II 

115TH CONGRESS 

2D SESSION S. 2700 

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

local areas affected by the opioid epidemic and to make financial assistance available to States, territories, Tribal nations, local areas, and 

public or private nonprofit entities to provide for the development, organization, coordination, and operation of more effective and cost efficient 

systems for the delivery of essential services to individuals with substance 

use disorder and their families. 

IN THE SENATE OF THE UNITED STATES 

APRIL 18, 2018 

Ms. WARREN introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To provide emergency assistance to States, territories, Tribal 

nations, and local areas affected by the opioid epidemic 

and to make financial assistance available to States, territories, Tribal nations, local areas, and public or private 

nonprofit entities to provide for the development, organization, coordination, and operation of more effective and 

cost efficient systems for the delivery of essential services 

to individuals with substance use disorder and their families. 

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


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Comprehensive Addiction Resources Emergency Act of 

4 2018’’. 

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

6 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Purpose. 

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

‘‘TITLE XXXIV—SUBSTANCE USE AND OPIOID HEALTH 

RESOURCES 

‘‘Subtitle A—Substance Use and Opioid Emergency Relief Grant Program 

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

‘‘Sec. 3402. Planning council. 

‘‘Sec. 3403. Amount of grant and use of amounts. 

‘‘Sec. 3404. Application. 

‘‘Sec. 3405. Technical assistance. 

‘‘Sec. 3406. Authorization of appropriations. 

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

Intervention Grant Program 

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

‘‘Sec. 3412. Amount of grant and use of amounts. 

‘‘Sec. 3413. Application and limitation. 

‘‘Sec. 3414. Technical assistance. 

‘‘Sec. 3415. Authorization of appropriations. 

‘‘Subtitle C—Other Grant Program 

‘‘Sec. 3421. Establishment of grant program. 

‘‘Sec. 3422. Use of amounts. 

‘‘Sec. 3423. Technical assistance. 

‘‘Sec. 3424. Planning and development grants. 

‘‘Sec. 3425. Authorization of appropriations. 

‘‘Subtitle D—Miscellaneous Provisions 

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

‘‘Sec. 3432. Education and training centers. 

‘‘Sec. 3433. Other provisions. 

‘‘Sec. 3434. Standards for substance use disorder treatment and recovery 

facilities. 

‘‘Sec. 3435. Naloxone distribution program. 

‘‘Sec. 3436. Additional funding for the National Institutes of Health. 

‘‘Sec. 3437. Additional funding for improved data collection and prevention 

of infectious disease transmission. 


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‘‘Sec. 3438. Definitions. 

Sec. 4. Amendments to the Controlled Substances Act. 

1 SEC. 2. PURPOSE. 

2 It is the purpose of this Act to provide emergency 

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

4 areas that are disproportionately affected by the opioid 

5 epidemic and to make financial assistance available to 

6 States, territories, Tribal nations, local areas, and other 

7 public or private nonprofit entities to provide for the devel8 opment, organization, coordination, and operation of more 

9 effective and cost efficient systems for the delivery of es10 sential services to individuals and families with substance 

11 use disorder. 

12 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

13 ACT. 

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

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

16 ‘‘TITLE XXXIV—SUBSTANCE USE 

17 AND OPIOID HEALTH RE18 SOURCES 

19 ‘‘Subtitle A—Substance Use and 

20 Opioid Emergency Relief Grant 

21 Program 

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

23 ‘‘(a) IN GENERAL.—The Secretary, in coordination 

24 with the Director of the Office of National Drug Control 


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1 Policy, shall award grants to eligible localities for the pur2 pose of addressing substance use within such localities. 

3 ‘‘(b) ELIGIBILITY.— 

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

5 grant under subsection (a) a locality shall— 

6 ‘‘(A) be— 

7 ‘‘(i) a county that can demonstrate 

8 that the rate of drug overdose deaths per 

9 100,000 individuals residing in the county 

10 during the most recent 3-year period for 

11 which such data are available was not less 

12 than the rate of such deaths for the county 

13 that ranked at the 67th percentile of all 

14 counties, as determined by the Secretary; 

15 ‘‘(ii) a county that can demonstrate 

16 that the number of drug overdose deaths 

17 during the most recent 3-year period for 

18 which such data are available was not less 

19 than the number of such deaths for the 

20 county that ranked at the 90th percentile 

21 of all counties, as determined by the Sec22 retary; or 

23 ‘‘(iii) a city that is located within a 

24 county described in clause (i) or (ii), that 


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1 meets the requirements of paragraph (3); 

2 and 

3 ‘‘(B) submit to the Secretary an applica4 tion in accordance with section 3404. 

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

6 the case of an eligible county that is contiguous to 

7 one or more other eligible counties within the same 

8 State, the group of counties shall— 

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

10 county for purposes of a grant under this sec11 tion; 

12 ‘‘(B) submit a single application under sec13 tion 3404; 

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

15 purposes of section 3402); and 

16 ‘‘(D) establish, through intergovernmental 

17 agreements, an administrative mechanism to al18 locate funds and substance use disorder treat19 ment services under the grant based on— 

20 ‘‘(i) the number and rate of drug 

21 overdose deaths and nonfatal drug 

22 overdoses in each of the counties that com23 pose the eligible county; 

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

25 in each such county; and 


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1 ‘‘(iii) the health and support per2 sonnel needs of each such county. 

3 ‘‘(3) CITIES AND COUNTIES WITHIN MULTIPLE

4 CONTIGUOUS COUNTIES.— 

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

6 an eligible county described in paragraph (1), 

7 or a group of counties that is within a group of 

8 counties determined to be an eligible county 

9 under paragraph (2), shall be eligible to receive 

10 a grant under section 3401 if such city or coun11 ty or group of counties meets the requirements 

12 of subparagraph (B). 

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

14 meets the requirements of this subparagraph if 

15 such city or county— 

16 ‘‘(i) except as provided in subpara17 graph (C), has a population of not less 

18 than 50,000 residents; 

19 ‘‘(ii) meets the requirements of para20 graph (1)(A); 

21 ‘‘(iii) submits an application under 

22 section 3404; 

23 ‘‘(iv) establishes a planning council 

24 (for purposes of section 3402); and 


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1 ‘‘(v) establishes an administrative 

2 mechanism to allocate funds and services 

3 under the grant based on— 

4 ‘‘(I) the number and rate of drug 

5 overdose deaths and nonfatal drug 

6 overdoses in the city or county; 

7 ‘‘(II) the severity of need for sub8 stance use disorder treatment services 

9 in the city or county; and 

10 ‘‘(III) the health and support 

11 personnel needs of the city or county. 

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

13 county or group of counties that does not meet 

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

15 apply to the Secretary for a waiver of such re16 quirement. Such application shall dem17 onstrate— 

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

19 to be served are distinct or that addressing 

20 substance use in the service area would be 

21 best served by the formation of an inde22 pendent council; and 

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

24 of counties has the capacity to administer 

25 the funding received under this subtitle. 


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1 ‘‘(D) MINIMUM FUNDING.—A city or coun2 ty that meets the requirement of this paragraph 

3 and receives a grant under section 3401 shall 

4 be entitled to an amount of funding under the 

5 grant in an amount that is not less than the 

6 amount determined under section 3403(a) with 

7 respect to such city or county. 

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

9 that are not located within the territory of a county 

10 shall be treated as eligible counties for purposes of 

11 this subtitle. 

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

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

14 governance, the Secretary shall determine the local 

15 political subdivisions within such States that are eli16 gible to receive a grant under section 3401 and such 

17 subdivisions shall be treated as eligible counties for 

18 purposes of this subtitle. 

19 ‘‘(6) DETERMINATIONS WHERE THERE IS A

20 LACK OF DATA.—The Secretary shall establish eligi21 bility and allocation criteria related to the prevalence 

22 of drug overdose deaths, the mortality rate from 

23 drug overdoses, and that provides an equivalent 

24 measure of need for funding for cities and counties 


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

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

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

4 date of enactment of this title, the Comptroller Gen5 eral shall conduct a study to determine whether the 

6 data utilized for purposes of paragraph (1)(A) pro7 vides the most precise measure of local area need re8 lated to substance use and addiction prevalence and 

9 whether additional data would provide more precise 

10 measures of substance use and addiction prevalence 

11 in local areas. Such study shall identify barriers to 

12 collecting or analyzing such data, and make rec13 ommendations for revising the indicators used under 

14 such paragraph to determine eligibility in order to 

15 direct funds to the local areas in most need of fund16 ing to provide assistance related to substance use 

17 and addiction. 

18 ‘‘(8) REFERENCE.—For purposes of this sub19 title, the term ‘eligible local area’ includes— 

20 ‘‘(A) a city or county described in para21 graph (1); 

22 ‘‘(B) multiple contiguous counties de23 scribed in paragraph (2); 

24 ‘‘(C) an independent locality described in 

25 paragraph (3); 


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1 ‘‘(D) an independent city described in 

2 paragraph (4); and 

3 ‘‘(E) a political subdivision described in 

4 paragraph (5). 

5 ‘‘(c) ADMINISTRATION.— 

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

7 under a grant awarded under this section shall be 

8 directed to the chief elected official of the eligible 

9 local area who shall administer the grant funds. 

10 ‘‘(2) MULTIPLE CONTIGUOUS COUNTIES.— 

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

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

13 county described in subsection (b)(2), assist14 ance made available under a grant awarded 

15 under this section shall be directed to the chief 

16 elected official of the particular county des17 ignated in the application submitted for the 

18 grant under section 3404. Such chief elected of19 ficial shall be the administrator of the grant. 

20 ‘‘(B) STATE ADMINISTRATION.—Notwith21 standing subparagraph (A), the eligible county 

22 described in subsection (b)(2) may elect to des23 ignate the chief elected State official of the 

24 State in which the eligible county is located as 

25 the administrator of the grant funds. 


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1 ‘‘SEC. 3402. PLANNING COUNCIL. 

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

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

4 eligible local area shall establish or designate a substance 

5 use disorder treatment and services planning council that 

6 shall, to the maximum extent practicable— 

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

8 the population of individuals with substance use dis9 order in the area; and 

10 ‘‘(2) include representatives of— 

11 ‘‘(A) health care providers, including feder12 ally qualified health centers, rural health clinics, 

13 Indian health programs as defined in section 4 

14 of the Indian Health Care Improvement Act, 

15 urban Indian organizations as defined in section 

16 4 of the Indian Health Care Improvement Act, 

17 Native Hawaiian organizations as defined in 

18 section 12 of the Native Hawaiian Health Care 

19 Act of 1988, and facilities operated by the De20 partment of Veterans Affairs; 

21 ‘‘(B) community-based health, harm reduc22 tion, or addiction service organizations, includ23 ing, where applicable, representatives of Drug 

24 Free Communities Coalition grantees; 


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1 ‘‘(C) social service providers, including pro2 viders of housing and homelessness services and 

3 recovery residence providers; 

4 ‘‘(D) mental health care providers; 

5 ‘‘(E) local public health agencies; 

6 ‘‘(F) law enforcement officials, including 

7 officials from High Intensity Drug Trafficking 

8 Area program, where applicable; 

9 ‘‘(G) affected communities, including indi10 viduals with substance use disorder or a history 

11 of substance use disorder, including individuals 

12 in recovery from substance use disorders; 

13 ‘‘(H) State governments, including the 

14 State Medicaid agency and the Single State 

15 Agency for Substance Abuse Services; 

16 ‘‘(I) local governments; 

17 ‘‘(J) non-elected community leaders; 

18 ‘‘(K) substance use disorder treatment pro19 viders; 

20 ‘‘(L) Indian tribes and tribal organizations 

21 as defined in section 4 of the Indian Self-Deter22 mination and Education Assistance Act; 

23 ‘‘(M) urban Indians as defined in section 4 

24 of the Indian Health Care Improvement Act; 


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1 ‘‘(N) historically underserved groups and 

2 subpopulations; 

3 ‘‘(O) individuals who were formerly incar4 cerated; 

5 ‘‘(P) organizations serving individuals who 

6 are currently or were formerly incarcerated; 

7 ‘‘(Q) representatives of Federal agencies; 

8 ‘‘(R) representatives of organizations that 

9 provide services to youth at risk of substance 

10 use; 

11 ‘‘(S) representatives of medical examiners 

12 or coroners; 

13 ‘‘(T) representatives of labor unions and 

14 the workplace community; and 

15 ‘‘(U) representatives of local fire depart16 ments and emergency medical services. 

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

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

19 for purposes of subsection (a), the chief elected offi20 cial of the eligible local area may establish the coun21 cil directly or designate an existing entity to serve as 

22 the council, subject to paragraph (2). 

23 ‘‘(2) CONSIDERATION REGARDING DESIGNATION

24 OF COUNCIL.—In making a determination of wheth25 er to establish or designate a council under paraVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 graph (1), the chief elected official shall give priority 

2 to the designation of an existing entity that has 

3 demonstrated experience in the provision of health 

4 and support services to individuals with substance 

5 use disorder within the eligible local area, that has 

6 a structure that recognizes the Federal trust respon7 sibility when spending Federal health care dollars, 

8 and that has demonstrated a commitment to re9 specting the obligation of government agencies using 

10 Federal dollars to consult with Indian tribes and 

11 confer with Urban Indian health programs. 

12 ‘‘(3) JOINT COUNCIL.—The Secretary shall es13 tablish a process to permit an eligible local area that 

14 is not contiguous with any other eligible local area 

15 to form a joint planning council with such other eli16 gible local area or areas, as long as such areas are 

17 located in geographical proximity to each other, as 

18 determined by the Secretary, and submit a joint ap19 plication under section 3404. 

20 ‘‘(4) JOINT COUNCIL ACROSS STATE LINES.— 

21 Eligible local areas may form a joint planning coun22 cil with other eligible local areas across State lines 

23 if such areas are located in geographical proximity 

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1 tablish intergovernmental agreements to allow the 

2 administration of the grant across State lines. 

3 ‘‘(c) MEMBERSHIP.—Members of the planning coun4 cil established or designated under subsection (a) shall— 

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

6 open process; 

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

8 and vice chair; 

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

10 Indian tribes located within any eligible local area 

11 that receives funding under the grant program es12 tablished in section 3401; and 

13 ‘‘(4) serve no more than 3 consecutive years on 

14 the planning council. 

