II 

114TH CONGRESS 

1ST SESSION S. 1410 

To amend the Public Health Service Act to provide grants to improve the 

treatment of substance use disorders. 

IN THE SENATE OF THE UNITED STATES 

MAY 21, 2015 

Mr. MARKEY introduced the following bill; which was read twice and referred 

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

A BILL 

To amend the Public Health Service Act to provide grants 

to improve the treatment of substance use disorders. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Treatment and Recov5 ery Investment Act’’. 

6 SEC. 2. OPIOID TREATMENT AND RECOVERY INITIATIVE. 

7 Subpart 1 of part B of title V of the Public Health 

8 Service Act (42 U.S.C. 290bb et seq.) is amended— 

9 (1) by redesignating the second section 514 re10 lating to the methamphetamine and amphetamine 

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1 treatment initiative (42 U.S.C. 290bb–9) as section 

2 514B; and 

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

4 ‘‘SEC. 514C. OPIOID TREATMENT AND RECOVERY INITIA5 TIVE. 

6 ‘‘(a) GRANTS.— 

7 ‘‘(1) AUTHORITY TO MAKE GRANTS.—The Di8 rector of the Center for Substance Abuse Treatment 

9 may award grants to the State agencies responsible 

10 for administering funds received under the substance 

11 abuse prevention and treatment block grant program 

12 under title XIX, units of local government that have 

13 a high rate, or have had a rapid increase, in the use 

14 of, or death related to the use of, heroin or other 

15 opioids, including prescription opioids, and Indian 

16 tribes or tribal organizations (as defined in section 

17 4 of the Indian Health Care Improvement Act), in 

18 order to permit such entities to expand evidence19 based treatment activities and related recovery serv20 ices in the specific geographical areas of such enti21 ties where there exists a need to address the use of, 

22 or death related to the use of, heroin or other 

23 opioids. 

24 ‘‘(2) RECIPIENTS.—Grants awarded under 

25 paragraph (1) shall be directed to the substance 

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1 abuse directors of the States and the appropriate 

2 tribal government authorities of the Indian tribes. 

3 ‘‘(3) NATURE OF ACTIVITIES.—Grant funds 

4 awarded under paragraph (1) shall be used for ac5 tivities that are based on reliable scientific evidence 

6 of efficacy in the treatment of problems related to 

7 the use or misuse of heroin or other opioids. 

8 ‘‘(b) GEOGRAPHIC DISTRIBUTION.—The Director 

9 shall ensure that grants awarded under subsection (a) are 

10 distributed equitably among the various regions of the 

11 United States and among rural, urban, and suburban 

12 areas that are affected by the use of heroin or other 

13 opioids. 

14 ‘‘(c) EVALUATION AND REPORTING.—A State agen15 cy, unit of local government, or Indian tribe or tribal orga16 nization receiving a grant under subsection (a) shall pro17 vide the Director with aggregate data and other informa18 tion determined by the Director to be necessary to enable 

19 the Director— 

20 ‘‘(1) to evaluate the success of the grant pro21 gram involved in achieving its purposes; and 

22 ‘‘(2) to prepare and submit the report to Con23 gress on an annual basis. 

24 ‘‘(d) ADDITIONAL ACTIVITIES.—In carrying out this 

25 section, the Director shall— 

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1 ‘‘(1) disseminate widely such findings derived 

2 from the evaluation conducted under subsection (c) 

3 as the Director considers appropriate; 

4 ‘‘(2) provide States, Indian tribes, and tribal or5 ganizations, and health care providers with technical 

6 assistance in connection with the provision of evi7 dence-based treatment for problems related to heroin 

8 and other opioids; and 

9 ‘‘(3) give priority to applications for grants 

10 under this section that support recovery and related 

11 services as a critical component of the grant pro12 gram, including comprehensive social services that 

13 assist with housing, employment, or education. 

14 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 

15 ‘‘(1) IN GENERAL.—There is authorized to be 

16 appropriated to carry out this section, $27,000,000 

17 for fiscal year 2016, and such sums as may be nec18 essary for each of fiscal years 2016 through 2020. 

19 ‘‘(2) USE OF CERTAIN FUNDS.—Of the funds 

20 appropriated to carry out this section in any fiscal 

21 year under paragraph (1), the lesser of 5 percent of 

22 such funds or $1,000,000 shall be available to the 

23 Director for purposes of carrying out subsection 

24 (c).’’. 

