II 

Calendar No. 398 

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, Mrs. MURRAY, Mr. ISAKSON, Mr. CASSIDY, Mr. 

HELLER, Mr. MANCHIN, Ms. BALDWIN, Mr. KAINE, Ms. HEITKAMP, 

Mrs. CAPITO, Mr. JONES, Ms. MURKOWSKI, Mr. HATCH, Ms. SMITH, Ms. 

COLLINS, Mr. RUBIO, Mr. CASEY, and Mrs. MCCASKILL) introduced the 

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

Health, Education, Labor, and Pensions 

MAY 7, 2018 

Reported by Mr. ALEXANDER, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

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’’. 


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

2 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. 

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. 


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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. 

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; 


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1 (4) by redesignating subsection (f) as sub2 section (j); 

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

4 (A) in paragraph (1)— 

5 (i) in the paragraph heading, by in6 serting ‘‘AND INDIAN TRIBE’’ after 

7 ‘‘STATE’’; 

8 (ii) by striking ‘‘States for the pur9 pose of addressing the opioid abuse crisis 

10 within such States’’ and inserting ‘‘States 

11 and Indian tribes for the purpose of ad12 dressing the opioid abuse crisis within such 

13 States and Indian tribes’’; 

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

15 after ‘‘preference to States’’; and 

16 (iv) by inserting before the period of 

17 the second sentence ‘‘or other Indian 

18 tribes, as applicable’’; and 

19 (B) in paragraph (2)— 

20 (i) in the matter preceding subpara21 graph (A), by striking ‘‘to a State’’; 

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

23 ‘‘State’’; 

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

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1 stances,’’ after ‘‘treatment programs,’’; 

2 and 

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

4 ‘‘as the State determines appropriate, re5 lated to addressing the opioid abuse crisis 

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

7 State or Indian tribe determines appro8 priate, related to addressing the opioid 

9 abuse crisis within the State, including di10 recting resources in accordance with local 

11 needs related to substance use disorders’’; 

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

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

14 (b)’’; 

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

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

17 by striking ‘‘the authorization of appropriations 

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

19 (h)’’; and 

20 (B) in paragraph (1), by striking ‘‘sub21 section (c)’’ and inserting ‘‘subsection (b)’’; and 

22 (8) by inserting after subsection (d), as so re23 designated, the following: 

24 ‘‘(e) INDIAN TRIBES.— 


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1 ‘‘(1) DEFINITION.—For purposes of this sec2 tion, the term ‘Indian tribe’ has the meaning given 

3 such term in section 4 of the Indian Self-Determina4 tion and Education Assistance Act (25 U.S.C. 

5 5304). 

6 ‘‘(2) APPROPRIATE MECHANISMS.—The Sec7 retary, in consultation with Indian tribes, shall iden8 tify and establish appropriate mechanisms for tribes 

9 to demonstrate or report the information as required 

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

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

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

13 the date of enactment of the Opioid Crisis Response Act 

14 of 2018, pursuant to subsection (b), and annually there15 after, the Secretary shall submit to the Committee on 

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

17 the Committee on Energy and Commerce of the House 

18 of Representatives a report summarizing the information 

19 provided to the Secretary in reports made pursuant to 

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

21 funds are awarded under this section and the activities 

22 of such grant recipients. 

23 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary, in24 cluding through the Tribal Training and Technical Assist25 ance Center of the Substance Abuse and Mental Health 


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1 Services Administration, shall provide State agencies and 

2 Indian tribes, as applicable, with technical assistance con3 cerning grant application and submission procedures 

4 under this section, award management activities, and en5 hancing outreach and direct support to rural and under6 served communities and providers in addressing the opioid 

7 crisis. 

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

9 purposes of carrying out the grant program under sub10 section (b), there are authorized to be appropriated 

11 $500,000,000 for each of fiscal years 2019 through 2021, 

12 to remain available until expended. 

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

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

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

16 shall be made available to Indian tribes, and up to 15 per17 cent of such amount for such fiscal year may be set aside 

18 for States with the highest age-adjusted mortality rate as19 sociated with opioid use disorders based on the ordinal 

20 ranking of States according to the age-adjusted overdose 

21 mortality rates of the Centers for Disease Control and 

22 Prevention.’’. 

23 (b) PREVIOUSLY APPROPRIATED AMOUNTS.— 

24 (1) APPROPRIATION OF AMOUNTS REMAINING

25 IN ACCOUNT.—Any unobligated amounts remaining, 


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

2 For the State Response to the Opioid Abuse Crisis 

3 established under section 1003(b) of the 21st Cen4 tury Cures Act (Public Law 114–255) (as in effect 

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

6 are hereby appropriated to the Secretary of Health 

7 and Human Services for purposes of carrying out 

8 the grant program under subsection (b) of section 

9 1003 of the 21st Century Cures Act (Public Law 

10 114–255) (as redesignated by subsection (a)(3) of 

11 this section). 

12 (2) AVAILABLE UNTIL EXPENDED.—Amounts 

13 appropriated under paragraph (1) of this subsection 

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

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

16 of this Act) shall remain available until expended. 

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

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

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

20 the Account For the State Response to the Opioid Abuse 

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


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1 TITLE II—RESEARCH AND 

2 INNOVATION 

3 SEC. 201. ADVANCING CUTTING-EDGE RESEARCH. 

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

5 (42 U.S.C. 282(n)(1)) is amended— 

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

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

8 and inserting ‘‘; or’’; and 

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

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

11 that fosters scientific creativity and increases 

12 fundamental biological understanding leading to 

13 the prevention, diagnosis, or treatment of dis14 eases and disorders, or research urgently re15 quired to respond to a public health threat.’’. 

16 SEC. 202. PAIN RESEARCH. 

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

18 U.S.C. 284q(b)) is amended— 

19 (1) in paragraph (5)— 

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

21 treatment of pain and diseases and disorders 

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

23 and management of pain and diseases and dis24 orders associated with pain, including informa25 tion on best practices for utilization of nonVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6401 E:\BILLS\S2680.RS S2680

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1 pharmacologic treatments, non-addictive med2 ical products, and other drugs approved, or de3 vices approved or cleared, by the Food and 

4 Drug Administration’’; 

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

6 the symptoms and causes of pain;’’ and insert7 ing the following: ‘‘on— 

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

9 ‘‘(ii) the diagnosis, prevention, treat10 ment, and management of pain; and 

11 ‘‘(iii) risk factors for, and early warn12 ing signs of, substance use disorders; and’’; 

13 (C) by striking subparagraphs (C) through 

14 (E) and inserting the following: 

15 ‘‘(C) make recommendations to the Direc16 tor of NIH— 

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

18 National Institutes of Health and other 

19 Federal agencies are free of unnecessary 

20 duplication of effort; 

21 ‘‘(ii) on how best to disseminate infor22 mation on pain care; and 

23 ‘‘(iii) on how to expand partnerships 

24 between public entities and private entities 


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1 to expand collaborative, cross-cutting re2 search.’’; 

3 (2) by redesignating paragraph (6) as para4 graph (7); and 

5 (3) by inserting after paragraph (5) the fol6 lowing: 

7 ‘‘(6) REPORT.—The Director of NIH shall en8 sure that recommendations and actions taken by the 

9 Director with respect to the topics discussed at the 

10 meetings described in paragraph (4) are included in 

11 appropriate reports to Congress.’’. 

12 TITLE III—MEDICAL PRODUCTS 

13 AND CONTROLLED SUB14 STANCES SAFETY 

15 SEC. 301. CLARIFYING FDA REGULATION OF NON-ADDICT16 IVE PAIN PRODUCTS. 

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

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

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

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

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

22 to address the challenges and barriers of developing non23 addictive medical products intended to treat pain or addic24 tion, which may include— 


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1 (1) the manner by which the Secretary may in2 corporate the risks of misuse and abuse of a con3 trolled substance (as defined in section 102 of the 

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

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

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

7 355(e)), section 510(k) of such Act (21 U.S.C. 

8 360(k)), or section 515(c) of such Act (21 U.S.C. 

9 360e(c)), as applicable; 

10 (2) the application of novel clinical trial designs 

11 (consistent with section 3021 of the 21st Century 

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

13 evidence (consistent with section 505F of the Fed14 eral Food, Drug, and Cosmetic Act (21 U.S.C. 

15 355g)), and use of patient experience data (con16 sistent with section 569C of the Federal Food, 

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

18 the development of non-addictive medical products 

19 intended to treat pain or addiction; 

20 (3) the evidentiary standards and the develop21 ment of opioid sparing data for inclusion in the la22 beling of medical products; and 

23 (4) the application of eligibility criteria under 

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

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1 addictive medical products intended to treat pain or 

2 addiction. 

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

4 public meetings are conducted under subsection (a) the 

5 Secretary shall issue one or more final guidance docu6 ments, or update existing guidance documents, to help ad7 dress challenges to developing non-addictive medical prod8 ucts to treat pain or addiction. Such guidance documents 

9 shall include information regarding— 

10 (1) how the Food and Drug Administration 

11 may apply sections 506 and 515B of the Federal 

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

13 360e–3) to non-addictive medical products intended 

14 to treat pain or addiction, including the cir15 cumstances under which the Secretary— 

16 (A) may apply the eligibility criteria under 

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

18 non-addictive medical products intended to 

19 treat pain or addiction; 

20 (B) considers the risk of addiction of con21 trolled substances approved to treat pain when 

22 establishing unmet medical need; and 

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

24 management in assessing whether a disease or 


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1 condition is a serious or life-threatening disease 

2 or condition; 

3 (2) the methods by which sponsors may evalu4 ate acute and chronic pain, endpoints for non-addict5 ive medical products intended to treat pain, the 

6 manner in which endpoints and evaluations of effi7 cacy will be applied across and within review divi8 sions, taking into consideration the etiology of the 

9 underlying disease, and the manner in which spon10 sors may use surrogate endpoints, intermediate 

11 endpoints, and real world evidence; 

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

13 Administration will assess evidence to support the 

14 inclusion of opioid sparing data in the labeling of 

15 non-addictive medical products intended to treat 

16 pain, including— 

17 (A) data collection methodologies, includ18 ing the use of novel clinical trial designs (con19 sistent with section 3021 of the 21st Century 

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

21 world evidence (consistent with section 505F of 

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

23 U.S.C. 355g)), as appropriate, to support prod24 uct labeling; 


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1 (B) ethical considerations of exposuring 

2 subjects to controlled substances in clinical 

3 trials to develop opioid sparing data and consid4 erations on data collection methods that reduce 

5 harm, which may include the reduction of 

6 opioid use as a clinical benefit; 

7 (C) endpoints, including primary, sec8 ondary, and surrogate endpoints, to evaluate 

9 the reduction of opioid use; 

10 (D) best practices for communication be11 tween sponsors and the agency on the develop12 ment of data collection methods, including the 

13 initiation of data collection; and 

14 (E) the appropriate format to submit such 

15 data results to the Secretary; and 

16 (4) the circumstances under which the Food 

17 and Drug Administration considers misuse and 

18 abuse of drugs in making determinations of safety 

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

20 section 505 of the Federal Food, Drug, and Cos21 metic Act (21 U.S.C. 355) and in finding that a 

22 drug is unsafe under paragraph (1) or (2) of sub23 section (e) of such section. 

24 (c) DEFINITIONS.—In this section— 


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

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

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

4 321(g)(1))), biological product (as defined in section 

5 351(i) of the Public Health Service Act (42 U.S.C. 

6 262(i))), or device (as defined in section 201(h) of 

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

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

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

10 replacing, or avoiding the use of opioids or other 

11 controlled substances. 

12 SEC. 302. CLARIFYING FDA PACKAGING AUTHORITIES. 

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

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

15 at the end the following: 

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

17 The Secretary may require a risk evaluation mitiga18 tion strategy for a drug for which there is a serious 

19 risk of an adverse drug experience described in sub20 paragraph (B) or (C) of subsection (b)(1), taking 

21 into consideration the factors described in subpara22 graphs (C) and (D) of subsection (f)(2), which may 

23 include requiring that— 

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1 aging, packaging that provides a set duration, 

2 or other packaging system that the Secretary 

3 determines may help mitigate such serious risk; 

4 or 

5 ‘‘(B) the drug be dispensed to certain pa6 tients with a safe disposal packaging or safe 

7 disposal system for purposes of rendering un8 used drugs non-retrievable (as defined in sec9 tion 1300.05 of title 21, Code of Federal Regu10 lations (or any successor regulation)) if the Sec11 retary has determines that such safe disposal 

12 packaging or system may help mitigate such se13 rious risk and exists in sufficient quantities, in 

14 consultation with other relevant Federal agen15 cies with authorities over drug packaging.’’. 

16 SEC. 303. STRENGTHENING FDA AND CBP COORDINATION 

17 AND CAPACITY. 

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

19 Human Services (referred to in this section as the ‘‘Sec20 retary’’), acting through the Commissioner of Food and 

21 Drugs, shall coordinate with the Secretary of Homeland 

22 Security to carry out activities related to customs and bor23 der protection and response to illegal controlled substances 

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

25 international mail facilities). Such Secretaries may carry 


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1 out such activities through a memorandum of under2 standing between the Food and Drug Administration and 

3 the United States Customs and Border Protection. 

4 (b) FDA IMPORT FACILITIES AND INSPECTION CA5 PACITY.—In carrying out this section, the Secretary 

6 shall— 

7 (1) in collaboration with the Secretary of 

8 Homeland Security and the Postmaster General of 

9 the United States Postal Service, provide that im10 port facilities in which the Food and Drug Adminis11 tration operates or carries out activities related to 

12 drug imports within the international mail facilities 

13 include— 

14 (A) facility upgrades and improved capac15 ity in order to increase and improve inspection 

16 and detection capabilities, which may include, 

17 as the Secretary determines appropriate— 

18 (i) improvements to facilities, such as 

19 upgrades or renovations, and support for 

20 the maintenance of existing import facili21 ties and sites to improve coordination be22 tween Federal agencies; 

23 (ii) the construction of, or upgrades 

24 to, laboratory capacity for purposes of de25 tection and testing of imported goods; 


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1 (iii) upgrades to the security of import 

2 facilities; and 

3 (iv) innovative technology and equip4 ment to facilitate improved and near-real5 time information sharing between the Food 

6 and Drug Administration, the Department 

7 of Homeland Security, and the United 

8 States Postal Service; and 

9 (B) provide import facilities in which the 

10 Food and Drug Administration operates or car11 ries out activities related to drug imports within 

12 the international mail facilities with innovative 

13 technology, including controlled substance de14 tection and testing equipment and other appli15 cable technology, and collaborate with United 

16 States Customs and Border Protection to share 

17 near-real-time information, including informa18 tion about test results, as appropriate, provided 

19 that such technology is interoperable with tech20 nology used by other relevant Federal agencies, 

21 including the United States Customs and Bor22 der Protection, as applicable, and is used in the 

23 time and manner that the Secretary determines 

24 appropriate. 


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

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

3 with the Secretary of Homeland Security and the Post4 master General of the United States Postal Service, shall 

5 report to the relevant committees of Congress on the im6 plementation of this section, including a summary of 

7 progress made towards near-real-time information sharing 

8 and the interoperability of such technologies. 

9 (d) AUTHORIZATION OF APPROPRIATIONS.—Out of 

10 amounts otherwise available to the Secretary, the Sec11 retary may allocate such sums as may be necessary for 

12 purposes of carrying out this section. 

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

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

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

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

17 which may include reduced effectiveness that is not in ac18 cordance with the labeling of such drug’’. 

19 SEC. 305. FIRST RESPONDER TRAINING. 

20 Section 546 of the Public Health Service Act (42 

21 U.S.C. 290ee–1) is amended— 

22 (1) in subsection (c)— 

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

24 the end; 


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1 (B) in paragraph (3), by striking the pe2 riod and inserting ‘‘; and’’; and 

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

4 ‘‘(4) train and provide resources for first re5 sponders and members of other key community sec6 tors on safety around fentanyl and other dangerous 

7 illicit drugs to protect themselves from exposure to 

8 fentanyl and respond appropriately when exposure 

9 occurs.’’; 

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

11 around fentanyl and other dangerous illicit drugs’’ 

12 before the period; 

13 (3) in subsection (f)— 

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

15 the end; 

16 (B) in paragraph (4), by striking the pe17 riod and inserting a semicolon; and 

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

19 ‘‘(5) the number of first responders and mem20 bers of other key community sectors trained on safe21 ty around fentanyl and other dangerous illicit 

22 drugs.’’; and 

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

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1 serting ‘‘$36,000,000 for each of fiscal years 2019 

2 through 2023’’. 

3 SEC. 306. DISPOSAL OF CONTROLLED SUBSTANCES OF A 

4 DECEASED HOSPICE PATIENT BY EMPLOY5 EES OF A HOSPICE PROGRAM. 

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

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

8 at the end the following: 

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

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

11 place of residence of a hospice patient, any controlled sub12 stance that was lawfully dispensed to the hospice patient, 

13 for the purpose of assisting in the disposal of the con14 trolled substance after the hospice patient’s death. 

15 ‘‘(B) In this paragraph: 

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

17 program’ means a physician, physician assistant, or 

18 nurse who— 

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

20 to arrangements made with, a qualified hospice 

21 program; and 

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

23 such employment or acts in accordance with ap24 plicable State law. 


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1 ‘‘(ii) The terms ‘hospice care’ and ‘hospice pro2 gram’ have the meanings given those terms in sec3 tion 1861(dd) of the Social Security Act (42 U.S.C. 

4 1395x(dd)). 

5 ‘‘(iii) The term ‘hospice patient’ means an indi6 vidual receiving hospice care. 

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

8 means a hospice program that— 

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

10 employees of the hospice program to use assist11 ing in the disposal of the controlled substances 

12 of a hospice patient after the hospice patient’s 

13 death; 

14 ‘‘(II) at the time when the controlled sub15 stances are first ordered— 

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

17 policies and procedures to the hospice pa18 tient or hospice patient representative and 

19 the family of the hospice patient; 

20 ‘‘(bb) discusses the policies and proce21 dures with the hospice patient or hospice 

22 patient’s representative and the hospice 

23 patient’s family in a language and manner 

24 that such individuals understand to ensure 

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1 ing the safe disposal of controlled sub2 stances; and 

3 ‘‘(cc) documents in the clinical record 

4 of the hospice patient that the written poli5 cies and procedures were provided and dis6 cussed with the hospice patient or hospice 

7 patient’s representative; and 

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

9 hospice program assists in the disposal of con10 trolled substances of a hospice patient, docu11 ments in the clinical record of the hospice pa12 tient a list of all controlled substances disposed 

13 of. 

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

15 include additional types of licensed medical profes16 sionals in the definition of the term ‘employee of a 

17 qualified hospice program’ under subparagraph 

18 (B).’’. 

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

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

21 amended by adding at the end the following: 

22 ‘‘(4) An employee of a qualified hospice pro23 gram for the purpose of assisting in the disposal of 

24 a controlled substance in accordance with subsection 

25 (g)(5).’’. 


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

2 guidance to qualified hospice programs to assist the pro3 grams in satisfying the requirements under paragraph (5) 

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

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

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

7 section or the amendments made by this section shall be 

8 construed to prevent a State or local government from im9 posing additional controls or restrictions relating to the 

10 regulation of the disposal of controlled substances in hos11 pice care or hospice programs. 

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

13 DRUG MANAGEMENT. 

14 (a) STUDY.— 

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

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

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

18 requirements applicable to and challenges of hospice 

19 programs with regard to the management and dis20 posal of controlled substances in the home of an in21 dividual. 

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

23 paragraph (1), the Comptroller General shall in24 clude— 


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1 (A) an overview of challenges encountered 

2 by hospice programs regarding the disposal of 

3 controlled substances, such as opioids, in a 

4 home setting, including any key changes in poli5 cies, procedures, or best practices for the dis6 posal of controlled substances over time; and 

7 (B) a description of Federal requirements, 

8 including requirements under the Medicare pro9 gram, for hospice programs regarding the dis10 posal of controlled substances in a home set11 ting, and oversight of compliance with those re12 quirements. 

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

14 date of enactment of this Act, the Comptroller General 

15 shall submit to Congress a report containing the results 

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

17 recommendations, if any, for such legislation and adminis18 trative action as the Comptroller General determines ap19 propriate. 


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

2 PHARMACY TO BE ADMINISTERED BY INJEC3 TION, IMPLANTATION, OR INTRATHECAL 

4 PUMP. 

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

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

7 the following: 

8 ‘‘DELIVERY OF A CONTROLLED SUBSTANCE BY A

9 PHARMACY TO AN ADMINISTERING PRACTITIONER

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

11 section 102(10), a pharmacy may deliver a controlled sub12 stance to a practitioner in accordance with a prescription 

13 that meets the requirements of this title and the regula14 tions issued by the Attorney General under this title, for 

15 the purpose of administering of the controlled substance 

16 by the practitioner if— 

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

18 pharmacy to the prescribing practitioner or the prac19 titioner administering the controlled substance, as 

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

21 certificate of registration issued under this title; 

22 ‘‘(2)(A) in the case of administering of the con23 trolled substance for the purpose of maintenance or 

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

25 ‘‘(i) the practitioner who issued the pre26 scription is a qualifying practitioner authorized 


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1 under, and acting within the scope of that sec2 tion; and 

3 ‘‘(ii) the controlled substance is to be ad4 ministered by injection or implantation; or 

5 ‘‘(B) in the case of administering of the con6 trolled substance for a purpose other than mainte7 nance or detoxification treatment, the controlled 

8 substance is to be administered by a practitioner 

9 through use of an intrathecal pump; 

10 ‘‘(3) the pharmacy and the practitioner are au11 thorized to conduct the activities specified in this 

12 section under the law of the State in which such ac13 tivities take place; 

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

15 practitioner with a stock of controlled substances for 

16 the purpose of general dispensing to patients; 

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

18 controlled substance is to be administered only to 

19 the patient named on the prescription not later than 

20 14 days after the date of receipt of the controlled 

21 substance by the practitioner; and 

22 ‘‘(6) notwithstanding any exceptions under sec23 tion 307, the prescribing practitioner, and the prac24 titioner administering the controlled substance, as 

25 applicable, maintain complete and accurate records 


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1 of all controlled substances delivered, received, ad2 ministered, or otherwise disposed of under this sec3 tion, including the persons to whom controlled sub4 stances were delivered and such other information as 

5 may be required by regulations of the Attorney Gen6 eral. 

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

8 WHICH CONTROLLED SUBSTANCE SHALL BE ADMINIS9 TERED.— 

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

11 year period beginning on the date of enactment of 

12 this section, the Attorney General, in coordination 

13 with the Secretary, may reduce the number of days 

14 described in subsection (a)(5) if the Attorney Gen15 eral determines that such reduction will— 

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

17 ‘‘(B) protect the public health. 

18 ‘‘(2) MODIFICATIONS AFTER SUBMISSION OF

19 REPORT.—After the date on which the report de20 scribed in subsection (c) is submitted, the Attorney 

21 General, in coordination with the Secretary, may 

22 modify the number of days described in subsection 

23 (a)(5). 


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1 ‘‘(3) MINIMUM NUMBER OF DAYS.—Any modi2 fication under this subsection shall be for a period 

3 of not less than 7 days.’’. 

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

5 after the date of enactment of this section, the Comp6 troller General of the United States shall conduct a study 

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

8 diversion of controlled substances administered by injec9 tion, implantation, or through the use of an intrathecal 

10 pump. 

11 (c) TECHNICAL AND CONFORMING AMENDMENT.— 

12 The table of contents for the Comprehensive Drug Abuse 

13 Prevention and Control Act of 1970 is amended by insert14 ing after the item relating to section 309 the following: 

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

15 TITLE IV—TREATMENT AND 

16 RECOVERY 

17 SEC. 401. COMPREHENSIVE OPIOID RECOVERY CENTERS. 

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

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

20 following new section: 

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

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

23 the Assistant Secretary for Mental Health and Substance 

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


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1 entities to establish or operate a comprehensive opioid re2 covery center (referred to in this section as a ‘Center’). 

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

4 network. 