15 ‘‘(d) MEMBERSHIP TERMS.—Members of the plan16 ning council established or designated under subsection 

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

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

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

20 designated under subsection (a) shall— 

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

22 grant funds within the eligible local area that em23 phasize reducing drug overdose and substance use 

24 disorder through evidence-based interventions in 


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1 both community and criminal justice settings and 

2 that are based on— 

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

4 use disorder treatment and intervention strate5 gies that comply with best practices identified 

6 by the Secretary; 

7 ‘‘(B) the demonstrated or probable cost-ef8 fectiveness of proposed substance use disorder 

9 treatment services; 

10 ‘‘(C) the health priorities of the commu11 nities within the eligible local area that are af12 fected by substance use; 

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

14 with substance use disorder; and 

15 ‘‘(E) the availability of other governmental 

16 and nongovernmental services; 

17 ‘‘(2) ensure the use of grant funds are con18 sistent with any existing State or local plan regard19 ing the provision of substance use disorder treat20 ment services to individuals with substance use dis21 order; 

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

23 work with local public health agencies to develop a 

24 comprehensive plan for the organization and delivery 

25 of substance use disorder treatment services; 


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1 ‘‘(4) regularly assess the efficiency of the ad2 ministrative mechanism in rapidly allocating funds 

3 to support evidence-based substance use disorder 

4 treatment services in the areas of greatest need 

5 within the eligible local area; 

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

7 determine the size and demographics of the popu8 lation of individuals with substance use disorders 

9 and the types of substance use that are most preva10 lent in the eligible local area; 

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

12 determine the needs of such population, including 

13 the need for substance use disorder treatment serv14 ices; 

15 ‘‘(7) work with local public agencies to deter16 mine the disparities in access to services among af17 fected subpopulations and historically underserved 

18 communities, including infrastructure and capacity 

19 shortcomings of providers that contribute to these 

20 disparities; 

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

22 methods for obtaining input on community needs 

23 and priorities, including by partnering with organi24 zations that serve targeted communities experiencing 

25 high opioid related health disparities to gather data 


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1 using culturally attuned data collection methodolo2 gies; 

3 ‘‘(9) coordinate with Federal grantees that pro4 vide substance use disorder treatment services within 

5 the eligible local area; and 

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

7 substance use disorder treatment services being sup8 ported by the grant received by the eligible local 

9 area, including— 

10 ‘‘(A) reductions in the rates of overdose 

11 and death from substance use disorders; 

12 ‘‘(B) rates of discontinuation from sub13 stance use disorder treatment services; 

14 ‘‘(C) long-term outcomes among individ15 uals receiving treatment for substance use dis16 orders; and 

17 ‘‘(D) the availability of substance use dis18 order treatment services needed by individuals 

19 with substance use disorders over their life20 times. 

21 ‘‘(f) CONFLICTS OF INTEREST.— 

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

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

24 administration of a grant under section 3401. 


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

2 may serve on the planning council under subsection 

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

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

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

6 individual is a member of a public or private organi7 zation, and such entity or organization is seeking 

8 amounts from a grant under section 3401, the indi9 vidual will not, with respect to the purpose for which 

10 the entity seeks such amounts, participate (directly 

11 or in an advisory capacity) in the process of select12 ing entities to receive such amounts for such pur13 pose. 

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

15 under subsection (a) shall develop procedures for address16 ing grievances with respect to funding under this subtitle, 

17 including procedures for submitting grievances that can18 not be resolved to binding arbitration. Such procedures 

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

20 ‘‘(h) PUBLIC DELIBERATIONS.—With respect to a 

21 planning council under subsection (a), in accordance with 

22 criteria established by the Secretary, the following applies: 

23 ‘‘(1) The meetings of the council shall be open 

24 to the public and shall be held only after adequate 

25 notice to the public. 


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1 ‘‘(2) The records, reports, transcripts, minutes, 

2 agenda, or other documents which were made avail3 able to or prepared for or by the council shall be 

4 available for public inspection and copying at a sin5 gle location. 

6 ‘‘(3) Detailed minutes of each meeting of the 

7 council shall be kept. The accuracy of all minutes 

8 shall be certified to by the chair of the council. 

9 ‘‘(4) This subparagraph does not apply to any 

10 disclosure of information of a personal nature that 

11 would constitute a clearly unwarranted invasion of 

12 personal privacy, including any disclosure of medical 

13 information or personnel matters. 

14 ‘‘SEC. 3403. AMOUNT OF GRANT AND USE OF AMOUNTS. 

15 ‘‘(a) AMOUNT OF GRANT.— 

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

17 AREA.— 

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

19 subtitle, the Secretary shall make a grant for 

20 each eligible local area for which an application 

21 under section 3404 has been approved. Each 

22 such grant shall be made in an amount deter23 mined in accordance with paragraph (3). 

24 ‘‘(B) EXPEDITED DISTRIBUTION.—Not 

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1 comes available to carry out this subtitle for a 

2 fiscal year, the Secretary shall disburse 53 per3 cent of the amount made available under sec4 tion 3406 for carrying out this subtitle for such 

5 fiscal year through grants to eligible local areas 

6 under section 3401, in accordance with sub7 paragraphs (C) and (D). 

8 ‘‘(C) AMOUNT.— 

9 ‘‘(i) IN GENERAL.—Subject to the ex10 tent of amounts made available in appro11 priations Acts, a grant made for purposes 

12 of this subparagraph to an eligible local 

13 area shall be made in an amount equal to 

14 the product of— 

15 ‘‘(I) an amount equal to the 

16 amount available for distribution 

17 under subparagraph (B) for the fiscal 

18 year involved; and 

19 ‘‘(II) the percentage constituted 

20 by the ratio of the distribution factor 

21 for the eligible local area to the sum 

22 of the respective distribution factors 

23 for all eligible local areas; 

24 which product shall then, as applicable, be 

25 increased under subparagraph (D). 


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1 ‘‘(ii) DISTRIBUTION FACTOR.—For 

2 purposes of clause (i)(II), the term ‘dis3 tribution factor’ means— 

4 ‘‘(I) an amount equal to— 

5 ‘‘(aa) the estimated number 

6 of drug overdose deaths in the el7 igible local area, as determined 

8 under clause (iii); or 

9 ‘‘(bb) the estimated number 

10 of non-fatal drug overdoses in the 

11 eligible local area, as determined 

12 under clause (iv); 

13 as determined by the Secretary based 

14 on which distribution factor (item (aa) 

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

16 area receiving the greatest amount of 

17 funds; or 

18 ‘‘(II) in the case of an eligible 

19 local area for which the data de20 scribed in subclause (I) is not avail21 able, an amount determined by the 

22 Secretary— 

23 ‘‘(aa) based on other data 

24 the Secretary determines appro25 priate; and 


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1 ‘‘(bb) that is related to the 

2 prevalence of non-fatal drug 

3 overdoses, drug overdose deaths, 

4 and the mortality rate from drug 

5 overdoses and provides an equiv6 alent measure of need for fund7 ing. 

8 ‘‘(iii) NUMBER OF DRUG OVERDOSE

9 DEATHS.—The number of drug overdose 

10 deaths determined under this clause for an 

11 eligible county for a fiscal year for pur12 poses of clause (ii) is the number of drug 

13 overdose deaths during the most recent 3- 

14 year period for which such data are avail15 able. 

16 ‘‘(iv) NUMBER OF NON-FATAL DRUG

17 OVERDOSES.—The number of non-fatal 

18 drug overdose deaths determined under 

19 this clause for an eligible county for a fis20 cal year for purposes of clause (ii) may be 

21 determined by using data including emer22 gency department syndromic data, visits, 

23 or other emergency medical services for 

24 drug-related causes during the most recent 


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1 3-year period for which such data are 

2 available. 

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

4 after the date of enactment of this title, 

5 the Comptroller General shall conduct a 

6 study to determine whether the data uti7 lized for purposes of clause (ii) provide the 

8 most precise measure of local area need re9 lated to substance use and addiction preva10 lence in local areas and whether additional 

11 data would provide more precise measures 

12 of substance use and addiction prevalence 

13 in local areas. Such study shall identify 

14 barriers to collecting or analyzing such 

15 data, and make recommendations for revis16 ing the distribution factors used under 

17 such clause to determine funding levels in 

18 order to direct funds to the local areas in 

19 most need of funding to provide substance 

20 use disorder treatment services. 

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

22 local area that is an eligible local area for 

23 a year loses such eligibility in a subsequent 

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1 quirements of section 3401(b)(1)(A), such 

2 area will remain eligible to receive— 

3 ‘‘(I) for such subsequent year, an 

4 amount equal to 80 percent of the 

5 amount received under the grant in 

6 the previous year; and 

7 ‘‘(II) for the second such subse8 quent year, an amount equal to 50 

9 percent of the amount received in the 

10 such previous year. 

11 ‘‘(2) SUPPLEMENTAL GRANTS.— 

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

13 disburse the remainder of amounts not dis14 bursed under paragraph (1) for such fiscal year 

15 for the purpose of making grants to cities and 

16 counties whose application under section 

17 3404— 

18 ‘‘(i) contains a report concerning the 

19 dissemination of emergency relief funds 

20 under paragraph (1) and the plan for utili21 zation of such funds, if applicable; 

22 ‘‘(ii) demonstrates the need in such 

23 local area, on an objective and quantified 

24 basis, for supplemental financial assistance 

25 to combat substance use disorder; 


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1 ‘‘(iii) demonstrates the existing com2 mitment of local resources of the area, 

3 both financial and in-kind, to combating 

4 substance use disorder; 

5 ‘‘(iv) demonstrates the ability of the 

6 area to utilize such supplemental financial 

7 resources in a manner that is immediately 

8 responsive and cost effective; 

9 ‘‘(v) demonstrates that resources will 

10 be allocated in accordance with the local 

11 demographic incidence of substance use 

12 disorders and drug overdose mortality; 

13 ‘‘(vi) demonstrates the inclusiveness of 

14 affected communities and individuals with 

15 substance use disorders, including those 

16 communities and individuals that are dis17 proportionately affected or historically un18 derserved; 

19 ‘‘(vii) demonstrates the manner in 

20 which the proposed services are consistent 

21 with the local needs assessment and the 

22 statewide coordinated statement of need 

23 required in section 3413(e); 


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1 ‘‘(viii) demonstrates success in identi2 fying individuals with substance use dis3 orders; and 

4 ‘‘(ix) demonstrates that support for 

5 substance use disorder treatment services 

6 is organized to maximize the value to the 

7 population to be served with an appro8 priate mix of substance use disorder treat9 ment services and attention to transition in 

10 care. 

11 ‘‘(B) AMOUNT.— 

12 ‘‘(i) IN GENERAL.—The amount of 

13 each grant made for purposes of this para14 graph shall be determined by the Sec15 retary. In making such determination, the 

16 Secretary shall consider— 

17 ‘‘(I) the rate of drug overdose 

18 deaths per 100,000 population in the 

19 eligible local area; and 

20 ‘‘(II) the increasing need for sub21 stance use disorder treatment serv22 ices, including relative rates of in23 crease in the number of drug 

24 overdoses or drug overdose deaths, re25 cent increases in drug overdoses or 


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1 drug overdose deaths since data was 

2 provided under section 3401(b), if ap3 plicable. 

4 ‘‘(ii) DEMONSTRATED NEED.—The 

5 factors considered by the Secretary in de6 termining whether a local area has a dem7 onstrated need for purposes of clause 

8 (i)(II) may include any or all of the fol9 lowing: 

10 ‘‘(I) The unmet need for sub11 stance use disorder treatment serv12 ices, including factors identified in 

13 subparagraph (B)(i)(II). 

14 ‘‘(II) Relative rates of increase in 

15 the number of drug overdoses or drug 

16 overdose deaths. 

17 ‘‘(III) The relative rates of in18 crease in the number of drug 

19 overdoses or drug overdose deaths 

20 within new or emerging subpopula21 tions. 

22 ‘‘(IV) The current prevalence of 

23 substance use disorders. 

24 ‘‘(V) Relevant factors related to 

25 the cost and complexity of delivering 


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1 substance use disorder treatment serv2 ices to individuals in the eligible local 

3 area. 

4 ‘‘(VI) The impact of co-morbid 

5 factors, including co-occurring condi6 tions, determined relevant by the Sec7 retary. 

8 ‘‘(VII) The prevalence of home9 lessness among individuals with sub10 stance use disorders. 

11 ‘‘(VIII) The relevant factors that 

12 limit access to health care, including 

13 geographic variation, adequacy of 

14 health insurance coverage, and lan15 guage barriers. 

16 ‘‘(IX) The impact of a decline in 

17 the amount received pursuant to para18 graph (1) on substance use disorder 

19 treatment services available to all in20 dividuals with substance use disorders 

21 identified and eligible under this sub22 title. 

23 ‘‘(X) The increasing incidence in 

24 conditions related to substance use, 

25 including hepatitis C, human immunoVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 deficiency virus, hepatitis B and other 

2 infections associated with injection 

3 drug use. 

4 ‘‘(C) APPLICATION OF PROVISIONS.—A 

5 local area that receives a grant under this para6 graph— 

7 ‘‘(i) shall use amounts received in ac8 cordance with subsection (b); 

9 ‘‘(ii) shall not have to meet the eligi10 ble criteria in section 3401(b); and 

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

12 planning council under section 3402. 

13 ‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN14 MENTS.— 

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

16 term ‘Indian tribe’ has the meaning given such 

17 term in section 4 of the Indian Self-Determina18 tion and Education Assistance Act. 

19 ‘‘(B) FORMULA GRANTS.—The Secretary, 

20 acting through the Indian Health Service, shall 

21 use 10 percent of the amount available under 

22 section 3406 for each fiscal year to provide for23 mula grants to Indian tribes disproportionately 

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1 teria developed by the Secretary in consultation 

2 with Indian tribes, for the purposes of address3 ing substance use. 

4 ‘‘(C) USE OF AMOUNTS.—Notwithstanding 

5 any requirements in this section, an Indian 

6 tribe may use amounts provided under grants 

7 awarded under this paragraph for the uses 

8 identified in subsection (b) and any other activi9 ties determined appropriate by the Secretary, in 

10 consultation with Indian tribes. 

11 ‘‘(b) USE OF AMOUNTS.— 

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

13 make a grant under section 3401 to an eligible local 

14 area unless the chief elected official of the area 

15 agrees that— 

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

17 within the area under the grant will be made in 

18 accordance with the priorities established by the 

19 substance use disorder treatment services plan20 ning council; and 

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

22 be expended for— 

23 ‘‘(i) prevention services described in 

24 paragraph (3); 


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1 ‘‘(ii) core medical services described in 

2 paragraph (4); 

3 ‘‘(iii) recovery and support services 

4 described in paragraph (5); 

5 ‘‘(iv) early intervention and engage6 ment services described in paragraph (6); 

7 ‘‘(v) harm reduction services described 

8 in paragraph (7); 

9 ‘‘(vi) financial assistance with health 

10 insurance described in paragraph (8); and 

11 ‘‘(vii) administrative expenses de12 scribed in paragraph (10). 

13 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 

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

15 shall use amounts received under a grant under 

16 section 3401 to provide direct financial assist17 ance to eligible entities for the purpose of pro18 viding prevention services, core medical services, 

19 recovery and support services, harm reduction 

20 services, and early intervention and engagement 

21 services. 

22 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi23 nancial assistance may be provided under sub24 paragraph (A) to public or nonprofit private en25 tities, or private for-profit entities if such entiVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 ties are the only available provider of quality 

2 substance use disorder treatment services in the 

3 area. 

4 ‘‘(3) PREVENTION SERVICES.— 

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

6 subsection, the term ‘prevention services’ means 

7 services, programs, or multi-sector strategies to 

8 prevent substance use disorder (such as evi9 dence-based education campaigns, community10 based prevention programs, opioid diversion, 

11 collection and disposal or unused opioids, and 

12 services to at-risk populations). 

