering 

23 and coordinating the activities authorized under section 

24 3412, including technical assistance for the development 


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1 of State applications for supplementary grants authorized 

2 in section 3412(a)(2). 

3 ‘‘SEC. 3415. AUTHORIZATION OF APPROPRIATIONS. 

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

5 this subtitle— 

6 ‘‘(1) $4,600,000,000 for fiscal year 2024; 

7 ‘‘(2) $4,600,000,000 for fiscal year 2025; 

8 ‘‘(3) $4,600,000,000 for fiscal year 2026; 

9 ‘‘(4) $4,600,000,000 for fiscal year 2027; 

10 ‘‘(5) $4,600,000,000 for fiscal year 2028; 

11 ‘‘(6) $4,600,000,000 for fiscal year 2029; 

12 ‘‘(7) $4,600,000,000 for fiscal year 2030; 

13 ‘‘(8) $4,600,000,000 for fiscal year 2031; 

14 ‘‘(9) $4,600,000,000 for fiscal year 2032; and 

15 ‘‘(10) $4,600,000,000 for fiscal year 2033. 

16 ‘‘Subtitle C—Other Grant Program 

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

18 ‘‘(a) GRANTS.— 

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

20 grants to public entities, nonprofit entities, Indian 

21 entities, and other eligible Medicaid providers for the 

22 purpose of funding prevention services, core medical 

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1 ministrative expenses in accordance with this sec2 tion. 

3 ‘‘(2) PRIORITIZATION.— 

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

5 under this section, the Secretary shall, to the 

6 extent practicable, prioritize the distribution of 

7 grant funds to grantees that have— 

8 ‘‘(i) an explicit policy not to deter em9 ployees with respect to— 

10 ‘‘(I) labor organizing for the em11 ployees engaged in the covered activi12 ties; and 

13 ‘‘(II) such employees’ choice to 

14 form and join labor organizations; or 

15 ‘‘(ii) policies that require— 

16 ‘‘(I) the posting and maintenance 

17 of notices in the workplace to such 

18 employees of their rights under the 

19 National Labor Relations Act (29 

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

21 ‘‘(II) that such employees are, at 

22 the beginning of their employment, 

23 provided notice and information re24 garding the employees’ rights under 

25 such Act; and 


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1 ‘‘(III) the employer to voluntarily 

2 recognize a union in cases where such 

3 workers of the employer have joined 

4 and requested representation. 

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

6 not apply to Indian tribes. 

7 ‘‘(b) ELIGIBILITY.— 

8 ‘‘(1) ENTITIES.—Public entities, nonprofit enti9 ties, urban Indian organizations, and other Medicaid 

10 providers eligible to receive a grant under subsection 

11 (a) may include— 

12 ‘‘(A) Federally-qualified health centers 

13 under section 1905(l)(2)(B) of the Social Secu14 rity Act; 

15 ‘‘(B) family planning clinics; 

16 ‘‘(C) rural health clinics; 

17 ‘‘(D) Indian entities, including Indian 

18 health programs as defined in section 4 of the 

19 Indian Health Care Improvement Act, urban 

20 Indian organizations as defined in section 4 of 

21 the Indian Health Care Improvement Act, and 

22 Native Hawaiian organizations as defined in 

23 section 11 of the Native Hawaiian Health Care 

24 Act of 1988; 


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1 ‘‘(E) community-based organizations, clin2 ics, hospitals, and other health facilities that 

3 provide substance use disorder treatment serv4 ices; 

5 ‘‘(F) other nonprofit entities that provide 

6 substance use disorder treatment services; 

7 ‘‘(G) certified community behavioral health 

8 clinics and certified community behavioral 

9 health clinic expansion grant recipients, under 

10 section 223 of the Protecting Access to Medi11 care Act (42 U.S.C. 1396a note); and 

12 ‘‘(H) other Medicaid providers if more 

13 than half of their patients are diagnosed with a 

14 substance use disorder and covered by Med15 icaid. 

16 ‘‘(2) UNDERSERVED POPULATIONS.—Entities 

17 described in paragraph (1) shall serve underserved 

18 populations which may include— 

19 ‘‘(A) minority populations and Indian pop20 ulations; 

21 ‘‘(B) formerly incarcerated individuals; 

22 ‘‘(C) individuals with comorbidities includ23 ing human immunodeficiency virus, hepatitis B, 

24 hepatitis C, mental health disorder or other be25 havioral health disorders; 


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1 ‘‘(D) low-income populations; 

2 ‘‘(E) people with disabilities; 

3 ‘‘(F) urban populations; 

4 ‘‘(G) rural populations; 

5 ‘‘(H) the lesbian, gay, bisexual, 

6 transgender, queer (LGBTQ) community; and 

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

8 of developing, substance use disorder and in9 fants with neonatal abstinence syndrome. 

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

11 grant under this section, public entities, nonprofit 

12 entities, and other Medicaid providers described in 

13 this subsection shall prepare and submit to the Sec14 retary an application in such form, and containing 

15 such information, as the Secretary shall require, in16 cluding— 

17 ‘‘(A) a complete accounting of the dis18 bursement of any prior grants received under 

19 this subtitle by the applicant and the results 

20 achieved by these expenditures; 

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

22 the grant, including— 

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

24 local need for the funds sought; 


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1 ‘‘(ii) a plan for providing substance 

2 use disorder treatment services that is con3 sistent with local needs; and 

4 ‘‘(iii) goals and objectives to be 

5 achieved with grant funds provided under 

6 this section, including targets and mile7 stones that are intended to be met and a 

8 description of the activities that will be un9 dertaken to achieve those targets; 

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

11 use funds in a manner that provides substance 

12 use disorder treatment services compliant with 

13 the evidence-based standards developed in ac14 cordance with section 3435, including all drugs 

15 approved by the Food and Drug Administration 

16 for the treatment of substance use disorder for 

17 which the applicant offers treatment, in accord18 ance with section 3435(c); 

19 ‘‘(D) information on the number of individ20 uals to be served by the funds sought, including 

21 demographic data on the populations to be 

22 served; 

23 ‘‘(E) a demonstration that resources pro24 vided under the grant will be allocated in ac25 cordance with the local demographic incidence 


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1 of substance use, including allocations for serv2 ices for children, youths, and women; 

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

4 and medical expense criteria will be established 

5 and applied to those who qualify for assistance 

6 under the program; and 

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

8 this section, data provided in such form as the 

9 Secretary shall require detailing, at a minimum, 

10 the extent to which the activities supported by 

11 the funding met the goals and objectives speci12 fied in the application for the funding, the num13 ber of individuals who accessed medication for 

14 addiction treatment by age, gender, race, sexual 

15 orientation, disability status, and other demo16 graphic criteria relevant to the program, and 

17 the effect of the program on overdose rates and 

18 rates of death due to overdose in the region 

19 served by the program. 

20 ‘‘(4) REQUIREMENT OF STATUS AS MEDICAID

21 PROVIDER.— 

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

23 subparagraph (B), the Secretary may not make 

24 a grant under this section for the provision of 

25 substance use disorder treatment services under 


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

2 such service that is available pursuant to the 

3 State plan approved under title XIX of the So4 cial Security Act for the State— 

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

6 provide the service directly, and the appli7 cant has entered into a participation agree8 ment under the State plan and is qualified 

9 to receive payments under such plan; or 

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

11 enter into an agreement with public or 

12 nonprofit entities, Indian entities, or other 

13 Medicaid providers if more than half of 

14 their patients are diagnosed with a sub15 stance use disorder and covered by Med16 icaid, under which such entities and other 

17 providers will provide the substance use 

18 disorder treatment service, and such enti19 ties and other providers have entered into 

20 such a participation agreement and are 

21 qualified to receive such payments; and 

22 ‘‘(ii) the applicant ensures that pay23 ment will be sought for each such service 

24 rendered in accordance with the usual pay25 ment schedule under the State plan. 


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

2 making an agreement pursuant to subpara3 graph (A) regarding the provision of substance 

4 use disorder treatment services, the require5 ment established in such paragraph shall be 

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

7 providing such services, impose a charge or ac8 cept reimbursement available from any third9 party payor, including reimbursement under 

10 any insurance policy or under any Federal or 

11 State health benefits program. A waiver under 

12 this subparagraph shall not be longer than 2 

13 years in duration and shall not be renewed. 

14 ‘‘(C) DETERMINATION.—A determination 

15 by the State of whether an entity referred to in 

16 subparagraph (A) meets the criteria for a waiv17 er under such subparagraph shall be made 

18 without regard to whether the entity accepts 

19 voluntary donations for the purpose of pro20 viding services to the public. 

21 ‘‘(5) REQUIRED TERMS FOR EXPANDING AND

22 IMPROVING CARE.—A funding agreement for a grant 

23 under this section is that— 

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

25 not be utilized to make payments for any item 


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1 or service to the extent that payment has been 

2 made, or can reasonably be expected to be 

3 made, with respect to that item or service under 

4 a State compensation program, under an insur5 ance 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); 

9 ‘‘(B) entities providing substance use dis10 order treatment services with assistance made 

11 available under the grant shall offer all drugs 

12 approved by the Food and Drug Administration 

13 for the treatment of substance use disorder for 

14 which the applicant offers treatment, in accord15 ance with section 3435(c); 

16 ‘‘(C) substance use disorder treatment 

17 services provided with assistance made available 

18 under the grant will be provided without re19 gard— 

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

21 pay for such services; and 

22 ‘‘(ii) to the current or past health con23 dition of the individual to be served; 

24 ‘‘(D) substance use disorder treatment 

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1 cessible to low-income individuals with sub2 stance use disorders and to individuals with 

3 substance use disorders residing in rural areas; 

4 and 

5 ‘‘(E) the confidentiality of individuals re6 ceiving substance use disorder treatment serv7 ices will be maintained in a manner not incon8 sistent with applicable law. 

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

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

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

12 section 4 of the Indian Self-Determination and Edu13 cation Assistance Act. 

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

15 through the Indian Health Service, shall use 10 per16 cent of the amount available under section 3425 for 

17 each fiscal year to provide grants to Indian entities 

18 in an amount determined pursuant to criteria devel19 oped by the Secretary in consultation with Indian 

20 tribes and after conferring with urban Indian orga21 nizations, for the purposes of addressing substance 

22 use. 

