II 

115TH CONGRESS 

2D SESSION S. 2680 

To address the opioid crisis. 

IN THE SENATE OF THE UNITED STATES 

APRIL 16, 2018 

Mr. ALEXANDER (for himself and Mrs. MURRAY) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To address the opioid crisis. 

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 ‘‘Opioid Crisis Response Act of 2018’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—REAUTHORIZATION OF CURES FUNDING 

Sec. 101. State response to the opioid abuse crisis. 

TITLE II—RESEARCH AND INNOVATION 

Sec. 201. Advancing cutting-edge research. 

Sec. 202. Pain research. 


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TITLE III—MEDICAL PRODUCTS AND CONTROLLED SUBSTANCES 

SAFETY 

Sec. 301. Clarifying FDA regulation of non-addictive pain products. 

Sec. 302. Clarifying FDA packaging authorities. 

Sec. 303. Strengthening FDA and CBP coordination and capacity. 

Sec. 304. Clarifying FDA post-market authorities. 

Sec. 305. First responder training. 

Sec. 306. Disposal of controlled substances of a deceased hospice patient by 

employees of a hospice program. 

Sec. 307. GAO study and report on hospice safe drug management. 

Sec. 308. Delivery of a controlled substance by a pharmacy to be administered 

by injection, implantation, or intrathecal pump. 

TITLE IV—TREATMENT AND RECOVERY 

Sec. 401. Comprehensive opioid recovery centers. 

Sec. 402. Program to support coordination and continuation of care for drug 

overdose patients. 

Sec. 403. Alternatives to opioids. 

Sec. 404. Peer support technical assistance. 

Sec. 405. Medication-assisted treatment for recovery from addiction. 

Sec. 406. National recovery housing best practices. 

Sec. 407. Addressing economic and workforce impacts of the opioid crisis. 

Sec. 408. Youth prevention and recovery. 

Sec. 409. Plans of safe care. 

Sec. 410. Regulations relating to special registration for telemedicine. 

Sec. 411. National Health Service Corps behavioral and mental health professionals providing obligated service in schools and other community-based settings. 

Sec. 412. Loan repayment for substance use disorder treatment providers. 

Sec. 413. Improving treatment for pregnant and postpartum women. 

Sec. 414. Early interventions for pregnant women and infants. 

TITLE V—PREVENTION 

Sec. 501. Study on prescribing limits. 

Sec. 502. Programs for health care workforce. 

Sec. 503. Education and awareness campaigns. 

Sec. 504. Enhanced controlled substance overdoses data collection, analysis, 

and dissemination. 

Sec. 505. Preventing overdoses of controlled substances. 

Sec. 506. CDC surveillance and data collection for child, youth, and adult trauma. 

Sec. 507. Reauthorization of NASPER. 

Sec. 508. Jessie’s Law. 

Sec. 509. Development and dissemination of model training programs for substance use disorder patient records. 

Sec. 510. Communication with families during emergencies. 

Sec. 511. Prenatal and postnatal health. 

Sec. 512. Surveillance and education regarding infections associated with injection drug use and other risk factors. 

Sec. 513. Task force to develop best practices for trauma-informed identification, referral, and support. 


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Sec. 514. Grants to improve trauma support services and mental health care 

for children and youth in educational settings. 

Sec. 515. National Child Traumatic Stress Initiative. 

1 TITLE I—REAUTHORIZATION OF 

2 CURES FUNDING 

3 SEC. 101. STATE RESPONSE TO THE OPIOID ABUSE CRISIS. 

4 (a) IN GENERAL.—Section 1003 of the 21st Century 

5 Cures Act (Public Law 114–255) is amended— 

6 (1) in subsection (a)— 

7 (A) by striking ‘‘the authorization of ap8 propriations under subsection (b) to carry out 

9 the grant program described in subsection (c)’’ 

10 and inserting ‘‘subsection (h) to carry out the 

11 grant program described in subsection (b)’’; 

12 and 

13 (B) by inserting after ‘‘and Indian tribes’’ 

14 after ‘‘States’’; 

15 (2) by striking subsection (b); 

16 (3) by redesignating subsections (c) through (e) 

17 as subsections (b) through (d), respectively; 

18 (4) by redesignating subsection (f) as sub19 section (j); 

20 (5) in subsection (b), as so redesignated— 

21 (A) in paragraph (1)— 

22 (i) in the paragraph heading, by in23 serting ‘‘AND INDIAN TRIBE’’ after 

24 ‘‘STATE’’; 


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1 (ii) by striking ‘‘States for the pur2 pose of addressing the opioid abuse crisis 

3 within such States’’ and inserting ‘‘States 

4 and Indian tribes for the purpose of ad5 dressing the opioid abuse crisis within such 

6 States and Indian tribes’’; 

7 (iii) by inserting ‘‘or Indian tribes’’ 

8 after ‘‘preference to States’’; and 

9 (iv) by inserting before the period of 

10 the second sentence ‘‘or other Indian 

11 tribes, as applicable’’; and 

12 (B) in paragraph (2)— 

13 (i) in the matter preceding subpara14 graph (A), by striking ‘‘to a State’’; 

15 (ii) in subparagraph (A), by striking 

16 ‘‘State’’; 

17 (iii) in subparagraph (C), by inserting 

18 ‘‘preventing diversion of controlled sub19 stances,’’ after ‘‘treatment programs,’’; 

20 and 

21 (iv) in subparagraph (E), by striking 

22 ‘‘as the State determines appropriate, re23 lated to addressing the opioid abuse crisis 

24 within the State’’ and inserting ‘‘as the 

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1 priate, related to addressing the opioid 

2 abuse crisis within the State, including di3 recting resources in accordance with local 

4 needs related to substance use disorders’’; 

5 (6) in subsection (c), as so redesignated, by 

6 striking ‘‘subsection (c)’’ and inserting ‘‘subsection 

7 (b)’’; 

8 (7) in subsection (d), as so redesignated— 

9 (A) in the matter preceding paragraph (1), 

10 by striking ‘‘the authorization of appropriations 

11 under subsection (b)’’ and inserting ‘‘subsection 

12 (h)’’; and 

13 (B) in paragraph (1), by striking ‘‘sub14 section (c)’’ and inserting ‘‘subsection (b)’’; and 

15 (8) by inserting after subsection (d), as so re16 designated, the following: 

17 ‘‘(e) INDIAN TRIBES.— 

18 ‘‘(1) DEFINITION.—For purposes of this sec19 tion, the term ‘Indian tribe’ has the meaning given 

20 such term in section 4 of the Indian Self-Determina21 tion and Education Assistance Act (25 U.S.C. 

22 5304). 

23 ‘‘(2) APPROPRIATE MECHANISMS.—The Sec24 retary, in consultation with Indian tribes, shall iden25 tify and establish appropriate mechanisms for tribes 


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1 to demonstrate or report the information as required 

2 under subsections (b), (c), and (d). 

3 ‘‘(f) REPORT TO CONGRESS.—Not later than 1 year 

4 after the date on which amounts are first awarded, after 

5 the date of enactment of the Opioid Crisis Response Act 

6 of 2018, pursuant to subsection (b), and annually there7 after, the Secretary shall submit to the Committee on 

8 Health, Education, Labor, and Pensions of the Senate and 

9 the Committee on Energy and Commerce of the House 

10 of Representatives a report summarizing the information 

11 provided to the Secretary in reports made pursuant to 

12 subsection (c), including the purposes for which grant 

13 funds are awarded under this section and the activities 

14 of such grant recipients. 

15 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary, in16 cluding through the Tribal Training and Technical Assist17 ance Center of the Substance Abuse and Mental Health 

18 Services Administration, shall provide State agencies and 

19 Indian tribes, as applicable, with technical assistance con20 cerning grant application and submission procedures 

21 under this section, award management activities, and en22 hancing outreach and direct support to rural and under23 served communities and providers in addressing the opioid 

24 crisis. 


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1 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For 

2 purposes of carrying out the grant program under sub3 section (b), there are authorized to be appropriated 

4 $500,000,000 for each of fiscal years 2019 through 2021, 

5 to remain available until expended. 

6 ‘‘(i) SET ASIDE.—Of the amounts made available for 

7 each fiscal year to award grants under subsection (b) for 

8 a fiscal year, 5 percent of such amount for such fiscal year 

9 shall be made available to Indian tribes, and up to 15 per10 cent of such amount for such fiscal year may be set aside 

11 for States with the highest age-adjusted mortality rate as12 sociated with opioid use disorders based on the ordinal 

13 ranking of States according to the age-adjusted overdose 

14 mortality rates of the Centers for Disease Control and 

15 Prevention.’’. 

16 (b) PREVIOUSLY APPROPRIATED AMOUNTS.— 

17 (1) APPROPRIATION OF AMOUNTS REMAINING

18 IN ACCOUNT.—Any unobligated amounts remaining, 

19 on the date of enactment of this Act, in the Account 

20 For the State Response to the Opioid Abuse Crisis 

21 established under section 1003(b) of the 21st Cen22 tury Cures Act (Public Law 114–255) (as in effect 

23 on the day before the date of enactment of this Act) 

24 are hereby appropriated to the Secretary of Health 

25 and Human Services for purposes of carrying out 


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1 the grant program under subsection (b) of section 

2 1003 of the 21st Century Cures Act (Public Law 

3 114–255) (as redesignated by subsection (a)(3) of 

4 this section). 

5 (2) AVAILABLE UNTIL EXPENDED.—Amounts 

6 appropriated under paragraph (1) of this subsection 

7 or section 1003(b)(3) of the 21st Century Cures Act 

8 (as in effect on the day before the date of enactment 

9 of this Act) shall remain available until expended. 

10 (c) CONFORMING AMENDMENT.—Section 1004(c) of 

11 the 21st Century Cures Act (Public Law 114–255) is 

12 amended by striking ‘‘, the FDA Innovation Account, or 

13 the Account For the State Response to the Opioid Abuse 

14 Crisis’’ and inserting ‘‘or the FDA Innovation Account’’. 

15 TITLE II—RESEARCH AND 

16 INNOVATION 

17 SEC. 201. ADVANCING CUTTING-EDGE RESEARCH. 

18 Section 402(n)(1) of the Public Health Service Act 

19 (42 U.S.C. 282(n)(1)) is amended— 

20 (1) in subparagraph (A), by striking ‘‘or’’; 

21 (2) in subparagraph (B), by striking the period 

22 and inserting ‘‘; or’’; and 

23 (3) by adding at the end the following: 

24 ‘‘(C) high impact cutting-edge research 

25 that fosters scientific creativity and increases 


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1 fundamental biological understanding leading to 

2 the prevention, diagnosis, or treatment of dis3 eases and disorders, or research urgently re4 quired to respond to a public health threat.’’. 

5 SEC. 202. PAIN RESEARCH. 

6 Section 409J(b) of the Public Health Service Act (42 

7 U.S.C. 284q(b)) is amended— 

8 (1) in paragraph (5)— 

9 (A) in subparagraph (A), by striking ‘‘and 

10 treatment of pain and diseases and disorders 

11 associated with pain’’ and inserting ‘‘treatment, 

12 and management of pain and diseases and dis13 orders associated with pain, including informa14 tion on best practices for utilization of non15 pharmacologic treatments, non-addictive med16 ical products, and other drugs approved, or de17 vices approved or cleared, by the Food and 

18 Drug Administration’’; 

19 (B) in subparagraph (B), by striking ‘‘on 

20 the symptoms and causes of pain;’’ and insert21 ing the following: ‘‘on— 

22 ‘‘(i) the symptoms and causes of pain; 

23 ‘‘(ii) the diagnosis, prevention, treat24 ment, and management of pain; and 


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1 ‘‘(iii) risk factors for, and early warn2 ing signs of, substance use disorders; and’’; 

3 (C) by striking subparagraphs (C) through 

4 (E) and inserting the following: 

5 ‘‘(C) make recommendations to the Direc6 tor of NIH— 

7 ‘‘(i) to ensure that the activities of the 

8 National Institutes of Health and other 

9 Federal agencies are free of unnecessary 

10 duplication of effort; 

11 ‘‘(ii) on how best to disseminate infor12 mation on pain care; and 

13 ‘‘(iii) on how to expand partnerships 

14 between public entities and private entities 

15 to expand collaborative, cross-cutting re16 search.’’; 

17 (2) by redesignating paragraph (6) as para18 graph (7); and 

19 (3) by inserting after paragraph (5) the fol20 lowing: 

21 ‘‘(6) REPORT.—The Director of NIH shall en22 sure that recommendations and actions taken by the 

23 Director with respect to the topics discussed at the 

24 meetings described in paragraph (4) are included in 

25 appropriate reports to Congress.’’. 


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1 TITLE III—MEDICAL PRODUCTS 

2 AND CONTROLLED SUB3 STANCES SAFETY 

4 SEC. 301. CLARIFYING FDA REGULATION OF NON-ADDICT5 IVE PAIN PRODUCTS. 

6 (a) PUBLIC MEETINGS.—Not later than 1 year after 

7 the date of enactment of this Act, the Secretary of Health 

8 and Human Services (referred to in this section as the 

9 ‘‘Secretary’’), acting through the Commissioner of Food 

10 and Drugs, shall hold not less than one public meeting 

11 to address the challenges and barriers of developing non12 addictive medical products intended to treat pain or addic13 tion, which may include— 

14 (1) the manner by which the Secretary may in15 corporate the risks of misuse and abuse of a con16 trolled substance (as defined in section 102 of the 

17 Controlled Substances Act (21 U.S.C. 802) into the 

18 risk benefit assessment under section 505(e) of the 

19 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 

20 355(e)), section 510(k) of such Act (21 U.S.C. 

21 360(k)), or section 515(c) of such Act (21 U.S.C. 

22 360e(c)), as applicable; 

23 (2) the application of novel clinical trial designs 

24 (consistent with section 3021 of the 21st Century 

25 Cures Act (Public Law 114–255)), use of real world 


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1 evidence (consistent with section 505F of the Fed2 eral Food, Drug, and Cosmetic Act (21 U.S.C. 

3 355g)), and use of patient experience data (con4 sistent with section 569C of the Federal Food, 

5 Drug, and Cosmetic Act (21 U.S.C. 360bbb–8c)) for 

6 the development of non-addictive medical products 

7 intended to treat pain or addiction; 

8 (3) the evidentiary standards and the develop9 ment of opioid sparing data for inclusion in the la10 beling of medical products; and 

11 (4) the application of eligibility criteria under 

12 sections 506 and 515B of the Federal Food, Drug, 

13 and Cosmetic Act (21 U.S.C. 356, 360e–3) for non14 addictive medical products intended to treat pain or 

15 addiction. 

16 (b) GUIDANCE.—Not less than one year after the 

17 public meetings are conducted under subsection (a) the 

18 Secretary shall issue one or more final guidance docu19 ments, or update existing guidance documents, to help ad20 dress challenges to developing non-addictive medical prod21 ucts to treat pain or addiction. Such guidance documents 

22 shall include information regarding— 

23 (1) how the Food and Drug Administration 

24 may apply sections 506 and 515B of the Federal 

25 Food, Drug, and Cosmetic Act (21 U.S.C. 356, 


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1 360e–3) to non-addictive medical products intended 

2 to treat pain or addiction, including the cir3 cumstances under which the Secretary— 

4 (A) may apply the eligibility criteria under 

5 such sections 506 and 515B to non-opioid or 

6 non-addictive medical products intended to 

7 treat pain or addiction; 

8 (B) considers the risk of addiction of con9 trolled substances approved to treat pain when 

10 establishing unmet medical need; and 

11 (C) considers pain, pain control, or pain 

12 management in assessing whether a disease or 

13 condition is a serious or life-threatening disease 

14 or condition; 

15 (2) the methods by which sponsors may evalu16 ate acute and chronic pain, endpoints for non-addict17 ive medical products intended to treat pain, the 

18 manner in which endpoints and evaluations of effi19 cacy will be applied across and within review divi20 sions, taking into consideration the etiology of the 

21 underlying disease, and the manner in which spon22 sors may use surrogate endpoints, intermediate 

23 endpoints, and real world evidence; 

24 (3) the manner in which the Food and Drug 

25 Administration will assess evidence to support the 


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1 inclusion of opioid sparing data in the labeling of 

2 non-addictive medical products intended to treat 

3 pain, including— 

4 (A) data collection methodologies, includ5 ing the use of novel clinical trial designs (con6 sistent with section 3021 of the 21st Century 

7 Cures Act (Public Law 114–255)), and real 

8 world evidence (consistent with section 505F of 

9 the Federal Food, Drug, and Cosmetic Act (21 

10 U.S.C. 355g)), as appropriate, to support prod11 uct labeling; 

12 (B) ethical considerations of exposuring 

13 subjects to controlled substances in clinical 

14 trials to develop opioid sparing data and consid15 erations on data collection methods that reduce 

16 harm, which may include the reduction of 

17 opioid use as a clinical benefit; 

18 (C) endpoints, including primary, sec19 ondary, and surrogate endpoints, to evaluate 

20 the reduction of opioid use; 

21 (D) best practices for communication be22 tween sponsors and the agency on the develop23 ment of data collection methods, including the 

24 initiation of data collection; and 


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1 (E) the appropriate format to submit such 

2 data results to the Secretary; and 

3 (4) the circumstances under which the Food 

4 and Drug Administration considers misuse and 

5 abuse of drugs in making determinations of safety 

6 under paragraphs (2) and (4) of subsection (d) of 

7 section 505 of the Federal Food, Drug, and Cos8 metic Act (21 U.S.C. 355) and in finding that a 

9 drug is unsafe under paragraph (1) or (2) of sub10 section (e) of such section. 

11 (c) DEFINITIONS.—In this section— 

12 (1) the term ‘‘medical product’’ means a drug 

13 (as defined in section 201(g)(1) of the Federal 

14 Food, Drug, and Cosmetic Act (21 U.S.C. 

15 321(g)(1))), biological product (as defined in section 

16 351(i) of the Public Health Service Act (42 U.S.C. 

17 262(i))), or device (as defined in section 201(h) of 

18 the Federal Food, Drug, and Cosmetic Act (21 

19 U.S.C. 321(h))); and 

20 (2) the term ‘‘opioid sparing’’ means reducing, 

21 replacing, or avoiding the use of opioids or other 

22 controlled substances. 


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1 SEC. 302. CLARIFYING FDA PACKAGING AUTHORITIES. 

2 Section 505–1(e) of the Federal Food, Drug, and 

3 Cosmetic Act (21 U.S.C. 355–1(e)) is amended by adding 

4 at the end the following: 

5 ‘‘(4) SERIOUS ADVERSE DRUG EXPERIENCE.— 

6 The Secretary may require a risk evaluation mitiga7 tion strategy for a drug for which there is a serious 

8 risk of an adverse drug experience described in sub9 paragraph (B) or (C) of subsection (b)(1), taking 

10 into consideration the factors described in subpara11 graphs (C) and (D) of subsection (f)(2), which may 

12 include requiring that— 

13 ‘‘(A) the drug be made available for dis14 pensing to certain patients in unit dose pack15 aging, packaging that provides a set duration, 

16 or other packaging system that the Secretary 

17 determines may help mitigate such serious risk; 

18 or 

19 ‘‘(B) the drug be dispensed to certain pa20 tients with a safe disposal packaging or safe 

21 disposal system for purposes of rendering un22 used drugs non-retrievable (as defined in sec23 tion 1300.05 of title 21, Code of Federal Regu24 lations (or any successor regulation)) if the Sec25 retary has determines that such safe disposal 

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1 rious risk and exists in sufficient quantities, in 

2 consultation with other relevant Federal agen3 cies with authorities over drug packaging.’’. 

