II 

116TH CONGRESS 

1ST SESSION S. 1365 

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

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

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

systems for the delivery of essential services to individuals with substance 

use disorder and their families. 

IN THE SENATE OF THE UNITED STATES 

MAY 8, 2019 

Ms. WARREN (for herself, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. BOOKER, 

Ms. HARRIS, Mr. MARKEY, Mr. SANDERS, Mr. UDALL, and Mr. VAN

HOLLEN) introduced the following bill; which was read twice and referred 

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

A BILL 

To provide emergency assistance to States, territories, Tribal 

nations, and local areas affected by the opioid epidemic 

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

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

cost efficient systems for the delivery of essential services 

to individuals with substance use disorder and their families. 


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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Comprehensive Addiction Resources Emergency Act of 

6 2019’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Purpose. 

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

‘‘TITLE XXXIV—SUBSTANCE USE AND OPIOID HEALTH 

RESOURCES 

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

Program 

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

‘‘Sec. 3402. Planning council. 

‘‘Sec. 3403. Amount of grant, use of amounts, and funding agreement. 

‘‘Sec. 3404. Application. 

‘‘Sec. 3405. Technical assistance. 

‘‘Sec. 3406. Authorization of appropriations. 

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

Intervention Grant Program 

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

‘‘Sec. 3412. Amount of grant, use of amounts, and funding agreement. 

‘‘Sec. 3413. Application. 

‘‘Sec. 3414. Technical assistance. 

‘‘Sec. 3415. Authorization of appropriations. 

‘‘Subtitle C—Other Grant Program 

‘‘Sec. 3421. Establishment of grant program. 

‘‘Sec. 3422. Use of amounts. 

‘‘Sec. 3423. Technical assistance. 

‘‘Sec. 3424. Planning and development grants. 

‘‘Sec. 3425. Authorization of appropriations. 

‘‘Subtitle D—Innovation, Training, and Health Systems Strengthening 

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

‘‘Sec. 3432. Education and training centers. 

‘‘Sec. 3433. Substance use disorder treatment provider capacity under the 

Medicaid program. 


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‘‘Sec. 3434. Programs to support employees. 

‘‘Sec. 3435. Improving and expanding care. 

‘‘Sec. 3436. Naloxone distribution program. 

‘‘Sec. 3437. Additional funding for the National Institutes of Health. 

‘‘Sec. 3438. Additional funding for the Centers for Disease Control and 

Prevention. 

‘‘Sec. 3439. Definitions. 

Sec. 4. Amendments to the Controlled Substances Act. 

1 SEC. 2. PURPOSE. 

2 It is the purpose of this Act to provide emergency 

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

4 areas that are disproportionately affected by the opioid 

5 epidemic and to make financial assistance available to 

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

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

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

11 including with co-occurring mental health and substance 

12 use disorders, and their families. 

13 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

14 ACT. 

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

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


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1 ‘‘TITLE XXXIV—SUBSTANCE USE 

2 AND OPIOID HEALTH RE3 SOURCES 

4 ‘‘Subtitle A—Local Substance Use 

5 and Opioid Emergency Relief 

6 Grant Program 

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

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

9 grants to eligible localities for the purpose of addressing 

10 substance use within such localities. 

11 ‘‘(b) ELIGIBILITY.— 

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

13 grant under subsection (a) a locality shall— 

14 ‘‘(A) be— 

15 ‘‘(i) a county that can demonstrate 

16 that the rate of drug overdose deaths per 

17 100,000 population in the county during 

18 the most recent 3-year period for which 

19 such data are available was not less than 

20 the rate of such deaths for the county that 

21 ranked at the 67th percentile of all coun22 ties, as determined by the Secretary; 

23 ‘‘(ii) a county that can demonstrate 

24 that the number of drug overdose deaths 

25 during the most recent 3-year period for 


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1 which such data are available was not less 

2 than the number of such deaths for the 

3 county that ranked at the 90th percentile 

4 of all counties, as determined by the Sec5 retary; or 

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

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

8 meets the requirements of paragraph (3); 

9 and 

10 ‘‘(B) submit to the Secretary an applica11 tion in accordance with section 3404. 

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

13 the case of an eligible county that is contiguous to 

14 one or more other eligible counties within the same 

15 State, the group of counties shall— 

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

17 county for purposes of a grant under this sec18 tion; 

19 ‘‘(B) submit a single application under sec20 tion 3404; 

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

22 purposes of section 3402); and 

23 ‘‘(D) establish, through intergovernmental 

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1 locate funds and substance use disorder treat2 ment services under the grant based on— 

3 ‘‘(i) the number and rate of drug 

4 overdose deaths and nonfatal drug 

5 overdoses in each of the counties that com6 pose the eligible county; 

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

8 in each such county; and 

9 ‘‘(iii) the health and support per10 sonnel needs of each such county. 