5 ‘‘(b) GRANT PERIOD.— 

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

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

8 5 years. 

9 ‘‘(2) RENEWAL.—A grant awarded under sub10 section (a) may be renewed, on a competitive basis, 

11 for additional periods of time, as determined by the 

12 Secretary. In determining whether to renew a grant 

13 under this paragraph, the Secretary shall consider 

14 the data submitted under subsection (h). 

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

16 shall allocate the amounts made available under sub17 section (j) such that not fewer than 10 grants may be 

18 awarded. Not more than one grant shall be made to enti19 ties in a single State for any one period. 

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

21 grant under subsection (a), an entity shall submit an ap22 plication to the Secretary at such time and in such manner 

23 as the Secretary may require. Such application shall in24 clude— 


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

2 capable of coordinating with other entities to carry 

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

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

5 may require. 

6 ‘‘(e) PRIORITY.—In awarding grants under sub7 section (a), the Secretary shall give priority to eligible enti8 ties located in a State with an overdose mortality rate that 

9 is above the national overdose mortality rate, as deter10 mined by the Director of the Centers for Disease Control 

11 and Prevention. 

12 ‘‘(f) PREFERENCE.—In awarding grants under sub13 section (a), the Secretary may give preference to eligible 

14 entities utilizing technology-enabled collaborative learning 

15 and capacity building models, including such models as de16 fined in section 2 of the Expanding Capacity for Health 

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

18 conduct the activities described in this section. 

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

20 minimum, carry out the following activities directly, 

21 through referral, or through contractual arrangements, 

22 which may include carrying out such activities through 

23 technology-enabled collaborative learning and capacity 

24 building models described in subsection (f): 


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

2 Each Center shall— 

3 ‘‘(A) ensure that intake and evaluations 

4 meet the individualized clinical needs of pa5 tients, including by offering assessments for 

6 services and care recommendations through 

7 independent, evidence-based verification proc8 esses for reviewing patient placement in treat9 ment settings; 

10 ‘‘(B) provide the full continuum of treat11 ment services, including— 

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

13 and Drug Administration to treat sub14 stance use disorders; 

15 ‘‘(ii) medically supervised withdrawal 

16 management that includes patient evalua17 tion, stabilization, and readiness for and 

18 entry into treatment; 

19 ‘‘(iii) counseling provided by a pro20 gram counselor or other certified profes21 sional who is licensed and qualified by edu22 cation, training, or experience to assess the 

23 psychological and sociological background 

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1 priate treatment plan for the patient, and 

2 to monitor patient progress; 

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

4 patients with co-occurring substance use 

5 and mental health disorders; 

6 ‘‘(v) residential rehabilitation, and 

7 outpatient and intensive outpatient pro8 grams; 

9 ‘‘(vi) recovery housing; 

10 ‘‘(vii) community-based and peer re11 covery support services; 

12 ‘‘(viii) job training, job placement as13 sistance, and continuing education assist14 ance to support reintegration into the 

15 workforce; and 

16 ‘‘(ix) other best practices to provide 

17 the full continuum of treatment and serv18 ices, as determined by the Secretary; 

19 ‘‘(C) periodically conduct patient assess20 ments to support sustained and clinically sig21 nificant recovery, as defined by the Assistant 

22 Secretary for Mental Health and Substance 

23 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 

25 ‘‘participating partnership’’ means a partnership esVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6401 E:\BILLS\S2680.RS S2680

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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 

23 services and activities support the State’s strat24 egy for addressing problems described in subVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6401 E:\BILLS\S2680.RS S2680

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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 

24 (VII) any other appropriate ca25 reer service or training service deVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6401 E:\BILLS\S2680.RS S2680

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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, 

25 which may include developing or improving existing proVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6401 E:\BILLS\S2680.RS S2680

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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 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6401 E:\BILLS\S2680.RS 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 

24 Disease Control and Prevention and the AssistVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6401 E:\BILLS\S2680.RS S2680

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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 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6401 E:\BILLS\S2680.RS 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’’. 

8 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

10 ‘‘Opioid Crisis Response Act of 2018’’. 

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

12 Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

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. 

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. Restricting entrance of illicit drugs. 

Sec. 306. First responder training. 

Sec. 307. Disposal of controlled substances of hospice patients. 

Sec. 308. GAO study and report on hospice safe drug management. 

Sec. 309. Delivery of a controlled substance by a pharmacy to be administered 

by injection or implantation. 

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. 


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Sec. 403. Alternatives to opioids. 

Sec. 404. Building communities of recovery. 

Sec. 405. Peer support technical assistance center. 

Sec. 406. Medication-assisted treatment for recovery from addiction. 

Sec. 407. Grant program. 

Sec. 408. Allowing for more flexibility with respect to medication-assisted treatment for opioid use disorders. 

Sec. 409. National recovery housing best practices. 

Sec. 410. Addressing economic and workforce impacts of the opioid crisis. 

Sec. 411. Youth prevention and recovery. 

Sec. 412. Plans of safe care. 

Sec. 413. Regulations relating to special registration for telemedicine. 

Sec. 414. National Health Service Corps behavioral and mental health professionals providing obligated service in schools and other community-based settings. 

Sec. 415. Loan repayment for substance use disorder treatment providers. 

Sec. 416. Protecting moms and infants. 

Sec. 417. Early interventions for pregnant women and infants. 

Sec. 418. Report on investigations regarding parity in mental health and substance use disorder benefits. 

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 illicit 

drug use and other risk factors. 

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

referral, and support. 

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 SEC. 2. DEFINITIONS. 

2 In this Act— 

3 (1) the terms ‘‘Indian tribe’’ and ‘‘tribal organi4 zation’’ have the meanings given such terms in section 


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1 4 of the Indian Self-Determination and Education 

2 Assistance Act (25 U.S.C. 5304); and 

3 (2) the term ‘‘Secretary’’ means the Secretary of 

4 Health and Human Services, unless otherwise speci5 fied. 

6 TITLE I—REAUTHORIZATION OF 

7 CURES FUNDING 

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

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

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

11 (1) in subsection (a)— 

12 (A) by striking ‘‘the authorization of appro13 priations under subsection (b) to carry out the 

14 grant program described in subsection (c)’’ and 

15 inserting ‘‘subsection (h) to carry out the grant 

16 program described in subsection (b)’’; and 

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

18 ‘‘States’’ 

19 (2) by striking subsection (b); 

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

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

22 (4) by redesignating subsection (f) as subsection 

23 (j); 

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

25 (A) in paragraph (1)— 


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1 (i) in the paragraph heading, by in2 serting ‘‘AND INDIAN TRIBE’’ after ‘‘STATE’’ 

3 (ii) by striking ‘‘States for the purpose 

4 of addressing the opioid abuse crisis within 

5 such States’’ and inserting ‘‘States and In6 dian tribes for the purpose of addressing the 

7 opioid abuse crisis within such States and 

8 Indian tribes’’; 

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

10 after ‘‘preference to States’’; and 

11 (iv) by inserting before the period of 

12 the second sentence ‘‘or other Indian tribes, 

13 as applicable’’; 

14 (B) in paragraph (2)— 

15 (i) in the matter preceding subpara16 graph (A), by striking ‘‘to a State’’; 

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

18 ‘‘State’’; 

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

20 ‘‘preventing diversion of controlled sub21 stances,’’ after ‘‘treatment programs,’’; and 

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

23 ‘‘as the State determines appropriate, re24 lated to addressing the opioid abuse crisis 

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


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1 State or Indian tribe determines appro2 priate, related to addressing the opioid 

3 abuse crisis within the State, including di4 recting resources in accordance with local 

5 needs related to substance use disorders’’; 

6 (6) in subsection (c), as so redesignated, by strik7 ing ‘‘subsection (c)’’ and inserting ‘‘subsection (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 redes16 ignated, the following: 

17 ‘‘(e) INDIAN TRIBES.— 

18 ‘‘(1) DEFINITION.—For purposes of this section, 

19 the term ‘Indian tribe’ has the meaning given such 

20 term in section 4 of the Indian Self-Determination 

21 and Education Assistance Act (25 U.S.C. 5304). 

22 ‘‘(2) APPROPRIATE MECHANISMS.—The Sec23 retary, in consultation with Indian tribes, shall iden24 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 of 

10 Representatives a report summarizing the information pro11 vided to the Secretary in reports made pursuant to sub12 section (c), including the purposes for which grant funds 

13 are awarded under this section and the activities of such 

14 grant recipients. 

15 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary, includ16 ing through the Tribal Training and Technical Assistance 

17 Center of the Substance Abuse and Mental Health Services 

18 Administration, shall provide State agencies and Indian 

19 tribes, as applicable, with technical assistance concerning 

20 grant application and submission procedures under this 

21 section, award management activities, and enhancing out22 reach and direct support to rural and underserved commu23 nities and providers in addressing the opioid crisis. 

24 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For pur25 poses of carrying out the grant program under subsection 


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1 (b), there are authorized to be appropriated $500,000,000 

2 for each of fiscal years 2019 through 2021, to remain avail3 able until expended. 

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

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

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

7 shall be made available to Indian tribes, and up to 15 per8 cent of such amount for such fiscal year may be set aside 

9 for States with the highest age-adjusted rate of drug over10 dose death based on the ordinal ranking of States according 

11 to the Director of the Centers for Disease Control and Pre12 vention.’’. 

13 (b) CONFORMING AMENDMENT.—Section 1004(c) of the 

14 21st Century Cures Act (Public Law 114–255) is amended 

15 by striking ‘‘, the FDA Innovation Account, or the Account 

16 For the State Response to the Opioid Abuse Crisis’’ and 

17 inserting ‘‘or the FDA Innovation Account’’. 

18 TITLE II—RESEARCH AND 

19 INNOVATION 

20 SEC. 201. ADVANCING CUTTING-EDGE RESEARCH. 

21 Section 402(n)(1) of the Public Health Service Act (42 

22 U.S.C. 282(n)(1)) is amended— 

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

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

25 and inserting ‘‘; or’’; and 


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

2 ‘‘(C) high impact cutting-edge research that 

3 fosters scientific creativity and increases funda4 mental biological understanding leading to the 

5 prevention, diagnosis, or treatment of diseases 

6 and disorders, or research urgently required to 

7 respond to a public health threat.’’. 

8 SEC. 202. PAIN RESEARCH. 

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

10 U.S.C. 284q(b)) is amended— 

11 (1) in paragraph (5)— 

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

13 treatment of pain and diseases and disorders as14 sociated with pain’’ and inserting ‘‘treatment, 

15 and management of pain and diseases and dis16 orders associated with pain, including informa17 tion on best practices for utilization of non-phar18 macologic treatments, non-addictive medical 

19 products, and other drugs approved, or devices 

20 approved or cleared, by the Food and Drug Ad21 ministration’’; 

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

23 the symptoms and causes of pain;’’ and inserting 

24 the following: ‘‘on— 


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1 ‘‘(i) the symptoms and causes of pain, 

2 including the identification of relevant bio3 markers and screening models; 

4 ‘‘(ii) the diagnosis, prevention, treat5 ment, and management of pain; and 

6 ‘‘(iii) risk factors for, and early warn7 ing signs of, substance use disorders; and’’; 

8 and 

9 (C) by striking subparagraphs (C) through 

10 (E) and inserting the following: 

11 ‘‘(C) make recommendations to the Director 

12 of NIH— 

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

14 National Institutes of Health and other 

15 Federal agencies are free of unnecessary du16 plication of effort; 

17 ‘‘(ii) on how best to disseminate infor18 mation on pain care; and 

19 ‘‘(iii) on how to expand partnerships 

20 between public entities and private entities 

21 to expand collaborative, cross-cutting re22 search.’’; 

23 (2) by redesignating paragraph (6) as para24 graph (7); and 


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1 (3) by inserting after paragraph (5) the fol2 lowing: 

3 ‘‘(6) REPORT.—The Director of NIH shall ensure 

4 that recommendations and actions taken by the Direc5 tor with respect to the topics discussed at the meetings 

6 described in paragraph (4) are included in appro7 priate reports to Congress.’’. 

8 TITLE III—MEDICAL PRODUCTS 

9 AND CONTROLLED SUB10 STANCES SAFETY 

11 SEC. 301. CLARIFYING FDA REGULATION OF NON-ADDICT12 IVE PAIN PRODUCTS. 

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

14 the date of enactment of this Act, the Secretary, acting 

15 through the Commissioner of Food and Drugs, shall hold 

16 not less than one public meeting to address the challenges 

17 and barriers of developing non-addictive medical products 

18 intended to treat pain or addiction, which may include— 

19 (1) the manner by which the Secretary may in20 corporate the risks of misuse and abuse of a controlled 

21 substance (as defined in section 102 of the Controlled 

22 Substances Act (21 U.S.C. 802) into the risk benefit 

23 assessments under subsections (d) and (e) of section 

24 505 of the Federal Food, Drug, and Cosmetic Act (21 

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


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1 360(k)), or section 515(c) of such Act (21 U.S.C. 

2 360e(c)), as applicable; 

3 (2) the application of novel clinical trial designs 

4 (consistent with section 3021 of the 21st Century 

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

6 evidence (consistent with section 505F of the Federal 

7 Food, Drug, and Cosmetic Act (21 U.S.C. 355g)), and 

8 use of patient experience data (consistent with section 

9 569C of the Federal Food, Drug, and Cosmetic Act 

10 (21 U.S.C. 360bbb–8c)) for the development of non11 addictive medical products intended to treat pain or 

12 addiction; 

13 (3) the evidentiary standards and the develop14 ment of opioid sparing data for inclusion in the label15 ing of medical products; and 

16 (4) the application of eligibility criteria under 

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

18 and Cosmetic Act (21 U.S.C. 356, 360e–3) for non19 addictive medical products intended to treat pain or 

20 addiction. 

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

22 meetings are conducted under subsection (a) the Secretary 

23 shall issue one or more final guidance documents, or update 

24 existing guidance documents, to help address challenges to 

25 developing non-addictive medical products to treat pain or 


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1 addiction. Such guidance documents shall include informa2 tion regarding— 

3 (1) how the Food and Drug Administration may 

4 apply sections 506 and 515B of the Federal Food, 

5 Drug, and Cosmetic Act (21 U.S.C. 356, 360e–3) to 

6 non-addictive medical products intended to treat pain 

7 or addiction, including the circumstances under 

8 which the Secretary— 

9 (A) may apply the eligibility criteria under 

10 such sections 506 and 515B to non-addictive 

11 medical products intended to treat pain or ad12 diction; 

13 (B) considers the risk of addiction of con14 trolled substances approved to treat pain when 

15 establishing unmet medical need; and 

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

17 management in assessing whether a disease or 

18 condition is a serious or life-threatening disease 

19 or condition; 

20 (2) the methods by which sponsors may evaluate 

21 acute and chronic pain, endpoints for non-addictive 

22 medical products intended to treat pain, the manner 

23 in which endpoints and evaluations of efficacy will be 

24 applied across and within review divisions, taking 

25 into consideration the etiology of the underlying disVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 ease, and the manner in which sponsors may use sur2 rogate endpoints, intermediate endpoints, and real 

3 world evidence; 

4 (3) the manner in which the Food and Drug Ad5 ministration will assess evidence to support the inclu6 sion of opioid sparing data in the labeling of non-ad7 dictive medical products intended to treat pain, in8 cluding— 

9 (A) data collection methodologies, including 

10 the use of novel clinical trial designs (consistent 

11 with section 3021 of the 21st Century Cures Act 

12 (Public Law 114–255)) and real world evidence 

13 (consistent with section 505F of the Federal 

14 Food, Drug, and Cosmetic Act (21 U.S.C. 355g)), 

15 as appropriate, to support product labeling; 

16 (B) ethical considerations of exposing sub17 jects to controlled substances in clinical trials to 

18 develop opioid sparing data and considerations 

19 on data collection methods that reduce harm, 

20 which may include the reduction of opioid use as 

21 a clinical benefit; 

22 (C) endpoints, including primary, sec23 ondary, and surrogate endpoints, to evaluate the 

24 reduction of opioid use; 


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1 (D) best practices for communication be2 tween sponsors and the agency on the develop3 ment of data collection methods, including the 

4 initiation of data collection; and 

5 (E) the appropriate format to submit such 

6 data results to the Secretary; and 

7 (4) the circumstances under which the Food and 

8 Drug Administration considers misuse and abuse of a 

9 controlled substance (as defined in section 102 of the 

10 Controlled Substances Act (21 U.S.C. 802) in making 

11 the risk benefit assessment under paragraphs (2) and 

12 (4) of subsection (d) of section 505 of the Federal 

13 Food, Drug, and Cosmetic Act (21 U.S.C. 355) and 

14 in finding that a drug is unsafe under paragraph (1) 

15 or (2) of subsection (e) of such section. 

16 (c) DEFINITIONS.—In this section— 

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

18 (as defined in section 201(g)(1) of the Federal Food, 

19 Drug, and Cosmetic Act (21 U.S.C. 321(g)(1))), bio20 logical product (as defined in section 351(i) of the 

21 Public Health Service Act (42 U.S.C. 262(i))), or de22 vice (as defined in section 201(h) of the Federal Food, 

23 Drug, and Cosmetic Act (21 U.S.C. 321(h))); and 


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

2 replacing, or avoiding the use of opioids or other con3 trolled substances. 

4 SEC. 302. CLARIFYING FDA PACKAGING AUTHORITIES. 

5 (a) ADDITIONAL POTENTIAL ELEMENTS OF STRAT6 EGY.—Section 505–1(e) of the Federal Food, Drug, and 

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

8 at the end the following: 

9 ‘‘(4) PACKAGING AND DISPOSAL.—The Secretary 

10 may require a risk evaluation mitigation strategy for 

11 a drug for which there is a serious risk of an adverse 

12 drug experience described in subparagraph (B) or (C) 

13 of subsection (b)(1), taking into consideration the fac14 tors described in subparagraphs (C) and (D) of sub15 section (f)(2) and in consultation with other relevant 

16 Federal agencies with authorities over drug pack17 aging, which may include requiring that— 

18 ‘‘(A) the drug be made available for dis19 pensing to certain patients in unit dose pack20 aging, packaging that provides a set duration, or 

21 another packaging system that the Secretary de22 termines may mitigate such serious risk; or 

23 ‘‘(B) the drug be dispensed to certain pa24 tients with a safe disposal packaging or safe dis25 posal system for purposes of rendering drugs 


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1 non-retrievable (as defined in section 1300.05 of 

2 title 21, Code of Federal Regulations (or any 

3 successor regulation)) if the Secretary has deter4 mines that such safe disposal packaging or sys5 tem may mitigate such serious risk and exists in 

6 sufficient quantities.’’. 

7 (b) ASSURING ACCESS AND MINIMIZING BURDEN.— 

8 Section 505–1(f)(2)(C) of the Federal Food, Drug, and Cos9 metic Act (21 U.S.C. 355–1(f)(2)(C)) is amended— 

10 (1) in clause (i) by striking ‘‘and’’ at the end; 

11 and 

12 (2) by adding at the end the following: 

13 ‘‘(iii) patients with functional needs; 

14 and’’. 

15 (c) APPLICATION TO ABBREVIATED NEW DRUG APPLI16 CATIONS.—Section 505–1(i) of the Federal Food, Drug, and 

17 Cosmetic Act (21 U.S.C. 355–1(i)) is amended— 

18 (1) in paragraph (1)— 

19 (A) by redesignating subparagraph (B) as 

20 subparagraph (C); and 

21 (B) inserting after subparagraph (A) the 

22 following: 

23 ‘‘(B) A packaging or disposal requirement, 

24 if required under subsection (e)(4) for the appli25 cable listed drug.’’; and 


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1 (2) in paragraph (2)— 

2 (A) in subparagraph (A), by striking ‘‘and’’ 

3 at the end; 

4 (B) by redesignating subparagraph (B) as 

5 subparagraph (C); and 

6 (C) by inserting after subparagraph (A) the 

7 following: 

8 ‘‘(B) shall permit packaging systems and 

9 safe disposal packaging or safe disposal systems 

10 that are different from those required for the ap11 plicable listed drug under subsection (e)(4); 

12 and’’. 

13 SEC. 303. STRENGTHENING FDA AND CBP COORDINATION 

14 AND CAPACITY. 

15 (a) IN GENERAL.—The Secretary, acting through the 

16 Commissioner of Food and Drugs, shall coordinate with the 

17 Secretary of Homeland Security to carry out activities re18 lated to customs and border protection and response to ille19 gal controlled substances and drug imports, including at 

20 sites of import (such as international mail facilities). Such 

21 Secretaries may carry out such activities through a memo22 randum of understanding between the Food and Drug Ad23 ministration and the United States Customs and Border 

24 Protection. 


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1 (b) FDA IMPORT FACILITIES AND INSPECTION CAPAC2 ITY.— 

3 (1) IN GENERAL.—In carrying out this section, 

4 the Secretary shall, in collaboration with the Sec5 retary of Homeland Security and the Postmaster 

6 General of the United States Postal Service, provide 

7 that import facilities in which the Food and Drug 

8 Administration operates or carries out activities re9 lated to drug imports within the international mail 

10 facilities include— 

11 (A) facility upgrades and improved capac12 ity in order to increase and improve inspection 

13 and detection capabilities, which may include, as 

14 the Secretary determines appropriate— 

15 (i) improvements to facilities, such as 

16 upgrades or renovations, and support for 

17 the maintenance of existing import facilities 

18 and sites to improve coordination between 

19 Federal agencies; 

20 (ii) the construction of, or upgrades to, 

21 laboratory capacity for purposes of detec22 tion and testing of imported goods; 

23 (iii) upgrades to the security of import 

24 facilities; and 


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1 (iv) innovative technology and equip2 ment to facilitate improved and near-real3 time information sharing between the Food 

4 and Drug Administration, the Department 

5 of Homeland Security, and the United 

6 States Postal Service; and 

7 (B) innovative technology, including con8 trolled substance detection and testing equipment 

9 and other applicable technology, in order to col10 laborate with United States Customs and Border 

11 Protection to share near-real-time information, 

12 including information about test results, as ap13 propriate. 

14 (2) INNOVATIVE TECHNOLOGY.—Any technology 

15 used in accordance with paragraph (1)(B) shall be 

16 interoperable with technology used by other relevant 

17 Federal agencies, including the United States Cus18 toms and Border Protection, as the Secretary deter19 mines appropriate. 

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

21 of enactment of this Act, the Secretary, in consultation with 

22 the Secretary of Homeland Security and the Postmaster 

23 General of the United States Postal Service, shall report 

24 to the relevant committees of Congress on the implementa25 tion of this section, including a summary of progress made 


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1 towards near-real-time information sharing and the inter2 operability of such technologies. 

3 (d) AUTHORIZATION OF APPROPRIATIONS.—Out of 

4 amounts otherwise available to the Secretary, the Secretary 

5 may allocate such sums as may be necessary for purposes 

6 of carrying out this section. 

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

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

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

10 striking ‘‘of the drug’’ and inserting ‘‘of the drug, which 

11 may include reduced effectiveness under the conditions of 

12 use prescribed in the labeling of such drug, but which may 

13 not include reduced effectiveness that is in accordance with 

14 such labeling’’. 

15 SEC. 305. RESTRICTING ENTRANCE OF ILLICIT DRUGS. 

16 (a) IN GENERAL.—The Secretary, acting through the 

17 Commissioner of Food and Drugs, upon discovering or re18 ceiving, in a package being offered for import, a controlled 

19 substance that is offered for import in violation of any re20 quirement of the Controlled Substances Act (21 U.S.C. 801 

21 et seq.), the Controlled Substances Import and Export Act 

22 (21 U.S.C. 951 et seq.), the Federal Food, Drug, and Cos23 metic Act (21 U.S.C. 301 et seq.), or any other applicable 

24 law, shall transfer such package to the U.S. Customs and 

25 Border Protection. If the Secretary identifies additional 


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1 packages that appear to be the same as such package con2 taining a controlled substance, such additional packages 

3 may also be transferred to U.S. Customs and Border Protec4 tion. The U.S. Customs and Border Protection shall receive 

5 such packages consistent with the requirements of the Con6 trolled Substances Act (21 U.S.C. 801 et seq.). 