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

14 use not to exceed 20 percent of the amount of 

15 the grant under section 3401 for prevention 

16 services. An eligible local area may apply to the 

17 Secretary for a waiver of this subparagraph. 

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

19 of this subsection, the term ‘core medical services’ 

20 means the following evidence-based services provided 

21 to individuals with substance use disorder or at risk 

22 for developing substance use disorder: 

23 ‘‘(A) Substance use disorder treatments, 

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1 sive inpatient treatment, intensive outpatient 

2 treatment, all forms of Federally-approved 

3 medication-assisted treatment, outpatient treat4 ment, and residential recovery treatment. 

5 ‘‘(B) Outpatient and ambulatory health 

6 services, including those administered by Feder7 ally qualified health centers and rural health 

8 clinics. 

9 ‘‘(C) Hospice services. 

10 ‘‘(D) Mental health services. 

11 ‘‘(E) Naloxone procurement, distribution, 

12 and training. 

13 ‘‘(F) Pharmaceutical assistance and diag14 nostic testing related to the management of 

15 substance-use disorders a co-morbid conditions. 

16 ‘‘(G) Home and community based health 

17 services. 

18 ‘‘(H) Comprehensive Case Management, 

19 including substance use disorder treatment ad20 herence services. 

21 ‘‘(I) Health insurance enrollment and cost22 sharing assistance in accordance with para23 graph (8). 

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

25 purposes of paragraph (1)(B)(ii), the term ‘recovery 


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1 and support services’ means services, subject to the 

2 approval of the Secretary, that are provided to indi3 viduals with substance use disorder, including resi4 dential recovery treatment and housing, including 

5 for individuals receiving medication-assisted treat6 ment, long term recovery services, 24/7 hotline crisis 

7 center support, medical transportation services, res8 pite care for persons caring for individuals with sub9 stance use disorder, child care and family services 

10 while an individual is receiving inpatient treatment 

11 services or at the time of outpatient services, out12 reach services, peer recovery services, nutrition serv13 ices, and referrals for job training and career serv14 ices, housing, legal services, and child care and fam15 ily services. 

16 ‘‘(6) EARLY INTERVENTION AND ENGAGEMENT

17 SERVICES.—For purposes of this section, the term 

18 ‘early intervention and engagement services’ means 

19 services to provide rapid access to substance use dis20 order treatment, counseling provided to individuals 

21 who have misused substances, who have experienced 

22 an overdose, or are at risk of developing substance 

23 use disorder, and the provision of referrals to facili24 tate the access of such individuals to core medical 

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1 ties through which such services may be provided in2 clude emergency rooms, fire departments and emer3 gency medical services, detention facilities, homeless 

4 shelters, law enforcement agencies, health care 

5 points of entry specified by eligible local areas, Fed6 erally qualified health centers, and rural health clin7 ics. 

8 ‘‘(7) HARM REDUCTION SERVICES.—For pur9 poses of this section, the term ‘harm reduction serv10 ices’ means evidence-based services provided to indi11 viduals engaging in substance use that reduce the 

12 risk of infectious disease transmission, overdose, or 

13 death, including by increasing access to health care. 

14 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV15 ERAGE.—An eligible local area may use amounts 

16 provided under a grant awarded under section 3401 

17 to establish a program of financial assistance to as18 sist eligible individuals with substance use disorder 

19 in— 

20 ‘‘(A) enrolling in health insurance cov21 erage; or 

22 ‘‘(B) affording health care services, includ23 ing assistance paying cost-sharing amounts, in24 cluding premiums. 


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1 ‘‘(9) REQUIREMENT OF STATUS AS MEDICAID

2 PROVIDER.— 

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

4 paragraph (2), the Secretary may not make a 

5 grant under section 3401 for the provision of 

6 substance use disorder treatment services under 

7 this section in an eligible local area unless, in 

8 the case of any such service that is available 

9 pursuant to the State plan approved under title 

10 XIX of the Social Security Act for the State— 

11 ‘‘(i) the political subdivision involved 

12 will provide the service directly, and the 

13 political subdivision has entered into a par14 ticipation agreement under the State plan 

15 and is qualified to receive payments under 

16 such plan; or 

17 ‘‘(ii) the eligible local area involved 

18 will enter into an agreement with a public 

19 or nonprofit private entity under which the 

20 entity will provide the service, and the enti21 ty has entered into such a participation 

22 agreement and is qualified to receive such 

23 payments. 

24 ‘‘(B) WAIVER.— 


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

2 entity making an agreement pursuant to 

3 subparagraph (A)(ii) regarding the provi4 sion of substance use disorder treatment 

5 services, the requirement established in 

6 such subparagraph shall be waived by the 

7 substance use planning council for the area 

8 involved if the entity does not, in providing 

9 health care services, impose a charge or ac10 cept reimbursement available from any 

11 third-party payor, including reimbursement 

12 under any insurance policy or under any 

13 Federal or State health benefits program. 

14 ‘‘(ii) DETERMINATION.—A determina15 tion by the substance use planning council 

16 of whether an entity referred to in clause 

17 (i) meets the criteria for a waiver under 

18 such clause shall be made without regard 

19 to whether the entity accepts voluntary do20 nations for the purpose of providing serv21 ices to the public. 

22 ‘‘(10) ADMINISTRATION AND PLANNING.—An 

23 eligible local area shall not use in excess of 10 per24 cent of amounts received under a grant under sec25 tion 3401 for administration, accounting, reporting, 


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1 and program oversight functions, including the de2 velopment of systems to improve data collection and 

3 data sharing. 

4 ‘‘(11) INCARCERATED INDIVIDUALS.—Amounts 

5 received under a grant under section 3401 may be 

6 used to provide substance use disorder treatment 

7 services to currently incarcerated individuals. 

8 ‘‘SEC. 3404. APPLICATION. 

9 ‘‘(a) IN GENERAL.—To be eligible to receive a grant 

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

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

12 containing such information, as the Secretary shall re13 quire, including— 

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

15 of any prior grants received under this subtitle by 

16 the applicant and the results achieved through such 

17 disbursements; 

18 ‘‘(2) a demonstration of the extent of local need 

19 for the funds under the grant and a plan for pro20 posed substance use disorder treatment services that 

21 is consistent with local needs, including a com22 prehensive plan for the use of the grant funds devel23 oped by the planning council established under sec24 tion 3402, except that the planning council requireVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 ment shall not apply with respect to areas receiving 

2 supplemental grant funds under section 3403(a)(2); 

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

4 funds in a manner that provides substance use dis5 order treatment services compliant with the evi6 dence-based standards developed in accordance with 

7 section 3434, including all forms of Federally-ap8 proved medication-assisted treatments; 

9 ‘‘(4) information on the number of individuals 

10 likely to be served by the funds sought, including de11 mographic data on the populations to be served; 

12 ‘‘(5) key outcomes that will be measured by all 

13 entities that receive assistance, as well as an expla14 nation of how the outcomes will be measured; 

15 ‘‘(6) a demonstration that resources provided 

16 under the grant will be allocated in accordance with 

17 the local demographic incidence of substance use, in18 cluding allocations for services for children, youths, 

19 and women; 

20 ‘‘(7) a demonstration that funds received from 

21 a grant under this subtitle in any prior year were ex22 pended in accordance with the priorities established 

23 by the planning council; 

24 ‘‘(8) a demonstration that at least one rep25 resentative from Indian tribes located within any eliVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 gible local area are included in the membership of a 

2 planning council; 

3 ‘‘(9) a demonstration that the confidentiality of 

4 individuals receiving substance use disorder treat5 ment services will be maintained in a manner not in6 consistent with applicable law; and 

7 ‘‘(10) an explanation of how income, asset, and 

8 medical expense criteria will be established and ap9 plied to those who qualify for assistance under the 

10 program under this subtitle. 

11 ‘‘(b) ASSURANCES.—To be eligible to receive a grant 

12 under section 3401, the application submitted by the eligi13 ble local area shall include assurances adequate to en14 sure— 

15 ‘‘(1) that funds received under the grant will be 

16 utilized to supplement not supplant other State or 

17 local funds made available in the year for which the 

18 grant is awarded to provide substance use disorder 

19 treatment services; 

20 ‘‘(2) that the political subdivisions within the el21 igible local area will maintain the level of expendi22 tures by such political subdivisions for substance 

23 use-related services at a level that is equal to the 

24 level of such expenditures by such political subdivi25 sions for the preceding fiscal year; 


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1 ‘‘(3) that political subdivisions within the eligi2 ble local area will not use funds received under a 

3 grant awarded under section 3401 in maintaining 

4 the level of substance use disorder treatment services 

5 as required in paragraph (2); 

6 ‘‘(4) that substance use disorder treatment 

7 services provided with assistance made available 

8 under the grant will be provided without regard— 

9 ‘‘(A) to the ability of the individual to pay 

10 for such services; and 

11 ‘‘(B) to the current or past health condi12 tion of the individual to be served; 

13 ‘‘(5) that substance use disorder treatment 

14 services will be provided in a setting that is acces15 sible to low-income individuals with substance use 

16 disorder, and to individuals with substance use dis17 order residing in rural areas; 

18 ‘‘(6) that a program of outreach will be pro19 vided to low-income individuals with substance use 

20 disorder to inform such individuals of substance use 

21 disorder treatment services, and to individuals with 

22 substance use disorder residing in rural areas; and 

23 ‘‘(7) that funds received under a grant awarded 

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1 ment has been made, or can reasonably be expected 

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

3 under any State compensation program, under an 

4 insurance policy, or under any Federal or State 

5 health benefits program (except for a program ad6 ministered by, or providing the services of, the In7 dian Health Service). 

8 ‘‘(c) REQUIREMENTS REGARDING IMPOSITION OF

9 CHARGES FOR SERVICES.— 

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

11 make a grant under section 3401 to an eligible local 

12 area unless the eligible local area provides assur13 ances that in the provision of substance use disorder 

14 treatment services with assistance provided under 

15 the grant— 

16 ‘‘(A) in the case of individuals with an in17 come less than or equal to 138 percent of the 

18 official poverty level, the provider will not im19 pose charges on any such individual for the 

20 services provided under the grant; 

21 ‘‘(B) in the case of individuals with an in22 come greater than 138 percent of the official 

23 poverty level, the provider will impose a charge 

24 on each such individual according to a schedule 

25 of charges made available to the public; 


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1 ‘‘(C) in the case of individuals with an in2 come greater than 138 percent of the official 

3 poverty level but not exceeding 200 percent of 

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

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

7 the individual; 

8 ‘‘(D) in the case of individuals with an in9 come greater than 200 percent of the official 

10 poverty level but not exceeding 300 percent of 

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

12 calendar year, impose charges in an amount ex13 ceeding 7 percent of the annual gross income of 

14 the individual involved; 

15 ‘‘(E) in the case of individuals with an in16 come greater than 300 percent of the official 

17 poverty level, the provider will not, for any cal18 endar year, impose charges in an amount ex19 ceeding 15 percent of the annual gross income 

20 of the individual involved; and 

21 ‘‘(F) in the case of eligible American In22 dian and Alaska Native individuals as defined 

23 by section 447.50 of title 42, Code of Federal 

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

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1 stance use disorder treatment services, includ2 ing any charges or cost-sharing prohibited by 

3 section 1402(d) of the Patient Protection and 

4 Affordable Care Act. 

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

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

7 eligible local area may, in the case of individuals 

8 subject to a charge— 

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

10 the discretion of the area, including imposing 

11 only a nominal charge for the provision of sub12 stance use disorder treatment services, subject 

13 to the provisions of the paragraph regarding 

14 public schedules and regarding limitations on 

15 the maximum amount of charges; and 

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

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

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

21 may not make a grant under section 3401 to an eli22 gible local area unless the area agrees that the limi23 tations on charges for substance use disorder treat24 ment services under this subsection applies to the 

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1 ices, however the charges are characterized, includes 

2 enrollment fees, premiums, deductibles, cost sharing, 

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

4 charges. 

5 ‘‘(d) INDIAN TRIBES.—Any application requirements 

6 for grants distributed in accordance with section 

7 3403(a)(3) shall be developed by the Secretary in con8 sultation with Indian tribes. 

9 ‘‘SEC. 3405. TECHNICAL ASSISTANCE. 

10 ‘‘The Secretary shall, beginning on the date of enact11 ment of this title, provide technical assistance, including 

12 assistance from other grantees, contractors or subcontrac13 tors under this title to assist newly eligible local areas in 

14 the establishment of planning councils and, to assist enti15 ties in complying with the requirements of this subtitle 

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

17 under this subtitle. The Secretary may make planning 

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

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

20 eligible for funding under section 3401 in the following 

21 fiscal year. Such grant amounts shall be deducted from 

22 the first year formula award to eligible local areas accept23 ing such grants. 


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1 ‘‘SEC. 3406. AUTHORIZATION OF APPROPRIATIONS. 

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

3 this subtitle— 

4 ‘‘(1) $2,700,000,000 for fiscal year 2019; 

5 ‘‘(2) $2,700,000,000 for fiscal year 2020; 

6 ‘‘(3) $2,700,000,000 for fiscal year 2021; 

7 ‘‘(4) $2,700,000,000 for fiscal year 2022; 

8 ‘‘(5) $2,700,000,000 for fiscal year 2023; 

9 ‘‘(6) $2,700,000,000 for fiscal year 2024; 

10 ‘‘(7) $2,700,000,000 for fiscal year 2025; 

11 ‘‘(8) $2,700,000,000 for fiscal year 2026; 

12 ‘‘(9) $2,700,000,000 for fiscal year 2027; and 

13 ‘‘(10) $2,700,000,000 for fiscal year 2028. 

14 ‘‘Subtitle B—State and Tribal Sub15 stance Use Disorder Prevention 

16 and Intervention Grant Pro17 gram 

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

19 ‘‘The Secretary, acting in coordination with the Di20 rector of the Office of National Drug Control Policy, shall 

21 award grants to States, territories, and tribal governments 

22 for the purpose of addressing substance use within such 

23 States. 

24 ‘‘SEC. 3412. AMOUNT OF GRANT AND USE OF AMOUNTS. 

25 ‘‘(a) AMOUNT OF GRANT TO STATES AND TERRI26 TORIES.— 


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1 ‘‘(1) IN GENERAL.— 

2 ‘‘(A) EXPEDITED DISTRIBUTION.—Not 

3 later than 90 days after an appropriation be4 comes available, the Secretary shall disburse 50 

5 percent of the amount made available under 

6 section 3415 for carrying out this subtitle for 

7 such fiscal year through grants to States under 

8 section 3411, in accordance with subparagraphs 

9 (B) and (C). 

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

11 the amount made available under section 3415, 

12 the amount of a grant under section 3411 for— 

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

14 of Columbia, and Puerto Rico for a fiscal 

15 year shall be the greater of— 

16 ‘‘(I) $2,000,000; or 

17 ‘‘(II) an amount determined 

18 under the subparagraph (C); and 

19 ‘‘(ii) each territory other than Puerto 

20 Rico for a fiscal year shall be the greater 

21 of— 

22 ‘‘(I) $500,000; or 

23 ‘‘(II) an amount determined 

24 under the subparagraph (C). 