4 SEC. 303. STRENGTHENING FDA AND CBP COORDINATION 

5 AND CAPACITY. 

6 (a) IN GENERAL.—The Secretary of Health and 

7 Human Services (referred to in this section as the ‘‘Sec8 retary’’), acting through the Commissioner of Food and 

9 Drugs, shall coordinate with the Secretary of Homeland 

10 Security to carry out activities related to customs and bor11 der protection and response to illegal controlled substances 

12 and drug imports, including at sites of import (such as 

13 international mail facilities). Such Secretaries may carry 

14 out such activities through a memorandum of under15 standing between the Food and Drug Administration and 

16 the United States Customs and Border Protection. 

17 (b) FDA IMPORT FACILITIES AND INSPECTION CA18 PACITY.—In carrying out this section, the Secretary 

19 shall— 

20 (1) in collaboration with the Secretary of 

21 Homeland Security and the Postmaster General of 

22 the United States Postal Service, provide that im23 port facilities in which the Food and Drug Adminis24 tration operates or carries out activities related to 


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1 drug imports within the international mail facilities 

2 include— 

3 (A) facility upgrades and improved capac4 ity in order to increase and improve inspection 

5 and detection capabilities, which may include, 

6 as the Secretary determines appropriate— 

7 (i) improvements to facilities, such as 

8 upgrades or renovations, and support for 

9 the maintenance of existing import facili10 ties and sites to improve coordination be11 tween Federal agencies; 

12 (ii) the construction of, or upgrades 

13 to, laboratory capacity for purposes of de14 tection and testing of imported goods; 

15 (iii) upgrades to the security of import 

16 facilities; and 

17 (iv) innovative technology and equip18 ment to facilitate improved and near-real19 time information sharing between the Food 

20 and Drug Administration, the Department 

21 of Homeland Security, and the United 

22 States Postal Service; and 

23 (B) provide import facilities in which the 

24 Food and Drug Administration operates or car25 ries out activities related to drug imports within 


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1 the international mail facilities with innovative 

2 technology, including controlled substance de3 tection and testing equipment and other appli4 cable technology, and collaborate with United 

5 States Customs and Border Protection to share 

6 near-real-time information, including informa7 tion about test results, as appropriate, provided 

8 that such technology is interoperable with tech9 nology used by other relevant Federal agencies, 

10 including the United States Customs and Bor11 der Protection, as applicable, and is used in the 

12 time and manner that the Secretary determines 

13 appropriate. 

14 (c) REPORT.—Not later than 6 months after the date 

15 of enactment of this Act, the Secretary, in consultation 

16 with the Secretary of Homeland Security and the Post17 master General of the United States Postal Service, shall 

18 report to the relevant committees of Congress on the im19 plementation of this section, including a summary of 

20 progress made towards near-real-time information sharing 

21 and the interoperability of such technologies. 

22 (d) AUTHORIZATION OF APPROPRIATIONS.—Out of 

23 amounts otherwise available to the Secretary, the Sec24 retary may allocate such sums as may be necessary for 

25 purposes of carrying out this section. 


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1 SEC. 304. CLARIFYING FDA POST-MARKET AUTHORITIES. 

2 Section 505–1(b)(1)(E) of the Federal Food, Drug, 

3 and Cosmetic Act (21 U.S.C. 355–1(b)(1)(E)) is amended 

4 by striking ‘‘of the drug’’ and inserting ‘‘of the drug, 

5 which may include reduced effectiveness that is not in ac6 cordance with the labeling of such drug’’. 

7 SEC. 305. FIRST RESPONDER TRAINING. 

8 Section 546 of the Public Health Service Act (42 

9 U.S.C. 290ee–1) is amended— 

10 (1) in subsection (c)— 

11 (A) in paragraph (2), by striking ‘‘and’’ at 

12 the end; 

13 (B) in paragraph (3), by striking the pe14 riod and inserting ‘‘; and’’; and 

15 (C) by adding at the end the following: 

16 ‘‘(4) train and provide resources for first re17 sponders and members of other key community sec18 tors on safety around fentanyl and other dangerous 

19 illicit drugs to protect themselves from exposure to 

20 fentanyl and respond appropriately when exposure 

21 occurs.’’; 

22 (2) in subsection (d), by inserting ‘‘, and safety 

23 around fentanyl and other dangerous illicit drugs’’ 

24 before the period; 

25 (3) in subsection (f)— 


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1 (A) in paragraph (3), by striking ‘‘and’’ at 

2 the end; 

3 (B) in paragraph (4), by striking the pe4 riod and inserting a semicolon; and 

5 (C) by adding at the end the following: 

6 ‘‘(5) the number of first responders and mem7 bers of other key community sectors trained on safe8 ty around fentanyl and other dangerous illicit 

9 drugs.’’; and 

10 (4) in subsection (g), by striking ‘‘$12,000,000 

11 for each of fiscal years 2017 through 2021’’ and in12 serting ‘‘$36,000,000 for each of fiscal years 2019 

13 through 2023’’. 

14 SEC. 306. DISPOSAL OF CONTROLLED SUBSTANCES OF A 

15 DECEASED HOSPICE PATIENT BY EMPLOY16 EES OF A HOSPICE PROGRAM. 

17 (a) IN GENERAL.—Section 302(g) of the Controlled 

18 Substances Act (21 U.S.C. 822(g)) is amended by adding 

19 at the end the following: 

20 ‘‘(5)(A) An employee of a qualified hospice program 

21 acting within the scope of employment may handle, in the 

22 place of residence of a hospice patient, any controlled sub23 stance that was lawfully dispensed to the hospice patient, 

24 for the purpose of assisting in the disposal of the con25 trolled substance after the hospice patient’s death. 


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1 ‘‘(B) In this paragraph: 

2 ‘‘(i) The term ‘employee of a qualified hospice 

3 program’ means a physician, physician assistant, or 

4 nurse who— 

5 ‘‘(I) is employed by, or is acting pursuant 

6 to arrangements made with, a qualified hospice 

7 program; and 

8 ‘‘(II) is licensed or certified to perform 

9 such employment or acts in accordance with ap10 plicable State law. 

11 ‘‘(ii) The terms ‘hospice care’ and ‘hospice pro12 gram’ have the meanings given those terms in sec13 tion 1861(dd) of the Social Security Act (42 U.S.C. 

14 1395x(dd)). 

15 ‘‘(iii) The term ‘hospice patient’ means an indi16 vidual receiving hospice care. 

17 ‘‘(iv) The term ‘qualified hospice program’ 

18 means a hospice program that— 

19 ‘‘(I) has written policies and procedures for 

20 employees of the hospice program to use assist21 ing in the disposal of the controlled substances 

22 of a hospice patient after the hospice patient’s 

23 death; 

24 ‘‘(II) at the time when the controlled sub25 stances are first ordered— 


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1 ‘‘(aa) provides a copy of the written 

2 policies and procedures to the hospice pa3 tient or hospice patient representative and 

4 the family of the hospice patient; 

5 ‘‘(bb) discusses the policies and proce6 dures with the hospice patient or hospice 

7 patient’s representative and the hospice 

8 patient’s family in a language and manner 

9 that such individuals understand to ensure 

10 that such individuals are informed regard11 ing the safe disposal of controlled sub12 stances; and 

13 ‘‘(cc) documents in the clinical record 

14 of the hospice patient that the written poli15 cies and procedures were provided and dis16 cussed with the hospice patient or hospice 

17 patient’s representative; and 

18 ‘‘(III) at the time when an employee of the 

19 hospice program assists in the disposal of con20 trolled substances of a hospice patient, docu21 ments in the clinical record of the hospice pa22 tient a list of all controlled substances disposed 

23 of. 

24 ‘‘(C) The Attorney General may, by regulation, 

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1 sionals in the definition of the term ‘employee of a 

2 qualified hospice program’ under subparagraph 

3 (B).’’. 

4 (b) NO REGISTRATION REQUIRED.—Section 302(c) 

5 of the Controlled Substances Act (21 U.S.C. 822(c)) is 

6 amended by adding at the end the following: 

7 ‘‘(4) An employee of a qualified hospice pro8 gram for the purpose of assisting in the disposal of 

9 a controlled substance in accordance with subsection 

10 (g)(5).’’. 

11 (c) GUIDANCE.—The Attorney General may issue 

12 guidance to qualified hospice programs to assist the pro13 grams in satisfying the requirements under paragraph (5) 

14 of section 302(g) of the Controlled Substances Act (21 

15 U.S.C. 822(g)), as added by subsection (a). 

16 (d) STATE AND LOCAL AUTHORITY.—Nothing in this 

17 section or the amendments made by this section shall be 

18 construed to prevent a State or local government from im19 posing additional controls or restrictions relating to the 

20 regulation of the disposal of controlled substances in hos21 pice care or hospice programs. 

22 SEC. 307. GAO STUDY AND REPORT ON HOSPICE SAFE 

23 DRUG MANAGEMENT. 

24 (a) STUDY.— 


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1 (1) IN GENERAL.—The Comptroller General of 

2 the United States (in this section referred to as the 

3 ‘‘Comptroller General’’) shall conduct a study on the 

4 requirements applicable to and challenges of hospice 

5 programs with regard to the management and dis6 posal of controlled substances in the home of an in7 dividual. 

8 (2) CONTENTS.—In conducting the study under 

9 paragraph (1), the Comptroller General shall in10 clude— 

11 (A) an overview of challenges encountered 

12 by hospice programs regarding the disposal of 

13 controlled substances, such as opioids, in a 

14 home setting, including any key changes in poli15 cies, procedures, or best practices for the dis16 posal of controlled substances over time; and 

17 (B) a description of Federal requirements, 

18 including requirements under the Medicare pro19 gram, for hospice programs regarding the dis20 posal of controlled substances in a home set21 ting, and oversight of compliance with those re22 quirements. 

23 (b) REPORT.—Not later than 18 months after the 

24 date of enactment of this Act, the Comptroller General 

25 shall submit to Congress a report containing the results 


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1 of the study conducted under subsection (a), together with 

2 recommendations, if any, for such legislation and adminis3 trative action as the Comptroller General determines ap4 propriate. 

5 SEC. 308. DELIVERY OF A CONTROLLED SUBSTANCE BY A 

6 PHARMACY TO BE ADMINISTERED BY INJEC7 TION, IMPLANTATION, OR INTRATHECAL 

8 PUMP. 

9 (a) IN GENERAL.—The Controlled Substances Act is 

10 amended by inserting after section 309 (21 U.S.C. 829) 

11 the following: 

12 ‘‘DELIVERY OF A CONTROLLED SUBSTANCE BY A

13 PHARMACY TO AN ADMINISTERING PRACTITIONER

14 ‘‘SEC. 309A. (a) IN GENERAL.—Notwithstanding 

15 section 102(10), a pharmacy may deliver a controlled sub16 stance to a practitioner in accordance with a prescription 

17 that meets the requirements of this title and the regula18 tions issued by the Attorney General under this title, for 

19 the purpose of administering of the controlled substance 

20 by the practitioner if— 

21 ‘‘(1) the controlled substance is delivered by the 

22 pharmacy to the prescribing practitioner or the prac23 titioner administering the controlled substance, as 

24 applicable, at the location listed on the practitioner’s 

25 certificate of registration issued under this title; 


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1 ‘‘(2)(A) in the case of administering of the con2 trolled substance for the purpose of maintenance or 

3 detoxification treatment under section 303(g)(2)— 

4 ‘‘(i) the practitioner who issued the pre5 scription is a qualifying practitioner authorized 

6 under, and acting within the scope of that sec7 tion; and 

8 ‘‘(ii) the controlled substance is to be ad9 ministered by injection or implantation; or 

10 ‘‘(B) in the case of administering of the con11 trolled substance for a purpose other than mainte12 nance or detoxification treatment, the controlled 

13 substance is to be administered by a practitioner 

14 through use of an intrathecal pump; 

15 ‘‘(3) the pharmacy and the practitioner are au16 thorized to conduct the activities specified in this 

17 section under the law of the State in which such ac18 tivities take place; 

19 ‘‘(4) the prescription is not issued to supply any 

20 practitioner with a stock of controlled substances for 

21 the purpose of general dispensing to patients; 

22 ‘‘(5) except as provided in subsection (b), the 

23 controlled substance is to be administered only to 

24 the patient named on the prescription not later than 


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1 14 days after the date of receipt of the controlled 

2 substance by the practitioner; and 

3 ‘‘(6) notwithstanding any exceptions under sec4 tion 307, the prescribing practitioner, and the prac5 titioner administering the controlled substance, as 

6 applicable, maintain complete and accurate records 

7 of all controlled substances delivered, received, ad8 ministered, or otherwise disposed of under this sec9 tion, including the persons to whom controlled sub10 stances were delivered and such other information as 

11 may be required by regulations of the Attorney Gen12 eral. 

13 ‘‘(b) MODIFICATION OF NUMBER OF DAYS BEFORE

14 WHICH CONTROLLED SUBSTANCE SHALL BE ADMINIS15 TERED.— 

16 ‘‘(1) INITIAL 2-YEAR PERIOD.—During the 2- 

17 year period beginning on the date of enactment of 

18 this section, the Attorney General, in coordination 

19 with the Secretary, may reduce the number of days 

20 described in subsection (a)(5) if the Attorney Gen21 eral determines that such reduction will— 

22 ‘‘(A) reduce the risk of diversion; or 

23 ‘‘(B) protect the public health. 

24 ‘‘(2) MODIFICATIONS AFTER SUBMISSION OF

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1 scribed in subsection (c) is submitted, the Attorney 

2 General, in coordination with the Secretary, may 

3 modify the number of days described in subsection 

4 (a)(5). 

5 ‘‘(3) MINIMUM NUMBER OF DAYS.—Any modi6 fication under this subsection shall be for a period 

7 of not less than 7 days.’’. 

8 (b) STUDY AND REPORT.—Not later than 2 years 

9 after the date of enactment of this section, the Comp10 troller General of the United States shall conduct a study 

11 and submit to Congress a report on access to and potential 

12 diversion of controlled substances administered by injec13 tion, implantation, or through the use of an intrathecal 

14 pump. 

15 (c) TECHNICAL AND CONFORMING AMENDMENT.— 

16 The table of contents for the Comprehensive Drug Abuse 

17 Prevention and Control Act of 1970 is amended by insert18 ing after the item relating to section 309 the following: 

‘‘Sec. 309A. Delivery of a controlled substance by a pharmacy to an administering practitioner.’’. 

19 TITLE IV—TREATMENT AND 

20 RECOVERY 

21 SEC. 401. COMPREHENSIVE OPIOID RECOVERY CENTERS. 

22 (a) IN GENERAL.—Part D of title V of the Public 

23 Health Service Act is amended by adding at the end the 

24 following new section: 


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1 ‘‘SEC. 550. COMPREHENSIVE OPIOID RECOVERY CENTERS. 

2 ‘‘(a) IN GENERAL.—The Secretary, acting through 

3 the Assistant Secretary for Mental Health and Substance 

4 Use, shall award grants on a competitive basis to eligible 

5 entities to establish or operate a comprehensive opioid re6 covery center (referred to in this section as a ‘Center’). 

7 A Center may be a single entity or an integrated delivery 

8 network. 

9 ‘‘(b) GRANT PERIOD.— 

10 ‘‘(1) IN GENERAL.—A grant awarded under 

11 subsection (a) shall be for a period not more than 

12 5 years. 

13 ‘‘(2) RENEWAL.—A grant awarded under sub14 section (a) may be renewed, on a competitive basis, 

15 for additional periods of time, as determined by the 

16 Secretary. In determining whether to renew a grant 

17 under this paragraph, the Secretary shall consider 

18 the data submitted under subsection (h). 

19 ‘‘(c) MINIMUM NUMBER OF GRANTS.—The Secretary 

20 shall allocate the amounts made available under sub21 section (j) such that not fewer than 10 grants may be 

22 awarded. Not more than one grant shall be made to enti23 ties in a single State for any one period. 

24 ‘‘(d) APPLICATION.—In order to be eligible for a 

25 grant under subsection (a), an entity shall submit an ap26 plication to the Secretary at such time and in such manner 


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1 as the Secretary may require. Such application shall in2 clude— 

3 ‘‘(1) evidence that such entity carries out, or is 

4 capable of coordinating with other entities to carry 

5 out, the activities described in subsection (g); and 

6 ‘‘(2) such other information as the Secretary 

7 may require. 

8 ‘‘(e) PRIORITY.—In awarding grants under sub9 section (a), the Secretary shall give priority to eligible enti10 ties located in a State with an overdose mortality rate that 

11 is above the national overdose mortality rate, as deter12 mined by the Director of the Centers for Disease Control 

13 and Prevention. 

14 ‘‘(f) PREFERENCE.—In awarding grants under sub15 section (a), the Secretary may give preference to eligible 

16 entities utilizing technology-enabled collaborative learning 

17 and capacity building models, including such models as de18 fined in section 2 of the Expanding Capacity for Health 

19 Outcomes Act (Public Law 114–270; 130 Stat. 1395), to 

20 conduct the activities described in this section. 

21 ‘‘(g) CENTER ACTIVITIES.—Each Center shall, at a 

22 minimum, carry out the following activities directly, 

23 through referral, or through contractual arrangements, 

24 which may include carrying out such activities through 


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1 technology-enabled collaborative learning and capacity 

2 building models described in subsection (f): 

3 ‘‘(1) TREATMENT AND RECOVERY SERVICES.— 

4 Each Center shall— 

5 ‘‘(A) ensure that intake and evaluations 

6 meet the individualized clinical needs of pa7 tients, including by offering assessments for 

8 services and care recommendations through 

9 independent, evidence-based verification proc10 esses for reviewing patient placement in treat11 ment settings; 

12 ‘‘(B) provide the full continuum of treat13 ment services, including— 

14 ‘‘(i) all drugs approved by the Food 

15 and Drug Administration to treat sub16 stance use disorders; 

17 ‘‘(ii) medically supervised withdrawal 

18 management that includes patient evalua19 tion, stabilization, and readiness for and 

20 entry into treatment; 

21 ‘‘(iii) counseling provided by a pro22 gram counselor or other certified profes23 sional who is licensed and qualified by edu24 cation, training, or experience to assess the 

25 psychological and sociological background 


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1 of patients, to contribute to the appro2 priate treatment plan for the patient, and 

3 to monitor patient progress; 

4 ‘‘(iv) treatment, as appropriate, for 

5 patients with co-occurring substance use 

6 and mental health disorders; 

7 ‘‘(v) residential rehabilitation, and 

8 outpatient and intensive outpatient pro9 grams; 

10 ‘‘(vi) recovery housing; 

11 ‘‘(vii) community-based and peer re12 covery support services; 

13 ‘‘(viii) job training, job placement as14 sistance, and continuing education assist15 ance to support reintegration into the 

16 workforce; and 

17 ‘‘(ix) other best practices to provide 

18 the full continuum of treatment and serv19 ices, as determined by the Secretary; 

20 ‘‘(C) periodically conduct patient assess21 ments to support sustained and clinically sig22 nificant recovery, as defined by the Assistant 

23 Secretary for Mental Health and Substance 

24 Use; 


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1 ‘‘(D) administer an onsite pharmacy and 

2 provide toxicology services, for purposes of car3 rying out this section; and 

4 ‘‘(E) operate a secure, confidential, and 

5 interoperable electronic health information sys6 tem. 

7 ‘‘(2) OUTREACH.—Each Center shall carry out 

8 outreach activities to publicize the services offered 

9 through the Centers, which may include— 

10 ‘‘(A) training and supervising outreach 

11 staff, as appropriate, to work with State and 

12 local health departments, health care providers, 

13 State and local education agencies, institutions 

14 of higher education, State and local workforce 

15 development boards, State and local community 

16 action agencies, public safety officials, first re17 sponders, child welfare agencies, as appropriate, 

18 and other community partners and the public, 

19 including patients, to identify and respond to 

20 community needs, and ensuring that such enti21 ties are aware of the services of the Center; and 

22 ‘‘(B) disseminating and making publicly 

23 available, including through the internet, evi24 dence-based resources that educate profes25 sionals and the public on opioid use disorder 


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1 and other substance use disorders, including co2 occurring substance use and mental health dis3 orders. 