11 ‘‘(3) CITIES AND COUNTIES WITHIN MULTIPLE

12 CONTIGUOUS COUNTIES.— 

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

14 an eligible county described in paragraph (1), 

15 or a county or group of counties that is within 

16 a group of counties determined to be an eligible 

17 county under paragraph (2), shall be eligible to 

18 receive a grant under section 3401 if such city 

19 or county or group of counties meets the re20 quirements of subparagraph (B). 

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

22 meets the requirements of this subparagraph if 

23 such city or county— 


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1 ‘‘(i) except as provided in subpara2 graph (C), has a population of not less 

3 than 50,000 residents; 

4 ‘‘(ii) meets the requirements of para5 graph (1)(A); 

6 ‘‘(iii) submits an application under 

7 section 3404; 

8 ‘‘(iv) establishes a planning council 

9 (for purposes of section 3402); and 

10 ‘‘(v) establishes an administrative 

11 mechanism to allocate funds and services 

12 under the grant based on— 

13 ‘‘(I) the number and rate of drug 

14 overdose deaths and nonfatal drug 

15 overdoses in the city or county; 

16 ‘‘(II) the severity of need for sub17 stance use disorder treatment services 

18 in the city or county; and 

19 ‘‘(III) the health and support 

20 personnel needs of the city or county. 

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

22 county or group of counties that does not meet 

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

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1 quirement. Such application shall dem2 onstrate— 

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

4 to be served are distinct or that addressing 

5 substance use in the service area would be 

6 best served by the formation of an inde7 pendent council; and 

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

9 of counties has the capacity to administer 

10 the funding received under this subtitle. 

11 ‘‘(D) MINIMUM FUNDING.—A city or coun12 ty that meets the requirement of this paragraph 

13 and receives a grant under section 3401 shall 

14 be entitled to an amount of funding under the 

15 grant in an amount that is not less than the 

16 amount determined under section 3403(a) with 

17 respect to such city or county. 

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

19 that are not located within the territory of a county 

20 shall be treated as eligible counties for purposes of 

21 this subtitle. 

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

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

24 governance, the Secretary shall determine the local 

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1 gible to receive a grant under section 3401 and such 

2 subdivisions shall be treated as eligible counties for 

3 purposes of this subtitle. 

4 ‘‘(6) DETERMINATIONS WHERE THERE IS A

5 LACK OF DATA.—The Secretary shall establish eligi6 bility and allocation criteria related to the prevalence 

7 of drug overdose deaths, the mortality rate from 

8 drug overdoses, and that provides an equivalent 

9 measure of need for funding for cities and counties 

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

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

12 ‘‘(7) DATA FROM TRIBAL AREAS.—The Sec13 retary, acting through the Indian Health Service, 

14 shall consult with Indian tribes to establish eligibility 

15 and allocation criteria that provide an equivalent 

16 measure of need for Tribal areas for which the data 

17 described in paragraph (1)(A) or (2)(D)(i) are not 

18 available or do not apply. 

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

20 date of enactment of this title, the Comptroller Gen21 eral shall conduct a study to determine whether the 

22 data utilized for purposes of paragraph (1)(A) pro23 vide the most precise measure of local area need re24 lated to substance use and addiction prevalence and 

25 whether additional data would provide more precise 


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1 measures of substance use and addiction prevalence 

2 in local areas. Such study shall identify barriers to 

3 collecting or analyzing such data, and make rec4 ommendations for revising the indicators used under 

5 such paragraph to determine eligibility in order to 

6 direct funds to the local areas in most need of fund7 ing to provide assistance related to substance use 

8 and addiction. 

9 ‘‘(9) REFERENCE.—For purposes of this sub10 title, the term ‘eligible local area’ includes— 

11 ‘‘(A) a city or county described in para12 graph (1); 

13 ‘‘(B) multiple contiguous counties de14 scribed in paragraph (2); 

15 ‘‘(C) cities or counties within multiple con16 tiguous counties described in paragraph (3); 

17 ‘‘(D) an independent city described in 

18 paragraph (4); and 

19 ‘‘(E) a political subdivision described in 

20 paragraph (5). 

21 ‘‘(c) ADMINISTRATION.— 

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

23 under a grant awarded under this section shall be 

24 directed to the chief elected official of the eligible 

25 local area who shall administer the grant funds. 


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1 ‘‘(2) MULTIPLE CONTIGUOUS COUNTIES.— 

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

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

4 county described in subsection (b)(2), assist5 ance made available under a grant awarded 

6 under this section shall be directed to the chief 

7 elected official of the particular county des8 ignated in the application submitted for the 

9 grant under section 3404. Such chief elected of10 ficial shall be the administrator of the grant. 