25 ‘‘(C) DETERMINATION.— 


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1 ‘‘(i) FORMULA.—For purposes of sub2 paragraph (B), the amount referred to in 

3 this subparagraph for a State (including a 

4 territory) for a fiscal year is— 

5 ‘‘(I) an amount equal to the 

6 amount made available under section 

7 3415 for the fiscal year involved for 

8 grants pursuant to subparagraph (B); 

9 and 

10 ‘‘(II) the percentage constituted 

11 by the sum of— 

12 ‘‘(aa) the product of 0.85 

13 and the ratio of the State dis14 tribution factor for the State or 

15 territory to the sum of the re16 spective distribution factors for 

17 all States; and 

18 ‘‘(bb) the product of 0.15 

19 and the ratio of the non-local dis20 tribution factor for the State or 

21 territory (as determined under 

22 clause (iv)) to the sum of the re23 spective non-local distribution 

24 factors for all States or terri25 tories. 


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1 ‘‘(ii) STATE DISTRIBUTION FACTOR.— 

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

3 ‘State distribution factor’ means an 

4 amount equal to— 

5 ‘‘(I) the estimated number of 

6 drug overdose deaths in the State, as 

7 determined under clause (iii); or 

8 ‘‘(II) the number of non-fatal 

9 drug overdoses in the State, as deter10 mined under clause (iv); 

11 as determined by the Secretary based on 

12 which distribution factor (subclause (I) or 

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

14 greatest amount of funds. 

15 ‘‘(iii) NUMBER OF DRUG

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

17 the number of drug overdose deaths deter18 mined under this clause for a State for a 

19 fiscal year is the number of drug overdose 

20 deaths during the most recent 3-year pe21 riod for which such data are available. 

22 ‘‘(iv) NUMBER OF NON-FATAL DRUG

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

24 the number of non-fatal drug overdose 

25 deaths determined under this clause for 


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1 State for a fiscal year for purposes of 

2 clause (ii) may be determined by using 

3 data including emergency department 

4 syndromic data, visits, or other emergency 

5 medical services for drug-related causes 

6 during the most recent 3-year period for 

7 which such data are available. 

8 ‘‘(v) NON-LOCAL DISTRIBUTION FAC9 TORS.—For purposes of clause (i)(II)(bb), 

10 the term ‘non-local distribution factor’ 

11 means an amount equal to the sum of— 

12 ‘‘(I) the number of drug 

13 overdoses deaths in the State involved, 

14 as determined under clause (iii), or 

15 the number of non-fatal drug 

16 overdoses in the State, based on the 

17 criteria used by the State under 

18 clause (ii); less 

19 ‘‘(II) the total number of drug 

20 overdose deaths or non-fatal drug 

21 overdoses that are within areas in 

22 such State or territory that are eligi23 ble counties under section 3401. 

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

25 after the date of enactment of this title, 


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1 the Comptroller General shall conduct a 

2 study to determine whether the data uti3 lized for purposes of clause (ii) provides 

4 the most precise measure of State need re5 lated to substance use and addiction preva6 lence and whether additional data would 

7 provide more precise measures the levels of 

8 substance use and addiction prevalent in 

9 States. Such study shall identify barriers 

10 to collecting or analyzing such data, and 

11 make recommendations for revising the 

12 distribution factors used under such clause 

13 to determine funding levels in order to di14 rect funds to the States in most need of 

15 funding to provide substance use disorder 

16 treatment services. 

17 ‘‘(2) SUPPLEMENTAL GRANTS.— 

18 ‘‘(A) IN GENERAL.—Subject to subpara19 graph (C), the Secretary shall disburse the re20 mainder of amounts not disbursed under para21 graph (1) for such fiscal year for the purpose 

22 of making grants to States whose application— 

23 ‘‘(i) contains a report concerning the 

24 dissemination of emergency relief funds 


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

3 ‘‘(ii) demonstrates the need in such 

4 State, on an objective and quantified basis, 

5 for supplemental financial assistance to 

6 combat substance use disorder; 

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

9 both financial and in-kind, to combating 

10 substance use disorder; 

11 ‘‘(iv) demonstrates the ability of the 

12 State to utilize such supplemental financial 

13 resources in a manner that is immediately 

14 responsive and cost effective; 

15 ‘‘(v) demonstrates that resources will 

16 be allocated in accordance with the local 

17 demographic incidence of substances use 

18 disorders and drug overdose mortality; 

19 ‘‘(vi) demonstrates the inclusiveness of 

20 affected communities and individuals with 

21 substance use disorders, including those 

22 communities and individuals that are dis23 proportionately affected or historically un24 derserved; 


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1 ‘‘(vii) demonstrates the manner in 

2 which the proposed services are consistent 

3 with the local needs assessment and the 

4 statewide coordinated statement of need 

5 required under section 3413(e); 

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

9 ‘‘(ix) demonstrates that support for 

10 substance use disorder treatment services 

11 is organized to maximize the value to the 

12 population to be served with an appro13 priate mix of substance use disorder treat14 ment services and attention to transition in 

15 care. 

16 ‘‘(B) AMOUNT.— 

17 ‘‘(i) IN GENERAL.—The amount of 

18 each grant made for purposes of this para19 graph shall be determined by the Sec20 retary. In making such determination, the 

21 Secretary shall consider: 

22 ‘‘(I) the rate of drug overdose 

23 deaths per 100,000 population in the 

24 State; and 


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

5 overdoses or drug overdose deaths, or 

6 recent increases in drug overdoses or 

7 drug overdose deaths since the data 

8 was reported under section 3413. 

9 ‘‘(ii) DEMONSTRATED NEED.—The 

10 factors considered by the Secretary in de11 termining whether a State has a dem12 onstrated need for purposes of subpara13 graph (A)(ii) may include any or all of the 

14 following: 

15 ‘‘(I) The unmet need for such 

16 services, including the factors identi17 fied in clause (i)(II). 

18 ‘‘(II) Relative rates of increase in 

19 the number of drug overdoses or drug 

20 overdose deaths. 

21 ‘‘(III) The relative rates of in22 crease in the number of drug deaths 

23 within new or emerging subpopula24 tions. 


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1 ‘‘(IV) The current prevalence of 

2 substance use disorders. 

3 ‘‘(V) Relevant factors related to 

4 the cost and complexity of delivering 

5 substance use disorder treatment serv6 ices to individuals in the State. 

7 ‘‘(VI) The impact of co-morbid 

8 factors, including co-occurring condi9 tions, determined relevant by the Sec10 retary. 

11 ‘‘(VII) The prevalence of home12 lessness among individuals with sub13 stance use disorder. 

14 ‘‘(VIII) The relevant factors that 

15 limit access to health care, including 

16 geographic variation, adequacy of 

17 health insurance coverage, and lan18 guage barriers. 

19 ‘‘(IX) The impact of a decline in 

20 the amount received pursuant to para21 graph (1) on substance use disorder 

22 treatment services available to all in23 dividuals with substance use disorders 

24 identified and eligible under this sub25 title. 


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1 ‘‘(X) The increasing incidence in 

2 conditions related to substance use, 

3 including hepatitis C, human immuno4 deficiency virus, hepatitis B and other 

5 infections associated with injection 

6 drug use. 

7 ‘‘(C) MODEL STANDARDS.— 

8 ‘‘(i) PREFERENCE.—In determining 

9 whether a State will receive funds under 

10 this paragraph, except as provided in 

11 clause (ii), the Secretary shall give pref12 erence to States that have adopted the 

13 model standards developed in accordance 

14 with section 3434. 

15 ‘‘(ii) REQUIREMENT.—Effective begin16 ning in fiscal year 2025, the Secretary 

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

19 adopted the model standards developed in 

20 accordance with section 3434. 

21 ‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN22 MENTS.— 

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

24 term ‘Indian tribe’ has the meaning given such 


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1 term in section 4 of the Indian Self-Determina2 tion and Education Assistance Act. 

3 ‘‘(B) FORMULA GRANTS.—The Secretary, 

4 acting through the Indian Health Service, shall 

5 use 10 percent of the amount available under 

6 section 3415 for each fiscal year to provide for7 mula grants to Indian tribes in an amount de8 termined pursuant to a formula and eligibility 

9 criteria developed by the Secretary in consulta10 tion with Indian tribes, for the purposes of ad11 dressing substance use. 

12 ‘‘(C) USE OF AMOUNTS.—Notwithstanding 

13 any requirements in this section, an Indian 

14 tribe may use amounts provided under grants 

15 awarded under this paragraph for the uses 

16 identified in subsection (b) and any other activi17 ties determined appropriate by the Secretary, in 

18 consultation with Indian tribes. 

19 ‘‘(b) USE OF AMOUNTS.— 

20 ‘‘(1) IN GENERAL.—A State may use amounts 

21 provided under grants awarded under section 3411 

22 for— 

23 ‘‘(A) prevention services described in para24 graph (2); 


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1 ‘‘(B) core medical services described in 

2 paragraph (3); 

3 ‘‘(C) recovery and support services de4 scribed in paragraph (4); 

5 ‘‘(D) early intervention and engagement 

6 services described in paragraph (5); 

7 ‘‘(E) harm reduction services described in 

8 paragraph (6); and 

9 ‘‘(F) administrative expenses described in 

10 paragraph (8). 

11 ‘‘(2) PREVENTION SERVICES.— 

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

13 subsection, the term ‘prevention services’ means 

14 services, programs, or multi-sector strategies to 

15 prevent substance use disorder (including evi16 dence-based education campaigns, community17 based prevention programs, opioid diversion, 

18 collection and disposal of unused opioids, and 

19 services to at-risk populations). 

20 ‘‘(B) LIMIT.—A State may use not to ex21 ceed 20 percent of the amount of the grant 

22 under section 3411 for prevention services. A 

23 State may apply to the Secretary for a waiver 

24 of this subparagraph. 


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1 ‘‘(3) CORE MEDICAL SERVICES.—For purposes 

2 of this subsection, the term ‘core medical services’ 

3 means the following evidence-based services when 

4 provided to individuals with substance use disorder 

5 or at risk for developing substance use disorder: 

6 ‘‘(A) Substance use disorder treatments, 

7 including clinical stabilization services, with8 drawal management and detoxification, inten9 sive inpatient treatment, intensive outpatient 

10 treatment, all forms of Federally-approved 

11 medication-assisted treatment, outpatient treat12 ment, and residential recovery treatment. 

13 ‘‘(B) Outpatient and ambulatory health 

14 services, including those administered by Feder15 ally qualified health centers and rural health 

16 clinics. 

17 ‘‘(C) Hospice services. 

18 ‘‘(D) Mental health services. 

19 ‘‘(E) Naloxone procurement, distribution, 

20 and training. 

21 ‘‘(F) Pharmaceutical assistance related to 

22 the management of substance-use disorders and 

23 co-morbid conditions. 

24 ‘‘(G) Home and community based health 

25 services. 


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1 ‘‘(H) Comprehensive Case Management 

2 and care coordination, including treatment ad3 herence services. 

4 ‘‘(I) Health insurance enrollment and cost5 sharing assistance in accordance with sub6 section (e). 

7 ‘‘(4) RECOVERY AND SUPPORT SERVICES.—For 

8 purposes of paragraph (1)(C), the term ‘recovery 

9 and support services’ means services, subject to the 

10 approval of the Secretary, that are provided to indi11 viduals with substance use disorder, including resi12 dential recovery treatment and housing, including 

13 for individuals receiving medication-assisted treat14 ment, long term recovery services, 24/7 hotline crisis 

15 center services, medical transportation services, res16 pite care for persons caring for individuals with sub17 stance use disorder, child care and family services 

18 while an individual is receiving inpatient treatment 

19 services or at the time of outpatient services, out20 reach services, peer recovery services, nutrition serv21 ices, and referrals for job training and career serv22 ices, housing, legal services, and child care and fam23 ily services. 

24 ‘‘(5) EARLY INTERVENTION AND ENGAGEMENT

25 SERVICES.—For purposes of this subsection, the 


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1 term ‘early intervention and engagement services’ 

2 means services to provide rapid access to substance 

3 use disorder treatment services, counseling provided 

4 to individuals who have misused substances, who 

5 have experienced an overdose, or are at risk of devel6 oping substance use disorder, and the provision of 

7 referrals to facilitate the access of such individuals 

8 to core medical services or recovery and support 

9 services. The entities through which such services 

10 may be provided include emergency rooms, fire de11 partments and emergency medical services, detention 

12 facilities, homeless shelters, law enforcement agen13 cies, health care points of entry specified by eligible 

14 areas, Federally qualified health centers, and rural 

15 health clinics. 

16 ‘‘(6) HARM REDUCTION SERVICES.—For pur17 poses of this subsection, the term ‘harm reduction 

18 services’ means evidence-based services provided to 

19 individuals engaging in substance use disorder that 

20 reduce the risk of infectious disease transmission, 

21 overdose, or death, including by increasing access to 

22 health care. 

23 ‘‘(7) AFFORDABLE HEALTH INSURANCE COV24 ERAGE.—A State may use amounts provided under 

25 a grant awarded under section 3411 to establish a 


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1 program of financial assistance to assist eligible indi2 viduals with substance use disorder in— 

3 ‘‘(A) enrolling in health insurance cov4 erage; or 

5 ‘‘(B) affording health care services, includ6 ing assistance paying cost-sharing amounts, in7 cluding premiums. 

8 ‘‘(8) ADMINISTRATION AND PLANNING.—A 

9 State shall not use in excess of 10 percent of 

10 amounts received under a grant under section 3411 

11 for administration, accounting, reporting, and pro12 gram oversight functions, including the development 

13 of systems to improve data collection and data shar14 ing. 

15 ‘‘(9) INCARCERATED INDIVIDUALS.—Amounts 

16 received under a grant under section 3411 may be 

17 used to provide substance use disorder treatment 

18 services to currently incarcerated individuals. 

19 ‘‘SEC. 3413. APPLICATION AND LIMITATION. 

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

21 under section 3411, a State shall prepare and submit to 

22 the Secretary an application in such form, and containing 

23 such information, as the Secretary shall require, includ24 ing— 


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

2 of any prior grants received under this subtitle by 

3 the applicant and the results achieved by these ex4 penditures; 

5 ‘‘(2) a comprehensive plan for the use of the 

6 grant, including a demonstration of the extent of 

7 local need for the funds sought and a plan for pro8 posed substance use disorder treatment services that 

9 is consistent with local needs; 

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

11 funds in a manner that provides substance use dis12 order treatment services compliant with the evi13 dence-based standards developed in accordance with 

14 section 3434, including all Federally-approved medi15 cation-assisted treatments; 

16 ‘‘(4) information on the number of individuals 

17 likely to be served by the funds sought, including de18 mographic data on the populations to be served; 

19 ‘‘(5) an identification of key outcomes that will 

20 be measured by all entities that receive assistance, 

21 as well as an explanation of how the outcomes will 

22 be measured; 

23 ‘‘(6) a demonstration that resources provided 

24 under the grant will be allocated in accordance with 

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1 cluding allocations for services for children, youths, 

2 and women; 

3 ‘‘(7) a demonstration that funds received from 

4 a grant under this subtitle in any prior year were ex5 pended in accordance with State priorities; 

6 ‘‘(8) a demonstration that the confidentiality of 

7 individuals receiving substance use disorder treat8 ment services will be maintained in a manner not in9 consistent with applicable law; and 

10 ‘‘(9) an explanation of how income, asset, and 

11 medical expense criteria will be established and ap12 plied to those who qualify for assistance under the 

13 program. 