7 (b) DEBARMENT, TEMPORARY DENIAL OF APPROVAL, 

8 AND SUSPENSION.— 

9 (1) IN GENERAL.—Section 306(b) of the Federal 

10 Food, Drug, and Cosmetic Act (21 U.S.C. 335a(b)) is 

11 amended— 

12 (A) in paragraph (1)— 

13 (i) in the matter preceding subpara14 graph (A), by inserting ‘‘or (3)’’ after 

15 ‘‘paragraph (2)’’; 

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

17 the comma at the end and inserting a semi18 colon; 

19 (iii) in subparagraph (B), by striking 

20 ‘‘, or’’ and inserting a semicolon; 

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

22 the period and inserting ‘‘; or’’; and 

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

24 ‘‘(D) a person from importing or offering 

25 for import into the United States a drug.’’; and 


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1 (B) in paragraph (3)— 

2 (i) in the heading, by striking ‘‘FOOD’’; 

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

4 ‘‘; or’’ and inserting a semicolon; 

5 (iii) in subparagraph (B), by striking 

6 the period and inserting ‘‘; or’’; and 

7 (iv) and by adding at the end the fol8 lowing: 

9 ‘‘(C) the person has been convicted of a fel10 ony for conduct relating to the importation into 

11 the United States of any drug or controlled sub12 stance (as defined in section 102 of the Con13 trolled Substances Act).’’. 

14 (2) PROHIBITED ACT.—Section 301(cc) of the 

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

16 331(cc)) is amended by inserting ‘‘or a drug’’ after 

17 ‘‘food’’. 

18 (c) IMPORTS AND EXPORTS.—Section 801(a) of the 

19 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 381(a)) 

20 is amended— 

21 (1) by striking the second sentence; 

22 (2) by striking ‘‘If it appears’’ and inserting 

23 ‘‘Subject to subsection (b), if it appears’’; 

24 (3) by striking ‘‘regarding such article, then such 

25 article shall be refused’’ and inserting the following: 


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1 ‘‘regarding such article, or (5) such article is being 

2 imported or offered for import in violation of section 

3 301(cc), then any such article described in any of 

4 clauses (1) through (5) may be refused admission. If 

5 it appears from the examination of such samples or 

6 otherwise that the article is a counterfeit drug, such 

7 article shall be refused admission.’’; 

8 (4) by striking ‘‘this Act, then such article shall 

9 be refused admission’’ and inserting ‘‘this Act, then 

10 such article may be refused admission’’; and 

11 (5) by striking ‘‘Clause (2) of the third sentence’’ 

12 and all that follows through the period at the end and 

13 inserting the following: ‘‘Neither clause (2) nor clause 

14 (5) of the second sentence of this subsection shall be 

15 construed to prohibit the admission of narcotic drugs, 

16 the importation of which is permitted under the Con17 trolled Substances Import and Export Act.’’. 

18 SEC. 306. FIRST RESPONDER TRAINING. 

19 Section 546 of the Public Health Service Act (42 

20 U.S.C. 290ee–1) is amended— 

21 (1) in subsection (c)— 

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

23 the end; 

24 (B) in paragraph (3), by striking the period 

25 and inserting ‘‘; and’’; and 


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

2 ‘‘(4) train and provide resources for first re3 sponders and members of other key community sectors 

4 on safety around fentanyl, carfentanil, and other dan5 gerous licit and illicit drugs to protect themselves 

6 from exposure to such drugs and respond appro7 priately when exposure occurs.’’; 

8 (2) in subsection (d), by striking ‘‘and mecha9 nisms for referral to appropriate treatment for an en10 tity receiving a grant under this section’’ and insert11 ing ‘‘mechanisms for referral to appropriate treat12 ment, and safety around fentanyl, carfentanil, and 

13 other dangerous licit and illicit drugs’’; 

14 (3) in subsection (f)— 

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

16 the end; 

17 (B) in paragraph (4), by striking the period 

18 and inserting ‘‘; and’’; and 

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

20 ‘‘(5) the number of first responders and members 

21 of other key community sectors trained on safety 

22 around fentanyl, carfentanil, and other dangerous 

23 licit and illicit drugs.’’; and 

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

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1 serting ‘‘$36,000,000 for each of fiscal years 2019 

2 through 2023’’. 

3 SEC. 307. DISPOSAL OF CONTROLLED SUBSTANCES OF HOS4 PICE PATIENTS. 

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

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

7 at the end the following: 

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

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

10 place of residence of a hospice patient, any controlled sub11 stance that was lawfully dispensed to the hospice patient, 

12 for the purpose of assisting in the disposal of the controlled 

13 substance— 

14 ‘‘(i) after the hospice patient’s death; 

15 ‘‘(ii) if the controlled substance is expired; or 

16 ‘‘(iii) if— 

17 ‘‘(I) the employee is— 

18 ‘‘(aa) the physician of the hospice pa19 tient; and 

20 ‘‘(bb) registered under section 303(f); 

21 and 

22 ‘‘(II) the hospice patient no longer requires 

23 the controlled substance because the plan of care 

24 of the hospice patient has been modified. 

25 ‘‘(B) In this paragraph: 


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

2 program’ means a physician, physician assistant, 

3 registered nurse, or nurse practitioner who— 

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

5 to arrangements made with, a qualified hospice 

6 program; and 

7 ‘‘(II) is licensed or certified to perform such 

8 employment, or such activities arranged by the 

9 qualified hospice program, in accordance with 

10 applicable State law. 

11 ‘‘(ii) The terms ‘hospice care’ and ‘hospice pro12 gram’ have the meanings given those terms in section 

13 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 when as21 sisting in the disposal of the controlled sub22 stances of a hospice patient in a circumstance 

23 described in clause (i), (ii), or (iii) of subpara24 graph (A); 


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1 ‘‘(II) at the time when the controlled sub2 stances are first ordered— 

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

4 policies and procedures to the hospice pa5 tient or hospice patient representative and 

6 the family of the hospice patient; 

7 ‘‘(bb) discusses the policies and proce8 dures with the hospice patient or hospice 

9 patient’s representative and the hospice pa10 tient’s family in a language and manner 

11 that such individuals understand to ensure 

12 that such individuals are informed regard13 ing the safe disposal of controlled sub14 stances; and 

15 ‘‘(cc) documents in the clinical record 

16 of the hospice patient that the written poli17 cies and procedures were provided and dis18 cussed with the hospice patient or hospice 

19 patient’s representative; and 

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

21 hospice program assists in the disposal of con22 trolled substances of a hospice patient, documents 

23 in the clinical record of the hospice patient a list 

24 of all controlled substances disposed of. 


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1 ‘‘(C) The Attorney General may, by regulation, include 

2 additional types of licensed medical professionals in the def3 inition of the term ‘employee of a qualified hospice pro4 gram’ under subparagraph (B).’’. 

5 (b) NO REGISTRATION REQUIRED.—Section 302(c) of 

6 the Controlled Substances Act (21 U.S.C. 822(c)) is amend7 ed by adding at the end the following: 

8 ‘‘(4) An employee of a qualified hospice program 

9 for the purpose of assisting in the disposal of a con10 trolled substance in accordance with subsection (g)(5), 

11 except as provided in subparagraph (A)(iii) of that 

12 subsection.’’. 

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

14 guidance to qualified hospice programs to assist the pro15 grams in satisfying the requirements under paragraph (5) 

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

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

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

19 section or the amendments made by this section shall be 

20 construed to prevent a State or local government from im21 posing additional controls or restrictions relating to the reg22 ulation of the disposal of controlled substances in hospice 

23 care or hospice programs. 


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1 SEC. 308. GAO STUDY AND REPORT ON HOSPICE SAFE DRUG 

2 MANAGEMENT. 

3 (a) STUDY.— 

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

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

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

7 requirements applicable to and challenges of hospice 

8 programs with regard to the management and dis9 posal of controlled substances in the home of an indi10 vidual. 

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

12 paragraph (1), the Comptroller General shall in13 clude— 

14 (A) an overview of challenges encountered 

15 by hospice programs regarding the disposal of 

16 controlled substances, such as opioids, in a home 

17 setting, including any key changes in policies, 

18 procedures, or best practices for the disposal of 

19 controlled substances over time; and 

20 (B) a description of Federal requirements, 

21 including requirements under the Medicare pro22 gram, for hospice programs regarding the dis23 posal of controlled substances in a home setting, 

24 and oversight of compliance with those require25 ments. 


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

2 of enactment of this Act, the Comptroller General shall sub3 mit to Congress a report containing the results of the study 

4 conducted under subsection (a), together with recommenda5 tions, if any, for such legislation and administrative action 

6 as the Comptroller General determines appropriate. 

7 SEC. 309. DELIVERY OF A CONTROLLED SUBSTANCE BY A 

8 PHARMACY TO BE ADMINISTERED BY INJEC9 TION OR IMPLANTATION. 

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

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

12 following: 

13 ‘‘DELIVERY OF A CONTROLLED SUBSTANCE BY A PHARMACY

14 TO AN ADMINISTERING PRACTITIONER

15 ‘‘SEC. 309A. (a) IN GENERAL.—Notwithstanding sec16 tion 102(10), a pharmacy may deliver a controlled sub17 stance to a practitioner in accordance with a prescription 

18 that meets the requirements of this title and the regulations 

19 issued by the Attorney General under this title, for the pur20 pose of administering of the controlled substance by the 

21 practitioner if— 

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

23 pharmacy to the prescribing practitioner or the prac24 titioner administering the controlled substance, as ap25 plicable, at the location listed on the practitioner’s 

26 certificate of registration issued under this title; 


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1 ‘‘(2) 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 ‘‘(A) 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 ‘‘(B) the controlled substance is to be ad9 ministered by injection or implantation; 

10 ‘‘(3) the pharmacy and the practitioner are au11 thorized to conduct the activities specified in this sec12 tion under the law of the State in which such activi13 ties take place; 

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

15 practitioner with a stock of controlled substances for 

16 the purpose of general dispensing to patients; 

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

18 controlled substance is to be administered only to the 

19 patient named on the prescription not later than 14 

20 days after the date of receipt of the controlled sub21 stance by the practitioner; and 

22 ‘‘(6) notwithstanding any exceptions under sec23 tion 307, the prescribing practitioner, and the practi24 tioner administering the controlled substance, as ap25 plicable, maintain complete and accurate records of 


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1 all controlled substances delivered, received, adminis2 tered, or otherwise disposed of under this section, in3 cluding the persons to whom controlled substances 

4 were delivered and such other information as may be 

5 required by regulations of the Attorney General. 

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

7 WHICH CONTROLLED SUBSTANCE SHALL BE ADMINIS8 TERED.— 

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

10 year period beginning on the date of enactment of this 

11 section, the Attorney General, in coordination with 

12 the Secretary, may reduce the number of days de13 scribed in subsection (a)(5) if the Attorney General 

14 determines that such reduction will— 

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

16 ‘‘(B) protect the public health. 

17 ‘‘(2) MODIFICATIONS AFTER SUBMISSION OF RE18 PORT.—After the date on which the report described 

19 in subsection (c) is submitted, the Attorney General, 

20 in coordination with the Secretary, may modify the 

21 number of days described in subsection (a)(5). 

22 ‘‘(3) MINIMUM NUMBER OF DAYS.—Any modi23 fication under this subsection shall be for a period of 

24 not less than 7 days.’’. 


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

2 the date of enactment of this section, the Comptroller Gen3 eral of the United States shall conduct a study and submit 

4 to Congress a report on access to and potential diversion 

5 of controlled substances administered by injection or im6 plantation. 

7 (c) TECHNICAL AND CONFORMING AMENDMENT.—The 

8 table of contents for the Comprehensive Drug Abuse Preven9 tion and Control Act of 1970 is amended by inserting after 

10 the item relating to section 309 the following: 

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

11 TITLE IV—TREATMENT AND 

12 RECOVERY 

13 SEC. 401. COMPREHENSIVE OPIOID RECOVERY CENTERS. 

14 (a) IN GENERAL.—The Secretary shall award grants 

15 on a competitive basis to eligible entities to establish or op16 erate a comprehensive opioid recovery center (referred to in 

17 this section as a ‘‘Center’’). A Center may be a single entity 

18 or an integrated delivery network. 

19 (b) GRANT PERIOD.— 

20 (1) IN GENERAL.—A grant awarded under sub21 section (a) shall be for a period not more than 5 

22 years. 

23 (2) RENEWAL.—A grant awarded under sub24 section (a) may be renewed, on a competitive basis, 


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1 for additional periods of time, as determined by the 

2 Secretary. In determining whether to renew a grant 

3 under this paragraph, the Secretary shall consider the 

4 data submitted under subsection (h). 

5 (c) MINIMUM NUMBER OF GRANTS.—The Secretary 

6 shall allocate the amounts made available under subsection 

7 (j) such that not fewer than 10 grants may be awarded. 

8 Not more than one grant shall be made to entities in a sin9 gle State for any one period. 

10 (d) APPLICATION.— 

11 (1) ELIGIBLE ENTITY.—An entity is eligible for 

12 a grant under this section if the entity offers treat13 ment and other services for individuals with a sub14 stance use disorder. 

15 (2) SUBMISSION OF APPLICATION.—In order to 

16 be eligible for a grant under subsection (a), an entity 

17 shall submit an application to the Secretary at such 

18 time and in such manner as the Secretary may re19 quire. Such application shall include— 

20 (A) evidence that such entity carries out, or 

21 is capable of coordinating with other entities to 

22 carry out, the activities described in subsection 

23 (g); and 

24 (B) such other information as the Secretary 

25 may require. 


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1 (e) PRIORITY.—In awarding grants under subsection 

2 (a), the Secretary shall give priority to eligible entities lo3 cated in a State with an age-adjusted rate of drug overdose 

4 deaths that is above the national overdose mortality rate, 

5 as determined by the Director of the Centers for Disease 

6 Control and Prevention. 

7 (f) PREFERENCE.—In awarding grants under sub8 section (a), the Secretary may give preference to eligible en9 tities utilizing technology-enabled collaborative learning 

10 and capacity building models, including such models as de11 fined in section 2 of the Expanding Capacity for Health 

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

13 conduct the activities described in this section. 

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

15 minimum, carry out the following activities directly, 

16 through referral, or through contractual arrangements, 

17 which may include carrying out such activities through 

18 technology-enabled collaborative learning and capacity 

19 building models described in subsection (f): 

20 (1) TREATMENT AND RECOVERY SERVICES.— 

21 Each Center shall— 

22 (A) ensure that intake and evaluations meet 

23 the individualized clinical needs of patients, in24 cluding by offering assessments for services and 

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1 dence-based verification processes for reviewing 

2 patient placement in treatment settings; 

3 (B) provide the full continuum of treatment 

4 services, including— 

5 (i) all drugs approved by the Food and 

6 Drug Administration to treat substance use 

7 disorders, pursuant to Federal and State 

8 law; 

9 (ii) medically supervised withdrawal 

10 management that includes patient evalua11 tion, stabilization, and readiness for and 

12 entry into treatment; 

13 (iii) counseling provided by a program 

14 counselor or other certified professional who 

15 is licensed and qualified by education, 

16 training, or experience to assess the psycho17 logical and sociological background of pa18 tients, to contribute to the appropriate 

19 treatment plan for the patient, and to mon20 itor patient progress; 

21 (iv) treatment, as appropriate, for pa22 tients with co-occurring substance use and 

23 mental disorders; 


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1 (v) testing, as appropriate, for infec2 tions commonly associated with illicit drug 

3 use; 

4 (vi) residential rehabilitation, and out5 patient and intensive outpatient programs; 

6 (vii) recovery housing; 

7 (viii) community-based and peer recov8 ery support services; 

9 (ix) job training, job placement assist10 ance, and continuing education assistance 

11 to support reintegration into the workforce; 

12 and 

13 (x) other best practices to provide the 

14 full continuum of treatment and services, as 

15 determined by the Secretary; 

16 (C) ensure that all programs covered by the 

17 Center include medication-assisted treatment, as 

18 appropriate, and do not exclude individuals re19 ceiving medication-assisted treatment from any 

20 service; 

21 (D) periodically conduct patient assess22 ments to support sustained and clinically sig23 nificant recovery, as defined by the Assistant 

24 Secretary for Mental Health and Substance Use; 


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1 (E) administer an onsite pharmacy and 

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

4 (F) 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 staff, 

11 as appropriate, to work with State and local 

12 health departments, health care providers, the 

13 Indian Health Service, State and local edu14 cational agencies, schools funded by the Indian 

15 Bureau of Education, institutions of higher edu16 cation, State and local workforce development 

17 boards, State and local community action agen18 cies, public safety officials, first responders, In19 dian tribes, child welfare agencies, as appro20 priate, and other community partners and the 

21 public, including patients, to identify and re22 spond to community needs; 

23 (B) ensuring that the entities described in 

24 subparagraph (A) are aware of the services of the 

25 Center; and 


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1 (C) disseminating and making publicly 

2 available, including through the internet, evi3 dence-based resources that educate professionals 

4 and the public on opioid use disorder and other 

5 substance use disorders, including co-occurring 

6 substance use and mental disorders. 

7 (h) DATA REPORTING AND PROGRAM OVERSIGHT.— 

8 With respect to a grant awarded under subsection (a), not 

9 later than 90 days after the end of the first year of the grant 

10 period, and annually thereafter for the duration of the 

11 grant period (including the duration of any renewal period 

12 for such grant), the entity shall submit data, as appro13 priate, to the Secretary regarding— 

14 (1) the programs and activities funded by the 

15 grant; 

16 (2) health outcomes of the population of individ17 uals with a substance use disorder who received serv18 ices from the Center, evaluated by an independent 

19 program evaluator through the use of outcomes meas20 ures, as determined by the Secretary; 

21 (3) the retention rate of program participants; 

22 and 

23 (4) any other information that the Secretary 

24 may require for the purpose of ensuring that the Cen25 ter is complying with all the requirements of the 


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1 grant, including providing the full continuum of serv2 ices described in subsection (g)(1)(B). 

3 (i) PRIVACY.—The provisions of this section, including 

4 with respect to data reporting and program oversight, shall 

5 be subject to all applicable Federal and State privacy laws. 

6 (j) AUTHORIZATION OF APPROPRIATIONS.—There is 

7 authorized to be appropriated $10,000,000 for each of fiscal 

8 years 2019 through 2023 for purposes of carrying out this 

9 section. 

10 (k) REPORTS TO CONGRESS.— 

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

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

13 Secretary shall submit to Congress a preliminary re14 port that analyzes data submitted under subsection 

15 (h). 

16 (2) FINAL REPORT.—Not later than 2 year after 

17 submitting the preliminary report required under 

18 paragraph (1), the Secretary shall submit to Congress 

19 a final report that includes— 

20 (A) an evaluation of the effectiveness of the 

21 comprehensive services provided by the Centers 

22 established or operated pursuant to this section 

23 on health outcomes of the population of individ24 uals with substance use disorder who receive 

25 services from the Center, which shall include an 


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1 evaluation of the effectiveness of services for 

2 treatment and recovery support and to reduce re3 lapse, recidivism, and overdose; and 

4 (B) recommendations, as appropriate, re5 garding ways to improve Federal programs re6 lated to substance use disorders, which may in7 clude dissemination of best practices for the 

8 treatment of substance use disorders to health 

9 care professionals. 

10 SEC. 402. PROGRAM TO SUPPORT COORDINATION AND CON11 TINUATION OF CARE FOR DRUG OVERDOSE 

12 PATIENTS. 

13 (a) IN GENERAL.—The Secretary shall identify or fa14 cilitate the development of best practices for— 

15 (1) emergency treatment of known or suspected 

16 drug overdose; 

17 (2) the use of recovery coaches, as appropriate, 

18 to encourage individuals who experience a non-fatal 

19 overdose to seek treatment for substance use disorder 

20 and to support coordination and continuation of care; 

21 (3) coordination and continuation of care and 

22 treatment, including, as appropriate, through refer23 rals, of individuals after an opioid overdose; and 

24 (4) the provision of overdose reversal medication, 

25 as appropriate. 


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1 (b) GRANT ESTABLISHMENT AND PARTICIPATION.— 

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

3 grants on a competitive basis to eligible entities to 

4 support implementation of voluntary programs for 

5 care and treatment of individuals after an opioid 

6 overdose, as appropriate, which may include imple7 mentation of the best practices described in subsection 

8 (a). 

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

10 ‘‘eligible entity’’ means— 

11 (A) a State alcohol or drug agency; or 

12 (B) an entity that offers treatment or other 

13 services for individuals in response to, or fol14 lowing, drug overdoses or a drug overdose, in 

15 consultation with a State alcohol and drug agen16 cy. 

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

18 grant under this section shall submit an application 

19 to the Secretary, at such time and in such manner as 

20 the Secretary may require, that includes— 

21 (A) evidence that such eligible entity carries 

22 out, or is capable of contracting and coordi23 nating with other community entities to carry 

24 out, the activities described in paragraph (4); 


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1 (B) evidence that such eligible entity will 

2 work with a recovery community organization to 

3 recruit, train, hire, mentor, and supervise recov4 ery coaches and fulfill the requirements described 

5 in paragraph (4)(A); and 

6 (C) such additional information as the Sec7 retary may require. 

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

9 awarded a grant under this section shall use such 

10 grant funds to— 

11 (A) hire or utilize recovery coaches to help 

12 support recovery, including by— 

13 (i) connecting patients to a continuum 

14 of care services, such as— 

15 (I) treatment and recovery sup16 port programs; 

17 (II) programs that provide non18 clinical recovery support services; 

19 (III) peer support networks; 

20 (IV) recovery community organi21 zations; 

22 (V) health care providers, includ23 ing physicians and other providers of 

24 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 and overdose reversal to patients 

8 and families, as appropriate; 

9 (iii) providing follow-up services for 

10 patients after an overdose to ensure contin11 ued recovery and connection to support 

12 services; 

13 (iv) collecting and evaluating outcome 

14 data for patients receiving recovery coach15 ing services; and 

16 (v) providing other services the Sec17 retary determines necessary to help ensure 

18 continued connection with recovery support 

19 services; 

20 (B) establish policies and procedures that 

21 address the provision of overdose reversal medi22 cation, the administration of all drugs approved 

23 by the Food and Drug Administration to treat 

24 substance use disorder, and subsequent continu25 ation of, or referral to, evidence-based treatment 


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1 for patients with a substance use disorder who 

2 have experienced a non-fatal drug overdose, in 

3 order to support long-term treatment, prevent re4 lapse, and reduce recidivism and future overdose; 

5 and 

6 (C) establish integrated models of care for 

7 individuals who have experienced a non-fatal 

8 drug overdose which may include patient assess9 ment, follow up, and transportation to and from 

10 treatment facilities. 

11 (5) ADDITIONAL PERMISSIBLE USES.—In addi12 tion to the uses described in paragraph (4), a grant 

13 awarded under this section may be used, directly or 

14 through contractual arrangements, to provide— 

15 (A) all drugs approved by the Food and 

16 Drug Administration to treat substance use dis17 orders, pursuant to Federal and State law; 

18 (B) withdrawal and detoxification services 

19 that include patient evaluation, stabilization, 

20 and preparation for treatment of substance use 

21 disorder, including treatment described in sub22 paragraph (A), as appropriate; or 

23 (C) mental health services provided by a 

24 program counselor, social worker, therapist, or 

25 other certified professional who is licensed and 


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1 qualified by education, training, or experience to 

2 assess the psychosocial background of patients, to 

3 contribute to the appropriate treatment plan for 

4 patients with substance use disorder, and to 

5 monitor patient progress. 

6 (6) PREFERENCE.—In awarding grants under 

7 this section, the Secretary shall give preference to eli8 gible entities that meet any or all of the following cri9 teria: 

10 (A) The eligible entity is a critical access 

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

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

13 1395x(mm)(1))), a low volume hospital (as de14 fined in section 1886(d)(12)(C)(i) of such Act 

15 (42 U.S.C. 1395ww(d)(12)(C)(i))), or a sole com16 munity hospital (as defined in section 

17 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 

18 1395ww(d)(5)(D)(iii))). 

