```

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2680 Introduced in Senate (IS)]

<DOC>

115th CONGRESS
  2d Session
                                S. 2680

                     To address the opioid crisis.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             April 16, 2018

 Mr. Alexander (for himself and Mrs. Murray) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
                     To address the opioid crisis.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Opioid Crisis 
Response Act of 2018''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
               TITLE I--REAUTHORIZATION OF CURES FUNDING

Sec. 101. State response to the opioid abuse crisis.
                   TITLE II--RESEARCH AND INNOVATION

Sec. 201. Advancing cutting-edge research.
Sec. 202. Pain research.
      TITLE III--MEDICAL PRODUCTS AND CONTROLLED SUBSTANCES SAFETY

Sec. 301. Clarifying FDA regulation of non-addictive pain products.
Sec. 302. Clarifying FDA packaging authorities.
Sec. 303. Strengthening FDA and CBP coordination and capacity.
Sec. 304. Clarifying FDA post-market authorities.
Sec. 305. First responder training.
Sec. 306. Disposal of controlled substances of a deceased hospice 
                            patient by employees of a hospice program.
Sec. 307. GAO study and report on hospice safe drug management.
Sec. 308. Delivery of a controlled substance by a pharmacy to be 
                            administered by injection, implantation, or 
                            intrathecal pump.
                    TITLE IV--TREATMENT AND RECOVERY

Sec. 401. Comprehensive opioid recovery centers.
Sec. 402. Program to support coordination and continuation of care for 
                            drug overdose patients.
Sec. 403. Alternatives to opioids.
Sec. 404. Peer support technical assistance.
Sec. 405. Medication-assisted treatment for recovery from addiction.
Sec. 406. National recovery housing best practices.
Sec. 407. Addressing economic and workforce impacts of the opioid 
                            crisis.
Sec. 408. Youth prevention and recovery.
Sec. 409. Plans of safe care.
Sec. 410. Regulations relating to special registration for 
                            telemedicine.
Sec. 411. National Health Service Corps behavioral and mental health 
                            professionals providing obligated service 
                            in schools and other community-based 
                            settings.
Sec. 412. Loan repayment for substance use disorder treatment 
                            providers.
Sec. 413. Improving treatment for pregnant and postpartum women.
Sec. 414. Early interventions for pregnant women and infants.
                          TITLE V--PREVENTION

Sec. 501. Study on prescribing limits.
Sec. 502. Programs for health care workforce.
Sec. 503. Education and awareness campaigns.
Sec. 504. Enhanced controlled substance overdoses data collection, 
                            analysis, and dissemination.
Sec. 505. Preventing overdoses of controlled substances.
Sec. 506. CDC surveillance and data collection for child, youth, and 
                            adult trauma.
Sec. 507. Reauthorization of NASPER.
Sec. 508. Jessie's Law.
Sec. 509. Development and dissemination of model training programs for 
                            substance use disorder patient records.
Sec. 510. Communication with families during emergencies.
Sec. 511. Prenatal and postnatal health.
Sec. 512. Surveillance and education regarding infections associated 
                            with injection drug use and other risk 
                            factors.
Sec. 513. Task force to develop best practices for trauma-informed 
                            identification, referral, and support.
Sec. 514. Grants to improve trauma support services and mental health 
                            care for children and youth in educational 
                            settings.
Sec. 515. National Child Traumatic Stress Initiative.

               TITLE I--REAUTHORIZATION OF CURES FUNDING

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

    (a) In General.--Section 1003 of the 21st Century Cures Act (Public 
Law 114-255) is amended--
            (1) in subsection (a)--
                    (A) by striking ``the authorization of 
                appropriations under subsection (b) to carry out the 
                grant program described in subsection (c)'' and 
                inserting ``subsection (h) to carry out the grant 
                program described in subsection (b)''; and
                    (B) by inserting after ``and Indian tribes'' after 
                ``States'';
            (2) by striking subsection (b);
            (3) by redesignating subsections (c) through (e) as 
        subsections (b) through (d), respectively;
            (4) by redesignating subsection (f) as subsection (j);
            (5) in subsection (b), as so redesignated--
                    (A) in paragraph (1)--
                            (i) in the paragraph heading, by inserting 
                        ``and indian tribe'' after ``State'';
                            (ii) by striking ``States for the purpose 
                        of addressing the opioid abuse crisis within 
                        such States'' and inserting ``States and Indian 
                        tribes for the purpose of addressing the opioid 
                        abuse crisis within such States and Indian 
                        tribes'';
                            (iii) by inserting ``or Indian tribes'' 
                        after ``preference to States''; and
                            (iv) by inserting before the period of the 
                        second sentence ``or other Indian tribes, as 
                        applicable''; and
                    (B) in paragraph (2)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``to a State'';
                            (ii) in subparagraph (A), by striking 
                        ``State'';
                            (iii) in subparagraph (C), by inserting 
                        ``preventing diversion of controlled 
                        substances,'' after ``treatment programs,''; 
                        and
                            (iv) in subparagraph (E), by striking ``as 
                        the State determines appropriate, related to 
                        addressing the opioid abuse crisis within the 
                        State'' and inserting ``as the State or Indian 
                        tribe determines appropriate, related to 
                        addressing the opioid abuse crisis within the 
                        State, including directing resources in 
                        accordance with local needs related to 
                        substance use disorders'';
            (6) in subsection (c), as so redesignated, by striking 
        ``subsection (c)'' and inserting ``subsection (b)'';
            (7) in subsection (d), as so redesignated--
                    (A) in the matter preceding paragraph (1), by 
                striking ``the authorization of appropriations under 
                subsection (b)'' and inserting ``subsection (h)''; and
                    (B) in paragraph (1), by striking ``subsection 
                (c)'' and inserting ``subsection (b)''; and
            (8) by inserting after subsection (d), as so redesignated, 
        the following:
    ``(e) Indian Tribes.--
            ``(1) Definition.--For purposes of this section, the term 
        `Indian tribe' has the meaning given such term in section 4 of 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 5304).
            ``(2) Appropriate mechanisms.--The Secretary, in 
        consultation with Indian tribes, shall identify and establish 
        appropriate mechanisms for tribes to demonstrate or report the 
        information as required under subsections (b), (c), and (d).
    ``(f) Report to Congress.--Not later than 1 year after the date on 
which amounts are first awarded, after the date of enactment of the 
Opioid Crisis Response Act of 2018, pursuant to subsection (b), and 
annually thereafter, the Secretary shall submit to the Committee on 
Health, Education, Labor, and Pensions of the Senate and the Committee 
on Energy and Commerce of the House of Representatives a report 
summarizing the information provided to the Secretary in reports made 
pursuant to subsection (c), including the purposes for which grant 
funds are awarded under this section and the activities of such grant 
recipients.
    ``(g) Technical Assistance.--The Secretary, including through the 
Tribal Training and Technical Assistance Center of the Substance Abuse 
and Mental Health Services Administration, shall provide State agencies 
and Indian tribes, as applicable, with technical assistance concerning 
grant application and submission procedures under this section, award 
management activities, and enhancing outreach and direct support to 
rural and underserved communities and providers in addressing the 
opioid crisis.
    ``(h) Authorization of Appropriations.--For purposes of carrying 
out the grant program under subsection (b), there are authorized to be 
appropriated $500,000,000 for each of fiscal years 2019 through 2021, 
to remain available until expended.
    ``(i) Set Aside.--Of the amounts made available for each fiscal 
year to award grants under subsection (b) for a fiscal year, 5 percent 
of such amount for such fiscal year shall be made available to Indian 
tribes, and up to 15 percent of such amount for such fiscal year may be 
set aside for States with the highest age-adjusted mortality rate 
associated with opioid use disorders based on the ordinal ranking of 
States according to the age-adjusted overdose mortality rates of the 
Centers for Disease Control and Prevention.''.
    (b) Previously Appropriated Amounts.--
            (1) Appropriation of amounts remaining in account.--Any 
        unobligated amounts remaining, on the date of enactment of this 
        Act, in the Account For the State Response to the Opioid Abuse 
        Crisis established under section 1003(b) of the 21st Century 
        Cures Act (Public Law 114-255) (as in effect on the day before 
        the date of enactment of this Act) are hereby appropriated to 
        the Secretary of Health and Human Services for purposes of 
        carrying out the grant program under subsection (b) of section 
        1003 of the 21st Century Cures Act (Public Law 114-255) (as 
        redesignated by subsection (a)(3) of this section).
            (2) Available until expended.--Amounts appropriated under 
        paragraph (1) of this subsection or section 1003(b)(3) of the 
        21st Century Cures Act (as in effect on the day before the date 
        of enactment of this Act) shall remain available until 
        expended.
    (c) Conforming Amendment.--Section 1004(c) of the 21st Century 
Cures Act (Public Law 114-255) is amended by striking ``, the FDA 
Innovation Account, or the Account For the State Response to the Opioid 
Abuse Crisis'' and inserting ``or the FDA Innovation Account''.

                   TITLE II--RESEARCH AND INNOVATION

SEC. 201. ADVANCING CUTTING-EDGE RESEARCH.

    Section 402(n)(1) of the Public Health Service Act (42 U.S.C. 
282(n)(1)) is amended--
            (1) in subparagraph (A), by striking ``or'';
            (2) in subparagraph (B), by striking the period and 
        inserting ``; or''; and
            (3) by adding at the end the following:
                    ``(C) high impact cutting-edge research that 
                fosters scientific creativity and increases fundamental 
                biological understanding leading to the prevention, 
                diagnosis, or treatment of diseases and disorders, or 
                research urgently required to respond to a public 
                health threat.''.

SEC. 202. PAIN RESEARCH.

    Section 409J(b) of the Public Health Service Act (42 U.S.C. 
284q(b)) is amended--
            (1) in paragraph (5)--
                    (A) in subparagraph (A), by striking ``and 
                treatment of pain and diseases and disorders associated 
                with pain'' and inserting ``treatment, and management 
                of pain and diseases and disorders associated with 
                pain, including information on best practices for 
                utilization of non-pharmacologic treatments, non-
                addictive medical products, and other drugs approved, 
                or devices approved or cleared, by the Food and Drug 
                Administration'';
                    (B) in subparagraph (B), by striking ``on the 
                symptoms and causes of pain;'' and inserting the 
                following: ``on--
                            ``(i) the symptoms and causes of pain;
                            ``(ii) the diagnosis, prevention, 
                        treatment, and management of pain; and
                            ``(iii) risk factors for, and early warning 
                        signs of, substance use disorders; and'';
                    (C) by striking subparagraphs (C) through (E) and 
                inserting the following:
                    ``(C) make recommendations to the Director of NIH--
                            ``(i) to ensure that the activities of the 
                        National Institutes of Health and other Federal 
                        agencies are free of unnecessary duplication of 
                        effort;
                            ``(ii) on how best to disseminate 
                        information on pain care; and
                            ``(iii) on how to expand partnerships 
                        between public entities and private entities to 
                        expand collaborative, cross-cutting 
                        research.'';
            (2) by redesignating paragraph (6) as paragraph (7); and
            (3) by inserting after paragraph (5) the following:
            ``(6) Report.--The Director of NIH shall ensure that 
        recommendations and actions taken by the Director with respect 
        to the topics discussed at the meetings described in paragraph 
        (4) are included in appropriate reports to Congress.''.

      TITLE III--MEDICAL PRODUCTS AND CONTROLLED SUBSTANCES SAFETY

SEC. 301. CLARIFYING FDA REGULATION OF NON-ADDICTIVE PAIN PRODUCTS.

    (a) Public Meetings.--Not later than 1 year after the date of 
enactment of this Act, the Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), acting through the 
Commissioner of Food and Drugs, shall hold not less than one public 
meeting to address the challenges and barriers of developing non-
addictive medical products intended to treat pain or addiction, which 
may include--
            (1) the manner by which the Secretary may incorporate the 
        risks of misuse and abuse of a controlled substance (as defined 
        in section 102 of the Controlled Substances Act (21 U.S.C. 802) 
        into the risk benefit assessment under section 505(e) of the 
        Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(e)), 
        section 510(k) of such Act (21 U.S.C. 360(k)), or section 
        515(c) of such Act (21 U.S.C. 360e(c)), as applicable;
            (2) the application of novel clinical trial designs 
        (consistent with section 3021 of the 21st Century Cures Act 
        (Public Law 114-255)), use of real world evidence (consistent 
        with section 505F of the Federal Food, Drug, and Cosmetic Act 
        (21 U.S.C. 355g)), and use of patient experience data 
        (consistent with section 569C of the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 360bbb-8c)) for the development of non-
        addictive medical products intended to treat pain or addiction;
            (3) the evidentiary standards and the development of opioid 
        sparing data for inclusion in the labeling of medical products; 
        and
            (4) the application of eligibility criteria under sections 
        506 and 515B of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 356, 360e-3) for non-addictive medical products intended 
        to treat pain or addiction.
    (b) Guidance.--Not less than one year after the public meetings are 
conducted under subsection (a) the Secretary shall issue one or more 
final guidance documents, or update existing guidance documents, to 
help address challenges to developing non-addictive medical products to 
treat pain or addiction. Such guidance documents shall include 
information regarding--
            (1) how the Food and Drug Administration may apply sections 
        506 and 515B of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 356, 360e-3) to non-addictive medical products intended 
        to treat pain or addiction, including the circumstances under 
        which the Secretary--
                    (A) may apply the eligibility criteria under such 
                sections 506 and 515B to non-opioid or non-addictive 
                medical products intended to treat pain or addiction;
                    (B) considers the risk of addiction of controlled 
                substances approved to treat pain when establishing 
                unmet medical need; and
                    (C) considers pain, pain control, or pain 
                management in assessing whether a disease or condition 
                is a serious or life-threatening disease or condition;
            (2) the methods by which sponsors may evaluate acute and 
        chronic pain, endpoints for non-addictive medical products 
        intended to treat pain, the manner in which endpoints and 
        evaluations of efficacy will be applied across and within 
        review divisions, taking into consideration the etiology of the 
        underlying disease, and the manner in which sponsors may use 
        surrogate endpoints, intermediate endpoints, and real world 
        evidence;
            (3) the manner in which the Food and Drug Administration 
        will assess evidence to support the inclusion of opioid sparing 
        data in the labeling of non-addictive medical products intended 
        to treat pain, including--
                    (A) data collection methodologies, including the 
                use of novel clinical trial designs (consistent with 
                section 3021 of the 21st Century Cures Act (Public Law 
                114-255)), and real world evidence (consistent with 
                section 505F of the Federal Food, Drug, and Cosmetic 
                Act (21 U.S.C. 355g)), as appropriate, to support 
                product labeling;
                    (B) ethical considerations of exposuring subjects 
                to controlled substances in clinical trials to develop 
                opioid sparing data and considerations on data 
                collection methods that reduce harm, which may include 
                the reduction of opioid use as a clinical benefit;
                    (C) endpoints, including primary, secondary, and 
                surrogate endpoints, to evaluate the reduction of 
                opioid use;
                    (D) best practices for communication between 
                sponsors and the agency on the development of data 
                collection methods, including the initiation of data 
                collection; and
                    (E) the appropriate format to submit such data 
                results to the Secretary; and
            (4) the circumstances under which the Food and Drug 
        Administration considers misuse and abuse of drugs in making 
        determinations of safety under paragraphs (2) and (4) of 
        subsection (d) of section 505 of the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 355) and in finding that a drug is 
        unsafe under paragraph (1) or (2) of subsection (e) of such 
        section.
    (c) Definitions.--In this section--
            (1) the term ``medical product'' means a drug (as defined 
        in section 201(g)(1) of the Federal Food, Drug, and Cosmetic 
        Act (21 U.S.C. 321(g)(1))), biological product (as defined in 
        section 351(i) of the Public Health Service Act (42 U.S.C. 
        262(i))), or device (as defined in section 201(h) of the 
        Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(h))); and
            (2) the term ``opioid sparing'' means reducing, replacing, 
        or avoiding the use of opioids or other controlled substances.

SEC. 302. CLARIFYING FDA PACKAGING AUTHORITIES.

    Section 505-1(e) of the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 355-1(e)) is amended by adding at the end the following:
            ``(4) Serious adverse drug experience.--The Secretary may 
        require a risk evaluation mitigation strategy for a drug for 
        which there is a serious risk of an adverse drug experience 
        described in subparagraph (B) or (C) of subsection (b)(1), 
        taking into consideration the factors described in 
        subparagraphs (C) and (D) of subsection (f)(2), which may 
        include requiring that--
                    ``(A) the drug be made available for dispensing to 
                certain patients in unit dose packaging, packaging that 
                provides a set duration, or other packaging system that 
                the Secretary determines may help mitigate such serious 
                risk; or
                    ``(B) the drug be dispensed to certain patients 
                with a safe disposal packaging or safe disposal system 
                for purposes of rendering unused drugs non-retrievable 
                (as defined in section 1300.05 of title 21, Code of 
                Federal Regulations (or any successor regulation)) if 
                the Secretary has determines that such safe disposal 
                packaging or system may help mitigate such serious risk 
                and exists in sufficient quantities, in consultation 
                with other relevant Federal agencies with authorities 
                over drug packaging.''.