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1 SEC. 3. GRANTS FOR ENHANCING PRIMARY CARE ACCESS 

2 FOR OPIOID DEPENDENT PREGNANT AND 

3 PARENTING WOMEN. 

4 Subpart 1 of part B of title V of the Public Health 

5 Service Act (42 U.S.C. 290bb et seq.), as amended by sec6 tion 2, is further amended by adding at the end the fol7 lowing: 

8 ‘‘SEC. 514D. GRANTS FOR ENHANCING PRIMARY CARE AC9 CESS FOR OPIOID DEPENDENT PREGNANT 

10 AND PARENTING WOMEN. 

11 ‘‘(a) IN GENERAL.—The Director of the Center for 

12 Substance Abuse Treatment shall award grants to State 

13 substance abuse agencies, Indian tribes or tribal organiza14 tions (as defined in section 4 of the Indian Health Care 

15 Improvement Act), and public nonprofit entities for the 

16 purpose of enhancing access to primary care and related 

17 services for pregnant and parenting women diagnosed with 

18 opioid dependence. 

19 ‘‘(b) USE OF FUNDS.—Amount awarded under a 

20 grant under subsection (a) may be used to assist health 

21 care providers or facilities caring for pregnant and par22 enting opioid dependent women to provide the following 

23 services: 

24 ‘‘(1) Clinically appropriate trauma informed 

25 gender-specific services that are based on reliable 

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1 scientific evidence of efficacy in the treatment of 

2 problems related to substance use disorder. 

3 ‘‘(2) Prenatal and postpartum care. 

4 ‘‘(3) Child care for infants and other children 

5 under the age of 18 of the opioid dependent woman. 

6 ‘‘(4) Prevention and wellness services, including 

7 nutrition education, exercise instruction, and train8 ing in other life and coping skills. 

9 ‘‘(5) Developmental and therapeutic services for 

10 children of opioid dependent woman. 

11 ‘‘(6) Domestic violence services. 

12 ‘‘(7) Educational services for women on proper 

13 care for newborns with neonatal abstinence syn14 drome and other clinical indications for newborns re15 lated to substance use during pregnancy. 

16 ‘‘(8) Parenting courses. 

17 ‘‘(9) HIV/AIDS and Hepatitis C care and serv18 ices. 

19 ‘‘(10) Dental services. 

20 ‘‘(11) Recovery coaches and mentors that can 

21 assist in supporting the opioid dependent woman in 

22 achieving long term recovery according to the needs 

23 of the woman. 

24 ‘‘(12) Case management services, including as25 sistance in establishing eligibility for public promstockstill on DSK4VPTVN1PROD with BILLS

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1 grams, housing assistance, job training, educational 

2 or vocational opportunities, transportation, and 

3 other related activities. 

4 ‘‘(c) LENGTH OF GRANT.—Each grant awarded 

5 under subsection (a) shall be for a period of 5 years. 

6 ‘‘(d) ADDITIONAL ACTIVITIES.—The Director shall— 

7 ‘‘(1) collect and evaluate data regarding activi8 ties supported by grants awarded under subsection 

9 (a); 

10 ‘‘(2) give priority in awarding grants to appli11 cants that are meeting a geographical need for sub12 stance use disorder services for pregnant, 

13 postpartum or parenting women; and 

14 ‘‘(3) give priority in awarding grants to entities 

15 that are collaborating with State health care, public 

16 health, criminal justice, and child welfare agencies 

17 as well as local Federally qualified health centers for 

18 the purpose of enhancing access to primary care and 

19 related services for pregnant and parenting women 

20 diagnosed with opioid dependence. 

21 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 

22 ‘‘(1) IN GENERAL.—There is authorized to be 

23 appropriated to carry out this section, $15,000,000 

24 for fiscal year 2016, and such sums as may be nec25 essary for each of fiscal years 2016 through 2020. 

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1 ‘‘(2) USE OF CERTAIN FUNDS.—Of the funds 

2 appropriated to carry out this section in any fiscal 

3 year, the lesser of 5 percent of such funds or 

4 $1,000,000 shall be available to the Director for 

5 purposes of carrying out subsection (d).’’. 

6 SEC. 4. ADOLESCENT TREATMENT PROGRAMS. 

7 Subpart 1 of part B of title V of the Public Health 

8 Service Act (42 U.S.C. 290bb et seq.), as amended by sec9 tion 3, is further amended by adding at the end the fol10 lowing: 

11 ‘‘SEC. 514E. GRANTS TO IMPROVE ACCESS TO TREATMENT 

12 AND RECOVERY FOR ADOLESCENTS. 

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

14 the Director of the Center for Substance Abuse Treat15 ment, shall award grants, contracts, or cooperative agree16 ments to eligible State substance abuse agencies and other 

17 entities determined appropriate by the Director for the 

18 purpose of increasing the capacity of substance use dis19 order treatment and recovery services for adolescents. 