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

24 requirements in this section, Native entities may use 

25 amounts provided under grants awarded under this 


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1 section for the uses identified in section 3422 and 

2 any other activities determined appropriate by the 

3 Secretary, in consultation with Indian tribes. 

4 ‘‘SEC. 3422. USE OF AMOUNTS. 

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

6 received under a grant under section 3421 to provide di7 rect financial assistance to eligible entities for the purpose 

8 of delivering or enhancing— 

9 ‘‘(1) prevention services described in subsection 

10 (b); 

11 ‘‘(2) core medical services described in sub12 section (c); 

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

14 subsection (d); 

15 ‘‘(4) early intervention and engagement services 

16 described in subsection (e); 

17 ‘‘(5) harm reduction services described in sub18 section (f); and 

19 ‘‘(6) administrative expenses described in sub20 section (g). 

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

22 section, the term ‘prevention services’ means evidence23 based services, programs, or multi-sector strategies to pre24 vent substance use disorder (including education cam25 paigns, community-based prevention programs, risk idenVerDate Sep 11 2014 03:37 Jun 06, 2024 Jkt 049200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H8323.IH H8323

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1 tification programs, opioid diversion, collection and dis2 posal of unused opioids, services to at-risk populations, 

3 and trauma support services). 

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

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

6 following evidence-based services provided to individuals 

7 with substance use disorder or at risk for developing sub8 stance use disorder, including through the use of telemedi9 cine or a hub and spoke model: 

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

11 fully described in section 3439(4), including assess12 ment of disease presence, severity, and co-occurring 

13 conditions, treatment planning, clinical stabilization 

14 services, withdrawal management and detoxification, 

15 intensive inpatient treatment, intensive outpatient 

16 treatment, outpatient treatment, residential inpa17 tient services, treatment for co-occurring mental 

18 health and substance use disorders, and all drugs 

19 approved by the Food and Drug Administration for 

20 the treatment of substance use disorder. 

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

22 including those administered by Federally-qualified 

23 health centers, rural health clinics, tribal clinics and 

24 hospitals, urban Indian organizations, certified com25 munity behavioral health clinics (as described in secVerDate Sep 11 2014 03:37 Jun 06, 2024 Jkt 049200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\H8323.IH H8323

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1 tion 223 of the Protecting Access to Medicare Act), 

2 HIV services organizations, Native Hawaiian organi3 zations (as defined in section 11 of the Native Ha4 waiian Health Care Act of 1988), and comprehen5 sive opioid recovery centers (as described in section 

6 552 of this Act). 

7 ‘‘(3) Hospice services. 

8 ‘‘(4) Mental health services. 

9 ‘‘(5) Opioid overdose reversal drug products 

10 procurement, distribution, and training. 

11 ‘‘(6) Pharmaceutical assistance related to the 

12 management of substance use disorder and co-mor13 bid conditions. 

14 ‘‘(7) Home- and community-based health serv15 ices. 

16 ‘‘(8) Comprehensive Case Management and care 

17 coordination, including substance use disorder treat18 ment adherence services. 

19 ‘‘(9) Health insurance enrollment and cost20 sharing assistance in accordance with section 3412. 

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

22 dispatch mental health professionals, harm reduction 

23 providers, or community health workers to respond 

24 in lieu of law enforcement officers in emergencies in 

25 which— 


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1 ‘‘(A) an individual calling 911, the Na2 tional Suicide Hotline, or another emergency 

3 hotlines states that a person is experiencing a 

4 drug overdose or is otherwise under the influ5 ence of a legal or illegal substance; and 

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

7 responder, or other individual identifies a per8 son as being (or possibly being) under the influ9 ence of a legal or illegal substance. 

10 ‘‘(d) RECOVERY AND SUPPORT SERVICES.—For pur11 poses of this section, the term ‘recovery and support serv12 ices’ means services that are provided to individuals with 

13 substance use disorder, including residential recovery 

14 housing, mental health services, long term recovery serv15 ices, 24/7 hotline crisis center support, medical transpor16 tation services, respite care for persons caring for individ17 uals with substance use disorder, child care and family 

18 services while an individual is receiving inpatient treat19 ment services or at the time of outpatient services, out20 reach services, peer recovery services, nutrition services, 

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

22 legal services, and child care and family services. The enti23 ties through which such services may be provided include 

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1 port services, so long as they do not exclude individuals 

2 on the basis that such individuals receive medication for 

3 addiction treatment. 

4 ‘‘(e) EARLY INTERVENTION SERVICES.—For pur5 poses of this section, the term ‘early intervention services’ 

6 means services to provide screening and connection to the 

7 appropriate level of substance use disorder and mental 

8 health treatment (including same-day connection), coun9 seling provided to individuals who have misused sub10 stances, who have experienced an overdose, or are at risk 

11 of developing substance use disorder, the provision of re12 ferrals to facilitate the access of such individuals to core 

13 medical services or recovery and support services for sub14 stance use disorder, and rapid access to medication for 

15 addiction treatment in the setting of recent overdose. The 

16 entities through which such services may be provided in17 clude emergency rooms, fire departments and emergency 

18 medical services, detention facilities, prisons and jails 

19 homeless shelters, health care points of entry specified by 

20 eligible local areas, Federally-qualified health centers, 

21 workforce agencies and job centers, youth development 

22 centers, tribal clinics and hospitals, urban Indian organi23 zations, and rural health clinics. 

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

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


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1 services provided to individuals engaging in substance use 

2 that are scientifically accepted to reduce the risk of infec3 tious disease transmission, overdose, or death, including 

4 syringe services programs and other safe use services, such 

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

6 or analyzes a substance to determine its composition or 

7 that detects substances. 

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

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

10 10 percent of amounts received under a grant under sec11 tion 3421 for administration, accounting, reporting, and 

12 program oversight functions, including for the purposes of 

13 developing systems to improve data collection and data 

14 sharing. 

15 ‘‘(h) RELATION TO EXISTING EMERGENCY MEDICAL

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

17 diminish or alter the rights, privileges, remedies, or obliga18 tions of any provider or any Federal, State, or local gov19 ernment to provide emergency medical services. 

20 ‘‘SEC. 3423. TECHNICAL ASSISTANCE. 

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

22 contracts, provide technical assistance to public or non23 profit entities, Indian entities, and other eligible Medicaid 

24 providers regarding the process of submitting to the Sec25 retary applications for grants under section 3421, and 


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1 may provide technical assistance with respect to the plan2 ning, development, and operation of any program or serv3 ice carried out pursuant to such section. 

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

5 ‘‘(a) IN GENERAL.—The Secretary may provide plan6 ning grants to public or nonprofit entities, Indian entities, 

7 and other eligible Medicaid providers for purposes of as8 sisting such entities and providers in expanding their ca9 pacity to provide substance use disorder treatment services 

10 in low-income communities and affected subpopulations 

11 that are underserviced with respect to such services. 

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

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

14 ‘‘SEC. 3425. AUTHORIZATION OF APPROPRIATIONS. 

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

16 this subtitle— 

17 ‘‘(1) $1,000,000,000 for fiscal year 2024; 

18 ‘‘(2) $1,000,000,000 for fiscal year 2025; 

19 ‘‘(3) $1,000,000,000 for fiscal year 2026; 

20 ‘‘(4) $1,000,000,000 for fiscal year 2027; 

21 ‘‘(5) $1,000,000,000 for fiscal year 2028; 

22 ‘‘(6) $1,000,000,000 for fiscal year 2029; 

23 ‘‘(7) $1,000,000,000 for fiscal year 2030; 

24 ‘‘(8) $1,000,000,000 for fiscal year 2031; 

25 ‘‘(9) $1,000,000,000 for fiscal year 2032; and 


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

2 ‘‘Subtitle D—Innovation, Training, 

3 and Health Systems Strengthening 

4 ‘‘SEC. 3431. SPECIAL PROJECTS OF NATIONAL SIGNIFI5 CANCE. 

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

7 grants to entities to administer special projects of national 

8 significance to support the development of innovative and 

9 original models for the delivery of substance use disorder 

10 treatment and harm reduction services. 

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

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

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

14 emerging needs of individuals receiving assistance under 

15 this title. 

16 ‘‘(c) REPLICATION.—The Secretary shall make infor17 mation concerning successful models or programs devel18 oped under this section available to grantees under this 

19 title for the purpose of coordination, replication, and inte20 gration. To facilitate efforts under this section, the Sec21 retary may provide for peer-based technical assistance for 

22 grantees funded under this section. 

23 ‘‘(d) GRANTS TO TRIBAL GOVERNMENTS.— 

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) USE OF FUNDS.—The Secretary, acting 

4 through the Indian Health Service, shall use 10 per5 cent of the amount available under this section for 

6 each fiscal year to provide grants to Indian tribes 

7 for the purposes of supporting the development of 

8 innovative and original models for the delivery of 

9 substance use disorder treatment services, including 

10 the development of culturally informed care models. 

11 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

12 is authorized to be appropriated to carry out this section— 

13 ‘‘(1) $500,000,000 for fiscal year 2024; 

14 ‘‘(2) $500,000,000 for fiscal year 2025; 

15 ‘‘(3) $500,000,000 for fiscal year 2026; 

16 ‘‘(4) $500,000,000 for fiscal year 2027; 

17 ‘‘(5) $500,000,000 for fiscal year 2028; 

18 ‘‘(6) $500,000,000 for fiscal year 2029; 

19 ‘‘(7) $500,000,000 for fiscal year 2030; 

20 ‘‘(8) $500,000,000 for fiscal year 2031; 

21 ‘‘(9) $500,000,000 for fiscal year 2032; and 

22 ‘‘(10) $500,000,000 for fiscal year 2033. 

23 ‘‘SEC. 3432. EDUCATION AND TRAINING CENTERS. 