11 ‘‘(B) STATE ADMINISTRATION.—Notwith12 standing subparagraph (A), the eligible county 

13 described in subsection (b)(2) may elect to des14 ignate the chief elected State official of the 

15 State in which the eligible county is located as 

16 the administrator of the grant funds. 

17 ‘‘SEC. 3402. PLANNING COUNCIL. 

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

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

20 eligible local area shall establish or designate a substance 

21 use disorder treatment and services planning council that 

22 shall, to the maximum extent practicable— 

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

24 the population of individuals with substance use dis25 order in the area; 


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1 ‘‘(2) include representatives of— 

2 ‘‘(A) health care providers, including feder3 ally qualified health centers, rural health clinics, 

4 Indian health programs as defined in section 4 

5 of the Indian Health Care Improvement Act, 

6 urban Indian organizations as defined in section 

7 4 of the Indian Health Care Improvement Act, 

8 Native Hawaiian organizations as defined in 

9 section 11 of the Native Hawaiian Health Care 

10 Act of 1988, and facilities operated by the De11 partment of Veterans Affairs; 

12 ‘‘(B) community-based health, harm reduc13 tion, or addiction service organizations, includ14 ing, where applicable, representatives of Drug 

15 Free Communities Coalition grantees; 

16 ‘‘(C) social service providers, including pro17 viders of housing and homelessness services and 

18 recovery residence providers; 

19 ‘‘(D) mental health care providers; 

20 ‘‘(E) local public health agencies; 

21 ‘‘(F) law enforcement officials, including 

22 officials from the High Intensity Drug Traf23 ficking Area program, where applicable; 

24 ‘‘(G) individuals with substance use dis25 order; 


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1 ‘‘(H) individuals in recovery from sub2 stance use disorders; 

3 ‘‘(I) State governments, including the 

4 State Medicaid agency and the Single State 

5 Agency for Substance Abuse Services; 

6 ‘‘(J) local governments; 

7 ‘‘(K) non-elected community leaders; 

8 ‘‘(L) substance use disorder treatment pro9 viders; 

10 ‘‘(M) Indian tribes and tribal organizations 

11 as defined in section 4 of the Indian Self-Deter12 mination and Education Assistance Act; 

13 ‘‘(N) Urban Indians as defined in section 

14 4 of the Indian Health Care Improvement Act; 

15 ‘‘(O) historically underserved groups and 

16 subpopulations; 

17 ‘‘(P) individuals who were formerly incar18 cerated; 

19 ‘‘(Q) organizations serving individuals who 

20 are currently incarcerated or in pre-trial deten21 tion or were formerly incarcerated; 

22 ‘‘(R) Federal agencies; 

23 ‘‘(S) organizations that provide drug pre24 vention programs and services to youth at risk 

25 of substance use; 


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1 ‘‘(T) medical examiners or coroners; 

2 ‘‘(U) labor unions and the workplace com3 munity; 

4 ‘‘(V) local fire departments and emergency 

5 medical services; 

6 ‘‘(W) the lesbian, gay, bisexual, 

7 transgender, queer or questioning (LGBTQ) 

8 community; and 

9 ‘‘(X) certified or accredited addiction re10 covery community organizations. 

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

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

13 for purposes of subsection (a), the chief elected offi14 cial of the eligible local area may establish the coun15 cil directly or designate an existing entity to serve as 

16 the council, subject to paragraph (2). 

17 ‘‘(2) CONSIDERATION REGARDING DESIGNATION

18 OF COUNCIL.—In making a determination of wheth19 er to establish or designate a council under para20 graph (1), the chief elected official shall give priority 

21 to the designation of an existing entity that has 

22 demonstrated experience in the provision of health 

23 and support services to individuals with substance 

24 use disorder within the eligible local area, that has 

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1 sibility when spending Federal health care dollars, 

2 and that has demonstrated a commitment to re3 specting the obligation of government agencies using 

4 Federal dollars to consult with Indian tribes and 

5 confer with Urban Indian health programs. 

6 ‘‘(3) DESIGNATION OF EXISTING ENTITY.—If 

7 an existing entity is designated to serve as the coun8 cil under this section, the membership of the entity 

9 shall comply with the requirements of subsection 

10 (a)(1) before it performs any of the duties set forth 

11 in subsection (e). 

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

14 is not contiguous with any other eligible local area 

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

17 located in geographical proximity to each other, as 

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

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

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

23 if such areas are located in geographical proximity 

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1 tablish intergovernmental agreements to allow the 

2 administration of the grant across State lines. 

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

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

6 open process; 

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

8 and vice chair; 

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

10 Indian tribes located within any eligible local area 

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

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

14 the planning council. 