20 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant, 

21 contract, or cooperative agreement under subsection (a) 

22 an entity shall— 

23 ‘‘(1) prepare and submit to the Director an ap24 plication at such time, in such manner, and contain 

25 such information as the Director may require, inmstockstill on DSK4VPTVN1PROD with BILLS

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1 cluding a plan for the evaluation of any activities 

2 carried out with the funds provided under this sec3 tion; 

4 ‘‘(2) ensure that all entities receiving support 

5 under the grant, contract, or cooperative agreement 

6 comply with all applicable State licensure or certifi7 cation requirements regarding the provision of the 

8 services involved; and 

9 ‘‘(3) provide the Director with periodic evalua10 tions of the progress of the activities funded under 

11 this section and an evaluation at the completion of 

12 such activities, as the Director determines to be ap13 propriate. 

14 ‘‘(c) PRIORITY.—In awarding grants, contracts, and 

15 cooperative agreements under subsection (a), the Director 

16 shall give priority to applicants who propose to fill a dem17 onstrated geographic need for adolescent specific residen18 tial treatment services. 

19 ‘‘(d) USE OF FUNDS.—Amounts awarded under 

20 grants, contracts, or cooperative agreements under this 

21 section may be used to enable health care providers or fa22 cilities that provide treatment and recovery assistance for 

23 adolescents with a substance use disorder to provide the 

24 following services: 

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1 ‘‘(1) Individualized patient centered care that is 

2 specific to circumstances of the individual patient. 

3 ‘‘(2) Clinically appropriate, trauma-informed, 

4 gender-specific and age appropriate treatment serv5 ices that are based on reliable scientific evidence of 

6 efficacy in the treatment of problems related to sub7 stance use disorders. 

8 ‘‘(3) Clinically appropriate care to address 

9 treatment for substance use and any co-occurring 

10 physical and mental health disorders at the same lo11 cation, and through access to primary care services. 

12 ‘‘(4) Coordination of treatment services with re13 covery and other social support, including edu14 cational, vocational training, assistance with the ju15 venile justice system, child welfare, and mental 

16 health agencies. 

17 ‘‘(5) Aftercare and long-term recovery support, 

18 including peer support services. 

19 ‘‘(e) DURATION OF ASSISTANCE.—Grants, contracts, 

20 and cooperative agreements awarded under subsection (a) 

21 shall be for a period of not to exceed 5 years. 

22 ‘‘(f) ADDITIONAL ACTIVITIES.—The Director shall— 

23 ‘‘(1) collect and evaluate the activities carried 

24 out with amount received under subsection (a); 

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1 ‘‘(2) disseminate widely such significant infor2 mation derived from the evaluation as the Secretary 

3 considers appropriate. 

4 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.— 

5 ‘‘(1) IN GENERAL.—There is authorized to be 

6 appropriated to carry out this section, $25,000,000 

7 for fiscal year 2016, and such sums as may be nec8 essary for each of fiscal years 2016 through 2020. 

9 ‘‘(2) USE OF CERTAIN FUNDS.—Of the funds 

10 appropriated to carry out this section in any fiscal 

11 year, the lesser of 5 percent of such funds or 

12 $1,000,000 shall be available to the Director for 

13 purposes of carrying out subsection (f).’’. 

14 SEC. 5. GRANTS TO ENHANCE AND EXPAND RECOVERY 

15 SUPPORT SERVICES. 

16 Subpart 1 of part B of title V of the Public Health 

17 Service Act (42 U.S.C. 290bb et seq.), as amended by sec18 tion 4, is further amended by adding at the end the fol19 lowing: 

20 ‘‘SEC. 514F. GRANTS TO ENHANCE AND EXPAND RECOVERY 

21 SUPPORT SERVICES. 

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

23 the Administrator of the Substance Abuse and Mental 

24 Health Services Administration, shall award grants to 

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1 tions to develop, expand, and enhance recovery support 

2 services for individuals with substance use disorders. 