24 ‘‘(a) IN GENERAL.—The Secretary may make grants 

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1 ties, public or nonprofit schools, and academic health cen2 ters in meeting the cost of projects— 

3 ‘‘(1) to train health professionals, including 

4 practitioners in programs under this title and other 

5 community providers, including physician addiction 

6 specialists, psychologists, counselors, case managers, 

7 social workers, peer recovery coaches, harm reduc8 tion workers, public health workers, and community 

9 health workers, and paraprofessionals, such as peer 

10 support specialists and recovery coaches, in the diag11 nosis, treatment, and prevention of substance use 

12 disorders and drug use-related health issues, includ13 ing measures for the prevention and treatment of co14 occurring infectious diseases, mental health dis15 orders, and other conditions, and including (as appli16 cable to the type of health professional involved), 

17 care for women, pregnant women, and children; 

18 ‘‘(2) to train the faculty of schools of medicine, 

19 nursing, public health, osteopathic medicine, den20 tistry, allied health, social work, and mental health 

21 practice to teach health professions students to 

22 screen for and provide for the needs of individuals 

23 with substance use disorders or at risk of substance 

24 use; and 


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1 ‘‘(3) to develop and disseminate curricula and 

2 resource materials relating to evidence-based prac3 tices for the screening, prevention, and treatment of 

4 substance use disorders and drug use-related health 

5 issues, including information about combating stig6 ma, prescribing best practices, overdose reversal, al7 ternative pain therapies, and all drugs approved by 

8 the Food and Drug Administration for the treat9 ment of substance use disorders, including for the 

10 purposes authorized under the amendments made by 

11 section 3203 of the SUPPORT for Patients and 

12 Communities Act. 

13 ‘‘(b) PREFERENCE IN MAKING GRANTS.—In making 

14 grants under subsection (a), the Secretary shall give pref15 erence to qualified projects that will— 

16 ‘‘(1) train, or result in the training of, health 

17 professionals and other community providers de18 scribed in subsection (a)(1), to provide substance 

19 use disorder treatments for underserved groups, in20 cluding minority individuals and Indians with sub21 stance use disorder and other individuals who are at 

22 a high risk of substance use; 

23 ‘‘(2) train, or result in the training of, minority 

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1 fessionals, to provide substance use disorder treat2 ment for individuals with such disease; 

3 ‘‘(3) train or result in the training of individ4 uals who will provide substance use disorder treat5 ment in rural or other areas that are underserved by 

6 current treatment structures; 

7 ‘‘(4) train or result in the training of health 

8 professionals and allied health professionals, includ9 ing counselors, case managers, social workers, peer 

10 recovery coaches, and harm reduction workers, pub11 lic health workers, and community health workers, 

12 to provide treatment for infectious diseases and 

13 mental health disorders co-occurring with substance 

14 use disorder; and 

15 ‘‘(5) train or result in the training of health 

16 professionals and other community providers to pro17 vide substance use disorder treatments for pregnant 

18 women, children, and adolescents. 

19 ‘‘(c) NATIVE EDUCATION AND TRAINING CEN20 TERS.—The Secretary shall use 10 percent of the amount 

21 available under subsection (d) for each fiscal year to pro22 vide grants authorized under this subtitle to— 

23 ‘‘(1) tribal colleges and universities; 

24 ‘‘(2) Indian Health Service grant funded insti25 tutions; and 


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1 ‘‘(3) Native partner institutions, including insti2 tutions of higher education with medical training 

3 programs that partner with one or more Indian 

4 tribes, tribal organizations, Native Hawaiian organi5 zations, or tribal colleges and universities to train 

6 Native health professionals that will provide sub7 stance use disorder treatment services in Native 

8 communities. 

9 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

10 is authorized to be appropriated to carry out this section— 

11 ‘‘(1) $500,000,000 for fiscal year 2024; 

12 ‘‘(2) $500,000,000 for fiscal year 2025; 

13 ‘‘(3) $500,000,000 for fiscal year 2026; 

14 ‘‘(4) $500,000,000 for fiscal year 2027; 

15 ‘‘(5) $500,000,000 for fiscal year 2028; 

16 ‘‘(6) $500,000,000 for fiscal year 2029; 

17 ‘‘(7) $500,000,000 for fiscal year 2030; 

18 ‘‘(8) $500,000,000 for fiscal year 2031; 

19 ‘‘(9) $500,000,000 for fiscal year 2032; and 

20 ‘‘(10) $500,000,000 for fiscal year 2033. 

21 ‘‘SEC. 3433. SUBSTANCE USE DISORDER TREATMENT PRO22 VIDER CAPACITY UNDER THE MEDICAID PRO23 GRAM. 

24 ‘‘(a) PROJECTS.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall use 

2 amounts appropriated under this section to provide 

3 funding for projects in any State or territory to in4 crease substance use provider capacity, as provided 

5 for in section 1903(aa) of the Social Security Act. 

6 ‘‘(2) PRIORITIZATIONS.— 

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

8 under this section, the Secretary shall, to the 

9 extent practicable, prioritize the distribution of 

10 grant funds to grantees that have— 

11 ‘‘(i) an explicit policy not to deter em12 ployees with respect to— 

13 ‘‘(I) labor organizing for the em14 ployees engaged in the covered activi15 ties; and 

16 ‘‘(II) such employees’ choice to 

17 form and join labor organizations; and 

18 ‘‘(ii) policies that require— 

19 ‘‘(I) the posting and maintenance 

20 of notices in the workplace to such 

21 employees of their rights under the 

22 National Labor Relations Act (29 

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

24 ‘‘(II) that such employees are, at 

25 the beginning of their employment, 


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1 provided notice and information re2 garding the employees’ rights under 

3 such Act; and 

4 ‘‘(III) the employer to voluntarily 

5 recognize a union in cases where such 

6 workers of the employer have joined 

7 and requested representation. 

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

9 not apply to Indian tribes. 

10 ‘‘(b) AMOUNT OF GRANT TO INDIAN ENTITIES.— 

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

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

13 section 4 of the Indian Self-Determination and Edu14 cation Assistance Act. 

15 ‘‘(2) URBAN INDIAN ORGANIZATION.—In this 

16 section, the term ‘urban Indian organization’ has the 

17 meaning given such in section 4 of the Indian 

18 Health Care Improvement Act. 

19 ‘‘(3) GRANTS.—The Secretary, acting through 

20 the Indian Health Service, shall use 10 percent of 

21 the amount appropriated under this section for each 

22 fiscal year to award grants to Indian tribes and 

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1 retary in consultation with Indian tribes and in con2 ference with urban Indian organizations. 

3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section— 

5 ‘‘(1) $50,000,000 for fiscal year 2024; 

6 ‘‘(2) $50,000,000 for fiscal year 2025; 

7 ‘‘(3) $50,000,000 for fiscal year 2026; 

8 ‘‘(4) $50,000,000 for fiscal year 2027; 

9 ‘‘(5) $50,000,000 for fiscal year 2028; 

10 ‘‘(6) $50,000,000 for fiscal year 2029; 

11 ‘‘(7) $50,000,000 for fiscal year 2030; 

12 ‘‘(8) $50,000,000 for fiscal year 2031; 

13 ‘‘(9) $50,000,000 for fiscal year 2032; and 

14 ‘‘(10) $50,000,000 for fiscal year 2033. 

15 ‘‘SEC. 3434. PROGRAMS TO SUPPORT EMPLOYEES. 

16 ‘‘(a) GRANT PROGRAM FOR WORKERS.— 

17 ‘‘(1) IN GENERAL.—The Secretary, acting 

18 through the Director of the National Institute for 

19 Occupational Safety and Health, shall award grants 

20 to non-profit entities that meet the requirements of 

21 this section to fund programs and projects to assist 

22 workers who are at risk of substance use disorder, 

23 who have substance use disorder, or who are recov24 ering from substance use disorder to maintain or 

25 gain employment. 


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1 ‘‘(2) GRANTS FOR WORKERS.— 

2 ‘‘(A) IN GENERAL.—The Secretary shall, 

3 on a competitive basis, award grants for a pe4 riod of not more than 3 years to non-profit en5 tities that submit an application under para6 graph (3) to enable such entities to implement, 

7 conduct, continue, and expand evidence-based 

8 programs and projects to assist individuals de9 scribed in subparagraph (G). 

10 ‘‘(B) USE OF AMOUNTS.—An entity may 

11 use amounts provided under this subsection 

12 for— 

13 ‘‘(i) prevention services described in 

14 subparagraph (C), including providing edu15 cation and information to workers regard16 ing the dangers of illicit and licit drug use, 

17 non-opioid pain management and non-drug 

18 pain management, or occupational injury 

19 and illness prevention; 

20 ‘‘(ii) early intervention services de21 scribed in subparagraph (D) to enable in22 dividuals to maintain or gain employment; 

23 ‘‘(iii) recovery and support services 

24 described in subparagraph (E) to enable 


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1 individuals to maintain or gain employ2 ment; 

3 ‘‘(iv) harm reduction services de4 scribed in subparagraph (F) to enable indi5 viduals to maintain or gain employment; 

6 ‘‘(v) hiring case managers, care coor7 dinators, and peer support specialists to 

8 assist employed individuals who are experi9 encing substance use disorder, or who are 

10 recovering from substance use disorder, in 

11 accessing substance use disorder treatment 

12 services; or 

13 ‘‘(vi) providing vocational, life skills, 

14 and other forms of job training to workers 

15 who are receiving substance use disorder 

16 treatment services to enable such workers 

17 to maintain or gain employment. 

18 ‘‘(C) PREVENTION SERVICES.—For pur19 poses of this section, the term ‘prevention serv20 ices’ means evidence-based services, programs, 

21 or multi-sector strategies to prevent substance 

22 use disorder (including education campaigns, 

23 community-based prevention programs, risk 

24 identification programs, opioid diversion, collec25 tion and disposal of unused opioids, services to 


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1 at-risk populations, and trauma support serv2 ices). 

3 ‘‘(D) RECOVERY AND SUPPORT SERV4 ICES.—For purposes of this section, the term 

5 ‘recovery and support services’ means services 

6 including residential recovery housing, mental 

7 health services, long term recovery services, 24/ 

8 7 hotline crisis center services, medical trans9 portation services, respite care for persons car10 ing for individuals with substance use disorder, 

11 child care and family services while an indi12 vidual is receiving inpatient treatment services 

13 or at the time of outpatient services, outreach 

14 services, peer recovery services, nutrition serv15 ices, and referrals for job training and career 

16 services, housing, legal services, and child care 

17 and family services so long as they do not ex18 clude individuals on the basis that such individ19 uals receive medication for addiction treatment. 

20 ‘‘(E) EARLY INTERVENTION SERVICES.— 

21 For purposes of this section, the term ‘early 

22 intervention services’ means services to provide 

23 screening and connection to the appropriate 

24 level of substance use disorder and mental 

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1 tion), counseling provided to individuals who 

2 have misused substances, who have experienced 

3 an overdose, or are at risk of developing sub4 stance use disorder, the provision of referrals to 

5 facilitate the access of such individuals to core 

6 medical services or recovery and support serv7 ices for substance use disorder, and rapid ac8 cess to medication for addiction treatment in 

9 the setting of recent overdose. 