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

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

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

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

20 designated under subsection (a) shall— 

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

22 grant funds within the eligible local area that em23 phasize reducing drug use rates, overdose, and sub24 stance use disorder through evidence-based intervenVerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365

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1 tions in both community and criminal justice set2 tings and that are based on— 

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

4 use disorder prevention, intervention, treat5 ment, and recovery strategies that comply with 

6 best practices identified by the Secretary; 

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

9 prevention, intervention, treatment, and recov10 ery services; 

11 ‘‘(C) the health priorities of the commu12 nities within the eligible local area that are af13 fected by substance use; 

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

15 with substance use disorder; and 

16 ‘‘(E) the availability of other governmental 

17 and non-governmental services; 

18 ‘‘(2) ensure the use of grant funds will advance 

19 any existing State or local plan regarding the provi20 sion of substance use disorder treatment services to 

21 individuals with substance use disorder; 

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

23 work with local public health agencies to develop a 

24 comprehensive plan for the organization and delivery 


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1 of substance use disorder prevention and treatment 

2 services; 

3 ‘‘(4) regularly assess the efficiency of the ad4 ministrative mechanism in rapidly allocating funds 

5 to support evidence-based substance use disorder 

6 prevention and treatment services in the areas of 

7 greatest need within the eligible local area; 

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

9 determine the size and demographics of the popu10 lation of individuals with substance use disorders 

11 and the types of substance use that are most preva12 lent in the eligible local area; 

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

14 determine the needs of such population, including 

15 the need for substance use disorder prevention, 

16 intervention, treatment, and recovery services; 

17 ‘‘(7) work with local public agencies to deter18 mine the disparities in access to services among af19 fected subpopulations and historically underserved 

20 communities, including infrastructure and capacity 

21 shortcomings of providers that contribute to these 

22 disparities; 

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

24 methods for obtaining input on community needs 

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1 zations that serve targeted communities experiencing 

2 high opioid and other addictive substance-related 

3 health disparities to gather data using culturally-at4 tuned data collection methodologies; 

5 ‘‘(9) coordinate with Federal grantees that pro6 vide substance use disorder prevention and treat7 ment services within the eligible local area; and 

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

9 substance use disorder prevention and treatment 

10 services being supported by the grant received by the 

11 eligible local area, including, to the extent possible— 

12 ‘‘(A) reductions in the rates of substance 

13 use, overdose, and death from substance use; 

14 ‘‘(B) rates of discontinuation from sub15 stance use disorder treatment services and rates 

16 of sustained recovery; 

17 ‘‘(C) long-term outcomes among individ18 uals receiving treatment for substance use dis19 orders; and 

20 ‘‘(D) the availability and use of substance 

21 use disorder treatment services needed by indi22 viduals with substance use disorders over their 

23 lifetimes. 

24 ‘‘(f) CONFLICTS OF INTEREST.— 


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

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

3 administration of a grant under section 3401. 

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

5 may serve on the planning council under subsection 

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

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

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

9 individual is a member of a public or private organi10 zation, and such entity or organization is seeking 

11 amounts from a grant under section 3401, the indi12 vidual will not, with respect to the purpose for which 

13 the entity seeks such amounts, participate (directly 

14 or in an advisory capacity) in the process of select15 ing entities to receive such amounts for such pur16 pose. 

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

18 under subsection (a) shall develop procedures for address19 ing grievances with respect to funding under this subtitle, 

20 including procedures for submitting grievances that can21 not be resolved to binding arbitration. Such procedures 

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

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

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

25 criteria established by the Secretary, the following applies: 


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

2 to the public and shall be held only after adequate 

3 notice to the public. 

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

5 agenda, or other documents which were made avail6 able to or prepared for or by the council shall be 

7 available for public inspection and copying at a sin8 gle location. 

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

10 council shall be kept. The accuracy of all minutes 

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

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

13 disclosure of information of a personal nature that 

14 would constitute a clearly unwarranted invasion of 

15 personal privacy, including any disclosure of medical 

16 information or personnel matters. 

17 ‘‘SEC. 3403. AMOUNT OF GRANT, USE OF AMOUNTS, AND 

18 FUNDING AGREEMENT. 

19 ‘‘(a) AMOUNT OF GRANT.— 

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

21 AREA.— 

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

23 subtitle, the Secretary shall make a grant for 

24 each eligible local area for which an application 

25 under section 3404 has been approved. Each 


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1 such grant shall be made in an amount deter2 mined in accordance with paragraph (3). 

3 ‘‘(B) EXPEDITED DISTRIBUTION.—Not 

4 later than 90 days after an appropriation be5 comes available to carry out this subtitle for a 

6 fiscal year, the Secretary shall disburse 53 per7 cent of the amount made available under sec8 tion 3406 for carrying out this subtitle for such 

9 fiscal year through grants to eligible local areas 

10 under section 3401, in accordance with sub11 paragraphs (C) and (D). 