4 ‘‘(h) DATA REPORTING AND PROGRAM OVER5 SIGHT.—With respect to a grant awarded under sub6 section (a), not later than 90 days after the end of the 

7 first year of the grant period, and annually thereafter for 

8 the duration of the grant period (including the duration 

9 of any renewal period for such grant), the entity shall sub10 mit data, as appropriate, to the Secretary regarding— 

11 ‘‘(1) the programs and activities funded by the 

12 grant; 

13 ‘‘(2) health outcomes of the population of indi14 viduals with a substance use disorder who received 

15 services from the Center, evaluated by an inde16 pendent program evaluator through the use of out17 comes measures, as determined by the Secretary; 

18 ‘‘(3) the retention rate of program participants; 

19 and 

20 ‘‘(4) any other information that the Secretary 

21 may require for the purpose of ensuring that the 

22 Center is complying with all the requirements of the 

23 grant, including providing the full continuum of 

24 services described in subsection (g)(1)(B). 


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1 ‘‘(i) PRIVACY.—The provisions of this section, includ2 ing with respect to data reporting and program oversight, 

3 shall be subject to all applicable Federal and State privacy 

4 laws. 

5 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

6 is authorized to be appropriated $10,000,000 for each of 

7 fiscal years 2019 through 2023 for purposes of carrying 

8 out this section.’’. 

9 (b) REPORTS TO CONGRESS.— 

10 (1) PRELIMINARY REPORT.—Not later than 3 

11 years after the date of the enactment of this Act, the 

12 Secretary of Health and Human Services shall sub13 mit to Congress a preliminary report that analyzes 

14 data submitted under section 550(h) of the Public 

15 Health Service Act, as added by subsection (a). 

16 (2) FINAL REPORT.—Not later than 2 years 

17 after submitting the preliminary report required 

18 under paragraph (1), the Secretary of Health and 

19 Human Services shall submit to Congress a final re20 port that includes— 

21 (A) an evaluation of the effectiveness of 

22 the comprehensive services provided by the Cen23 ters established or operated pursuant to section 

24 550 of the Public Health Service Act, as added 

25 by subsection (a), on health outcomes of the 


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1 population of individuals with substance use 

2 disorder who receive services from the Center, 

3 which shall include an evaluation of the effec4 tiveness of services for treatment and recovery 

5 support and to reduce relapse, recidivism, and 

6 overdose; and 

7 (B) recommendations, as appropriate, re8 garding ways to improve Federal programs re9 lated to substance use disorders, which may in10 clude dissemination of best practices for the 

11 treatment of substance use disorders to health 

12 care professionals. 

13 SEC. 402. PROGRAM TO SUPPORT COORDINATION AND 

14 CONTINUATION OF CARE FOR DRUG OVER15 DOSE PATIENTS. 

16 (a) IN GENERAL.—The Secretary of Health and 

17 Human Services (referred to in this section as the ‘‘Sec18 retary’’) shall identify or facilitate the development of best 

19 practices for— 

20 (1) emergency treatment of known or suspected 

21 drug overdose; 

22 (2) coordination and continuation of care and 

23 treatment, including, as appropriate, through refer24 rals, of individuals after an opioid overdose; and 


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1 (3) the provision of overdose reversal medica2 tion, as appropriate. 

3 (b) GRANT ESTABLISHMENT AND PARTICIPATION.— 

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

5 grants on a competitive basis to eligible entities to 

6 support implementation of voluntary programs for 

7 care and treatment of individuals after an opioid 

8 overdose, as appropriate, which may include imple9 mentation of the best practices described in sub10 section (a). 

11 (2) ELIGIBLE ENTITY.—In this section, the 

12 term ‘‘eligible entity’’ means an entity that offers 

13 treatment or other services for individuals in re14 sponse to, or following, drug overdoses or a drug 

15 overdose. 

16 (3) APPLICATION.—An eligible entity desiring a 

17 grant under this section, in consultation with the 

18 principal agency of a State in which such entity of19 fers treatment or other services that is responsible 

20 for carrying out the block grant for prevention and 

21 treatment of substance abuse under subpart II of 

22 part B of title XIX of the Public Health Service Act 

23 (42 U.S.C. 300x–21 et seq.), shall submit an appli24 cation to the Secretary, at such time and in such 


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1 manner as the Secretary may require, that in2 cludes— 

3 (A) evidence that such eligible entity car4 ries out, or is capable of coordinating with 

5 other entities to carry out, the activities de6 scribed in paragraph (4); and 

7 (B) such additional information as the Sec8 retary may require. 

9 (4) USE OF GRANT FUNDS.—An eligible entity 

10 awarded a grant under this section shall use such 

11 grant funds to— 

12 (A) hire or utilize recovery coaches to help 

13 support recovery, including by— 

14 (i) connecting patients to a continuum 

15 of care services, such as— 

16 (I) treatment and recovery sup17 port programs; 

18 (II) programs that provide non19 clinical recovery support services; 

20 (III) peer support networks; 

21 (IV) recovery community organi22 zations; 

23 (V) health care providers, includ24 ing physicians and other providers of 

25 behavioral health and primary care; 


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1 (VI) educational and vocational 

2 schools; 

3 (VII) employers; 

4 (VIII) housing services; and 

5 (IX) child welfare agencies; 

6 (ii) providing education on overdose 

7 prevention to patients; and 

8 (iii) providing other services the Sec9 retary determines necessary to help ensure 

10 continued connection with recovery support 

11 services; 

12 (B) establish policies and procedures that 

13 address the provision of overdose reversal medi14 cation, the administration of all drugs approved 

15 by the Food and Drug Administration to treat 

16 substance use disorder, and subsequent continu17 ation of, or referral to, evidence-based treat18 ment for patients with a substance use disorder 

19 who have experienced a non-fatal drug over20 dose, in order to prevent relapse, and reduce re21 cidivism and future overdose; 

22 (C) develop or implement best practices for 

23 treating non-fatal drug overdoses, including, 

24 with respect to care coordination and integrated 

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1 ery options for individuals with a substance use 

2 disorder who have experienced a non-fatal drug 

3 overdose; and 

4 (D) establish integrated models of care for 

5 individuals who have experienced a non-fatal 

6 drug overdose which may include patient as7 sessment, follow up, and transportation to and 

8 from treatment facilities. 

9 (5) ADDITIONAL PERMISSIBLE USES.—In addi10 tion to the uses described in paragraph (4), a grant 

11 awarded under this section may be used, directly or 

12 through contractual arrangements, to provide— 

13 (A) all drugs approved by the Food and 

14 Drug Administration to treat substance use dis15 orders, pursuant to Federal and State law; 

16 (B) withdrawal and detoxification services 

17 that include patient evaluation, stabilization, 

18 and preparation for treatment of substance use 

19 disorder, including treatment described in sub20 paragraph (A), as appropriate; or 

21 (C) mental health services provided by a 

22 program counselor, social worker, therapist, or 

23 other certified professional who is licensed and 

24 qualified by education, training, or experience 

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1 tients, to contribute to the appropriate treat2 ment plan for patients with substance use dis3 order, and to monitor patient progress. 

4 (6) PREFERENCE.—In awarding grants under 

5 this section, the Secretary shall give preference to el6 igible entities that meet any or all of the following 

7 criteria: 

8 (A) The eligible entity is a critical access 

9 hospital (as defined in section 1861(mm)(1) of 

10 the Social Security Act (42 U.S.C. 

11 1395x(mm)(1))), a low volume hospital (as de12 fined in section 1886(d)(12)(C)(i) of such Act 

13 (42 U.S.C. 1395ww(d)(12)(C)(i))), or a sole 

14 community hospital (as defined in section 

15 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 

16 1395ww(d)(5)(D)(iii))). 

17 (B) The eligible entity is located in a State 

18 with an overdose mortality rate that is above 

19 the national overdose mortality rate, as deter20 mined by the Director of the Centers for Dis21 ease Control and Prevention. 

22 (C) The eligible entity demonstrates that 

23 recovery coaches will be placed in both health 

24 care settings and community settings. 


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1 (7) PERIOD OF GRANT.—A grant awarded to an 

2 eligible entity under this section shall be for a period 

3 of not more than 5 years. 

4 (c) DEFINITION.—In this section, the term ‘‘recovery 

5 coach’’ means an individual— 

6 (1) with knowledge of, or experience with, re7 covery from a substance use disorder; and 

8 (2) who has completed training from, and is de9 termined to be in good standing by, a recovery serv10 ices organization capable of conducting such training 

11 and making such determination. 

12 (d) REPORTING REQUIREMENTS.— 

13 (1) REPORTS BY GRANTEES.—Each eligible en14 tity awarded a grant under this section shall submit 

15 to the Secretary an annual report for each year for 

16 which the entity has received such grant that in17 cludes information on— 

18 (A) the number of individuals treated by 

19 the entity for non-fatal overdoses, including the 

20 number of non-fatal overdoses where overdose 

21 reversal medication was administered; 

22 (B) the number of individuals administered 

23 medication-assisted treatment by the entity; 

24 (C) the number of individuals referred by 

25 the entity to other treatment facilities after a 


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1 non-fatal overdose, the types of such other fa2 cilities, and the number of such individuals ad3 mitted to such other facilities pursuant to such 

4 referrals; and 

5 (D) the frequency and number of patients 

6 with reoccurrences, including readmissions for 

7 non-fatal overdoses and evidence of relapse re8 lated to substance abuse disorder. 

9 (2) REPORT BY SECRETARY.—Not later than 5 

10 years after the date of enactment of this Act, the 

11 Secretary shall submit to Congress a report that in12 cludes an evaluation of the effectiveness of the grant 

13 program carried out under this section with respect 

14 to long term health outcomes of the population of in15 dividuals who have experienced a drug overdose, the 

16 percentage of patients treated or referred to treat17 ment by grantees, and the frequency and number of 

18 patients who experienced relapse, were readmitted 

19 for treatment, or experienced another overdose. 

20 (e) PRIVACY.—The requirements of this section, in21 cluding with respect to data reporting and program over22 sight, shall be subject to all applicable Federal and State 

23 privacy laws. 

24 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

25 authorized to be appropriated to carry out this section 


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1 such sums as may be necessary for each of fiscal years 

2 2019 through 2023. 

3 SEC. 403. ALTERNATIVES TO OPIOIDS. 

4 (a) IN GENERAL.—The Secretary of Health and 

5 Human Services shall, directly or through grants to, or 

6 contracts with, public and private entities, provide tech7 nical assistance to hospitals and other acute care settings 

8 on alternatives to opioids for pain management. The tech9 nical assistance provided shall be for the purpose of— 

10 (1) utilizing information from acute care pro11 viders including emergency departments and other 

12 providers that have successfully implemented alter13 natives to opioids programs, promoting non-opioid 

14 protocols and medications while appropriately lim15 iting the use of opioids; 

16 (2) identifying or facilitating the development of 

17 best practices on the use of alternatives to opioids, 

18 which may include pain-management strategies that 

19 involve non-addictive medical products, non-pharma20 cologic treatments, and technologies or techniques to 

21 identify patients at-risk for opioid use disorder; 

22 (3) identifying or facilitating the development of 

23 best practices on the use of alternatives to opioids 

24 that target common painful conditions and include 


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1 certain patient populations, such as geriatric pa2 tients, pregnant women, and children; 

3 (4) disseminating information on the use of al4 ternatives to opioids to providers in acute care set5 tings, which may include emergency departments, 

6 outpatient clinics, critical access hospitals, and Fed7 erally qualified health centers; and 

8 (5) collecting data and reporting on health out9 comes associated with the use of alternatives to 

10 opioids. 

11 (b) AUTHORIZATION OF APPROPRIATIONS.—There is 

12 authorized to be appropriated to carry out this section 

13 such sums as may be necessary for each of fiscal years 

14 2019 through 2023. 

15 SEC. 404. PEER SUPPORT TECHNICAL ASSISTANCE. 

16 (a) TECHNICAL ASSISTANCE FOR PEER SUPPORT

17 SERVICES.—The Secretary of Health and Human Services 

18 (referred to in this section as the ‘‘Secretary’’), acting 

19 through the Assistant Secretary for Mental Health and 

20 Substance Abuse, shall provide technical assistance and 

21 support to organizations providing peer support services 

22 related to substance use disorder, including technical as23 sistance and support related to— 

24 (1) training on identifying— 

25 (A) signs of substance use disorder; 


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1 (B) resources to assist individuals with a 

2 substance use disorder, or resources for families 

3 of an individual with a substance use disorder; 

4 and 

5 (C) best practices for the delivery of recov6 ery support services; 

7 (2) the provision of translation services, inter8 pretation, or other such services for clients with lim9 ited English speaking proficiency; 

10 (3) capacity building; and 

11 (4) evaluation and improvement, as necessary, 

12 of the effectiveness of such peer support services. 

13 (b) BEST PRACTICES.—The Secretary shall periodi14 cally issue best practices related to peer support services 

15 for use by organizations that provide peer support serv16 ices. 

17 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section 

19 such sums as may be necessary for each of fiscal years 

20 2019 through 2023. 

21 SEC. 405. MEDICATION-ASSISTED TREATMENT FOR RECOV22 ERY FROM ADDICTION. 

23 (a) REPEAL OF REQUIREMENT TO UPDATE REGULA24 TIONS.—Section 303 of the Comprehensive Addiction and 


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1 Recovery Act of 2016 (Public Law 114–198; 130 Stat. 

2 720) is amended by striking subsection (c). 

3 (b) CODIFICATION OF EXPANSION OF MAXIMUM

4 NUMBER OF PATIENTS FOR MEDICATION-ASSISTED

5 TREATMENT.—Section 303(g)(2)(B)(iii)(II) of the Con6 trolled Substances Act (21 U.S.C. (g)(2)(B)(iii)(II)) is 

7 amended by striking ‘‘100’’ each place it appears and in8 serting ‘‘275’’. 

9 SEC. 406. NATIONAL RECOVERY HOUSING BEST PRAC10 TICES. 

11 (a) BEST PRACTICES.—The Secretary of Health and 

12 Human Services (referred to in this section as the ‘‘Sec13 retary’’), in consultation with the Secretary for Housing 

14 and Urban Development, patients with a history of opioid 

15 use disorder, and other stakeholders, which may include 

16 State accrediting entities and reputable providers of, and 

17 analysts of, recovery housing services, shall identify or fa18 cilitate the development of best practices, which may in19 clude model laws for implementing suggested minimum 

20 standards, for operating recovery housing. 

21 (b) DISSEMINATION.—The Secretary shall dissemi22 nate the best practices identified or developed under sub23 section (a) to— 


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1 (1) State agencies, which may include the provi2 sion of technical assistance to State agencies seeking 

3 to adopt or implement such best practices; 

4 (2) recovery housing entities; and 

5 (3) the public, as appropriate. 

6 (c) REQUIREMENTS.—In identifying or facilitating 

7 the development of best practices under subsection (a), the 

8 Secretary, in consultation with appropriate stakeholders, 

9 shall consider how recovery housing is able to (including 

10 by improving access and adherence to treatment) support 

11 recovery and prevent relapse, recidivism, or overdose, in12 cluding overdose death. 

13 (d) RULE OF CONSTRUCTION.—Nothing in this sec14 tion shall be construed to provide the Secretary with the 

15 ability to require States to adhere to minimum standards 

16 in the State oversight of recovery housing. 

17 (e) DEFINITION.—In this section, the term ‘‘recovery 

18 housing’’ means a shared living environment free from al19 cohol and illicit drug use and centered on peer support 

20 and connection to services that promote sustained recovery 

21 from substance use disorders. 

22 SEC. 407. ADDRESSING ECONOMIC AND WORKFORCE IM23 PACTS OF THE OPIOID CRISIS. 

24 (a) DEFINITIONS.—Except as otherwise expressly 

25 provided, in this section: 


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1 (1) EDUCATION PROVIDER.—The term ‘‘edu2 cation provider’’ means— 

3 (A) an institution of higher education, as 

4 defined in section 101 of the Higher Education 

5 Act of 1965 (20 U.S.C. 1001); or 

6 (B) a postsecondary vocational institution, 

7 as defined in section 102(c) of such Act (20 

8 U.S.C. 1002(c)). 

9 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti10 ty’’ means— 

11 (A) a State workforce agency; 

12 (B) a State board; 

13 (C) an outlying area, as defined in section 

14 3 of the Workforce Innovation and Opportunity 

15 Act (29 U.S.C. 3102); or 

16 (D) a Tribal entity. 

17 (3) LOCAL AREA; LOCAL BOARD; ONE-STOP OP18 ERATOR.—The terms ‘‘local area’’, ‘‘local board’’, 

19 and ‘‘one-stop operator’’ have the meanings given 

20 such terms in section 3 of the Workforce Innovation 

21 and Opportunity Act (29 U.S.C. 3102). 

22 (4) LOCAL ENTITY.—The term ‘‘local entity’’ 

23 means a local board or one-stop operator. 

24 (5) PARTICIPATING PARTNERSHIP.—The term 

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1 tablished under subsection (e)(1) by a local entity 

2 receiving a subgrant under subsection (d). 

3 (6) PROGRAM PARTICIPANT.—The term ‘‘pro4 gram participant’’ means an individual who— 

5 (A) is a member of a population of workers 

6 described in subsection (e)(2) that is served by 

7 a participating partnership through the pilot 

8 program under this section; and 

9 (B) enrolls with the applicable partici10 pating partnership to receive any of the services 

11 described in subsection (e)(3). 

12 (7) SECRETARY.—The term ‘‘Secretary’’ means 

13 the Secretary of Labor. 

14 (8) STATE BOARD.—The term ‘‘State board’’ 

15 has the meaning given the term in section 3 of the 

16 Workforce Innovation and Opportunity Act (29 

17 U.S.C. 3102). 

18 (9) STATE WORKFORCE AGENCY.—The term 

19 ‘‘State workforce agency’’ means the lead State 

20 agency with responsibility for the administration of 

21 a program under chapter 2 or 3 of subtitle B of title 

22 I of the Workforce Innovation and Opportunity Act 

23 (29 U.S.C. 3161 et seq., 3171 et seq.). 

24 (10) SUBSTANCE USE DISORDER.—The term 

25 ‘‘substance use disorder’’ means such a disorder 


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1 within the meaning of title V of the Public Health 

2 Service Act (42 U.S.C. 290aa et seq.). 

3 (11) SUPPORTIVE SERVICES.—The term ‘‘sup4 portive services’’ has the meaning given such term in 

5 section 3 of the Workforce Innovation and Oppor6 tunity Act (29 U.S.C. 3102). 

7 (12) TREATMENT PROVIDER.—The term ‘‘treat8 ment provider’’— 

9 (A) means a health care provider that of10 fers services for treating substance use dis11 orders and is licensed in accordance with appli12 cable State law to provide such services; 

13 (B) accepts health insurance for such serv14 ices, including coverage under title XIX of the 

15 Social Security Act (42 U.S.C. 1396 et seq.); 

16 and 

17 (C) may include— 

18 (i) a nonprofit provider of peer recov19 ery support services, as defined by the 

20 State involved in regulation or guidance; 

21 (ii) a community health care provider; 

22 or 

23 (iii) a Federally qualified health cen24 ter (as defined in section 1861(aa) of the 

25 Social Security Act (42 U.S.C. 1395x)). 


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1 (13) TRIBAL ENTITY.—The term ‘‘Tribal enti2 ty’’ includes any Indian tribe, tribal organization, 

3 Indian-controlled organization serving Indians, Na4 tive Hawaiian organization, or Alaska Native entity, 

5 as such terms are defined or used in section 166 of 

6 the Workforce Innovation and Opportunity Act (29 

7 U.S.C. 3221). 

8 (b) PILOT PROGRAM AND GRANTS AUTHORIZED.— 

9 (1) IN GENERAL.—The Secretary, in consulta10 tion with the Secretary of Health and Human Serv11 ices, shall carry out a pilot program to address eco12 nomic and workforce impacts associated with a high 

13 rate of a substance use disorder. In carrying out the 

14 pilot program, the Secretary shall make grants, on 

15 a competitive basis, to eligible entities to enable such 

16 entities to make subgrants to local boards and one17 stop operators to address the economic and work18 force impacts associated with a high rate of a sub19 stance use disorder. 