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

15 under section 3401, the application submitted by an eligi16 ble State shall include assurances adequate to ensure— 

17 ‘‘(1) that funds received under the grant will be 

18 utilized to supplement not supplant other State or 

19 local funds made available in the year for which the 

20 grant is awarded to provide substance use disorder 

21 treatment services to individuals with substance use 

22 disorder; 

23 ‘‘(2) that the political subdivisions within the 

24 State will maintain the level of expenditures by such 

25 political subdivisions for substance use disorder 


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1 treatment services at a level that is equal to the level 

2 of such expenditures by such political subdivisions 

3 for the preceding fiscal year; 

4 ‘‘(3) that political subdivisions within the State 

5 will not use funds received under a grant awarded 

6 under section 3411 in maintaining the level of sub7 stance use disorder treatment services as required in 

8 paragraph (2); 

9 ‘‘(4) that substance use disorder treatment 

10 services provided with assistance made available 

11 under the grant will be provided without regard— 

12 ‘‘(A) to the ability of the individual to pay 

13 for such services; and 

14 ‘‘(B) to the current or past health condi15 tion of the individual to be served; 

16 ‘‘(5) that substance use disorder treatment 

17 services will be provided in a setting that is acces18 sible to low-income individuals with substance use 

19 disorders and to individuals with substance use dis20 orders residing in rural areas; 

21 ‘‘(6) that a program of outreach will be pro22 vided to low-income individuals with substance use 

23 disorders to inform such individuals of substance use 

24 disorder treatment services and to individuals with 

25 substance use disorders residing in rural areas; 


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1 ‘‘(7) that Indian tribes are included in planning 

2 for the use of grant funds and that the Federal 

3 trust responsibility is upheld at all levels of program 

4 administration; and 

5 ‘‘(8) that funds received under a grant awarded 

6 under this section will not be utilized to make pay7 ments for any item or service to the extent that pay8 ment has been made, or can reasonably be expected 

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

10 under a State compensation program, under an in11 surance policy, or under any Federal or State health 

12 benefits program (except for a program administered 

13 by or providing the services of the Indian Health 

14 Service). 

15 ‘‘(c) MEDICAID IMD WAIVER APPLICATION RE16 QUIREMENT.—A State shall not be eligible to receive a 

17 grant under this subtitle for a fiscal year unless the 

18 State— 

19 ‘‘(1) has in effect for the year a waiver under 

20 section 1115 of the Social Security Act (42 U.S.C. 

21 1315) to provide medical assistance under the State 

22 plan under title XIX of such Act to individuals 

23 who— 

24 ‘‘(A) have not attained age 65 (or, if the 

25 State provides the medical assistance described 


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1 in section 1905(a)(16) of such Act, have at2 tained age 21 but have not attained age 65); 

3 ‘‘(B) are patients in an institution for 

4 mental diseases; and 

5 ‘‘(C) are eligible for medical assistance 

6 under the State plan; or 

7 ‘‘(2) has submitted an application for the year 

8 for such a waiver. 

9 ‘‘(d) REQUIREMENTS REGARDING IMPOSITION OF

10 CHARGES FOR SERVICES.— 

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

12 make a grant under section 3411 to a State unless 

13 the State provides assurances that in the provision 

14 of services with assistance provided under the 

15 grant— 

16 ‘‘(A) in the case of individuals with an in17 come less than or equal to 138 percent of the 

18 official poverty level, the provider will not im19 pose charges on any such individual for the 

20 services provided under the grant; 

21 ‘‘(B) in the case of individuals with an in22 come greater than 138 percent of the official 

23 poverty level, the provider will impose a charge 

24 on each such individual according to a schedule 

25 of charges made available to the public; 


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1 ‘‘(C) in the case of individuals with an in2 come greater than 138 percent of the official 

3 poverty level but not exceeding 200 percent of 

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

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

7 the individual; 

8 ‘‘(D) in the case of individuals with an in9 come greater than 200 percent of the official 

10 poverty level but not exceeding 300 percent of 

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

12 calendar year, impose charges in an amount ex13 ceeding 7 percent of the annual gross income of 

14 the individual involved; 

15 ‘‘(E) in the case of individuals with an in16 come greater than 300 percent of the official 

17 poverty level, the provider will not, for any cal18 endar year, impose charges in an amount ex19 ceeding 15 percent of the annual gross income 

20 of the individual involved; and 

21 ‘‘(F) in the case of eligible American In22 dian and Alaska Native individuals as defined 

23 by section 447.50 of title 42, Code of Federal 

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

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1 stance use disorder treatment services, includ2 ing any charges or cost-sharing prohibited by 

3 section 1402(d) of the Patient Protection and 

4 Affordable Care Act. 

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

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

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

8 charge— 

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

10 the discretion of the State, including imposing 

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

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

15 and 

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

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

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

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

22 unless the State agrees that the limitations on 

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

4 ‘‘(e) STATEWIDE COORDINATED STATEMENT OF

5 NEED.—A State shall not be eligible to receive a grant 

6 under this subtitle for a fiscal year unless the State devel7 ops and publishes a statewide coordinated statement of 

8 need, including a demonstration of the extent of State 

9 need for assistance in addressing addiction and substance 

10 use disorder in the State and identifying priorities for the 

11 delivery of essential services to individuals with substance 

12 use disorder and their families. 

13 ‘‘(f) INDIAN TRIBES.—Any application requirements 

14 applying to grants distributed in accordance with section 

15 3412(c) shall be developed by the Secretary in consulta16 tion with Indian tribes. 

17 ‘‘SEC. 3414. TECHNICAL ASSISTANCE. 

18 ‘‘The Secretary shall provide technical assistance in 

19 administering and coordinating the activities authorized 

20 under section 3412, including technical assistance for the 

21 development of State applications for supplementary 

22 grants authorized in section 3212(a)(2). 

23 ‘‘SEC. 3415. AUTHORIZATION OF APPROPRIATIONS. 

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

25 this subtitle— 


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1 ‘‘(1) $4,000,000,000 for fiscal year 2019; 

2 ‘‘(2) $4,000,000,000 for fiscal year 2020; 

3 ‘‘(3) $4,000,000,000 for fiscal year 2021; 

4 ‘‘(4) $4,000,000,000 for fiscal year 2022; 

5 ‘‘(5) $4,000,000,000 for fiscal year 2023; 

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

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

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

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

10 ‘‘(10) $4,000,000,000 for fiscal year 2028. 

11 ‘‘Subtitle C—Other Grant Program 

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

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

14 grants to public, nonprofit, and Native entities for the 

15 purpose of funding core medical services, recovery and 

16 support services, harm reduction services, administrative 

17 expenses, and early intervention and engagement services 

18 in accordance with this section. 

19 ‘‘(b) ELIGIBILITY.— 

20 ‘‘(1) ENTITIES.—Public, nonprofit, or Native 

21 entities eligible to receive a grant under subsection 

22 (a) may include— 

23 ‘‘(A) federally qualified health centers 

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


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1 ‘‘(B) family planning clinics; 

2 ‘‘(C) rural health clinics; 

3 ‘‘(D) Native entities, including Indian 

4 health programs as defined in section 4 of the 

5 Indian Health Care Improvement Act, urban 

6 Indian organizations as defined in section 4 of 

7 the Indian Health Care Improvement Act, and 

8 Native Hawaiian organizations as defined in 

9 section 12 of the Native Hawaiian Health Care 

10 Act of 1988; 

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

13 provide substance use disorder treatment serv14 ices; 

15 ‘‘(F) other nonprofit entities that provide 

16 substance use disorder treatment services; and 

17 ‘‘(G) faith based organizations that provide 

18 substance use disorder treatment services. 

19 ‘‘(2) UNDERSERVED POPULATIONS.—Entities 

20 described in paragraph (1) shall serve underserved 

21 populations which may include minority populations 

22 and Indian populations, ex-offenders, individuals 

23 with comorbidities including HIV/AIDS, hepatitis B 

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1 orders, low-income populations, inner city popu2 lations, and rural populations. 

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

4 grant under this section, a public or nonprofit entity 

5 described in this subsection shall prepare and submit 

6 to the Secretary an application in such form, and 

7 containing such information, as the Secretary shall 

8 require, including— 

9 ‘‘(A) a complete accounting of the dis10 bursement of any prior grants received under 

11 this subtitle by the applicant and the results 

12 achieved by these expenditures; 

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

14 the grant, including a demonstration of the ex15 tent of local need for the funds sought and a 

16 plan for proposed substance use disorder treat17 ment services that is consistent with local 

18 needs; 

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

20 use funds in a manner that provides substance 

21 use disorder treatment services compliant with 

22 the evidence-based standards developed in ac23 cordance with section 3434, including all Feder24 ally-approved medication-assisted treatments; 


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1 ‘‘(D) information on the number of individ2 uals likely to be served by the funds sought, in3 cluding demographic data on the populations to 

4 be served; 

5 ‘‘(E) an identification of key outcomes that 

6 will be measured by all entities that receive as7 sistance, as well as an explanation of how the 

8 outcomes will be measured; 

9 ‘‘(F) a demonstration that resources pro10 vided under the grant will be allocated in ac11 cordance with the local demographic incidence 

12 of substance use, including allocations for serv13 ices for children, youths, and women; 

14 ‘‘(G) a demonstration that the confiden15 tiality of individuals receiving substance use dis16 order treatment services will be maintained in a 

17 manner not inconsistent with applicable law; 

18 and 

19 ‘‘(H) an explanation of how income, asset, 

20 and medical expense criteria will be established 

21 and applied to those who qualify for assistance 

22 under the program. 

23 ‘‘(c) REQUIREMENT OF STATUS AS MEDICAID PRO24 VIDER.— 


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1 ‘‘(1) PROVISION OF SERVICE.—Subject to para2 graph (2), the Secretary may not make a grant 

3 under this section for the provision of substance use 

4 disorder treatment services under this section in a 

5 State unless, in the case of any such service that is 

6 available pursuant to the State plan approved under 

7 title XIX of the Social Security Act for the State— 

8 ‘‘(A) the political subdivision involved will 

9 provide the substance use disorder treatment 

10 service directly, and the political subdivision has 

11 entered into a participation agreement under 

12 the State plan and is qualified to receive pay13 ments under such plan; or 

14 ‘‘(B) the political subdivision involved will 

15 enter into an agreement with a public or non16 profit private entity under which the entity will 

17 provide the substance use disorder treatment 

18 service, and the entity has entered into such a 

19 participation agreement and is qualified to re20 ceive such payments. 

21 ‘‘(2) WAIVER.— 

22 ‘‘(A) IN GENERAL.—In the case of an enti23 ty making an agreement pursuant to paragraph 

24 (1)(B) regarding the provision of substance use 

25 disorder treatment services, the requirement esVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 tablished in such paragraph shall be waived by 

2 the State if the entity does not, in providing 

3 such services, impose a charge or accept reim4 bursement available from any third-party payor, 

5 including reimbursement under any insurance 

6 policy or under any Federal or State health 

7 benefits program. 

8 ‘‘(B) DETERMINATION.—A determination 

9 by the State of whether an entity referred to in 

10 subparagraph (A) meets the criteria for a waiv11 er under such subparagraph shall be made 

12 without regard to whether the entity accepts 

13 voluntary donations for the purpose of pro14 viding services to the public. 

15 ‘‘(d) AMOUNT OF GRANT TO NATIVE ENTITIES.— 

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

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

18 section 4 of the Indian Self-Determination and Edu19 cation Assistance Act. 

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

21 through the Indian Health Service, shall use 10 per22 cent of the amount available under section 3425 for 

23 each fiscal year to provide grants to Native entities 

24 in an amount determined pursuant to criteria develVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 oped by the Secretary in consultation with Indian 

2 tribes, for the purposes of addressing substance use. 

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

4 requirements in this section, Native entities may use 

5 amounts provided under grants awarded under this 

6 section for the uses identified in section 3422 and 

7 any other activities determined appropriate by the 

8 Secretary, in consultation with Indian tribes. 

9 ‘‘SEC. 3422. USE OF AMOUNTS. 

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

11 received under a grant under section 3421 to provide di12 rect financial assistance to eligible entities for the purpose 

13 of delivering or enhancing— 

14 ‘‘(1) prevention services described in subsection 

15 (b); 

16 ‘‘(2) core medical services described in sub17 section (c); 

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

19 subsection (d); 

20 ‘‘(4) early intervention and engagement services 

21 described in subsection (e); 

22 ‘‘(5) harm reduction services described in sub23 section (f); and 

24 ‘‘(6) administrative expenses described in sub25 section (g). 


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

2 subsection, the term ‘prevention services’ means services, 

3 programs, or multi-sector strategies to prevent substance 

4 use disorder, including evidence-based education cam5 paigns, community-based prevention programs, opioid di6 version, collection and disposal of unused opioids, and 

7 services to at-risk populations. 

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

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

10 following services when provided to individuals with sub11 stance use disorder or at risk for developing substance use 

12 disorder: 

13 ‘‘(1) Substance use disorder treatments, includ14 ing clinical stabilization services, withdrawal man15 agement and detoxification, intensive inpatient treat16 ment, intensive outpatient treatment, all forms of 

17 Federally-approved medication-assisted treatment, 

18 and residential recovery treatment. 

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

20 including those administered by federally qualified 

21 health centers and rural health clinics. 

22 ‘‘(3) Hospice services. 

23 ‘‘(4) Mental health services. 

24 ‘‘(5) Naloxone procurement, distribution, and 

25 training. 


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1 ‘‘(6) Pharmaceutical assistance and diagnostic 

2 testing related to the management of substance-use 

3 disorder and co-morbid conditions. 

4 ‘‘(7) Home and community based health serv5 ices. 

6 ‘‘(8) Comprehensive Case Management and care 

7 coordination, including treatment adherence services. 

8 ‘‘(9) Health insurance enrollment and cost9 sharing assistance in accordance with section 3412. 

10 ‘‘(d) RECOVERY AND SUPPORT SERVICES.—For pur11 poses of subsection (a)(3), the term ‘recovery and support 

12 services’ means services, subject to the approval of the 

13 Secretary, that are provided to individuals with substance 

14 use disorder, including residential recovery treatment and 

15 housing, including for individuals receiving medication-as16 sisted treatment, long term recovery services, 24/7 hotline 

17 services, medical transportation services, respite care for 

18 persons caring for individuals with substance use disorder, 

19 child care and family services while an individual is receiv20 ing inpatient treatment services or at the time of out21 patient services, outreach services, peer recovery services, 

22 nutrition services, and referrals for job training and career 

23 services, housing, legal services, and child care and family 

24 services. 


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1 ‘‘(e) EARLY INTERVENTION AND ENGAGEMENT

2 SERVICES.—For purposes of this section, the term ‘early 

3 intervention and engagement services’ means services to 

4 provide rapid access to substance use disorder treatment 

5 services, counseling provided to individuals who have mis6 used substances, who have experienced an overdose, or are 

7 at risk of developing substance use disorder and the provi8 sion of referrals to facilitate the access of such individuals 

9 to core medical services or recovery and support services. 

10 The entities through which such services may be provided 

11 include emergency rooms, fire departments and emergency 

12 medical services, detention facilities, homeless shelters, 

13 law enforcement agencies, health care points of entry spec14 ified by eligible areas, Federally qualified health centers, 

15 and rural health clinics. 