12 ‘‘(C) AMOUNT.— 

13 ‘‘(i) IN GENERAL.—Subject to the ex14 tent of amounts made available in appro15 priations Acts, a grant made for purposes 

16 of this subparagraph to an eligible local 

17 area shall be made in an amount equal to 

18 the product of— 

19 ‘‘(I) an amount equal to the 

20 amount available for distribution 

21 under subparagraph (B) for the fiscal 

22 year involved; and 

23 ‘‘(II) the percentage constituted 

24 by the ratio of the distribution factor 

25 for the eligible local area to the sum 


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1 of the respective distribution factors 

2 for all eligible local areas; 

3 which product shall then, as applicable, be 

4 increased under subparagraph (D). 

5 ‘‘(ii) DISTRIBUTION FACTOR.—For 

6 purposes of clause (i)(II), the term ‘dis7 tribution factor’ means— 

8 ‘‘(I) an amount equal to— 

9 ‘‘(aa) the estimated number 

10 of drug overdose deaths in the el11 igible local area, as determined 

12 under clause (iii); or 

13 ‘‘(bb) the estimated number 

14 of non-fatal drug overdoses in the 

15 eligible local area, as determined 

16 under clause (iv); 

17 as determined by the Secretary based 

18 on which distribution factor (item (aa) 

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

20 area receiving the greatest amount of 

21 funds; or 

22 ‘‘(II) in the case of an eligible 

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1 able, an amount determined by the 

2 Secretary— 

3 ‘‘(aa) based on other data 

4 the Secretary determines appro5 priate; and 

6 ‘‘(bb) that is related to the 

7 prevalence of non-fatal drug 

8 overdoses, drug overdose deaths, 

9 and the mortality rate from drug 

10 overdoses and provides an equiv11 alent measure of need for fund12 ing. 

13 ‘‘(iii) NUMBER OF DRUG OVERDOSE

14 DEATHS.—The number of drug overdose 

15 deaths determined under this clause for an 

16 eligible county for a fiscal year for pur17 poses of clause (ii) is the number of drug 

18 overdose deaths during the most recent 3- 

19 year period for which such data are avail20 able. 

21 ‘‘(iv) NUMBER OF NON-FATAL DRUG

22 OVERDOSES.—The number of non-fatal 

23 drug overdose deaths determined under 

24 this clause for an eligible county for a fis25 cal year for purposes of clause (ii) may be 


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1 determined by using data including emer2 gency department syndromic data, visits, 

3 other emergency medical services for drug4 related causes, or Overdose Detection Map5 ping Application Program (ODMAP) data 

6 during the most recent 3-year period for 

7 which such data are available. 

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

9 after the date of enactment of this title, 

10 the Comptroller General shall conduct a 

11 study to determine whether the data uti12 lized for purposes of clause (ii) provide the 

13 most precise measure of local area need re14 lated to substance use and addiction preva15 lence in local areas and whether additional 

16 data would provide more precise measures 

17 of substance use and addiction prevalence 

18 in local areas. Such study shall identify 

19 barriers to collecting or analyzing such 

20 data, and make recommendations for revis21 ing the distribution factors used under 

22 such clause to determine funding levels in 

23 order to direct funds to the local areas in 

24 most need of funding to provide substance 

25 use disorder treatment services. 


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1 ‘‘(vi) REDUCTIONS IN AMOUNTS.—If a 

2 local area that is an eligible local area for 

3 a year loses such eligibility in a subsequent 

4 year based on the failure to meet the re5 quirements of paragraph (1)(A) or (6) of 

6 section 3401(b), such area will remain eli7 gible to receive— 

8 ‘‘(I) for such subsequent year, an 

9 amount equal to 80 percent of the 

10 amount received under the grant in 

11 the previous year; and 

12 ‘‘(II) for the second such subse13 quent year, an amount equal to 50 

14 percent of the amount received in the 

15 previous year. 

16 ‘‘(2) SUPPLEMENTAL GRANTS.— 

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

18 disburse the remainder of amounts not dis19 bursed under paragraph (1) for such fiscal year 

20 for the purpose of making grants to cities and 

21 counties whose application under section 

22 3404— 

23 ‘‘(i) contains a report concerning the 

24 dissemination of emergency relief funds 


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

3 ‘‘(ii) demonstrates the need in such 

4 local area, on an objective and quantified 

5 basis, for supplemental financial assistance 

6 to combat substance use disorder; 

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

9 both financial and in-kind, to preventing, 

10 treating, and managing substance use dis11 order and supporting sustained recovery; 

12 ‘‘(iv) demonstrates the ability of the 

13 area to utilize such supplemental financial 

14 resources in a manner that is immediately 

15 responsive and cost effective; 

16 ‘‘(v) demonstrates that resources will 

17 be allocated in accordance with the local 

18 demographic incidence of substance use 

19 disorders and drug overdose mortality; 

20 ‘‘(vi) demonstrates the inclusiveness of 

21 affected communities and individuals with 

22 substance use disorders, including those 

23 communities and individuals that are dis24 proportionately affected or historically un25 derserved; 


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1 ‘‘(vii) demonstrates the manner in 

2 which the proposed services are consistent 

3 with the local needs assessment and the 

4 State plan approved by the Secretary pur5 suant to section 1932(b); 

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

9 ‘‘(ix) demonstrates that support for 

10 substance use disorder prevention and 

11 treatment services is organized to maxi12 mize the value to the population to be 

13 served with an appropriate mix of sub14 stance use disorder prevention and treat15 ment services and attention to transition in 

16 care. 