10 ‘‘(F) HARM REDUCTION SERVICES.—For 

11 purposes of this section, the term ‘harm reduc12 tion services’ means services provided to indi13 viduals engaging in substance use scientifically 

14 accepted to reduce the risk of infectious disease 

15 transmission, overdose, or death, including sy16 ringe services programs and other safe use serv17 ices, such as utilization of a device, kit, or 

18 chemical agent that tests or analyzes a sub19 stance to determine its composition or that de20 tects substances. 

21 ‘‘(G) INDIVIDUALS DESCRIBED.—Individ22 uals described in this subparagraph are individ23 uals who— 

24 ‘‘(i)(I) have been employed in the 12- 

25 month period immediately preceding the 


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1 date on which the determination is being 

2 made, or who are participating in an em3 ployee training or apprenticeship program; 

4 and 

5 ‘‘(II) are at high risk of developing 

6 substance use disorder, including as a re7 sult of employment in industries that expe8 rience high rates of occupational injuries 

9 and illness; or 

10 ‘‘(ii) are experiencing a substance use 

11 disorder or are in recovery from a sub12 stance use disorder. 

13 ‘‘(3) APPLICATIONS.—To be eligible for a grant 

14 under this subsection, an entity shall submit to the 

15 Secretary an application at such time, in such man16 ner, and containing such information as the Sec17 retary may require, including— 

18 ‘‘(A) a complete accounting of the dis19 bursement of any prior grants received under 

20 this title by the applicant and the results 

21 achieved by such expenditures; 

22 ‘‘(B) a description of the population to be 

23 served with grant funds provided under this 

24 section, including a description of the unique 

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1 pational injuries or exposure to illicit sub2 stances; 

3 ‘‘(C) the goals and objectives to be 

4 achieved with grant funds provided under this 

5 section, including targets and milestones that 

6 are intended to be met, the activities that will 

7 be undertaken to achieve those targets, and the 

8 number of individuals likely to be served by the 

9 grant funds, including demographic data on the 

10 populations to be served; 

11 ‘‘(D) a demonstration of the ability of the 

12 applicant to reach the individuals described in 

13 paragraph (2)(G) and to provide services de14 scribed in paragraph (2)(B) included in the ap15 plicant’s grant application, including by 

16 partnering with local stakeholders; 

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

18 this subsection, data provided in such form as 

19 the Secretary shall require detailing, at a min20 imum, the extent to which the activities sup21 ported by the funding met the goals, objectives, 

22 targets, and milestones specified in the applica23 tion for the funding, and the number of individ24 uals with and without substance use disorder 

25 who received services supported by the funding, 


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1 including the services provided to these individ2 uals, the industries in which the individuals 

3 were employed when they received services, and 

4 whether the individuals were still employed in 

5 that same industry or in any industry when the 

6 individuals ceased receiving services supported 

7 by the funding; and 

8 ‘‘(F) any other information the Secretary 

9 shall require. 

10 ‘‘(4) DATA REPORTING AND OVERSIGHT.—An 

11 entity awarded a grant under this subsection shall 

12 submit to the Secretary an annual report at such 

13 time and in such manner as the Secretary shall re14 quire. Such report shall include, at a minimum, a 

15 description of— 

16 ‘‘(A) the activities funded by the grant; 

17 ‘‘(B) the number of individuals with and 

18 without substance use disorder served through 

19 activities funded by the grant, including the 

20 services provided to those individuals and the 

21 industries in which those individuals were em22 ployed at the time they received services sup23 ported by the grant; 

24 ‘‘(C) for workers experiencing substance 

25 use disorder or recovering from substance use 


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1 disorder served by activities funded by the 

2 grant, the number of individuals who main3 tained employment, the number of individuals 

4 who gained employment, and the number of in5 dividuals who failed to maintain employment 

6 over the course of the reporting period; and 

7 ‘‘(D) any other information required by the 

8 Secretary. 

9 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

10 There is authorized to be appropriated to carry out 

11 this subsection— 

12 ‘‘(A) $40,000,000 for fiscal year 2024; 

13 ‘‘(B) $40,000,000 for fiscal year 2025; 

14 ‘‘(C) $40,000,000 for fiscal year 2026; 

15 ‘‘(D) $40,000,000 for fiscal year 2027; 

16 ‘‘(E) $40,000,000 for fiscal year 2028; 

17 ‘‘(F) $40,000,000 for fiscal year 2029; 

18 ‘‘(G) $40,000,000 for fiscal year 2030; 

19 ‘‘(H) $40,000,000 for fiscal year 2031; 

20 ‘‘(I) $40,000,000 for fiscal year 2032; and 

21 ‘‘(J) $40,000,000 for fiscal year 2033. 

22 ‘‘(b) RESEARCH ON THE IMPACT OF SUBSTANCE USE

23 DISORDER IN THE WORKPLACE AND ON DIRECT SERVICE

24 PROVIDERS.— 


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1 ‘‘(1) RISKS OF SUBSTANCE USE DISORDER.— 

2 The Secretary, in consultation with the Director of 

3 the National Institute for Occupational Safety and 

4 Health, shall conduct (directly or through grants or 

5 contracts) research, experiments, and demonstra6 tions, and publish studies relating to— 

7 ‘‘(A) the risks faced by employees in var8 ious occupations of developing substance use 

9 disorder and of drug overdose deaths and non10 fatal drug overdoses, and the formulation of 

11 prevention activities tailored to the risks identi12 fied in these occupations, including occupational 

13 injury and illness prevention; 

14 ‘‘(B) the prevalence of substance use dis15 order among employees in various occupations; 

16 ‘‘(C) efforts that employers may undertake 

17 to assist employees who are undergoing sub18 stance use disorder treatment services in main19 taining employment while ensuring workplaces 

20 are safe and healthful; 

21 ‘‘(D) risks of occupational exposure to 

22 opioids and other illicit substances and the for23 mulation of prevention activities tailored to the 

24 risks identified; and 


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1 ‘‘(E) other subjects related to substance 

2 use disorder in the workplace as the Secretary 

3 determines. 

4 ‘‘(2) DIRECT SERVICE PROVIDERS.—The Sec5 retary shall conduct (directly or through grants or 

6 contracts) research, experiments, and demonstra7 tions, and publish studies relating to the occupa8 tional health and safety, recruitment, and retention 

9 of behavioral health providers who, as part of their 

10 job responsibilities, provide direct services to individ11 uals who are at risk of experiencing substance use 

12 disorder or who are experiencing or recovering from 

13 substance use disorder, including— 

14 ‘‘(A) identifying factors that the Secretary 

15 believes may endanger the health or safety of 

16 such workers, including factors that affect the 

17 risks such workers face of developing substance 

18 use disorder; 

19 ‘‘(B) motivational and behavioral factors 

20 relating to the field of behavioral health pro21 viders; 

22 ‘‘(C) strategies to support the recruitment 

23 and retention of behavioral health providers; 

24 and 


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1 ‘‘(D) other subjects related to behavioral 

2 health providers engaged in direct provision of 

3 substance use disorder prevention and treat4 ment services as the Secretary determines ap5 propriate. 

6 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

7 There is authorized to be appropriated to carry out 

8 this subsection— 

9 ‘‘(A) $10,000,000 for fiscal year 2024; 

10 ‘‘(B) $10,000,000 for fiscal year 2025; 

11 ‘‘(C) $10,000,000 for fiscal year 2026; 

12 ‘‘(D) $10,000,000 for fiscal year 2027; 

13 ‘‘(E) $10,000,000 for fiscal year 2028; 

14 ‘‘(F) $10,000,000 for fiscal year 2029; 

15 ‘‘(G) $10,000,000 for fiscal year 2030; 

16 ‘‘(H) $10,000,000 for fiscal year 2031; 

17 ‘‘(I) $10,000,000 for fiscal year 2032; and 

18 ‘‘(J) $10,000,000 for fiscal year 2033. 

19 ‘‘SEC. 3435. IMPROVING AND EXPANDING CARE. 

20 ‘‘(a) LEVEL OF CARE STANDARDS FOR SUBSTANCE

21 USE DISORDER TREATMENT SERVICES.— 

22 ‘‘(1) IN GENERAL.—Not later than 1 year after 

23 the date of enactment of this title, the Secretary, in 

24 consultation with the American Society of Addiction 

25 Medicine, State and Tribal officials selected by the 


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1 Secretary, and other stakeholders as the Secretary 

2 determines necessary, and after seeking public input, 

3 shall promulgate model standards for the regulation 

4 of substance use disorder treatment services. 

5 ‘‘(2) SUBSTANCE USE DISORDER TREATMENT

6 SERVICES.—The model standards promulgated 

7 under paragraph (1) shall, at a minimum— 

8 ‘‘(A) identify the types of substance use 

9 disorder treatment services intended to be cov10 ered without regard to whether they participate 

11 in any Federal health care program (as defined 

12 in section 1128B(f) of the Social Security Act) 

13 and shall not include— 

14 ‘‘(i) a private practitioner who is al15 ready licensed by a State licensing board 

16 and whose practice is limited to non-inten17 sive outpatient care; or 

18 ‘‘(ii) any substance use disorder treat19 ment service provided on a non-intensive 

20 outpatient basis in the office of a private 

21 practitioner who is licensed by a State li22 censing board; 

23 ‘‘(B) require the designation of a single 

24 State agency to serve as the primary regulator 


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1 in the State for substance use disorder treat2 ment services; 

3 ‘‘(C) subject to paragraph (3), require that 

4 substance use disorder treatment services iden5 tified in accordance with subparagraph (A), be 

6 licensed by the respective States according to 

7 the standards for levels of care set forth by the 

8 American Society of Addiction Medicine in 

9 2013 or an equivalent set of standards; 

10 ‘‘(D) require implementation of a process 

11 to ensure that substance use disorder treatment 

12 program qualifications are verified by means of 

13 an onsite inspection not less frequently than 

14 every 3 years by the State agency serving as 

15 the primary regulator in the State for substance 

16 use disorder treatment services or by an inde17 pendent third party that is approved by the 

18 State’s primary regulator; and 

19 ‘‘(E) require that all patients leaving a res20 idential treatment program receive a written 

21 transition plan prior to discharge from that 

22 level of care. 