20 (2) GRANT AMOUNTS.—The Secretary shall 

21 make each such grant in an amount that is not less 

22 than $500,000, and not more than $5,000,000, for 

23 a fiscal year. 

24 (c) GRANT APPLICATIONS.— 


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1 (1) IN GENERAL.—An eligible entity applying 

2 for a grant under this section shall submit an appli3 cation to the Secretary at such time and in such 

4 form and manner as the Secretary may reasonably 

5 require, including the information described in this 

6 subsection. 

7 (2) SIGNIFICANT IMPACT ON COMMUNITY BY

8 OPIOID ABUSE AND SUBSTANCE USE DISORDER-RE9 LATED PROBLEMS.— 

10 (A) DEMONSTRATION.—An eligible entity 

11 shall include in the application information that 

12 demonstrates significant impact on the commu13 nity by problems related to opioid abuse or an14 other substance use disorder, by— 

15 (i) identifying the communities, re16 gions, or local areas that will be served 

17 through the grant (each referred to in this 

18 section as a ‘‘service area’’); and 

19 (ii) showing, for each such service 

20 area, an increase equal to or greater than 

21 the national increase in such problems, be22 tween— 

23 (I) 1999; and 

24 (II) 2016 or the latest year for 

25 which data are available. 


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1 (B) INFORMATION.—In making the show2 ing described in subparagraph (A)(ii), the eligi3 ble entity may use information including data 

4 on— 

5 (i) the incidence or prevalence of 

6 opioid abuse and other substance use dis7 orders; 

8 (ii) the per capita drug overdose mor9 tality rate, as determined by the Director 

10 of the Centers for Disease Control and 

11 Prevention; 

12 (iii) the rate of non-fatal hospitaliza13 tions related to opioid abuse or another 

14 substance use disorder; or 

15 (iv) the number of arrests or convic16 tions, or a relevant law enforcement sta17 tistic, that reasonably shows an increase in 

18 opioid abuse or another substance use dis19 order. 

20 (C) SUPPORT FOR STATE STRATEGY.—The 

21 eligible entity shall also include in the applica22 tion information describing how the proposed 

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1 paragraph (A) in specific regions or across the 

2 State, outlaying area, or Tribal entity. 

3 (3) ECONOMIC AND EMPLOYMENT CONDITIONS

4 DEMONSTRATE ADDITIONAL FEDERAL SUPPORT

5 NEEDED.— 

6 (A) DEMONSTRATION.—An eligible entity 

7 shall include in the application information that 

8 demonstrates that a high rate of a substance 

9 use disorder has caused, or is coincident to, an 

10 economic or employment downturn in the serv11 ice area. 

12 (B) INFORMATION.—In making the dem13 onstration described in subparagraph (A), the 

14 eligible entity may use information including— 

15 (i) documentation of any layoff, an16 nounced future layoff, legacy industry de17 cline, decrease in an employment or labor 

18 market participation rate, or economic im19 pact, whether or not the result described in 

20 this clause is overtly related to a high rate 

21 of a substance use disorder; 

22 (ii) documentation showing decreased 

23 economic activity related to, caused by, or 

24 contributing to a high rate of a substance 

25 use disorder, including a description of 


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1 how the service area has been impacted, or 

2 will be impacted, by such a decrease; 

3 (iii) in particular, information on eco4 nomic indicators, labor market analyses, 

5 information from public announcements, 

6 and demographic and industry data; 

7 (iv) information on rapid response ac8 tivities (as defined in section 3 of the 

9 Workforce Innovation and Opportunity Act 

10 (29 U.S.C. 3102)) that have been or will 

11 be conducted, including demographic data 

12 gathered by employer or worker surveys or 

13 through other methods; 

14 (v) data or documentation, beyond an15 ecdotal evidence, showing that employers 

16 face challenges filling job vacancies due to 

17 a lack of skilled workers able to pass a 

18 drug test; or 

19 (vi) any additional relevant data or in20 formation on the economy, workforce, or 

21 another aspect of the service area to sup22 port the application. 

23 (4) WORKFORCE SHORTAGE RELATED TO

24 TREATMENT WORKFORCE.— 


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1 (A) IN GENERAL.—An eligible entity may 

2 include in the application a demonstration of 

3 the workforce shortage in a professional area to 

4 be addressed under the grant. Such professional 

5 areas may include— 

6 (i) substance use disorder treatment 

7 and related services; 

8 (ii) non-opioid pain therapy and pain 

9 management services; or 

10 (iii) mental health care treatment 

11 services. 

12 (B) INFORMATION TO BE INCLUDED.—An 

13 eligible entity demonstrating a workforce short14 age under subparagraph (A) shall demonstrate 

15 the workforce shortage through information 

16 that may include— 

17 (i) the distance between— 

18 (I) communities affected by 

19 opioid abuse or another substance use 

20 disorder; and 

21 (II) facilities or professionals of22 fering services in the professional 

23 area; 

24 (ii) the maximum capacity of facilities 

25 or professionals to serve individuals in an 


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1 affected community, or increases in arrests 

2 related to opioid abuse or another sub3 stance use disorder, overdose deaths, or 

4 nonfatal overdose emergencies in the com5 munity; or 

6 (iii) other information that can dem7 onstrate such a shortage. 

8 (d) SUBGRANT AUTHORIZATION AND APPLICATION

9 PROCESS.— 

10 (1) SUBGRANTS AUTHORIZED.— 

11 (A) IN GENERAL.—An eligible entity re12 ceiving a grant under subsection (b)— 

13 (i) may use not more than 5 percent 

14 of the grant funds for the administrative 

15 costs of carrying out the grant; and 

16 (ii) shall use the remaining grant 

17 funds to make subgrants to local entities 

18 in the area served by the eligible entity to 

19 carry out the services and activities de20 scribed in subsection (e). 

21 (B) GEOGRAPHIC DISTRIBUTION.—In mak22 ing subgrants under this subsection, an eligible 

23 entity shall ensure, to the extent practicable, 

24 the equitable geographic distribution (such as 


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1 urban and rural distribution) of areas receiving 

2 subgrant funds. 

3 (2) SUBGRANT APPLICATION.— 

4 (A) IN GENERAL.—A local entity desiring 

5 to receive a subgrant under this subsection shall 

6 submit an application at such time and in such 

7 and manner as the eligible entity may reason8 ably require, including the information de9 scribed in this paragraph. 

10 (B) CONTENTS.—Each application de11 scribed in subparagraph (A) shall include an 

12 analysis of the estimated performance of the 

13 local entity in carrying out the proposed serv14 ices and activities under the subgrant that— 

15 (i) uses primary indicators of per16 formance described in section 

17 116(c)(1)(A)(i) of the Workforce Innova18 tion and Opportunity Act (29 U.S.C. 

19 3141(c)(1)(A)(i)), to assess estimated ef20 fectiveness of the proposed services and ac21 tivities, including the estimated number of 

22 individuals with a substance use disorder 

23 who may be served by the proposed serv24 ices and activities; 


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1 (ii) analyzes the record of the local 

2 entity in serving individuals with a barrier 

3 to employment; and 

4 (iii) analyzes the ability of the local 

5 entity to establish the partnership de6 scribed in subsection (e)(1). 

7 (C) ANALYSIS.—The analysis described in 

8 subparagraph (B) may include or utilize— 

9 (i) data from the National Center for 

10 Health Statistics of the Centers for Dis11 ease Control and Prevention; 

12 (ii) data from the Center for Behav13 ioral Health Statistics and Quality of the 

14 Substance Abuse and Mental Health Serv15 ices Administration; 

16 (iii) State vital statistics; 

17 (iv) municipal police department 

18 records; 

19 (v) reports from local coroners; or 

20 (vi) other relevant data. 

21 (e) SUBGRANT SERVICES AND ACTIVITIES.— 

22 (1) FORMATION OF PARTNERSHIP.— 

23 (A) IN GENERAL.—Each local entity that 

24 receives a subgrant under subsection (d) shall 

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1 ten contract or other agreement, with members 

2 described in subparagraph (B), and shall carry 

3 out the services and activities described in this 

4 subsection through the partnership. 

5 (B) MEMBERS OF THE PARTNERSHIP.—A 

6 partnership described in subparagraph (A) shall 

7 include 1 or more of the following: 

8 (i) The eligible entity. 

9 (ii) A treatment provider. 

10 (iii) An employer or industry organi11 zation. 

12 (iv) An education provider. 

13 (v) A justice or law enforcement orga14 nization. 

15 (vi) A faith-based or community-based 

16 organization. 

17 (vii) Other State or local agencies. 

18 (viii) Other organizations, as deter19 mined to be necessary by the local entity. 

20 (2) SELECTION OF POPULATION TO BE

21 SERVED.—A participating partnership shall elect to 

22 provide services and activities under the subgrant to 

23 one or both of the following populations of workers: 

24 (A) Workers, including dislocated workers, 

25 new entrants in the workforce, or incumbent 


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1 workers (employed or underemployed), who are 

2 directly or indirectly affected by a high rate of 

3 a substance use disorder and each of whom is— 

4 (i) an individual who voluntarily con5 firms that the individual, or a friend or 

6 family member of the individual, has a his7 tory of opioid abuse or another substance 

8 use disorder; or 

9 (ii) an individual who works or resides 

10 in a community substantially impacted by 

11 a high rate of a substance use disorder or 

12 can otherwise demonstrate job loss as a re13 sult of a high rate of a substance use dis14 order. 

15 (B) Workers, including dislocated workers, 

16 new entrants in the workforce, or incumbent 

17 workers (employed or underemployed), who— 

18 (i) seek to transition to professions 

19 that support individuals struggling with a 

20 substance use disorder or at risk for devel21 oping such disorder, such as professions 

22 that provide— 

23 (I) substance use disorder treat24 ment and related services; 


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1 (II) peer recovery support serv2 ices described in subsection 

3 (a)(12)(C)(i); 

4 (III) non-opioid pain therapy and 

5 pain management services; or 

6 (IV) mental health care; and 

7 (ii) need new or upgraded skills to 

8 better serve such a population of strug9 gling or at-risk individuals. 

10 (3) SERVICES AND ACTIVITIES.—Each partici11 pating partnership shall use funds available through 

12 a subgrant under this subsection to carry out 1 or 

13 more of the following: 

14 (A) ENGAGING EMPLOYERS.—Engaging 

15 with employers to— 

16 (i) learn about the skill and hiring re17 quirements of employers; 

18 (ii) learn about the support needed by 

19 employers to hire and retain program par20 ticipants, and other individuals with a sub21 stance use disorder, and the support need22 ed by such employers to obtain their com23 mitment to testing creative solutions to 

24 employing program participants and such 

25 individuals; 


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1 (iii) connect employers and workers to 

2 on-the-job or customized training programs 

3 before or after layoff to help facilitate re4 employment; 

5 (iv) connect employers with an edu6 cation provider to develop classroom in7 struction to complement on-the-job learn8 ing for program participants and such in9 dividuals; 

10 (v) help employers develop the cur11 riculum design of a work-based learning 

12 program for program participants and 

13 such individuals; or 

14 (vi) help employers employ program 

15 participants or such individuals engaging 

16 in a work-based learning program for a 

17 transitional period before hiring such a 

18 program participant or individual for full19 time employment of not less than 30 hours 

20 a week. 

21 (B) SCREENING SERVICES.—Providing 

22 screening services, which may include— 

23 (i) using an evidence-based screening 

24 method to screen each individual seeking 

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1 mine whether the individual has a sub2 stance use disorder; 

3 (ii) conducting an assessment of each 

4 such individual to determine the services 

5 needed for such individual to obtain or re6 tain employment, including an assessment 

7 of strengths and general work readiness; 

8 and 

9 (iii) accepting walk-ins or referrals 

10 from employers, labor organizations, or 

11 other entities recommending individuals to 

12 participate in such program. 

13 (C) INDIVIDUAL TREATMENT AND EM14 PLOYMENT PLAN.—Developing an individual 

15 treatment and employment plan for each pro16 gram participant, which shall include providing 

17 a case manager to work with each participant 

18 to develop the plan, which may include— 

19 (i) identifying employment and career 

20 goals; 

21 (ii) exploring career pathways that 

22 lead to in-demand industries and sectors as 

23 determined by the State board and the 

24 head of the State workforce agency; 


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1 (iii) setting appropriate achievement 

2 objectives to attain the employment and 

3 career goals identified under clause (i); or 

4 (iv) developing the appropriate com5 bination of services to enable the partici6 pant to achieve the employment and career 

7 goals. 

8 (D) OUTPATIENT TREATMENT AND RECOV9 ERY CARE.—In the case of a participating part10 nership serving program participants described 

11 in paragraph (2)(A)(i) with a substance use dis12 order, providing individualized and group out13 patient treatment and recovery services for such 

14 program participants that are offered during 

15 the day and evening, and on weekends. Such 

16 treatment and recovery services— 

17 (i) shall be based on a model that uti18 lizes combined behavioral interventions and 

19 other evidence-based or evidence-informed 

20 interventions; and 

21 (ii) may include additional services 

22 such as— 

23 (I) health, mental health, addic24 tion, or other forms of outpatient 

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1 stance use disorder and co-occurring 

2 conditions; 

3 (II) drug testing for a current 

4 substance use disorder prior to enroll5 ment in career or training services or 

6 prior to employment; 

7 (III) linkages to community serv8 ices, including services offered by 

9 partner organizations designed to sup10 port program participants; and 

11 (IV) referrals to health care, in12 cluding referrals to substance use dis13 order treatment and mental health 

14 services. 

15 (E) SUPPORTIVE SERVICES.—Providing 

16 supportive services, which shall include services 

17 such as— 

18 (i) coordinated wraparound services to 

19 provide maximum support for program 

20 participants to ensure that the program 

21 participants maintain employment and re22 covery for not less than 12 months, as ap23 propriate; 

24 (ii) assistance in establishing eligi25 bility for assistance under Federal, State, 


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1 and local programs providing health serv2 ices, mental health services, housing serv3 ices, transportation services, or social serv4 ices; 

5 (iii) peer recovery support services de6 scribed in subsection (a)(12)(C)(i); 

7 (iv) networking and mentorship op8 portunities; or 

9 (v) any supportive services determined 

10 necessary by the local entity. 

11 (F) CAREER AND JOB TRAINING SERV12 ICES.—Offering career services and training 

13 services, and related services, concurrently or 

14 sequentially with the services provided under 

15 subparagraphs (B) through (E). Such services 

16 shall include the following: 

17 (i) Services provided to program par18 ticipants who are in a pre-employment 

19 stage of the program. Such services may 

20 include— 

21 (I) initial education and skills as22 sessments; 

23 (II) traditional classroom train24 ing funded through individual training 

25 accounts under chapter 3 of subtitle B 


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1 of title I of the Workforce Innovation 

2 and Opportunity Act (29 U.S.C. 3171 

3 et seq.); 

4 (III) services to promote employ5 ability skills such as punctuality, per6 sonal maintenance skills, and profes7 sional conduct; 

8 (IV) in-depth interviewing and 

9 evaluation to identify employment bar10 riers and to develop individual em11 ployment plans; 

12 (V) career planning that in13 cludes— 

14 (aa) career pathways leading 

15 to in-demand, high-wage jobs; 

16 and 

17 (bb) job coaching, job 

18 matching, and job placement 

19 services; 

20 (VI) provision of payments and 

21 fees for employment and training-re22 lated applications, tests, and certifi23 cations; or 

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1 scribed in section 134(c) of the Work2 force Innovation and Opportunity Act 

3 (29 U.S.C. 3174(c)). 

4 (ii) Services provided to program par5 ticipants during their first 6 months of 

6 employment to ensure job retention, which 

7 may include— 

8 (I) case management and support 

9 services, including a continuation of 

10 the services described in clause (i); 

11 (II) a continuation of skills train12 ing, and career and technical edu13 cation, described in clause (i) that is 

14 conducted in collaboration with the 

15 employers of such participants; 

16 (III) mentorship services and job 

17 retention support for such partici18 pants; or 

19 (IV) targeted training for man20 agers and workers working with such 

21 participants (such as mentors), and 

22 human resource representatives in the 

23 business in which such participants 

24 are employed. 


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1 (iii) Services to assist program partici2 pants in maintaining employment for not 

3 less than 12 months, as appropriate. 

4 (G) PROVEN AND PROMISING PRAC5 TICES.—Leading efforts in the service area to 

6 identify and promote proven and promising 

7 strategies and initiatives for meeting the needs 

8 of employers and program participants. 

9 (4) LIMITATIONS.—A participating partnership 

10 may not use— 

11 (A) more than 5 percent of the funds re12 ceived under a subgrant under subsection (d) 

13 for the administrative costs of the partnership; 

14 (B) more than 10 percent of the funds re15 ceived under such subgrant for the provision of 

16 treatment and recovery services, as described in 

17 paragraph (3)(D); or 

18 (C) more than 10 percent of the funds re19 ceived under such subgrant for the provision of 

20 supportive services described in paragraph 

21 (3)(E) to program participants. 

22 (f) PERFORMANCE ACCOUNTABILITY.— 

23 (1) REPORTS.—The Secretary shall establish 

24 quarterly reporting requirements for recipients of 

25 grants and subgrants under this section that, to the 


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1 extent practicable, are based on the performance ac2 countability system under section 116 of the Work3 force Innovation and Opportunity Act (29 U.S.C. 

4 3141), including the indicators described in sub5 section (c)(1)(A)(i) of such section and the require6 ments for local area performance reports under sub7 section (d) of such section. 

8 (2) EVALUATIONS.— 

9 (A) AUTHORITY TO ENTER INTO AGREE10 MENTS.—The Secretary shall ensure that an 

11 independent evaluation is conducted on the pilot 

12 program carried out under this section to deter13 mine the impact of the program on employment 

14 of individuals with substance use disorders. The 

15 Secretary shall enter into an agreement with el16 igible entities receiving grants under this sec17 tion to pay for all or part of such evaluation. 

18 (B) METHODOLOGIES TO BE USED.—The 

19 independent evaluation required under this 

20 paragraph shall use experimental designs using 

21 random assignment or, when random assign22 ment is not feasible, other reliable, evidence23 based research methodologies that allow for the 

24 strongest possible causal inferences. 

25 (g) FUNDING.— 


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1 (1) COVERED FISCAL YEAR.—In this sub2 section, the term ‘‘covered fiscal year’’ means any of 

3 fiscal years 2018 through 2023. 

4 (2) USING FUNDING FOR NATIONAL DIS5 LOCATED WORKER GRANTS.—Subject to paragraph 

6 (4) and notwithstanding section 132(a)(2)(A) and 

7 subtitle D of the Workforce Innovation and Oppor8 tunity Act (29 U.S.C. 3172(a)(2)(A), 3221 et seq.) 

9 or any other provision of law, the Secretary may use, 

10 to carry out the pilot program under this section for 

11 a covered fiscal year— 

12 (A) funds made available to carry out sec13 tion 170 of such Act (29 U.S.C. 3225) for that 

14 fiscal year; 

15 (B) funds made available to carry out sec16 tion 170 of such Act that remain available for 

17 that fiscal year; and 

18 (C) funds that remain available under sec19 tion 172(f) of such Act (29 U.S.C. 3227(f)). 

20 (3) AVAILABILITY OF FUNDS.—Funds appro21 priated under section 136(c) of such Act (29 U.S.C. 

22 3181(c)) and made available to carry out section 

23 170 of such Act for a fiscal year shall remain avail24 able for use under paragraph (2) for a subsequent 

25 fiscal year until expended. 