17 ‘‘(B) AMOUNT.— 

18 ‘‘(i) IN GENERAL.—The amount of 

19 each grant made for purposes of this para20 graph shall be determined by the Sec21 retary. In making such determination, the 

22 Secretary shall consider— 

23 ‘‘(I) the rate of drug overdose 

24 deaths per 100,000 population in the 

25 eligible local area; and 


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

5 overdoses or drug overdose deaths, or 

6 recent increases in drug overdoses or 

7 drug overdose deaths since data were 

8 provided under section 3401(b), if ap9 plicable. 

10 ‘‘(ii) DEMONSTRATED NEED.—The 

11 factors considered by the Secretary in de12 termining whether a local area has a dem13 onstrated need for purposes of clause 

14 (i)(II) may include any or all of the fol15 lowing: 

16 ‘‘(I) The unmet need for sub17 stance use disorder treatment serv18 ices, including factors identified in 

19 subparagraph (B)(i)(II). 

20 ‘‘(II) Relative rates of increase in 

21 the number of drug overdoses or drug 

22 overdose deaths. 

23 ‘‘(III) The relative rates of in24 crease in the number of drug 

25 overdoses or drug overdose deaths 


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1 within new or emerging subpopula2 tions. 

3 ‘‘(IV) The current prevalence of 

4 substance use disorders. 

5 ‘‘(V) Relevant factors related to 

6 the cost and complexity of delivering 

7 substance use disorder treatment serv8 ices to individuals in the eligible local 

9 area. 

10 ‘‘(VI) The impact of co-morbid 

11 factors, including co-occurring condi12 tions, determined relevant by the Sec13 retary. 

14 ‘‘(VII) The prevalence of home15 lessness among individuals with sub16 stance use disorders. 

17 ‘‘(VIII) The relevant factors that 

18 limit access to health care, including 

19 geographic variation, adequacy of 

20 health insurance coverage, and lan21 guage barriers. 

22 ‘‘(IX) The impact of a decline in 

23 the amount received pursuant to para24 graph (1) on substance use disorder 

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1 dividuals with substance use disorders 

2 identified and eligible under this sub3 title. 

4 ‘‘(X) The increasing incidence in 

5 conditions related to substance use, 

6 including hepatitis C, human immuno7 deficiency virus, hepatitis B and other 

8 infections associated with injection 

9 drug use. 

10 ‘‘(C) APPLICATION OF PROVISIONS.—A 

11 local area that receives a grant under this para12 graph— 

13 ‘‘(i) shall use amounts received in ac14 cordance with subsection (b); 

15 ‘‘(ii) shall not have to meet the eligi16 ble criteria in section 3401(b); and 

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

18 planning council under section 3402. 

19 ‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN20 MENTS.— 

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

22 term ‘Indian tribe’ has the meaning given such 

23 term in section 4 of the Indian Self-Determina24 tion and Education Assistance Act. 


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

2 acting through the Indian Health Service, shall 

3 use 10 percent of the amount available under 

4 section 3406 for each fiscal year to provide for5 mula grants to Indian tribes disproportionately 

6 affected by substance use, in an amount deter7 mined pursuant to a formula and eligibility cri8 teria developed by the Secretary in consultation 

9 with Indian tribes, for the purposes of address10 ing substance use. 

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

12 any requirements in this section, an Indian 

13 tribe may use amounts provided under grants 

14 awarded under this paragraph for the uses 

15 identified in subsection (b) and any other activi16 ties determined appropriate by the Secretary, in 

17 consultation with Indian tribes. An Indian tribe 

18 shall not be required to allocate funds and serv19 ices in accordance with the goals, priorities, or 

20 objectives established by a planning council 

21 under section 3402. 

22 ‘‘(b) USE OF AMOUNTS.— 

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

24 make a grant under section 3401 to an eligible local 


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1 area unless the chief elected official of the area 

2 agrees that— 

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

4 within the area under the grant will be made in 

5 accordance with the priorities established by the 

6 planning council; and 

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

8 be expended for— 

9 ‘‘(i) prevention services described in 

10 paragraph (3); 

11 ‘‘(ii) core medical services described in 

12 paragraph (4); 

13 ‘‘(iii) recovery and support services 

14 described in paragraph (5); 

15 ‘‘(iv) early intervention services de16 scribed in paragraph (6); 

17 ‘‘(v) harm reduction services described 

18 in paragraph (7); 

19 ‘‘(vi) financial assistance with health 

20 insurance described in paragraph (8); and 

21 ‘‘(vii) administrative expenses de22 scribed in paragraph (9). 

