I 

116TH CONGRESS 

1ST SESSION H. R. 3496 

To authorize the Attorney General to make grants to, and enter into cooperative agreements with, States and units of local government to develop, 

implement, or expand one or more programs to provide medicationassisted treatment to individuals who have opioid use disorder and are 

incarcerated within the jurisdictions of the States or units of local government. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 26, 2019 

Ms. KUSTER of New Hampshire (for herself, Mr. TURNER, Ms. BLUNT ROCHESTER, and Mrs. WALORSKI) introduced the following bill; which was referred to the Committee on the Judiciary 

A BILL 

To authorize the Attorney General to make grants to, and 

enter into cooperative agreements with, States and units 

of local government to develop, implement, or expand 

one or more programs to provide medication-assisted 

treatment to individuals who have opioid use disorder 

and are incarcerated within the jurisdictions of the 

States or units of local government. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Community Re-Entry 

3 through Addiction Treatment to Enhance Opportunities 

4 Act’’ or as the ‘‘CREATE Opportunities Act’’. 

5 SEC. 2. MEDICATION-ASSISTED TREATMENT CORRECTIONS 

6 AND COMMUNITY REENTRY PROGRAM. 

7 (a) DEFINITIONS.—In this section— 

8 (1) the term ‘‘Attorney General’’ means the At9 torney General, acting through the Director of the 

10 National Institute of Corrections; 

11 (2) the term ‘‘certified recovery coach’’ means 

12 an individual— 

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

14 recovery from a substance use disorder; and 

15 (B) who— 

16 (i) has completed training through, 

17 and is determined to be in good standing 

18 by— 

19 (I) a single State agency; or 

20 (II) a recovery community orga21 nization that is capable of conducting 

22 that training and making that deter23 mination; and 

24 (ii) meets the criteria specified by the 

25 Attorney General, in consultation with the 

26 Secretary of Health and Human Services, 


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1 for qualifying as a certified recovery coach 

2 for the purposes of this Act; 

3 (3) the term ‘‘correctional facility’’ has the 

4 meaning given the term in section 901 of title I of 

5 the Omnibus Crime Control and Safe Streets Act of 

6 1968 (34 U.S.C. 10251); 

7 (4) the term ‘‘covered grant or cooperative 

8 agreement’’ means a grant received, or cooperative 

9 agreement entered into, under the Program; 

10 (5) the term ‘‘covered program’’ means a pro11 gram— 

12 (A) to provide medication-assisted treat13 ment to individuals who have opioid use dis14 order and are incarcerated within the jurisdic15 tion of the State or unit of local government 

16 carrying out the program; and 

17 (B) that is developed, implemented, or ex18 panded through a covered grant or cooperative 

19 agreement; 

20 (6) the term ‘‘medication-assisted treatment’’ 

21 means the use of one or more drugs, or one or more 

22 combinations of drugs, that have been approved 

23 under the Federal Food, Drug, and Cosmetic Act 

24 (21 U.S.C. 301 et seq.) or section 351 of the Public 

25 Health Service Act (42 U.S.C. 262) for the treatVerDate Sep 11 2014 03:03 Jul 10, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3496.IH H3496

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1 ment of an opioid use disorder, in combination with 

2 evidence-based counseling and behavioral therapies, 

3 such as psychosocial counseling, overseen by one or 

4 more social work professionals and one or more 

5 qualified clinicians, to provide a comprehensive ap6 proach to the treatment of substance use disorders; 

7 (7) the term ‘‘nonprofit organization’’ means an 

8 organization that is described in section 501(c)(3) of 

9 the Internal Revenue Code of 1986 and is exempt 

10 from taxation under section 501(a) of such Code; 

11 (8) the term ‘‘Panel’’ means the Medication-as12 sisted Treatment Corrections and Community Re13 entry Application Review Panel established under 

14 subsection (e)(2); 

15 (9) the term ‘‘participant’’ means an individual 

16 who participates in a covered program; 

17 (10) the term ‘‘political appointee’’ has the 

18 meaning given the term in section 714(h) of title 38, 

19 United States Code; 

20 (11) the term ‘‘Program’’ means the Medica21 tion-Assisted Treatment Corrections and Community 

22 Reentry Program established under subsection (b); 

23 (12) the term ‘‘psychosocial’’ means the inter24 relation of social factors and individual thought and 

25 behavior; 


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1 (13) the term ‘‘recovery community organiza2 tion’’ has the meaning given the term in section 547 

3 of the Public Health Service Act (42 U.S.C. 290ee– 

4 2); 

5 (14) the term ‘‘single State agency’’ means, 

6 with respect to a State or unit of local government, 

7 the single State agency identified by the State, or 

8 the State in which the unit of local government is 

9 located, in the plan submitted by that State under 

10 section 1932(b)(1)(A)(i) of the Public Health Serv11 ice Act (42 U.S.C. 300x–32(b)(1)(A)(i)); 