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

17 this subsection, the term ‘harm reduction services’ means 

18 evidence-based services provided to individuals engaging in 

19 substance use that reduce the risk of infectious disease 

20 transmission, overdose, or death, including by increasing 

21 access to health care. 

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

23 shall not use in excess of 10 percent of amounts received 

24 under a grant under section 3421 for administration, ac25 counting, reporting, and program oversight functions, inVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 cluding for the purposes of developing systems to improve 

2 data collection and data sharing. 

3 ‘‘SEC. 3423. TECHNICAL ASSISTANCE. 

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

5 contracts, provide technical assistance to nonprofit private 

6 entities and Native entities regarding the process of sub7 mitting to the Secretary applications for grants under sec8 tion 3421, and may provide technical assistance with re9 spect to the planning, development, and operation of any 

10 program or service carried out pursuant to such section. 

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

12 ‘‘(a) IN GENERAL.—The Secretary may provide plan13 ning grants to public, nonprofit private, and Native enti14 ties for purposes of assisting such entities in expanding 

15 their capacity to provide substance use disorder treatment 

16 services in low-income communities and affected sub17 populations that are underserviced with respect to such 

18 services. 

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

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

21 ‘‘SEC. 3425. AUTHORIZATION OF APPROPRIATIONS. 

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

23 this subtitle— 

24 ‘‘(1) $500,000,000 for fiscal year 2019; 

25 ‘‘(2) $500,000,000 for fiscal year 2020; 


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1 ‘‘(3) $500,000,000 for fiscal year 2021; 

2 ‘‘(4) $500,000,000 for fiscal year 2022; 

3 ‘‘(5) $500,000,000 for fiscal year 2023; 

4 ‘‘(6) $500,000,000 for fiscal year 2024; 

5 ‘‘(7) $500,000,000 for fiscal year 2025; 

6 ‘‘(8) $500,000,000 for fiscal year 2026; 

7 ‘‘(9) $500,000,000 for fiscal year 2027; and 

8 ‘‘(10) $500,000,000 for fiscal year 2028. 

9 ‘‘Subtitle D—Miscellaneous 

10 Provisions 

11 ‘‘SEC. 3431. SPECIAL PROJECTS OF NATIONAL SIGNIFI12 CANCE. 

13 ‘‘(a) IN GENERAL.—The Secretary, acting in con14 sultation with the Director of the Office of National Drug 

15 Control Policy, shall award grants to entities to administer 

16 special projects of national significance to support the de17 velopment of innovative and original models for the deliv18 ery of substance use disorder treatment services. 

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

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

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

22 emerging needs of individuals receiving assistance under 

23 this title. 

24 ‘‘(c) REPLICATION.—The Secretary shall make infor25 mation concerning successful models or programs develVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 oped under this section available to grantees under this 

2 title for the purpose of coordination, replication, and inte3 gration. To facilitate efforts under this subsection, the 

4 Secretary may provide for peer-based technical assistance 

5 for grantees funded under this section. 

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

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

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

9 section 4 of the Indian Self-Determination and Edu10 cation Assistance Act. 

11 ‘‘(2) USE OF FUNDS.—The Secretary, acting 

12 through the Indian Health Service, shall use 10 per13 cent of the amount available under this section for 

14 each fiscal year to provide grants to Indian tribes 

15 for the purposes of supporting the development of 

16 innovative and original models for the delivery of 

17 substance use disorder treatment and services, in18 cluding the development of culturally-informed care 

19 models. 

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

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

22 ‘‘(1) $500,000,000 for fiscal year 2019; 

23 ‘‘(2) $500,000,000 for fiscal year 2020; 

24 ‘‘(3) $500,000,000 for fiscal year 2021; 

25 ‘‘(4) $500,000,000 for fiscal year 2022; 


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1 ‘‘(5) $500,000,000 for fiscal year 2023; 

2 ‘‘(6) $500,000,000 for fiscal year 2024; 

3 ‘‘(7) $500,000,000 for fiscal year 2025; 

4 ‘‘(8) $500,000,000 for fiscal year 2026; 

5 ‘‘(9) $500,000,000 for fiscal year 2027; and 

6 ‘‘(10) $500,000,000 for fiscal year 2028. 

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

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

9 and enter into contracts to assist public and nonprofit pri10 vate entities, and schools, and academic health centers in 

11 meeting the cost of projects— 

12 ‘‘(1) to train health personnel, including practi13 tioners in programs under this title and other com14 munity providers, including counselors, case man15 agers, social workers, peer recovery coaches, and 

16 harm reduction workers, in the diagnosis, treatment, 

17 and prevention of substance use disorders, including 

18 measures for the prevention and treatment of co-oc19 curring infectious diseases and other conditions, and 

20 including (as applicable to the type of health profes21 sional involved), care for women, pregnant women, 

22 and children; 

23 ‘‘(2) to train the faculty of schools of medicine, 

24 nursing, public health, osteopathic medicine, den25 tistry, allied health, and mental health practice to 


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1 teach health professions students to screen for and 

2 provide for the needs of individuals with substance 

3 use disorders or at risk of substance use; and 

4 ‘‘(3) to develop and disseminate curricula and 

5 resource materials relating to evidence-based prac6 tices for the screening, prevention, and treatment of 

7 substance use disorders, including information about 

8 prescribing best practices, alternative pain therapies, 

9 and Federally-approved medication-assisted treat10 ment options. 

11 ‘‘(b) PREFERENCE IN MAKING GRANTS.—In making 

12 grants under subsection (a), the Secretary shall give pref13 erence to qualified projects that will— 

14 ‘‘(1) train, or result in the training of, health 

15 professionals, including counselors, case managers, 

16 social workers, peer recovery coaches, and harm re17 duction workers, who will provide substance use dis18 order treatments for underserved groups, including 

19 minority individuals and Indians with substance use 

20 disorder and other individuals who are at a high risk 

21 of substance use; 

22 ‘‘(2) train, or result in the training of, minority 

23 health professionals and minority allied health pro24 fessionals, including counselors, case managers, so25 cial workers, peer recovery coaches, and harm reducVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 tion workers, to provide substance use disorder 

2 treatment for individuals with such disease; 

3 ‘‘(3) train or result in the training of individ4 uals, including counselors, case managers, social 

5 workers, peer recovery coaches, and harm reduction 

6 workers, who will provide substance use disorder 

7 treatment in rural or other areas that are under8 served by current treatment structures; and 

9 ‘‘(4) train or result in the training of health 

10 professionals and allied health professionals, includ11 ing counselors, case managers, social workers, peer 

12 recovery coaches, and harm reduction workers, to 

13 provide treatment for infectious diseases and mental 

14 health conditions co-occurring with substance use 

15 disorder. 

16 ‘‘(c) NATIVE EDUCATION AND TRAINING CEN17 TERS.—The Secretary shall use 10 percent of the amount 

18 available under subsection (d) for each fiscal year to pro19 vide grants authorized under this subtitle to— 

20 ‘‘(1) tribal colleges and universities; 

21 ‘‘(2) Indian Health Service grant funded insti22 tutions; and 

23 ‘‘(3) Native partner institutions, including insti24 tutions of higher education with medical training 

25 programs that partner with one or more Indian 


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1 tribes, tribal organizations, Native Hawaiian organi2 zations, or tribal colleges and universities to train 

3 Native health professionals that will provide sub4 stance use disorder treatment services in Native 

5 communities. 

6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

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

8 ‘‘(1) $400,000,000 for fiscal year 2019; 

9 ‘‘(2) $400,000,000 for fiscal year 2020; 

10 ‘‘(3) $400,000,000 for fiscal year 2021; 

11 ‘‘(4) $400,000,000 for fiscal year 2022; 

12 ‘‘(5) $400,000,000 for fiscal year 2023; 

13 ‘‘(6) $400,000,000 for fiscal year 2024; 

14 ‘‘(7) $400,000,000 for fiscal year 2025; 

15 ‘‘(8) $400,000,000 for fiscal year 2026; 

16 ‘‘(9) $400,000,000 for fiscal year 2027; and 

17 ‘‘(10) $400,000,000 for fiscal year 2028. 

18 ‘‘SEC. 3433. OTHER PROVISIONS. 

19 ‘‘(a) MEDICATION-ASSISTED TREATMENT.—The Sec20 retary may not make a grant under this title unless the 

21 applicant for the grant agrees to require all entities offer22 ing substance use disorder treatment services under the 

23 grant to offer all Federally-approved forms of medication24 assisted substance use treatment for the substance use 

25 disorders for which the applicant offers treatment. 


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1 ‘‘(b) WAIVER.—The Secretary may grant a waiver 

2 with respect to any requirement of this title if the grant 

3 applicant involved— 

4 ‘‘(1) submits to the Secretary a justification 

5 containing such information as the Secretary shall 

6 require; and 

7 ‘‘(2) agrees to require all entities offering sub8 stance use disorder treatment services under the 

9 grant— 

10 ‘‘(A) to offer at least two Federally-ap11 proved forms of medication-assisted treatment 

12 on site; 

13 ‘‘(B) provide counseling to patients on the 

14 benefits and risks of all forms of Federally-ap15 proved medication-assisted treatments; and 

16 ‘‘(C) maintain an affiliation with a pro17 vider that can prescribe or otherwise dispense 

18 all other forms of Federally-approved medica19 tion-assisted treatment. 

20 ‘‘(c) GAO STUDY.—Not later than 1 year after the 

21 date of enactment of this title, the Comptroller General 

22 of the United States shall submit to Congress a com23 prehensive report describing any relationship between sub24 stance use rates, pain management practices of the Indian 

25 Health Service, and patient request denials through the 


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1 purchased/referred care program of the Indian Health 

2 Service. 

3 ‘‘SEC. 3434. STANDARDS FOR SUBSTANCE USE DISORDER 

4 TREATMENT AND RECOVERY FACILITIES. 

5 ‘‘(a) IN GENERAL.—Not later than 3 years after the 

6 date of enactment of this title, the Secretary, in consulta7 tion with the American Society of Addiction Medicine, 

8 shall promulgate model standards for the regulation of 

9 substance use disorder treatment services. 

10 ‘‘(b) CONTENTS.—The model standards promulgated 

11 under subsection (a) shall— 

12 ‘‘(1) identify the types of providers intended to 

13 be covered without regard to whether such providers 

14 participate in any Federal health care program (as 

15 defined in section 1128B(f) of the Social Security 

16 Act (42 U.S.C. 1320a–7b(f))) and shall not include 

17 a private practitioner who is already licensed by a 

18 State medical licensing board and whose practice is 

19 limited to outpatient care; 

20 ‘‘(2) require that all substance use disorder 

21 treatment services be licensed by the respective 

22 States for the levels of care which they provide; 

23 ‘‘(3) identify the professional credentials needed 

24 by each type of substance use disorder treatment 

25 professional; 


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1 ‘‘(4) require that patients have access to li2 censed substance use disorder treatment services, in3 cluding health care providers and physicians, for in4 patient and outpatient care; 

5 ‘‘(5) identify and develop strategies for States 

6 to ensure that all substance use disorder patients re7 ceive a medical assessment, including for co-occur8 ring mental health issues and infectious diseases; 

9 ‘‘(6) require States to implement a process to 

10 ensure that residential treatment provider qualifica11 tions are verified by the single State agency serving 

12 as the primary regulator in the State for substance 

13 use disorder treatment services (as required in para14 graph (13)) or by an independent third party with 

15 the necessary competencies to use evidence-based pa16 tient placement assessment tools and nationally-rec17 ognized program standards, as applicable; 

18 ‘‘(7) ensure that patients receiving substance 

19 use disorder treatment have access directly, by refer20 ral, or in such other manner as determined by the 

21 Secretary, to all Federally-approved medication-as22 sisted treatments for substance use disorder; 

23 ‘‘(8) develop standards for data reporting and 

24 require compilation of Statewide reports; 


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1 ‘‘(9) develop standards for licensed providers to 

2 ensure all patients receive an outpatient treatment 

3 and discharge plan; 

4 ‘‘(10) develop standards for the certification of 

5 recovery residences that have an ongoing economic 

6 relationship with any commercial substance use dis7 order treatment service, including any relationship 

8 with any such service that includes receiving or mak9 ing referrals for substance use disorder treatment, 

10 including— 

11 ‘‘(A) application, inspection, and renewal 

12 procedures for recovery residences; 

13 ‘‘(B) fire, safety, and health standards; 

14 ‘‘(C) standards for equipping residences 

15 with naloxone and training residence owners, 

16 operators, and employees in the administration 

17 of naloxone; 

18 ‘‘(D) standards for recovery residence own19 ers and operators; and 

20 ‘‘(E) standards to identify, disqualify from 

21 grant funding, and refer to the appropriate reg22 ulatory authority any entity engaged in the so23 liciting or receiving of a commission, benefit, 

24 bonus, rebate, kickback, or bribe, directly or in25 directly, in cash or in kind, or engaging in any 


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1 split-fee arrangement, aimed at inducing the re2 ferral of a patient to or from a substance use 

3 disorder treatment service; 

4 ‘‘(11) establish a toll-free telephone number to 

5 handle complaints about recovery residences; 

6 ‘‘(12) establish and maintain on a publicly ac7 cessible internet website a list of all recovery resi8 dences in the State that have a certification in effect 

9 in accordance with this section; 

10 ‘‘(13) require the designation of a single State 

11 agency to serve as the primary regulator in the 

12 State for substance use disorder treatment services; 

13 ‘‘(14) require a single State agency to imple14 ment a process to ensure that treatment provider as15 sessments for all substance use disorder treatment 

16 services, including levels of care and length-of-stay 

17 recommendations, are verified by an independent 

18 third party that has the necessary competencies to 

19 use evidence-based patient placement assessment 

20 tools and nationally-recognized program standards, 

21 as applicable; and 

22 ‘‘(15) consider existing barriers to substance 

23 use disorder treatment and service access, including 

24 capacity and infrastructure needs, as well as access 

25 to culturally attuned services. 


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1 ‘‘(c) ANNUAL ASSESSMENT.—Beginning with respect 

2 to fiscal year 2021, the Secretary shall make a determina3 tion with respect to each State on whether the State has 

4 adopted the model standards promulgated in accordance 

5 with this section. 

6 ‘‘(d) QUALITY MEASURES.—The Secretary shall en7 gage a nonprofit, non-partisan standards development and 

8 quality measurement organization to convene government 

9 regulators, State representatives, consumer representa10 tives, substance use disorder treatment providers, recovery 

11 residence owners and operators, and purchasers of sub12 stance use disorder treatments exercising leadership in 

13 quality-based purchasing to develop and annually revise 

14 a set of health care quality measures for substance use 

15 disorder treatment providers and owners and operators of 

16 recovery residences. 

17 ‘‘SEC. 3435. NALOXONE DISTRIBUTION PROGRAM. 

18 ‘‘(a) ESTABLISHMENT OF PROGRAM.— 

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

20 for the purchase and delivery of Federally-approved 

21 opioid overdose reversal drug products on behalf of 

22 each State (or Indian tribe as defined in section 4 

23 of the Indian Health Care Improvement Act) that 

24 receives a grant under subtitle B. This paragraph 

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1 priations Acts, and represents the obligation of the 

2 Federal Government to provide for the purchase and 

3 delivery to States of the opioid overdose reversal 

4 drug products in accordance with this paragraph. 