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

20 with an age-adjusted rate of drug overdose deaths 

21 that is above the national overdose mortality 

22 rate, as determined by the Director of the Centers 

23 for Disease Control and Prevention. 


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1 (C) The eligible entity demonstrates that re2 covery coaches will be placed in both health care 

3 settings and community settings. 

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

5 eligible entity under this section shall be for a period 

6 of not more than 5 years. 

7 (c) DEFINITIONS.—In this section: 

8 (1) RECOVERY COACH.—the term ‘‘recovery 

9 coach’’ means an individual— 

10 (A) with knowledge of, or experience with, 

11 recovery from a substance use disorder; and 

12 (B) who has completed training from, and 

13 is determined to be in good standing by, a recov14 ery services organization capable of conducting 

15 such training and making such determination. 

16 (2) RECOVERY COMMUNITY ORGANIZATION.—The 

17 term ‘‘recovery community organization’’ has the 

18 meaning given such term in section 547(a) of the 

19 Public Health Service Act (42 U.S.C. 290ee–2(a)). 

20 (3) STATE ALCOHOL AND DRUG AGENCY.—The 

21 term ‘‘State alcohol and drug agency’’ means the 

22 principal agency of a State that is responsible for 

23 carrying out the block grant for prevention and treat24 ment of substance abuse under subpart II of part B 


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1 of title XIX of the Public Health Service Act (42 

2 U.S.C. 300x–21 et seq.) 

3 (d) REPORTING REQUIREMENTS.— 

4 (1) REPORTS BY GRANTEES.—Each eligible enti5 ty awarded a grant under this section shall submit to 

6 the Secretary an annual report for each year for 

7 which the entity has received such grant that includes 

8 information on— 

9 (A) the number of individuals treated by the 

10 entity for non-fatal overdoses, including the 

11 number of non-fatal overdoses where overdose re12 versal medication was administered; 

13 (B) the number of individuals administered 

14 medication-assisted treatment by the entity; 

15 (C) the number of individuals referred by 

16 the entity to other treatment facilities after a 

17 non-fatal overdose, the types of such other facili18 ties, and the number of such individuals admit19 ted to such other facilities pursuant to such refer20 rals; and 

21 (D) the frequency and number of patients 

22 with reoccurrences, including readmissions for 

23 non-fatal overdoses and evidence of relapse re24 lated to substance use disorder. 


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

2 years after the date of enactment of this Act, the Sec3 retary shall submit to Congress a report that includes 

4 an evaluation of the effectiveness of the grant program 

5 carried out under this section with respect to long 

6 term health outcomes of the population of individuals 

7 who have experienced a drug overdose, the percentage 

8 of patients treated or referred to treatment by grant9 ees, and the frequency and number of patients who ex10 perienced relapse, were readmitted for treatment, or 

11 experienced another overdose. 

12 (e) PRIVACY.—The requirements of this section, includ13 ing with respect to data reporting and program oversight, 

14 shall be subject to all applicable Federal and State privacy 

15 laws. 

16 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

17 authorized to be appropriated to carry out this section such 

18 sums as may be necessary for each of fiscal years 2019 

19 through 2023. 

20 SEC. 403. ALTERNATIVES TO OPIOIDS. 

21 (a) IN GENERAL.—The Secretary shall, directly or 

22 through grants to, or contracts with, public and private en23 tities, provide technical assistance to hospitals and other 

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1 agement. The technical assistance provided shall be for the 

2 purpose of— 

3 (1) utilizing information from acute care pro4 viders including emergency departments and other 

5 providers that have successfully implemented alter6 natives to opioids programs, promoting non-addictive 

7 protocols and medications while appropriately lim8 iting the use of opioids; 

9 (2) identifying or facilitating the development of 

10 best practices on the use of alternatives to opioids, 

11 which may include pain-management strategies that 

12 involve non-addictive medical products, non-pharma13 cologic treatments, and technologies or techniques to 

14 identify patients at-risk for opioid use disorder; 

15 (3) identifying or facilitating the development of 

16 best practices on the use of alternatives to opioids that 

17 target common painful conditions and include certain 

18 patient populations, such as geriatric patients, preg19 nant women, and children; 

20 (4) disseminating information on the use of al21 ternatives to opioids to providers in acute care set22 tings, which may include emergency departments, 

23 outpatient clinics, critical access hospitals, and Fed24 erally qualified health centers; and 


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1 (5) collecting data and reporting on health out2 comes associated with the use of alternatives to 

3 opioids. 

4 (b) PAIN MANAGEMENT AND FUNDING.— 

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

6 grants to hospitals and other acute care settings relat7 ing to alternatives to opioids for pain management. 

8 (2) AUTHORIZATION OF APPROPRIATIONS.— 

9 There is authorized to be appropriated $5,000,000 for 

10 each of fiscal years 2019 through 2023 for purposes 

11 of carrying out this section. 

12 SEC. 404. BUILDING COMMUNITIES OF RECOVERY. 

13 Section 547 of the Public Health Service Act (42 

14 U.S.C. 290ee–2) is amended to read as follows: 

15 ‘‘SEC. 547. BUILDING COMMUNITIES OF RECOVERY. 

16 ‘‘(a) DEFINITION.—In this section, the term ‘recovery 

17 community organization’ means an independent nonprofit 

18 organization that— 

19 ‘‘(1) mobilizes resources within and outside of 

20 the recovery community, which may include through 

21 a peer support network, to increase the prevalence 

22 and quality of long-term recovery from substance use 

23 disorders; and 


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1 ‘‘(2) is wholly or principally governed by people 

2 in recovery for substance use disorders who reflect the 

3 community served. 

4 ‘‘(b) GRANTS AUTHORIZED.—The Secretary shall 

5 award grants to recovery community organizations to en6 able such organizations to develop, expand, and enhance re7 covery services. 

8 ‘‘(c) FEDERAL SHARE.—The Federal share of the costs 

9 of a program funded by a grant under this section may 

10 not exceed 85 percent. 

11 ‘‘(d) USE OF FUNDS.—Grants awarded under sub12 section (b)— 

13 ‘‘(1) shall be used to develop, expand, and en14 hance community and statewide recovery support 

15 services; and 

16 ‘‘(2) may be used to— 

17 ‘‘(A) build connections between recovery net18 works, including between recovery community 

19 organizations and peer support networks, and 

20 with other recovery support services, including— 

21 ‘‘(i) behavioral health providers; 

22 ‘‘(ii) primary care providers and phy23 sicians; 

24 ‘‘(iii) educational and vocational 

25 schools; 


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1 ‘‘(iv) employers; 

2 ‘‘(v) housing services; 

3 ‘‘(vi) child welfare agencies; and 

4 ‘‘(vii) other recovery support services 

5 that facilitate recovery from substance use 

6 disorders, including non-clinical commu7 nity services; 

8 ‘‘(B) reduce the stigma associated with sub9 stance use disorders; and 

10 ‘‘(C) conduct outreach on issues relating to 

11 substance use disorders and recovery, includ12 ing— 

13 ‘‘(i) identifying the signs of substance 

14 use disorder; 

15 ‘‘(ii) the resources available to individ16 uals with substance use disorder and to 

17 families of an individual with a substance 

18 use disorder, including programs that men19 tor and provide support services to children; 

20 ‘‘(iii) the resources available to help 

21 support individuals in recovery; and 

22 ‘‘(iv) related medical outcomes of sub23 stance use disorders, the potential of acquir24 ing an infection commonly associated with 

25 illicit drug use, and neonatal abstinence 


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1 syndrome among infants exposed to opioids 

2 during pregnancy. 

3 ‘‘(e) SPECIAL CONSIDERATION.—In carrying out this 

4 section, the Secretary shall give special consideration to the 

5 unique needs of rural areas, including areas with an age6 adjusted rate of drug overdose deaths that is above the na7 tional average and areas with a shortage of prevention and 

8 treatment services. 

9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There are 

10 authorized to be appropriated to carry out this section 

11 $5,000,000 for each of fiscal years 2019 through 2023.’’. 

12 SEC. 405. PEER SUPPORT TECHNICAL ASSISTANCE CENTER. 

13 (a) ESTABLISHMENT.—The Secretary, acting through 

14 the Assistant Secretary for Mental Health and Substance 

15 Abuse, shall establish or operate a National Peer-Run 

16 Training and Technical Assistance Center for Addiction 

17 Recovery Support (referred to in this subsection as the 

18 ‘‘Center’’). 

19 (b) FUNCTIONS.—The Center established under sub20 section (a) shall provide technical assistance and support 

21 to recovery community organizations and peer support net22 works, including such assistance and support related to— 

23 (1) training on identifying— 

24 (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) data collection to support research, including 

11 for translational research; 

12 (4) capacity building; and 

13 (5) evaluation and improvement, as necessary, of 

14 the effectiveness of such services provided by recovery 

15 community organizations (as defined in section 547 

16 of the Public Health Service Act). 

17 (c) BEST PRACTICES.—The Center established under 

18 subsection (a) shall periodically issue best practices for use 

19 by recovery community organizations and peer support net20 works. 

21 (d) RECOVERY COMMUNITY ORGANIZATION.—In this 

22 section, the term ‘‘recovery community organization’’ has 

23 the meaning given such term in section 547 of the Public 

24 Health Service Act. 


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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to carry out this section such 

3 sums as may be necessary for each of fiscal years 2019 

4 through 2023. 

5 SEC. 406. MEDICATION-ASSISTED TREATMENT FOR RECOV6 ERY FROM ADDICTION. 

7 (a) WAIVERS FOR MAINTENANCE OR DETOXIFICATION

8 TREATMENT.—Section 303(g)(2)(G)(ii) of the Controlled 

9 Substances Act (21 U.S.C. 823(g)(2)(G)(ii)) is amended by 

10 adding at the end the following: 

11 ‘‘(VIII) The physician graduated in good 

12 standing from an accredited school of allopathic 

13 medicine or osteopathic medicine in the United 

14 States during the 5-year period immediately pre15 ceding the date on which the physician submits 

16 to the Secretary a written notification under 

17 subparagraph (B) and successfully completed a 

18 comprehensive allopathic or osteopathic medicine 

19 curriculum or accredited medical residency 

20 that— 

21 ‘‘(aa) included not less than 24 hours 

22 of training on treating and managing opi23 ate-dependent patients; and 

24 ‘‘(bb) included, at a minimum— 


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1 ‘‘(AA) the training described in 

2 items (aa) through (gg) of subclause 

3 (IV); and 

4 ‘‘(BB) training with respect to 

5 any other best practice the Secretary 

6 determines should be included in the 

7 curriculum, which may include train8 ing on pain management, including 

9 assessment and appropriate use of 

10 opioid and non-opioid alternatives.’’. 

11 (b) TREATMENT FOR CHILDREN.—The Secretary shall 

12 consider ways to ensure that an adequate number of physi13 cians who meet the requirements under the amendment 

14 made by subsection (a) and have a specialty in pediatrics, 

15 or the treatment of children or of adolescents, are granted 

16 a waiver under section 303(g)(2) of the Controlled Sub17 stances Act (21 U.S.C. 823(g)(2)) to treat children and ado18 lescents with substance use disorders. 

19 (c) TECHNICAL AMENDMENT.—Section 102(24) of the 

20 Controlled Substances Act (21 U.S.C. 802(24)) is amended 

21 by striking ‘‘Health, Education, and Welfare’’ and insert22 ing ‘‘Health and Human Services’’. 

23 SEC. 407. GRANT PROGRAM. 

24 (a) IN GENERAL.—The Secretary shall establish a 

25 grant program under which the Secretary may make grants 


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1 to accredited schools of allopathic medicine or osteopathic 

2 medicine and teaching hospitals located in the United 

3 States to support the development of curricula that meet 

4 the requirements under subclause (VIII) of section 

5 303(g)(2)(G)(ii) of the Controlled Substances Act, as added 

6 by section 406(a) of this Act. 

7 (b) AUTHORIZATION OF APPROPRIATIONS.—There are 

8 authorized to be appropriated for grants under subsection 

9 (a), $4,000,000 for each of fiscal years 2019 through 2023. 

10 SEC. 408. ALLOWING FOR MORE FLEXIBILITY WITH RE11 SPECT TO MEDICATION-ASSISTED TREAT12 MENT FOR OPIOID USE DISORDERS. 

13 Subclause (II) of section 303(g)(2)(B)(iii) of the Con14 trolled Substances Act (21 U.S.C. 823(g)(2)(B)(iii)) is 

15 amended to read as follows: 

16 ‘‘(II) The applicable number is— 

17 ‘‘(aa) 100 if, not sooner than 1 year after 

18 the date on which the practitioner submitted the 

19 initial notification, the practitioner submits a 

20 second notification to the Secretary of the need 

21 and intent of the practitioner to treat up to 100 

22 patients; or 

23 ‘‘(bb) 275 if the practitioner meets the re24 quirements specified in section 8.610 of title 42, 


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1 Code of Federal Regulations (or successor regula2 tions).’’. 

3 SEC. 409. NATIONAL RECOVERY HOUSING BEST PRACTICES. 

4 (a) BEST PRACTICES.—The Secretary, in consultation 

5 with the Secretary for Housing and Urban Development, 

6 patients with a history of opioid use disorder, and other 

7 stakeholders, which may include State accrediting entities 

8 and reputable providers of, and analysts of, recovery hous9 ing services, shall identify or facilitate the development of 

10 best practices, which may include model laws for imple11 menting suggested minimum standards, for operating re12 covery housing. 

13 (b) DISSEMINATION.—The Secretary shall disseminate 

14 the best practices identified or developed under subsection 

15 (a) to— 

16 (1) State agencies, which may include the provi17 sion of technical assistance to State agencies seeking 

18 to adopt or implement such best practices; 

19 (2) Indian tribes and tribally designated housing 

20 entities; 

21 (3) recovery housing entities; and 

22 (4) the public, as appropriate. 

23 (c) REQUIREMENTS.—In identifying or facilitating the 

24 development of best practices under subsection (a), the Sec25 retary, in consultation with appropriate stakeholders, shall 


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1 consider how recovery housing is able to support recovery 

2 and prevent relapse, recidivism, or overdose (including 

3 overdose death), including by improving access and adher4 ence to treatment, including medication-assisted treatment. 

5 (d) RULE OF CONSTRUCTION.—Nothing in this section 

6 shall be construed to provide the Secretary with the author7 ity to require States to adhere to minimum standards in 

8 the State oversight of recovery housing. 

9 (e) DEFINITIONS.—In this section— 

10 (1) the term ‘‘recovery housing’’ means a shared 

11 living environment free from alcohol and illicit drug 

12 use and centered on peer support and connection to 

13 services that promote sustained recovery from sub14 stance use disorders; and 

15 (2) the term ‘‘tribally designated housing entity’’ 

16 has the meaning given such term in the section 4 of 

17 the Native American Housing Assistance and Self-De18 termination Act of 1996 (25 U.S.C. 4103). 

19 SEC. 410. ADDRESSING ECONOMIC AND WORKFORCE IM20 PACTS OF THE OPIOID CRISIS. 

21 (a) DEFINITIONS.—Except as otherwise expressly pro22 vided, in this section: 

23 (1) WIOA DEFINITIONS.—The terms ‘‘core pro24 gram’’, ‘‘individual with a barrier to employment’’, 

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1 lying area’’, ‘‘State’’, ‘‘State board’’, and ‘‘supportive 

2 services’’ have the meanings given the terms in section 

3 3 of the Workforce Innovation and Opportunity Act 

4 (29 U.S.C. 3102). 

5 (2) EDUCATION PROVIDER.—The term ‘‘edu6 cation provider’’ means— 

7 (A) an institution of higher education, as 

8 defined in section 101 of the Higher Education 

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

10 (B) a postsecondary vocational institution, 

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

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

13 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti14 ty’’ means— 

15 (A) a State workforce agency; 

16 (B) an outlying area; or 

17 (C) a Tribal entity. 

18 (4) PARTICIPATING PARTNERSHIP.—The term 

19 ‘‘participating partnership’’ means a partnership— 

20 (A) evidenced by a written contract or 

21 agreement; and 

22 (B) including, as members of the partner23 ship, a local board receiving a subgrant under 

24 subsection (d) and 1 or more of the following: 

25 (i) The eligible entity. 


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1 (ii) A treatment provider. 

2 (iii) An employer or industry organi3 zation. 

4 (iv) An education provider. 

5 (v) A legal service or law enforcement 

6 organization. 

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

8 organization. 

9 (vii) Other State or local agencies, in10 cluding counties or local government. 

11 (viii) Other organizations, as deter12 mined to be necessary by the local board. 

13 (5) PROGRAM PARTICIPANT.—The term ‘‘pro14 gram participant’’ means an individual who— 

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

16 described in subsection (e)(2) that is served by a 

17 participating partnership through the pilot pro18 gram under this section; and 

19 (B) enrolls with the applicable partici20 pating partnership to receive any of the services 

21 described in subsection (e)(3). 

22 (6) PROVIDER OF PEER RECOVERY SUPPORT

23 SERVICES.—The term ‘‘provider of peer recovery sup24 port services’’ means a provider that delivers peer re25 covery support services through an organization deVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 scribed in section 547(a) of the Public Health Service 

2 Act (42 U.S.C. 290ee–2(a)). 

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

4 the Secretary of Labor. 

5 (8) STATE WORKFORCE AGENCY.—The term 

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

7 with responsibility for the administration of a pro8 gram under chapter 2 or 3 of subtitle B of title I of 

9 the Workforce Innovation and Opportunity Act (29 

10 U.S.C. 3161 et seq., 3171 et seq.). 

11 (9) SUBSTANCE USE DISORDER.—The term ‘‘sub12 stance use disorder’’ has the meaning given such term 

13 by the Assistant Secretary for Mental Health and 

14 Substance Use. 

15 (10) TREATMENT PROVIDER.—The term ‘‘treat16 ment provider’’— 

17 (A) means a health care provider that— 

18 (i) offers services for treating substance 

19 use disorders and is licensed in accordance 

20 with applicable State law to provide such 

21 services; and 

22 (ii) accepts health insurance for such 

23 services, including coverage under title XIX 

24 of the Social Security Act (42 U.S.C. 1396 

25 et seq.); and 


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1 (B) may include— 

2 (i) a nonprofit provider of peer recov3 ery support services; 

4 (ii) a community health care provider; 

5 (iii) a Federally qualified health center 

6 (as defined in section 1861(aa) of the Social 

7 Security Act (42 U.S.C. 1395x)); 

8 (iv) an Indian health program (as de9 fined in section 3 of the Indian Health Care 

10 Improvement Act (25 U.S.C. 1603)), includ11 ing an Indian health program that serves 

12 an urban center (as defined in such sec13 tion); and 

14 (v) a Native Hawaiian health center 

15 (as defined in section 12 of the Native Ha16 waiian Health Care Improvement Act (42 

17 U.S.C. 11711)). 

18 (11) TRIBAL ENTITY.—The term ‘‘Tribal entity’’ 

19 includes any Indian tribe, tribal organization, In20 dian-controlled organization serving Indians, Native 

21 Hawaiian organization, or Alaska Native entity, as 

22 such terms are defined or used in section 166 of the 

23 Workforce Innovation and Opportunity Act (29 

24 U.S.C. 3221). 

25 (b) PILOT PROGRAM AND GRANTS AUTHORIZED.— 


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1 (1) IN GENERAL.—The Secretary, in consultation 

2 with the Secretary of Health and Human Services, 

3 shall carry out a pilot program to address economic 

4 and workforce impacts associated with a high rate of 

5 a substance use disorder. In carrying out the pilot 

6 program, the Secretary shall make grants, on a com7 petitive basis, to eligible entities to enable such enti8 ties to make subgrants to local boards to address the 

9 economic and workforce impacts associated with a 

10 high rate of a substance use disorder. 

11 (2) GRANT AMOUNTS.—The Secretary shall make 

12 each such grant in an amount that is not less than 

13 $500,000, and not more than $5,000,000, for a fiscal 

14 year. 

15 (c) GRANT APPLICATIONS.— 

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

17 for a grant under this section shall submit an appli18 cation to the Secretary at such time and in such form 

19 and manner as the Secretary may reasonably require, 

20 including the information described in this sub21 section. 

22 (2) SIGNIFICANT IMPACT ON COMMUNITY BY

23 OPIOID AND SUBSTANCE USE DISORDER-RELATED

24 PROBLEMS.— 


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1 (A) DEMONSTRATION.—An eligible entity 

2 shall include in the application— 

3 (i) information that demonstrates sig4 nificant impact on the community by prob5 lems related to opioid abuse or another sub6 stance use disorder, by— 

7 (I) identifying the counties, com8 munities, regions, or local areas that 

9 have been significantly impacted and 

10 will be served through the grant (each 

11 referred to in this section as a ‘‘service 

12 area’’); and 

13 (II) demonstrating for each such 

14 service area, an increase equal to or 

15 greater than the national increase in 

16 such problems, between— 

17 (aa) 1999; and 

18 (bb) 2016 or the latest year 

19 for which data are available; and 

20 (ii) a description of how the eligible 

21 entity will prioritize support for signifi22 cantly impacted service areas described in 

23 clause (i)(I). 

24 (B) INFORMATION.—To meet the require25 ments described in subparagraph (A)(i)(II), the 


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1 eligible entity may use information including 

2 data on— 

3 (i) the incidence or prevalence of 

4 opioid abuse and other substance use dis5 orders; 

6 (ii) the age-adjusted rate of drug over7 dose deaths, as determined by the Director 

8 of the Centers for Disease Control and Pre9 vention; 

10 (iii) the rate of non-fatal hospitaliza11 tions related to opioid abuse or another sub12 stance use disorder; 

13 (iv) the number of arrests or convic14 tions, or a relevant law enforcement sta15 tistic, that reasonably shows an increase in 

16 opioid abuse or another substance use dis17 order; or 

18 (v) in the case of an eligible entity de19 scribed in subsection (a)(3)(C), other alter20 native relevant data as determined appro21 priate by the Secretary. 

22 (C) SUPPORT FOR STATE STRATEGY.—The 

23 eligible entity may include in the application in24 formation describing how the proposed services 

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1 lying area, or Tribal strategy, as applicable, for 

2 addressing problems described in subparagraph 

3 (A) in specific service areas or across the State, 

4 outlying area, or Tribal land. 

5 (3) ECONOMIC AND EMPLOYMENT CONDITIONS

6 DEMONSTRATE ADDITIONAL FEDERAL SUPPORT NEED7 ED.— 

8 (A) DEMONSTRATION.—An eligible entity 

9 shall include in the application information that 

10 demonstrates that a high rate of a substance use 

11 disorder has caused, or is coincident to— 

12 (i) an economic or employment down13 turn in the service area; or 

14 (ii) persistent economically depressed 

15 conditions in such service area. 

16 (B) INFORMATION.—To meet the require17 ments of subparagraph (A), an eligible entity 

18 may use information including— 

19 (i) documentation of any layoff, an20 nounced future layoff, legacy industry de21 cline, decrease in an employment or labor 

22 market participation rate, or economic im23 pact, whether or not the result described in 

24 this clause is overtly related to a high rate 

25 of a substance use disorder; 


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1 (ii) documentation showing decreased 

2 economic activity related to, caused by, or 

3 contributing to a high rate of a substance 

4 use disorder, including a description of how 

5 the service area has been impacted, or will 

6 be impacted, by such a decrease; 

7 (iii) information on economic indica8 tors, labor market analyses, information 

9 from public announcements, and demo10 graphic and industry data; 

11 (iv) information on rapid response ac12 tivities (as defined in section 3 of the Work13 force Innovation and Opportunity Act (29 

14 U.S.C. 3102)) that have been or will be con15 ducted, including demographic data gath16 ered by employer or worker surveys or 

17 through other methods; 

18 (v) data or documentation, beyond an19 ecdotal evidence, showing that employers 

20 face challenges filling job vacancies due to a 

21 lack of skilled workers able to pass a drug 

22 test; or 

23 (vi) any additional relevant data or 

24 information on the economy, workforce, or 


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1 another aspect of the service area to support 

2 the application. 