SEC. 303. STRENGTHENING FDA AND CBP COORDINATION AND CAPACITY.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), acting through the 
Commissioner of Food and Drugs, shall coordinate with the Secretary of 
Homeland Security to carry out activities related to customs and border 
protection and response to illegal controlled substances and drug 
imports, including at sites of import (such as international mail 
facilities). Such Secretaries may carry out such activities through a 
memorandum of understanding between the Food and Drug Administration 
and the United States Customs and Border Protection.
    (b) FDA Import Facilities and Inspection Capacity.--In carrying out 
this section, the Secretary shall--
            (1) in collaboration with the Secretary of Homeland 
        Security and the Postmaster General of the United States Postal 
        Service, provide that import facilities in which the Food and 
        Drug Administration operates or carries out activities related 
        to drug imports within the international mail facilities 
        include--
                    (A) facility upgrades and improved capacity in 
                order to increase and improve inspection and detection 
                capabilities, which may include, as the Secretary 
                determines appropriate--
                            (i) improvements to facilities, such as 
                        upgrades or renovations, and support for the 
                        maintenance of existing import facilities and 
                        sites to improve coordination between Federal 
                        agencies;
                            (ii) the construction of, or upgrades to, 
                        laboratory capacity for purposes of detection 
                        and testing of imported goods;
                            (iii) upgrades to the security of import 
                        facilities; and
                            (iv) innovative technology and equipment to 
                        facilitate improved and near-real-time 
                        information sharing between the Food and Drug 
                        Administration, the Department of Homeland 
                        Security, and the United States Postal Service; 
                        and
                    (B) provide import facilities in which the Food and 
                Drug Administration operates or carries out activities 
                related to drug imports within the international mail 
                facilities with innovative technology, including 
                controlled substance detection and testing equipment 
                and other applicable technology, and collaborate with 
                United States Customs and Border Protection to share 
                near-real-time information, including information about 
                test results, as appropriate, provided that such 
                technology is interoperable with technology used by 
                other relevant Federal agencies, including the United 
                States Customs and Border Protection, as applicable, 
                and is used in the time and manner that the Secretary 
                determines appropriate.
    (c) Report.--Not later than 6 months after the date of enactment of 
this Act, the Secretary, in consultation with the Secretary of Homeland 
Security and the Postmaster General of the United States Postal 
Service, shall report to the relevant committees of Congress on the 
implementation of this section, including a summary of progress made 
towards near-real-time information sharing and the interoperability of 
such technologies.
    (d) Authorization of Appropriations.--Out of amounts otherwise 
available to the Secretary, the Secretary may allocate such sums as may 
be necessary for purposes of carrying out this section.

SEC. 304. CLARIFYING FDA POST-MARKET AUTHORITIES.

    Section 505-1(b)(1)(E) of the Federal Food, Drug, and Cosmetic Act 
(21 U.S.C. 355-1(b)(1)(E)) is amended by striking ``of the drug'' and 
inserting ``of the drug, which may include reduced effectiveness that 
is not in accordance with the labeling of such drug''.

SEC. 305. FIRST RESPONDER TRAINING.

    Section 546 of the Public Health Service Act (42 U.S.C. 290ee-1) is 
amended--
            (1) in subsection (c)--
                    (A) in paragraph (2), by striking ``and'' at the 
                end;
                    (B) in paragraph (3), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(4) train and provide resources for first responders and 
        members of other key community sectors on safety around 
        fentanyl and other dangerous illicit drugs to protect 
        themselves from exposure to fentanyl and respond appropriately 
        when exposure occurs.'';
            (2) in subsection (d), by inserting ``, and safety around 
        fentanyl and other dangerous illicit drugs'' before the period;
            (3) in subsection (f)--
                    (A) in paragraph (3), by striking ``and'' at the 
                end;
                    (B) in paragraph (4), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following:
            ``(5) the number of first responders and members of other 
        key community sectors trained on safety around fentanyl and 
        other dangerous illicit drugs.''; and
            (4) in subsection (g), by striking ``$12,000,000 for each 
        of fiscal years 2017 through 2021'' and inserting ``$36,000,000 
        for each of fiscal years 2019 through 2023''.

SEC. 306. DISPOSAL OF CONTROLLED SUBSTANCES OF A DECEASED HOSPICE 
              PATIENT BY EMPLOYEES OF A HOSPICE PROGRAM.

    (a) In General.--Section 302(g) of the Controlled Substances Act 
(21 U.S.C. 822(g)) is amended by adding at the end the following:
    ``(5)(A) An employee of a qualified hospice program acting within 
the scope of employment may handle, in the place of residence of a 
hospice patient, any controlled substance that was lawfully dispensed 
to the hospice patient, for the purpose of assisting in the disposal of 
the controlled substance after the hospice patient's death.
    ``(B) In this paragraph:
            ``(i) The term `employee of a qualified hospice program' 
        means a physician, physician assistant, or nurse who--
                    ``(I) is employed by, or is acting pursuant to 
                arrangements made with, a qualified hospice program; 
                and
                    ``(II) is licensed or certified to perform such 
                employment or acts in accordance with applicable State 
                law.
            ``(ii) The terms `hospice care' and `hospice program' have 
        the meanings given those terms in section 1861(dd) of the 
        Social Security Act (42 U.S.C. 1395x(dd)).
            ``(iii) The term `hospice patient' means an individual 
        receiving hospice care.
            ``(iv) The term `qualified hospice program' means a hospice 
        program that--
                    ``(I) has written policies and procedures for 
                employees of the hospice program to use assisting in 
                the disposal of the controlled substances of a hospice 
                patient after the hospice patient's death;
                    ``(II) at the time when the controlled substances 
                are first ordered--
                            ``(aa) provides a copy of the written 
                        policies and procedures to the hospice patient 
                        or hospice patient representative and the 
                        family of the hospice patient;
                            ``(bb) discusses the policies and 
                        procedures with the hospice patient or hospice 
                        patient's representative and the hospice 
                        patient's family in a language and manner that 
                        such individuals understand to ensure that such 
                        individuals are informed regarding the safe 
                        disposal of controlled substances; and
                            ``(cc) documents in the clinical record of 
                        the hospice patient that the written policies 
                        and procedures were provided and discussed with 
                        the hospice patient or hospice patient's 
                        representative; and
                    ``(III) at the time when an employee of the hospice 
                program assists in the disposal of controlled 
                substances of a hospice patient, documents in the 
                clinical record of the hospice patient a list of all 
                controlled substances disposed of.
            ``(C) The Attorney General may, by regulation, include 
        additional types of licensed medical professionals in the 
        definition of the term `employee of a qualified hospice 
        program' under subparagraph (B).''.
    (b) No Registration Required.--Section 302(c) of the Controlled 
Substances Act (21 U.S.C. 822(c)) is amended by adding at the end the 
following:
            ``(4) An employee of a qualified hospice program for the 
        purpose of assisting in the disposal of a controlled substance 
        in accordance with subsection (g)(5).''.
    (c) Guidance.--The Attorney General may issue guidance to qualified 
hospice programs to assist the programs in satisfying the requirements 
under paragraph (5) of section 302(g) of the Controlled Substances Act 
(21 U.S.C. 822(g)), as added by subsection (a).
    (d) State and Local Authority.--Nothing in this section or the 
amendments made by this section shall be construed to prevent a State 
or local government from imposing additional controls or restrictions 
relating to the regulation of the disposal of controlled substances in 
hospice care or hospice programs.

SEC. 307. GAO STUDY AND REPORT ON HOSPICE SAFE DRUG MANAGEMENT.

    (a) Study.--
            (1) In general.--The Comptroller General of the United 
        States (in this section referred to as the ``Comptroller 
        General'') shall conduct a study on the requirements applicable 
        to and challenges of hospice programs with regard to the 
        management and disposal of controlled substances in the home of 
        an individual.
            (2) Contents.--In conducting the study under paragraph (1), 
        the Comptroller General shall include--
                    (A) an overview of challenges encountered by 
                hospice programs regarding the disposal of controlled 
                substances, such as opioids, in a home setting, 
                including any key changes in policies, procedures, or 
                best practices for the disposal of controlled 
                substances over time; and
                    (B) a description of Federal requirements, 
                including requirements under the Medicare program, for 
                hospice programs regarding the disposal of controlled 
                substances in a home setting, and oversight of 
                compliance with those requirements.
    (b) Report.--Not later than 18 months after the date of enactment 
of this Act, the Comptroller General shall submit to Congress a report 
containing the results of the study conducted under subsection (a), 
together with recommendations, if any, for such legislation and 
administrative action as the Comptroller General determines 
appropriate.

SEC. 308. DELIVERY OF A CONTROLLED SUBSTANCE BY A PHARMACY TO BE 
              ADMINISTERED BY INJECTION, IMPLANTATION, OR INTRATHECAL 
              PUMP.

    (a) In General.--The Controlled Substances Act is amended by 
inserting after section 309 (21 U.S.C. 829) the following:

``delivery of a controlled substance by a pharmacy to an administering 
                              practitioner

    ``Sec. 309A.  (a) In General.--Notwithstanding section 102(10), a 
pharmacy may deliver a controlled substance to a practitioner in 
accordance with a prescription that meets the requirements of this 
title and the regulations issued by the Attorney General under this 
title, for the purpose of administering of the controlled substance by 
the practitioner if--
            ``(1) the controlled substance is delivered by the pharmacy 
        to the prescribing practitioner or the practitioner 
        administering the controlled substance, as applicable, at the 
        location listed on the practitioner's certificate of 
        registration issued under this title;
            ``(2)(A) in the case of administering of the controlled 
        substance for the purpose of maintenance or detoxification 
        treatment under section 303(g)(2)--
                    ``(i) the practitioner who issued the prescription 
                is a qualifying practitioner authorized under, and 
                acting within the scope of that section; and
                    ``(ii) the controlled substance is to be 
                administered by injection or implantation; or
            ``(B) in the case of administering of the controlled 
        substance for a purpose other than maintenance or 
        detoxification treatment, the controlled substance is to be 
        administered by a practitioner through use of an intrathecal 
        pump;
            ``(3) the pharmacy and the practitioner are authorized to 
        conduct the activities specified in this section under the law 
        of the State in which such activities take place;
            ``(4) the prescription is not issued to supply any 
        practitioner with a stock of controlled substances for the 
        purpose of general dispensing to patients;
            ``(5) except as provided in subsection (b), the controlled 
        substance is to be administered only to the patient named on 
        the prescription not later than 14 days after the date of 
        receipt of the controlled substance by the practitioner; and
            ``(6) notwithstanding any exceptions under section 307, the 
        prescribing practitioner, and the practitioner administering 
        the controlled substance, as applicable, maintain complete and 
        accurate records of all controlled substances delivered, 
        received, administered, or otherwise disposed of under this 
        section, including the persons to whom controlled substances 
        were delivered and such other information as may be required by 
        regulations of the Attorney General.
    ``(b) Modification of Number of Days Before Which Controlled 
Substance Shall Be Administered.--
            ``(1) Initial 2-year period.--During the 2-year period 
        beginning on the date of enactment of this section, the 
        Attorney General, in coordination with the Secretary, may 
        reduce the number of days described in subsection (a)(5) if the 
        Attorney General determines that such reduction will--
                    ``(A) reduce the risk of diversion; or
                    ``(B) protect the public health.
            ``(2) Modifications after submission of report.--After the 
        date on which the report described in subsection (c) is 
        submitted, the Attorney General, in coordination with the 
        Secretary, may modify the number of days described in 
        subsection (a)(5).
            ``(3) Minimum number of days.--Any modification under this 
        subsection shall be for a period of not less than 7 days.''.
    (b) Study and Report.--Not later than 2 years after the date of 
enactment of this section, the Comptroller General of the United States 
shall conduct a study and submit to Congress a report on access to and 
potential diversion of controlled substances administered by injection, 
implantation, or through the use of an intrathecal pump.
    (c) Technical and Conforming Amendment.--The table of contents for 
the Comprehensive Drug Abuse Prevention and Control Act of 1970 is 
amended by inserting after the item relating to section 309 the 
following:

``Sec. 309A. Delivery of a controlled substance by a pharmacy to an 
                            administering practitioner.''.

                    TITLE IV--TREATMENT AND RECOVERY

SEC. 401. COMPREHENSIVE OPIOID RECOVERY CENTERS.

    (a) In General.--Part D of title V of the Public Health Service Act 
is amended by adding at the end the following new section:

``SEC. 550. COMPREHENSIVE OPIOID RECOVERY CENTERS.

    ``(a) In General.--The Secretary, acting through the Assistant 
Secretary for Mental Health and Substance Use, shall award grants on a 
competitive basis to eligible entities to establish or operate a 
comprehensive opioid recovery center (referred to in this section as a 
`Center'). A Center may be a single entity or an integrated delivery 
network.
    ``(b) Grant Period.--
            ``(1) In general.--A grant awarded under subsection (a) 
        shall be for a period not more than 5 years.
            ``(2) Renewal.--A grant awarded under subsection (a) may be 
        renewed, on a competitive basis, for additional periods of 
        time, as determined by the Secretary. In determining whether to 
        renew a grant under this paragraph, the Secretary shall 
        consider the data submitted under subsection (h).
    ``(c) Minimum Number of Grants.--The Secretary shall allocate the 
amounts made available under subsection (j) such that not fewer than 10 
grants may be awarded. Not more than one grant shall be made to 
entities in a single State for any one period.
    ``(d) Application.--In order to be eligible for a grant under 
subsection (a), an entity shall submit an application to the Secretary 
at such time and in such manner as the Secretary may require. Such 
application shall include--
            ``(1) evidence that such entity carries out, or is capable 
        of coordinating with other entities to carry out, the 
        activities described in subsection (g); and
            ``(2) such other information as the Secretary may require.
    ``(e) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to eligible entities located in a State 
with an overdose mortality rate that is above the national overdose 
mortality rate, as determined by the Director of the Centers for 
Disease Control and Prevention.
    ``(f) Preference.--In awarding grants under subsection (a), the 
Secretary may give preference to eligible entities utilizing 
technology-enabled collaborative learning and capacity building models, 
including such models as defined in section 2 of the Expanding Capacity 
for Health Outcomes Act (Public Law 114-270; 130 Stat. 1395), to 
conduct the activities described in this section.
    ``(g) Center Activities.--Each Center shall, at a minimum, carry 
out the following activities directly, through referral, or through 
contractual arrangements, which may include carrying out such 
activities through technology-enabled collaborative learning and 
capacity building models described in subsection (f):
            ``(1) Treatment and recovery services.--Each Center shall--
                    ``(A) ensure that intake and evaluations meet the 
                individualized clinical needs of patients, including by 
                offering assessments for services and care 
                recommendations through independent, evidence-based 
                verification processes for reviewing patient placement 
                in treatment settings;
                    ``(B) provide the full continuum of treatment 
                services, including--
                            ``(i) all drugs approved by the Food and 
                        Drug Administration to treat substance use 
                        disorders;
                            ``(ii) medically supervised withdrawal 
                        management that includes patient evaluation, 
                        stabilization, and readiness for and entry into 
                        treatment;
                            ``(iii) counseling provided by a program 
                        counselor or other certified professional who 
                        is licensed and qualified by education, 
                        training, or experience to assess the 
                        psychological and sociological background of 
                        patients, to contribute to the appropriate 
                        treatment plan for the patient, and to monitor 
                        patient progress;
                            ``(iv) treatment, as appropriate, for 
                        patients with co-occurring substance use and 
                        mental health disorders;
                            ``(v) residential rehabilitation, and 
                        outpatient and intensive outpatient programs;
                            ``(vi) recovery housing;
                            ``(vii) community-based and peer recovery 
                        support services;
                            ``(viii) job training, job placement 
                        assistance, and continuing education assistance 
                        to support reintegration into the workforce; 
                        and
                            ``(ix) other best practices to provide the 
                        full continuum of treatment and services, as 
                        determined by the Secretary;
                    ``(C) periodically conduct patient assessments to 
                support sustained and clinically significant recovery, 
                as defined by the Assistant Secretary for Mental Health 
                and Substance Use;
                    ``(D) administer an onsite pharmacy and provide 
                toxicology services, for purposes of carrying out this 
                section; and
                    ``(E) operate a secure, confidential, and 
                interoperable electronic health information system.
            ``(2) Outreach.--Each Center shall carry out outreach 
        activities to publicize the services offered through the 
        Centers, which may include--
                    ``(A) training and supervising outreach staff, as 
                appropriate, to work with State and local health 
                departments, health care providers, State and local 
                education agencies, institutions of higher education, 
                State and local workforce development boards, State and 
                local community action agencies, public safety 
                officials, first responders, child welfare agencies, as 
                appropriate, and other community partners and the 
                public, including patients, to identify and respond to 
                community needs, and ensuring that such entities are 
                aware of the services of the Center; and
                    ``(B) disseminating and making publicly available, 
                including through the internet, evidence-based 
                resources that educate professionals and the public on 
                opioid use disorder and other substance use disorders, 
                including co-occurring substance use and mental health 
                disorders.