12 (15) the term ‘‘State’’ means— 

13 (A) each State of the United States; 

14 (B) the District of Columbia; and 

15 (C) each commonwealth, territory, or pos16 session of the United States; and 

17 (16) the term ‘‘unit of local government’’ has 

18 the meaning given the term in section 901 of title 

19 I of the Omnibus Crime Control and Safe Streets 

20 Act of 1968 (34 U.S.C. 10251), except that such 

21 term also includes a tribal organization, as defined 

22 in section 4 of the Indian Self-Determination and 

23 Education Assistance Act (25 U.S.C. 5304). 

24 (b) AUTHORIZATION.—Not later than 90 days after 

25 the date of enactment of this Act, the Attorney General, 


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1 in consultation with the Secretary of Health and Human 

2 Services, shall establish a program— 

3 (1) that shall be known as the ‘‘Medication-As4 sisted Treatment Corrections and Community Re5 entry Program’’; and 

6 (2) under which the Attorney General— 

7 (A) may make grants to, and enter into co8 operative agreements with, States or units of 

9 local government to develop, implement, or ex10 pand one or more programs to provide medica11 tion-assisted treatment that meets the standard 

12 of care generally accepted for the treatment of 

13 opioid use disorder to individuals who have 

14 opioid use disorder and are incarcerated within 

15 the jurisdictions of the States or units of local 

16 government; and 

17 (B) shall establish a working relationship 

18 with one or more knowledgeable corrections or19 ganizations with expertise in security, medical 

20 health, mental health, and addiction care to 

21 oversee and support implementation of the pro22 gram, including through the use of evidence23 based clinical practices. 

24 (c) PURPOSES.—The purposes of the Program are 

25 to— 


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1 (1) develop medication-assisted treatment pro2 grams in consultation with nonprofit organizations 

3 and community organizations that are qualified to 

4 provide technical support for the programs; 

5 (2) reduce the risk of overdose to participants 

6 after the participants are released from incarcer7 ation; and 

8 (3) reduce the rate of reincarceration. 

9 (d) PROGRAM REQUIREMENTS.—In carrying out a 

10 covered program, a State or unit of local government 

11 shall— 

12 (1) in providing medication-assisted treatment 

13 under the covered program, offer to participants 2 

14 or more drugs that— 

15 (A) have been approved under the Federal 

16 Food, Drug, and Cosmetic Act (21 U.S.C. 301 

17 et seq.) or section 351 of the Public Health 

18 Service Act (42 U.S.C. 262) for the treatment 

19 of an opioid use disorder; and 

20 (B) do not contain the same active moiety; 

21 and 

22 (2) use— 

23 (A) screening tools with psychometric reli24 ability and validity that provide useful clinical 


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1 data to guide the long-term treatment of par2 ticipants who have— 

3 (i) opioid use disorder; or 

4 (ii) co-occurring opioid use disorder 

5 and mental disorders; 

6 (B) at each correctional facility at which 

7 the covered program is carried out, a sufficient 

8 number of personnel, as determined by the At9 torney General in light of the number of indi10 viduals incarcerated at the correctional facility 

11 and the number of those individuals who the 

12 correctional facility has screened and identified 

13 as having opioid use disorder, to— 

14 (i) monitor participants with active 

15 opioid use disorder who begin participation 

16 in the covered program while dem17 onstrating, or develop, signs and symptoms 

18 of opioid withdrawal; 

19 (ii) provide evidence-based medically 

20 managed withdrawal care or assistance to 

21 the participants described in clause (i); 

22 (iii) prescribe or otherwise dispense— 

23 (I) the drugs that are offered 

24 under the covered program, as re25 quired under paragraph (1); and 


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1 (II) naloxone or any other emer2 gency opioid antagonist approved by 

3 the Commissioner of Food and Drugs 

4 to treat opioid overdose; and 

5 (iv) discuss with participants the risks 

6 and benefits of, and differences among, the 

7 opioid antagonist, opioid agonist, and par8 tial agonist drugs used to treat opioid use 

9 disorder; and 

10 (C) a certified recovery coach, social work 

11 professional, or other qualified clinician who, in 

12 order to support the sustained recovery of par13 ticipants, shall work with participants who are 

14 recovering from opioid use disorder. 