3 (d) SUBGRANT AUTHORIZATION AND APPLICATION

4 PROCESS.— 

5 (1) SUBGRANTS AUTHORIZED.— 

6 (A) IN GENERAL.—An eligible entity receiv7 ing a grant under subsection (b)— 

8 (i) may use not more than 5 percent of 

9 the grant funds for the administrative costs 

10 of carrying out the grant; 

11 (ii) in the case of an eligible entity de12 scribed in subparagraph (A) or (B) of sub13 section (a)(3), shall use the remaining grant 

14 funds to make subgrants to local entities in 

15 the service area to carry out the services 

16 and activities described in subsection (e); 

17 and 

18 (iii) in the case of an eligible entity 

19 described in subsection (a)(3)(C), shall use 

20 the remaining grant funds to carry out the 

21 services and activities described in sub22 section (e). 

23 (B) EQUITABLE DISTRIBUTION.—In making 

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1 ty shall ensure, to the extent practicable, the eq2 uitable distribution of subgrants, based on— 

3 (i) geography (such as urban and rural 

4 distribution); and 

5 (ii) significantly impacted service 

6 areas as described in subsection (c)(2). 

7 (C) TIMING OF SUBGRANT FUNDS DISTRIBU8 TION.—An eligible entity making subgrants 

9 under this subsection shall disburse subgrant 

10 funds to a local board receiving a subgrant from 

11 the eligible entity by the later of— 

12 (i) the date that is 90 days after the 

13 date on which the Secretary makes the 

14 funds available to the eligible entity; or 

15 (ii) the date that is 15 days after the 

16 date that the eligible entity makes the 

17 subgrant under subparagraph (A)(ii). 

18 (2) SUBGRANT APPLICATION.— 

19 (A) IN GENERAL.—A local board desiring to 

20 receive a subgrant under this subsection from an 

21 eligible entity shall submit an application at 

22 such time and in such and manner as the eligi23 ble entity may reasonably require, including the 

24 information described in this paragraph. 


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1 (B) CONTENTS.—Each application de2 scribed in subparagraph (A) shall include— 

3 (i) an analysis of the estimated per4 formance of the local board in carrying out 

5 the proposed services and activities under 

6 the subgrant— 

7 (I) based on— 

8 (aa) primary indicators of 

9 performance described in section 

10 116(c)(1)(A)(i) of the Workforce 

11 Innovation and Opportunity Act 

12 (29 U.S.C. 3141(c)(1)(A)(i), to as13 sess estimated effectiveness of the 

14 proposed services and activities, 

15 including the estimated number of 

16 individuals with a substance use 

17 disorder who may be served by the 

18 proposed services and activities; 

19 (bb) the record of the local 

20 board in serving individuals with 

21 a barrier to employment; and 

22 (cc) the ability of the local 

23 board to establish a participating 

24 partnership; and 


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1 (II) which may include or uti2 lize— 

3 (aa) data from the National 

4 Center for Health Statistics of the 

5 Centers for Disease Control and 

6 Prevention; 

7 (bb) data from the Center for 

8 Behavioral Health Statistics and 

9 Quality of the Substance Abuse 

10 and Mental Health Services Ad11 ministration; 

12 (cc) State vital statistics; 

13 (dd) municipal police de14 partment records; 

15 (ee) reports from local coro16 ners; or 

17 (ff) other relevant data; and 

18 (ii) in the case of a local board pro19 posing to serve a population described in 

20 subsection (e)(2)(B), a demonstration of the 

21 workforce shortage in the professional area 

22 to be addressed under the subgrant (which 

23 may include substance use disorder treat24 ment and related services, non-addictive 

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1 ices, mental health care treatment services, 

2 emergency response services, or mental 

3 health care), which shall include informa4 tion that can demonstrate such a shortage, 

5 such as— 

6 (I) the distance between— 

7 (aa) communities affected by 

8 opioid abuse or another substance 

9 use disorder; and 

10 (bb) facilities or professionals 

11 offering services in the profes12 sional area; or 

13 (II) the maximum capacity of fa14 cilities or professionals to serve indi15 viduals in an affected community, or 

16 increases in arrests related to opioid or 

17 another substance use disorder, over18 dose deaths, or nonfatal overdose emer19 gencies in the community. 

20 (e) SUBGRANT SERVICES AND ACTIVITIES.— 

21 (1) IN GENERAL.—Each local board that receives 

22 a subgrant under subsection (d) shall carry out the 

23 services and activities described in this subsection 

24 through a participating partnership. 


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1 (2) SELECTION OF POPULATION TO BE

2 SERVED.—A participating partnership shall elect to 

3 provide services and activities under the subgrant to 

4 one or both of the following populations of workers: 

5 (A) Workers, including dislocated workers, 

6 individuals with barriers to employment, new 

7 entrants in the workforce, or incumbent workers 

8 (employed or underemployed), each of whom— 

9 (i) are directly or indirectly affected by 

10 a high rate of a substance use disorder; and 

11 (ii) voluntarily confirms that the work12 er, or a friend or family member of the 

13 worker, has a history of opioid abuse or an14 other substance use disorder. 

15 (B) Workers, including dislocated workers, 

16 individuals with barriers to employment, new 

17 entrants in the workforce, or incumbent workers 

18 (employed or underemployed), who— 

19 (i) seek to transition to professions that 

20 support individuals with a substance use 

21 disorder or at risk for developing such dis22 order, such as professions that provide— 

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


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1 (II) services offered through pro2 viders of peer recovery support services; 

3 (III) non-addictive pain therapy 

4 and pain management services; 

5 (IV) emergency response services; 

6 or 

7 (V) mental health care; and 

8 (ii) need new or upgraded skills to bet9 ter serve such a population of struggling or 

10 at-risk individuals. 

11 (3) SERVICES AND ACTIVITIES.—Each partici12 pating partnership shall use funds available through 

13 a subgrant under this subsection to carry out 1 or 

14 more of the following: 

15 (A) ENGAGING EMPLOYERS.—Engaging 

16 with employers to— 

17 (i) learn about the skill and hiring re18 quirements of employers; 

19 (ii) learn about the support needed by 

20 employers to hire and retain program par21 ticipants, and other individuals with a sub22 stance use disorder, and the support needed 

23 by such employers to obtain their commit24 ment to testing creative solutions to employVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 ing program participants and such individ2 uals; 

3 (iii) connect employers and workers to 

4 on-the-job or customized training programs 

5 before or after layoff to help facilitate reem6 ployment; 

7 (iv) connect employers with an edu8 cation provider to develop classroom in9 struction to complement on-the-job learning 

10 for program participants and such individ11 uals; 

12 (v) help employers develop the cur13 riculum design of a work-based learning 

14 program for program participants and such 

15 individuals; 

16 (vi) help employers employ program 

17 participants or such individuals engaging 

18 in a work-based learning program for a 

19 transitional period before hiring such a pro20 gram participant or individual for full-time 

21 employment of not less than 30 hours a 

22 week; or 

23 (vii) connect employers to program 

24 participants receiving concurrent outpatient 

25 treatment and job training services. 


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1 (B) SCREENING SERVICES.—Providing 

2 screening services, which may include— 

3 (i) using an evidence-based screening 

4 method to screen each individual seeking 

5 participation in the pilot program to deter6 mine whether the individual has a sub7 stance use disorder; 

8 (ii) conducting an assessment of each 

9 such individual to determine the services 

10 needed for such individual to obtain or re11 tain employment, including an assessment 

12 of strengths and general work readiness; or 

13 (iii) accepting walk-ins or referrals 

14 from employers, labor organizations, or 

15 other entities recommending individuals to 

16 participate in such program. 

17 (C) INDIVIDUAL TREATMENT AND EMPLOY18 MENT PLAN.—Developing an individual treat19 ment and employment plan for each program 

20 participant— 

21 (i) in coordination, as appropriate, 

22 with other programs serving the participant 

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1 force Innovation and Opportunity Act (29 

2 U.S.C. 3101 et seq.); and 

3 (ii) which shall include providing a 

4 case manager to work with each participant 

5 to develop the plan, which may include— 

6 (I) identifying employment and 

7 career goals; 

8 (II) exploring career pathways 

9 that lead to in-demand industries and 

10 sectors, as determined by the State 

11 board and the head of the State work12 force agency or, as applicable, the 

13 Tribal entity; 

14 (III) setting appropriate achieve15 ment objectives to attain the employ16 ment and career goals identified under 

17 subclause (I); or 

18 (IV) developing the appropriate 

19 combination of services to enable the 

20 participant to achieve the employment 

21 and career goals identified under sub22 clause (I). 

23 (D) OUTPATIENT TREATMENT AND RECOV24 ERY CARE.—In the case of a participating part25 nership serving program participants described 


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1 in paragraph (2)(A) with a substance use dis2 order, providing individualized and group out3 patient treatment and recovery services for such 

4 program participants that are offered during the 

5 day and evening, and on weekends. Such treat6 ment and recovery services— 

7 (i) shall be based on a model that uti8 lizes combined behavioral interventions and 

9 other evidence-based or evidence-informed 

10 interventions; and 

11 (ii) may include additional services 

12 such as— 

13 (I) health, mental health, addic14 tion, or other forms of outpatient treat15 ment that may impact a substance use 

16 disorder and co-occurring conditions; 

17 (II) drug testing for a current 

18 substance use disorder prior to enroll19 ment in career or training services or 

20 prior to employment; 

21 (III) linkages to community serv22 ices, including services offered by part23 ner organizations designed to support 

24 program participants; or 


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1 (IV) referrals to health care, in2 cluding referrals to substance use dis3 order treatment and mental health 

4 services. 

5 (E) SUPPORTIVE SERVICES.—Providing 

6 supportive services, which shall include services 

7 such as— 

8 (i) coordinated wraparound services to 

9 provide maximum support for program 

10 participants to assist the program partici11 pants in maintaining employment and re12 covery for not less than 12 months, as ap13 propriate; 

14 (ii) assistance in establishing eligi15 bility for assistance under Federal, State, 

16 Tribal, and local programs providing health 

17 services, mental health services, vocational 

18 services, housing services, transportation 

19 services, social services, or services through 

20 early childhood education programs (as de21 fined in section 103 of the Higher Edu22 cation Act of 1965 (20 U.S.C. 1003)); 

23 (iii) services offered through providers 

24 of peer recovery support services; 


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1 (iv) networking and mentorship oppor2 tunities; or 

3 (v) any supportive services determined 

4 necessary by the local board. 

5 (F) CAREER AND JOB TRAINING SERV6 ICES.—Offering career services and training 

7 services, and related services, concurrently or se8 quentially with the services provided under sub9 paragraphs (B) through (E). Such services shall 

10 include the following: 

11 (i) Services provided to program par12 ticipants who are in a pre-employment 

13 stage of the program, which may include— 

14 (I) initial education and skills as15 sessments; 

16 (II) traditional classroom train17 ing funded through individual training 

18 accounts under chapter 3 of subtitle B 

19 of title I of the Workforce Innovation 

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

21 et seq.); 

22 (III) services to promote employ23 ability skills such as punctuality, per24 sonal maintenance skills, and profes25 sional conduct; 


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1 (IV) in-depth interviewing and 

2 evaluation to identify employment bar3 riers and to develop individual em4 ployment plans; 

5 (V) career planning that in6 cludes— 

7 (aa) career pathways leading 

8 to in-demand, high-wage jobs; and 

9 (bb) job coaching, job match10 ing, and job placement services; 

11 (VI) provision of payments and 

12 fees for employment and training-re13 lated applications, tests, and certifi14 cations; or 

15 (VII) any other appropriate ca16 reer service or training service de17 scribed in section 134(c) of the Work18 force Innovation and Opportunity Act 

19 (29 U.S.C. 3174(c)). 

20 (ii) Services provided to program par21 ticipants during their first 6 months of em22 ployment to ensure job retention, which 

23 may include— 


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1 (I) case management and support 

2 services, including a continuation of 

3 the services described in clause (i); 

4 (II) a continuation of skills train5 ing, and career and technical edu6 cation, described in clause (i) that is 

7 conducted in collaboration with the 

8 employers of such participants; 

9 (III) mentorship services and job 

10 retention support for such partici11 pants; or 

12 (IV) targeted training for man13 agers and workers working with such 

14 participants (such as mentors), and 

15 human resource representatives in the 

16 business in which such participants 

17 are employed. 

18 (iii) Services to assist program partici19 pants in maintaining employment for not 

20 less than 12 months, as appropriate. 

21 (G) PROVEN AND PROMISING PRACTICES.— 

22 Leading efforts in the service area to identify 

23 and promote proven and promising strategies 

24 and initiatives for meeting the needs of employ25 ers and program participants. 


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1 (4) LIMITATIONS.—A participating partnership 

2 may not use— 

3 (A) more than 10 percent of the funds re4 ceived under a subgrant under subsection (d) for 

5 the administrative costs of the partnership; 

6 (B) more than 10 percent of the funds re7 ceived under such subgrant for the provision of 

8 treatment and recovery services, as described in 

9 paragraph (3)(D); and 

10 (C) more than 10 percent of the funds re11 ceived under such subgrant for the provision of 

12 supportive services described in paragraph 

13 (3)(E) to program participants. 

14 (f) PERFORMANCE ACCOUNTABILITY.— 

15 (1) REPORTS.—The Secretary shall establish 

16 quarterly reporting requirements for recipients of 

17 grants and subgrants under this section that, to the 

18 extent practicable, are based on the performance ac19 countability system under section 116 of the Work20 force Innovation and Opportunity Act (29 U.S.C. 

21 3141) and, in the case of a grant awarded to an eligi22 ble entity described in subsection (a)(3)(C), section 

23 166(h) of such Act ( 29 U.S.C. 3221(h)), including the 

24 indicators described in subsection (c)(1)(A)(i) of such 

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1 formance reports under subsection (d) of such section 

2 116. 

3 (2) EVALUATIONS.— 

4 (A) AUTHORITY TO ENTER INTO AGREE5 MENTS.—The Secretary shall ensure that an 

6 independent evaluation is conducted on the pilot 

7 program carried out under this section to deter8 mine the impact of the program on employment 

9 of individuals with substance use disorders. The 

10 Secretary shall enter into an agreement with eli11 gible entities receiving grants under this section 

12 to pay for all or part of such evaluation. 

13 (B) METHODOLOGIES TO BE USED.—The 

14 independent evaluation required under this 

15 paragraph shall use experimental designs using 

16 random assignment or, when random assignment 

17 is not feasible, other reliable, evidence-based re18 search methodologies that allow for the strongest 

19 possible causal inferences. 

20 (g) FUNDING.— 

21 (1) COVERED FISCAL YEAR.—In this subsection, 

22 the term ‘‘covered fiscal year’’ means any of fiscal 

23 years 2018 through 2023. 

24 (2) USING FUNDING FOR NATIONAL DISLOCATED

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1 withstanding section 132(a)(2)(A) and subtitle D of 

2 the Workforce Innovation and Opportunity Act (29 

3 U.S.C. 3172(a)(2)(A), 3221 et seq.), the Secretary 

4 may use, to carry out the pilot program under this 

5 section for a covered fiscal year— 

6 (A) funds made available to carry out sec7 tion 170 of such Act (29 U.S.C. 3225) for that 

8 fiscal year; 

9 (B) funds made available to carry out sec10 tion 170 of such Act that remain available for 

11 that fiscal year; and 

12 (C) funds that remain available under sec13 tion 172(f) of such Act (29 U.S.C. 3227(f)). 

14 (3) AVAILABILITY OF FUNDS.—Funds appro15 priated under section 136(c) of such Act (29 U.S.C. 

16 3181(c)) and made available to carry out section 170 

17 of such Act for a fiscal year shall remain available 

18 for use under paragraph (2) for a subsequent fiscal 

19 year until expended. 

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

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

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

23 section. 


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1 SEC. 411. YOUTH PREVENTION AND RECOVERY. 

2 (a) SUBSTANCE ABUSE TREATMENT SERVICES FOR

3 CHILDREN, ADOLESCENTS, AND YOUNG ADULTS.—Section 

4 514 of the Public Health Service Act (42 U.S.C. 290bb– 

5 7) is amended— 

6 (1) in the section heading, by striking ‘‘CHIL7 DREN AND ADOLESCENTS’’ and inserting ‘‘CHIL8 DREN, ADOLESCENTS, AND YOUNG ADULTS’’; 

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

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

11 young adults, including’’; and 

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

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

14 and young adults’’. 

15 (b) YOUTH PREVENTION AND RECOVERY INITIATIVE.— 

16 (1) IN GENERAL.—The Secretary, in consultation 

17 with Secretary of Education, shall administer a pro18 gram to provide support for communities to support 

19 the prevention, treatment, and recovery of substance 

20 use disorders for children, adolescents, and young 

21 adults. 

22 (2) DEFINITIONS.—In this subsection: 

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

24 entity’’ means— 

25 (i) a local educational agency that is 

26 seeking to establish or expand substance use 


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1 prevention or recovery support services at 

2 one or more high schools; 

3 (ii) a State educational agency; 

4 (iii) an institution of higher education 

5 (or consortia of such institutions), which 

6 may include a recovery program at an in7 stitution of higher education; 

8 (iv) a local board or one-stop operator; 

9 (v) a nonprofit organization with ap10 propriate expertise in providing services or 

11 programs for children, adolescents, or young 

12 adults, excluding a school; 

13 (vi) a State, political subdivision of a 

14 State, Indian Tribe, or tribal organization; 

15 or 

16 (vii) a high school or dormitory serv17 ing high school students that receives fund18 ing from the Bureau of Indian Education. 

19 (B) EVIDENCE-BASED.—The term ‘‘evi20 dence-based’’ has the meaning given such term in 

21 section 8101 of the Elementary and Secondary 

22 Education Act (20 U.S.C. 7801). 

23 (C) FOSTER CARE.—The term ‘‘foster care’’ 

24 has the meaning given such term in section 


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1 1355.20(a) of title 45, Code of Federal Regula2 tions (or any successor regulations). 

3 (D) HIGH SCHOOL.—The term ‘‘high 

4 school’’ has the meaning given such term in sec5 tion 8101 of the Elementary and Secondary 

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

7 (E) HOMELESS YOUTH.—The term ‘‘home8 less youth’’ has the meaning given the term 

9 ‘‘homeless children or youths’’ in section 725 of 

10 the McKinney-Vento Homeless Assistance Act (42 

11 U.S.C. 11434a); 

12 (F) INSTITUTION OF HIGHER EDUCATION.— 

13 The term ‘‘institution of higher education’’ has 

14 the meaning given such term in section 101 of 

15 the Higher Education Act of 1965 (20 U.S.C. 

16 1001) and includes a ‘‘postsecondary vocational 

17 institution’’ as defined in section 102(c) of such 

18 Act (20 U.S.C. 1002(c)). 

19 (G) LOCAL EDUCATIONAL AGENCY.—The 

20 term ‘‘local educational agency’’ has the meaning 

21 given the term in section 8101 of the Elementary 

22 and Secondary Education Act of 1965 (20 

23 U.S.C. 7801). 

24 (H) LOCAL BOARD; ONE-STOP OPERATOR.— 

25 The terms ‘‘local board’’ and ‘‘one-stop operator’’ 


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1 have the meanings given such terms in section 3 

2 of the Workforce Innovation and Opportunity 

3 Act (29 U.S.C. 3102). 

4 (I) OUT OF SCHOOL YOUTH.—The term 

5 ‘‘out-of-school youth’’ has the meaning given such 

6 term in section 129(a)(1)(B) of the Workforce In7 novation and Opportunity Act (29 U.S.C. 

8 3164(a)(1)(B)). 

9 (J) RECOVERY PROGRAM.—The term ‘‘recov10 ery program’’ means a program— 

11 (i) to help children, adolescents, or 

12 young adults who are recovering from sub13 stance use disorders to initiate, stabilize, 

14 and maintain healthy and productive lives 

15 in the community; and 

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

17 delivered by individuals with lived experi18 ence in recovery, and communal activities 

19 to build recovery skills and supportive so20 cial networks. 

21 (K) STATE EDUCATIONAL AGENCY.—The 

22 term ‘‘State educational agency’’ has the mean23 ing given the term in section 8101 of the Ele24 mentary and Secondary Education Act (20 

25 U.S.C. 7801). 


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1 (3) BEST PRACTICES.—The Secretary, in con2 sultation with the Secretary of Education, shall— 

3 (A) identify or facilitate the development of 

4 evidence-based best practices for prevention of 

5 substance misuse and abuse by children, adoles6 cents, and young adults, including for specific 

7 populations such as youth in foster care, home8 less youth, out-of-school youth, and youth who 

9 are at risk of or have experienced trafficking that 

10 address— 

11 (i) primary prevention; 

12 (ii) appropriate recovery support serv13 ices; 

14 (iii) appropriate use of medication-as15 sisted treatment for such individuals, if ap16 plicable, and ways of overcoming barriers to 

17 the use of medication-assisted treatment in 

18 such population; and 

19 (iv) efficient and effective communica20 tion, which may include the use of social 

21 media, to maximize outreach efforts; 

22 (B) disseminate such best practices to State 

23 educational agencies, local educational agencies, 

24 schools and dormitories funded by the Bureau of 

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1 cation, recovery programs at institutions of high2 er education, local boards, one-stop operators, 

3 family and youth homeless providers, and non4 profit organizations, as appropriate; 

5 (C) conduct a rigorous evaluation of each 

6 grant funded under this subsection, particularly 

7 its impact on the indicators described in para8 graph (8)(B); and 

9 (D) provide technical assistance for grantees 

10 under this subsection. 

11 (4) GRANTS AUTHORIZED.—The Secretary, in 

12 consultation with the Secretary of Education, shall 

13 award 3-year grants, on a competitive basis, to eligi14 ble entities to enable such entities, in coordination 

15 with Indian tribes, if applicable, and State agencies 

16 responsible for carrying out substance use disorder 

17 prevention and treatment programs, to carry out evi18 dence-based programs for— 

19 (A) prevention of substance misuse and 

20 abuse by children, adolescents, and young adults, 

21 which may include primary prevention; 

22 (B) recovery support services for children, 

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1 munity-based services, family support groups, 

2 peer mentoring, and recovery coaching; or 

3 (C) treatment or referrals for treatment of 

4 substance use disorders, which may include the 

5 use of medication-assisted treatment, as appro6 priate. 

7 (5) SPECIAL CONSIDERATION.—In awarding 

8 grants under this subsection, the Secretary shall give 

9 special consideration to the unique needs of tribal, 

10 urban, suburban, and rural populations. 

11 (6) APPLICATION.—To be eligible for a grant 

12 under this subsection, an entity shall submit to the 

13 Secretary an application at such time, in such man14 ner, and containing such information as the Sec15 retary may require. Such application shall include— 

16 (A) a description of— 

17 (i) the impact of substance use dis18 orders in the population that will be served 

19 by the grant program; 

20 (ii) how the eligible entity has solicited 

21 input from relevant stakeholders, which 

22 may include faculty, teachers, staff, fami23 lies, students, and experts in substance use 

24 prevention and treatment in developing 

25 such application; 


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1 (iii) the goals of the proposed project, 

2 including the intended outcomes; 

3 (iv) how the eligible entity plans to use 

4 grant funds for evidence-based activities, in 

5 accordance with this subsection to prevent, 

6 provide recovery support for, or treat sub7 stance use disorders amongst such individ8 uals, or a combination of such activities; 

9 and 

10 (v) how the eligible entity will collabo11 rate with relevant partners, which may in12 clude State educational agencies, local edu13 cational agencies, institutions of higher edu14 cation, juvenile justice agencies, prevention 

15 and recovery support providers, local service 

16 providers, including substance use disorder 

17 treatment programs, providers of mental 

18 health services, youth serving organizations, 

19 family and youth homeless providers, child 

20 welfare agencies, and primary care pro21 viders, in carrying out the grant program; 

22 and 

23 (B) an assurance that the eligible entity 

24 will participate in the evaluation described in 

25 paragraph (3)(C). 