    ``(h) Data Reporting and Program Oversight.--With respect to a 
grant awarded under subsection (a), not later than 90 days after the 
end of the first year of the grant period, and annually thereafter for 
the duration of the grant period (including the duration of any renewal 
period for such grant), the entity shall submit data, as appropriate, 
to the Secretary regarding--
            ``(1) the programs and activities funded by the grant;
            ``(2) health outcomes of the population of individuals with 
        a substance use disorder who received services from the Center, 
        evaluated by an independent program evaluator through the use 
        of outcomes measures, as determined by the Secretary;
            ``(3) the retention rate of program participants; and
            ``(4) any other information that the Secretary may require 
        for the purpose of ensuring that the Center is complying with 
        all the requirements of the grant, including providing the full 
        continuum of services described in subsection (g)(1)(B).
    ``(i) Privacy.--The provisions of this section, including with 
respect to data reporting and program oversight, shall be subject to 
all applicable Federal and State privacy laws.
    ``(j) Authorization of Appropriations.--There is authorized to be 
appropriated $10,000,000 for each of fiscal years 2019 through 2023 for 
purposes of carrying out this section.''.
    (b) Reports to Congress.--
            (1) Preliminary report.--Not later than 3 years after the 
        date of the enactment of this Act, the Secretary of Health and 
        Human Services shall submit to Congress a preliminary report 
        that analyzes data submitted under section 550(h) of the Public 
        Health Service Act, as added by subsection (a).
            (2) Final report.--Not later than 2 years after submitting 
        the preliminary report required under paragraph (1), the 
        Secretary of Health and Human Services shall submit to Congress 
        a final report that includes--
                    (A) an evaluation of the effectiveness of the 
                comprehensive services provided by the Centers 
                established or operated pursuant to section 550 of the 
                Public Health Service Act, as added by subsection (a), 
                on health outcomes of the population of individuals 
                with substance use disorder who receive services from 
                the Center, which shall include an evaluation of the 
                effectiveness of services for treatment and recovery 
                support and to reduce relapse, recidivism, and 
                overdose; and
                    (B) recommendations, as appropriate, regarding ways 
                to improve Federal programs related to substance use 
                disorders, which may include dissemination of best 
                practices for the treatment of substance use disorders 
                to health care professionals.

SEC. 402. PROGRAM TO SUPPORT COORDINATION AND CONTINUATION OF CARE FOR 
              DRUG OVERDOSE PATIENTS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall identify or 
facilitate the development of best practices for--
            (1) emergency treatment of known or suspected drug 
        overdose;
            (2) coordination and continuation of care and treatment, 
        including, as appropriate, through referrals, of individuals 
        after an opioid overdose; and
            (3) the provision of overdose reversal medication, as 
        appropriate.
    (b) Grant Establishment and Participation.--
            (1) In general.--The Secretary shall award grants on a 
        competitive basis to eligible entities to support 
        implementation of voluntary programs for care and treatment of 
        individuals after an opioid overdose, as appropriate, which may 
        include implementation of the best practices described in 
        subsection (a).
            (2) Eligible entity.--In this section, the term ``eligible 
        entity'' means an entity that offers treatment or other 
        services for individuals in response to, or following, drug 
        overdoses or a drug overdose.
            (3) Application.--An eligible entity desiring a grant under 
        this section, in consultation with the principal agency of a 
        State in which such entity offers treatment or other services 
        that is responsible for carrying out the block grant for 
        prevention and treatment of substance abuse under subpart II of 
        part B of title XIX of the Public Health Service Act (42 U.S.C. 
        300x-21 et seq.), shall submit an application to the Secretary, 
        at such time and in such manner as the Secretary may require, 
        that includes--
                    (A) evidence that such eligible entity carries out, 
                or is capable of coordinating with other entities to 
                carry out, the activities described in paragraph (4); 
                and
                    (B) such additional information as the Secretary 
                may require.
            (4) Use of grant funds.--An eligible entity awarded a grant 
        under this section shall use such grant funds to--
                    (A) hire or utilize recovery coaches to help 
                support recovery, including by--
                            (i) connecting patients to a continuum of 
                        care services, such as--
                                    (I) treatment and recovery support 
                                programs;
                                    (II) programs that provide non-
                                clinical recovery support services;
                                    (III) peer support networks;
                                    (IV) recovery community 
                                organizations;
                                    (V) health care providers, 
                                including physicians and other 
                                providers of behavioral health and 
                                primary care;
                                    (VI) educational and vocational 
                                schools;
                                    (VII) employers;
                                    (VIII) housing services; and
                                    (IX) child welfare agencies;
                            (ii) providing education on overdose 
                        prevention to patients; and
                            (iii) providing other services the 
                        Secretary determines necessary to help ensure 
                        continued connection with recovery support 
                        services;
                    (B) establish policies and procedures that address 
                the provision of overdose reversal medication, the 
                administration of all drugs approved by the Food and 
                Drug Administration to treat substance use disorder, 
                and subsequent continuation of, or referral to, 
                evidence-based treatment for patients with a substance 
                use disorder who have experienced a non-fatal drug 
                overdose, in order to prevent relapse, and reduce 
                recidivism and future overdose;
                    (C) develop or implement best practices for 
                treating non-fatal drug overdoses, including, with 
                respect to care coordination and integrated care 
                models, for long term treatment and recovery options 
                for individuals with a substance use disorder who have 
                experienced a non-fatal drug overdose; and
                    (D) establish integrated models of care for 
                individuals who have experienced a non-fatal drug 
                overdose which may include patient assessment, follow 
                up, and transportation to and from treatment 
                facilities.
            (5) Additional permissible uses.--In addition to the uses 
        described in paragraph (4), a grant awarded under this section 
        may be used, directly or through contractual arrangements, to 
        provide--
                    (A) all drugs approved by the Food and Drug 
                Administration to treat substance use disorders, 
                pursuant to Federal and State law;
                    (B) withdrawal and detoxification services that 
                include patient evaluation, stabilization, and 
                preparation for treatment of substance use disorder, 
                including treatment described in subparagraph (A), as 
                appropriate; or
                    (C) mental health services provided by a program 
                counselor, social worker, therapist, or other certified 
                professional who is licensed and qualified by 
                education, training, or experience to assess the 
                psychosocial background of patients, to contribute to 
                the appropriate treatment plan for patients with 
                substance use disorder, and to monitor patient 
                progress.
            (6) Preference.--In awarding grants under this section, the 
        Secretary shall give preference to eligible entities that meet 
        any or all of the following criteria:
                    (A) The eligible entity is a critical access 
                hospital (as defined in section 1861(mm)(1) of the 
                Social Security Act (42 U.S.C. 1395x(mm)(1))), a low 
                volume hospital (as defined in section 
                1886(d)(12)(C)(i) of such Act (42 U.S.C. 
                1395ww(d)(12)(C)(i))), or a sole community hospital (as 
                defined in section 1886(d)(5)(D)(iii) of such Act (42 
                U.S.C. 1395ww(d)(5)(D)(iii))).
                    (B) The eligible entity is located in a State with 
                an overdose mortality rate that is above the national 
                overdose mortality rate, as determined by the Director 
                of the Centers for Disease Control and Prevention.
                    (C) The eligible entity demonstrates that recovery 
                coaches will be placed in both health care settings and 
                community settings.
            (7) Period of grant.--A grant awarded to an eligible entity 
        under this section shall be for a period of not more than 5 
        years.
    (c) Definition.--In this section, the term ``recovery coach'' means 
an individual--
            (1) with knowledge of, or experience with, recovery from a 
        substance use disorder; and
            (2) who has completed training from, and is determined to 
        be in good standing by, a recovery services organization 
        capable of conducting such training and making such 
        determination.
    (d) Reporting Requirements.--
            (1) Reports by grantees.--Each eligible entity awarded a 
        grant under this section shall submit to the Secretary an 
        annual report for each year for which the entity has received 
        such grant that includes information on--
                    (A) the number of individuals treated by the entity 
                for non-fatal overdoses, including the number of non-
                fatal overdoses where overdose reversal medication was 
                administered;
                    (B) the number of individuals administered 
                medication-assisted treatment by the entity;
                    (C) the number of individuals referred by the 
                entity to other treatment facilities after a non-fatal 
                overdose, the types of such other facilities, and the 
                number of such individuals admitted to such other 
                facilities pursuant to such referrals; and
                    (D) the frequency and number of patients with 
                reoccurrences, including readmissions for non-fatal 
                overdoses and evidence of relapse related to substance 
                abuse disorder.
            (2) Report by secretary.--Not later than 5 years after the 
        date of enactment of this Act, the Secretary shall submit to 
        Congress a report that includes an evaluation of the 
        effectiveness of the grant program carried out under this 
        section with respect to long term health outcomes of the 
        population of individuals who have experienced a drug overdose, 
        the percentage of patients treated or referred to treatment by 
        grantees, and the frequency and number of patients who 
        experienced relapse, were readmitted for treatment, or 
        experienced another overdose.
    (e) Privacy.--The requirements of this section, including with 
respect to data reporting and program oversight, shall be subject to 
all applicable Federal and State privacy laws.
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2019 through 2023.

SEC. 403. ALTERNATIVES TO OPIOIDS.

    (a) In General.--The Secretary of Health and Human Services shall, 
directly or through grants to, or contracts with, public and private 
entities, provide technical assistance to hospitals and other acute 
care settings on alternatives to opioids for pain management. The 
technical assistance provided shall be for the purpose of--
            (1) utilizing information from acute care providers 
        including emergency departments and other providers that have 
        successfully implemented alternatives to opioids programs, 
        promoting non-opioid protocols and medications while 
        appropriately limiting the use of opioids;
            (2) identifying or facilitating the development of best 
        practices on the use of alternatives to opioids, which may 
        include pain-management strategies that involve non-addictive 
        medical products, non-pharmacologic treatments, and 
        technologies or techniques to identify patients at-risk for 
        opioid use disorder;
            (3) identifying or facilitating the development of best 
        practices on the use of alternatives to opioids that target 
        common painful conditions and include certain patient 
        populations, such as geriatric patients, pregnant women, and 
        children;
            (4) disseminating information on the use of alternatives to 
        opioids to providers in acute care settings, which may include 
        emergency departments, outpatient clinics, critical access 
        hospitals, and Federally qualified health centers; and
            (5) collecting data and reporting on health outcomes 
        associated with the use of alternatives to opioids.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2019 through 2023.

SEC. 404. PEER SUPPORT TECHNICAL ASSISTANCE.

    (a) Technical Assistance for Peer Support Services.--The Secretary 
of Health and Human Services (referred to in this section as the 
``Secretary''), acting through the Assistant Secretary for Mental 
Health and Substance Abuse, shall provide technical assistance and 
support to organizations providing peer support services related to 
substance use disorder, including technical assistance and support 
related to--
            (1) training on identifying--
                    (A) signs of substance use disorder;
                    (B) resources to assist individuals with a 
                substance use disorder, or resources for families of an 
                individual with a substance use disorder; and
                    (C) best practices for the delivery of recovery 
                support services;
            (2) the provision of translation services, interpretation, 
        or other such services for clients with limited English 
        speaking proficiency;
            (3) capacity building; and
            (4) evaluation and improvement, as necessary, of the 
        effectiveness of such peer support services.
    (b) Best Practices.--The Secretary shall periodically issue best 
practices related to peer support services for use by organizations 
that provide peer support services.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2019 through 2023.

SEC. 405. MEDICATION-ASSISTED TREATMENT FOR RECOVERY FROM ADDICTION.

    (a) Repeal of Requirement To Update Regulations.--Section 303 of 
the Comprehensive Addiction and Recovery Act of 2016 (Public Law 114-
198; 130 Stat. 720) is amended by striking subsection (c).
    (b) Codification of Expansion of Maximum Number of Patients for 
Medication-Assisted Treatment.--Section 303(g)(2)(B)(iii)(II) of the 
Controlled Substances Act (21 U.S.C. (g)(2)(B)(iii)(II)) is amended by 
striking ``100'' each place it appears and inserting ``275''.

SEC. 406. NATIONAL RECOVERY HOUSING BEST PRACTICES.

    (a) Best Practices.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), in consultation 
with the Secretary for Housing and Urban Development, patients with a 
history of opioid use disorder, and other stakeholders, which may 
include State accrediting entities and reputable providers of, and 
analysts of, recovery housing services, shall identify or facilitate 
the development of best practices, which may include model laws for 
implementing suggested minimum standards, for operating recovery 
housing.
    (b) Dissemination.--The Secretary shall disseminate the best 
practices identified or developed under subsection (a) to--
            (1) State agencies, which may include the provision of 
        technical assistance to State agencies seeking to adopt or 
        implement such best practices;
            (2) recovery housing entities; and
            (3) the public, as appropriate.
    (c) Requirements.--In identifying or facilitating the development 
of best practices under subsection (a), the Secretary, in consultation 
with appropriate stakeholders, shall consider how recovery housing is 
able to (including by improving access and adherence to treatment) 
support recovery and prevent relapse, recidivism, or overdose, 
including overdose death.
    (d) Rule of Construction.--Nothing in this section shall be 
construed to provide the Secretary with the ability to require States 
to adhere to minimum standards in the State oversight of recovery 
housing.
    (e) Definition.--In this section, the term ``recovery housing'' 
means a shared living environment free from alcohol and illicit drug 
use and centered on peer support and connection to services that 
promote sustained recovery from substance use disorders.

SEC. 407. ADDRESSING ECONOMIC AND WORKFORCE IMPACTS OF THE OPIOID 
              CRISIS.

    (a) Definitions.--Except as otherwise expressly provided, in this 
section:
            (1) Education provider.--The term ``education provider'' 
        means--
                    (A) an institution of higher education, as defined 
                in section 101 of the Higher Education Act of 1965 (20 
                U.S.C. 1001); or
                    (B) a postsecondary vocational institution, as 
                defined in section 102(c) of such Act (20 U.S.C. 
                1002(c)).
            (2) Eligible entity.--The term ``eligible entity'' means--
                    (A) a State workforce agency;
                    (B) a State board;
                    (C) an outlying area, as defined in section 3 of 
                the Workforce Innovation and Opportunity Act (29 U.S.C. 
                3102); or
                    (D) a Tribal entity.
            (3) Local area; local board; one-stop operator.--The terms 
        ``local area'', ``local board'', and ``one-stop operator'' have 
        the meanings given such terms in section 3 of the Workforce 
        Innovation and Opportunity Act (29 U.S.C. 3102).
            (4) Local entity.--The term ``local entity'' means a local 
        board or one-stop operator.
            (5) Participating partnership.--The term ``participating 
        partnership'' means a partnership established under subsection 
        (e)(1) by a local entity receiving a subgrant under subsection 
        (d).
            (6) Program participant.--The term ``program participant'' 
        means an individual who--
                    (A) is a member of a population of workers 
                described in subsection (e)(2) that is served by a 
                participating partnership through the pilot program 
                under this section; and
                    (B) enrolls with the applicable participating 
                partnership to receive any of the services described in 
                subsection (e)(3).
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Labor.
            (8) State board.--The term ``State board'' has the meaning 
        given the term in section 3 of the Workforce Innovation and 
        Opportunity Act (29 U.S.C. 3102).
            (9) State workforce agency.--The term ``State workforce 
        agency'' means the lead State agency with responsibility for 
        the administration of a program under chapter 2 or 3 of 
        subtitle B of title I of the Workforce Innovation and 
        Opportunity Act (29 U.S.C. 3161 et seq., 3171 et seq.).
            (10) Substance use disorder.--The term ``substance use 
        disorder'' means such a disorder within the meaning of title V 
        of the Public Health Service Act (42 U.S.C. 290aa et seq.).
            (11) Supportive services.--The term ``supportive services'' 
        has the meaning given such term in section 3 of the Workforce 
        Innovation and Opportunity Act (29 U.S.C. 3102).
            (12) Treatment provider.--The term ``treatment provider''--
                    (A) means a health care provider that offers 
                services for treating substance use disorders and is 
                licensed in accordance with applicable State law to 
                provide such services;
                    (B) accepts health insurance for such services, 
                including coverage under title XIX of the Social 
                Security Act (42 U.S.C. 1396 et seq.); and
                    (C) may include--
                            (i) a nonprofit provider of peer recovery 
                        support services, as defined by the State 
                        involved in regulation or guidance;
                            (ii) a community health care provider; or
                            (iii) a Federally qualified health center 
                        (as defined in section 1861(aa) of the Social 
                        Security Act (42 U.S.C. 1395x)).
            (13) Tribal entity.--The term ``Tribal entity'' includes 
        any Indian tribe, tribal organization, Indian-controlled 
        organization serving Indians, Native Hawaiian organization, or 
        Alaska Native entity, as such terms are defined or used in 
        section 166 of the Workforce Innovation and Opportunity Act (29 
        U.S.C. 3221).
    (b) Pilot Program and Grants Authorized.--
            (1) In general.--The Secretary, in consultation with the 
        Secretary of Health and Human Services, shall carry out a pilot 
        program to address economic and workforce impacts associated 
        with a high rate of a substance use disorder. In carrying out 
        the pilot program, the Secretary shall make grants, on a 
        competitive basis, to eligible entities to enable such entities 
        to make subgrants to local boards and one-stop operators to 
        address the economic and workforce impacts associated with a 
        high rate of a substance use disorder.
            (2) Grant amounts.--The Secretary shall make each such 
        grant in an amount that is not less than $500,000, and not more 
        than $5,000,000, for a fiscal year.