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1 (4) LIMITATION.—The Secretary may not use 

2 more than $100,000,000 of the funds described in 

3 paragraph (2) for any covered fiscal year under this 

4 section. 

5 SEC. 408. YOUTH PREVENTION AND RECOVERY. 

6 (a) SUBSTANCE ABUSE TREATMENT SERVICES FOR

7 CHILDREN, ADOLESCENTS, AND YOUNG ADULTS.—Sec8 tion 514 of the Public Health Service Act (42 U.S.C. 

9 290bb–7) is amended— 

10 (1) in the section heading, by striking ‘‘CHIL11 DREN AND ADOLESCENTS’’ and inserting ‘‘CHIL12 DREN, ADOLESCENTS, AND YOUNG ADULTS’’; 

13 (2) in subsection (a)(2), by striking ‘‘children, 

14 including’’ and inserting ‘‘children, adolescents, and 

15 young adults, including’’; and 

16 (3) by striking ‘‘children and adolescents’’ each 

17 place it appears and inserting ‘‘children, adolescents, 

18 and young adults’’. 

19 (b) YOUTH PREVENTION AND RECOVERY INITIA20 TIVE.— 

21 (1) DEFINITIONS.—In this subsection: 

22 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 

23 entity’’ means— 

24 (i) a local educational agency that is 

25 seeking to establish or expand substance 


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1 use prevention and recovery support serv2 ices at one or more high schools; 

3 (ii) an institution of higher education; 

4 (iii) a recovery program at an institu5 tion of higher education; 

6 (iv) a local board or one-stop oper7 ator; or 

8 (v) a nonprofit organization, excluding 

9 a school. 

10 (B) HIGH SCHOOL.—The term ‘‘high 

11 school’’ has the meaning given such term in 

12 section 8101 of the Elementary and Secondary 

13 Education Act of 1965 (20 U.S.C. 7801). 

14 (C) INSTITUTION OF HIGHER EDU15 CATION.—The term ‘‘institution of higher edu16 cation’’ has the meaning given such term in 

17 section 101 of the Higher Education Act of 

18 1965 (20 U.S.C. 1001) and includes a ‘‘post19 secondary vocational institution’’ as defined in 

20 section 102(c) of such Act (20 U.S.C. 1002(c)). 

21 (D) LOCAL EDUCATION AGENCY.—The 

22 term ‘‘local educational agency’’ has the mean23 ing given the term in section 8101 of the Ele24 mentary and Secondary Education Act of 1965. 


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1 (E) LOCAL BOARD; ONE-STOP OPER2 ATOR.—The terms ‘‘local board’’ and ‘‘one-stop 

3 operator’’ have the meanings given such terms 

4 in section 3 of the Workforce Innovation and 

5 Opportunity Act (29 U.S.C. 3102). 

6 (F) RECOVERY PROGRAM.—The term ‘‘re7 covery program’’ means a program— 

8 (i) to help children, adolescents, or 

9 young adults who are recovering from sub10 stance use disorders to initiate, stabilize, 

11 and maintain healthy and productive lives 

12 in the community; and 

13 (ii) that includes peer-to-peer support 

14 delivered by individuals with lived experi15 ence in recovery, and communal activities 

16 to build recovery skills and supportive so17 cial networks. 

18 (G) SECRETARY.—The term ‘‘Secretary’’ 

19 means the Secretary of Health and Human 

20 Services, except as otherwise specified. 

21 (2) BEST PRACTICES.—The Secretary, in con22 sultation with the Secretary of Education, shall— 

23 (A) identify or facilitate the development of 

24 evidence-based best practices for prevention of 

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1 cents, and young adults, for appropriate recov2 ery support services, and for appropriate use of 

3 medication-assisted treatment for such individ4 uals, if applicable; 

5 (B) disseminate such best practices to local 

6 educational agencies, institutions of higher edu7 cation, recovery programs at institutions of 

8 higher education, local boards, one-stop opera9 tors, and nonprofit organizations, as appro10 priate; 

11 (C) conduct a rigorous, independent eval12 uation of each grant funded under this sub13 section, particularly its impact on the indicators 

14 described in paragraph (5)(B); and 

15 (D) provide technical assistance for grant16 ees under this subsection. 

17 (3) GRANTS AUTHORIZED.—The Secretary, in 

18 consultation with the Secretary of Education, shall 

19 award 3-year grants, on a competitive basis, to eligi20 ble entities to enable such entities, in coordination 

21 with State agencies responsible for carrying out sub22 stance use disorder prevention and treatment pro23 grams, to carry out evidence-based or promising pro24 grams for— 


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1 (A) prevention of substance abuse and mis2 use by children, adolescents, and young adults; 

3 (B) recovery support services for children, 

4 adolescents, and young adults, which may in5 clude counseling, job training, linkages to com6 munity-based services, family support groups, 

7 and recovery coaching; and 

8 (C) treatment or referrals for treatment of 

9 substance use disorders, as appropriate. 

10 (4) APPLICATION.—To be eligible for a grant 

11 under this subsection, an entity shall submit to the 

12 Secretary an application at such time, in such man13 ner, and containing such information as the Sec14 retary may require. Such application shall include— 

15 (A) a description of the impact of sub16 stance use disorders on children, adolescents, 

17 and young adults enrolled in the local edu18 cational agency, one-stop operator, local board, 

19 or institution of higher education; 

20 (B) a description of how the eligible entity 

21 has solicited input from faculty, teachers, staff, 

22 families, students, and experts in substance use 

23 prevention and treatment in developing such 

24 application; 


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1 (C) how the eligible entity plans to use 

2 grant funds for evidence-based or promising ac3 tivities, in accordance with this subsection to 

4 prevent, provide recovery support for, and treat 

5 substance use disorders amongst such individ6 uals; 

7 (D) an assurance that the eligible entity 

8 will participate in the evaluation described in 

9 paragraph (2)(C); and 

10 (E) a description of how the eligible entity 

11 will collaborate with local service providers, in12 cluding substance use disorder treatment pro13 grams, providers of mental health services, and 

14 primary care providers, in carrying out the 

15 grant program. 

16 (5) REPORT.—Each eligible entity awarded a 

17 grant under this section shall submit to the appro18 priate committees of Congress, a report at such time 

19 and in such manner as the Secretary may require. 

20 Such report shall include— 

21 (A) a description of how the eligible entity 

22 used grant funds, in accordance with this sub23 section, including the number of children, ado24 lescents, and young adults reached through pro25 gramming; and 


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1 (B) a description of how the grant pro2 gram has made an impact on— 

3 (i) indicators of student success, in4 cluding student well-being and academic 

5 achievement; and 

6 (ii) substance use disorders amongst 

7 children, adolescents, and young adults, in8 cluding the number of overdoses and 

9 deaths amongst children, adolescents, and 

10 young adults during the grant period. 

11 (6) AUTHORIZATION OF APPROPRIATIONS.— 

12 There is authorized to be appropriated, such sums 

13 as may be necessary to carry out this subsection. 

14 SEC. 409. PLANS OF SAFE CARE. 

15 (a) IN GENERAL.—Section 105(a) of the Child Abuse 

16 Prevention and Treatment Act (42 U.S.C. 5106(a)) is 

17 amended by adding at the end the following: 

18 ‘‘(7) GRANTS TO STATES TO IMPROVE AND CO19 ORDINATE THEIR RESPONSE TO ENSURE THE SAFE20 TY, PERMANENCY, AND WELL-BEING OF INFANTS

21 AFFECTED BY SUBSTANCE USE.— 

22 ‘‘(A) PROGRAM AUTHORIZED.—The Sec23 retary shall make grants to States for the pur24 pose of assisting child welfare agencies, social 

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1 ment agencies, public health and mental health 

2 agencies, and maternal and child health agen3 cies to facilitate collaboration in developing, up4 dating, and implementing plans of safe care de5 scribed in section 106(b)(2)(B)(iii). 

6 ‘‘(B) DISTRIBUTION OF FUNDS.— 

7 ‘‘(i) RESERVATIONS.—Of the amounts 

8 appropriated under subparagraph (H), the 

9 Secretary shall reserve— 

10 ‘‘(I) no more than 3 percent for 

11 the purposes described in subpara12 graph (G); and 

13 ‘‘(II) up to 3 percent for grants 

14 to Indian Tribes and tribal organiza15 tions for purposes consistent with this 

16 section, as the Secretary determines 

17 appropriate. 

18 ‘‘(ii) ALLOTMENTS TO STATES AND

19 TERRITORIES.—The Secretary shall allot 

20 the amount appropriated under subpara21 graph (H) that remains after application 

22 of clause (i) on a competitive basis to 

23 States that apply for such a grant. 

24 ‘‘(iii) SELECTION CRITERIA.—The 

25 Secretary shall allot funds to States that 


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1 demonstrate a strong need for such funds, 

2 and a strong commitment to using such 

3 funds, to meet the purposes described in 

4 subparagraph (A) in accordance with sub5 paragraph (D). 

6 ‘‘(C) APPLICATION.—A State desiring a 

7 grant under this paragraph shall submit an ap8 plication to the Secretary at such time and in 

9 such manner as the Secretary may require. 

10 Such application shall include— 

11 ‘‘(i) a description of— 

12 ‘‘(I) the impact of substance use 

13 disorder in such State, including with 

14 respect to the substance or class of 

15 substances with the highest incidence 

16 of abuse in the previous year in such 

17 State, including— 

18 ‘‘(aa) the prevalence of sub19 stance use disorder in such State; 

20 ‘‘(bb) the aggregate rate of 

21 births in the State of infants af22 fected by substance abuse or 

23 withdrawal symptoms or a fetal 

24 alcohol spectrum disorder (as de25 termined by hospitals, insurance 


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1 claims, claims submitted to the 

2 State Medicaid program, or other 

3 records), if available and to the 

4 extent practicable; and 

5 ‘‘(cc) the number of infants 

6 identified, for whom a plan of 

7 safe care was developed, and for 

8 whom a referral was made for 

9 appropriate services, as reported 

10 under section 106(d)(18); 

11 ‘‘(II) the challenges the State 

12 faces in developing and implementing 

13 plans of safe care in accordance with 

14 section 106(b)(2)(B)(iii); 

15 ‘‘(III) the State’s lead agency for 

16 the grant program and how that agen17 cy will coordinate with relevant State 

18 entities and programs, including the 

19 child welfare agency, the substance 

20 use disorder treatment agency, the 

21 public health and mental health agen22 cies, programs funded by the Residen23 tial Treatment for Pregnant and 

24 Postpartum Women grant program of 

25 the Substance Abuse and Mental 


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1 Health Services Administration under 

2 section 508 of the Public Health Serv3 ice Act (42 U.S.C. 290bb–1), the 

4 State Medicaid program, the State 

5 agency administering the block grant 

6 program under title V of the Social 

7 Security Act (42 U.S.C. 701 et seq.), 

8 the State agency administering the 

9 programs funded under part C of the 

10 Individuals with Disabilities Edu11 cation Act (20 U.S.C. 1431 et seq.), 

12 the maternal, infant, and early child13 hood home visiting program under 

14 section 511 of the Social Security Act 

15 (42 U.S.C. 711), the State judicial 

16 system, and other agencies, as deter17 mined by the Secretary; 

18 ‘‘(IV) how the State will monitor 

19 local implementation of plans of safe 

20 care, in accordance with section 

21 106(b)(2)(B)(iii)(II); 

22 ‘‘(V) how the State meets the re23 quirements of section 1927 of the 

24 Public Health Service Act (42 U.S.C. 

25 300x–27); 


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1 ‘‘(VI) how the State plans to uti2 lize funding authorized under part E 

3 of title IV of the Social Security Act 

4 (42 U.S.C. 670 et seq.) to assist in 

5 carrying out any plan of safe care, in6 cluding such funding authorized under 

7 section 471(e) of such Act (as in ef8 fect on October 1, 2018) for mental 

9 health and substance abuse prevention 

10 and treatment services and in-home 

11 parent skill-based programs and fund12 ing authorized under such section 

13 472(j) (as in effect on October 1, 

14 2018) for children with a parent in a 

15 licensed residential family-based treat16 ment facility for substance abuse; and 

17 ‘‘(VII) an assessment of the 

18 treatment and other services and pro19 grams available in the State, to effec20 tively carry out any plan of safe care 

21 developed, including identification of 

22 needed treatment, and other services 

23 and programs to ensure the wellbeing 

24 of young children and their families 

25 affected by substance use disorder, 


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1 such as programs carried out under 

2 part C of the Individuals with Disabil3 ities Education Act and comprehen4 sive early childhood development serv5 ices and programs such as Head Start 

6 programs; 

7 ‘‘(ii) a description of how the State 

8 plans to use funds for activities described 

9 in subparagraph (D) for the purposes of 

10 ensuring State compliance with require11 ments under clauses (ii) and (iii) of section 

12 106(b)(2)(B); and 

13 ‘‘(iii) an assurance that the State 

14 will— 

15 ‘‘(I) comply with this Act and 

16 parts B and E of title IV of the Social 

17 Security Act (42 U.S.C. 621 et seq., 

18 670 et seq.); and 

19 ‘‘(II) comply with requirements 

20 to refer a child identified as sub21 stance-exposed to early intervention 

22 services as required pursuant to a 

23 grant under part C of the Individuals 

24 with Disabilities Education Act (20 

25 U.S.C. 1431 et seq.). 


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1 ‘‘(D) USES OF FUNDS.—Funds awarded to 

2 a State under this paragraph may be used for 

3 the following activities, which may be carried 

4 out by the State directly, or through grants or 

5 subgrants, contracts, or cooperative agreements: 

6 ‘‘(i) Improving State and local sys7 tems with respect to the development and 

8 implementation of plans of safe care, 

9 which— 

10 ‘‘(I) shall include parent and 

11 caregiver engagement, as required 

12 under section 106(b)(2)(B)(iii)(I), re13 garding available treatment and serv14 ice options, which may include re15 sources available for pregnant, 

16 perinatal, and postnatal women; and 

17 ‘‘(II) may include activities such 

18 as— 

19 ‘‘(aa) developing policies, 

20 procedures, or protocols for the 

21 administration of evidence-based 

22 and validated screening tools for 

23 infants who may be affected by 

24 substance use withdrawal symp25 toms or a fetal alcohol spectrum 


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1 disorder and pregnant, perinatal, 

2 and postnatal women whose in3 fants may be affected by sub4 stance use withdrawal symptoms 

5 or a fetal alcohol spectrum dis6 order; 

7 ‘‘(bb) improving assessments 

8 used to determine the needs of 

9 the infant and family; 

10 ‘‘(cc) improving ongoing 

11 case management services; and 

12 ‘‘(dd) improving access to 

13 treatment services, which may be 

14 prior to the pregnant woman’s 

15 delivery date. 

16 ‘‘(ii) Developing policies, procedures, 

17 or protocols in consultation and coordina18 tion with health professionals, public and 

19 private health facilities, and substance use 

20 disorder treatment agencies to ensure 

21 that— 

22 ‘‘(I) appropriate notification to 

23 child protective services is made in a 

24 timely manner; 


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1 ‘‘(II) a plan of safe care is in 

2 place, where needed, before the infant 

3 is discharged from the birth or health 

4 care facility; and 

5 ‘‘(III) such health and related 

6 agency professionals are trained on 

7 how to follow such protocols and are 

8 aware of the supports that may be 

9 provided under a plan of safe care. 

10 ‘‘(iii) Training health professionals 

11 and health system leaders, child welfare 

12 workers, substance use disorder treatment 

13 agencies, and other related professionals 

14 such as home visiting agency staff and law 

15 enforcement in relevant topics including— 

16 ‘‘(I) State mandatory reporting 

17 laws and the referral and notification 

18 process; 

19 ‘‘(II) the co-occurrence of preg20 nancy and substance use disorder; 

21 ‘‘(III) the clinical guidance about 

22 treating substance use disorder in 

23 pregnant and postpartum women; 

24 ‘‘(IV) appropriate screening and 

25 interventions for infants affected by 


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1 substance use disorder, withdrawal 

2 symptoms, or a fetal alcohol spectrum 

3 disorder and the requirements under 

4 section 106(b)(2)(B)(iii); and 

5 ‘‘(V) appropriate strategies to ad6 dress the mental health needs of the 

7 parent and child together. 

8 ‘‘(iv) Establishing partnerships, agree9 ments, or memoranda of understanding be10 tween the lead agency and health profes11 sionals, health facilities, child welfare pro12 fessionals, substance use disorder and 

13 mental health disorder treatment pro14 grams, early childhood education pro15 grams, and maternal and child health and 

16 early intervention professionals, including 

17 home visiting providers, peer-to-peer recov18 ery programs such as parent mentoring 

19 programs, and housing agencies to facili20 tate the implementation of, and compliance 

21 with section 106(b)(2) and clause (ii) of 

22 this subparagraph, in areas which may in23 clude— 

24 ‘‘(I) developing a comprehensive, 

25 multi-disciplinary assessment and 


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1 intervention process for infants and 

2 their families who are affected by sub3 stance use disorder, withdrawal symp4 toms, or a fetal alcohol spectrum dis5 order, that includes meaningful en6 gagement with and takes into account 

7 the unique needs of each family and 

8 addresses differences between legal, 

9 medically supervised substance use, 

10 and substance use disorder; 

11 ‘‘(II) ensuring that treatment ap12 proaches for serving infants, pregnant 

13 women, and perinatal and postnatal 

14 women whose infants may be affected 

15 by substance use, withdrawal symp16 toms, or a fetal alcohol spectrum dis17 order, are designed to, where appro18 priate, keep infants with their moth19 ers during both inpatient and out20 patient treatment; and 

21 ‘‘(III) increasing access to evi22 dence-based medication-assisted treat23 ment approved by the Food and Drug 

24 Administration, behavioral therapy, 

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1 ment of substance use disorders, as 

2 appropriate. 

3 ‘‘(v) Developing and updating systems 

4 of technology for improved data collection 

5 and monitoring under section 

6 106(b)(2)(B)(iii), including existing elec7 tronic medical records, to measure the out8 comes achieved through the plans of safe 

9 care, including monitoring systems to meet 

10 the requirements of this Act and submis11 sion of performance measures. 

12 ‘‘(E) REPORTING.—Each State that re13 ceives funds under this paragraph, for each 

14 year such funds are received, shall submit a re15 port to the Secretary, disaggregated by geo16 graphic location, economic status, and major 

17 racial and ethnic groups, except that such 

18 disaggregation shall not be required if the re19 sults would reveal personally identifiable infor20 mation, on the following: 

21 ‘‘(i) The number of the infants identi22 fied under section 106(b)(2)(B)(ii) who ex23 perienced removal due to parental sub24 stance use concerns who are reunified with 


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1 parents, and the length of time between 

2 such removal and reunification. 

3 ‘‘(ii) The number of the infants iden4 tified under section 106(b)(2)(B)(ii) who 

5 experienced substantiated reports of child 

6 abuse or neglect and received differential 

7 response while in the care of their birth 

8 parents or within 1 year after a reunifica9 tion has occurred. 

10 ‘‘(iii) The number of the infants iden11 tified under section 106(b)(2)(B)(ii) who 

12 experienced a return to out-of-home care 

13 within one year after reunification. 

14 ‘‘(F) SECRETARY’S REPORT TO CON15 GRESS.—The Secretary shall submit an annual 

16 report to the Committee on Health, Education, 

17 Labor, and Pensions and the Committee on Ap18 propriations of the Senate and the Committee 

19 on Education and the Workforce and the Com20 mittee on Appropriations of the House of Rep21 resentatives that includes the information de22 scribed in subparagraph (E) and recommenda23 tions or observations on the challenges, suc24 cesses, and lessons derived from implementation 

25 of the grant program. 