23 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 

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

25 shall use amounts received under a grant under 


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1 section 3401 to provide direct financial assist2 ance to eligible entities for the purpose of pro3 viding prevention services, core medical services, 

4 recovery and support services, early intervention 

5 services, and harm reduction services. 

6 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi7 nancial assistance may be provided under sub8 paragraph (A) to public or nonprofit private en9 tities, or private for-profit entities if such enti10 ties are the only available provider of quality 

11 substance use disorder treatment services in the 

12 area. 

13 ‘‘(C) LIMITATION.—An eligible local area 

14 (not including tribal areas) may not provide di15 rect financial assistance to any entity that pro16 vides medication-assisted treatment if that enti17 ty does not also offer mental health services or 

18 psychotherapy by licensed clinicians through a 

19 referral or onsite. 

20 ‘‘(3) PREVENTION SERVICES.— 

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

22 section, the term ‘prevention services’ means 

23 evidence-based services, programs, or multi-sec24 tor strategies to prevent substance use disorder 

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1 based prevention programs, risk identification 

2 programs, opioid diversion, collection and dis3 posal of unused opioids, services to at-risk pop4 ulations, and trauma support services). 

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

6 use not to exceed 20 percent of the amount of 

7 the grant under section 3401 for prevention 

8 services. An eligible local area may apply to the 

9 Secretary for a waiver of this subparagraph. 

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

11 of this section, the term ‘core medical services’ 

12 means the following evidence-based services provided 

13 to individuals with substance use disorder or at risk 

14 for developing substance use disorder, including 

15 through the use of telemedicine or a hub and spoke 

16 model: 

17 ‘‘(A) Substance use disorder treatments, as 

18 more fully described in section 3439, including 

19 assessment of disease presence, severity, and 

20 co-occurring conditions, treatment planning, 

21 clinical stabilization services, withdrawal man22 agement and detoxification, intensive inpatient 

23 treatment, intensive outpatient treatment, out24 patient treatment, residential inpatient services, 

25 treatment for co-occurring mental health and 


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1 substance use disorders, and all drugs approved 

2 by the Food and Drug Administration for the 

3 treatment of substance use disorder. 

4 ‘‘(B) Outpatient and ambulatory health 

5 services, including those administered by feder6 ally qualified health centers, rural health clinics, 

7 tribal clinics and hospitals, urban Indian health 

8 facilities, certified community behavioral health 

9 clinics (as described in section 223 of the Pro10 tecting Access to Medicare Act), and com11 prehensive opioid recovery centers (as described 

12 in section 552 of this Act). 

13 ‘‘(C) Hospice services. 

14 ‘‘(D) Mental health services. 

15 ‘‘(E) Opioid overdose reversal drug prod16 ucts procurement, distribution, and training. 

17 ‘‘(F) Pharmaceutical assistance and diag18 nostic testing related to the management of 

19 substance use disorders and co-morbid condi20 tions. 

21 ‘‘(G) Home and community based health 

22 services. 

23 ‘‘(H) Comprehensive Case Management 

24 and care coordination, including substance use 

25 disorder treatment adherence services. 


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1 ‘‘(I) Health insurance enrollment and cost2 sharing assistance in accordance with para3 graph (8). 

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

5 purposes of this section, the term ‘recovery and sup6 port services’ means services that are provided to in7 dividuals with substance use disorder, including resi8 dential recovery housing, mental health services, 

9 long term recovery services, 24/7 hotline crisis center 

10 support, medical transportation services, respite care 

11 for persons caring for individuals with substance use 

12 disorder, child care and family services while an in13 dividual is receiving inpatient treatment services or 

14 at the time of outpatient services, outreach services, 

15 peer recovery services, nutrition services, and refer16 rals for job training and career services, housing, 

17 legal services, and child care and family services. 

18 The entities through which such services may be 

19 provided include local and tribal authorities that 

20 provide child care, housing, community development, 

21 and other recovery and support services, so long as 

22 they do not exclude individuals on the basis that 

23 such individuals receive medication-assisted treat24 ment. 


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1 ‘‘(6) EARLY INTERVENTION SERVICES.—For 

2 purposes of this section, the term ‘early intervention 

3 services’ means services to provide screening and 

4 connection to the appropriate level of substance use 

5 disorder and mental health treatment (including 

6 same-day connection), counseling provided to indi7 viduals who have misused substances, who have ex8 perienced an overdose, or are at risk of developing 

9 substance use disorder, the provision of referrals to 

10 facilitate the access of such individuals to core med11 ical services or recovery and support services for 

12 substance use disorder, and rapid access to medica13 tion-assisted treatment in the setting of recent over14 dose. The entities through which such services may 

15 be provided include emergency rooms, fire depart16 ments and emergency medical services, detention fa17 cilities, prisons and jails, homeless shelters, law en18 forcement agencies, health care points of entry speci19 fied by eligible local areas, federally qualified health 

20 centers, tribal clinics and hospitals, urban Indian 

21 health facilities, and rural health clinics. 