23 ‘‘(3) ANNUAL ASSESSMENT.—Beginning with 

24 respect to fiscal year 2024, the Secretary shall make 

25 a determination with respect to each State on 


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1 whether the State has adopted, for each of the sub2 stance use disorder treatment services identified in 

3 accordance with paragraph (2)(A), licensure stand4 ards that are in compliance in all material respects 

5 with the model standards promulgated in accordance 

6 with this subsection. In the event the American Soci7 ety of Addiction Medicine revises its criteria, the 

8 Secretary shall revise the national model level of 

9 care standards accordingly and disseminate any such 

10 update to the States, and the States may adopt any 

11 such updates to be in compliance with this sub12 section. 

13 ‘‘(b) STANDARDS FOR OTHER SPECIFIED MATTERS

14 RELATED TO SUBSTANCE USE DISORDER TREATMENT

15 SERVICES AND RECOVERY RESIDENCES.— 

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

17 after the date of enactment of this title, the Sec18 retary, in consultation with representatives of non19 profit service providers and State and Tribal officials 

20 as the Secretary determines necessary, shall promul21 gate model standards for the regulation of— 

22 ‘‘(A) other specified matters related to sub23 stance use disorder treatment services; and 

24 ‘‘(B) recovery residences. 


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1 ‘‘(2) OTHER SPECIFIED MATTERS RELATED TO

2 SUBSTANCE USE DISORDER TREATMENT SERV3 ICES.—The model standards promulgated under 

4 paragraph (1)(A) shall, at a minimum— 

5 ‘‘(A) identify the professional credentials 

6 needed by each type of substance use disorder 

7 treatment professional; 

8 ‘‘(B) include standards for data reporting 

9 and require compilation of statewide reports; 

10 ‘‘(C) require the establishment and mainte11 nance within each State of a toll-free telephone 

12 number to receive complaints from the public 

13 regarding substance use disorder treatment 

14 service providers; and 

15 ‘‘(D) require the establishment and main16 tenance on a publicly accessible internet website 

17 of a list of all substance use disorder treatment 

18 services in the State that have a certification in 

19 effect in accordance with this section. 

20 ‘‘(3) RECOVERY RESIDENCES.— 

21 ‘‘(A) ECONOMIC RELATIONSHIP.—The 

22 model standards promulgated under paragraph 

23 (1)(B) shall, at a minimum, be applied to recov24 ery residences that have an ongoing economic 


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1 relationship with any commercial substance use 

2 disorder treatment service. 

3 ‘‘(B) MINIMUM REQUIREMENTS.—The 

4 model standards promulgated under paragraph 

5 (1)(B), which may include any model laws de6 veloped under section 550(a) shall, at a min7 imum, identify requirements for— 

8 ‘‘(i) the designation of a single State 

9 agency to certify recovery residences; 

10 ‘‘(ii) the implementation of a process 

11 to ensure that the qualifications of recov12 ery residences in which not fewer than 10 

13 individuals may lawfully reside are verified 

14 by means of an onsite inspection not less 

15 frequently than every 3 years by the State 

16 agency serving as the primary regulator in 

17 the State or by an independent third party 

18 that is approved by the State’s primary 

19 regulator; 

20 ‘‘(iii) fire, safety, and health stand21 ards; 

22 ‘‘(iv) equipping residences with opioid 

23 overdose reversal drug products, such as 

24 naloxone and training residence owners, 


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1 operators, and employees in the adminis2 tration of naloxone; 

3 ‘‘(v) recovery residence owners and 

4 operators; 

5 ‘‘(vi) a written policy that prohibits 

6 the exclusion of individuals on the basis 

7 that such individuals receive drugs ap8 proved by the Food and Drug Administra9 tion for the treatment of substance use dis10 order; 

11 ‘‘(vii) the establishment and mainte12 nance within each State of a toll-free tele13 phone number to receive complaints from 

14 the public regarding recovery residences; 

15 and 

16 ‘‘(viii) the establishment and mainte17 nance on a publicly accessible internet 

18 website of a list of all recovery residences 

19 in the State that have a certification in ef20 fect in accordance with this section. 

21 ‘‘(4) ANNUAL ASSESSMENT.—Beginning with 

22 respect to fiscal year 2025, the Secretary shall make 

23 a determination with respect to each State on 

24 whether the State has adopted, for each of the other 

25 specified substance use disorder treatment services 


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1 identified in this section and for recovery residences, 

2 standards that are in compliance in all material re3 spects with the model standards promulgated in ac4 cordance with this subsection. 

5 ‘‘(c) ENSURING ACCESS TO MEDICATION FOR SUB6 STANCE USE DISORDER TREATMENT.— 

7 ‘‘(1) MEDICATION FOR ADDICTION TREAT8 MENT.—The Secretary may not make a grant under 

9 this section unless the applicant for the grant agrees 

10 to require all entities offering substance use disorder 

11 treatment services under the grant to offer all drugs 

12 approved by the Food and Drug Administration for 

13 the treatment of substance use disorder for which 

14 the applicant offers treatment. 

15 ‘‘(2) WAIVER.—The Secretary may grant a 

16 waiver with respect to any requirement of this sec17 tion if the grant applicant involved— 

18 ‘‘(A) submits to the Secretary a justifica19 tion for such waiver containing such informa20 tion as the Secretary shall require; and 

21 ‘‘(B) agrees to require all entities offering 

22 substance use disorder treatment services under 

23 the grant to— 

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1 tion for the treatment of substance use dis2 order; 

3 ‘‘(ii) provide counseling to patients on 

4 the benefits and risks of all drugs ap5 proved by the Food and Drug Administra6 tion for the treatment of substance use dis7 order; and 

8 ‘‘(iii) maintain an affiliation agree9 ment with a provider that can prescribe or 

10 otherwise dispense all other forms of drugs 

11 approved by the Food and Drug Adminis12 tration for the treatment of substance use 

13 disorder. 

14 ‘‘(3) GAO STUDY.—Not later than 1 year after 

15 the date of enactment of this title, the Comptroller 

16 General of the United States shall submit to Con17 gress a comprehensive report describing any rela18 tionship between substance use rates, pain manage19 ment practices of the Indian Health Service, and pa20 tient request denials through the purchased/referred 

21 care program of the Indian Health Service. 

22 ‘‘(d) ENSURING A FULL CONTINUUM OF SERV23 ICES.— 

24 ‘‘(1) IN GENERAL.—Not later than 6 months 

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1 ministrator of the Centers for Medicare & Medicaid 

2 Services shall issue a State Medicaid Director letter 

3 and Tribal leader letter explaining how States and 

4 tribes can ensure access to a continuum of services 

5 for adults with substance use disorders who are re6 ceiving medical assistance under title XIX of the So7 cial Security Act. Such letter shall describe how 

8 States can cover the continuum of community-based, 

9 residential, and inpatient substance use disorder 

10 services and care coordination between different lev11 els of care as medical assistance, as defined in sec12 tion 1905(a) of such Act, including through section 

13 1915 of such Act and through demonstration 

14 projects under section 1115 of such Act. 

15 ‘‘(2) MACPAC ANALYSIS.—Not later than 1 

16 year after the date of the enactment of this title, the 

17 Medicaid and CHIP Payment and Access Commis18 sion shall conduct an analysis, and make publicly 

19 available a report containing the results of such 

20 analysis, of States’ coverage of substance use serv21 ices for Medicaid beneficiaries. Such report shall in22 clude examples of promising strategies States use to 

23 cover a continuum of community-based substance 

24 use services. 


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1 ‘‘(3) ANNUAL ASSESSMENT.—Beginning with 

2 respect to fiscal year 2026, the Secretary shall make 

3 a determination with respect to each State on 

4 whether the State has carried out the requirements 

5 to ensure a continuum of services as described in 

6 section 1915(l)(4)(C) of the Social Security Act. 

7 ‘‘SEC. 3436. NALOXONE DISTRIBUTION PROGRAM. 

8 ‘‘(a) ESTABLISHMENT OF PROGRAM.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall provide 

10 for the purchase and delivery of federally approved 

11 opioid overdose reversal drug products on behalf of 

12 each State (or Indian tribe as defined in section 4 

13 of the Indian Health Care Improvement Act) that 

14 receives a grant under subtitle B. This paragraph 

15 constitutes budget authority in advance of appro16 priations Acts, and represents the obligation of the 

17 Federal Government to provide for the purchase and 

18 delivery to States and Indian tribes of the opioid 

19 overdose reversal drug products in accordance with 

20 this paragraph. 

21 ‘‘(2) SPECIAL RULES WHERE OPIOID OVERDOSE

22 REVERSAL DRUG PRODUCTS ARE UNAVAILABLE.—To 

23 the extent that a sufficient quantity of opioid over24 dose reversal drug products are not available for 

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1 retary shall provide for the purchase and delivery of 

2 the available opioid overdose reversal drug products 

3 in accordance with priorities established by the Sec4 retary, with priority given to States with at least one 

5 local area eligible for funding under section 3401(a). 

6 ‘‘(b) NEGOTIATION OF CONTRACTS WITH MANUFAC7 TURERS.— 

8 ‘‘(1) IN GENERAL.—For the purpose of car9 rying out this section, the Secretary shall negotiate 

10 and enter into contracts with manufacturers of 

11 opioid overdose reversal drug products consistent 

12 with the requirements of this subsection and, to the 

13 maximum extent practicable, consolidate such con14 tracting with any other contracting activities con15 ducted by the Secretary to purchase opioid overdose 

16 reversal drug products. The Secretary may enter 

17 into such contracts under which the Federal Govern18 ment is obligated to make outlays, the budget au19 thority for which is not provided for in advance in 

20 appropriations Acts, for the purchase and delivery of 

21 opioid overdose reversal drug products under sub22 section (a). 

23 ‘‘(2) AUTHORITY TO DECLINE CONTRACTS.— 

24 The Secretary may decline to enter into contracts 


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1 under this subsection and may modify or extend 

2 such contracts. 

3 ‘‘(3) CONTRACT PRICE.— 

4 ‘‘(A) IN GENERAL.—The Secretary, in ne5 gotiating the prices at which opioid overdose re6 versal drug products will be purchased and de7 livered from a manufacturer under this sub8 section, shall take into account quantities of 

9 opioid overdose reversal drug products to be 

10 purchased by States under the option under 

11 paragraph (4)(B). 