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1 ‘‘(G) RESERVATION OF FUNDS.—The Sec2 retary shall use the amount reserved under sub3 paragraph (B)(i)(I) for the purposes of— 

4 ‘‘(i) providing technical assistance, in5 cluding programs of in-depth technical as6 sistance, to additional States, territories, 

7 and Indian tribes in accordance with the 

8 substance-exposed infant initiative devel9 oped by the National Center on Substance 

10 Abuse and Child Welfare; 

11 ‘‘(ii) issuing guidance on the require12 ments of this Act with respect to infants 

13 born with and identified as being affected 

14 by substance use or withdrawal symptoms 

15 or fetal alcohol spectrum disorder, as de16 scribed in clauses (ii) and (iii) of section 

17 106(b)(2)(B), including by— 

18 ‘‘(I) clarifying key terms; and 

19 ‘‘(II) disseminating best practices 

20 on implementation of plans of safe 

21 care, on such topics as differential re22 sponse, collaboration and coordina23 tion, and identification and delivery of 

24 services, for different populations; 


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1 ‘‘(iii) supporting State efforts to de2 velop information technology systems to 

3 manage plans of safe care; and 

4 ‘‘(iv) preparing the Secretary’s report 

5 to Congress described in subparagraph 

6 (F). 

7 ‘‘(H) AUTHORIZATION OF APPROPRIA8 TIONS.—To carry out the program under this 

9 paragraph, there are authorized to be appro10 priated $60,000,000 for each of fiscal years 

11 2019 through 2023.’’. 

12 (b) DEFINITION.—Section 3 of the Child Abuse Pre13 vention and Treatment Act (42 U.S.C. 5101 note) is 

14 amended— 

15 (1) in paragraph (7), by striking ‘‘; and’’ and 

16 inserting a semicolon; 

17 (2) by redesignating paragraph (8) as para18 graph (9); and 

19 (3) by inserting after paragraph (7) the fol20 lowing: 

21 ‘‘(8) the term ‘substance use disorder’ means 

22 the abuse of alcohol or other drugs; and’’. 


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1 SEC. 410. REGULATIONS RELATING TO SPECIAL REGISTRA2 TION FOR TELEMEDICINE. 

3 Section 311(h) of the Controlled Substances Act (21 

4 U.S.C. 831(h)) is amended by striking paragraph (2) and 

5 inserting the following: 

6 ‘‘(2) REGULATIONS.— 

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

8 after the date of enactment of the Opioid Crisis 

9 Response Act of 2018, in consultation with the 

10 Secretary, and in accordance with the procedure 

11 described in subparagraph (B), the Attorney 

12 General shall promulgate final regulations 

13 specifying— 

14 ‘‘(i) the limited circumstances in 

15 which a special registration under this sub16 section may be issued; and 

17 ‘‘(ii) the procedure for obtaining a 

18 special registration under this subsection. 

19 ‘‘(B) PROCEDURE.—In promulgating final 

20 regulations under subparagraph (A), the Attor21 ney General shall— 

22 ‘‘(i) issue a notice of proposed rule23 making that includes a copy of the pro24 posed regulations; 


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1 ‘‘(ii) provide a period of not less than 

2 60 days for comments on the proposed reg3 ulations; 

4 ‘‘(iii) finalize the proposed regulation 

5 not later than 6 months after the close of 

6 the comment period; and 

7 ‘‘(iv) publish the final regulations not 

8 later than 30 days before the effective date 

9 of the final regulations.’’. 

10 SEC. 411. NATIONAL HEALTH SERVICE CORPS BEHAVIORAL 

11 AND MENTAL HEALTH PROFESSIONALS PRO12 VIDING OBLIGATED SERVICE IN SCHOOLS 

13 AND OTHER COMMUNITY-BASED SETTINGS. 

14 Subpart III of part D of title III of the Public Health 

15 Service Act (42 U.S.C. 254l et seq.) is amended by adding 

16 at the end the following: 

17 ‘‘SEC. 338N. BEHAVIORAL AND MENTAL HEALTH PROFES18 SIONALS PROVIDING OBLIGATED SERVICE IN 

19 SCHOOLS AND OTHER COMMUNITY-BASED 

20 SETTINGS. 

21 ‘‘(a) SCHOOLS AND COMMUNITY-BASED SETTINGS.— 

22 An entity to which a Corps member is assigned under sec23 tion 333 may direct such Corps member to provide service 

24 as a behavioral and mental health professional at a school 


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1 or other community-based setting located in a health pro2 fessional shortage area. 

3 ‘‘(b) OBLIGATED SERVICE.— 

4 ‘‘(1) IN GENERAL.—Any service described in 

5 subsection (a) that a Corps member provides may 

6 count towards such Corps member’s completion of 

7 any obligated service requirements under the Schol8 arship Program or the Loan Repayment Program, 

9 subject to any limitation imposed under paragraph 

10 (2). 

11 ‘‘(2) LIMITATION.—The Secretary may impose 

12 a limitation on the number of hours of service de13 scribed in subsection (a) that a Corps member may 

14 credit towards completing obligated service require15 ments, provided that the limitation allows a member 

16 to credit service described in subsection (a) for not 

17 less than 50 percent of the total hours required to 

18 complete such obligated service requirements. 

19 ‘‘(c) RULE OF CONSTRUCTION.—The authorization 

20 under subsection (a) shall be notwithstanding any other 

21 provision of this subpart or subpart II.’’. 

22 SEC. 412. LOAN REPAYMENT FOR SUBSTANCE USE DIS23 ORDER TREATMENT PROVIDERS. 

24 (a) LOAN REPAYMENT FOR SUBSTANCE USE TREAT25 MENT PROVIDERS.—The Secretary of Health and Human 


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1 Services (referred to in this section as the ‘‘Secretary’’) 

2 shall enter into contracts under section 338B of the Public 

3 Health Service Act (42 U.S.C. 254l–1) with eligible health 

4 professionals providing substance use disorder treatment 

5 services in substance use disorder treatment facilities, as 

6 defined by the Secretary. 

7 (b) PROVISION OF SUBSTANCE USE DISORDER

8 TREATMENT.—In carrying out the activities described in 

9 subsection (a)— 

10 (1) such facilities shall be located in mental 

11 health professional shortage areas designated under 

12 section 332 of the Public Health Service Act (42 

13 U.S.C. 254e); 

14 (2) section 331(a)(3)(D) of such Act (42 U.S.C. 

15 254d(a)(3)(D)) shall be applied as if the term ‘‘pri16 mary health services’’ includes health services re17 garding substance use disorder treatment; 

18 (3) section 331(a)(3)(E)(i) of such Act (42 

19 U.S.C. 254d(a)(3)(E)(i)) shall be applied as if the 

20 term ‘‘behavioral and mental health professionals’’ 

21 includes masters level, licensed substance use dis22 order treatment counselors; and 

23 (4) such professionals and facilities shall pro24 vide— 


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1 (A) counseling by a program counselor or 

2 other certified professional who is licensed and 

3 qualified by education, training, or experience 

4 to assess the psychological and sociological 

5 background of patients, to contribute to the ap6 propriate treatment plan for the patient, and to 

7 monitor progress; and 

8 (B) all drugs approved by the Food and 

9 Drug Administration to treat substance use dis10 orders. 

11 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

12 authorized to be appropriated to carry out this section, 

13 $25,000,000 for each of fiscal years 2019 through 2023. 

14 SEC. 413. IMPROVING TREATMENT FOR PREGNANT AND 

15 POSTPARTUM WOMEN. 

16 (a) REPORT.— 

17 (1) IN GENERAL.—Not later than 60 days after 

18 the date of enactment of this Act, the Secretary of 

19 Health and Human Services (referred to in this sub20 section as the ‘‘Secretary’’) shall submit to the ap21 propriate committees of Congress and make avail22 able to the public on the internet website of the De23 partment of Health and Human Services a report 

24 regarding the implementation of the recommenda25 tions in the strategy relating to prenatal opioid use, 


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1 including neonatal abstinence syndrome, developed 

2 pursuant to section 2 of the Protecting Our Infants 

3 Act of 2015 (Public Law 114–91). Such report shall 

4 include— 

5 (A) an update on the implementation of 

6 the recommendations in the strategy, including 

7 information regarding the agencies involved in 

8 the implementation; and 

9 (B) information on additional funding or 

10 authority the Secretary requires, if any, to im11 plement the strategy, which may include au12 thorities needed to coordinate implementation 

13 of such strategy across the Department of 

14 Health and Human Services. 

15 (2) PERIODIC UPDATES.—The Secretary shall 

16 periodically update the report under paragraph (1). 

17 (b) RESIDENTIAL TREATMENT PROGRAMS FOR

18 PREGNANT AND POSTPARTUM WOMEN.—Section 508(s) 

19 of the Public Health Service Act (42 U.S.C. 290bb–1(s)) 

20 is amended by striking ‘‘$16,900,000 for each of fiscal 

21 years 2017 through 2021’’ and inserting ‘‘$29,931,000 for 

22 each of fiscal years 2019 through 2023’’. 


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1 SEC. 414. EARLY INTERVENTIONS FOR PREGNANT WOMEN 

2 AND INFANTS. 

3 (a) DEVELOPMENT OF EDUCATIONAL MATERIALS BY

4 CENTER FOR SUBSTANCE ABUSE PREVENTION.—Section 

5 515(b) of the Public Health Service Act (42 U.S.C. 

6 290bb–21(b)) is amended— 

7 (1) in paragraph (13), by striking ‘‘and’’ at the 

8 end; 

9 (2) in paragraph (14), by striking the period at 

10 the end and inserting ‘‘; and’’; and 

11 (3) by adding at the end the following: 

12 ‘‘(15) in cooperation with relevant stakeholders 

13 and the Director of the Centers for Disease Control 

14 and Prevention, develop educational materials for 

15 clinicians to use with pregnant women for shared de16 cisionmaking regarding pain management during 

17 pregnancy.’’. 

18 (b) GUIDELINES AND RECOMMENDATIONS BY CEN19 TER FOR SUBSTANCE ABUSE TREATMENT.—Section 

20 507(b) of the Public Health Service Act (42 U.S.C. 

21 290bb(b)) is amended— 

22 (1) in paragraph (13), by striking ‘‘and’’ at the 

23 end; 

24 (2) in paragraph (14), by striking the period at 

25 the end and inserting a semicolon; and 

26 (3) by adding at the end the following: 


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1 ‘‘(15) in cooperation with the Secretary, imple2 ment and disseminate, as appropriate, the rec3 ommendations in the report entitled ‘Protecting Our 

4 Infants Act: Final Strategy’ issued by the Depart5 ment of Health and Human Services in 2017; and’’. 

6 (c) SUPPORT OF PARTNERSHIPS BY CENTER FOR

7 SUBSTANCE ABUSE TREATMENT.—Section 507(b) of the 

8 Public Health Service Act (42 U.S.C. 290bb(b)), as 

9 amended by subsection (b), is further amended by adding 

10 at the end the following: 

11 ‘‘(16) in cooperation with relevant stakeholders, 

12 support public-private partnerships to assist with 

13 education about, and support with respect to, sub14 stance use disorder for pregnant women and health 

15 care providers who treat pregnant women and ba16 bies.’’. 

17 TITLE V—PREVENTION 

18 SEC. 501. STUDY ON PRESCRIBING LIMITS. 

19 Not later than 2 years after the date of enactment 

20 of this Act, the Secretary of Health and Human Services, 

21 in consultation with the Attorney General, shall submit to 

22 the Committee on Health, Education, Labor, and Pen23 sions of the Senate and the Committee on Energy and 

24 Commerce of the House of Representatives a report on 

25 the impact of Federal and State laws and regulations that 


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1 limit the length, quantity, or dosage of opioid prescrip2 tions. Such report shall address— 

3 (1) the impact of such limits on— 

4 (A) the incidence and prevalence of over5 dose related to prescription opioids; 

6 (B) the incidence and prevalence of over7 dose related to illicit opioids; 

8 (C) the prevalence of opioid use disorders; 

9 and 

10 (D) medically appropriate use of, and ac11 cess to, opioids, including any impact on travel 

12 expenses and pain management outcomes for 

13 patients, whether such limits are associated 

14 with significantly higher rates of negative 

15 health outcomes, including suicide, and whether 

16 the impact of such limits differs based on clin17 ical indication for which opioids are prescribed; 

18 (2) whether such limits lead to a significant in19 crease in burden for prescribers of opioids or pre20 scribers of treatments for opioid use disorder, in21 cluding any impact on patient access to treatment, 

22 and whether any such burden is mitigated by any 

23 factors such as electronic prescribing; and 

24 (3) the impact of such limits on diversion or 

25 misuse of any controlled substance in schedule II, 


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1 III, or IV of section 202(c) of the Controlled Sub2 stances Act (21 U.S.C. 812(c)). 

3 SEC. 502. PROGRAMS FOR HEALTH CARE WORKFORCE. 

4 (a) PROGRAM FOR EDUCATION AND TRAINING IN

5 PAIN CARE.—Section 759 of the Public Health Service 

6 Act (42 U.S.C. 294i) is amended— 

7 (1) in subsection (a), by inserting ‘‘nonprofit’’ 

8 after ‘‘private’’; 

9 (2) in subsection (b)— 

10 (A) in the matter preceding paragraph (1), 

11 by striking ‘‘award may be made under sub12 section (a) only if the applicant for the award 

13 agrees that the program carried out with the 

14 award will include’’ and inserting ‘‘entity receiv15 ing an award under this section shall develop a 

16 comprehensive education and training plan that 

17 includes’’; 

18 (B) in paragraph (1)— 

19 (i) by inserting ‘‘preventing,’’ after 

20 ‘‘diagnosing,’’; and 

21 (ii) by inserting ‘‘non-addictive med22 ical products and non-pharmacologic treat23 ments and’’ after ‘‘including’’; 

24 (C) in paragraph (2)— 


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1 (i) by inserting ‘‘Federal, State, and 

2 local’’ after ‘‘applicable’’; and 

3 (ii) by striking ‘‘the degree to which’’ 

4 and all that follows through ‘‘effective pain 

5 care’’ and inserting ‘‘opioids’’; 

6 (D) in paragraph (3), by inserting ‘‘and, 

7 as appropriate, non-pharmacotherapy’’ before 

8 the semicolon; 

9 (E) in paragraph (4)— 

10 (i) by inserting ‘‘any’’ before ‘‘cul11 tural’’; and 

12 (ii) by striking ‘‘; and’’ and inserting 

13 ‘‘;’’; 

14 (F) in paragraph (5), by striking ‘‘provi15 sion of pain care.’’ and inserting ‘‘scientific 

16 basis of pain and the provision of pain care, in17 cluding through non-addictive medical products 

18 and non-pharmacologic treatments; and’’; and 

19 (G) by adding at the end the following: 

20 ‘‘(6) the dangers of opioid abuse, detection of 

21 early warning signs of opioid use disorders, and safe 

22 disposal options for prescription medications, includ23 ing such options provided by law enforcement, or 

24 other innovative deactivation mechanisms.’’; 


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1 (3) in subsection (d), by inserting ‘‘prevention,’’ 

2 after ‘‘diagnosis,’’; and 

3 (4) in subsection (e), by striking ‘‘2010 through 

4 2012’’ and inserting ‘‘2019 through 2023’’. 

5 (b) MENTAL AND BEHAVIORAL HEALTH EDUCATION

6 AND TRAINING PROGRAM.—Section 756(a) of the Public 

7 Health Service Act (42 U.S.C. 294e–1(a)) is amended— 

8 (1) in paragraph (1), by inserting ‘‘, trauma,’’ 

9 after ‘‘focus on child and adolescent mental health’’; 

10 and 

11 (2) in paragraphs (2) and (3), by inserting 

12 ‘‘trauma-informed care and’’ before ‘‘substance use 

13 disorder prevention and treatment services’’. 

14 SEC. 503. EDUCATION AND AWARENESS CAMPAIGNS. 

15 Section 102 of the Comprehensive Addiction and Re16 covery Act of 2016 (Public Law 114–198) is amended— 

17 (1) by amending subsection (a) to read as fol18 lows: 

19 ‘‘(a) IN GENERAL.—The Secretary of Health and 

20 Human Services, acting through the Director of the Cen21 ters for Disease Control and Prevention and in coordina22 tion with the heads of other departments and agencies, 

23 shall advance education and awareness regarding the risks 

24 related to misuse and abuse of opioids, as appropriate, 

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1 grams, conducting activities, and awarding grants that ad2 vance the education and awareness of— 

3 ‘‘(1) the public, including patients and con4 sumers; 

5 ‘‘(2) patients, consumers, and other appropriate 

6 members of the public, regarding such risks related 

7 to unused opioids and the dispensing options under 

8 section 309(f) of the Controlled Substances Act, as 

9 applicable; 

10 ‘‘(3) providers, which may include— 

11 ‘‘(A) providing for continuing education on 

12 appropriate prescribing practices; 

13 ‘‘(B) education related to applicable State 

14 or local prescriber limit laws, information on 

15 the use of non-addictive or non-opioid alter16 natives for pain management, and the use of 

17 overdose reversal drugs, as appropriate; 

18 ‘‘(C) disseminating and improving the use 

19 of evidence-based opioid prescribing guidelines 

20 across relevant health care settings, as appro21 priate, and updating guidelines as necessary; 

22 ‘‘(D) implementing strategies, such as best 

23 practices, to encourage and facilitate the use of 

24 prescriber guidelines, in accordance with State 

25 and local law; and 


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1 ‘‘(E) disseminating information to pro2 viders about prescribing options for controlled 

3 substances, including such options under sec4 tion 309(f) of the Controlled Substances Act, as 

5 applicable; and 

6 ‘‘(4) other appropriate entities.’’; and 

7 (2) in subsection (b)— 

8 (A) by striking ‘‘opioid abuse’’ each place 

9 such term appears and inserting ‘‘opioid misuse 

10 and abuse’’; and 

11 (B) in paragraph (2), by striking ‘‘safe dis12 posal of prescription medications and other’’ 

13 and inserting ‘‘non-addictive or non-opioid 

14 treatment options, safe disposal options for pre15 scription medications, and other applicable’’. 

16 SEC. 504. ENHANCED CONTROLLED SUBSTANCE 

17 OVERDOSES DATA COLLECTION, ANALYSIS, 

18 AND DISSEMINATION. 

19 Part J of title III of the Public Health Service Act 

20 is amended by inserting after section 392 (42 U.S.C. 

21 280b–1) the following: 


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1 ‘‘SEC. 392A. ENHANCED CONTROLLED SUBSTANCE 

2 OVERDOSES DATA COLLECTION, ANALYSIS, 

3 AND DISSEMINATION. 

4 ‘‘(a) IN GENERAL.—The Director of the Centers for 

5 Disease Control and Prevention, using the authority pro6 vided to the Director under section 392, may— 

7 ‘‘(1) to the extent practicable, carry out and ex8 pand any controlled substance overdose data collec9 tion, analysis, and dissemination activity described 

10 in subsection (b); 

11 ‘‘(2) provide training and technical assistance 

12 to States, localities, and Indian tribes for the pur13 pose of carrying out any such activity; and 

14 ‘‘(3) award grants to States, localities, and In15 dian tribes for the purpose of carrying out any such 

16 activity. 

17 ‘‘(b) CONTROLLED SUBSTANCE OVERDOSE DATA

18 COLLECTION AND ANALYSIS ACTIVITIES.—A controlled 

19 substance overdose data collection, analysis, and dissemi20 nation activity described in this subsection is any of the 

21 following activities: 

22 ‘‘(1) Improving the timeliness of reporting ag23 gregate data to the public, including data on fatal 

24 and nonfatal controlled substance overdoses. 

25 ‘‘(2) Enhancing the comprehensiveness of con26 trolled substance overdose data by collecting inforVerDate Sep 11 2014 02:08 Apr 18, 2018 Jkt 079200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\S2680.IS S2680

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1 mation on such overdoses from appropriate sources 

2 such as toxicology reports, death scene investiga3 tions, and emergency department services. 

4 ‘‘(3) Modernizing the system for coding causes 

5 of death related to controlled substance overdoses to 

6 use an electronic-based system. 