    (c) Grant Applications.--
            (1) In general.--An eligible entity applying for a grant 
        under this section shall submit an application to the Secretary 
        at such time and in such form and manner as the Secretary may 
        reasonably require, including the information described in this 
        subsection.
            (2) Significant impact on community by opioid abuse and 
        substance use disorder-related problems.--
                    (A) Demonstration.--An eligible entity shall 
                include in the application information that 
                demonstrates significant impact on the community by 
                problems related to opioid abuse or another substance 
                use disorder, by--
                            (i) identifying the communities, regions, 
                        or local areas that will be served through the 
                        grant (each referred to in this section as a 
                        ``service area''); and
                            (ii) showing, for each such service area, 
                        an increase equal to or greater than the 
                        national increase in such problems, between--
                                    (I) 1999; and
                                    (II) 2016 or the latest year for 
                                which data are available.
                    (B) Information.--In making the showing described 
                in subparagraph (A)(ii), the eligible entity may use 
                information including data on--
                            (i) the incidence or prevalence of opioid 
                        abuse and other substance use disorders;
                            (ii) the per capita drug overdose mortality 
                        rate, as determined by the Director of the 
                        Centers for Disease Control and Prevention;
                            (iii) the rate of non-fatal 
                        hospitalizations related to opioid abuse or 
                        another substance use disorder; or
                            (iv) the number of arrests or convictions, 
                        or a relevant law enforcement statistic, that 
                        reasonably shows an increase in opioid abuse or 
                        another substance use disorder.
                    (C) Support for state strategy.--The eligible 
                entity shall also include in the application 
                information describing how the proposed services and 
                activities support the State's strategy for addressing 
                problems described in subparagraph (A) in specific 
                regions or across the State, outlaying area, or Tribal 
                entity.
            (3) Economic and employment conditions demonstrate 
        additional federal support needed.--
                    (A) Demonstration.--An eligible entity shall 
                include in the application information that 
                demonstrates that a high rate of a substance use 
                disorder has caused, or is coincident to, an economic 
                or employment downturn in the service area.
                    (B) Information.--In making the demonstration 
                described in subparagraph (A), the eligible entity may 
                use information including--
                            (i) documentation of any layoff, announced 
                        future layoff, legacy industry decline, 
                        decrease in an employment or labor market 
                        participation rate, or economic impact, whether 
                        or not the result described in this clause is 
                        overtly related to a high rate of a substance 
                        use disorder;
                            (ii) documentation showing decreased 
                        economic activity related to, caused by, or 
                        contributing to a high rate of a substance use 
                        disorder, including a description of how the 
                        service area has been impacted, or will be 
                        impacted, by such a decrease;
                            (iii) in particular, information on 
                        economic indicators, labor market analyses, 
                        information from public announcements, and 
                        demographic and industry data;
                            (iv) information on rapid response 
                        activities (as defined in section 3 of the 
                        Workforce Innovation and Opportunity Act (29 
                        U.S.C. 3102)) that have been or will be 
                        conducted, including demographic data gathered 
                        by employer or worker surveys or through other 
                        methods;
                            (v) data or documentation, beyond anecdotal 
                        evidence, showing that employers face 
                        challenges filling job vacancies due to a lack 
                        of skilled workers able to pass a drug test; or
                            (vi) any additional relevant data or 
                        information on the economy, workforce, or 
                        another aspect of the service area to support 
                        the application.
            (4) Workforce shortage related to treatment workforce.--
                    (A) In general.--An eligible entity may include in 
                the application a demonstration of the workforce 
                shortage in a professional area to be addressed under 
                the grant. Such professional areas may include--
                            (i) substance use disorder treatment and 
                        related services;
                            (ii) non-opioid pain therapy and pain 
                        management services; or
                            (iii) mental health care treatment 
                        services.
                    (B) Information to be included.--An eligible entity 
                demonstrating a workforce shortage under subparagraph 
                (A) shall demonstrate the workforce shortage through 
                information that may include--
                            (i) the distance between--
                                    (I) communities affected by opioid 
                                abuse or another substance use 
                                disorder; and
                                    (II) facilities or professionals 
                                offering services in the professional 
                                area;
                            (ii) the maximum capacity of facilities or 
                        professionals to serve individuals in an 
                        affected community, or increases in arrests 
                        related to opioid abuse or another substance 
                        use disorder, overdose deaths, or nonfatal 
                        overdose emergencies in the community; or
                            (iii) other information that can 
                        demonstrate such a shortage.
    (d) Subgrant Authorization and Application Process.--
            (1) Subgrants authorized.--
                    (A) In general.--An eligible entity receiving a 
                grant under subsection (b)--
                            (i) may use not more than 5 percent of the 
                        grant funds for the administrative costs of 
                        carrying out the grant; and
                            (ii) shall use the remaining grant funds to 
                        make subgrants to local entities in the area 
                        served by the eligible entity to carry out the 
                        services and activities described in subsection 
                        (e).
                    (B) Geographic distribution.--In making subgrants 
                under this subsection, an eligible entity shall ensure, 
                to the extent practicable, the equitable geographic 
                distribution (such as urban and rural distribution) of 
                areas receiving subgrant funds.
            (2) Subgrant application.--
                    (A) In general.--A local entity desiring to receive 
                a subgrant under this subsection shall submit an 
                application at such time and in such and manner as the 
                eligible entity may reasonably require, including the 
                information described in this paragraph.
                    (B) Contents.--Each application described in 
                subparagraph (A) shall include an analysis of the 
                estimated performance of the local entity in carrying 
                out the proposed services and activities under the 
                subgrant that--
                            (i) uses primary indicators of performance 
                        described in section 116(c)(1)(A)(i) of the 
                        Workforce Innovation and Opportunity Act (29 
                        U.S.C. 3141(c)(1)(A)(i)), to assess estimated 
                        effectiveness of the proposed services and 
                        activities, including the estimated number of 
                        individuals with a substance use disorder who 
                        may be served by the proposed services and 
                        activities;
                            (ii) analyzes the record of the local 
                        entity in serving individuals with a barrier to 
                        employment; and
                            (iii) analyzes the ability of the local 
                        entity to establish the partnership described 
                        in subsection (e)(1).
                    (C) Analysis.--The analysis described in 
                subparagraph (B) may include or utilize--
                            (i) data from the National Center for 
                        Health Statistics of the Centers for Disease 
                        Control and Prevention;
                            (ii) data from the Center for Behavioral 
                        Health Statistics and Quality of the Substance 
                        Abuse and Mental Health Services 
                        Administration;
                            (iii) State vital statistics;
                            (iv) municipal police department records;
                            (v) reports from local coroners; or
                            (vi) other relevant data.
    (e) Subgrant Services and Activities.--
            (1) Formation of partnership.--
                    (A) In general.--Each local entity that receives a 
                subgrant under subsection (d) shall form a partnership, 
                established through a written contract or other 
                agreement, with members described in subparagraph (B), 
                and shall carry out the services and activities 
                described in this subsection through the partnership.
                    (B) Members of the partnership.--A partnership 
                described in subparagraph (A) shall include 1 or more 
                of the following:
                            (i) The eligible entity.
                            (ii) A treatment provider.
                            (iii) An employer or industry organization.
                            (iv) An education provider.
                            (v) A justice or law enforcement 
                        organization.
                            (vi) A faith-based or community-based 
                        organization.
                            (vii) Other State or local agencies.
                            (viii) Other organizations, as determined 
                        to be necessary by the local entity.
            (2) Selection of population to be served.--A participating 
        partnership shall elect to provide services and activities 
        under the subgrant to one or both of the following populations 
        of workers:
                    (A) Workers, including dislocated workers, new 
                entrants in the workforce, or incumbent workers 
                (employed or underemployed), who are directly or 
                indirectly affected by a high rate of a substance use 
                disorder and each of whom is--
                            (i) an individual who voluntarily confirms 
                        that the individual, or a friend or family 
                        member of the individual, has a history of 
                        opioid abuse or another substance use disorder; 
                        or
                            (ii) an individual who works or resides in 
                        a community substantially impacted by a high 
                        rate of a substance use disorder or can 
                        otherwise demonstrate job loss as a result of a 
                        high rate of a substance use disorder.
                    (B) Workers, including dislocated workers, new 
                entrants in the workforce, or incumbent workers 
                (employed or underemployed), who--
                            (i) seek to transition to professions that 
                        support individuals struggling with a substance 
                        use disorder or at risk for developing such 
                        disorder, such as professions that provide--
                                    (I) substance use disorder 
                                treatment and related services;
                                    (II) peer recovery support services 
                                described in subsection (a)(12)(C)(i);
                                    (III) non-opioid pain therapy and 
                                pain management services; or
                                    (IV) mental health care; and
                            (ii) need new or upgraded skills to better 
                        serve such a population of struggling or at-
                        risk individuals.
            (3) Services and activities.--Each participating 
        partnership shall use funds available through a subgrant under 
        this subsection to carry out 1 or more of the following:
                    (A) Engaging employers.--Engaging with employers 
                to--
                            (i) learn about the skill and hiring 
                        requirements of employers;
                            (ii) learn about the support needed by 
                        employers to hire and retain program 
                        participants, and other individuals with a 
                        substance use disorder, and the support needed 
                        by such employers to obtain their commitment to 
                        testing creative solutions to employing program 
                        participants and such individuals;
                            (iii) connect employers and workers to on-
                        the-job or customized training programs before 
                        or after layoff to help facilitate 
                        reemployment;
                            (iv) connect employers with an education 
                        provider to develop classroom instruction to 
                        complement on-the-job learning for program 
                        participants and such individuals;
                            (v) help employers develop the curriculum 
                        design of a work-based learning program for 
                        program participants and such individuals; or
                            (vi) help employers employ program 
                        participants or such individuals engaging in a 
                        work-based learning program for a transitional 
                        period before hiring such a program participant 
                        or individual for full-time employment of not 
                        less than 30 hours a week.
                    (B) Screening services.--Providing screening 
                services, which may include--
                            (i) using an evidence-based screening 
                        method to screen each individual seeking 
                        participation in the pilot program to determine 
                        whether the individual has a substance use 
                        disorder;
                            (ii) conducting an assessment of each such 
                        individual to determine the services needed for 
                        such individual to obtain or retain employment, 
                        including an assessment of strengths and 
                        general work readiness; and
                            (iii) accepting walk-ins or referrals from 
                        employers, labor organizations, or other 
                        entities recommending individuals to 
                        participate in such program.
                    (C) Individual treatment and employment plan.--
                Developing an individual treatment and employment plan 
                for each program participant, which shall include 
                providing a case manager to work with each participant 
                to develop the plan, which may include--
                            (i) identifying employment and career 
                        goals;
                            (ii) exploring career pathways that lead to 
                        in-demand industries and sectors as determined 
                        by the State board and the head of the State 
                        workforce agency;
                            (iii) setting appropriate achievement 
                        objectives to attain the employment and career 
                        goals identified under clause (i); or
                            (iv) developing the appropriate combination 
                        of services to enable the participant to 
                        achieve the employment and career goals.
                    (D) Outpatient treatment and recovery care.--In the 
                case of a participating partnership serving program 
                participants described in paragraph (2)(A)(i) with a 
                substance use disorder, providing individualized and 
                group outpatient treatment and recovery services for 
                such program participants that are offered during the 
                day and evening, and on weekends. Such treatment and 
                recovery services--
                            (i) shall be based on a model that utilizes 
                        combined behavioral interventions and other 
                        evidence-based or evidence-informed 
                        interventions; and
                            (ii) may include additional services such 
                        as--
                                    (I) health, mental health, 
                                addiction, or other forms of outpatient 
                                treatment that may impact a substance 
                                use disorder and co-occurring 
                                conditions;
                                    (II) drug testing for a current 
                                substance use disorder prior to 
                                enrollment in career or training 
                                services or prior to employment;
                                    (III) linkages to community 
                                services, including services offered by 
                                partner organizations designed to 
                                support program participants; and
                                    (IV) referrals to health care, 
                                including referrals to substance use 
                                disorder treatment and mental health 
                                services.
                    (E) Supportive services.--Providing supportive 
                services, which shall include services such as--
                            (i) coordinated wraparound services to 
                        provide maximum support for program 
                        participants to ensure that the program 
                        participants maintain employment and recovery 
                        for not less than 12 months, as appropriate;
                            (ii) assistance in establishing eligibility 
                        for assistance under Federal, State, and local 
                        programs providing health services, mental 
                        health services, housing services, 
                        transportation services, or social services;
                            (iii) peer recovery support services 
                        described in subsection (a)(12)(C)(i);
                            (iv) networking and mentorship 
                        opportunities; or
                            (v) any supportive services determined 
                        necessary by the local entity.
                    (F) Career and job training services.--Offering 
                career services and training services, and related 
                services, concurrently or sequentially with the 
                services provided under subparagraphs (B) through (E). 
                Such services shall include the following:
                            (i) Services provided to program 
                        participants who are in a pre-employment stage 
                        of the program. Such services may include--
                                    (I) initial education and skills 
                                assessments;
                                    (II) traditional classroom training 
                                funded through individual training 
                                accounts under chapter 3 of subtitle B 
                                of title I of the Workforce Innovation 
                                and Opportunity Act (29 U.S.C. 3171 et 
                                seq.);
                                    (III) services to promote 
                                employability skills such as 
                                punctuality, personal maintenance 
                                skills, and professional conduct;
                                    (IV) in-depth interviewing and 
                                evaluation to identify employment 
                                barriers and to develop individual 
                                employment plans;
                                    (V) career planning that includes--
                                            (aa) career pathways 
                                        leading to in-demand, high-wage 
                                        jobs; and
                                            (bb) job coaching, job 
                                        matching, and job placement 
                                        services;
                                    (VI) provision of payments and fees 
                                for employment and training-related 
                                applications, tests, and 
                                certifications; or
                                    (VII) any other appropriate career 
                                service or training service described 
                                in section 134(c) of the Workforce 
                                Innovation and Opportunity Act (29 
                                U.S.C. 3174(c)).
                            (ii) Services provided to program 
                        participants during their first 6 months of 
                        employment to ensure job retention, which may 
                        include--
                                    (I) case management and support 
                                services, including a continuation of 
                                the services described in clause (i);
                                    (II) a continuation of skills 
                                training, and career and technical 
                                education, described in clause (i) that 
                                is conducted in collaboration with the 
                                employers of such participants;
                                    (III) mentorship services and job 
                                retention support for such 
                                participants; or
                                    (IV) targeted training for managers 
                                and workers working with such 
                                participants (such as mentors), and 
                                human resource representatives in the 
                                business in which such participants are 
                                employed.
                            (iii) Services to assist program 
                        participants in maintaining employment for not 
                        less than 12 months, as appropriate.
                    (G) Proven and promising practices.--Leading 
                efforts in the service area to identify and promote 
                proven and promising strategies and initiatives for 
                meeting the needs of employers and program 
                participants.
            (4) Limitations.--A participating partnership may not use--
                    (A) more than 5 percent of the funds received under 
                a subgrant under subsection (d) for the administrative 
                costs of the partnership;
                    (B) more than 10 percent of the funds received 
                under such subgrant for the provision of treatment and 
                recovery services, as described in paragraph (3)(D); or
                    (C) more than 10 percent of the funds received 
                under such subgrant for the provision of supportive 
                services described in paragraph (3)(E) to program 
                participants.
    (f) Performance Accountability.--
            (1) Reports.--The Secretary shall establish quarterly 
        reporting requirements for recipients of grants and subgrants 
        under this section that, to the extent practicable, are based 
        on the performance accountability system under section 116 of 
        the Workforce Innovation and Opportunity Act (29 U.S.C. 3141), 
        including the indicators described in subsection (c)(1)(A)(i) 
        of such section and the requirements for local area performance 
        reports under subsection (d) of such section.
            (2) Evaluations.--
                    (A) Authority to enter into agreements.--The 
                Secretary shall ensure that an independent evaluation 
                is conducted on the pilot program carried out under 
                this section to determine the impact of the program on 
                employment of individuals with substance use disorders. 
                The Secretary shall enter into an agreement with 
                eligible entities receiving grants under this section 
                to pay for all or part of such evaluation.
                    (B) Methodologies to be used.--The independent 
                evaluation required under this paragraph shall use 
                experimental designs using random assignment or, when 
                random assignment is not feasible, other reliable, 
                evidence-based research methodologies that allow for 
                the strongest possible causal inferences.
    (g) Funding.--
            (1) Covered fiscal year.--In this subsection, the term 
        ``covered fiscal year'' means any of fiscal years 2018 through 
        2023.
            (2) Using funding for national dislocated worker grants.--
        Subject to paragraph (4) and notwithstanding section 
        132(a)(2)(A) and subtitle D of the Workforce Innovation and 
        Opportunity Act (29 U.S.C. 3172(a)(2)(A), 3221 et seq.) or any 
        other provision of law, the Secretary may use, to carry out the 
        pilot program under this section for a covered fiscal year--
                    (A) funds made available to carry out section 170 
                of such Act (29 U.S.C. 3225) for that fiscal year;
                    (B) funds made available to carry out section 170 
                of such Act that remain available for that fiscal year; 
                and
                    (C) funds that remain available under section 
                172(f) of such Act (29 U.S.C. 3227(f)).