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1 (7) PRIORITY.—In awarding grants under this 

2 subsection, the Secretary shall give priority to eligible 

3 entities that propose to use grant funds for activities 

4 that meet the criteria described in subclauses (I) and 

5 (II) of section 8101(21)(A)(i) of the Elementary and 

6 Secondary Education Act (20 U.S.C. 7801(21)(A)(i)). 

7 (8) REPORTS TO THE SECRETARY.—Each eligible 

8 entity awarded a grant under this subsection shall 

9 submit to the Secretary, a report at such time and in 

10 such manner as the Secretary may require. Such re11 port shall include— 

12 (A) a description of how the eligible entity 

13 used grant funds, in accordance with this sub14 section, including the number of children, adoles15 cents, and young adults reached through pro16 gramming; and 

17 (B) a description, including relevant data, 

18 of how the grant program has made an impact 

19 on the intended outcomes described in paragraph 

20 (6)(A)(iii), including— 

21 (i) indicators of student success, which, 

22 if the eligible entity is an educational insti23 tution, shall include student well-being and 

24 academic achievement; 


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1 (ii) substance use disorders amongst 

2 children, adolescents, and young adults, in3 cluding the number of overdoses and deaths 

4 amongst children, adolescents, and young 

5 adults during the grant period; and 

6 (iii) other indicators, as the Secretary 

7 determines appropriate. 

8 (9) REPORT TO CONGRESS.—The Secretary shall, 

9 not later than October 1, 2022, submit a report to the 

10 Committee on Health, Education, Labor, and Pen11 sions of the Senate, and the Committee on Energy 

12 and Commerce and the Committee on Education and 

13 the Workforce of the House of Representatives, a re14 port summarizing the effectiveness of the grant pro15 gram under this subsection, based on the information 

16 submitted in reports required under paragraph (8). 

17 (10) AUTHORIZATION OF APPROPRIATIONS.— 

18 There is authorized to be appropriated, such sums as 

19 may be necessary to carry out this subsection for each 

20 of fiscal years 2019 through 2023. 

21 SEC. 412. PLANS OF SAFE CARE. 

22 Section 105(a) of the Child Abuse Prevention and 

23 Treatment Act (42 U.S.C. 5106(a)) is amended by adding 

24 at the end the following: 


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1 ‘‘(7) GRANTS TO STATES TO IMPROVE AND CO2 ORDINATE THEIR RESPONSE TO ENSURE THE SAFETY, 

3 PERMANENCY, AND WELL-BEING OF INFANTS AF4 FECTED BY SUBSTANCE USE.— 

5 ‘‘(A) PROGRAM AUTHORIZED.—The Sec6 retary shall make grants to States for the pur7 pose of assisting child welfare agencies, social 

8 services agencies, substance use disorder treat9 ment agencies, hospitals with labor and delivery 

10 units, medical staff, public health and mental 

11 health agencies, and maternal and child health 

12 agencies to facilitate collaboration in developing, 

13 updating, implementing, and monitoring plans 

14 of safe care described in section 

15 106(b)(2)(B)(iii). 

16 ‘‘(B) DISTRIBUTION OF FUNDS.— 

17 ‘‘(i) RESERVATIONS.—Of the amounts 

18 appropriated under subparagraph (H), the 

19 Secretary shall reserve— 

20 ‘‘(I) no more than 3 percent for 

21 the purposes described in subparagraph 

22 (G); and 

23 ‘‘(II) up to 3 percent for grants to 

24 Indian tribes and tribal organizations 

25 to address the needs of infants born 


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1 with, and identified as being affected 

2 by, substance abuse or withdrawal 

3 symptoms resulting from prenatal drug 

4 exposure or a fetal alcohol spectrum 

5 disorder and their families or care6 givers, which to the extent practicable, 

7 shall be consistent with the uses of 

8 funds described under subparagraph 

9 (D). 

10 ‘‘(ii) ALLOTMENTS TO STATES AND

11 TERRITORIES.—The Secretary shall allot 

12 the amount appropriated under subpara13 graph (H) that remains after application of 

14 clause (i) to each States that applies for 

15 such a grant, in an amount equal to the 

16 sum of— 

17 ‘‘(I) $500,000; and 

18 ‘‘(II) an amount that bears the 

19 same relationship to any funds appro20 priated under subparagraph (H) and 

21 remaining after application of clause 

22 (i), as the number of live births in the 

23 State in the previous calendar year 

24 bears to the number of live births in all 

25 States in such year. 


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1 ‘‘(iii) RATABLE REDUCTION.—If the 

2 amount appropriated under subparagraph 

3 (H) is insufficient to satisfy the require4 ments of clause (ii), the Secretary shall rat5 ably reduce each allotment to a State. 

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. Such 

10 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 sub15 stances with the highest incidence of 

16 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 with23 drawal symptoms or a fetal alco24 hol spectrum disorder (as deter25 mined 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 safe 

7 care was developed, and for whom 

8 a referral was made for appro9 priate services, as reported under 

10 section 106(d)(18); 

11 ‘‘(II) the challenges the State faces 

12 in developing, implementing, and mon13 itoring plans of safe care in accordance 

14 with 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 use 

20 disorder treatment agency, hospitals 

21 with labor and delivery units, health 

22 care providers, the public health and 

23 mental health agencies, programs fund24 ed by the Substance Abuse and Mental 

25 Health Services Administration that 


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1 provide substance use disorder treat2 ment for women, the State Medicaid 

3 program, the State agency admin4 istering the block grant program under 

5 title V of the Social Security Act (42 

6 U.S.C. 701 et seq.), the State agency 

7 administering the programs funded 

8 under part C of the Individuals with 

9 Disabilities Education Act (20 U.S.C. 

10 1431 et seq.), the maternal, infant, and 

11 early childhood home visiting program 

12 under section 511 of the Social Secu13 rity Act (42 U.S.C. 711), the State ju14 dicial system, and other agencies, as 

15 determined by the Secretary, and In16 dian tribes and tribal organizations, as 

17 appropriate; 

18 ‘‘(IV) how the State will monitor 

19 local development and implementation 

20 of plans of safe care, in accordance 

21 with section 106(b)(2)(B)(iii)(II), in22 cluding how the State will monitor to 

23 ensure plans of safe care address dif24 ferences between substance use disorder 

25 and medically supervised substance 


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1 use, including for the treatment of a 

2 substance use disorder; 

3 ‘‘(V) how the State meets the re4 quirements of section 1927 of the Pub5 lic Health Service Act (42 U.S.C. 

6 300x–27); 

7 ‘‘(VI) how the State plans to uti8 lize funding authorized under part E 

9 of title IV of the Social Security Act 

10 (42 U.S.C. 670 et seq.) to assist in car11 rying out any plan of safe care, in12 cluding such funding authorized under 

13 section 471(e) of such Act (as in effect 

14 on October 1, 2018) for mental health 

15 and substance abuse prevention and 

16 treatment services and in-home parent 

17 skill-based programs and funding au18 thorized under such section 472(j) (as 

19 in effect on October 1, 2018) for chil20 dren with a parent in a licensed resi21 dential family-based treatment facility 

22 for substance abuse; and 

23 ‘‘(VII) an assessment of the treat24 ment and other services and programs 

25 available in the State, to effectively 


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1 carry out any plan of safe care devel2 oped, including identification of needed 

3 treatment, and other services and pro4 grams to ensure the wellbeing of young 

5 children and their families affected by 

6 substance use disorder, such as pro7 grams carried out under part C of the 

8 Individuals with Disabilities Edu9 cation Act and comprehensive early 

10 childhood development services and 

11 programs such as Head Start pro12 grams; 

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

14 plans to use funds for activities described in 

15 subparagraph (D) for the purposes of ensur16 ing State compliance with requirements 

17 under clauses (ii) and (iii) of section 

18 106(b)(2)(B); and 

19 ‘‘(iii) an assurance that the State 

20 will— 

21 ‘‘(I) comply with this Act and 

22 parts B and E of title IV of the Social 

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

24 670 et seq.); and 


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1 ‘‘(II) comply with requirements to 

2 refer a child identified as substance-ex3 posed to early intervention services as 

4 required pursuant to a grant under 

5 part C of the Individuals with Disabil6 ities Education Act (20 U.S.C. 1431 et 

7 seq.). 

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

9 a State under this paragraph may be used for 

10 the following activities, which may be carried 

11 out by the State directly, or through grants or 

12 subgrants, contracts, or cooperative agreements: 

13 ‘‘(i) Improving State and local systems 

14 with respect to the development and imple15 mentation of plans of safe care, which— 

16 ‘‘(I) shall include parent and 

17 caregiver engagement, as required 

18 under section 106(b)(2)(B)(iii)(I), re19 garding available treatment and serv20 ice options, which may include re21 sources available for pregnant, 

22 perinatal, and postnatal women; and 

23 ‘‘(II) may include activities such 

24 as— 


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1 ‘‘(aa) developing policies, 

2 procedures, or protocols for the 

3 administration or development of 

4 evidence-based and validated 

5 screening tools for infants who 

6 may be affected by substance use 

7 withdrawal symptoms or a fetal 

8 alcohol spectrum disorder and 

9 pregnant, perinatal, and post10 natal women whose infants may 

11 be affected by substance use with12 drawal symptoms or a fetal alco13 hol spectrum disorder; 

14 ‘‘(bb) improving assessments 

15 used to determine the needs of the 

16 infant and family; 

17 ‘‘(cc) improving ongoing case 

18 management services; and 

19 ‘‘(dd) improving access to 

20 treatment services, which may be 

21 prior to the pregnant woman’s de22 livery date. 

23 ‘‘(ii) Developing policies, procedures, 

24 or protocols in consultation and coordina25 tion with health professionals, public and 


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1 private health facilities, and substance use 

2 disorder treatment agencies to ensure that— 

3 ‘‘(I) appropriate notification to 

4 child protective services is made in a 

5 timely manner; 

6 ‘‘(II) a plan of safe care is in 

7 place, in accordance with section 

8 106(b)(2)(B)(iii), before the infant is 

9 discharged from the birth or health 

10 care facility; and 

11 ‘‘(III) such health and related 

12 agency professionals are trained on 

13 how to follow such protocols and are 

14 aware of the supports that may be pro15 vided under a plan of safe care. 

16 ‘‘(iii) Training health professionals 

17 and health system leaders, child welfare 

18 workers, substance use disorder treatment 

19 agencies, and other related professionals 

20 such as home visiting agency staff and law 

21 enforcement in relevant topics including— 

22 ‘‘(I) State mandatory reporting 

23 laws and the referral and process and 

24 requirements for notification to child 


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1 protective services when child abuse or 

2 neglect reporting is not mandated; 

3 ‘‘(II) the co-occurrence of preg4 nancy and substance use disorder, and 

5 implications of prenatal exposure; 

6 ‘‘(III) the clinical guidance about 

7 treating substance use disorder in 

8 pregnant and postpartum women; 

9 ‘‘(IV) appropriate screening and 

10 interventions for infants affected by 

11 substance use disorder, withdrawal 

12 symptoms, or a fetal alcohol spectrum 

13 disorder and the requirements under 

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

15 ‘‘(V) appropriate 

16 multigenerational strategies to address 

17 the mental health needs of the parent 

18 and child together. 

19 ‘‘(iv) Establishing partnerships, agree20 ments, or memoranda of understanding be21 tween the lead agency and health profes22 sionals, health facilities, child welfare pro23 fessionals, juvenile and family court judges, 

24 substance use and mental disorder treat25 ment programs, early childhood education 


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1 programs, and maternal and child health 

2 and early intervention professionals, includ3 ing home visiting providers, peer-to-peer re4 covery programs such as parent mentoring 

5 programs, and housing agencies to facilitate 

6 the implementation of, and compliance with 

7 section 106(b)(2) and clause (ii) of this sub8 paragraph, in areas which may include— 

9 ‘‘(I) developing a comprehensive, 

10 multi-disciplinary assessment and 

11 intervention process for infants, preg12 nant women, and their families who 

13 are affected by substance use disorder, 

14 withdrawal symptoms, or a fetal alco15 hol spectrum disorder, that includes 

16 meaningful engagement with and takes 

17 into account the unique needs of each 

18 family and addresses differences be19 tween medically supervised substance 

20 use, including for the treatment of sub21 stance use disorder, and substance use 

22 disorder; 

23 ‘‘(II) ensuring that treatment ap24 proaches for serving infants, pregnant 

25 women, and perinatal and postnatal 


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1 women whose infants may be affected 

2 by substance use, withdrawal symp3 toms, or a fetal alcohol spectrum dis4 order, are designed to, where appro5 priate, keep infants with their mothers 

6 during both inpatient and outpatient 

7 treatment; and 

8 ‘‘(III) increasing access to all evi9 dence-based medication-assisted treat10 ment approved by the Food and Drug 

11 Administration, behavioral therapy, 

12 and counseling services for the treat13 ment of substance use disorders, as ap14 propriate. 

15 ‘‘(v) Developing and updating systems 

16 of technology for improved data collection 

17 and monitoring under section 

18 106(b)(2)(B)(iii), including existing elec19 tronic medical records, to measure the out20 comes achieved through the plans of safe 

21 care, including monitoring systems to meet 

22 the requirements of this Act and submission 

23 of performance measures. 

24 ‘‘(E) REPORTING.—Each State that receives 

25 funds under this paragraph, for each year such 


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1 funds are received, shall submit a report to the 

2 Secretary, disaggregated by geographic location, 

3 economic status, and major racial and ethnic 

4 groups, except that such disaggregation shall not 

5 be required if the results would reveal personally 

6 identifiable information, on, with respect to in7 fants identified under section 106(b)(2)(B)(ii)— 

8 ‘‘(i) the number who experienced re9 moval associated with parental substance 

10 use; 

11 ‘‘(ii) the number who experienced re12 moval and are subsequently are reunified 

13 with parents, and the length of time between 

14 such removal and reunification; 

15 ‘‘(iii) the number who are referred to 

16 community providers without a child pro17 tection case; 

18 ‘‘(iv) the number who received services 

19 while in the care of their birth parents; 

20 ‘‘(v) the number who receive post-re21 unification services within 1 year after a 

22 reunification has occurred; and 

23 ‘‘(vi) the number who experienced a re24 turn to out-of-home care within 1 year after 

25 reunification. 


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1 ‘‘(F) SECRETARY’S REPORT TO CON2 GRESS.—The Secretary shall submit an annual 

3 report to the Committee on Health, Education, 

4 Labor, and Pensions and the Committee on Ap5 propriations of the Senate and the Committee on 

6 Education and the Workforce and the Committee 

7 on Appropriations of the House of Representa8 tives that includes the information described in 

9 subparagraph (E) and recommendations or ob10 servations on the challenges, successes, and les11 sons derived from implementation of the grant 

12 program. 

13 ‘‘(G) RESERVATION OF FUNDS.—The Sec14 retary shall use the amount reserved under sub15 paragraph (B)(i)(I) for the purposes of— 

16 ‘‘(i) providing technical assistance, in17 cluding programs of in-depth technical as18 sistance, to additional States, territories, 

19 and Indian tribes and tribal organizations 

20 in accordance with the substance-exposed 

21 infant initiative developed by the National 

22 Center on Substance Abuse and Child Wel23 fare; 

24 ‘‘(ii) issuing guidance on the require25 ments of this Act with respect to infants 


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1 born with and identified as being affected 

2 by substance use or withdrawal symptoms 

3 or fetal alcohol spectrum disorder, as de4 scribed in clauses (ii) and (iii) of section 

5 106(b)(2)(B), including by— 

6 ‘‘(I) clarifying key terms; and 

7 ‘‘(II) disseminating best practices 

8 on implementation of plans of safe 

9 care, on such topics as differential re10 sponse, collaboration and coordination, 

11 and identification and delivery of serv12 ices for different populations; 

13 ‘‘(iii) supporting State efforts to de14 velop information technology systems to 

15 manage plans of safe care; and 

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

17 to Congress described in subparagraph (F). 

18 ‘‘(H) AUTHORIZATION OF APPROPRIA19 TIONS.—To carry out the program under this 

20 paragraph, there are authorized to be appro21 priated $60,000,000 for each of fiscal years 2019 

22 through 2023.’’. 


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1 SEC. 413. 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 speci13 fying— 

14 ‘‘(i) the limited circumstances in which 

15 a special registration under this subsection 

16 may be issued; and 

17 ‘‘(ii) the procedure for obtaining a spe18 cial 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 proposed 

24 regulations; 


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

2 60 days for comments on the proposed regu3 lations; 

4 ‘‘(iii) finalize the proposed regulation 

5 not later than 6 months after the close of the 

6 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. 414. 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 participant in the Scholarship Pro23 gram or the Loan Repayment Program (referred to in this 

24 section as a ‘participant’) is assigned under section 333 

25 may direct such participant to provide service as a behavVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 ioral or mental health professional at a school or other com2 munity-based setting located in a health professional short3 age area. 

4 ‘‘(b) OBLIGATED SERVICE.— 

5 ‘‘(1) IN GENERAL.—Any service described in sub6 section (a) that a participant provides may count to7 wards such participant’s completion of any obligated 

8 service requirements under the Scholarship Program 

9 or the Loan Repayment Program, subject to any limi10 tation imposed under paragraph (2). 

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

12 limitation on the number of hours of service described 

13 in subsection (a) that a participant may credit to14 wards completing obligated service requirements, pro15 vided that the limitation allows a member to credit 

16 service described in subsection (a) for not less than 50 

17 percent of the total hours required to complete such 

18 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. 415. LOAN REPAYMENT FOR SUBSTANCE USE DIS23 ORDER TREATMENT PROVIDERS. 

24 (a) LOAN REPAYMENT FOR SUBSTANCE USE TREAT25 MENT PROVIDERS.—The Secretary shall enter into conVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 tracts under section 338B of the Public Health Service Act 

2 (42 U.S.C. 254l-1) with eligible health professionals pro3 viding substance use disorder treatment services in sub4 stance use disorder treatment facilities, as defined by the 

5 Secretary. 

6 (b) PROVISION OF SUBSTANCE USE DISORDER TREAT7 MENT.—In carrying out the activities described in sub8 section (a)— 

9 (1) each such facility shall be located in or serv10 ing a mental health professional shortage area des11 ignated under section 332 of the Public Health Serv12 ice Act (42 U.S.C. 254e), or, as the Secretary deter13 mines appropriate, an area with an age-adjusted rate 

14 of drug overdose deaths that is above the national 

15 overdose mortality rate; 

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

17 254d(a)(3)(D)) shall be applied as if the term ‘‘pri18 mary health services’’ includes health services regard19 ing substance use disorder treatment and infections 

20 associated with illicit drug use; 

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

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

23 term ‘‘behavioral and mental health professionals’’ in24 cludes masters level, licensed substance use disorder 

25 treatment counselors, and other relevant professionals 


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1 or paraprofessionals, as the Secretary determines ap2 propriate; and 

3 (4) such professionals and facilities shall pro4 vide— 

5 (A) directly, or through the use of telehealth 

6 technology, and pursuant to Federal and State 

7 law, counseling by a program counselor or other 

8 certified professional who is licensed and quali9 fied by education, training, or experience to as10 sess the psychological and sociological back11 ground of patients, to contribute to the appro12 priate treatment plan for the patient, and to 

13 monitor progress; and 

14 (B) medication-assisted treatment, includ15 ing, to the extent practicable, all drugs approved 

16 by the Food and Drug Administration to treat 

17 substance use disorders, pursuant to Federal and 

18 State law. 

19 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated to carry out this section 

21 $25,000,000 for each of fiscal years 2019 through 2023. 

22 SEC. 416. PROTECTING MOMS AND INFANTS. 

23 (a) REPORT.— 

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

25 the date of enactment of this Act, the Secretary shall 


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1 submit to the appropriate committees of Congress and 

2 make available to the public on the internet website 

3 of the Department of Health and Human Services a 

4 report regarding the implementation of the rec5 ommendations in the strategy relating to prenatal 

6 opioid use, including neonatal abstinence syndrome, 

7 developed pursuant to section 2 of the Protecting Our 

8 Infants Act of 2015 (Public Law 114–91). Such re9 port shall include— 

10 (A) an update on the implementation of the 

11 recommendations in the strategy, including in12 formation regarding the agencies involved in the 

13 implementation; and 

14 (B) information on additional funding or 

15 authority the Secretary requires, if any, to im16 plement the strategy, which may include au17 thorities needed to coordinate implementation of 

18 such strategy across the Department of Health 

19 and Human Services. 

20 (2) PERIODIC UPDATES.—The Secretary shall 

21 periodically update the report under paragraph (1). 

22 (b) RESIDENTIAL TREATMENT PROGRAMS FOR PREG23 NANT AND POSTPARTUM WOMEN.—Section 508(s) of the 

24 Public Health Service Act (42 U.S.C. 290bb–1(s)) is amend25 ed by striking ‘‘$16,900,000 for each of fiscal years 2017 


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1 through 2021’’ and inserting ‘‘$29,931,000 for each of fiscal 

2 years 2019 through 2023’’. 

3 SEC. 417. EARLY INTERVENTIONS FOR PREGNANT WOMEN 

4 AND INFANTS. 

5 (a) DEVELOPMENT OF EDUCATIONAL MATERIALS BY

6 CENTER FOR SUBSTANCE ABUSE PREVENTION.—Section 

7 515(b) of the Public Health Service Act (42 U.S.C. 290bb– 

8 21(b)) is amended— 

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

10 end; 

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

12 the end and inserting ‘‘; and’’; and 

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

14 ‘‘(15) in cooperation with relevant stakeholders 

15 and the Director of the Centers for Disease Control 

16 and Prevention, develop educational materials for cli17 nicians to use with pregnant women for shared deci18 sionmaking regarding pain management during preg19 nancy.’’. 

20 (b) GUIDELINES AND RECOMMENDATIONS BY CENTER

21 FOR SUBSTANCE ABUSE TREATMENT.—Section 507(b) of 

22 the Public Health Service Act (42 U.S.C. 290bb(b)) is 

23 amended— 

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

25 end; 


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

2 the end and inserting a semicolon; and 

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

4 ‘‘(15) in cooperation with the Secretary, imple5 ment and disseminate, as appropriate, the rec6 ommendations in the report entitled ‘Protecting Our 

7 Infants Act: Final Strategy’ issued by the Depart8 ment of Health and Human Services in 2017; and’’. 

9 (c) SUPPORT OF PARTNERSHIPS BY CENTER FOR SUB10 STANCE ABUSE TREATMENT.—Section 507(b) of the Public 

11 Health Service Act (42 U.S.C. 290bb(b)), as amended by 

12 subsection (b), is further amended by adding at the end the 

13 following: 

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

15 support public-private partnerships to assist with 

16 education about, and support with respect to, sub17 stance use disorder for pregnant women and health 

18 care providers who treat pregnant women and ba19 bies.’’. 

20 SEC. 418. REPORT ON INVESTIGATIONS REGARDING PARITY 

21 IN MENTAL HEALTH AND SUBSTANCE USE 

22 DISORDER BENEFITS. 

23 (a) IN GENERAL.—Section 13003 of the 21st Century 

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


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1 (1) in subsection (a), by striking ‘‘with findings 

2 of any serious violation regarding’’ and inserting 

3 ‘‘concerning’’; and 

4 (2) in subsection (b)(1)— 

5 (A) by inserting ‘‘complaints received and 

6 number of’’ before ‘‘closed’’; and 

7 (B) by inserting before the period ‘‘, and, 

8 for each such investigation closed, which agency 

9 conducted the investigation, whether the health 

10 plan that is the subject of the investigation is 

11 fully insured or not fully insured and a sum12 mary of any coordination between the applicable 

13 State regulators and the Department of Labor, 

14 the Department of Health and Human Services, 

15 or the Department of the Treasury, and ref16 erences to any guidance provided by the agencies 

17 addressing the category of violation committed’’. 

18 (b) APPLICABILITY.—The amendments made by sub19 section (a) shall apply with respect to the second annual 

20 report required under such section 13003 and each such an21 nual report thereafter. 