5 ‘‘(2) SPECIAL RULES WHERE OPIOID OVERDOSE

6 REVERSAL DRUG PRODUCTS ARE UNAVAILABLE.—To 

7 the extent that a sufficient quantity of opioid over8 dose reversal drug products are not available for 

9 purchase or delivery under paragraph (1), the Sec10 retary shall provide for the purchase and delivery of 

11 the available opioid overdose reversal drug products 

12 in accordance with priorities established by the Sec13 retary, with priority given to States with at least one 

14 local area eligible for funding under section 3401(a). 

15 ‘‘(b) NEGOTIATION OF CONTRACTS WITH MANUFAC16 TURERS.— 

17 ‘‘(1) IN GENERAL.—For the purpose of car18 rying out this section, the Secretary shall negotiate 

19 and enter into contracts with manufacturers of 

20 opioid overdose reversal drug products consistent 

21 with the requirements of this subsection and, to the 

22 maximum extent practicable, consolidate such con23 tracting with any other contracting activities con24 ducted by the Secretary to purchase opioid overdose 

25 reversal drug products. The Secretary may enter 


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1 into such contracts under which the Federal Govern2 ment is obligated to make outlays, the budget au3 thority for which is not provided for in advance in 

4 appropriations Acts, for the purchase and delivery of 

5 opioid overdose reversal drug products under sub6 section (a). 

7 ‘‘(2) AUTHORITY TO DECLINE CONTRACTS.— 

8 The Secretary may decline to enter into contracts 

9 under this subsection and may modify or extend 

10 such contracts. 

11 ‘‘(3) CONTRACT PRICE.— 

12 ‘‘(A) IN GENERAL.—The Secretary, in ne13 gotiating the prices at which opioid overdose re14 versal drug products will be purchased and de15 livered from a manufacturer under this sub16 section, shall take into account quantities of 

17 opioid overdose reversal drug products to be 

18 purchased by States under the option under 

19 paragraph (4)(B). 

20 ‘‘(B) NEGOTIATION OF DISCOUNTED PRICE

21 FOR OPIOID OVERDOSE REVERSAL DRUG PROD22 UCTS.—With respect to contracts entered into 

23 for the purchase of opioid overdose reversal 

24 drug products on behalf of States under this 

25 subsection, the price for the purchase of such 


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1 drug product shall be a discounted price nego2 tiated by the Secretary. 

3 ‘‘(4) PRODUCT DOSAGE.—All opioid overdose 

4 reversal products purchased under this section shall 

5 contain— 

6 ‘‘(A) for each dose, the maximum amount 

7 of active pharmaceutical ingredient that acts as 

8 an opioid receptor antagonist as recommended 

9 by the Food and Drug Administration as an 

10 initial dose when administered by one of the ap11 proved, labeled routes of administration in 

12 adults; and 

13 ‘‘(B) a minimum of two doses packaged to14 gether. 

15 ‘‘(5) QUANTITIES AND TERMS OF DELIVERY.— 

16 Under contracts under this subsection— 

17 ‘‘(A) the Secretary shall provide, consistent 

18 with paragraph (6), for the purchase and deliv19 ery on behalf of States and Indian tribes of 

20 quantities of opioid overdose reversal drug 

21 products; and 

22 ‘‘(B) each State and Indian tribe, at the 

23 option of the State or tribe, shall be permitted 

24 to obtain additional quantities of opioid over25 dose reversal drug products (subject to amounts 


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1 specified to the Secretary by the State or tribe 

2 in advance of negotiations) through purchasing 

3 the opioid overdose reversal drug products from 

4 the manufacturers at the applicable price nego5 tiated by the Secretary consistent with para6 graph (3), if the State or tribe provides to the 

7 Secretary such information (at a time and man8 ner specified by the Secretary, including in ad9 vance of negotiations under paragraph (1)) as 

10 the Secretary determines to be necessary, to 

11 provide for quantities of opioid overdose rever12 sal drug products for the State or tribe to pur13 chase pursuant to this subsection and to deter14 mine annually the percentage of the opioid over15 dose reversal drug market that is purchased 

16 pursuant to this section and this subparagraph. 

17 The Secretary shall enter into the initial negotia18 tions not later than 180 days after the date of the 

19 enactment of this title. 

20 ‘‘(6) CHARGES FOR SHIPPING AND HAN21 DLING.—The Secretary may enter into a contract 

22 referred to in paragraph (1) only if the manufac23 turer involved agrees to submit to the Secretary 

24 such reports as the Secretary determines to be ap25 propriate to assure compliance with the contract and 


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1 if, with respect to a State program under this sec2 tion that does not provide for the direct delivery of 

3 qualified opioid overdose reversal drug products, the 

4 manufacturer involved agrees that the manufacturer 

5 will provide for the delivery of the opioid overdose 

6 reversal drug products on behalf of the State in ac7 cordance with such program and will not impose any 

8 charges for the costs of such delivery (except to the 

9 extent such costs are provided for in the price estab10 lished under paragraph (3)). 

11 ‘‘(7) MULTIPLE SUPPLIERS.—In the case of the 

12 opioid overdose reversal drug product involved, the 

13 Secretary may, as appropriate, enter into a contract 

14 referred to in paragraph (1) with each manufacturer 

15 of the opioid overdose reversal drug product that 

16 meets the terms and conditions of the Secretary for 

17 an award of such a contract (including terms and 

18 conditions regarding safety and quality). With re19 spect to multiple contracts entered into pursuant to 

20 this paragraph, the Secretary may have in effect dif21 ferent prices under each of such contracts and, with 

22 respect to a purchase by States pursuant to para23 graph (4)(B), each eligible State may choose which 

24 of such contracts will be applicable to the purchase. 


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1 ‘‘(c) USE OF OPIOID OVERDOSE REVERSAL DRUG

2 PRODUCT LIST.—Beginning not later than one year after 

3 the first contract has been entered into under this section, 

4 the Secretary shall use, for the purpose of the purchase, 

5 delivery, and administration of opioid overdose reversal 

6 drug products under this section, the list established (and 

7 periodically reviewed and, as appropriate, revised) by an 

8 advisory committee, established by the Secretary and lo9 cated within the Centers for Disease Control and Preven10 tion, which considers the cost effectiveness of each opioid 

11 overdose reversal drug product. 

12 ‘‘(d) STATE DISTRIBUTION OF OPIOID OVERDOSE

13 REVERSAL DRUG PRODUCTS.—States shall distribute 

14 opioid overdose reversal drug products received under this 

15 section to the following: 

16 ‘‘(1) First Responders, including— 

17 ‘‘(A) all State, county, and local law en18 forcement departments; 

19 ‘‘(B) all Tribal police departments; 

20 ‘‘(C) all local fire departments, including 

21 career fire departments, combination fire de22 partments, and volunteer fire departments; and 

23 ‘‘(D) all local emergency medical services 

24 organizations, including volunteer emergency 

25 medical services organizations. 


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1 ‘‘(2) Public entities with authority to administer 

2 local public health services, including all local health 

3 departments, for the purposes of making opioid over4 dose reversal drug products available to— 

5 ‘‘(A) public and nonprofit entities, includ6 ing— 

7 ‘‘(i) community-based organizations 

8 that provide substance use disorder treat9 ments or harm reduction services; 

10 ‘‘(ii) nonprofit entities that provide 

11 substance use disorder treatments or harm 

12 reduction services; and 

13 ‘‘(iii) faith based organizations that 

14 provide substance use disorder treatments 

15 or harm reduction services; and 

16 ‘‘(B) the general public. 

17 ‘‘(e) STATE REQUIREMENTS.—To be eligible to re18 ceive opioid overdose reversal drugs under this section, 

19 each State shall— 

20 ‘‘(1) establish a program for distributing opioid 

21 overdose reversal drug products to first responders 

22 and entities with authority to administer local public 

23 health services, including local health departments; 

24 ‘‘(2) beginning in the second year of the pro25 gram, demonstrate a distribution rate of a minimum 


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1 of 90 percent of the opioid overdose reversal drug 

2 products received under this program; and 

3 ‘‘(3) certify to the Secretary that the State has 

4 in place measures that enhance access to opioid 

5 overdose reversal drug products, such as laws that 

6 provide civil or disciplinary immunity for medical 

7 personnel who prescribe an opioid overdose reversal 

8 drug product, Good Samaritan Laws, Third Party 

9 Prescription Laws, Collaborative Practice Agree10 ments, and Standing Orders. 

11 ‘‘(f) INDIAN TRIBE REQUIREMENTS.—The Indian 

12 Health Service, in consultation with Indian tribes, shall 

13 determine any requirements that shall apply to Indian 

14 tribes receiving opioid overdose reversal drug products 

15 made available under this section. 

16 ‘‘(g) DEFINITIONS.—For purposes of this section: 

17 ‘‘(1) CAREER FIRE DEPARTMENT.—The term 

18 ‘career fire department’ means a fire department 

19 that has an all-paid force of firefighting personnel 

20 other than paid-on-call firefighters. 

21 ‘‘(2) COLLABORATIVE PRACTICE AGREEMENT.— 

22 The term ‘Collaborative Practice Agreement’ means 

23 an agreement under which a pharmacist operates 

24 under authority delegated by another licensed practi25 tioner with prescribing authority. 


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1 ‘‘(3) COMBINATION FIRE DEPARTMENT.—The 

2 term ‘combination fire department’ means a fire de3 partment that has paid firefighting personnel and 

4 volunteer firefighting personnel. 

5 ‘‘(4) EMERGENCY MEDICAL SERVICE.—The 

6 term ‘emergency medical service’ means resources 

7 used by a public or private nonprofit licensed entity 

8 to deliver medical care outside of a medical facility 

9 under emergency conditions that occur as a result of 

10 the condition of the patient and includes services de11 livered (either on a compensated or volunteer basis) 

12 by an emergency medical services provider or other 

13 provider that is licensed or certified by the State in14 volved as an emergency medical technician, a para15 medic, or an equivalent professional (as determined 

16 by the State). 

17 ‘‘(5) GOOD SAMARITAN LAW.—The term ‘Good 

18 Samaritan Law’ means a law that provides criminal 

19 immunity for a person who administers an opioid 

20 overdose reversal drug product, a person who, in 

21 good faith, seeks medical assistance for someone ex22 periencing a drug-related overdose, or a person who 

23 experiences a drug-related overdose and is in need of 

24 medical assistance and, in good faith, seeks such 


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1 medical assistance, or is the subject of such a good 

2 faith request for medical assistance. 

3 ‘‘(6) INDIANS.—The terms ‘Indian’, ‘Indian 

4 tribe’, ‘tribal organization’, and ‘Urban Indian 

5 Health Program’ have the meanings given such 

6 terms in section 4 of the Indian Health Care Im7 provement Act. 

8 ‘‘(7) MANUFACTURER.—The term ‘manufac9 turer’ means any corporation, organization, or insti10 tution, whether public or private (including Federal, 

11 State, and local departments, agencies, and instru12 mentalities), which manufactures, imports, proc13 esses, or distributes under its label any opioid over14 dose reversal drug product. The term ‘manufacture’ 

15 means to manufacture, import, process, or distribute 

16 an opioid overdose reversal drug. 

17 ‘‘(8) OPIOID OVERDOSE REVERSAL DRUG PROD18 UCT.—The term ‘opioid overdose reversal drug prod19 uct’ means a finished dosage form that has been ap20 proved by the Food and Drug Administration and 

21 that contains an active pharmaceutical ingredient 

22 that acts as an opioid receptor antagonist. The term 

23 ‘opioid overdose reversal drug product’ includes a 

24 combination product, as defined in section 3.2(e) of 

25 title 21, Code of Federal Regulations. 


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1 ‘‘(9) STANDING ORDER.—The term ‘standing 

2 order’ means a non-patient-specific order covering 

3 administration of medication by others to a patient 

4 who may be unknown to the prescriber at the time 

5 of the order. 

6 ‘‘(10) THIRD PARTY PRESCRIPTION.—The term 

7 ‘third party prescription’ means an order written for 

8 medication dispensed to one person with the inten9 tion that it will be administered to another person. 

10 ‘‘(11) VOLUNTEER FIRE DEPARTMENT.—The 

11 term ‘volunteer fire department’ means a fire de12 partment that has an all-volunteer force of fire13 fighting personnel. 

14 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this suc16 tion— 

17 ‘‘(1) $500,000,000 for fiscal year 2019; 

18 ‘‘(2) $500,000,000 for fiscal year 2020; 

19 ‘‘(3) $500,000,000 for fiscal year 2021; 

20 ‘‘(4) $500,000,000 for fiscal year 2022; 

21 ‘‘(5) $500,000,000 for fiscal year 2023; 

22 ‘‘(6) $500,000,000 for fiscal year 2024; 

23 ‘‘(7) $500,000,000 for fiscal year 2025; 

24 ‘‘(8) $500,000,000 for fiscal year 2026; 

25 ‘‘(9) $500,000,000 for fiscal year 2027; and 


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1 ‘‘(10) $500,000,000 for fiscal year 2028. 

2 ‘‘SEC. 3436. ADDITIONAL FUNDING FOR THE NATIONAL IN3 STITUTES OF HEALTH. 

4 ‘‘There is authorized to be appropriated to the Na5 tional Institute of Health for the purpose of conducting 

6 research on addiction and pain related to substance mis7 use, including research to develop overdose reversal drug 

8 products, non-addictive drug products for treating pain, 

9 and drug products used to treat substance use disorder— 

10 ‘‘(1) $1,000,000,000 for fiscal year 2019; 

11 ‘‘(2) $1,000,000,000 for fiscal year 2020; 

12 ‘‘(3) $1,000,000,000 for fiscal year 2021; 

13 ‘‘(4) $1,000,000,000 for fiscal year 2022; 

14 ‘‘(5) $1,000,000,000 for fiscal year 2023; 

15 ‘‘(6) $1,000,000,000 for fiscal year 2024; 

16 ‘‘(7) $1,000,000,000 for fiscal year 2025; 

17 ‘‘(8) $1,000,000,000 for fiscal year 2026; 

18 ‘‘(9) $1,000,000,000 for fiscal year 2027; and 

19 ‘‘(10) $1,000,000,000 for fiscal year 2028. 

20 ‘‘SEC. 3437. ADDITIONAL FUNDING FOR IMPROVED DATA 

21 COLLECTION AND PREVENTION OF INFEC22 TIOUS DISEASE TRANSMISSION. 

23 ‘‘(a) DATA COLLECTION.—The Centers for Disease 

24 Control and Prevention shall use a portion of the funding 

25 appropriated under this section to ensure that all States 


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1 participate in the Enhanced State Opioid Overdose Sur2 veillance program and to provide technical assistance to 

3 medical examiners and coroners to facilitate improved 

4 data collection on fatal overdoses through such program. 

5 ‘‘(b) CENTERS FOR DISEASE CONTROL AND PREVEN6 TION.—The Centers for Disease Control and Prevention 

7 shall use amounts appropriated under this section for the 

8 purpose of improving data on drug overdose deaths and 

9 non-fatal drug overdoses, surveillance related to addiction 

10 and substance use disorder, and the prevention of trans11 mission of infectious diseases related to substance use. 