            (3) Availability of funds.--Funds appropriated under 
        section 136(c) of such Act (29 U.S.C. 3181(c)) and made 
        available to carry out section 170 of such Act for a fiscal 
        year shall remain available for use under paragraph (2) for a 
        subsequent fiscal year until expended.
            (4) Limitation.--The Secretary may not use more than 
        $100,000,000 of the funds described in paragraph (2) for any 
        covered fiscal year under this section.

SEC. 408. YOUTH PREVENTION AND RECOVERY.

    (a)  Substance Abuse Treatment Services for Children, Adolescents, 
and Young Adults.--Section 514 of the Public Health Service Act (42 
U.S.C. 290bb-7) is amended--
            (1) in the section heading, by striking ``children and 
        adolescents'' and inserting ``children, adolescents, and young 
        adults'';
            (2) in subsection (a)(2), by striking ``children, 
        including'' and inserting ``children, adolescents, and young 
        adults, including''; and
            (3) by striking ``children and adolescents'' each place it 
        appears and inserting ``children, adolescents, and young 
        adults''.
    (b) Youth Prevention and Recovery Initiative.--
            (1) Definitions.--In this subsection:
                    (A) Eligible entity.--The term ``eligible entity'' 
                means--
                            (i) a local educational agency that is 
                        seeking to establish or expand substance use 
                        prevention and recovery support services at one 
                        or more high schools;
                            (ii) an institution of higher education;
                            (iii) a recovery program at an institution 
                        of higher education;
                            (iv) a local board or one-stop operator; or
                            (v) a nonprofit organization, excluding a 
                        school.
                    (B) High school.--The term ``high school'' has the 
                meaning given such term in section 8101 of the 
                Elementary and Secondary Education Act of 1965 (20 
                U.S.C. 7801).
                    (C) Institution of higher education.--The term 
                ``institution of higher education'' has the meaning 
                given such term in section 101 of the Higher Education 
                Act of 1965 (20 U.S.C. 1001) and includes a 
                ``postsecondary vocational institution'' as defined in 
                section 102(c) of such Act (20 U.S.C. 1002(c)).
                    (D) Local education agency.--The term ``local 
                educational agency'' has the meaning given the term in 
                section 8101 of the Elementary and Secondary Education 
                Act of 1965.
                    (E) Local board; one-stop operator.--The terms 
                ``local board'' and ``one-stop operator'' have the 
                meanings given such terms in section 3 of the Workforce 
                Innovation and Opportunity Act (29 U.S.C. 3102).
                    (F) Recovery program.--The term ``recovery 
                program'' means a program--
                            (i) to help children, adolescents, or young 
                        adults who are recovering from substance use 
                        disorders to initiate, stabilize, and maintain 
                        healthy and productive lives in the community; 
                        and
                            (ii) that includes peer-to-peer support 
                        delivered by individuals with lived experience 
                        in recovery, and communal activities to build 
                        recovery skills and supportive social networks.
                    (G) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services, except as 
                otherwise specified.
            (2) Best practices.--The Secretary, in consultation with 
        the Secretary of Education, shall--
                    (A) identify or facilitate the development of 
                evidence-based best practices for prevention of 
                substance misuse and abuse by children, adolescents, 
                and young adults, for appropriate recovery support 
                services, and for appropriate use of medication-
                assisted treatment for such individuals, if applicable;
                    (B) disseminate such best practices to local 
                educational agencies, institutions of higher education, 
                recovery programs at institutions of higher education, 
                local boards, one-stop operators, and nonprofit 
                organizations, as appropriate;
                    (C) conduct a rigorous, independent evaluation of 
                each grant funded under this subsection, particularly 
                its impact on the indicators described in paragraph 
                (5)(B); and
                    (D) provide technical assistance for grantees under 
                this subsection.
            (3) Grants authorized.--The Secretary, in consultation with 
        the Secretary of Education, shall award 3-year grants, on a 
        competitive basis, to eligible entities to enable such 
        entities, in coordination with State agencies responsible for 
        carrying out substance use disorder prevention and treatment 
        programs, to carry out evidence-based or promising programs 
        for--
                    (A) prevention of substance abuse and misuse by 
                children, adolescents, and young adults;
                    (B) recovery support services for children, 
                adolescents, and young adults, which may include 
                counseling, job training, linkages to community-based 
                services, family support groups, and recovery coaching; 
                and
                    (C) treatment or referrals for treatment of 
                substance use disorders, as appropriate.
            (4) Application.--To be eligible for a grant under this 
        subsection, an entity shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require. Such application 
        shall include--
                    (A) a description of the impact of substance use 
                disorders on children, adolescents, and young adults 
                enrolled in the local educational agency, one-stop 
                operator, local board, or institution of higher 
                education;
                    (B) a description of how the eligible entity has 
                solicited input from faculty, teachers, staff, 
                families, students, and experts in substance use 
                prevention and treatment in developing such 
                application;
                    (C) how the eligible entity plans to use grant 
                funds for evidence-based or promising activities, in 
                accordance with this subsection to prevent, provide 
                recovery support for, and treat substance use disorders 
                amongst such individuals;
                    (D) an assurance that the eligible entity will 
                participate in the evaluation described in paragraph 
                (2)(C); and
                    (E) a description of how the eligible entity will 
                collaborate with local service providers, including 
                substance use disorder treatment programs, providers of 
                mental health services, and primary care providers, in 
                carrying out the grant program.
            (5) Report.--Each eligible entity awarded a grant under 
        this section shall submit to the appropriate committees of 
        Congress, a report at such time and in such manner as the 
        Secretary may require. Such report shall include--
                    (A) a description of how the eligible entity used 
                grant funds, in accordance with this subsection, 
                including the number of children, adolescents, and 
                young adults reached through programming; and
                    (B) a description of how the grant program has made 
                an impact on--
                            (i) indicators of student success, 
                        including student well-being and academic 
                        achievement; and
                            (ii) substance use disorders amongst 
                        children, adolescents, and young adults, 
                        including the number of overdoses and deaths 
                        amongst children, adolescents, and young adults 
                        during the grant period.
            (6) Authorization of appropriations.--There is authorized 
        to be appropriated, such sums as may be necessary to carry out 
        this subsection.

SEC. 409. PLANS OF SAFE CARE.

    (a) In General.--Section 105(a) of the Child Abuse Prevention and 
Treatment Act (42 U.S.C. 5106(a)) is amended by adding at the end the 
following:
            ``(7) Grants to states to improve and coordinate their 
        response to ensure the safety, permanency, and well-being of 
        infants affected by substance use.--
                    ``(A) Program authorized.--The Secretary shall make 
                grants to States for the purpose of assisting child 
                welfare agencies, social services agencies, substance 
                use disorder treatment agencies, public health and 
                mental health agencies, and maternal and child health 
                agencies to facilitate collaboration in developing, 
                updating, and implementing plans of safe care described 
                in section 106(b)(2)(B)(iii).
                    ``(B) Distribution of funds.--
                            ``(i) Reservations.--Of the amounts 
                        appropriated under subparagraph (H), the 
                        Secretary shall reserve--
                                    ``(I) no more than 3 percent for 
                                the purposes described in subparagraph 
                                (G); and
                                    ``(II) up to 3 percent for grants 
                                to Indian Tribes and tribal 
                                organizations for purposes consistent 
                                with this section, as the Secretary 
                                determines appropriate.
                            ``(ii) Allotments to states and 
                        territories.--The Secretary shall allot the 
                        amount appropriated under subparagraph (H) that 
                        remains after application of clause (i) on a 
                        competitive basis to States that apply for such 
                        a grant.
                            ``(iii) Selection criteria.--The Secretary 
                        shall allot funds to States that demonstrate a 
                        strong need for such funds, and a strong 
                        commitment to using such funds, to meet the 
                        purposes described in subparagraph (A) in 
                        accordance with subparagraph (D).
                    ``(C) Application.--A State desiring a grant under 
                this paragraph shall submit an application to the 
                Secretary at such time and in such manner as the 
                Secretary may require. Such application shall include--
                            ``(i) a description of--
                                    ``(I) the impact of substance use 
                                disorder in such State, including with 
                                respect to the substance or class of 
                                substances with the highest incidence 
                                of abuse in the previous year in such 
                                State, including--
                                            ``(aa) the prevalence of 
                                        substance use disorder in such 
                                        State;
                                            ``(bb) the aggregate rate 
                                        of births in the State of 
                                        infants affected by substance 
                                        abuse or withdrawal symptoms or 
                                        a fetal alcohol spectrum 
                                        disorder (as determined by 
                                        hospitals, insurance claims, 
                                        claims submitted to the State 
                                        Medicaid program, or other 
                                        records), if available and to 
                                        the extent practicable; and
                                            ``(cc) the number of 
                                        infants identified, for whom a 
                                        plan of safe care was 
                                        developed, and for whom a 
                                        referral was made for 
                                        appropriate services, as 
                                        reported under section 
                                        106(d)(18);
                                    ``(II) the challenges the State 
                                faces in developing and implementing 
                                plans of safe care in accordance with 
                                section 106(b)(2)(B)(iii);
                                    ``(III) the State's lead agency for 
                                the grant program and how that agency 
                                will coordinate with relevant State 
                                entities and programs, including the 
                                child welfare agency, the substance use 
                                disorder treatment agency, the public 
                                health and mental health agencies, 
                                programs funded by the Residential 
                                Treatment for Pregnant and Postpartum 
                                Women grant program of the Substance 
                                Abuse and Mental Health Services 
                                Administration under section 508 of the 
                                Public Health Service Act (42 U.S.C. 
                                290bb-1), the State Medicaid program, 
                                the State agency administering the 
                                block grant program under title V of 
                                the Social Security Act (42 U.S.C. 701 
                                et seq.), the State agency 
                                administering the programs funded under 
                                part C of the Individuals with 
                                Disabilities Education Act (20 U.S.C. 
                                1431 et seq.), the maternal, infant, 
                                and early childhood home visiting 
                                program under section 511 of the Social 
                                Security Act (42 U.S.C. 711), the State 
                                judicial system, and other agencies, as 
                                determined by the Secretary;
                                    ``(IV) how the State will monitor 
                                local implementation of plans of safe 
                                care, in accordance with section 
                                106(b)(2)(B)(iii)(II);
                                    ``(V) how the State meets the 
                                requirements of section 1927 of the 
                                Public Health Service Act (42 U.S.C. 
                                300x-27);
                                    ``(VI) how the State plans to 
                                utilize funding authorized under part E 
                                of title IV of the Social Security Act 
                                (42 U.S.C. 670 et seq.) to assist in 
                                carrying out any plan of safe care, 
                                including such funding authorized under 
                                section 471(e) of such Act (as in 
                                effect on October 1, 2018) for mental 
                                health and substance abuse prevention 
                                and treatment services and in-home 
                                parent skill-based programs and funding 
                                authorized under such section 472(j) 
                                (as in effect on October 1, 2018) for 
                                children with a parent in a licensed 
                                residential family-based treatment 
                                facility for substance abuse; and
                                    ``(VII) an assessment of the 
                                treatment and other services and 
                                programs available in the State, to 
                                effectively carry out any plan of safe 
                                care developed, including 
                                identification of needed treatment, and 
                                other services and programs to ensure 
                                the wellbeing of young children and 
                                their families affected by substance 
                                use disorder, such as programs carried 
                                out under part C of the Individuals 
                                with Disabilities Education Act and 
                                comprehensive early childhood 
                                development services and programs such 
                                as Head Start programs;
                            ``(ii) a description of how the State plans 
                        to use funds for activities described in 
                        subparagraph (D) for the purposes of ensuring 
                        State compliance with requirements under 
                        clauses (ii) and (iii) of section 106(b)(2)(B); 
                        and
                            ``(iii) an assurance that the State will--
                                    ``(I) comply with this Act and 
                                parts B and E of title IV of the Social 
                                Security Act (42 U.S.C. 621 et seq., 
                                670 et seq.); and
                                    ``(II) comply with requirements to 
                                refer a child identified as substance-
                                exposed to early intervention services 
                                as required pursuant to a grant under 
                                part C of the Individuals with 
                                Disabilities Education Act (20 U.S.C. 
                                1431 et seq.).
                    ``(D) Uses of funds.--Funds awarded to a State 
                under this paragraph may be used for the following 
                activities, which may be carried out by the State 
                directly, or through grants or subgrants, contracts, or 
                cooperative agreements:
                            ``(i) Improving State and local systems 
                        with respect to the development and 
                        implementation of plans of safe care, which--
                                    ``(I) shall include parent and 
                                caregiver engagement, as required under 
                                section 106(b)(2)(B)(iii)(I), regarding 
                                available treatment and service 
                                options, which may include resources 
                                available for pregnant, perinatal, and 
                                postnatal women; and
                                    ``(II) may include activities such 
                                as--
                                            ``(aa) developing policies, 
                                        procedures, or protocols for 
                                        the administration of evidence-
                                        based and validated screening 
                                        tools for infants who may be 
                                        affected by substance use 
                                        withdrawal symptoms or a fetal 
                                        alcohol spectrum disorder and 
                                        pregnant, perinatal, and 
                                        postnatal women whose infants 
                                        may be affected by substance 
                                        use withdrawal symptoms or a 
                                        fetal alcohol spectrum 
                                        disorder;
                                            ``(bb) improving 
                                        assessments used to determine 
                                        the needs of the infant and 
                                        family;
                                            ``(cc) improving ongoing 
                                        case management services; and
                                            ``(dd) improving access to 
                                        treatment services, which may 
                                        be prior to the pregnant 
                                        woman's delivery date.
                            ``(ii) Developing policies, procedures, or 
                        protocols in consultation and coordination with 
                        health professionals, public and private health 
                        facilities, and substance use disorder 
                        treatment agencies to ensure that--
                                    ``(I) appropriate notification to 
                                child protective services is made in a 
                                timely manner;
                                    ``(II) a plan of safe care is in 
                                place, where needed, before the infant 
                                is discharged from the birth or health 
                                care facility; and
                                    ``(III) such health and related 
                                agency professionals are trained on how 
                                to follow such protocols and are aware 
                                of the supports that may be provided 
                                under a plan of safe care.
                            ``(iii) Training health professionals and 
                        health system leaders, child welfare workers, 
                        substance use disorder treatment agencies, and 
                        other related professionals such as home 
                        visiting agency staff and law enforcement in 
                        relevant topics including--
                                    ``(I) State mandatory reporting 
                                laws and the referral and notification 
                                process;
                                    ``(II) the co-occurrence of 
                                pregnancy and substance use disorder;
                                    ``(III) the clinical guidance about 
                                treating substance use disorder in 
                                pregnant and postpartum women;
                                    ``(IV) appropriate screening and 
                                interventions for infants affected by 
                                substance use disorder, withdrawal 
                                symptoms, or a fetal alcohol spectrum 
                                disorder and the requirements under 
                                section 106(b)(2)(B)(iii); and
                                    ``(V) appropriate strategies to 
                                address the mental health needs of the 
                                parent and child together.
                            ``(iv) Establishing partnerships, 
                        agreements, or memoranda of understanding 
                        between the lead agency and health 
                        professionals, health facilities, child welfare 
                        professionals, substance use disorder and 
                        mental health disorder treatment programs, 
                        early childhood education programs, and 
                        maternal and child health and early 
                        intervention professionals, including home 
                        visiting providers, peer-to-peer recovery 
                        programs such as parent mentoring programs, and 
                        housing agencies to facilitate the 
                        implementation of, and compliance with section 
                        106(b)(2) and clause (ii) of this subparagraph, 
                        in areas which may include--
                                    ``(I) developing a comprehensive, 
                                multi-disciplinary assessment and 
                                intervention process for infants and 
                                their families who are affected by 
                                substance use disorder, withdrawal 
                                symptoms, or a fetal alcohol spectrum 
                                disorder, that includes meaningful 
                                engagement with and takes into account 
                                the unique needs of each family and 
                                addresses differences between legal, 
                                medically supervised substance use, and 
                                substance use disorder;
                                    ``(II) ensuring that treatment 
                                approaches for serving infants, 
                                pregnant women, and perinatal and 
                                postnatal women whose infants may be 
                                affected by substance use, withdrawal 
                                symptoms, or a fetal alcohol spectrum 
                                disorder, are designed to, where 
                                appropriate, keep infants with their 
                                mothers during both inpatient and 
                                outpatient treatment; and
                                    ``(III) increasing access to 
                                evidence-based medication-assisted 
                                treatment approved by the Food and Drug 
                                Administration, behavioral therapy, and 
                                counseling services for the treatment 
                                of substance use disorders, as 
                                appropriate.
                            ``(v) Developing and updating systems of 
                        technology for improved data collection and 
                        monitoring under section 106(b)(2)(B)(iii), 
                        including existing electronic medical records, 
                        to measure the outcomes achieved through the 
                        plans of safe care, including monitoring 
                        systems to meet the requirements of this Act 
                        and submission of performance measures.