3 ‘‘(b) ELIGIBLE ENTITIES.—In the case of an appli4 cant that is not a State substance abuse agency, to be 

5 eligible to receive a grant under this section, the entity 

6 shall— 

7 ‘‘(1) prepare and submit to the Secretary an 

8 application at such time, in such manner, and con9 tain such information as the Secretary may require, 

10 including a plan for the evaluation of any activities 

11 carried out with the funds provided under this sec12 tion; 

13 ‘‘(2) demonstrate the inclusion of individuals in 

14 recovery from a substance use disorder in leadership 

15 levels or governing bodies of the entity; 

16 ‘‘(3) have as a primary mission the provision of 

17 long-term recovery support for substance use dis18 orders; and 

19 ‘‘(4) be accredited by the Council on the Ac20 creditation of Peer Recovery Support Services or 

21 meet any applicable State certification requirements 

22 regarding the provision of the recovery services in23 volved. 

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1 ‘‘(c) USE OF FUNDS.—Amounts awarded under a 

2 grant under this section shall be used to provide for the 

3 following activities: 

4 ‘‘(1) Educating and mentoring that assists indi5 viduals and families with substance use disorders in 

6 navigating systems of care. 

7 ‘‘(2) Peer recovery support services which in8 clude peer coaching and mentoring. 

9 ‘‘(3) Recovery-focused community education 

10 and outreach programs, including training on the 

11 use of all forms of opioid overdose antagonists used 

12 to counter the effects of an overdose. 

13 ‘‘(4) Training, mentoring, and education to de14 velop and enhance peer mentoring and coaching. 

15 ‘‘(5) Programs aimed at identifying and reduc16 ing stigma and discriminatory practices that serve as 

17 barriers to substance use disorder recovery and 

18 treatment of these disorders. 

19 ‘‘(6) Developing partnerships between networks 

20 that support recovery and other community organi21 zations and services, including— 

22 ‘‘(A) public and private substance use dis23 order treatment programs and systems; 

24 ‘‘(B) health care providers; 

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1 ‘‘(C) recovery-focused addiction and recov2 ery professionals; 

3 ‘‘(D) faith-based organizations; 

4 ‘‘(E) organizations focused on criminal jus5 tice reform; 

6 ‘‘(F) schools; and 

7 ‘‘(G) social service agencies in the commu8 nity, including educational, juvenile justice, 

9 child welfare, housing and mental health agen10 cies. 

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

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

13 $7,000,000 for fiscal year 2016, and such sums as may 

14 be necessary for each of fiscal years 2016 through 2020.’’. 

15 SEC. 6. INCREASING THE AUTHORIZATION OF THE SUB16 STANCE ABUSE PREVENTION AND TREAT17 MENT BLOCK GRANT. 

18 Section 1935(a) of the Public Health Service Act (42 

19 U.S.C. 300x–35(a)) is amended by striking 

20 ‘‘$2,000,000,000 for fiscal year 2001, and such sums as 

21 may be necessary for each of the fiscal years 2002 and 

22 2003’’ and inserting ‘‘$2,270,000,000 for fiscal year 

23 2016. For each fiscal year beginning with fiscal year 2017, 

24 there are authorized to be so appropriated, an amount 

25 equal to the amount authorized for the previous fiscal year 

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1 under this subsection increased by the annual percentage 

2 increase in the Consumer Price Index for such year’’. 

3 SEC. 7. STUDY ON TREATMENT INFRASTRUCTURE. 

4 Not later than one year after the date of enactment 

5 of this Act, the Comptroller General of the United States 

6 shall initiate an evaluation, and submit to Congress a re7 port, of the in-patient and outpatient treatment capacity, 

8 availability, and needs of the United States, which shall 

9 include— 

10 (1) the capacity of acute residential or inpatient 

11 detoxification programs; 

12 (2) the capacity of inpatient clinical stabiliza13 tion programs, transitional residential support serv14 ices, and residential rehabilitation programs; 

15 (3) the capacity of demographic specific resi16 dential or inpatient treatment programs, such as 

17 those designed for pregnant women or adolescents; 

18 (4) geographical differences of the availability 

19 of residential and outpatient treatment and recovery 

20 options for substance use disorders across the con21 tinuum of care; 

22 (5) the availability of residential and outpatient 

23 treatment programs that offer treatment options 

24 based on reliable scientific evidence of efficacy for 

25 the treatment of substance use disorders, including 

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1 the use of Food and Drug Administration-approved 

2 medicines and evidence-based nonpharmacological 

3 therapies; 

4 (6) the number of patients in residential and 

5 specialty outpatient treatment services for substance 

6 use disorders; and 

7 (7) an assessment of the need for residential 

8 and outpatient treatment for substance use disorders 

9 across the continuum of care. 

Æ 

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