22 TITLE V—PREVENTION 

23 SEC. 501. STUDY ON PRESCRIBING LIMITS. 

24 Not later than 2 years after the date of enactment of 

25 this Act, the Secretary, in consultation with the Attorney 


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1 General, shall submit to the Committee on Health, Edu2 cation, Labor, and Pensions of the Senate and the Com3 mittee on Energy and Commerce of the House of Represent4 atives a report on the impact of Federal and State laws 

5 and regulations that limit the length, quantity, or dosage 

6 of opioid prescriptions. Such report shall address— 

7 (1) the impact of such limits on— 

8 (A) the incidence and prevalence of overdose 

9 related to prescription opioids; 

10 (B) the incidence and prevalence of overdose 

11 related to illicit opioids; 

12 (C) the prevalence of opioid use disorders; 

13 (D) medically appropriate use of, and ac14 cess to, opioids, including any impact on travel 

15 expenses and pain management outcomes for pa16 tients, whether such limits are associated with 

17 significantly higher rates of negative health out18 comes, including suicide, and whether the impact 

19 of such limits differs based on clinical indication 

20 for which opioids are prescribed; 

21 (2) whether such limits lead to a significant in22 crease in burden for prescribers of opioids or pre23 scribers of treatments for opioid use disorder, includ24 ing any impact on patient access to treatment, and 


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1 whether any such burden is mitigated by any factors 

2 such as electronic prescribing or telemedicine; and 

3 (3) the impact of such limits on diversion or 

4 misuse of any controlled substance in schedule II, III, 

5 or IV of section 202(c) of the Controlled Substances 

6 Act (21 U.S.C. 812(c)). 

7 SEC. 502. PROGRAMS FOR HEALTH CARE WORKFORCE. 

8 (a) PROGRAM FOR EDUCATION AND TRAINING IN PAIN

9 CARE.—Section 759 of the Public Health Service Act (42 

10 U.S.C. 294i) is amended— 

11 (1) in subsection (a), by striking ‘‘hospices, and 

12 other public and private entities’’ and inserting ‘‘hos13 pices, tribal health programs (as defined in section 4 

14 of the Indian Health Care Improvement Act), and 

15 other public and nonprofit private entities’’ ; 

16 (2) in subsection (b)— 

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

18 by striking ‘‘award may be made under sub19 section (a) only if the applicant for the award 

20 agrees that the program carried out with the 

21 award will include’’ and inserting ‘‘entity re22 ceiving an award under this section shall develop 

23 a comprehensive education and training plan 

24 that includes’’; 

25 (B) in paragraph (1)— 


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1 (i) by inserting ‘‘preventing,’’ after 

2 ‘‘diagnosing,’’; and 

3 (ii) by inserting ‘‘non-addictive med4 ical products and non-pharmacologic treat5 ments and’’ after ‘‘including’’; 

6 (C) in paragraph (2)— 

7 (i) by inserting ‘‘Federal, State, and 

8 local’’ after ‘‘applicable’’; and 

9 (ii) by striking ‘‘the degree to which’’ 

10 and all that follows through ‘‘effective pain 

11 care’’ and inserting ‘‘opioids’’; 

12 (D) in paragraph (3), by inserting ‘‘, inte13 grated, evidence-based pain management, and, as 

14 appropriate, non-pharmacotherapy’’ before the 

15 semicolon; 

16 (E) in paragraph (4), by striking ‘‘; and’’ 

17 and inserting ‘‘;’’; and 

18 (F) by striking paragraph (5) and inserting 

19 the following: 

20 ‘‘(5) recent findings, developments, and advance21 ments in pain care research and the provision of pain 

22 care, which may include non-addictive medical prod23 ucts and non-pharmacologic treatments intended to 

24 treat pain; and 


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1 ‘‘(6) the dangers of opioid abuse and misuse, de2 tection of early warning signs of opioid use disorders 

3 (which may include best practices related to screening 

4 for opioid use disorders, training on screening, brief 

5 intervention, and referral to treatment), and safe dis6 posal options for prescription medications (including 

7 such options provided by law enforcement or other in8 novative deactivation mechanisms).’’; 

9 (3) in subsection (d), by inserting ‘‘prevention,’’ 

10 after ‘‘diagnosis,’’; and 

11 (4) in subsection (e), by striking ‘‘2010 through 

12 2012’’ and inserting ‘‘2019 through 2023’’. 

13 (b) MENTAL AND BEHAVIORAL HEALTH EDUCATION

14 AND TRAINING PROGRAM.—Section 756(a) of the Public 

15 Health Service Act (42 U.S.C. 294e–1(a)) is amended— 

16 (1) in paragraph (1), by inserting ‘‘, trauma,’’ 

17 after ‘‘focus on child and adolescent mental health’’; 

18 and 

19 (2) in paragraphs (2) and (3), by inserting 

20 ‘‘trauma-informed care and’’ before ‘‘substance use 

21 disorder prevention and treatment services’’. 

22 SEC. 503. EDUCATION AND AWARENESS CAMPAIGNS. 

23 Section 102 of the Comprehensive Addiction and Re24 covery Act of 2016 (Public Law 114–198) is amended— 


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1 (1) by amending subsection (a) to read as fol2 lows: 

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

4 Human Services, acting through the Director of the Centers 

5 for Disease Control and Prevention and in coordination 

6 with the heads of other departments and agencies, shall ad7 vance education and awareness regarding the risks related 

8 to misuse and abuse of opioids, as appropriate, which may 

9 include developing or improving existing programs, con10 ducting activities, and awarding grants that advance the 

11 education and awareness of— 

12 ‘‘(1) the public, including patients and con13 sumers; 

14 ‘‘(2) patients, consumers, and other appropriate 

15 members of the public, regarding such risks related to 

16 unused opioids and the dispensing options under sec17 tion 309(f) of the Controlled Substances Act, as appli18 cable; 

19 ‘‘(3) providers, which may include— 

20 ‘‘(A) providing for continuing education on 

21 appropriate prescribing practices; 

22 ‘‘(B) education related to applicable State 

23 or local prescriber limit laws, information on the 

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1 agement, and the use of overdose reversal drugs, 

2 as appropriate; 

3 ‘‘(C) disseminating and improving the use 

4 of evidence-based opioid prescribing guidelines 

5 across relevant health care settings, as appro6 priate, and updating guidelines as necessary; 

7 ‘‘(D) implementing strategies, such as best 

8 practices, to encourage and facilitate the use of 

9 prescriber guidelines, in accordance with State 

10 and local law; 

11 ‘‘(E) disseminating information to pro12 viders about prescribing options for controlled 

13 substances, including such options under section 

14 309(f) of the Controlled Substances Act, as appli15 cable; and 

16 ‘‘(F) disseminating information, as appro17 priate, on the National Pain Strategy developed 

18 by or in consultation with the Assistant Sec19 retary for Health; and 

20 ‘‘(4) other appropriate entities.’’; and 

21 (2) in subsection (b)— 

22 (A) by striking ‘‘opioid abuse’’ each place 

23 such term appears and inserting ‘‘opioid misuse 

24 and abuse’’; and 


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1 (B) in paragraph (2), by striking ‘‘safe dis2 posal of prescription medications and other’’ and 

3 inserting ‘‘non-addictive treatment options, safe 

4 disposal options for prescription medications, 

5 and other applicable’’. 

6 SEC. 504. ENHANCED CONTROLLED SUBSTANCE 

7 OVERDOSES DATA COLLECTION, ANALYSIS, 

8 AND DISSEMINATION. 

9 Part J of title III of the Public Health Service Act 

10 is amended by inserting after section 392 (42 U.S.C. 280b– 

11 1) the following: 

12 ‘‘SEC. 392A. ENHANCED CONTROLLED SUBSTANCE 

13 OVERDOSES DATA COLLECTION, ANALYSIS, 

14 AND DISSEMINATION. 

15 ‘‘(a) IN GENERAL.—The Director of the Centers for 

16 Disease Control and Prevention, using the authority pro17 vided to the Director under section 392, may— 

18 ‘‘(1) to the extent practicable, carry out and ex19 pand any controlled substance overdose data collec20 tion, analysis, and dissemination activity described 

21 in subsection (b); 

22 ‘‘(2) provide training and technical assistance to 

23 States, localities, and Indian tribes for the purpose of 

24 carrying out any such activity; and 


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1 ‘‘(3) award grants to States, localities, and In2 dian tribes for the purpose of carrying out any such 

3 activity. 

4 ‘‘(b) CONTROLLED SUBSTANCE OVERDOSE DATA COL5 LECTION AND ANALYSIS ACTIVITIES.—A controlled sub6 stance overdose data collection, analysis, and dissemination 

7 activity described in this subsection is any of the following 

8 activities: 

9 ‘‘(1) Improving the timeliness of reporting aggre10 gate data to the public, including data on fatal and 

11 nonfatal controlled substance overdoses. 

12 ‘‘(2) Enhancing the comprehensiveness of con13 trolled substance overdose data by collecting informa14 tion on such overdoses from appropriate sources such 

15 as toxicology reports, autopsy reports, death scene in16 vestigations, and emergency department services. 

17 ‘‘(3) Modernizing the system for coding causes of 

18 death related to controlled substance overdoses to use 

19 an electronic-based system. 

20 ‘‘(4) Using data to help identify risk factors as21 sociated with controlled substance overdoses, including 

22 the delivery of certain health care services. 

23 ‘‘(5) Supporting entities involved in reporting 

24 information on controlled substance overdoses, such as 

25 coroners and medical examiners, to improve accurate 


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1 testing and standardized reporting of causes and con2 tributing factors of such overdoses, and analysis of 

3 various opioid analogues to controlled substances 

4 overdoses. 

5 ‘‘(6) Working to enable and encourage the access, 

6 exchange, and use of data regarding controlled sub7 stances overdoses among data sources and entities. 

8 ‘‘(c) DEFINITIONS.—In this section— 

9 ‘‘(1) the term ‘controlled substance’ has the 

10 meaning given that term in section 102 of the Con11 trolled Substances Act; and 

12 ‘‘(2) the term ‘Indian tribe’ has the meaning 

13 given that term in section 4 of the Indian Self-Deter14 mination and Education Assistance Act.’’. 

15 SEC. 505. PREVENTING OVERDOSES OF CONTROLLED SUB16 STANCES. 

17 Part J of title III of the Public Health Service Act 

18 (42 U.S.C. 280b et seq.), as amended by section 504, is fur19 ther amended by inserting after section 392A the following: 

20 ‘‘SEC. 392B. PREVENTING OVERDOSES OF CONTROLLED 

21 SUBSTANCES. 

22 ‘‘(a) PREVENTION ACTIVITIES.— 

23 ‘‘(1) IN GENERAL.—The Director of the Centers 

24 for Disease Control and Prevention (referred to in 


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1 this section as the ‘Director’), using the authority 

2 provided to the Director under section 392, may— 

3 ‘‘(A) to the extent practicable, carry out and 

4 expand any prevention activity described in 

5 paragraph (2); 

6 ‘‘(B) provide training and technical assist7 ance to States, localities, and Indian tribes to 

8 carrying out any such activity; and 

9 ‘‘(C) award grants to States, localities, and 

10 Indian tribes for the purpose of carrying out any 

11 such activity. 

12 ‘‘(2) PREVENTION ACTIVITIES.—A prevention ac13 tivity described in this paragraph is an activity to 

14 improve the efficiency and use of a new or currently 

15 operating prescription drug monitoring program, 

16 such as— 

17 ‘‘(A) encouraging all authorized users (as 

18 specified by the State or other entity) to register 

19 with and use the program; 

20 ‘‘(B) enabling such users to access any data 

21 updates in as close to real-time as practicable; 

22 ‘‘(C) providing for a mechanism for the pro23 gram to notify authorized users of any potential 

24 misuse or abuse of controlled substances and any 


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1 detection of inappropriate prescribing or dis2 pensing practices relating to such substances; 

3 ‘‘(D) encouraging the analysis of prescrip4 tion drug monitoring data for purposes of pro5 viding de-identified, aggregate reports based on 

6 such analysis to State public health agencies, 

7 State alcohol and drug agencies, State licensing 

8 boards, and other appropriate State agencies, as 

9 permitted under applicable Federal and State 

10 law and the policies of the prescription drug 

11 monitoring program and not containing any 

12 protected health information, to prevent inappro13 priate prescribing, drug diversion, or abuse and 

14 misuse of controlled substances, and to facilitate 

15 better coordination among agencies; 

16 ‘‘(E) enhancing interoperability between the 

17 program and any health information technology 

18 (including certified health information tech19 nology), including by integrating program data 

20 into such technology; 

21 ‘‘(F) updating program capabilities to re22 spond to technological innovation for purposes of 

23 appropriately addressing the occurrence and evo24 lution of controlled substance overdoses; 


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1 ‘‘(G) developing or enhancing data exchange 

2 with other sources such as the Medicaid agency, 

3 the Medicare program, pharmacy benefit man4 agers, coroners’ reports, and workers’ compensa5 tion data; 

6 ‘‘(H) facilitating and encouraging data ex7 change between the program and the prescription 

8 drug monitoring programs of other States; 

9 ‘‘(I) enhancing data collection and quality, 

10 including improving patient matching and 

11 proactively monitoring data quality; and 

12 ‘‘(J) providing prescriber and dispenser 

13 practice tools, including prescriber practice in14 sight reports for practitioners to review their 

15 prescribing patterns in comparison to such pat16 ters of other practitioners the specialty. 

17 ‘‘(b) ADDITIONAL GRANTS.—The Director may award 

18 grants to States, localities, and Indian tribes— 

19 ‘‘(1) to carry out innovative projects for grantees 

20 to rapidly respond to controlled substance misuse, 

21 abuse, and overdoses, including changes in patterns of 

22 controlled substance use; and 

23 ‘‘(2) for any other evidence-based activity for 

24 preventing controlled substance misuse, abuse, and 

25 overdoses as the Director determines appropriate. 


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1 ‘‘(c) RESEARCH.—The Director, in coordination with 

2 the Assistant Secretary for Mental Health and Substance 

3 Use and the National Mental Health and Substance Use 

4 Policy Laboratory established under section 501A, as ap5 propriate and applicable, may conduct studies and evalua6 tions to address substance use disorders, including pre7 venting substance use disorders or other related topics the 

8 Director determines appropriate. 

9 ‘‘(d) PUBLIC AND PRESCRIBER EDUCATION.—Pursu10 ant to section 102 of the Comprehensive Addiction and Re11 covery Act of 2016, the Director may advance the education 

12 and awareness of prescribers and the public regarding the 

13 risk of abuse and misuse of prescription opioids. 

14 ‘‘(e) DEFINITIONS.—In this section— 

15 ‘‘(1) the term ‘controlled substance’ has the 

16 meaning given that term in section 102 of the Con17 trolled Substances Act; and 

18 ‘‘(2) the term ‘Indian tribe’ has the meaning 

19 given that term in section 4 of the Indian Self-Deter20 mination and Education Assistance Act. 

21 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For pur22 poses of carrying out this section, section 392A of this Act, 

23 and section 102 of the Comprehensive Addiction and Recov24 ery Act of 2016, there is authorized to be appropriated 

25 $486,000,000 for each of fiscal years 2019 through 2024.’’. 


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1 SEC. 506. CDC SURVEILLANCE AND DATA COLLECTION FOR 

2 CHILD, YOUTH, AND ADULT TRAUMA. 

3 (a) DATA COLLECTION.—The Director of the Centers 

4 for Disease Control and Prevention (referred to in this sec5 tion as the ‘‘Director’’) may, in cooperation with the States, 

6 collect and report data on adverse childhood experiences 

7 through the Behavioral Risk Factor Surveillance System, 

8 the Youth Risk Behavior Surveillance System, and other 

9 relevant public health surveys or questionnaires. 

10 (b) TIMING.—The collection of data under subsection 

11 (a) may occur in fiscal year 2019 and every 2 years there12 after. 

13 (c) DATA FROM TRIBAL AND RURAL AREAS.—The Di14 rector shall encourage each State that participates in col15 lecting and reporting data under subsection (a) to collect 

16 and report data from tribal and rural areas within such 

17 State, in order to generate a statistically reliable represen18 tation of such areas. 

19 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

20 out this section, there are authorized to be appropriated 

21 such sums as may be necessary for the period of fiscal years 

22 2019 through 2021. 

23 SEC. 507. REAUTHORIZATION OF NASPER. 

24 Section 399O of the Public Health Service Act (42 

25 U.S.C. 280g–3) is amended— 

26 (1) in subsection (a)— 


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1 (A) in paragraph (1), in the matter pre2 ceding subparagraph (A), by striking ‘‘in con3 sultation with the Administrator of the Sub4 stance Abuse and Mental Health Services Ad5 ministration and Director of the Centers for Dis6 ease Control and Prevention’’ and inserting ‘‘in 

7 coordination with the Director of the Centers for 

8 Disease Control and the heads of other depart9 ments and agencies as appropriate’’; and 

10 (B) by adding at the end the following: 

11 ‘‘(4) STATES AND LOCAL GOVERNMENTS.— 

12 ‘‘(A) IN GENERAL.—In the case of a State 

13 that does not have a prescription drug moni14 toring program, a county or other unit of local 

15 government within the State that has a prescrip16 tion drug monitoring program shall be treated as 

17 a State for purposes of this section, including for 

18 purposes of eligibility for grants under para19 graph (1). 

20 ‘‘(B) PLAN FOR INTEROPERABILITY.—For 

21 purposes of meeting the interoperability require22 ments under subsection (c)(3), a county or other 

23 unit of local government shall submit a plan out24 lining the methods such county or unit of local 

25 government will use to ensure the capability of 


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1 data sharing with other counties and units of 

2 local government within the State and with other 

3 States, as applicable.’’; 

4 (2) in subsection (c)— 

5 (A) in paragraph (1)(A)(iii)— 

6 (i) by inserting ‘‘as such standards be7 come available,’’ after ‘‘interoperability 

8 standards,’’; and 

9 (ii) by striking ‘‘generated or identified 

10 by the Secretary or his or her designee’’ and 

11 inserting ‘‘recognized by the Office of the 

12 National Coordinator for Health Informa13 tion Technology’’; and 

14 (B) in paragraph (3)(A), by inserting ‘‘in15 cluding electronic health records,’’ after ‘‘tech16 nology systems,’’; 

17 (3) in subsection (d)(1), by striking ‘‘not later 

18 than 1 week after the date of such dispensing’’ and 

19 inserting ‘‘in as close to real time as practicable’’; 

20 (4) in subsection (f)— 

21 (A) in paragraph (1)(D), by striking ‘‘med22 icaid’’ and inserting ‘‘Medicaid’’; and 

23 (B) in paragraph (2)— 

24 (i) in subparagraph (A), by striking 

25 ‘‘and’’ at the end; 


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1 (ii) in subparagraph (B), by striking 

2 the period and inserting a semicolon; and 

3 (iii) by adding at the end the fol4 lowing: 

5 ‘‘(C) may conduct analyses of controlled 

6 substance program data for purposes of pro7 viding appropriate State agencies with aggregate 

8 reports based on such analyses in as close to 

9 real-time as practicable, regarding prescription 

10 patterns flagged as potentially presenting a risk 

11 of misuse, abuse, addiction, overdose, and other 

12 aggregate information, as appropriate and in 

13 compliance with applicable Federal and State 

14 laws and provided that such reports shall not in15 clude protected health information; and 

16 ‘‘(D) may access information about pre17 scriptions, such as claims data, to ensure that 

18 such prescribing and dispensing history is up19 dated in as close to real-time as practicable, in 

20 compliance with applicable Federal and State 

21 laws and provided that such information shall 

22 not include protected health information.’’; 

23 (5) in subsection (i), by inserting ‘‘, in collabora24 tion with the National Coordinator for Health Infor25 mation Technology and the Director of the National 


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1 Institute of Standards and Technology,’’ after ‘‘The 

2 Secretary’’; and 

3 (6) in subsection (n), by striking ‘‘2021’’ and in4 serting ‘‘2026’’. 

5 SEC. 508. JESSIE’S LAW. 

6 (a) BEST PRACTICES.— 

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

8 the date of enactment of this Act, the Secretary, in 

9 consultation with appropriate stakeholders, including 

10 a patient with a history of opioid use disorder, an ex11 pert in electronic health records, an expert in the con12 fidentiality of patient health information and records, 

13 and a health care provider, shall identify or facilitate 

14 the development of best practices regarding— 

15 (A) the circumstances under which informa16 tion that a patient has provided to a health care 

17 provider regarding such patient’s history of 

18 opioid use disorder should, only at the patient’s 

19 request, be prominently displayed in the medical 

20 records (including electronic health records) of 

21 such patient; 

22 (B) what constitutes the patient’s request 

23 for the purpose described in subparagraph (A); 

24 and 


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1 (C) the process and methods by which the 

2 information should be so displayed. 

3 (2) DISSEMINATION.—The Secretary shall dis4 seminate the best practices developed under para5 graph (1) to health care providers and State agencies. 

6 (b) REQUIREMENTS.—In identifying or facilitating 

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

8 applicable, the Secretary, in consultation with appropriate 

9 stakeholders, shall consider the following: 

10 (1) The potential for addiction relapse or over11 dose, including overdose death, when opioid medica12 tions are prescribed to a patient recovering from 

13 opioid use disorder. 

14 (2) The benefits of displaying information about 

15 a patient’s opioid use disorder history in a manner 

16 similar to other potentially lethal medical concerns, 

17 including drug allergies and contraindications. 

18 (3) The importance of prominently displaying 

19 information about a patient’s opioid use disorder 

20 when a physician or medical professional is pre21 scribing medication, including methods for avoiding 

22 alert fatigue in providers. 

23 (4) The importance of a variety of appropriate 

24 medical professionals, including physicians, nurses, 

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1 scribed in this section when prescribing or dispensing 

2 opioid medication, consistent with Federal and State 

3 laws and regulations. 

4 (5) The importance of protecting patient pri5 vacy, including the requirements related to consent 

6 for disclosure of substance use disorder information 

7 under all applicable laws and regulations. 

8 (6) All applicable Federal and State laws and 

9 regulations. 

10 SEC. 509. DEVELOPMENT AND DISSEMINATION OF MODEL 

11 TRAINING PROGRAMS FOR SUBSTANCE USE 

12 DISORDER PATIENT RECORDS. 

13 (a) INITIAL PROGRAMS AND MATERIALS.—Not later 

14 than 1 year after the date of the enactment of this Act, the 

15 Secretary, in consultation with appropriate experts, shall 

16 identify the following model programs and materials (or 

17 if no such programs or materials exist, recognize private 

18 or public entities to develop and disseminate such programs 

19 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 pri3 vacy policies) concerning the permitted uses and dis4 closures, consistent with the standards and regula5 tions governing the privacy and security of substance 

6 use disorder patient records promulgated by the Sec7 retary under section 543 of the Public Health Service 

8 Act (42 U.S.C. 290dd–2) for the confidentiality of pa9 tient 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 mate15 rials described in paragraphs (1) and (2) of subsection (a) 

16 shall address circumstances under which disclosure of sub17 stance use disorder patient records is needed to— 

18 (1) facilitate communication between substance 

19 use disorder treatment providers and other health care 

20 providers to promote and provide the best possible in21 tegrated 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 ma8 terials to the individuals described in subsection 

9 (a)(1). 

10 (d) INPUT OF CERTAIN ENTITIES.—In identifying, re11 viewing, 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, such 

16 sums as may be necessary for each of fiscal years 2019 

17 through 2023. 

18 SEC. 510. COMMUNICATION WITH FAMILIES DURING EMER19 GENCIES. 

20 (a) PROMOTING AWARENESS OF AUTHORIZED DISCLO21 SURES DURING EMERGENCIES.—The Secretary shall annu22 ally notify health care providers regarding permitted disclo23 sures during emergencies, including overdoses, of certain 

24 health information to families and caregivers under Federal 

25 health care privacy laws and regulations. 


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1 (b) USE OF MATERIAL.—For the purposes of carrying 

2 out subsection (a), the Secretary may use material produced 

3 under section 509 of this Act or under section 11004 of the 

4 21st Century Cures Act (42 U.S.C. 1320d–2 note). 