                    ``(E) Reporting.--Each State that receives funds 
                under this paragraph, for each year such funds are 
                received, shall submit a report to the Secretary, 
                disaggregated by geographic location, economic status, 
                and major racial and ethnic groups, except that such 
                disaggregation shall not be required if the results 
                would reveal personally identifiable information, on 
                the following:
                            ``(i) The number of the infants identified 
                        under section 106(b)(2)(B)(ii) who experienced 
                        removal due to parental substance use concerns 
                        who are reunified with parents, and the length 
                        of time between such removal and reunification.
                            ``(ii) The number of the infants identified 
                        under section 106(b)(2)(B)(ii) who experienced 
                        substantiated reports of child abuse or neglect 
                        and received differential response while in the 
                        care of their birth parents or within 1 year 
                        after a reunification has occurred.
                            ``(iii) The number of the infants 
                        identified under section 106(b)(2)(B)(ii) who 
                        experienced a return to out-of-home care within 
                        one year after reunification.
                    ``(F) Secretary's report to congress.--The 
                Secretary shall submit an annual report to the 
                Committee on Health, Education, Labor, and Pensions and 
                the Committee on Appropriations of the Senate and the 
                Committee on Education and the Workforce and the 
                Committee on Appropriations of the House of 
                Representatives that includes the information described 
                in subparagraph (E) and recommendations or observations 
                on the challenges, successes, and lessons derived from 
                implementation of the grant program.
                    ``(G) Reservation of funds.--The Secretary shall 
                use the amount reserved under subparagraph (B)(i)(I) 
                for the purposes of--
                            ``(i) providing technical assistance, 
                        including programs of in-depth technical 
                        assistance, to additional States, territories, 
                        and Indian tribes in accordance with the 
                        substance-exposed infant initiative developed 
                        by the National Center on Substance Abuse and 
                        Child Welfare;
                            ``(ii) issuing guidance on the requirements 
                        of this Act with respect to infants born with 
                        and identified as being affected by substance 
                        use or withdrawal symptoms or fetal alcohol 
                        spectrum disorder, as described in clauses (ii) 
                        and (iii) of section 106(b)(2)(B), including 
                        by--
                                    ``(I) clarifying key terms; and
                                    ``(II) disseminating best practices 
                                on implementation of plans of safe 
                                care, on such topics as differential 
                                response, collaboration and 
                                coordination, and identification and 
                                delivery of services, for different 
                                populations;
                            ``(iii) supporting State efforts to develop 
                        information technology systems to manage plans 
                        of safe care; and
                            ``(iv) preparing the Secretary's report to 
                        Congress described in subparagraph (F).
                    ``(H) Authorization of appropriations.--To carry 
                out the program under this paragraph, there are 
                authorized to be appropriated $60,000,000 for each of 
                fiscal years 2019 through 2023.''.
    (b) Definition.--Section 3 of the Child Abuse Prevention and 
Treatment Act (42 U.S.C. 5101 note) is amended--
            (1) in paragraph (7), by striking ``; and'' and inserting a 
        semicolon;
            (2) by redesignating paragraph (8) as paragraph (9); and
            (3) by inserting after paragraph (7) the following:
            ``(8) the term `substance use disorder' means the abuse of 
        alcohol or other drugs; and''.

SEC. 410. REGULATIONS RELATING TO SPECIAL REGISTRATION FOR 
              TELEMEDICINE.

    Section 311(h) of the Controlled Substances Act (21 U.S.C. 831(h)) 
is amended by striking paragraph (2) and inserting the following:
            ``(2) Regulations.--
                    ``(A) In general.--Not later than 1 year after the 
                date of enactment of the Opioid Crisis Response Act of 
                2018, in consultation with the Secretary, and in 
                accordance with the procedure described in subparagraph 
                (B), the Attorney General shall promulgate final 
                regulations specifying--
                            ``(i) the limited circumstances in which a 
                        special registration under this subsection may 
                        be issued; and
                            ``(ii) the procedure for obtaining a 
                        special registration under this subsection.
                    ``(B) Procedure.--In promulgating final regulations 
                under subparagraph (A), the Attorney General shall--
                            ``(i) issue a notice of proposed rulemaking 
                        that includes a copy of the proposed 
                        regulations;
                            ``(ii) provide a period of not less than 60 
                        days for comments on the proposed regulations;
                            ``(iii) finalize the proposed regulation 
                        not later than 6 months after the close of the 
                        comment period; and
                            ``(iv) publish the final regulations not 
                        later than 30 days before the effective date of 
                        the final regulations.''.

SEC. 411. NATIONAL HEALTH SERVICE CORPS BEHAVIORAL AND MENTAL HEALTH 
              PROFESSIONALS PROVIDING OBLIGATED SERVICE IN SCHOOLS AND 
              OTHER COMMUNITY-BASED SETTINGS.

    Subpart III of part D of title III of the Public Health Service Act 
(42 U.S.C. 254l et seq.) is amended by adding at the end the following:

``SEC. 338N. BEHAVIORAL AND MENTAL HEALTH PROFESSIONALS PROVIDING 
              OBLIGATED SERVICE IN SCHOOLS AND OTHER COMMUNITY-BASED 
              SETTINGS.

    ``(a) Schools and Community-Based Settings.--An entity to which a 
Corps member is assigned under section 333 may direct such Corps member 
to provide service as a behavioral and mental health professional at a 
school or other community-based setting located in a health 
professional shortage area.
    ``(b) Obligated Service.--
            ``(1) In general.--Any service described in subsection (a) 
        that a Corps member provides may count towards such Corps 
        member's completion of any obligated service requirements under 
        the Scholarship Program or the Loan Repayment Program, subject 
        to any limitation imposed under paragraph (2).
            ``(2) Limitation.--The Secretary may impose a limitation on 
        the number of hours of service described in subsection (a) that 
        a Corps member may credit towards completing obligated service 
        requirements, provided that the limitation allows a member to 
        credit service described in subsection (a) for not less than 50 
        percent of the total hours required to complete such obligated 
        service requirements.
    ``(c) Rule of Construction.--The authorization under subsection (a) 
shall be notwithstanding any other provision of this subpart or subpart 
II.''.

SEC. 412. LOAN REPAYMENT FOR SUBSTANCE USE DISORDER TREATMENT 
              PROVIDERS.

    (a) Loan Repayment for Substance Use Treatment Providers.--The 
Secretary of Health and Human Services (referred to in this section as 
the ``Secretary'') shall enter into contracts under section 338B of the 
Public Health Service Act (42 U.S.C. 254l-1) with eligible health 
professionals providing substance use disorder treatment services in 
substance use disorder treatment facilities, as defined by the 
Secretary.
    (b) Provision of Substance Use Disorder Treatment.--In carrying out 
the activities described in subsection (a)--
            (1) such facilities shall be located in mental health 
        professional shortage areas designated under section 332 of the 
        Public Health Service Act (42 U.S.C. 254e);
            (2) section 331(a)(3)(D) of such Act (42 U.S.C. 
        254d(a)(3)(D)) shall be applied as if the term ``primary health 
        services'' includes health services regarding substance use 
        disorder treatment;
            (3) section 331(a)(3)(E)(i) of such Act (42 U.S.C. 
        254d(a)(3)(E)(i)) shall be applied as if the term ``behavioral 
        and mental health professionals'' includes masters level, 
        licensed substance use disorder treatment counselors; and
            (4) such professionals and facilities shall provide--
                    (A) counseling by a program counselor or other 
                certified professional who is licensed and qualified by 
                education, training, or experience to assess the 
                psychological and sociological background of patients, 
                to contribute to the appropriate treatment plan for the 
                patient, and to monitor progress; and
                    (B) all drugs approved by the Food and Drug 
                Administration to treat substance use disorders.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $25,000,000 for each of fiscal 
years 2019 through 2023.

SEC. 413. IMPROVING TREATMENT FOR PREGNANT AND POSTPARTUM WOMEN.

    (a) Report.--
            (1) In general.--Not later than 60 days after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (referred to in this subsection as the ``Secretary'') 
        shall submit to the appropriate committees of Congress and make 
        available to the public on the internet website of the 
        Department of Health and Human Services a report regarding the 
        implementation of the recommendations in the strategy relating 
        to prenatal opioid use, including neonatal abstinence syndrome, 
        developed pursuant to section 2 of the Protecting Our Infants 
        Act of 2015 (Public Law 114-91). Such report shall include--
                    (A) an update on the implementation of the 
                recommendations in the strategy, including information 
                regarding the agencies involved in the implementation; 
                and
                    (B) information on additional funding or authority 
                the Secretary requires, if any, to implement the 
                strategy, which may include authorities needed to 
                coordinate implementation of such strategy across the 
                Department of Health and Human Services.
            (2) Periodic updates.--The Secretary shall periodically 
        update the report under paragraph (1).
    (b) Residential Treatment Programs for Pregnant and Postpartum 
Women.--Section 508(s) of the Public Health Service Act (42 U.S.C. 
290bb-1(s)) is amended by striking ``$16,900,000 for each of fiscal 
years 2017 through 2021'' and inserting ``$29,931,000 for each of 
fiscal years 2019 through 2023''.

SEC. 414. EARLY INTERVENTIONS FOR PREGNANT WOMEN AND INFANTS.

    (a) Development of Educational Materials by Center for Substance 
Abuse Prevention.--Section 515(b) of the Public Health Service Act (42 
U.S.C. 290bb-21(b)) is amended--
            (1) in paragraph (13), by striking ``and'' at the end;
            (2) in paragraph (14), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(15) in cooperation with relevant stakeholders and the 
        Director of the Centers for Disease Control and Prevention, 
        develop educational materials for clinicians to use with 
        pregnant women for shared decisionmaking regarding pain 
        management during pregnancy.''.
    (b) Guidelines and Recommendations by Center for Substance Abuse 
Treatment.--Section 507(b) of the Public Health Service Act (42 U.S.C. 
290bb(b)) is amended--
            (1) in paragraph (13), by striking ``and'' at the end;
            (2) in paragraph (14), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following:
            ``(15) in cooperation with the Secretary, implement and 
        disseminate, as appropriate, the recommendations in the report 
        entitled `Protecting Our Infants Act: Final Strategy' issued by 
        the Department of Health and Human Services in 2017; and''.
    (c) Support of Partnerships by Center for Substance Abuse 
Treatment.--Section 507(b) of the Public Health Service Act (42 U.S.C. 
290bb(b)), as amended by subsection (b), is further amended by adding 
at the end the following:
            ``(16) in cooperation with relevant stakeholders, support 
        public-private partnerships to assist with education about, and 
        support with respect to, substance use disorder for pregnant 
        women and health care providers who treat pregnant women and 
        babies.''.

                          TITLE V--PREVENTION

SEC. 501. STUDY ON PRESCRIBING LIMITS.

    Not later than 2 years after the date of enactment of this Act, the 
Secretary of Health and Human Services, in consultation with the 
Attorney General, shall submit to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee on Energy and 
Commerce of the House of Representatives a report on the impact of 
Federal and State laws and regulations that limit the length, quantity, 
or dosage of opioid prescriptions. Such report shall address--
            (1) the impact of such limits on--
                    (A) the incidence and prevalence of overdose 
                related to prescription opioids;
                    (B) the incidence and prevalence of overdose 
                related to illicit opioids;
                    (C) the prevalence of opioid use disorders; and
                    (D) medically appropriate use of, and access to, 
                opioids, including any impact on travel expenses and 
                pain management outcomes for patients, whether such 
                limits are associated with significantly higher rates 
                of negative health outcomes, including suicide, and 
                whether the impact of such limits differs based on 
                clinical indication for which opioids are prescribed;
            (2) whether such limits lead to a significant increase in 
        burden for prescribers of opioids or prescribers of treatments 
        for opioid use disorder, including any impact on patient access 
        to treatment, and whether any such burden is mitigated by any 
        factors such as electronic prescribing; and
            (3) the impact of such limits on diversion or misuse of any 
        controlled substance in schedule II, III, or IV of section 
        202(c) of the Controlled Substances Act (21 U.S.C. 812(c)).

SEC. 502. PROGRAMS FOR HEALTH CARE WORKFORCE.

    (a) Program for Education and Training in Pain Care.--Section 759 
of the Public Health Service Act (42 U.S.C. 294i) is amended--
            (1) in subsection (a), by inserting ``nonprofit'' after 
        ``private'';
            (2) in subsection (b)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``award may be made under subsection (a) only 
                if the applicant for the award agrees that the program 
                carried out with the award will include'' and inserting 
                ``entity receiving an award under this section shall 
                develop a comprehensive education and training plan 
                that includes'';
                    (B) in paragraph (1)--
                            (i) by inserting ``preventing,'' after 
                        ``diagnosing,''; and
                            (ii) by inserting ``non-addictive medical 
                        products and non-pharmacologic treatments and'' 
                        after ``including'';
                    (C) in paragraph (2)--
                            (i) by inserting ``Federal, State, and 
                        local'' after ``applicable''; and
                            (ii) by striking ``the degree to which'' 
                        and all that follows through ``effective pain 
                        care'' and inserting ``opioids'';
                    (D) in paragraph (3), by inserting ``and, as 
                appropriate, non-pharmacotherapy'' before the 
                semicolon;
                    (E) in paragraph (4)--
                            (i) by inserting ``any'' before 
                        ``cultural''; and
                            (ii) by striking ``; and'' and inserting 
                        ``;'';
                    (F) in paragraph (5), by striking ``provision of 
                pain care.'' and inserting ``scientific basis of pain 
                and the provision of pain care, including through non-
                addictive medical products and non-pharmacologic 
                treatments; and''; and
                    (G) by adding at the end the following:
            ``(6) the dangers of opioid abuse, detection of early 
        warning signs of opioid use disorders, and safe disposal 
        options for prescription medications, including such options 
        provided by law enforcement, or other innovative deactivation 
        mechanisms.'';
            (3) in subsection (d), by inserting ``prevention,'' after 
        ``diagnosis,''; and
            (4) in subsection (e), by striking ``2010 through 2012'' 
        and inserting ``2019 through 2023''.
    (b) Mental and Behavioral Health Education and Training Program.--
Section 756(a) of the Public Health Service Act (42 U.S.C. 294e-1(a)) 
is amended--
            (1) in paragraph (1), by inserting ``, trauma,'' after 
        ``focus on child and adolescent mental health''; and
            (2) in paragraphs (2) and (3), by inserting ``trauma-
        informed care and'' before ``substance use disorder prevention 
        and treatment services''.

SEC. 503. EDUCATION AND AWARENESS CAMPAIGNS.

    Section 102 of the Comprehensive Addiction and Recovery Act of 2016 
(Public Law 114-198) is amended--
            (1) by amending subsection (a) to read as follows:
    ``(a) In General.--The Secretary of Health and Human Services, 
acting through the Director of the Centers for Disease Control and 
Prevention and in coordination with the heads of other departments and 
agencies, shall advance education and awareness regarding the risks 
related to misuse and abuse of opioids, as appropriate, which may 
include developing or improving existing programs, conducting 
activities, and awarding grants that advance the education and 
awareness of--
            ``(1) the public, including patients and consumers;
            ``(2) patients, consumers, and other appropriate members of 
        the public, regarding such risks related to unused opioids and 
        the dispensing options under section 309(f) of the Controlled 
        Substances Act, as applicable;
            ``(3) providers, which may include--
                    ``(A) providing for continuing education on 
                appropriate prescribing practices;
                    ``(B) education related to applicable State or 
                local prescriber limit laws, information on the use of 
                non-addictive or non-opioid alternatives for pain 
                management, and the use of overdose reversal drugs, as 
                appropriate;
                    ``(C) disseminating and improving the use of 
                evidence-based opioid prescribing guidelines across 
                relevant health care settings, as appropriate, and 
                updating guidelines as necessary;
                    ``(D) implementing strategies, such as best 
                practices, to encourage and facilitate the use of 
                prescriber guidelines, in accordance with State and 
                local law; and
                    ``(E) disseminating information to providers about 
                prescribing options for controlled substances, 
                including such options under section 309(f) of the 
                Controlled Substances Act, as applicable; and
            ``(4) other appropriate entities.''; and
            (2) in subsection (b)--
                    (A) by striking ``opioid abuse'' each place such 
                term appears and inserting ``opioid misuse and abuse''; 
                and
                    (B) in paragraph (2), by striking ``safe disposal 
                of prescription medications and other'' and inserting 
                ``non-addictive or non-opioid treatment options, safe 
                disposal options for prescription medications, and 
                other applicable''.

SEC. 504. ENHANCED CONTROLLED SUBSTANCE OVERDOSES DATA COLLECTION, 
              ANALYSIS, AND DISSEMINATION.

    Part J of title III of the Public Health Service Act is amended by 
inserting after section 392 (42 U.S.C. 280b-1) the following:

``SEC. 392A. ENHANCED CONTROLLED SUBSTANCE OVERDOSES DATA COLLECTION, 
              ANALYSIS, AND DISSEMINATION.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention, using the authority provided to the Director under 
section 392, may--
            ``(1) to the extent practicable, carry out and expand any 
        controlled substance overdose data collection, analysis, and 
        dissemination activity described in subsection (b);
            ``(2) provide training and technical assistance to States, 
        localities, and Indian tribes for the purpose of carrying out 
        any such activity; and
            ``(3) award grants to States, localities, and Indian tribes 
        for the purpose of carrying out any such activity.