15 (e) APPLICATION.— 

16 (1) IN GENERAL.—A State or unit of local gov17 ernment desiring a covered grant or cooperative 

18 agreement shall submit to the Attorney General an 

19 application that— 

20 (A) shall include— 

21 (i) a description of— 

22 (I) the objectives of the medica23 tion-assisted treatment program that 

24 the applicant will develop, implement, 


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1 or expand under the covered grant or 

2 cooperative agreement; 

3 (II) the activities that the appli4 cant will carry out under the covered 

5 program; 

6 (III) how the activities described 

7 under subclause (II) will achieve the 

8 objectives described in subclause (I); 

9 and 

10 (IV) the outreach and education 

11 component of the covered program 

12 that the applicant will carry out in 

13 order to encourage maximum partici14 pation in the covered program; 

15 (ii) if, under the covered program that 

16 the applicant will carry out, the applicant 

17 will not, in providing medication-assisted 

18 treatment, offer to participants not less 

19 than 1 drug that uses an opioid antago20 nist, not less than 1 drug that uses an 

21 opioid agonist, and not less than 1 drug 

22 that uses an opioid partial agonist, an ex23 planation of why the applicant is unable to 

24 or chooses not to offer a drug that uses an 

25 opioid antagonist, a drug that uses an 


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1 opioid agonist, or a drug that uses an 

2 opioid partial agonist, as applicable; 

3 (iii) a plan for— 

4 (I) measuring progress in achiev5 ing the objectives described in clause 

6 (i)(I), including a strategy to collect 

7 data that can be used to measure that 

8 progress; 

9 (II) collaborating with the single 

10 State agency for the applicant or one 

11 or more nonprofit organizations in the 

12 community of the applicant to help 

13 ensure that— 

14 (aa) if participants so desire, 

15 participants have continuity of 

16 care after release from incarcer17 ation with respect to the form of 

18 medication-assisted treatment the 

19 participants received during in20 carceration, including— 

21 (AA) by working with 

22 community service providers 

23 to assist eligible partici24 pants, before release from 

25 incarceration in registering 


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1 for the Medicaid program 

2 under title XIX of the Social 

3 Security Act (42 U.S.C. 

4 1396 et seq.) or other min5 imum essential coverage, as 

6 defined in section 5000A(f) 

7 of the Internal Revenue 

8 Code of 1986; and 

9 (BB) if a participant 

10 cannot afford, or does not 

11 qualify for, health insurance 

12 that provides coverage with 

13 respect to enrollment in a 

14 medication-assisted treat15 ment program, and if the 

16 participant cannot pay the 

17 cost of enrolling in a medi18 cation-assisted treatment 

19 program, by working with 

20 units of local government, 

21 nonprofit organizations, 

22 opioid use disorder treat23 ment providers, and entities 

24 carrying out programs under 

25 substance use disorder 


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1 grants to, before the partici2 pant is released from incar3 ceration, identify a resource, 

4 other than the applicant or 

5 the covered program to be 

6 carried out by the applicant, 

7 that may be used to pay the 

8 cost of enrolling the partici9 pant in a medication-as10 sisted treatment program; 

11 (bb) medications are se12 curely stored; and 

13 (cc) protocols relating to di14 version are maintained; and 

15 (III) with respect to each com16 munity in which a correctional facility 

17 at which a covered program will be 

18 carried out is located, collaborating 

19 with State agencies responsible for 

20 overseeing programs relating to sub21 stance use disorder and local public 

22 health officials and nonprofit organi23 zations in the community to help en24 sure that medication-assisted treat25 ment provided at each correctional faVerDate Sep 11 2014 03:03 Jul 10, 2019 Jkt 089200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H3496.IH H3496

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1 cility at which the covered program 

2 will be carried out is also available at 

3 locations that are not correctional fa4 cilities in those communities, to the 

5 greatest extent practicable; and 

6 (iv) a certification that— 

7 (I) each correctional facility at 

8 which the covered program will be 

9 carried out has access to a sufficient 

10 number of clinicians who are licensed 

11 to prescribe or otherwise dispense to 

12 participants the drugs for the treat13 ment of opioid use disorder required 

14 to be offered under subsection (d)(1), 

15 which may include clinicians who use 

16 telemedicine, in accordance with regu17 lations issued by the Administrator of 

18 the Drug Enforcement Administra19 tion, to provide services under the cov20 ered program; and 

21 (II) the covered program will 

22 provide evidence-based counseling and 

23 behavioral therapies, which may in24 clude counseling and therapy adminis25 tered through the use of telemedicine, 


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1 as appropriate, to participants as part 

2 of the medication-assisted treatment 

3 provided under the covered program; 

4 and 

5 (B) may include a statement indicating the 

6 number of participants that the applicant ex7 pects to serve through the covered program. 