12 ‘‘(B) NEGOTIATION OF DISCOUNTED PRICE

13 FOR OPIOID OVERDOSE REVERSAL DRUG PROD14 UCTS.—With respect to contracts entered into 

15 for the purchase of opioid overdose reversal 

16 drug products on behalf of States under this 

17 subsection, the price for the purchase of such 

18 drug product shall be a discounted price nego19 tiated by the Secretary. 

20 ‘‘(4) QUANTITIES AND TERMS OF DELIVERY.— 

21 Under contracts under this subsection— 

22 ‘‘(A) the Secretary shall provide, consistent 

23 with paragraph (6), for the purchase and deliv24 ery on behalf of States and Indian tribes of 


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1 quantities of opioid overdose reversal drug 

2 products; and 

3 ‘‘(B) each State and Indian tribe, at the 

4 option of the State or tribe, shall be permitted 

5 to obtain additional quantities of opioid over6 dose reversal drug products (subject to amounts 

7 specified to the Secretary by the State or tribe 

8 in advance of negotiations) through purchasing 

9 the opioid overdose reversal drug products from 

10 the manufacturers at the applicable price nego11 tiated by the Secretary consistent with para12 graph (3), if the State or tribe provides to the 

13 Secretary such information (at a time and man14 ner specified by the Secretary, including in ad15 vance of negotiations under paragraph (1)) as 

16 the Secretary determines to be necessary, to 

17 provide for quantities of opioid overdose rever18 sal drug products for the State or tribe to pur19 chase pursuant to this subsection and to deter20 mine annually the percentage of the opioid over21 dose reversal drug market that is purchased 

22 pursuant to this section and this subparagraph. 

23 The Secretary shall enter into the initial negotia24 tions not later than 180 days after the date of the 

25 enactment of this title. 


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1 ‘‘(5) CHARGES FOR SHIPPING AND HAN2 DLING.—The Secretary may enter into a contract 

3 referred to in paragraph (1) only if the manufac4 turer involved agrees to submit to the Secretary 

5 such reports as the Secretary determines to be ap6 propriate to assure compliance with the contract and 

7 if, with respect to a State program under this sec8 tion that does not provide for the direct delivery of 

9 qualified opioid overdose reversal drug products, the 

10 manufacturer involved agrees that the manufacturer 

11 will provide for the delivery of the opioid overdose 

12 reversal drug products on behalf of the State in ac13 cordance with such program and will not impose any 

14 charges for the costs of such delivery (except to the 

15 extent such costs are provided for in the price estab16 lished under paragraph (3)). 

17 ‘‘(6) MULTIPLE SUPPLIERS.—In the case of the 

18 opioid overdose reversal drug product involved, the 

19 Secretary may, as appropriate, enter into a contract 

20 referred to in paragraph (1) with each manufacturer 

21 of the opioid overdose reversal drug product that 

22 meets the terms and conditions of the Secretary for 

23 an award of such a contract (including terms and 

24 conditions regarding safety and quality). With re25 spect to multiple contracts entered into pursuant to 


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1 this paragraph, the Secretary may have in effect dif2 ferent prices under each of such contracts and, with 

3 respect to a purchase by States pursuant to para4 graph (4)(B), each eligible State may choose which 

5 of such contracts will be applicable to the purchase. 

6 ‘‘(c) USE OF OPIOID OVERDOSE REVERSAL DRUG

7 PRODUCT LIST.—Beginning not later than one year after 

8 the first contract has been entered into under this section, 

9 the Secretary shall use, for the purpose of the purchase, 

10 delivery, and administration of opioid overdose reversal 

11 drug products under this section, the list established (and 

12 periodically reviewed and, as appropriate, revised) by an 

13 advisory committee, established by the Secretary and lo14 cated within the Centers for Disease Control and Preven15 tion, which considers the cost effectiveness of each opioid 

16 overdose reversal drug product. 

17 ‘‘(d) STATE DISTRIBUTION OF OPIOID OVERDOSE

18 REVERSAL DRUG PRODUCTS.—States shall distribute 

19 opioid overdose reversal drug products received under this 

20 section to the following: 

21 ‘‘(1) First responders and local emergency med22 ical services organizations, including volunteer emer23 gency medical services organizations. 


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1 ‘‘(2) Public entities with authority to administer 

2 local public health services, including all local health 

3 departments; 

4 ‘‘(3) Nonprofit entities, including— 

5 ‘‘(A) community-based organizations that 

6 provide substance use disorder treatments or 

7 harm reduction services; 

8 ‘‘(B) nonprofit entities that provide sub9 stance use disorder treatments or harm reduc10 tion services; and 

11 ‘‘(C) faith-based organizations that provide 

12 substance use disorder treatments or harm re13 duction services; 

14 ‘‘(4) Other entities in areas of high need. 

15 ‘‘(5) The general public. 

16 ‘‘(e) STATE REQUIREMENTS.—To be eligible to re17 ceive opioid overdose reversal drugs under this section, 

18 each State shall— 

19 ‘‘(1) establish a program for distributing opioid 

20 overdose reversal drug products to first responders, 

21 nonprofit entities, the general public, and entities 

22 with authority to administer local public health serv23 ices, including local health departments; 

24 ‘‘(2) beginning in the second year of the pro25 gram, demonstrate a distribution rate of a minimum 


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1 of 90 percent of the opioid overdose reversal drug 

2 products received under this program; 

3 ‘‘(3) certify to the Secretary that the State has 

4 in place a Good Samaritan Law that ensures immu5 nity from arrest and prosecution, including from pa6 role and probation violations, except that the State 

7 may apply to the Secretary for a waiver of the re8 quirement of this paragraph, and such waiver if 

9 granted shall not be longer than 3 years in duration 

10 and may not be renewed unless the State can show 

11 progress being made towards instituting a Good Sa12 maritan Law; and 

13 ‘‘(4) certify to the Secretary that the State has 

14 in place additional measures that enhance access to 

15 opioid overdose reversal drug products, such as laws 

16 that provide civil or disciplinary immunity for med17 ical personnel who prescribe an opioid overdose re18 versal drug product, Third-Party Prescription Laws, 

19 Collaborative Practice Agreements, and Standing 

20 Orders. 

21 ‘‘(f) INDIAN TRIBE REQUIREMENTS.—The Indian 

22 Health Service, in consultation with Indian tribes, shall 

23 determine any requirements that shall apply to Indian 

24 tribes receiving opioid overdose reversal drug products 

25 made available under this section. 


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1 ‘‘(g) DEFINITIONS.—For purposes of this section: 

2 ‘‘(1) COLLABORATIVE PRACTICE AGREEMENT.— 

3 The term ‘Collaborative Practice Agreement’ means 

4 an agreement under which a pharmacist operates 

5 under authority delegated by another licensed practi6 tioner with prescribing authority. 

7 ‘‘(2) EMERGENCY MEDICAL SERVICE.—The 

8 term ‘emergency medical service’ means resources 

9 used by a public or private licensed entity to deliver 

10 medical care outside of a medical facility under 

11 emergency conditions that occur as a result of the 

12 condition of the patient and includes services deliv13 ered (either on a compensated or volunteer basis) by 

14 an emergency medical services provider or other pro15 vider that is licensed or certified by the State in16 volved as an emergency medical technician, a para17 medic, or an equivalent professional (as determined 

18 by the State). 

19 ‘‘(3) GOOD SAMARITAN LAW.—The term ‘Good 

20 Samaritan Law’ means a law that provides criminal 

21 immunity for a person who administers an opioid 

22 overdose reversal drug product, a person who, in 

23 good faith, seeks medical assistance for someone ex24 periencing a drug-related overdose, or a person who 

25 experiences a drug-related overdose and is in need of 


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1 medical assistance and, in good faith, seeks such 

2 medical assistance, or is the subject of such a good 

3 faith request for medical assistance. 

4 ‘‘(4) INDIANS.—The terms ‘Indian’, ‘Indian 

5 tribe’, ‘tribal organization’, and ‘urban Indian orga6 nization’ have the meanings given such terms in sec7 tion 4 of the Indian Health Care Improvement Act. 

8 ‘‘(5) MANUFACTURER.—The term ‘manufac9 turer’ means any corporation, organization, or insti10 tution, whether public or private (including Federal, 

11 State, and local departments, agencies, and instru12 mentalities), which manufactures, imports, proc13 esses, or distributes under its label any opioid over14 dose reversal drug product. The term ‘manufacture’ 

15 means to manufacture, import, process, or distribute 

16 an opioid overdose reversal drug. 

17 ‘‘(6) OPIOID OVERDOSE REVERSAL DRUG PROD18 UCT.—The term ‘opioid overdose reversal drug prod19 uct’ means a finished dosage form that has been ap20 proved by the Food and Drug Administration and 

21 that contains an active pharmaceutical ingredient 

22 that acts as an opioid receptor antagonist. The term 

23 ‘opioid overdose reversal drug product’ includes a 

24 combination product, as defined in section 3.2(e) of 

25 title 21, Code of Federal Regulations. 


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1 ‘‘(7) STANDING ORDER.—The term ‘standing 

2 order’ means a non-patient-specific order covering 

3 administration of medication by others to a patient 

4 who may be unknown to the prescriber at the time 

5 of the order. 

6 ‘‘(8) THIRD-PARTY PRESCRIPTION.—The term 

7 ‘third party prescription’ means an order written for 

8 medication dispensed to one person with the inten9 tion that it will be administered to another person. 

10 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

11 is authorized to be appropriated to carry out this suc12 tion— 

13 ‘‘(1) $1,000,000,000 for fiscal year 2024; 

14 ‘‘(2) $1,000,000,000 for fiscal year 2025; 

15 ‘‘(3) $1,000,000,000 for fiscal year 2026; 

16 ‘‘(4) $1,000,000,000 for fiscal year 2027; 

17 ‘‘(5) $1,000,000,000 for fiscal year 2028; 

18 ‘‘(6) $1,000,000,000 for fiscal year 2029; 

19 ‘‘(7) $1,000,000,000 for fiscal year 2030; 

20 ‘‘(8) $1,000,000,000 for fiscal year 2031; 

21 ‘‘(9) $1,000,000,000 for fiscal year 2032; and 

22 ‘‘(10) $1,000,000,000 for fiscal year 2033. 


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1 ‘‘SEC. 3437. ADDITIONAL FUNDING FOR THE NATIONAL IN2 STITUTES OF HEALTH. 