    ``(b) Controlled Substance Overdose Data Collection and Analysis 
Activities.--A controlled substance overdose data collection, analysis, 
and dissemination activity described in this subsection is any of the 
following activities:
            ``(1) Improving the timeliness of reporting aggregate data 
        to the public, including data on fatal and nonfatal controlled 
        substance overdoses.
            ``(2) Enhancing the comprehensiveness of controlled 
        substance overdose data by collecting information on such 
        overdoses from appropriate sources such as toxicology reports, 
        death scene investigations, and emergency department services.
            ``(3) Modernizing the system for coding causes of death 
        related to controlled substance overdoses to use an electronic-
        based system.
            ``(4) Using data to help identify risk factors associated 
        with controlled substance overdoses, including the delivery of 
        certain health care services.
            ``(5) Supporting entities involved in reporting information 
        on controlled substance overdoses, such as coroners and medical 
        examiners, to improve accurate testing and reporting of causes 
        and contributing factors of such overdoses, and analysis of 
        various opioid analogues to controlled substances overdoses.
            ``(6) Working to enable and encourage the access, exchange, 
        and use of data regarding controlled substances overdoses among 
        data sources and entities.
    ``(c) Controlled Substance Defined.--In this section, the term 
`controlled substance' has the meaning given that term in section 102 
of the Controlled Substances Act.''.

SEC. 505. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

    Part J of title III of the Public Health Service Act (42 U.S.C. 
280b et seq.), as amended by section 504, is further amended by 
inserting after section 392A the following:

``SEC. 392B. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

    ``(a) Prevention Activities.--
            ``(1) In general.--The Director of the Centers for Disease 
        Control and Prevention (referred to in this section as the 
        `Director'), using the authority provided to the Director under 
        section 392, may--
                    ``(A) to the extent practicable, carry out and 
                expand any prevention activity described in paragraph 
                (2);
                    ``(B) provide training and technical assistance to 
                States, localities, and Indian tribes to carrying out 
                any such activity; and
                    ``(C) award grants to States, localities, and 
                tribes for the purpose of carrying out any such 
                activity.
            ``(2) Prevention activities.--A prevention activity 
        described in this paragraph is an activity to improve the 
        efficiency and use of a new or currently operating prescription 
        drug monitoring program--
                    ``(A) encouraging all authorized users (as 
                specified by the State or other entity) to register 
                with and use the program;
                    ``(B) enabling such users to access any data 
                updates in as close to real-time as practicable;
                    ``(C) providing for a mechanism for the program to 
                notify authorized users of any potential misuse or 
                abuse of controlled substances and any detection of 
                inappropriate prescribing practices relating to such 
                substances;
                    ``(D) encouraging the analysis of prescription drug 
                monitoring data for purposes of providing de-
                identified, aggregate reports based on such analysis to 
                State public health agencies, State licensing boards, 
                and other appropriate State agencies, as permitted 
                under applicable Federal and State law and the policies 
                of the prescription drug monitoring program and not 
                containing any protected health information, to prevent 
                inappropriate prescribing, drug diversion, or abuse and 
                misuse of controlled substances, and to facilitate 
                better coordination among agencies;
                    ``(E) enhancing interoperability between the 
                program and any health information technology 
                (including certified health information technology), 
                including by integrating program data into such 
                technology;
                    ``(F) updating program capabilities to respond to 
                technological innovation for purposes of appropriately 
                addressing the occurrence and evolution of controlled 
                substance overdoses; and
                    ``(G) facilitating and encouraging data exchange 
                between the program and the prescription drug 
                monitoring programs of other States.
    ``(b) Additional Grants.--The Director may award grants to States, 
localities, and Indian tribes--
            ``(1) to carry out innovative projects for grantees to 
        rapidly respond to controlled substance misuse, abuse, and 
        overdoses, including changes in patterns of controlled 
        substance use; and
            ``(2) for any other evidence-based activity for preventing 
        controlled substance misuse, abuse, and overdoses as the 
        Director determines appropriate.
    ``(c) Research.--The Director may conduct studies and evaluations 
to address substance use disorders, including preventing substance use 
disorders or other related topics the Director determines appropriate.
    ``(d) Public and Prescriber Education.--Pursuant to section 102 of 
the Comprehensive Addiction and Recovery Act of 2016, the Director may 
advance the education and awareness of prescribers and the public 
regarding the risk of abuse of prescription opioids.
    ``(e) Controlled Substance Defined.--In this section, the term 
`controlled substance' has the meaning given that term in section 102 
of the Controlled Substances Act.
    ``(f) Authorization of Appropriations.--For purposes of carrying 
out this section, section 392A of this Act, and section 102 of the 
Comprehensive Addiction and Recovery Act of 2016, there is authorized 
to be appropriated $486,000,000 for each of fiscal years 2019 through 
2024.''.

SEC. 506. CDC SURVEILLANCE AND DATA COLLECTION FOR CHILD, YOUTH, AND 
              ADULT TRAUMA.

    (a) Data Collection.--The Director of the Centers for Disease 
Control and Prevention (referred to in this section as the 
``Director'') may, in cooperation with the States, collect and report 
data on adverse childhood experiences through the Behavioral Risk 
Factor Surveillance System, the Youth Risk Behavior Surveillance 
System, and other relevant public health surveys or questionnaires.
    (b) Timing.--The collection of data under subsection (a) may occur 
in fiscal year 2019 and every 2 years thereafter.
    (c) Data From Tribal and Rural Areas.--The Director shall encourage 
each State that participates in collecting and reporting data under 
subsection (a) to collect and report data from tribal and rural areas 
within such State, in order to generate a statistically reliable 
representation of such areas.
    (d) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for the period of fiscal years 2019 through 2021.

SEC. 507. REAUTHORIZATION OF NASPER.

    Section 399O of the Public Health Service Act (42 U.S.C. 280g-3) is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), in the matter preceding 
                subparagraph (A), by striking ``Administrator of the 
                Substance Abuse and Mental Health Services 
                Administration and Director of the Centers for Disease 
                Control and Prevention'' and inserting ``Director of 
                the Centers for Disease Control and Prevention and the 
                Assistant Secretary for Mental Health and Substance Use 
                Disorders''; and
                    (B) by adding at the end the following:
            ``(4) States and local governments.--
                    ``(A) In general.--In the case of a State that does 
                not have a prescription drug monitoring program, a 
                county or other unit of local government within the 
                State that has a prescription drug monitoring program 
                shall be treated as a State for purposes of this 
                section, including for purposes of eligibility for 
                grants under paragraph (1).
                    ``(B) Plan for interoperability.--For purposes of 
                meeting the interoperability requirements under 
                subsection (c)(3), a county or other unit of local 
                government shall submit a plan outlining the methods 
                such county or unit of local government will use to 
                ensure the capability of data sharing with other 
                counties and units of local government within the State 
                and with other States, as applicable.'';
            (2) in subsection (c)--
                    (A) in paragraph (1)(A)(iii)--
                            (i) by inserting ``as such standards become 
                        available,'' after ``interoperability 
                        standards,''; and
                            (ii) by striking ``generated or identified 
                        by the Secretary or his or her designee'' and 
                        inserting ``recognized by the Office of the 
                        National Coordinator for Health Information 
                        Technology''; and
                    (B) in paragraph (3)(A), by inserting ``including 
                electronic health records,'' after ``technology 
                systems,'';
            (3) in subsection (d)(1), by striking ``not later than 1 
        week after the date of such dispensing'' and inserting ``in as 
        close to real time as practicable'';
            (4) in subsection (f)(1)(D), by striking ``medicaid'' and 
        inserting ``Medicaid'';
            (5) in subsection (i), by inserting ``, in collaboration 
        with the National Coordinator for Health Information Technology 
        and the Director of the National Institute of Standards and 
        Technology,'' after ``The Secretary''; and
            (6) in subsection (n), by striking ``2021'' and inserting 
        ``2026''.

SEC. 508. JESSIE'S LAW.

    (a) Best Practices.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (referred to in this section as the ``Secretary''), in 
        consultation with appropriate stakeholders, including a patient 
        with a history of opioid use disorder, an expert in electronic 
        health records, an expert in the confidentiality of patient 
        health information and records, and a health care provider, 
        shall identify or facilitate the development of best practices 
        regarding--
                    (A) the circumstances under which information that 
                a patient has provided to a health care provider 
                regarding such patient's history of opioid use disorder 
                should, only at the patient's request, be prominently 
                displayed in the medical records (including electronic 
                health records) of such patient;
                    (B) what constitutes the patient's request for the 
                purpose described in subparagraph (A); and
                    (C) the process and methods by which the 
                information should be so displayed.
            (2) Dissemination.--The Secretary shall disseminate the 
        best practices developed under paragraph (1) to health care 
        providers and State agencies.
    (b) Requirements.--In identifying or facilitating the development 
of best practices under subsection (a), as applicable, the Secretary, 
in consultation with appropriate stakeholders, shall consider the 
following:
            (1) The potential for addiction relapse or overdose, 
        including overdose death, when opioid medications are 
        prescribed to a patient recovering from opioid use disorder.
            (2) The benefits of displaying information about a 
        patient's opioid use disorder history in a manner similar to 
        other potentially lethal medical concerns, including drug 
        allergies and contraindications.
            (3) The importance of prominently displaying information 
        about a patient's opioid use disorder when a physician or 
        medical professional is prescribing medication, including 
        methods for avoiding alert fatigue in providers.
            (4) The importance of a variety of appropriate medical 
        professionals, including physicians, nurses, and pharmacists, 
        having access to information described in this section when 
        prescribing or dispensing opioid medication, consistent with 
        Federal and State laws and regulations.
            (5) The importance of protecting patient privacy, including 
        the requirements related to consent for disclosure of substance 
        use disorder information under all applicable laws and 
        regulations.
            (6) All applicable Federal and State laws and regulations.

SEC. 509. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING PROGRAMS FOR 
              SUBSTANCE USE DISORDER PATIENT RECORDS.

    (a) Initial Programs and Materials.--Not later than 1 year after 
the date of the enactment of this Act, the Secretary of Health and 
Human Services (referred to in this section as the ``Secretary''), in 
consultation with appropriate experts, shall identify the following 
model programs and materials (or if no such programs or materials 
exist, recognize private or public entities to develop and disseminate 
such programs and materials):
            (1) Model programs and materials for training health care 
        providers (including physicians, emergency medical personnel, 
        psychiatrists, psychologists, counselors, therapists, nurse 
        practitioners, physician assistants, behavioral health 
        facilities and clinics, care managers, and hospitals, including 
        individuals such as general counsels or regulatory compliance 
        staff who are responsible for establishing provider privacy 
        policies) concerning the permitted uses and disclosures, 
        consistent with the standards and regulations governing the 
        privacy and security of substance use disorder patient records 
        promulgated by the Secretary under section 543 of the Public 
        Health Service Act (42 U.S.C. 290dd-2) for the confidentiality 
        of patient records.
            (2) Model programs and materials for training patients and 
        their families regarding their rights to protect and obtain 
        information under the standards and regulations described in 
        paragraph (1).
    (b) Requirements.--The model programs and materials described in 
paragraphs (1) and (2) of subsection (a) shall address circumstances 
under which disclosure of substance use disorder patient records is 
needed to--
            (1) facilitate communication between substance use disorder 
        treatment providers and other health care providers to promote 
        and provide the best possible integrated care;
            (2) avoid inappropriate prescribing that can lead to 
        dangerous drug interactions, overdose, or relapse; and
            (3) notify and involve families and caregivers when 
        individuals experience an overdose.
    (c) Periodic Updates.--The Secretary shall--
            (1) periodically review and update the model program and 
        materials identified or developed under subsection (a); and
            (2) disseminate such updated programs and materials to the 
        individuals described in subsection (a)(1).
    (d) Input of Certain Entities.--In identifying, reviewing, or 
updating the model programs and materials under this section, the 
Secretary shall solicit the input of relevant stakeholders.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2019 through 2023.

SEC. 510. COMMUNICATION WITH FAMILIES DURING EMERGENCIES.

    (a) Promoting Awareness of Authorized Disclosures During 
Emergencies.--The Secretary of Health and Human Services shall annually 
notify health care providers regarding permitted disclosures during 
emergencies, including overdoses, of certain health information to 
families and caregivers under Federal health care privacy laws and 
regulations.
    (b) Use of Material.--For the purposes of carrying out subsection 
(a), the Secretary of Health and Human Services may use material 
produced under section 509 of this Act or under section 11004 of the 
21st Century Cures Act (42 U.S.C. 1320d-2 note).

SEC. 511. PRENATAL AND POSTNATAL HEALTH.

    Section 317L of the Public Health Service Act (42 U.S.C. 247b-13) 
is amended--
            (1) in subsection (a)--
                    (A) by amending paragraph (1) to read as follows:
            ``(1) to collect, analyze, and make available data on 
        prenatal smoking, alcohol and substance abuse and misuse, 
        including--
                    ``(A) data on--
                            ``(i) the incidence, prevalence, and 
                        implications of such activities; and
                            ``(ii) the incidence and prevalence of 
                        implications and outcomes, including neonatal 
                        abstinence syndrome and other outcomes 
                        associated with such activities; and
                    ``(B) to inform such analysis, additional 
                information or data on family health history, 
                medication exposures during pregnancy, demographic 
                information, such as race, ethnicity, geographic 
                location, and family history, and other relevant 
                information, as appropriate;'';
                    (B) in paragraph (2)--
                            (i) by striking ``prevention of'' and 
                        inserting ``prevention and long-term outcomes 
                        associated with''; and
                            (ii) by striking ``illegal drug use'' and 
                        inserting ``substance abuse and misuse'';
                    (C) in paragraph (3), by striking ``and cessation 
                programs; and'' and inserting ``, treatment, and 
                cessation programs;'';
                    (D) in paragraph (4), by striking ``illegal drug 
                use.'' and inserting ``substance abuse and misuse; 
                and''; and
                    (E) by adding at the end the following:
            ``(5) to issue public reports on the analysis of data 
        described in paragraph (1), including analysis of--
                    ``(A) long-term outcomes of children affected by 
                neonatal abstinence syndrome;
                    ``(B) health outcomes associated with prenatal 
                smoking, alcohol, and substance abuse and misuse; and
                    ``(C) relevant studies, evaluations, or information 
                the Secretary determines to be appropriate.'';
            (2) in subsection (b), by inserting ``tribal entities,'' 
        after ``local governments,'';
            (3) by redesignating subsection (c) as subsection (d);
            (4) by inserting after subsection (b) the following:
    ``(c) Coordinating Activities.--To carry out this section, the 
Secretary may--
            ``(1) provide technical and consultative assistance to 
        entities receiving grants under subsection (b);
            ``(2) ensure a pathway for data sharing between States, 
        tribal entities, and the Centers for Disease Control and 
        Prevention;
            ``(3) ensure data collection under this section is 
        consistent with applicable State, Federal, and Tribal privacy 
        laws; and
            ``(4) coordinate with the National Coordinator for Health 
        Information Technology, as appropriate, to assist States and 
        tribes in implementing systems that use standards recognized by 
        such National Coordinator, as such recognized standards are 
        available, in order to facilitate interoperability between such 
        systems and health information technology systems, including 
        certified health information technology.''; and
            (5) in subsection (d), as so redesignated, by striking 
        ``2001 through 2005'' and inserting ``2019 through 2023''.

SEC. 512. SURVEILLANCE AND EDUCATION REGARDING INFECTIONS ASSOCIATED 
              WITH INJECTION DRUG USE AND OTHER RISK FACTORS.

    Section 317N of the Public Health Service Act (42 U.S.C. 247b-15) 
is amended--
            (1) by amending the section heading to read as follows: 
        ``surveillance and education regarding infections associated 
        with injection drug use and other risk factors'';
            (2) in subsection (a)--
                    (A) in the matter preceding paragraph (1), by 
                inserting ``activities'' before the colon;
                    (B) in paragraph (1)--
                            (i) by inserting ``or maintaining'' after 
                        ``implementing'';
                            (ii) by striking ``hepatitis C virus 
                        infection (in this section referred to as `HCV 
                        infection')'' and inserting ``infections 
                        commonly associated with injection drug use, 
                        including viral hepatitis and human 
                        immunodeficiency virus,''; and
                            (iii) by striking ``such infection'' and 
                        all that follows through the period at the end 
                        and inserting ``such infections, which may 
                        include the reporting of cases of such 
                        infections.'';
                    (C) in paragraph (2), by striking ``HCV infection'' 
                and all that follows through the period at the end and 
                inserting ``infections as a result of injection drug 
                use, receiving blood transfusions prior to July 1992, 
                or other risk factors.'';
                    (D) in paragraphs (4) and (5), by striking ``HCV 
                infection'' each place such term appears and inserting 
                ``infections described in paragraph (1)''; and
                    (E) in paragraph (5), by striking ``pediatricians 
                and other primary care physicians, and obstetricians 
                and gynecologists'' and inserting ``substance use 
                disorder treatment providers, pediatricians, other 
                primary care providers, and obstetrician-
                gynecologists'';
            (3) in subsection (b)--
                    (A) by striking ``directly and'' and inserting 
                ``directly or''; and
                    (B) by striking ``hepatitis C,'' and all that 
                follows through the period at the end and inserting 
                ``infections described in subsection (a)(1).'';
            (4) by redesignating subsection (c) as subsection (d);
            (5) by inserting after subsection (b) the following:
    ``(c) Definition.--In this section, the term `injection drug use' 
means--
            ``(1) intravenous administration of a substance in schedule 
        I of section 202(c) of the Controlled Substances Act;
            ``(2) intravenous administration of a substance in schedule 
        II, III, IV, or V of section 202(c) of the Controlled 
        Substances Act that has not been approved for intravenous use 
        under section 505 of the Federal Food, Drug and Cosmetic Act or 
        section 351 of the Public Health Service Act; or
            ``(3) intravenous administration of a substance in schedule 
        II, III, IV, or V of section 202(c) of the Controlled 
        Substances Act that has not been prescribed to the person using 
        the substance.''; and
            (6) in subsection (d), as so redesignated, by striking 
        ``such sums as may be necessary for each of the fiscal years 
        2001 through 2005'' and inserting ``$40,000,000 for each of 
        fiscal years 2019 through 2023''.