7 ‘‘(4) Using data to help identify risk factors as8 sociated with controlled substance overdoses, includ9 ing the delivery of certain health care services. 

10 ‘‘(5) Supporting entities involved in reporting 

11 information on controlled substance overdoses, such 

12 as coroners and medical examiners, to improve accu13 rate testing and reporting of causes and contributing 

14 factors of such overdoses, and analysis of various 

15 opioid analogues to controlled substances overdoses. 

16 ‘‘(6) Working to enable and encourage the ac17 cess, exchange, and use of data regarding controlled 

18 substances overdoses among data sources and enti19 ties. 

20 ‘‘(c) CONTROLLED SUBSTANCE DEFINED.—In this 

21 section, the term ‘controlled substance’ has the meaning 

22 given that term in section 102 of the Controlled Sub23 stances Act.’’. 


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1 SEC. 505. PREVENTING OVERDOSES OF CONTROLLED SUB2 STANCES. 

3 Part J of title III of the Public Health Service Act 

4 (42 U.S.C. 280b et seq.), as amended by section 504, is 

5 further amended by inserting after section 392A the fol6 lowing: 

7 ‘‘SEC. 392B. PREVENTING OVERDOSES OF CONTROLLED 

8 SUBSTANCES. 

9 ‘‘(a) PREVENTION ACTIVITIES.— 

10 ‘‘(1) IN GENERAL.—The Director of the Cen11 ters for Disease Control and Prevention (referred to 

12 in this section as the ‘Director’), using the authority 

13 provided to the Director under section 392, may— 

14 ‘‘(A) to the extent practicable, carry out 

15 and expand any prevention activity described in 

16 paragraph (2); 

17 ‘‘(B) provide training and technical assist18 ance to States, localities, and Indian tribes to 

19 carrying out any such activity; and 

20 ‘‘(C) award grants to States, localities, and 

21 tribes for the purpose of carrying out any such 

22 activity. 

23 ‘‘(2) PREVENTION ACTIVITIES.—A prevention 

24 activity described in this paragraph is an activity to 

25 improve the efficiency and use of a new or currently 

26 operating prescription drug monitoring program— 


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1 ‘‘(A) encouraging all authorized users (as 

2 specified by the State or other entity) to reg3 ister with and use the program; 

4 ‘‘(B) enabling such users to access any 

5 data updates in as close to real-time as prac6 ticable; 

7 ‘‘(C) providing for a mechanism for the 

8 program to notify authorized users of any po9 tential misuse or abuse of controlled substances 

10 and any detection of inappropriate prescribing 

11 practices relating to such substances; 

12 ‘‘(D) encouraging the analysis of prescrip13 tion drug monitoring data for purposes of pro14 viding de-identified, aggregate reports based on 

15 such analysis to State public health agencies, 

16 State licensing boards, and other appropriate 

17 State agencies, as permitted under applicable 

18 Federal and State law and the policies of the 

19 prescription drug monitoring program and not 

20 containing any protected health information, to 

21 prevent inappropriate prescribing, drug diver22 sion, or abuse and misuse of controlled sub23 stances, and to facilitate better coordination 

24 among agencies; 


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1 ‘‘(E) enhancing interoperability between 

2 the program and any health information tech3 nology (including certified health information 

4 technology), including by integrating program 

5 data into such technology; 

6 ‘‘(F) updating program capabilities to re7 spond to technological innovation for purposes 

8 of appropriately addressing the occurrence and 

9 evolution of controlled substance overdoses; and 

10 ‘‘(G) facilitating and encouraging data ex11 change between the program and the prescrip12 tion drug monitoring programs of other States. 

13 ‘‘(b) ADDITIONAL GRANTS.—The Director may 

14 award grants to States, localities, and Indian tribes— 

15 ‘‘(1) to carry out innovative projects for grant16 ees to rapidly respond to controlled substance mis17 use, abuse, and overdoses, including changes in pat18 terns of controlled substance use; and 

19 ‘‘(2) for any other evidence-based activity for 

20 preventing controlled substance misuse, abuse, and 

21 overdoses as the Director determines appropriate. 

22 ‘‘(c) RESEARCH.—The Director may conduct studies 

23 and evaluations to address substance use disorders, in24 cluding preventing substance use disorders or other re25 lated topics the Director determines appropriate. 


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1 ‘‘(d) PUBLIC AND PRESCRIBER EDUCATION.—Pursu2 ant to section 102 of the Comprehensive Addiction and 

3 Recovery Act of 2016, the Director may advance the edu4 cation and awareness of prescribers and the public regard5 ing the risk of abuse of prescription opioids. 

6 ‘‘(e) CONTROLLED SUBSTANCE DEFINED.—In this 

7 section, the term ‘controlled substance’ has the meaning 

8 given that term in section 102 of the Controlled Sub9 stances Act. 

10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 

11 purposes of carrying out this section, section 392A of this 

12 Act, and section 102 of the Comprehensive Addiction and 

13 Recovery Act of 2016, there is authorized to be appro14 priated $486,000,000 for each of fiscal years 2019 

15 through 2024.’’. 

16 SEC. 506. CDC SURVEILLANCE AND DATA COLLECTION FOR 

17 CHILD, YOUTH, AND ADULT TRAUMA. 

18 (a) DATA COLLECTION.—The Director of the Centers 

19 for Disease Control and Prevention (referred to in this 

20 section as the ‘‘Director’’) may, in cooperation with the 

21 States, collect and report data on adverse childhood expe22 riences through the Behavioral Risk Factor Surveillance 

23 System, the Youth Risk Behavior Surveillance System, 

24 and other relevant public health surveys or questionnaires. 


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1 (b) TIMING.—The collection of data under subsection 

2 (a) may occur in fiscal year 2019 and every 2 years there3 after. 

4 (c) DATA FROM TRIBAL AND RURAL AREAS.—The 

5 Director shall encourage each State that participates in 

6 collecting and reporting data under subsection (a) to col7 lect and report data from tribal and rural areas within 

8 such State, in order to generate a statistically reliable rep9 resentation of such areas. 

10 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

11 out this section, there are authorized to be appropriated 

12 such sums as may be necessary for the period of fiscal 

13 years 2019 through 2021. 

14 SEC. 507. REAUTHORIZATION OF NASPER. 

15 Section 399O of the Public Health Service Act (42 

16 U.S.C. 280g–3) is amended— 

17 (1) in subsection (a)— 

18 (A) in paragraph (1), in the matter pre19 ceding subparagraph (A), by striking ‘‘Adminis20 trator of the Substance Abuse and Mental 

21 Health Services Administration and Director of 

22 the Centers for Disease Control and Preven23 tion’’ and inserting ‘‘Director of the Centers for 

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1 ant Secretary for Mental Health and Substance 

2 Use Disorders’’; and 

3 (B) by adding at the end the following: 

4 ‘‘(4) STATES AND LOCAL GOVERNMENTS.— 

5 ‘‘(A) IN GENERAL.—In the case of a State 

6 that does not have a prescription drug moni7 toring program, a county or other unit of local 

8 government within the State that has a pre9 scription drug monitoring program shall be 

10 treated as a State for purposes of this section, 

11 including for purposes of eligibility for grants 

12 under paragraph (1). 

13 ‘‘(B) PLAN FOR INTEROPERABILITY.—For 

14 purposes of meeting the interoperability re15 quirements under subsection (c)(3), a county or 

16 other unit of local government shall submit a 

17 plan outlining the methods such county or unit 

18 of local government will use to ensure the capa19 bility of data sharing with other counties and 

20 units of local government within the State and 

21 with other States, as applicable.’’; 

22 (2) in subsection (c)— 

23 (A) in paragraph (1)(A)(iii)— 


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1 (i) by inserting ‘‘as such standards 

2 become available,’’ after ‘‘interoperability 

3 standards,’’; and 

4 (ii) by striking ‘‘generated or identi5 fied by the Secretary or his or her des6 ignee’’ and inserting ‘‘recognized by the 

7 Office of the National Coordinator for 

8 Health Information Technology’’; and 

9 (B) in paragraph (3)(A), by inserting ‘‘in10 cluding electronic health records,’’ after ‘‘tech11 nology systems,’’; 

12 (3) in subsection (d)(1), by striking ‘‘not later 

13 than 1 week after the date of such dispensing’’ and 

14 inserting ‘‘in as close to real time as practicable’’; 

15 (4) in subsection (f)(1)(D), by striking ‘‘med16 icaid’’ and inserting ‘‘Medicaid’’; 

17 (5) in subsection (i), by inserting ‘‘, in collabo18 ration with the National Coordinator for Health In19 formation Technology and the Director of the Na20 tional Institute of Standards and Technology,’’ after 

21 ‘‘The Secretary’’; and 

22 (6) in subsection (n), by striking ‘‘2021’’ and 

23 inserting ‘‘2026’’. 

24 SEC. 508. JESSIE’S LAW. 

25 (a) BEST PRACTICES.— 


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1 (1) IN GENERAL.—Not later than 1 year after 

2 the date of enactment of this Act, the Secretary of 

3 Health and Human Services (referred to in this sec4 tion as the ‘‘Secretary’’), in consultation with appro5 priate stakeholders, including a patient with a his6 tory of opioid use disorder, an expert in electronic 

7 health records, an expert in the confidentiality of pa8 tient health information and records, and a health 

9 care provider, shall identify or facilitate the develop10 ment of best practices regarding— 

11 (A) the circumstances under which infor12 mation that a patient has provided to a health 

13 care provider regarding such patient’s history of 

14 opioid use disorder should, only at the patient’s 

15 request, be prominently displayed in the med16 ical records (including electronic health records) 

17 of such patient; 

18 (B) what constitutes the patient’s request 

19 for the purpose described in subparagraph (A); 

20 and 

21 (C) the process and methods by which the 

22 information should be so displayed. 

23 (2) DISSEMINATION.—The Secretary shall dis24 seminate the best practices developed under paraVerDate Sep 11 2014 02:08 Apr 18, 2018 Jkt 079200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\S2680.IS S2680

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1 graph (1) to health care providers and State agen2 cies. 

3 (b) REQUIREMENTS.—In identifying or facilitating 

4 the development of best practices under subsection (a), as 

5 applicable, the Secretary, in consultation with appropriate 

6 stakeholders, shall consider the following: 

7 (1) The potential for addiction relapse or over8 dose, including overdose death, when opioid medica9 tions are prescribed to a patient recovering from 

10 opioid use disorder. 

11 (2) The benefits of displaying information 

12 about a patient’s opioid use disorder history in a 

13 manner similar to other potentially lethal medical 

14 concerns, including drug allergies and contraindica15 tions. 

16 (3) The importance of prominently displaying 

17 information about a patient’s opioid use disorder 

18 when a physician or medical professional is pre19 scribing medication, including methods for avoiding 

20 alert fatigue in providers. 

21 (4) The importance of a variety of appropriate 

22 medical professionals, including physicians, nurses, 

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1 pensing opioid medication, consistent with Federal 

2 and State laws and regulations. 

3 (5) The importance of protecting patient pri4 vacy, including the requirements related to consent 

5 for disclosure of substance use disorder information 

6 under all applicable laws and regulations. 

7 (6) All applicable Federal and State laws and 

8 regulations. 

9 SEC. 509. DEVELOPMENT AND DISSEMINATION OF MODEL 

10 TRAINING PROGRAMS FOR SUBSTANCE USE 

11 DISORDER PATIENT RECORDS. 

12 (a) INITIAL PROGRAMS AND MATERIALS.—Not later 

13 than 1 year after the date of the enactment of this Act, 

14 the Secretary of Health and Human Services (referred to 

15 in this section as the ‘‘Secretary’’), in consultation with 

16 appropriate experts, shall identify the following model pro17 grams and materials (or if no such programs or materials 

18 exist, recognize private or public entities to develop and 

19 disseminate such programs and materials): 

20 (1) Model programs and materials for training 

21 health care providers (including physicians, emer22 gency medical personnel, psychiatrists, psychologists, 

23 counselors, therapists, nurse practitioners, physician 

24 assistants, behavioral health facilities and clinics, 

25 care managers, and hospitals, including individuals 


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1 such as general counsels or regulatory compliance 

2 staff who are responsible for establishing provider 

3 privacy policies) concerning the permitted uses and 

4 disclosures, consistent with the standards and regu5 lations governing the privacy and security of sub6 stance use disorder patient records promulgated by 

7 the Secretary under section 543 of the Public 

8 Health Service Act (42 U.S.C. 290dd–2) for the 

9 confidentiality of patient records. 

10 (2) Model programs and materials for training 

11 patients and their families regarding their rights to 

12 protect and obtain information under the standards 

13 and regulations described in paragraph (1). 

14 (b) REQUIREMENTS.—The model programs and ma15 terials described in paragraphs (1) and (2) of subsection 

16 (a) shall address circumstances under which disclosure of 

17 substance use disorder patient records is needed to— 

18 (1) facilitate communication between substance 

19 use disorder treatment providers and other health 

20 care providers to promote and provide the best pos21 sible integrated care; 

22 (2) avoid inappropriate prescribing that can 

23 lead to dangerous drug interactions, overdose, or re24 lapse; and 


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1 (3) notify and involve families and caregivers 

2 when individuals experience an overdose. 

3 (c) PERIODIC UPDATES.—The Secretary shall— 

4 (1) periodically review and update the model 

5 program and materials identified or developed under 

6 subsection (a); and 

7 (2) disseminate such updated programs and 

8 materials to the individuals described in subsection 

9 (a)(1). 

10 (d) INPUT OF CERTAIN ENTITIES.—In identifying, 

11 reviewing, or updating the model programs and materials 

12 under this section, the Secretary shall solicit the input of 

13 relevant stakeholders. 

14 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to carry out this section, 

16 such sums as may be necessary for each of fiscal years 

17 2019 through 2023. 

18 SEC. 510. COMMUNICATION WITH FAMILIES DURING EMER19 GENCIES. 

20 (a) PROMOTING AWARENESS OF AUTHORIZED DIS21 CLOSURES DURING EMERGENCIES.—The Secretary of 

22 Health and Human Services shall annually notify health 

23 care providers regarding permitted disclosures during 

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1 mation to families and caregivers under Federal health 

2 care privacy laws and regulations. 

3 (b) USE OF MATERIAL.—For the purposes of car4 rying out subsection (a), the Secretary of Health and 

5 Human Services may use material produced under section 

6 509 of this Act or under section 11004 of the 21st Cen7 tury Cures Act (42 U.S.C. 1320d–2 note). 

8 SEC. 511. PRENATAL AND POSTNATAL HEALTH. 

9 Section 317L of the Public Health Service Act (42 

10 U.S.C. 247b–13) is amended— 

11 (1) in subsection (a)— 

12 (A) by amending paragraph (1) to read as 

13 follows: 

14 ‘‘(1) to collect, analyze, and make available data 

15 on prenatal smoking, alcohol and substance abuse 

16 and misuse, including— 

17 ‘‘(A) data on— 

18 ‘‘(i) the incidence, prevalence, and im19 plications of such activities; and 

20 ‘‘(ii) the incidence and prevalence of 

21 implications and outcomes, including neo22 natal abstinence syndrome and other out23 comes associated with such activities; and 

24 ‘‘(B) to inform such analysis, additional in25 formation or data on family health history, 


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1 medication exposures during pregnancy, demo2 graphic information, such as race, ethnicity, ge3 ographic location, and family history, and other 

4 relevant information, as appropriate;’’; 

5 (B) in paragraph (2)— 

6 (i) by striking ‘‘prevention of’’ and in7 serting ‘‘prevention and long-term out8 comes associated with’’; and 

9 (ii) by striking ‘‘illegal drug use’’ and 

10 inserting ‘‘substance abuse and misuse’’; 

11 (C) in paragraph (3), by striking ‘‘and ces12 sation programs; and’’ and inserting ‘‘, treat13 ment, and cessation programs;’’; 

14 (D) in paragraph (4), by striking ‘‘illegal 

15 drug use.’’ and inserting ‘‘substance abuse and 

16 misuse; and’’; and 

17 (E) by adding at the end the following: 

18 ‘‘(5) to issue public reports on the analysis of 

19 data described in paragraph (1), including analysis 

20 of— 

21 ‘‘(A) long-term outcomes of children af22 fected by neonatal abstinence syndrome; 

23 ‘‘(B) health outcomes associated with pre24 natal smoking, alcohol, and substance abuse 

25 and misuse; and 


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1 ‘‘(C) relevant studies, evaluations, or infor2 mation the Secretary determines to be appro3 priate.’’; 

4 (2) in subsection (b), by inserting ‘‘tribal enti5 ties,’’ after ‘‘local governments,’’; 

6 (3) by redesignating subsection (c) as sub7 section (d); 

8 (4) by inserting after subsection (b) the fol9 lowing: 

10 ‘‘(c) COORDINATING ACTIVITIES.—To carry out this 

11 section, the Secretary may— 

12 ‘‘(1) provide technical and consultative assist13 ance to entities receiving grants under subsection 

14 (b); 

15 ‘‘(2) ensure a pathway for data sharing between 

16 States, tribal entities, and the Centers for Disease 

17 Control and Prevention; 

18 ‘‘(3) ensure data collection under this section is 

19 consistent with applicable State, Federal, and Tribal 

20 privacy laws; and 

21 ‘‘(4) coordinate with the National Coordinator 

22 for Health Information Technology, as appropriate, 

23 to assist States and tribes in implementing systems 

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1 able, in order to facilitate interoperability between 

2 such systems and health information technology sys3 tems, including certified health information tech4 nology.’’; and 

5 (5) in subsection (d), as so redesignated, by 

6 striking ‘‘2001 through 2005’’ and inserting ‘‘2019 

7 through 2023’’. 

8 SEC. 512. SURVEILLANCE AND EDUCATION REGARDING IN9 FECTIONS ASSOCIATED WITH INJECTION 

10 DRUG USE AND OTHER RISK FACTORS. 

11 Section 317N of the Public Health Service Act (42 

12 U.S.C. 247b–15) is amended— 

13 (1) by amending the section heading to read as 

14 follows: ‘‘SURVEILLANCE AND EDUCATION RE15 GARDING INFECTIONS ASSOCIATED WITH IN16 JECTION DRUG USE AND OTHER RISK FAC17 TORS’’; 

18 (2) in subsection (a)— 

19 (A) in the matter preceding paragraph (1), 

20 by inserting ‘‘activities’’ before the colon; 

21 (B) in paragraph (1)— 

22 (i) by inserting ‘‘or maintaining’’ after 

23 ‘‘implementing’’; 

24 (ii) by striking ‘‘hepatitis C virus in25 fection (in this section referred to as ‘HCV 


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1 infection’)’’ and inserting ‘‘infections com2 monly associated with injection drug use, 

3 including viral hepatitis and human im4 munodeficiency virus,’’; and 

5 (iii) by striking ‘‘such infection’’ and 

6 all that follows through the period at the 

7 end and inserting ‘‘such infections, which 

8 may include the reporting of cases of such 

9 infections.’’; 

10 (C) in paragraph (2), by striking ‘‘HCV 

11 infection’’ and all that follows through the pe12 riod at the end and inserting ‘‘infections as a 

13 result of injection drug use, receiving blood 

14 transfusions prior to July 1992, or other risk 

15 factors.’’; 

16 (D) in paragraphs (4) and (5), by striking 

17 ‘‘HCV infection’’ each place such term appears 

18 and inserting ‘‘infections described in para19 graph (1)’’; and 

20 (E) in paragraph (5), by striking ‘‘pedia21 tricians and other primary care physicians, and 

22 obstetricians and gynecologists’’ and inserting 

23 ‘‘substance use disorder treatment providers, 

24 pediatricians, other primary care providers, and 

25 obstetrician-gynecologists’’; 


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1 (3) in subsection (b)— 

2 (A) by striking ‘‘directly and’’ and insert3 ing ‘‘directly or’’; and 

4 (B) by striking ‘‘hepatitis C,’’ and all that 

5 follows through the period at the end and in6 serting ‘‘infections described in subsection 

7 (a)(1).’’; 

8 (4) by redesignating subsection (c) as sub9 section (d); 

10 (5) by inserting after subsection (b) the fol11 lowing: 

12 ‘‘(c) DEFINITION.—In this section, the term ‘injec13 tion drug use’ means— 

14 ‘‘(1) intravenous administration of a substance 

15 in schedule I of section 202(c) of the Controlled 

16 Substances Act; 

17 ‘‘(2) intravenous administration of a substance 

18 in schedule II, III, IV, or V of section 202(c) of the 

19 Controlled Substances Act that has not been ap20 proved for intravenous use under section 505 of the 

21 Federal Food, Drug and Cosmetic Act or section 

22 351 of the Public Health Service Act; or 

23 ‘‘(3) intravenous administration of a substance 

24 in schedule II, III, IV, or V of section 202(c) of the 


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1 Controlled Substances Act that has not been pre2 scribed to the person using the substance.’’; and 

3 (6) in subsection (d), as so redesignated, by 

4 striking ‘‘such sums as may be necessary for each of 

5 the fiscal years 2001 through 2005’’ and inserting 

6 ‘‘$40,000,000 for each of fiscal years 2019 through 

7 2023’’. 