3 ‘‘There is authorized to be appropriated to the Na4 tional Institutes of Health for the purpose of conducting 

5 research on addiction and pain, including research to de6 velop overdose reversal drug products, non-opioid drug 

7 products and non-pharmacological treatments for address8 ing pain and substance use disorder, and drug products 

9 used to treat substance use disorder— 

10 ‘‘(1) $1,000,000,000 for fiscal year 2024; 

11 ‘‘(2) $1,000,000,000 for fiscal year 2025; 

12 ‘‘(3) $1,000,000,000 for fiscal year 2026; 

13 ‘‘(4) $1,000,000,000 for fiscal year 2027; 

14 ‘‘(5) $1,000,000,000 for fiscal year 2028; 

15 ‘‘(6) $1,000,000,000 for fiscal year 2029; 

16 ‘‘(7) $1,000,000,000 for fiscal year 2030; 

17 ‘‘(8) $1,000,000,000 for fiscal year 2031; 

18 ‘‘(9) $1,000,000,000 for fiscal year 2032; and 

19 ‘‘(10) $1,000,000,000 for fiscal year 2033. 

20 ‘‘SEC. 3438. ADDITIONAL FUNDING FOR THE CENTERS FOR 

21 DISEASE CONTROL AND PREVENTION. 

22 ‘‘(a) IMPROVED DATA COLLECTION AND PREVEN23 TION OF INFECTIOUS DISEASE TRANSMISSION.— 

24 ‘‘(1) DATA COLLECTION.—The Centers for Dis25 ease Control and Prevention shall use a portion of 

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1 sure that all States participate in the Enhanced 

2 State Opioid Overdose Surveillance program and to 

3 provide technical assistance to medical examiners 

4 and coroners to facilitate improved data collection on 

5 fatal overdoses through such program. 

6 ‘‘(2) CENTERS FOR DISEASE CONTROL AND

7 PREVENTION.—The Centers for Disease Control and 

8 Prevention shall use amounts appropriated under 

9 this section for the purpose of improving data on 

10 drug overdose deaths and non-fatal drug overdoses, 

11 surveillance related to addiction and substance use 

12 disorder, and the prevention of transmission of infec13 tious diseases related to substance use. 

14 ‘‘(3) TRIBAL DATA.—Not later than 6 months 

15 after the date of enactment of this title, the Director 

16 of the Centers for Disease Control and Prevention 

17 shall consult with Indian tribes and confer with 

18 urban Indian organizations to develop and imple19 ment strategies that improve surveillance and re20 porting of fatal overdose deaths among American In21 dians and Alaska Natives, including strategies that 

22 reduce the underestimation of fatal overdose deaths 

23 among American Indians and Alaska Natives due to 

24 undersampling or racial misclassification in State 

25 and Federal public health surveillance systems. 


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1 ‘‘(b) CHILDHOOD TRAUMA.—The Centers for Disease 

2 Control and Prevention shall use a portion of the funding 

3 appropriated under this section to fund the surveillance 

4 and data collection activities described in section 7131 of 

5 the SUPPORT for Patients and Communities Act, includ6 ing to encourage all States to participate in collecting and 

7 reporting data on adverse childhood experiences through 

8 the Behavioral Risk Factor Surveillance System, the 

9 Youth Risk Behavior Surveillance System, and other rel10 evant public health surveys or questionnaires. 

11 ‘‘(c) WORKER HEALTH RISKS.—The Centers for Dis12 ease Control and Prevention shall use a portion of the 

13 funding appropriated under this section for data collection 

14 and surveillance activities on substance use, substance use 

15 disorders, drug overdose deaths, and non-fatal drug 

16 overdoses among workers, and the factors and practices 

17 that contribute to such use, disorders, and overdoses, in18 cluding occupational injuries and illness as well as occupa19 tional exposure to opioids and other illicit and licit drugs. 

20 ‘‘(d) TRIBAL EPIDEMIOLOGY CENTERS.—There shall 

21 be made available to the Indian Health Service for the 

22 purpose of funding efforts by Indian tribes and tribal epi23 demiology centers to improve data on drug overdose 

24 deaths and non-fatal drug overdoses, surveillance related 

25 to addiction and substance use disorder, and prevention 


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1 of childhood trauma, not less than 1.5 percent of the total 

2 amount appropriated under this section for each fiscal 

3 year. 

4 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

5 is authorized to be appropriated to carry out this section— 

6 ‘‘(1) $500,000,000 for fiscal year 2024; 

7 ‘‘(2) $500,000,000 for fiscal year 2025; 

8 ‘‘(3) $500,000,000 for fiscal year 2026; 

9 ‘‘(4) $500,000,000 for fiscal year 2027; 

10 ‘‘(5) $500,000,000 for fiscal year 2028; 

11 ‘‘(6) $500,000,000 for fiscal year 2029; 

12 ‘‘(7) $500,000,000 for fiscal year 2030; 

13 ‘‘(8) $500,000,000 for fiscal year 2031; 

14 ‘‘(9) $500,000,000 for fiscal year 2032; and 

15 ‘‘(10) $500,000,000 for fiscal year 2033. 

16 ‘‘SEC. 3439. DEFINITIONS. 

17 ‘‘In this title: 

18 ‘‘(1) PLANNING COUNCIL.—The term ‘planning 

19 council’ means the substance use planning council 

20 established under section 3402. 

21 ‘‘(2) RECOVERY RESIDENCE.—The term ‘recov22 ery residence’ means a residential dwelling unit, or 

23 other form of group housing, that is offered or ad24 vertised through any means, including oral, written, 

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1 tity as a residence that provides an evidence-based, 

2 peer-supported living environment for individuals un3 dergoing any type of substance use disorder treat4 ment or who have received any type of substance use 

5 disorder treatment in the past 3 years, including 

6 medication for addiction treatment. 

7 ‘‘(3) STATE.— 

8 ‘‘(A) IN GENERAL.—The term ‘State’ 

9 means each of the 50 States, the District of Co10 lumbia, and each of the territories. 

11 ‘‘(B) TERRITORIES.—The term ‘territory’ 

12 means each of American Samoa, Guam, the 

13 Commonwealth of Puerto Rico, the Common14 wealth of the Northern Mariana Islands, the 

15 Virgin Islands, the Republic of the Marshall Is16 lands, the Federated States of Micronesia, and 

17 Palau. 

18 ‘‘(4) SUBSTANCE USE DISORDER TREAT19 MENT.— 

20 ‘‘(A) IN GENERAL.—The term ‘substance 

21 use disorder treatment’ means an evidence22 based, professionally directed, deliberate, and 

23 planned regimen including evaluation, observa24 tion, medical monitoring, and rehabilitative 

25 services and interventions such as 


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1 pharmacotherapy, mental health services, and 

2 individual and group counseling, on an inpa3 tient or outpatient basis, to help patients with 

4 substance use disorder reach remission and 

5 maintain recovery. 

6 ‘‘(B) TYPES OF TREATMENT.—Substance 

7 use disorder treatments shall include the fol8 lowing: 

9 ‘‘(i) Clinical stabilization services, 

10 which are evidence-based services provided 

11 in secure, acute care facilities (which may 

12 be referred to as ‘addictions receiving fa13 cilities’) that, at a minimum— 

14 ‘‘(I) provide intoxication manage15 ment and stabilization services; 

16 ‘‘(II) are operated 24 hours per 

17 day, 7 days per week; and 

18 ‘‘(III) that serve individuals 

19 found to be substance use impaired. 

20 These can also be referred to as ‘Ad21 dictions receiving facilities’. 

22 ‘‘(ii) Withdrawal management and de23 toxification, which is a medical service that 

24 is provided on an inpatient or an out25 patient basis to assist an individual in 


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1 managing the process of withdrawal from 

2 the physiological and psychological effects 

3 of substance use disorder. 

4 ‘‘(iii) All outpatient, residential, and 

5 inpatient services described in section 

6 1915(l)(4)(C) of the Social Security Act. 

7 ‘‘(C) LIMITATION.—Substance use disorder 

8 treatment providers shall not include— 

9 ‘‘(i) prevention only providers; and 

10 ‘‘(ii) a private practitioner who is li11 censed by a State licensing board and 

12 whose practice is limited to non-intensive 

13 outpatient care. 

14 ‘‘(5) SUBSTANCE USE DISORDER TREATMENT

15 SERVICES.—The term ‘substance use disorder treat16 ment services’ means any prevention services, core 

17 medical services, recovery and support services, early 

18 intervention services, and harm reduction services 

19 authorized under this title.’’. 

20 SEC. 4. AMENDMENTS TO THE CONTROLLED SUBSTANCES 

21 ACT. 

22 (a) CERTIFICATIONS.—Part C of the Controlled Sub23 stances Act (21 U.S.C. 821 et seq.) is amended by adding 

24 at the end the following: 


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1 ‘‘CERTIFICATIONS RELATING TO DIVERSION CONTROLS

2 AND MISBRANDING

3 ‘‘SEC. 313. (a) DEFINITIONS.—In this section— 

4 ‘‘(1) the term ‘covered dispenser’— 

5 ‘‘(A) means a dispenser— 

6 ‘‘(i) that is required to register under 

7 section 302(a)(2); and 

8 ‘‘(ii) dispenses a controlled substance 

9 in schedule II; and 

10 ‘‘(B) does not include a dispenser that is— 

11 ‘‘(i) registered to dispense opioid 

12 agonist treatment medication under section 

13 303(h)(1); and 

14 ‘‘(ii) operating in that capacity; 

15 ‘‘(2) the term ‘covered distributor’ means a dis16 tributor— 

17 ‘‘(A) that is required to register under sec18 tion 302(a)(1); and 

19 ‘‘(B) distributes a controlled substance in 

20 schedule II; 

21 ‘‘(3) the term ‘covered manufacturer’ means a 

22 manufacturer— 

23 ‘‘(A) that is required to register under sec24 tion 302(a)(1); and 


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1 ‘‘(B) manufactures a controlled substance 

2 in schedule II; 

3 ‘‘(4) the term ‘covered officer’, with respect to 

4 a covered person means— 

5 ‘‘(A) in the case of a covered person that 

6 is not an individual— 

7 ‘‘(i) the chief executive officer of the 

8 covered person; 

9 ‘‘(ii) the president of the covered per10 son; 

11 ‘‘(iii) the chief medical officer of the 

12 covered person; or 

13 ‘‘(iv) the chief counsel of the covered 

14 person; and 

15 ‘‘(B) in the case of a covered person that 

16 is an individual, that individual; and 

17 ‘‘(5) the term ‘covered person’ means— 

18 ‘‘(A) a covered dispenser; 

19 ‘‘(B) a covered distributor; or 

20 ‘‘(C) a covered manufacturer. 