5 SEC. 511. PRENATAL AND POSTNATAL HEALTH. 

6 Section 317L of the Public Health Service Act (42 

7 U.S.C. 247b–13) is amended— 

8 (1) in subsection (a)— 

9 (A) by amending paragraph (1) to read as 

10 follows: 

11 ‘‘(1) to collect, analyze, and make available data 

12 on prenatal smoking, alcohol and substance abuse and 

13 misuse, including— 

14 ‘‘(A) data on— 

15 ‘‘(i) the incidence, prevalence, and im16 plications of such activities; and 

17 ‘‘(ii) the incidence and prevalence of 

18 implications and outcomes, including neo19 natal abstinence syndrome and other mater20 nal and child health outcomes associated 

21 with such activities; and 

22 ‘‘(B) to inform such analysis, additional in23 formation or data on family health history, 

24 medication exposures during pregnancy, demo25 graphic information, such as race, ethnicity, geoVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 graphic location, and family history, and other 

2 relevant information, as appropriate;’’; 

3 (B) in paragraph (2)— 

4 (i) by striking ‘‘prevention of’’ and in5 serting ‘‘prevention and long-term outcomes 

6 associated with’’; and 

7 (ii) by striking ‘‘illegal drug use’’ and 

8 inserting ‘‘substance abuse and misuse’’; 

9 (C) in paragraph (3), by striking ‘‘and ces10 sation programs; and’’ and inserting ‘‘, treat11 ment, and cessation programs;’’; 

12 (D) in paragraph (4), by striking ‘‘illegal 

13 drug use.’’ and inserting ‘‘substance abuse and 

14 misuse; and’’; and 

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

16 ‘‘(5) to issue public reports on the analysis of 

17 data described in paragraph (1), including analysis 

18 of— 

19 ‘‘(A) long-term outcomes of children affected 

20 by neonatal abstinence syndrome; 

21 ‘‘(B) health outcomes associated with pre22 natal smoking, alcohol, and substance abuse and 

23 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 subsection 

7 (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 (b); 

14 ‘‘(2) ensure a pathway for data sharing between 

15 States, tribal entities, and the Centers for Disease 

16 Control and Prevention; 

17 ‘‘(3) ensure data collection under this section is 

18 consistent with applicable State, Federal, and Tribal 

19 privacy laws; and 

20 ‘‘(4) coordinate with the National Coordinator 

21 for Health Information Technology, as appropriate, 

22 to assist States and tribes in implementing systems 

23 that use standards recognized by such National Coor24 dinator, as such recognized standards are available, 

25 in order to facilitate interoperability between such 


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1 systems and health information technology systems, 

2 including certified health information technology.’’; 

3 and 

4 (5) in subsection (d), as so redesignated, by 

5 striking ‘‘2001 through 2005’’ and inserting ‘‘2019 

6 through 2023’’. 

7 SEC. 512. SURVEILLANCE AND EDUCATION REGARDING IN8 FECTIONS ASSOCIATED WITH ILLICIT DRUG 

9 USE AND OTHER RISK FACTORS. 

10 Section 317N of the Public Health Service Act (42 

11 U.S.C. 247b–15) is amended— 

12 (1) by amending the section heading to read as 

13 follows: ‘‘SURVEILLANCE AND EDUCATION RE14 GARDING INFECTIONS ASSOCIATED WITH IL15 LICIT DRUG USE AND OTHER RISK FACTORS’’; 

16 (2) in subsection (a)— 

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

18 by inserting ‘‘activities’’ before the colon; 

19 (B) in paragraph (1)— 

20 (i) by inserting ‘‘or maintaining’’ after 

21 ‘‘implementing’’; 

22 (ii) by striking ‘‘hepatitis C virus in23 fection (in this section referred to as ‘HCV 

24 infection’)’’ and inserting ‘‘infections com25 monly associated with illicit drug use, 


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1 which may include viral hepatitis, human 

2 immunodeficiency virus, and infective endo3 carditis,’’; and 

4 (iii) by striking ‘‘such infection’’ and 

5 all that follows through the period at the 

6 end and inserting ‘‘such infections, which 

7 may include the reporting of cases of such 

8 infections.’’; 

9 (C) in paragraph (2), by striking ‘‘HCV in10 fection’’ and all that follows through the period 

11 at the end and inserting ‘‘infections as a result 

12 of illicit drug use, receiving blood transfusions 

13 prior to July 1992, or other risk factors.’’; 

14 (D) in paragraphs (4) and (5), by striking 

15 ‘‘HCV infection’’ each place such term appears 

16 and inserting ‘‘infections described in paragraph 

17 (1)’’; and 

18 (E) in paragraph (5), by striking ‘‘pediatri19 cians and other primary care physicians, and 

20 obstetricians and gynecologists’’ and inserting 

21 ‘‘substance use disorder treatment providers, pe22 diatricians, other primary care providers, and 

23 obstetrician-gynecologists’’; 

24 (3) in subsection (b)— 


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1 (A) by striking ‘‘directly and’’ and insert2 ing ‘‘directly or’’; and 

3 (B) by striking ‘‘hepatitis C,’’ and all that 

4 follows through the period at the end and insert5 ing ‘‘infections described in subsection (a)(1).’’; 

6 and 

7 (4) in subsection (c), by striking ‘‘such sums as 

8 may be necessary for each of the fiscal years 2001 

9 through 2005’’ and inserting ‘‘$40,000,000 for each of 

10 fiscal years 2019 through 2023’’. 

11 SEC. 513. TASK FORCE TO DEVELOP BEST PRACTICES FOR 

12 TRAUMA-INFORMED IDENTIFICATION, REFER13 RAL, AND SUPPORT. 

14 (a) ESTABLISHMENT.—There is established a task 

15 force, to be known as the Interagency Task Force on Trau16 ma-Informed Care (in this section referred to as the ‘‘task 

17 force’’) that shall identify, evaluate, and make recommenda18 tions regarding best practices with respect to children and 

19 youth, and their families as appropriate, who have experi20 enced or are at risk of experiencing trauma. 

21 (b) MEMBERSHIP.— 

22 (1) COMPOSITION.—The task force shall be com23 posed of the heads of the following Federal depart24 ments and agencies, or their designees: 


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1 (A) The Centers for Medicare & Medicaid 

2 Services. 

3 (B) The Substance Abuse and Mental 

4 Health Services Administration. 

5 (C) The Agency for Healthcare Research 

6 and Quality. 

7 (D) The Centers for Disease Control and 

8 Prevention. 

9 (E) The Indian Health Service. 

10 (F) The Department of Veterans Affairs. 

11 (G) The National Institutes of Health. 

12 (H) The Food and Drug Administration. 

13 (I) The Health Resources and Services Ad14 ministration. 

15 (J) The Department of Defense. 

16 (K) The Office of Minority Health. 

17 (L) The Administration for Children and 

18 Families. 

19 (M) The Office of the Assistant Secretary 

20 for Planning and Evaluation. 

21 (N) The Office for Civil Rights at the De22 partment of Health and Human Services. 

23 (O) The Office of Juvenile Justice and De24 linquency Prevention of the Department of Jus25 tice. 


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1 (P) The Office of Community Oriented Po2 licing Services of the Department of Justice. 

3 (Q) The Office on Violence Against Women 

4 of the Department of Justice. 

5 (R) The National Center for Education 

6 Evaluation and Regional Assistance of the De7 partment of Education. 

8 (S) The National Center for Special Edu9 cation Research of the Institute of Education 

10 Science. 

11 (T) The Office of Elementary and Sec12 ondary Education of the Department of Edu13 cation. 

14 (U) The Office for Civil Rights at the De15 partment of Education. 

16 (V) The Office of Special Education and 

17 Rehabilitative Services of the Department of 

18 Education. 

19 (W) The Bureau of Indian Affairs of the 

20 Department of the Interior. 

21 (X) The Veterans Health Administration of 

22 the Department of Veterans Affairs. 

23 (Y) The Office of Special Needs Assistance 

24 Programs of the Department of Housing and 

25 Urban Development. 


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1 (Z) The Office of Head Start of the Admin2 istration for Children and Families. 

3 (AA) The Children’s Bureau of the Admin4 istration for Children and Families. 

5 (BB) The Bureau of Indian Education of 

6 the Department of the Interior. 

7 (CC) Such other Federal agencies as the 

8 Secretaries determine to be appropriate. 

9 (2) DATE OF APPOINTMENTS.—The heads of Fed10 eral departments and agencies shall appoint the cor11 responding members of the task force not later than 

12 6 months after the date of enactment of this Act. 

13 (3) CHAIRPERSON.—The task force shall be 

14 chaired by the Assistant Secretary for Mental Health 

15 and Substance Use. 

16 (c) TASK FORCE DUTIES.—The task force shall— 

17 (1) solicit input from stakeholders, including 

18 frontline service providers, educators, mental health 

19 professionals, researchers, experts in infant, child, and 

20 youth trauma, child welfare professionals, and the 

21 public, in order to inform the activities under para22 graph (2); and 

23 (2) identify, evaluate, make recommendations, 

24 and update such recommendations not less than an25 nually, to the general public, the Secretary of EduVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 cation, the Secretary of Health and Human Services, 

2 the Secretary of Labor, the Secretary of the Interior, 

3 the Attorney General, and other relevant cabinet Sec4 retaries, and Congress regarding— 

5 (A) a set of evidence-based, evidence-in6 formed, and promising best practices with re7 spect to— 

8 (i) the identification of infants, chil9 dren and youth, and their families as ap10 propriate, who have experienced or are at 

11 risk of experiencing trauma; and 

12 (ii) the expeditious referral to and im13 plementation of trauma-informed practices 

14 and supports that prevent and mitigate the 

15 effects of trauma; 

16 (B) a national strategy on how the task 

17 force and member agencies will collaborate, 

18 prioritize options for, and implement a coordi19 nated approach which may include data sharing 

20 and the awarding of grants that support infants, 

21 children, and youth, and their families as appro22 priate, who have experienced or are at risk of ex23 periencing trauma; and 

24 (C) existing Federal authorities at the De25 partment of Education, Department of Health 


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1 and Human Services, Department of Justice, 

2 Department of Labor, Department of Interior, 

3 and other relevant agencies, and specific Federal 

4 grant programs to disseminate best practices on, 

5 provide training in, or deliver services through, 

6 trauma-informed practices, and disseminate such 

7 information— 

8 (i) in writing to relevant program of9 fices at such agencies to encourage grant 

10 applicants in writing to use such funds, 

11 where appropriate, for trauma-informed 

12 practices; and 

13 (ii) to the general public through the 

14 internet website of the task force. 

15 (d) BEST PRACTICES.—In identifying, evaluating, 

16 and recommending the set of best practices under subsection 

17 (c), the task force shall— 

18 (1) include guidelines for providing professional 

19 development for front-line services providers, includ20 ing school personnel, early childhood education pro21 gram providers, providers from child- or youth-serv22 ing organizations, housing and homeless providers, 

23 primary and behavioral health care providers, child 

24 welfare and social services providers, juvenile and 

25 family court personnel, health care providers, individVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 uals who are mandatory reporters of child abuse or 

2 neglect, trained nonclinical providers (including peer 

3 mentors and clergy), and first responders, in— 

4 (A) understanding and identifying early 

5 signs and risk factors of trauma in infants, chil6 dren, and youth, and their families as appro7 priate, including through screening processes; 

8 (B) providing practices to prevent and 

9 mitigate the impact of trauma, including by fos10 tering safe and stable environments and relation11 ships; and 

12 (C) developing and implementing policies, 

13 procedures, or systems that— 

14 (i) are designed to quickly refer in15 fants, children, youth, and their families as 

16 appropriate, who have experienced or are at 

17 risk of experiencing trauma to the appro18 priate trauma-informed screening and sup19 port, including age-appropriate treatment, 

20 and to ensure such infants, children, youth, 

21 and family members receive such support; 

22 (ii) utilize and develop partnerships 

23 with early childhood education programs, 

24 local social services organizations, such as 

25 organizations serving youth, and clinical 


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1 mental health or health care service pro2 viders with expertise in providing support 

3 services (including age-appropriate trauma4 informed and evidence-based treatment) 

5 aimed at preventing or mitigating the ef6 fects of trauma; 

7 (iii) educate children and youth to— 

8 (I) understand and identify the 

9 signs, effects, or symptoms of trauma; 

10 and 

11 (II) build the resilience and cop12 ing skills to mitigate the effects of expe13 riencing trauma; 

14 (iv) promote and support multi15 generational practices that assist parents, 

16 foster parents, and kinship and other care17 givers in accessing resources related to, and 

18 developing environments conducive to, the 

19 prevention and mitigation of trauma; and 

20 (v) collect and utilize data from 

21 screenings, referrals, or the provision of 

22 services and supports to evaluate and im23 prove processes for trauma-informed sup24 port and outcomes that are culturally sen25 sitive, linguistically appropriate, and speVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 cific to age ranges and sex, as applicable; 

2 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 the 

9 date of enactment of this Act, the task force shall hold the 

10 first meeting. Not later than 2 years after such date of en11 actment, the task force shall submit to the Secretary of Edu12 cation, Secretary of Health and Human Services, Secretary 

13 of Labor, Secretary of the Interior, the Attorney General, 

14 and Congress an operating plan for carrying out the activi15 ties of the task force described in subsection (c)(2). Such 

16 operating plan shall include— 

17 (1) a list of specific activities that the task force 

18 plans to carry out for purposes of carrying out duties 

19 described in subsection (c)(2), which may include 

20 public engagement; 

21 (2) a plan for carrying out the activities under 

22 subsection (c)(2); 

23 (3) a list of members of the task force and other 

24 individuals who are not members of the task force 

25 that may be consulted to carry out such activities; 


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1 (4) an explanation of Federal agency involve2 ment and coordination needed to carry out such ac3 tivities, including any statutory or regulatory bar4 riers to such coordination; 

5 (5) a budget for carrying out such activities; and 

6 (6) other information that the task force deter7 mines appropriate. 

8 (f) FINAL REPORT.—Not later than 3 years after the 

9 date of the first meeting of the task force, the task force shall 

10 submit to the general public, Secretary of Education, Sec11 retary of Health and Human Services, Secretary of Labor, 

12 Secretary of the Interior, the Attorney General, and other 

13 relevant cabinet Secretaries, and Congress, a final report 

14 containing all of the findings and recommendations re15 quired under this section. 

16 (g) DEFINITION.—In this section, the term ‘‘early 

17 childhood education program’’ has the meaning given such 

18 term in section 103 of the Higher Education Act of 1965 

19 (20 U.S.C. 1003). 

20 (h) AUTHORIZATION OF APPROPRIATIONS.—To carry 

21 out this section, there are authorized to be appropriated 

22 such sums as may be necessary for each of fiscal years 2019 

23 through 2022. 


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1 (i) SUNSET.—The task force shall on the date that is 

2 60 days after the submission of the final report under sub3 section (f), but not later than September 30, 2022. 

4 SEC. 514. GRANTS TO IMPROVE TRAUMA SUPPORT SERV5 ICES AND MENTAL HEALTH CARE FOR CHIL6 DREN AND YOUTH IN EDUCATIONAL SET7 TINGS. 

8 (a) GRANTS, CONTRACTS, AND COOPERATIVE AGREE9 MENTS AUTHORIZED.—The Secretary, in coordination with 

10 the Assistant Secretary for Mental Health and Substance 

11 Use, is authorized to award grants to, or enter into con12 tracts or cooperative agreements with, State educational 

13 agencies, local educational agencies, Head Start agencies 

14 (including Early Head Start agencies), State or local agen15 cies that administer public preschool programs, Indian 

16 tribes or their tribal educational agencies, a school operated 

17 by the Bureau of Indian Education, a Regional Corpora18 tion (as defined in section 3 of the Alaska Native Claims 

19 Settlement Act (43 U.S.C. 1602)), or a Native Hawaiian 

20 educational organization (as defined in section 6207 of the 

21 Elementary and Secondary Education Act of 1965 (20 

22 U.S.C. 7517)), for the purpose of increasing student access 

23 to evidence-based trauma support services and mental 

24 health care by developing innovative initiatives, activities, 

25 or programs to link local school systems with local traumaVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 informed support and mental health systems, including 

2 those under the Indian Health Service. 

3 (b) DURATION.—With respect to a grant, contract, or 

4 cooperative agreement awarded or entered into under this 

5 section, the period during which payments under such 

6 grant, contract or agreement are made to the recipient may 

7 not exceed 4 years. 

8 (c) USE OF FUNDS.—An entity that receives a grant, 

9 contract, or cooperative agreement under this section shall 

10 use amounts made available through such grant, contract, 

11 or cooperative agreement for evidence-based activities, 

12 which shall include any of the following: 

13 (1) Collaborative efforts between school-based 

14 service systems and trauma-informed support and 

15 mental health service systems to provide, develop, or 

16 improve prevention, screening, referral, and treatment 

17 and support services to students, such as by providing 

18 universal trauma screenings to identify students in 

19 need of specialized support. 

20 (2) To implement schoolwide multi-tiered posi21 tive behavioral interventions and supports, or other 

22 trauma-informed models of support. 

23 (3) To provide professional development to teach24 ers, teacher assistants, school leaders, specialized inVerDate Sep 11 2014 22:05 May 07, 2018 Jkt 079200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6203 E:\BILLS\S2680.RS S2680

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1 structional support personnel, and mental health pro2 fessionals that— 

3 (A) fosters safe and stable learning environ4 ments that prevent and mitigate the effects of 

5 trauma, including through social and emotional 

6 learning; 

7 (B) improves school capacity to identify, 

8 refer, and provide services to students in need of 

9 trauma support or behavioral health services; or 

10 (C) reflects the best practices developed by 

11 the Interagency Task Force on Trauma-Informed 

12 Care established under section 513. 

13 (4) Engaging families and communities in ef14 forts to increase awareness of child and youth trau15 ma, which may include sharing best practices with 

16 law enforcement regarding trauma-informed care and 

17 working with mental health professionals to provide 

18 interventions, as well as longer term coordinated care 

19 within the community for children and youth who 

20 have experienced trauma and their families. 

21 (5) To provide technical assistance to school sys22 tems 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 and 

2 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 innovative initiatives, 

10 activities, or programs to be funded under the grant, 

11 contract, or cooperative agreement, including how 

12 such program will increase access to evidence-based 

13 trauma support services and mental health care for 

14 students, and, as applicable, the families of such stu15 dents. 

16 (2) A description of how the program will pro17 vide linguistically appropriate and culturally com18 petent services. 

19 (3) A description of how the program will sup20 port students and the school in improving the school 

21 climate in order to support an environment conducive 

22 to learning. 

23 (4) An assurance that— 


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1 (A) persons providing services under the 

2 grant, contract, or cooperative agreement are 

3 adequately trained to provide such services; and 

4 (B) teachers, school leaders, administrators, 

5 specialized instructional support personnel, rep6 resentatives of local Indian tribes or tribal orga7 nizations as appropriate, other school personnel, 

8 and parents or guardians of students partici9 pating in services under this section will be en10 gaged and involved in the design and implemen11 tation of the services. 

12 (5) A description of how the applicant will sup13 port and integrate existing school-based services with 

14 the program in order to provide mental health serv15 ices for students, as appropriate. 

16 (e) INTERAGENCY AGREEMENTS.— 

17 (1) DESIGNATION OF LEAD AGENCY.—A recipient 

18 of a grant, contract, or cooperative agreement under 

19 this section shall designate a lead agency to direct the 

20 establishment of an interagency agreement among 

21 local educational agencies, agencies responsible for 

22 early childhood education programs, juvenile justice 

23 authorities, mental health agencies, child welfare 

24 agencies, and other relevant entities in the State or 

25 Indian tribe, in collaboration with local entities. 


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1 (2) CONTENTS.—The interagency agreement 

2 shall ensure the provision of the services described in 

3 subsection (c), specifying with respect to each agency, 

4 authority, or entity— 

5 (A) the financial responsibility for the serv6 ices; 

7 (B) the conditions and terms of responsi8 bility for the services, including quality, account9 ability, and coordination of the services; and 

10 (C) the conditions and terms of reimburse11 ment among the agencies, authorities, or entities 

12 that are parties to the interagency agreement, 

13 including procedures for dispute resolution. 

14 (f) EVALUATION.—The Secretary shall reserve not to 

15 exceed 3 percent of the funds made available under sub16 section (l) for each fiscal year to— 

17 (1) conduct a rigorous, independent evaluation 

18 of the activities funded under this section; and 

19 (2) disseminate and promote the utilization of 

20 evidence-based practices regarding trauma support 

21 services and mental health care. 

22 (g) DISTRIBUTION OF AWARDS.—The Secretary shall 

23 ensure that grants, contracts, and cooperative agreements 

24 awarded or entered into under this section are equitably 

25 distributed among the geographical regions of the United 


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1 States and among tribal, urban, suburban, and rural popu2 lations. 

3 (h) RULE OF CONSTRUCTION.—Nothing in this section 

4 shall be construed— 

5 (1) to prohibit an entity involved with a pro6 gram carried out under this section from reporting a 

7 crime that is committed by a student to appropriate 

8 authorities; or 

9 (2) to prevent Federal, State, and tribal law en10 forcement and judicial authorities from exercising 

11 their responsibilities with regard to the application of 

12 Federal, tribal, and State law to crimes committed by 

13 a student. 

14 (i) SUPPLEMENT, NOT SUPPLANT.—Any services pro15 vided through programs carried out under this section shall 

16 supplement, and not supplant, existing mental health serv17 ices, including any special education and related services 

18 provided under the Individuals with Disabilities Education 

19 Act (20 U.S.C. 1400 et seq.). 

20 (j) CONSULTATION WITH INDIAN TRIBES.—In car21 rying out subsection (a), the Secretary shall, in a timely 

22 manner, meaningfully consult, engage, and cooperate with 

23 Indian tribes and their representatives to ensure notice of 

24 eligibility. 

25 (k) DEFINITIONS.—In this section: 


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1 (1) ELEMENTARY OR SECONDARY SCHOOL.—The 

2 term ‘‘elementary or secondary school’’ means a pub3 lic elementary and secondary school as such term is 

4 defined in section 8101 of the Elementary and Sec5 ondary Education Act of 1965 (20 U.S.C. 7801). 

6 (2) EVIDENCE-BASED.—The term ‘‘evidence7 based’’ has the meaning given such term in section 

8 8101(21)(A)(i) of the Elementary and Secondary 

9 Education Act of 1965 (20 U.S.C. 7801(21)(A)(i)). 

10 (3) NATIVE HAWAIIAN EDUCATIONAL ORGANIZA11 TION.—The term ‘‘Native Hawaiian educational or12 ganization’’ has the meaning given such term in sec13 tion 6207 of the Elementary and Secondary Edu14 cation Act of 1965 (20 U.S.C. 7517). 

15 (4) SCHOOL LEADER.—The term ‘‘school leader’’ 

16 has the meaning given such term in section 8101 of 

17 the Elementary and Secondary Education Act of 

18 1965 (20 U.S.C. 7801). 

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

20 the Secretary of Education. 

21 (6) SPECIALIZED INSTRUCTIONAL SUPPORT PER22 SONNEL.—The term ‘‘specialized instructional sup23 port personnel’’ has the meaning given such term in 

24 8101 of the Elementary and Secondary Education 

25 Act of 1965 (20 U.S.C. 7801). 


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1 (l) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to carry out this section, such 

3 sums as may be necessary for each of fiscal years 2019 

4 through 2023. 

5 SEC. 515. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE. 

6 Section 582(j) of the Public Health Service Act (42 

7 U.S.C. 290hh–1(j)) (relating to grants to address the prob8 lems of persons who experience violence related stress) is 

9 amended by striking ‘‘$46,887,000 for each of fiscal years 

10 2018 through 2022’’ and inserting ‘‘$53,887,000 for each 

11 of fiscal years 2019 through 2023’’. 


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Calendar No. 398 

115TH CONGRESS 

2D SESSION S. 2680 

A BILL 

To address the opioid crisis. 

MAY 7, 2018 

Reported with an amendment 


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