12 ‘‘(c) TRIBAL EPIDEMIOLOGY CENTERS.—There shall 

13 be made available to the Indian Health Service for the 

14 purpose of funding efforts by tribal epidemiology centers 

15 to improve data on drug overdose deaths and non-fatal 

16 drug overdoses and surveillance related to addiction and 

17 substance use disorder, not less than 1.5 percent of the 

18 total amount appropriated under this section for each fis19 cal year. 

20 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

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

22 ‘‘(1) $400,000,000 for fiscal year 2019; 

23 ‘‘(2) $400,000,000 for fiscal year 2020; 

24 ‘‘(3) $400,000,000 for fiscal year 2021; 

25 ‘‘(4) $400,000,000 for fiscal year 2022; 


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1 ‘‘(5) $400,000,000 for fiscal year 2023; 

2 ‘‘(6) $400,000,000 for fiscal year 2024; 

3 ‘‘(7) $400,000,000 for fiscal year 2025; 

4 ‘‘(8) $400,000,000 for fiscal year 2026; 

5 ‘‘(9) $400,000,000 for fiscal year 2027; and 

6 ‘‘(10) $400,000,000 for fiscal year 2028. 

7 ‘‘SEC. 3438. DEFINITIONS. 

8 ‘‘In this title: 

9 ‘‘(1) PLANNING COUNCIL.—The term ‘planning 

10 council’ means the substance use planning council 

11 established under section 3402. 

12 ‘‘(2) RECOVERY RESIDENCE.—The term ‘recov13 ery residence’ means a residential dwelling unit, or 

14 other form of group housing, that is offered or ad15 vertised through any means, including oral, written, 

16 electronic, or printed means, by any individual or en17 tity as a residence that provides an evidence-based, 

18 peer-supported living environment for individuals un19 dergoing any type of substance use disorder treat20 ment or who have received any type of substance use 

21 disorder treatment in the past 3 years, including 

22 medication-assisted treatment. 

23 ‘‘(3) STATE.— 


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1 ‘‘(A) IN GENERAL.—The term ‘State’ 

2 means each of the 50 States, the District of Co3 lumbia, and each of the territories. 

4 ‘‘(B) TERRITORIES.—The term ‘territory’ 

5 means each of American Samoa, Guam, the 

6 Commonwealth of Puerto Rico, the Common7 wealth of the Northern Mariana Islands, the 

8 Virgin Islands, the Republic of the Marshall Is9 lands, the Federated States of Micronesia, and 

10 Palau. 

11 ‘‘(4) SUBSTANCE USE DISORDER TREAT12 MENT.— 

13 ‘‘(A) IN GENERAL.—The term ‘substance 

14 use disorder treatment’ means an evidence15 based, professionally directed, deliberate, and 

16 planned regimen including evaluation, observa17 tion, medical monitoring, and rehabilitative 

18 services and interventions such as 

19 pharmacotherapy, behavioral therapy, and indi20 vidual and group counseling, on an inpatient or 

21 outpatient basis, to help patients with substance 

22 use disorder reach recovery. 

23 ‘‘(B) TYPES OF TREATMENT.—Substance 

24 use disorder treatments shall include the fol25 lowing: 


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1 ‘‘(i) Clinical stabilization services, 

2 which are evidence-based services provided 

3 in secure, acute care facilities (which may 

4 be referred to as ‘addictions receiving fa5 cilities’) that, at a minimum— 

6 ‘‘(I) provide detoxification and 

7 stabilization services; 

8 ‘‘(II) are operated 24 hours per 

9 day, 7 days per week; and 

10 ‘‘(III) that serve individuals 

11 found to be substance use impaired. 

12 These can also be referred to as ‘Ad13 dictions receiving facilities’. 

14 ‘‘(ii) Withdrawal management and de15 toxification, which is a service that is pro16 vided on an inpatient or an outpatient 

17 basis to assist individuals manage the 

18 process of withdrawing from the physio19 logical and psychological effects of sub20 stance use disorder. 

21 ‘‘(iii) Intensive inpatient treatment, 

22 which is a service that provides a planned 

23 regimen of evidence-based evaluation, ob24 servation, medical monitoring, and evi25 dence-based rehabilitative services and 


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1 interventions such as pharmacotherapy, be2 havioral therapy, and counseling, 24 hours 

3 per day, 7 days per week, in a highly 

4 structured, residential environment. 

5 ‘‘(iv) Intensive outpatient treatment, 

6 which is a service that provides a planned 

7 regimen of evidence-based evaluation, ob8 servation, medical monitoring, and evi9 dence-based rehabilitative services and 

10 interventions such as pharmacotherapy, be11 havioral therapy, and counseling, in a 

12 structured, nonresidential environment at a 

13 higher level of intensity and duration than 

14 outpatient treatment. 

15 ‘‘(v) Medication-assisted treatment, 

16 which is a service that uses Federally-ap17 proved medication as authorized by Fed18 eral and State law, in combination with 

19 evidence-based medical, rehabilitative, and 

20 counseling services, in the treatment of in21 dividuals who suffer from substance use 

22 disorder. 

23 ‘‘(vi) Outpatient treatment, which is a 

24 service that provides a planned regimen of 

25 evidence-based evaluation, observation, 


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1 medical monitoring, and evidence-based re2 habilitative services and interventions such 

3 as pharmacotherapy, behavioral therapy, 

4 and counseling in a structured, nonresiden5 tial environment by appointment during 

6 scheduled operating hours. 

7 ‘‘(vii) Residential recovery treatment, 

8 which is a service that provides a planned 

9 regimen of evidence-based evaluation, ob10 servation, medical monitoring, and evi11 dence-based rehabilitative services and 

12 interventions such as pharmacotherapy, be13 havioral therapy, and counseling provided 

14 in a structured, live-in environment within 

15 a nonhospital setting on a 24-hours-per16 day, 7-days-per-week basis. 

17 ‘‘(C) LIMITATION.—Substance use disorder 

18 treatment providers shall not include— 

19 ‘‘(i) prevention only providers; and 

20 ‘‘(ii) a private practitioner who is li21 censed by a State medical licensing board 

22 and whose practice is limited to outpatient 

23 care. 

24 ‘‘(5) SUBSTANCE USE DISORDER TREATMENT

25 SERVICES.—The term ‘substance use disorder treatVerDate Sep 11 2014 01:46 Apr 21, 2018 Jkt 079200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\S2700.IS S2700

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1 ment services’ means any prevention services, core 

2 medical services, recovery and support services, early 

3 intervention and engagement services, and harm re4 duction services authorized under this title.’’. 

5 SEC. 4. AMENDMENTS TO THE CONTROLLED SUBSTANCES 

6 ACT. 

7 (a) CERTIFICATIONS.—Part C of the Controlled Sub8 stances Act (21 U.S.C. 821 et seq.) is amended by adding 

9 at the end the following: 

10 ‘‘CERTIFICATIONS RELATING TO DIVERSION CONTROLS

11 AND MISBRANDING

12 ‘‘SEC. 312. (a) DEFINITIONS.—In this section— 

13 ‘‘(1) the term ‘covered dispenser’— 

14 ‘‘(A) means a dispenser— 

15 ‘‘(i) that is required to register under 

16 section 302(a)(2); and 

17 ‘‘(ii) dispenses a controlled substance 

18 in schedule II; and 

19 ‘‘(B) does not include a dispenser that is— 

20 ‘‘(i) registered to dispense opioid 

21 agonist treatment medication under section 

22 303(g)(1); and 

23 ‘‘(ii) operating in that capacity; 

24 ‘‘(2) the term ‘covered distributor’ means a dis25 tributor— 


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1 ‘‘(A) that is required to register under sec2 tion 302(a)(1); and 

3 ‘‘(B) distributes a controlled substance in 

4 schedule II; 

5 ‘‘(3) the term ‘covered manufacturer’ means a 

6 manufacturer— 

7 ‘‘(A) that is required to register under sec8 tion 302(a)(1); and 

9 ‘‘(B) manufactures a controlled substance 

10 in schedule II; 

11 ‘‘(4) the term ‘covered officer’, with respect to 

12 a covered person means— 

13 ‘‘(A) in the case of a covered person that 

14 is not an individual— 

15 ‘‘(i) the chief executive officer of the 

16 covered person; 

17 ‘‘(ii) the president of the covered per18 son; 

19 ‘‘(iii) the chief medical officer of the 

20 covered person; and 

21 ‘‘(iv) the chief counsel of the covered 

22 person; and 

23 ‘‘(B) in the case of a covered person that 

24 is an individual, that individual; and 


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1 ‘‘(5) the term ‘covered person’ means a covered 

2 dispenser, a covered distributor, or a covered manu3 facturer. 

4 ‘‘(b) CERTIFICATIONS RELATING TO DIVERSION

5 CONTROLS.—Not later than 180 days after the date of 

6 enactment of this section, and each year thereafter, each 

7 covered officer of a covered person shall submit to the At8 torney General, for each controlled substance in schedule 

9 II dispensed, distributed, or manufactured by the covered 

10 person, a certification— 

11 ‘‘(1) signed by the covered officer; and 

12 ‘‘(2) certifying that— 

13 ‘‘(A) the covered person maintains effective 

14 controls against diversion of the controlled sub15 stance into channels other than legitimate med16 ical, scientific, research, or industrial channels; 

17 ‘‘(B) all information contained in any 

18 record, inventory, or report required to be kept 

19 or submitted to the Attorney General by the 

20 covered person under section 307, or under any 

21 regulation issued under that section, is accu22 rate; and 

23 ‘‘(C) the covered person is in compliance 

24 with all applicable requirements under Federal 


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1 law relating to reporting suspicious orders for 

2 controlled substances. 

3 ‘‘(c) CERTIFICATIONS RELATING TO MIS4 BRANDING.—Not later than 180 days after the date of en5 actment of this section, and each year thereafter, each cov6 ered officer of a covered manufacturer shall submit to the 

7 Attorney General, for each controlled substance in sched8 ule II manufactured by the covered manufacturer, a cer9 tification— 

10 ‘‘(1) signed by the covered officer; and 

11 ‘‘(2) certifying that the controlled substance is 

12 not misbranded, as described in section 502 of the 

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

14 352).’’. 

15 (b) OFFENSES.—Part D of title II of the Controlled 

16 Substances Act (21 U.S.C. 841 et seq.) is amended by 

17 adding at the end the following: 

18 ‘‘CERTIFICATIONS BY COVERED OFFICERS

19 ‘‘SEC. 424. (a) DEFINITIONS.—In this section, the 

20 terms ‘covered dispenser’, ‘covered distributor’, ‘covered 

21 manufacturer’, ‘covered officer’, and ‘covered person’ have 

22 the meanings given those terms in section 312. 

23 ‘‘(b) OFFENSES.— 

24 ‘‘(1) FAILURE TO SUBMIT CERTIFICATIONS.— 

25 ‘‘(A) CERTIFICATIONS RELATING TO DI26 VERSION CONTROLS.—It shall be unlawful for a 


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1 covered officer of a covered person to fail to 

2 submit a certification required under section 

3 312(b), without regard to the state of mind of 

4 the covered officer. 

5 ‘‘(B) CERTIFICATIONS RELATING TO MIS6 BRANDING.—It shall be unlawful for a covered 

7 officer of a covered manufacturer to fail to sub8 mit a certification required under section 

9 312(c), without regard to the state of mind of 

10 the covered officer. 

11 ‘‘(2) SUBMISSION OF FALSE CERTIFICATIONS.— 

12 ‘‘(A) FALSE CERTIFICATIONS RELATING TO

13 DIVERSION CONTROLS.—It shall be unlawful for 

14 a covered officer of a covered person to submit 

15 a certification required under section 312(b), 

16 without regard to the state of mind of the cov17 ered officer, that contains a materially false 

18 statement or representation relating to the in19 formation required to be certified under that 

20 section for the year for which the certification 

21 is submitted. 

22 ‘‘(B) FALSE CERTIFICATIONS RELATING

23 TO MISBRANDING.—It shall be unlawful for a 

24 covered officer of a covered manufacturer to 

25 submit a certification required under section 


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1 312(c), without regard to the state of mind of 

2 the covered officer, that contains a materially 

3 false statement or representation relating to the 

4 misbranding of a controlled substance with re5 spect to the year for which the certification is 

6 submitted. 

7 ‘‘(c) PENALTIES.— 

8 ‘‘(1) CIVIL PENALTIES.—Except as provided in 

9 paragraph (2), a covered officer who violates sub10 section (b) shall be subject to a civil penalty of not 

11 more than $25,000. 

12 ‘‘(2) CRIMINAL PENALTIES.—A covered officer 

13 who knowingly violates subsection (b)(2) shall be 

14 subject to criminal penalties under section 403(d). 

15 ‘‘(d) COMPREHENSIVE ADDICTION RESOURCES

16 FUND.— 

17 ‘‘(1) ESTABLISHMENT.—There is established in 

18 the Treasury a fund to be known as the ‘Com19 prehensive Addiction Resources Fund’. 

20 ‘‘(2) TRANSFER OF AMOUNTS.—There shall be 

21 transferred to the Comprehensive Addiction Re22 sources Fund 100 percent of— 

23 ‘‘(A) any civil penalty paid to the United 

24 States under this section; and 


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1 ‘‘(B) any fine paid to the United States 

2 under section 403(d) for a knowing violation of 

3 subsection (b)(2) of this section. 

4 ‘‘(3) AVAILABILITY AND USE OF FUNDS.— 

5 Amounts transferred to the Comprehensive Addic6 tion Fund under paragraph (2) shall— 

7 ‘‘(A) remain available until expended; and 

8 ‘‘(B) be made available to supplement 

9 amounts appropriated to carry out title XXXIV 

10 of the Public Health Service Act.’’. 

11 (c) CRIMINAL PENALTIES.—Section 403 of the Con12 trolled Substances Act (21 U.S.C. 843) is amended— 

13 (1) in subsection (d)(1)— 

14 (A) by inserting ‘‘or knowingly violates sec15 tion 424(b)(2)’’ after ‘‘any person who violates 

16 this section’’; and 

17 (B) by striking ‘‘violation of this section’’ 

18 and inserting ‘‘such a violation’’; and 

19 (2) in subsection (f)— 

20 (A) in paragraph (1), by striking ‘‘or 416’’ 

21 and inserting ‘‘or section 416, or knowing viola22 tions of section 424(b)(2)’’; and 

23 (B) in paragraph (3), by inserting ‘‘or 

24 knowing violations of section 424(b)(2)’’ before 

25 the period at the end. 


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1 (d) TECHNICAL AND CONFORMING AMENDMENTS.— 

2 The table of contents for the Comprehensive Drug Abuse 

3 Prevention and Control Act of 1970 (Public Law 91–513; 

4 84 Stat. 1236) is amended— 

5 (1) by inserting after the item relating to sec6 tion 311 the following: 

‘‘Sec. 312. Certifications relating to diversion controls and misbranding.’’; 

7 and 

8 (2) by inserting after the item relating to sec9 tion 423 the following: 

‘‘Sec. 424. Certifications by covered officers.’’. 

10 (e) EFFECTIVE DATE.—The amendments made by 

11 subsections (b) and (c) of this section shall take effect on 

12 the date that is 180 days after the date of enactment of 

13 this Act. 

Æ 


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