21 ‘‘(b) CERTIFICATIONS RELATING TO DIVERSION

22 CONTROLS.—Not later than 180 days after the date of 

23 enactment of this section, and each year thereafter, each 

24 covered officer of a covered person shall submit to the At25 torney General, for each controlled substance in schedule 


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1 II dispensed, distributed, or manufactured by the covered 

2 person, a certification— 

3 ‘‘(1) signed by the covered officer; and 

4 ‘‘(2) certifying that— 

5 ‘‘(A) the covered person maintains effective 

6 controls against diversion of the controlled sub7 stance into channels other than legitimate med8 ical, scientific, research, or industrial channels; 

9 ‘‘(B) all information contained in any 

10 record, inventory, or report required to be kept 

11 or submitted to the Attorney General by the 

12 covered person under section 307, or under any 

13 regulation issued under that section, is accu14 rate; and 

15 ‘‘(C) the covered person is in compliance 

16 with all applicable requirements under Federal 

17 law relating to reporting suspicious orders for 

18 controlled substances. 

19 ‘‘(c) CERTIFICATIONS RELATING TO MIS20 BRANDING.— 

21 ‘‘(1) IN GENERAL.—Not later than 180 days 

22 after the date of enactment of this section, and each 

23 year thereafter, each covered officer of a covered 

24 manufacturer shall submit to the Secretary, for each 


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1 controlled substance in schedule II manufactured by 

2 the covered manufacturer, a certification— 

3 ‘‘(A) signed by the covered officer; and 

4 ‘‘(B) certifying that the controlled sub5 stance is not misbranded, as described in sec6 tion 502 of the Federal Food, Drug, and Cos7 metic Act (21 U.S.C. 352). 

8 ‘‘(2) NOTIFICATION TO THE ATTORNEY GEN9 ERAL.— 

10 ‘‘(A) FAILURE TO SUBMIT CERTIFI11 CATIONS.—Not later than 30 days after the 

12 date on which a covered officer of a covered 

13 manufacturer is required to submit a certifi14 cation under paragraph (1) and fails to do so, 

15 the Secretary shall notify the Attorney General 

16 of the failure by the covered officer to submit 

17 the certification. 

18 ‘‘(B) FALSE CERTIFICATIONS RELATING

19 TO MISBRANDING.—Not later than 30 days 

20 after the date on which the Secretary becomes 

21 aware that a certification submitted under 

22 paragraph (1) contains a materially false state23 ment or representation relating to the mis24 branding of a controlled substance with respect 

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1 mitted, the Secretary shall notify the Attorney 

2 General that the certification contains the ma3 terially false statement or representation.’’. 

4 (b) OFFENSES.—Part D of title II of the Controlled 

5 Substances Act (21 U.S.C. 841 et seq.) is amended by 

6 adding at the end the following: 

7 ‘‘CERTIFICATIONS BY COVERED OFFICERS

8 ‘‘SEC. 424. (a) DEFINITIONS.—In this section, the 

9 terms ‘covered dispenser’, ‘covered distributor’, ‘covered 

10 manufacturer’, ‘covered officer’, and ‘covered person’ have 

11 the meanings given those terms in section 313. 

12 ‘‘(b) OFFENSES.— 

13 ‘‘(1) FAILURE TO SUBMIT CERTIFICATIONS.— 

14 ‘‘(A) CERTIFICATIONS RELATING TO DI15 VERSION CONTROLS.—It shall be unlawful for a 

16 covered officer of a covered person to fail to 

17 submit a certification required under section 

18 313(b), without regard to the state of mind of 

19 the covered officer. 

20 ‘‘(B) CERTIFICATIONS RELATING TO MIS21 BRANDING.—It shall be unlawful for a covered 

22 officer of a covered manufacturer to fail to sub23 mit a certification required under section 

24 313(c)(1), without regard to the state of mind 

25 of the covered officer. 

26 ‘‘(2) SUBMISSION OF FALSE CERTIFICATIONS.— 


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1 ‘‘(A) FALSE CERTIFICATIONS RELATING TO

2 DIVERSION CONTROLS.—It shall be unlawful for 

3 a covered officer of a covered person to submit 

4 a certification required under section 313(b), 

5 without regard to the state of mind of the cov6 ered officer, that contains a materially false 

7 statement or representation relating to the in8 formation required to be certified under that 

9 section for the year for which the certification 

10 is submitted. 

11 ‘‘(B) FALSE CERTIFICATIONS RELATING

12 TO MISBRANDING.—It shall be unlawful for a 

13 covered officer of a covered manufacturer to 

14 submit a certification required under section 

15 313(c)(1), without regard to the state of mind 

16 of the covered officer, that contains a materially 

17 false statement or representation relating to the 

18 misbranding of a controlled substance with re19 spect to the year for which the certification is 

20 submitted. 

21 ‘‘(c) PENALTIES.— 

22 ‘‘(1) CIVIL PENALTIES.—Except as provided in 

23 paragraph (2), a covered officer who violates sub24 section (b) shall be subject to a civil penalty of not 

25 more than $25,000. 


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1 ‘‘(2) CRIMINAL PENALTIES.—A covered officer 

2 who knowingly violates subsection (b)(2) shall be 

3 subject to criminal penalties under section 403(d). 

4 ‘‘(d) COMPREHENSIVE ADDICTION RESOURCES

5 FUND.— 

6 ‘‘(1) ESTABLISHMENT.—There is established in 

7 the Treasury a fund to be known as the ‘Com8 prehensive Addiction Resources Fund’. 

9 ‘‘(2) TRANSFER OF AMOUNTS.—There shall be 

10 transferred to the Comprehensive Addiction Re11 sources Fund 100 percent of— 

12 ‘‘(A) any civil penalty paid to the United 

13 States under this section; and 

14 ‘‘(B) any fine paid to the United States 

15 under section 403(d) for a knowing violation of 

16 subsection (b)(2) of this section. 

17 ‘‘(3) AVAILABILITY AND USE OF FUNDS.— 

18 Amounts transferred to the Comprehensive Addic19 tion Fund under paragraph (2) shall— 

20 ‘‘(A) remain available until expended; and 

21 ‘‘(B) be made available to supplement 

22 amounts appropriated to carry out title XXXIV 

23 of the Public Health Service Act.’’. 

24 (c) CRIMINAL PENALTIES.—Section 403 of the Con25 trolled Substances Act (21 U.S.C. 843) is amended— 


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1 (1) in subsection (d)(1)— 

2 (A) by inserting ‘‘or knowingly violates sec3 tion 424(b)(2)’’ after ‘‘any person who violates 

4 this section’’; and 

5 (B) by striking ‘‘violation of this section’’ 

6 and inserting ‘‘such a violation’’; and 

7 (2) in subsection (f)— 

8 (A) in paragraph (1), by striking ‘‘or 416’’ 

9 and inserting ‘‘or section 416, or knowing viola10 tions of section 424(b)(2)’’; and 

11 (B) in paragraph (3), by inserting ‘‘or 

12 knowing violations of section 424(b)(2)’’ before 

13 the period at the end. 

14 (d) TECHNICAL AND CONFORMING AMENDMENTS.— 

15 The table of contents for the Comprehensive Drug Abuse 

16 Prevention and Control Act of 1970 (Public Law 91–513; 

17 84 Stat. 1236) is amended— 

18 (1) by inserting after the item relating to sec19 tion 311 the following: 

‘‘Sec. 312. Suspicious orders. 

‘‘Sec. 313. Certifications relating to diversion controls and misbranding.’’; 

20 and 

21 (2) by inserting after the item relating to sec22 tion 423 the following: 

‘‘Sec. 424. Certifications by covered officers.’’. 


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1 (e) EFFECTIVE DATE.—The amendments made by 

2 subsections (b) and (c) of this section shall take effect on 

3 the date that is 180 days after the date of enactment of 

4 this Act. 

5 SEC. 5. GENERAL LIMITATION ON USE OF FUNDS. 

6 Amounts appropriated or provided under this Act, or 

7 an amendment made by this Act— 

8 (1) shall be used only for the public health pur9 poses described in this Act (including the amend10 ments made by this Act); and 

11 (2) shall not be used to— 

12 (A) fund the incarceration, institutionaliza13 tion, or involuntary treatment of individuals to 

14 address the illicit use of substances; or 

15 (B) procure equipment or support activi16 ties inconsistent with the public health purposes 

17 described in this Act (including the amend18 ments made by this Act). 

19 SEC. 6. FEDERAL DRUG DEMAND REDUCTION ACTIVITIES. 

20 (a) PUBLICATION OF LIST.— 

21 (1) AMENDMENT.—Section 705(f) of the Office 

22 of National Drug Control Policy Reauthorization Act 

23 of 1998 (21 U.S.C. 1704(f)) is amended by inserting 

24 at the end the following new paragraph: 


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1 ‘‘(5) PUBLICATION OF LIST.—The Director 

2 shall publish online a complete list of all drug con3 trol program grant programs and any other relevant 

4 information included in the system developed under 

5 paragraph (1).’’. 

6 (2) DEADLINE AND FREQUENCY.—Not later 

7 than one year after the date of the enactment of this 

8 Act, and annually thereafter, the Director of Na9 tional Drug Control Policy shall publish the list re10 quired under section 705(f)(5) of the National Drug 

11 Control Act of 1998, as added by paragraph (1). 

12 (b) NATIONAL DRUG CONTROL STRATEGY.—Section 

13 706(c)(1) of the National Drug Control Act of 1998 (21 

14 U.S.C. 1705(c)(1)) is amended by adding at the end the 

15 following new subparagraph: 

16 ‘‘(O) A review of all federally funded de17 mand reduction activities, including an evalua18 tion of— 

19 ‘‘(i) the effectiveness of those activi20 ties; 

21 ‘‘(ii) the contribution of those activi22 ties to demand reduction activities funded 

23 by State, local, and Tribal governments; 

24 and 


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1 ‘‘(iii) whether any duplication or inef2 ficiency in federally funded demand reduc3 tion activities needs to be addressed.’’. 

Æ 


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