8 (2) MEDICATION-ASSISTED TREATMENT COR9 RECTIONS AND COMMUNITY REENTRY APPLICATION

10 REVIEW PANEL.— 

11 (A) IN GENERAL.—Not later than 60 days 

12 after the date of enactment of this Act, the At13 torney General shall establish a Medication-As14 sisted Treatment Corrections and Community 

15 Reentry Application Review Panel that shall— 

16 (i) be composed of not fewer than 10 

17 individuals and not more than 15 individ18 uals; and 

19 (ii) include— 

20 (I) one or more employees, who 

21 are not political appointees, of— 

22 (aa) the Department of Jus23 tice; 

24 (bb) the Drug Enforcement 

25 Administration; 


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1 (cc) the Substance Abuse 

2 and Mental Health Service Ad3 ministration; 

4 (dd) the National Center for 

5 Injury Prevention and Control at 

6 the Centers for Disease Control 

7 and Prevention; and 

8 (ee) the Office of National 

9 Drug Control Policy; and 

10 (II) other stakeholders who— 

11 (aa) have expert knowledge 

12 relating to the opioid epidemic, 

13 drug treatment, or community 

14 addiction services; and 

15 (bb) represent law enforce16 ment organizations and public 

17 health entities. 

18 (B) DUTIES.— 

19 (i) IN GENERAL.—The Panel shall— 

20 (I) review and evaluate applica21 tions for covered grants and coopera22 tive agreements; and 

23 (II) make recommendations to 

24 the Attorney General relating to the 


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1 awarding of covered grants and coop2 erative agreements. 

3 (ii) RURAL COMMUNITIES.—In review4 ing and evaluating applications under 

5 clause (i), the Panel shall take into consid6 eration the unique circumstances, including 

7 the lack of resources relating to the treat8 ment of opioid use disorder, faced by rural 

9 States and units of local government. 

10 (C) TERMINATION.—The Panel shall ter11 minate on the last day of fiscal year 2023. 

12 (3) PUBLICATION OF CRITERIA IN FEDERAL

13 REGISTER.—Not later than 90 days after the date of 

14 enactment of this Act, the Attorney General, in con15 sultation with the Panel, shall publish in the Federal 

16 Register— 

17 (A) the process through which applications 

18 submitted under paragraph (1) shall be sub19 mitted and evaluated; and 

20 (B) the criteria used in awarding covered 

21 grants and cooperative agreements. 

22 (f) DURATION.—A covered grant or cooperative 

23 agreement shall be for a period of not more than 4 years, 

24 except that the Attorney General may extend the term of 

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1 come data or extenuating circumstances relating to the 

2 covered program carried out under the covered grant or 

3 cooperative agreement. 

4 (g) REPORT.— 

5 (1) IN GENERAL.—Not later than 2 years after 

6 the date on which a State or unit of local govern7 ment is awarded a covered grant or cooperative 

8 agreement, and each year thereafter until the date 

9 that is 1 year after the date on which the period of 

10 the covered grant or cooperative agreement ends, the 

11 State or unit of local government shall submit a re12 port to the Attorney General that includes informa13 tion relating to the covered program carried out by 

14 the State or unit of local government, including in15 formation relating to— 

16 (A) the goals of the covered program; 

17 (B) any evidence-based interventions car18 ried out under the covered program; 

19 (C) outcomes of the covered program, 

20 which shall— 

21 (i) be reported in a manner that dis22 tinguishes the outcomes based on the cat23 egories of, with respect to the participants 

24 in the covered program— 


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1 (I) the race of the participants; 

2 and 

3 (II) the gender of the partici4 pants; and 

5 (ii) include information relating to the 

6 rate of reincarceration among participants 

7 in the covered program; and 

8 (D) expenditures under the covered pro9 gram. 

10 (2) PUBLICATION.— 

11 (A) AWARDEE.—A State or unit of local 

12 government that submits a report under para13 graph (1) shall make the report publicly avail14 able on— 

15 (i) the website of each correctional fa16 cility at which the State or unit of local 

17 government carried out the covered grant 

18 program; and 

19 (ii) if a correctional facility at which 

20 the State or unit of local government car21 ried out the covered grant program does 

22 not operate a website, the website of the 

23 State or unit of local government. 

24 (B) ATTORNEY GENERAL.—The Attorney 

25 General shall make each report received under 


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1 paragraph (1) publicly available on the website 

2 of the National Institute of Corrections. 

3 (3) SUBMISSION TO CONGRESS.—Not later than 

4 2 years after the date on which the Attorney Gen5 eral awards the first covered grant or cooperative 

6 agreement, and each year thereafter, the Attorney 

7 General shall submit to the Committee on the Judi8 ciary of the Senate and the Committee on the Judi9 ciary of the House of Representatives a summary 

10 and compilation of the reports that the Attorney 

11 General has received under paragraph (1) during the 

12 year preceding the date on which the Attorney Gen13 eral submits the summary and compilation. 

14 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated $50,000,000 to carry out 

16 this section for each of fiscal years 2020 through 2023. 

Æ 


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