8 SEC. 513. TASK FORCE TO DEVELOP BEST PRACTICES FOR 

9 TRAUMA-INFORMED IDENTIFICATION, RE10 FERRAL, AND SUPPORT. 

11 (a) ESTABLISHMENT.—There is established a task 

12 force, to be known as the Interagency Task Force on 

13 Trauma-Informed Care (in this section referred to as the 

14 ‘‘task force’’) that shall identify, evaluate, and make rec15 ommendations regarding best practices with respect to 

16 children and youth, and their families as appropriate, who 

17 have experienced or are at risk of experiencing trauma. 

18 (b) MEMBERSHIP.— 

19 (1) COMPOSITION.—The task force shall be 

20 composed of the heads of the following Federal de21 partments and agencies, or their designees: 

22 (A) The Centers for Medicare & Medicaid 

23 Services. 

24 (B) The Substance Abuse and Mental 

25 Health Services Administration. 


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1 (C) The Agency for Healthcare Research 

2 and Quality. 

3 (D) The Centers for Disease Control and 

4 Prevention. 

5 (E) The Indian Health Service. 

6 (F) The Department of Veterans Affairs. 

7 (G) The National Institutes of Health. 

8 (H) The Food and Drug Administration. 

9 (I) The Health Resources and Services Ad10 ministration. 

11 (J) The Department of Defense. 

12 (K) The Office of Minority Health. 

13 (L) The Administration for Children and 

14 Families. 

15 (M) The Office of the Assistant Secretary 

16 for Planning and Evaluation. 

17 (N) The Office for Civil Rights at the De18 partment of Health and Human Services. 

19 (O) The Office of Juvenile Justice and De20 linquency Prevention of the Department of Jus21 tice. 

22 (P) The Office of Community Oriented Po23 licing Services of the Department of Justice. 

24 (Q) The Office on Violence Against 

25 Women of the Department of Justice. 


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1 (R) The National Center for Education 

2 Evaluation and Regional Assistance of the De3 partment of Education. 

4 (S) The National Center for Special Edu5 cation Research of the Institute of Education 

6 Science. 

7 (T) The Office of Elementary and Sec8 ondary Education of the Department of Edu9 cation. 

10 (U) The Office for Civil Rights at the De11 partment of Education. 

12 (V) The Office of Special Education and 

13 the Rehabilitative Services of the Department 

14 of Education. 

15 (W) the Bureau of Indian Affairs of the 

16 Department of the Interior. 

17 (X) The Veterans Health Administration 

18 of the Department of Veterans Affairs. 

19 (Y) The Office of Special Needs Assistance 

20 Programs of the Department of Housing and 

21 Urban Development. 

22 (Z) The Office of Head Start of the Ad23 ministration for Children and Families. 

24 (AA) The Children’s Bureau of the Admin25 istration for Children and Families. 


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1 (BB) The Bureau of Indian Education of 

2 the Department of the Interior. 

3 (CC) Such other Federal agencies as the 

4 Secretaries determine to be appropriate. 

5 (2) DATE OF APPOINTMENTS.—The heads of 

6 Federal departments and agencies shall appoint the 

7 corresponding members of the task force not later 

8 than 6 months after the date of enactment of this 

9 Act. 

10 (3) CHAIRPERSON.—The task force shall be 

11 chaired by the Assistant Secretary for Mental 

12 Health and Substance Use. 

13 (c) TASK FORCE DUTIES.—The task force shall— 

14 (1) solicit input from stakeholders, including 

15 frontline service providers, educators, mental health 

16 professionals, researchers, experts in infant, child, 

17 and youth trauma, child welfare professionals, and 

18 the public, in order to inform the activities under 

19 paragraph (2); and 

20 (2) identify, evaluate, make recommendations, 

21 and update such recommendations not less than an22 nually, to the general public, the Secretary of Edu23 cation, the Secretary of Health and Human Services, 

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1 rior, the Attorney General, and other relevant cabi2 net Secretaries, and Congress regarding— 

3 (A) a set of evidence-based, evidence-in4 formed, and promising best practices with re5 spect to— 

6 (i) the identification of infants, chil7 dren and youth, and their families as ap8 propriate, who have experienced or are at 

9 risk of experiencing trauma; and 

10 (ii) the expeditious referral to and im11 plementation of trauma-informed practices 

12 and supports that prevent and mitigate the 

13 effects of trauma; 

14 (B) a national strategy on how the task 

15 force and member agencies will collaborate, 

16 prioritize options for, and implement a coordi17 nated approach which may include data sharing 

18 and the awarding of grants that support chil19 dren and their families as appropriate, who 

20 have experienced or are at risk of experiencing 

21 trauma; and 

22 (C) existing Federal authorities at the De23 partment of Education, Department of Health 

24 and Human Services, Department of Justice, 

25 Department of Labor, Department of Interior, 


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1 and other relevant agencies, and specific Fed2 eral grant programs to disseminate best prac3 tices on, provide training in, or deliver services 

4 through, trauma-informed practices, and dis5 seminate such information— 

6 (i) in writing to relevant program of7 fices at such agencies to encourage grant 

8 applicants in writing to use such funds, 

9 where appropriate, for trauma-informed 

10 practices; and 

11 (ii) to the general public through the 

12 internet website of the task force. 

13 (d) BEST PRACTICES.—In identifying, evaluating, 

14 and recommending the set of best practices under sub15 section (c), the task force shall— 

16 (1) include guidelines for providing professional 

17 development for front-line services providers, includ18 ing school personnel, providers from child- or youth19 serving organizations, primary and behavioral health 

20 care providers, child welfare and social services pro21 viders, family and juvenile court judges and attor22 neys, health care providers, individuals who are 

23 mandatory reporters of child abuse or neglect, 

24 trained nonclinical providers (including peer mentors 

25 and clergy), and first responders, in— 


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1 (A) understanding and identifying early 

2 signs and risk factors of trauma in children and 

3 youth, and their families as appropriate, includ4 ing through screening processes; 

5 (B) providing practices to prevent and 

6 mitigate the impact of trauma, including by fos7 tering safe and stable environments and rela8 tionships; and 

9 (C) developing and implementing proce10 dures or systems that— 

11 (i) are designed to quickly refer in12 fants, children, youth, and their families as 

13 appropriate, who have experienced or are 

14 at risk of experiencing trauma to the ap15 propriate trauma-informed screening and 

16 support, including treatment appropriate 

17 to the age of the child, and to ensure such 

18 infants, children, youth, and family mem19 bers receive such support; 

20 (ii) utilize and develop partnerships 

21 with local social services organizations, 

22 such as organizations serving youth, and 

23 clinical mental health or health care service 

24 providers with expertise in providing sup25 port services (including trauma-informed 


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1 and evidence-based treatment appropriate 

2 to the age of the child) aimed at pre3 venting or mitigating the effects of trau4 ma; 

5 (iii) educate children and youth to— 

6 (I) understand and identify the 

7 signs, effects, or symptoms of trauma; 

8 and 

9 (II) build the resilience and cop10 ing skills to mitigate the effects of ex11 periencing trauma; 

12 (iv) promote and support multi13 generational practices that assist parents, 

14 foster parents, and kinship and other care15 givers in accessing resources related to, 

16 and developing environments conducive to, 

17 the prevention and mitigation of trauma; 

18 and 

19 (v) collect and utilize data from 

20 screenings, referrals, or the provision of 

21 services and supports, conducted in the 

22 covered settings, to evaluate and improve 

23 processes for trauma-informed support and 

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1 guistically appropriate, and specific to age 

2 ranges and sex, as applicable; and 

3 (2) recommend best practices that are designed 

4 to avoid unwarranted custody loss or criminal pen5 alties for parents or guardians in connection with in6 fants, children, and youth who have experienced or 

7 are at risk of experiencing trauma. 

8 (e) OPERATING PLAN.—Not later than 1 year after 

9 the date of enactment of this Act, the task force shall hold 

10 the first meeting. Not later than 2 years after such date 

11 of enactment, the task force shall submit to the Secretary 

12 of Education, Secretary of Health and Human Services, 

13 Secretary of Labor, Secretary of the Interior, the Attorney 

14 General, and Congress an operating plan for carrying out 

15 the activities of the task force described in paragraphs (2) 

16 and (3) of subsection (c). Such operating plan shall in17 clude— 

18 (1) a list of specific activities that the task 

19 force plans to carry out for purposes of carrying out 

20 duties described in subsection (c)(2), which may in21 clude public engagement; 

22 (2) a plan for carrying out the activities under 

23 paragraphs (2) and (3) of subsection (c); 

24 (3) a list of members of the task force and 

25 other individuals who are not members of the task 


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1 force that may be consulted to carry out such activi2 ties; 

3 (4) an explanation of Federal agency involve4 ment and coordination needed to carry out such ac5 tivities, including any statutory or regulatory bar6 riers to such coordination; 

7 (5) a budget for carrying out such activities; 

8 and 

9 (6) other information that the task force deter10 mines appropriate. 

11 (f) FINAL REPORT.—Not later than 3 years after the 

12 date of the first meeting of the task force, the task force 

13 shall submit to the general public, Secretary of Education, 

14 Secretary of Health and Human Services, Secretary of 

15 Labor, Secretary of the Interior, the Attorney General, 

16 and other relevant cabinet Secretaries, and Congress, a 

17 final report containing all of the findings and rec18 ommendations required under this section. 

19 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

20 out this section, there are authorized to be appropriated 

21 such sums as may be necessary for each of fiscal years 

22 2019 through 2022. 

23 (h) SUNSET.—The task force shall on the date that 

24 is 60 days after the submission of the final report under 

25 subsection (f), but not later than September 30, 2022. 


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1 SEC. 514. GRANTS TO IMPROVE TRAUMA SUPPORT SERV2 ICES AND MENTAL HEALTH CARE FOR CHIL3 DREN AND YOUTH IN EDUCATIONAL SET4 TINGS. 

5 (a) GRANTS, CONTRACTS, AND COOPERATIVE

6 AGREEMENTS AUTHORIZED.—The Secretary, in coordina7 tion with the Director of Substance Abuse and Mental 

8 Health Services Administration, is authorized to award 

9 grants to, or enter into contracts or cooperative agree10 ments with, State educational agencies, local educational 

11 agencies, Head Start agencies (including Early Head 

12 Start agencies), State or local agencies that administer 

13 public preschool programs, Indian tribes or their tribal 

14 educational agencies, a school operated by the Bureau of 

15 Indian Education, a Regional Corporation (as defined in 

16 section 3 of the Alaska Native Claims Settlement Act (43 

17 U.S.C. 1602)), or a Native Hawaiian educational organi18 zation (as defined in section 6207 of the Elementary and 

19 Secondary Education Act of 1965 (20 U.S.C. 7517)), for 

20 the purpose of increasing student access to evidence-based 

21 trauma support services and mental health care by devel22 oping innovative initiatives, activities, or programs to link 

23 local school systems with local trauma-informed support 

24 and mental health systems, including those under the In25 dian Health Service. 


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1 (b) DURATION.—With respect to a grant, contract, 

2 or cooperative agreement awarded or entered into under 

3 this section, the period during which payments under such 

4 grant, contract or agreement are made to the recipient 

5 may not exceed 4 years. 

6 (c) USE OF FUNDS.—An entity that receives a grant, 

7 contract, or cooperative agreement under this section shall 

8 use amounts made available through such grant, contract, 

9 or cooperative agreement for evidence-based or promising 

10 activities, which shall include any of the following: 

11 (1) Collaborative efforts between school-based 

12 service systems and trauma-informed support and 

13 mental health service systems to provide, develop, or 

14 improve prevention, screening, referral, and treat15 ment services to students, such as by providing uni16 versal trauma screenings to identify students in need 

17 of specialized support. 

18 (2) To implement multi-tiered positive behav19 ioral interventions and supports, or other trauma-in20 formed models of support. 

21 (3) To provide professional development to 

22 teachers, teacher assistants, school leaders, special23 ized instructional support personnel, and mental 

24 health professionals that— 


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1 (A) fosters safe and stable learning envi2 ronments that prevent and mitigate the effects 

3 of trauma, including through social and emo4 tional learning; 

5 (B) improves school capacity to identify, 

6 refer, and provide services to students in need 

7 of trauma support or behavioral health services; 

8 or 

9 (C) reflects the best practices developed by 

10 the Interagency Task Force on Trauma-In11 formed Care established under section 513. 

12 (4) Engaging families and communities in ef13 forts to increase awareness of child and youth trau14 ma, which may include sharing best practices with 

15 law enforcement regarding trauma-informed care 

16 and working with mental health professionals to pro17 vide interventions, as well as longer term coordi18 nated care within the community for children and 

19 youth who have experienced trauma and their fami20 lies. 

21 (5) To provide technical assistance to school 

22 systems and mental health agencies. 

23 (6) To evaluate the effectiveness of the program 

24 carried out under this section in increasing student 


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1 access to evidence-based trauma support services 

2 and mental health care. 

3 (d) APPLICATIONS.—To be eligible to receive a grant, 

4 contract, or cooperative agreement under this section, an 

5 entity described in subsection (a) shall submit an applica6 tion to the Secretary at such time, in such manner, and 

7 containing such information as the Secretary may reason8 ably require, which shall include the following: 

9 (1) A description of the program to be funded 

10 under the grant, contract, or cooperative agreement, 

11 including how such program will increase access to 

12 evidence-based trauma support services and mental 

13 health care for students, and, as applicable, the fam14 ilies of the students. 

15 (2) A description of how the program will pro16 vide linguistically appropriate and culturally com17 petent services. 

18 (3) A description of how the program will sup19 port students and the school in improving the school 

20 climate in order to support an environment condu21 cive to learning. 

22 (4) An assurance that— 

23 (A) persons providing services under the 

24 grant, contract, or cooperative agreement are 

25 adequately trained to provide such services; and 


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1 (B) teachers, school leaders, administra2 tors, specialized instructional support personnel, 

3 representatives of local Indian tribes as appro4 priate, other school personnel, and parents or 

5 guardians of students participating in services 

6 under this section will be engaged and involved 

7 in the design and implementation of the serv8 ices. 

9 (5) A description of how the applicant will sup10 port and integrate existing school-based services 

11 with the program in order to provide mental health 

12 services for students, as appropriate. 

13 (e) INTERAGENCY AGREEMENTS.— 

14 (1) DESIGNATION OF LEAD AGENCY.—A recipi15 ent of a grant, contract, or cooperative agreement 

16 under this section shall designate a lead agency to 

17 direct the establishment of an interagency agreement 

18 among local educational agencies, juvenile justice au19 thorities, mental health agencies, child welfare agen20 cies, and other relevant entities in the State, in col21 laboration with local entities, such as Indian tribes. 

22 (2) CONTENTS.—The interagency agreement 

23 shall ensure the provision of the services described 

24 in subsection (c), specifying with respect to each 

25 agency, authority, or entity— 


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1 (A) the financial responsibility for the serv2 ices; 

3 (B) the conditions and terms of responsi4 bility for the services, including quality, ac5 countability, and coordination of the services; 

6 and 

7 (C) the conditions and terms of reimburse8 ment among the agencies, authorities, or enti9 ties that are parties to the interagency agree10 ment, including procedures for dispute resolu11 tion. 

12 (f) EVALUATION.—The Secretary shall reserve not to 

13 exceed 3 percent of the funds made available under sub14 section (l) for each fiscal year to— 

15 (1) conduct a rigorous, independent evaluation 

16 of the activities funded under this section; and 

17 (2) disseminate and promote the utilization of 

18 evidence-based practices regarding trauma support 

19 services and mental health care. 

20 (g) DISTRIBUTION OF AWARDS.—The Secretary shall 

21 ensure that grants, contracts, and cooperative agreements 

22 awarded or entered into under this section are equitably 

23 distributed among the geographical regions of the United 

24 States and among tribal, urban, suburban, and rural pop25 ulations. 


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1 (h) RULE OF CONSTRUCTION.—Nothing in this sec2 tion shall be construed— 

3 (1) to prohibit an entity involved with a pro4 gram carried out under this section from reporting 

5 a crime that is committed by a student to appro6 priate authorities; or 

7 (2) to prevent Federal, State, and tribal law en8 forcement and judicial authorities from exercising 

9 their responsibilities with regard to the application 

10 of Federal, tribal, and State law to crimes com11 mitted by a student. 

12 (i) SUPPLEMENT, NOT SUPPLANT.—Any services 

13 provided through programs carried out under this section 

14 shall supplement, and not supplant, existing mental health 

15 services, including any special education and related serv16 ices provided under the Individuals with Disabilities Edu17 cation Act. 

18 (j) CONSULTATION WITH INDIAN TRIBES.—In car19 rying out subsection (a), the Secretary shall, in a timely 

20 manner, meaningfully consult, engage, and cooperate with 

21 Indian tribes and their representatives to ensure notice of 

22 eligibility. 

23 (k) DEFINITIONS.—In this section: 

24 (1) ELEMENTARY OR SECONDARY SCHOOL.— 

25 The term ‘‘elementary or secondary school’’ means a 


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1 public elementary and secondary school as such term 

2 is defined in section 8101 of the Elementary and 

3 Secondary Education Act of 1965 (20 U.S.C. 7801). 

4 (2) EVIDENCE-BASED.—The term ‘‘evidence5 based’’ has the meaning given such term in section 

6 8101(21)(A)(i) of the Elementary and Secondary 

7 Education Act of 1965 (20 U.S.C. 7801(21)(A)(i)). 

8 (3) SCHOOL LEADER.—The term ‘‘school lead9 er’’ has the meaning given such term in section 

10 8101 of the Elementary and Secondary Education 

11 Act of 1965 (20 U.S.C. 7801). 

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

13 the Secretary of Education. 

14 (5) SPECIALIZED INSTRUCTIONAL SUPPORT

15 PERSONNEL.—The term ‘‘specialized instructional 

16 support personnel’’ has the meaning given such term 

17 in 8101 of the Elementary and Secondary Education 

18 Act of 1965 (20 U.S.C. 7801). 

19 (l) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated to carry out this section, 

21 such sums as may be necessary for each of fiscal years 

22 2019 through 2023. 


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1 SEC. 515. NATIONAL CHILD TRAUMATIC STRESS INITIA2 TIVE. 

3 Section 582(j) of the Public Health Service Act (42 

4 U.S.C. 290hh–1(j)) is amended by striking ‘‘$46,887,000 

5 for each of fiscal years 2018 through 2022’’ and inserting 

6 ‘‘$53,887,000 for each of fiscal years 2019 through 

7 2023’’. 

Æ 


SSpencer on DSKBBXCHB2PROD with BILLS