SEC. 513. TASK FORCE TO DEVELOP BEST PRACTICES FOR TRAUMA-INFORMED 
              IDENTIFICATION, REFERRAL, AND SUPPORT.

    (a) Establishment.--There is established a task force, to be known 
as the Interagency Task Force on Trauma-Informed Care (in this section 
referred to as the ``task force'') that shall identify, evaluate, and 
make recommendations regarding best practices with respect to children 
and youth, and their families as appropriate, who have experienced or 
are at risk of experiencing trauma.
    (b) Membership.--
            (1) Composition.--The task force shall be composed of the 
        heads of the following Federal departments and agencies, or 
        their designees:
                    (A) The Centers for Medicare & Medicaid Services.
                    (B) The Substance Abuse and Mental Health Services 
                Administration.
                    (C) The Agency for Healthcare Research and Quality.
                    (D) The Centers for Disease Control and Prevention.
                    (E) The Indian Health Service.
                    (F) The Department of Veterans Affairs.
                    (G) The National Institutes of Health.
                    (H) The Food and Drug Administration.
                    (I) The Health Resources and Services 
                Administration.
                    (J) The Department of Defense.
                    (K) The Office of Minority Health.
                    (L) The Administration for Children and Families.
                    (M) The Office of the Assistant Secretary for 
                Planning and Evaluation.
                    (N) The Office for Civil Rights at the Department 
                of Health and Human Services.
                    (O) The Office of Juvenile Justice and Delinquency 
                Prevention of the Department of Justice.
                    (P) The Office of Community Oriented Policing 
                Services of the Department of Justice.
                    (Q) The Office on Violence Against Women of the 
                Department of Justice.
                    (R) The National Center for Education Evaluation 
                and Regional Assistance of the Department of Education.
                    (S) The National Center for Special Education 
                Research of the Institute of Education Science.
                    (T) The Office of Elementary and Secondary 
                Education of the Department of Education.
                    (U) The Office for Civil Rights at the Department 
                of Education.
                    (V) The Office of Special Education and the 
                Rehabilitative Services of the Department of Education.
                    (W) the Bureau of Indian Affairs of the Department 
                of the Interior.
                    (X) The Veterans Health Administration of the 
                Department of Veterans Affairs.
                    (Y) The Office of Special Needs Assistance Programs 
                of the Department of Housing and Urban Development.
                    (Z) The Office of Head Start of the Administration 
                for Children and Families.
                    (AA) The Children's Bureau of the Administration 
                for Children and Families.
                    (BB) The Bureau of Indian Education of the 
                Department of the Interior.
                    (CC) Such other Federal agencies as the Secretaries 
                determine to be appropriate.
            (2) Date of appointments.--The heads of Federal departments 
        and agencies shall appoint the corresponding members of the 
        task force not later than 6 months after the date of enactment 
        of this Act.
            (3) Chairperson.--The task force shall be chaired by the 
        Assistant Secretary for Mental Health and Substance Use.
    (c) Task Force Duties.--The task force shall--
            (1) solicit input from stakeholders, including frontline 
        service providers, educators, mental health professionals, 
        researchers, experts in infant, child, and youth trauma, child 
        welfare professionals, and the public, in order to inform the 
        activities under paragraph (2); and
            (2) identify, evaluate, make recommendations, and update 
        such recommendations not less than annually, to the general 
        public, the Secretary of Education, the Secretary of Health and 
        Human Services, the Secretary of Labor, the Secretary of the 
        Interior, the Attorney General, and other relevant cabinet 
        Secretaries, and Congress regarding--
                    (A) a set of evidence-based, evidence-informed, and 
                promising best practices with respect to--
                            (i) the identification of infants, children 
                        and youth, and their families as appropriate, 
                        who have experienced or are at risk of 
                        experiencing trauma; and
                            (ii) the expeditious referral to and 
                        implementation of trauma-informed practices and 
                        supports that prevent and mitigate the effects 
                        of trauma;
                    (B) a national strategy on how the task force and 
                member agencies will collaborate, prioritize options 
                for, and implement a coordinated approach which may 
                include data sharing and the awarding of grants that 
                support children and their families as appropriate, who 
                have experienced or are at risk of experiencing trauma; 
                and
                    (C) existing Federal authorities at the Department 
                of Education, Department of Health and Human Services, 
                Department of Justice, Department of Labor, Department 
                of Interior, and other relevant agencies, and specific 
                Federal grant programs to disseminate best practices 
                on, provide training in, or deliver services through, 
                trauma-informed practices, and disseminate such 
                information--
                            (i) in writing to relevant program offices 
                        at such agencies to encourage grant applicants 
                        in writing to use such funds, where 
                        appropriate, for trauma-informed practices; and
                            (ii) to the general public through the 
                        internet website of the task force.
    (d) Best Practices.--In identifying, evaluating, and recommending 
the set of best practices under subsection (c), the task force shall--
            (1) include guidelines for providing professional 
        development for front-line services providers, including school 
        personnel, providers from child- or youth-serving 
        organizations, primary and behavioral health care providers, 
        child welfare and social services providers, family and 
        juvenile court judges and attorneys, health care providers, 
        individuals who are mandatory reporters of child abuse or 
        neglect, trained nonclinical providers (including peer mentors 
        and clergy), and first responders, in--
                    (A) understanding and identifying early signs and 
                risk factors of trauma in children and youth, and their 
                families as appropriate, including through screening 
                processes;
                    (B) providing practices to prevent and mitigate the 
                impact of trauma, including by fostering safe and 
                stable environments and relationships; and
                    (C) developing and implementing procedures or 
                systems that--
                            (i) are designed to quickly refer infants, 
                        children, youth, and their families as 
                        appropriate, who have experienced or are at 
                        risk of experiencing trauma to the appropriate 
                        trauma-informed screening and support, 
                        including treatment appropriate to the age of 
                        the child, and to ensure such infants, 
                        children, youth, and family members receive 
                        such support;
                            (ii) utilize and develop partnerships with 
                        local social services organizations, such as 
                        organizations serving youth, and clinical 
                        mental health or health care service providers 
                        with expertise in providing support services 
                        (including trauma-informed and evidence-based 
                        treatment appropriate to the age of the child) 
                        aimed at preventing or mitigating the effects 
                        of trauma;
                            (iii) educate children and youth to--
                                    (I) understand and identify the 
                                signs, effects, or symptoms of trauma; 
                                and
                                    (II) build the resilience and 
                                coping skills to mitigate the effects 
                                of experiencing trauma;
                            (iv) promote and support multi-generational 
                        practices that assist parents, foster parents, 
                        and kinship and other caregivers in accessing 
                        resources related to, and developing 
                        environments conducive to, the prevention and 
                        mitigation of trauma; and
                            (v) collect and utilize data from 
                        screenings, referrals, or the provision of 
                        services and supports, conducted in the covered 
                        settings, to evaluate and improve processes for 
                        trauma-informed support and outcomes that are 
                        culturally sensitive, linguistically 
                        appropriate, and specific to age ranges and 
                        sex, as applicable; and
            (2) recommend best practices that are designed to avoid 
        unwarranted custody loss or criminal penalties for parents or 
        guardians in connection with infants, children, and youth who 
        have experienced or are at risk of experiencing trauma.
    (e) Operating Plan.--Not later than 1 year after the date of 
enactment of this Act, the task force shall hold the first meeting. Not 
later than 2 years after such date of enactment, the task force shall 
submit to the Secretary of Education, Secretary of Health and Human 
Services, Secretary of Labor, Secretary of the Interior, the Attorney 
General, and Congress an operating plan for carrying out the activities 
of the task force described in paragraphs (2) and (3) of subsection 
(c). Such operating plan shall include--
            (1) a list of specific activities that the task force plans 
        to carry out for purposes of carrying out duties described in 
        subsection (c)(2), which may include public engagement;
            (2) a plan for carrying out the activities under paragraphs 
        (2) and (3) of subsection (c);
            (3) a list of members of the task force and other 
        individuals who are not members of the task force that may be 
        consulted to carry out such activities;
            (4) an explanation of Federal agency involvement and 
        coordination needed to carry out such activities, including any 
        statutory or regulatory barriers to such coordination;
            (5) a budget for carrying out such activities; and
            (6) other information that the task force determines 
        appropriate.
    (f) Final Report.--Not later than 3 years after the date of the 
first meeting of the task force, the task force shall submit to the 
general public, Secretary of Education, Secretary of Health and Human 
Services, Secretary of Labor, Secretary of the Interior, the Attorney 
General, and other relevant cabinet Secretaries, and Congress, a final 
report containing all of the findings and recommendations required 
under this section.
    (g) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for each of fiscal years 2019 through 2022.
    (h) Sunset.--The task force shall on the date that is 60 days after 
the submission of the final report under subsection (f), but not later 
than September 30, 2022.

SEC. 514. GRANTS TO IMPROVE TRAUMA SUPPORT SERVICES AND MENTAL HEALTH 
              CARE FOR CHILDREN AND YOUTH IN EDUCATIONAL SETTINGS.

    (a) Grants, Contracts, and Cooperative Agreements Authorized.--The 
Secretary, in coordination with the Director of Substance Abuse and 
Mental Health Services Administration, is authorized to award grants 
to, or enter into contracts or cooperative agreements with, State 
educational agencies, local educational agencies, Head Start agencies 
(including Early Head Start agencies), State or local agencies that 
administer public preschool programs, Indian tribes or their tribal 
educational agencies, a school operated by the Bureau of Indian 
Education, a Regional Corporation (as defined in section 3 of the 
Alaska Native Claims Settlement Act (43 U.S.C. 1602)), or a Native 
Hawaiian educational organization (as defined in section 6207 of the 
Elementary and Secondary Education Act of 1965 (20 U.S.C. 7517)), for 
the purpose of increasing student access to evidence-based trauma 
support services and mental health care by developing innovative 
initiatives, activities, or programs to link local school systems with 
local trauma-informed support and mental health systems, including 
those under the Indian Health Service.
    (b) Duration.--With respect to a grant, contract, or cooperative 
agreement awarded or entered into under this section, the period during 
which payments under such grant, contract or agreement are made to the 
recipient may not exceed 4 years.
    (c) Use of Funds.--An entity that receives a grant, contract, or 
cooperative agreement under this section shall use amounts made 
available through such grant, contract, or cooperative agreement for 
evidence-based or promising activities, which shall include any of the 
following:
            (1) Collaborative efforts between school-based service 
        systems and trauma-informed support and mental health service 
        systems to provide, develop, or improve prevention, screening, 
        referral, and treatment services to students, such as by 
        providing universal trauma screenings to identify students in 
        need of specialized support.
            (2) To implement multi-tiered positive behavioral 
        interventions and supports, or other trauma-informed models of 
        support.
            (3) To provide professional development to teachers, 
        teacher assistants, school leaders, specialized instructional 
        support personnel, and mental health professionals that--
                    (A) fosters safe and stable learning environments 
                that prevent and mitigate the effects of trauma, 
                including through social and emotional learning;
                    (B) improves school capacity to identify, refer, 
                and provide services to students in need of trauma 
                support or behavioral health services; or
                    (C) reflects the best practices developed by the 
                Interagency Task Force on Trauma-Informed Care 
                established under section 513.
            (4) Engaging families and communities in efforts to 
        increase awareness of child and youth trauma, which may include 
        sharing best practices with law enforcement regarding trauma-
        informed care and working with mental health professionals to 
        provide interventions, as well as longer term coordinated care 
        within the community for children and youth who have 
        experienced trauma and their families.
            (5) To provide technical assistance to school systems and 
        mental health agencies.
            (6) To evaluate the effectiveness of the program carried 
        out under this section in increasing student access to 
        evidence-based trauma support services and mental health care.
    (d) Applications.--To be eligible to receive a grant, contract, or 
cooperative agreement under this section, an entity described in 
subsection (a) shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may reasonably require, which shall include the following:
            (1) A description of the program to be funded under the 
        grant, contract, or cooperative agreement, including how such 
        program will increase access to evidence-based trauma support 
        services and mental health care for students, and, as 
        applicable, the families of the students.
            (2) A description of how the program will provide 
        linguistically appropriate and culturally competent services.
            (3) A description of how the program will support students 
        and the school in improving the school climate in order to 
        support an environment conducive to learning.
            (4) An assurance that--
                    (A) persons providing services under the grant, 
                contract, or cooperative agreement are adequately 
                trained to provide such services; and
                    (B) teachers, school leaders, administrators, 
                specialized instructional support personnel, 
                representatives of local Indian tribes as appropriate, 
                other school personnel, and parents or guardians of 
                students participating in services under this section 
                will be engaged and involved in the design and 
                implementation of the services.
            (5) A description of how the applicant will support and 
        integrate existing school-based services with the program in 
        order to provide mental health services for students, as 
        appropriate.
    (e) Interagency Agreements.--
            (1) Designation of lead agency.--A recipient of a grant, 
        contract, or cooperative agreement under this section shall 
        designate a lead agency to direct the establishment of an 
        interagency agreement among local educational agencies, 
        juvenile justice authorities, mental health agencies, child 
        welfare agencies, and other relevant entities in the State, in 
        collaboration with local entities, such as Indian tribes.
            (2) Contents.--The interagency agreement shall ensure the 
        provision of the services described in subsection (c), 
        specifying with respect to each agency, authority, or entity--
                    (A) the financial responsibility for the services;
                    (B) the conditions and terms of responsibility for 
                the services, including quality, accountability, and 
                coordination of the services; and
                    (C) the conditions and terms of reimbursement among 
                the agencies, authorities, or entities that are parties 
                to the interagency agreement, including procedures for 
                dispute resolution.
    (f) Evaluation.--The Secretary shall reserve not to exceed 3 
percent of the funds made available under subsection (l) for each 
fiscal year to--
            (1) conduct a rigorous, independent evaluation of the 
        activities funded under this section; and
            (2) disseminate and promote the utilization of evidence-
        based practices regarding trauma support services and mental 
        health care.
    (g) Distribution of Awards.--The Secretary shall ensure that 
grants, contracts, and cooperative agreements awarded or entered into 
under this section are equitably distributed among the geographical 
regions of the United States and among tribal, urban, suburban, and 
rural populations.
    (h) Rule of Construction.--Nothing in this section shall be 
construed--
            (1) to prohibit an entity involved with a program carried 
        out under this section from reporting a crime that is committed 
        by a student to appropriate authorities; or
            (2) to prevent Federal, State, and tribal law enforcement 
        and judicial authorities from exercising their responsibilities 
        with regard to the application of Federal, tribal, and State 
        law to crimes committed by a student.
    (i) Supplement, Not Supplant.--Any services provided through 
programs carried out under this section shall supplement, and not 
supplant, existing mental health services, including any special 
education and related services provided under the Individuals with 
Disabilities Education Act.
    (j) Consultation With Indian Tribes.--In carrying out subsection 
(a), the Secretary shall, in a timely manner, meaningfully consult, 
engage, and cooperate with Indian tribes and their representatives to 
ensure notice of eligibility.
    (k) Definitions.--In this section:
            (1) Elementary or secondary school.--The term ``elementary 
        or secondary school'' means a public elementary and secondary 
        school as such term is defined in section 8101 of the 
        Elementary and Secondary Education Act of 1965 (20 U.S.C. 
        7801).
            (2) Evidence-based.--The term ``evidence-based'' has the 
        meaning given such term in section 8101(21)(A)(i) of the 
        Elementary and Secondary Education Act of 1965 (20 U.S.C. 
        7801(21)(A)(i)).
            (3) School leader.--The term ``school leader'' has the 
        meaning given such term in section 8101 of the Elementary and 
        Secondary Education Act of 1965 (20 U.S.C. 7801).
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Education.
            (5) Specialized instructional support personnel.--The term 
        ``specialized instructional support personnel'' has the meaning 
        given such term in 8101 of the Elementary and Secondary 
        Education Act of 1965 (20 U.S.C. 7801).
    (l) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2019 through 2023.

SEC. 515. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE.

    Section 582(j) of the Public Health Service Act (42 U.S.C. 290hh-
1(j)) is amended by striking ``$46,887,000 for each of fiscal years 
2018 through 2022'' and inserting ``$53,887,000 for each of fiscal 
years 2019 through 2023''.
                                 <all>
```