22 ‘‘(7) HARM REDUCTION SERVICES.—For pur23 poses of this section, the term ‘harm reduction serv24 ices’ means evidence-based services provided to indi25 viduals engaging in substance use that reduce the 


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1 risk of infectious disease transmission, overdose, or 

2 death, including by increasing access to health care, 

3 housing, and recovery and support services. 

4 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV5 ERAGE.—An eligible local area may use amounts 

6 provided under a grant awarded under section 3401 

7 to establish a program of financial assistance to as8 sist eligible individuals with substance use disorder 

9 in— 

10 ‘‘(A) enrolling in health insurance cov11 erage; or 

12 ‘‘(B) affording health care services, includ13 ing assistance paying cost-sharing amounts, in14 cluding premiums. 

15 ‘‘(9) ADMINISTRATION AND PLANNING.—An eli16 gible local area (not including tribal areas) shall not 

17 use in excess of 15 percent of amounts received 

18 under a grant under section 3401 for administra19 tion, accounting, reporting, and program oversight 

20 functions, including the development of systems to 

21 improve data collection and data sharing, in the first 

22 year of receiving the grant, and shall not use in ex23 cess of 10 percent of amounts received under a 

24 grant under section 3401 for such activities in sub25 sequent years. 


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1 ‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 

2 received under a grant under section 3401 may be 

3 used to provide substance use disorder treatment 

4 services, including medication-assisted treatment, to 

5 individuals who are currently incarcerated or in pre6 trial detention. 

7 ‘‘(c) REQUIRED TERMS.— 

8 ‘‘(1) REQUIREMENT OF STATUS AS MEDICAID

9 PROVIDER.— 

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

11 subparagraph (B), the Secretary may not make 

12 a grant under section 3401 for the provision of 

13 substance use disorder treatment services under 

14 this section in an eligible local area unless, in 

15 the case of any such service that is available 

16 pursuant to the State plan approved under title 

17 XIX of the Social Security Act for the State— 

18 ‘‘(i) the political subdivision involved 

19 will provide the service directly, and the 

20 political subdivision has entered into a par21 ticipation agreement under the State plan 

22 and is qualified to receive payments under 

23 such plan; or 

24 ‘‘(ii) the eligible local area involved— 


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1 ‘‘(I) will enter into agreements 

2 with public or nonprofit private enti3 ties under which the entities will pro4 vide the service, and the entities have 

5 entered into such a participation 

6 agreement and are qualified to receive 

7 such payments; and 

8 ‘‘(II) demonstrates that it will 

9 ensure that the entities providing the 

10 service will seek payment for each 

11 such service rendered in accordance 

12 with the usual payment schedule 

13 under the State plan. 

14 ‘‘(B) WAIVER.— 

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

16 entity making an agreement pursuant to 

17 subparagraph (A)(ii) regarding the provi18 sion of substance use disorder treatment 

19 services, the requirement established in 

20 such subparagraph shall be waived by the 

21 substance use planning council for the area 

22 involved if the entity does not, in providing 

23 health care services, impose a charge or ac24 cept reimbursement available from any 

25 third-party payor, including reimbursement 


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1 under any insurance policy or under any 

2 Federal or State health benefits program. 

3 A waiver under this subparagraph shall 

4 not be longer than 2 years in duration and 

5 shall not be renewed. 

6 ‘‘(ii) DETERMINATION.—A determina7 tion by the substance use planning council 

8 of whether an entity referred to in clause 

9 (i) meets the criteria for a waiver under 

10 such clause shall be made without regard 

11 to whether the entity accepts voluntary do12 nations for the purpose of providing serv13 ices to the public. 

14 ‘‘(2) REQUIRED TERMS FOR EXPANDING AND

15 IMPROVING CARE.—A funding agreement for a grant 

16 under this section shall— 

17 ‘‘(A) ensure that funds received under the 

18 grant will not be utilized to make payments for 

19 any item or service to the extent that payment 

20 has been made, or can reasonably be expected 

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

22 under a State compensation program, under an 

23 insurance policy, or under any Federal or State 

24 health benefits program (except for a program 


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1 administered by, or providing the services of, 

2 the Indian Health Service); and 

3 ‘‘(B) ensure that all entities providing sub4 stance use disorder treatment services with as5 sistance made available under the grant offer 

6 all drugs approved by the Food and Drug Ad7 ministration for the treatment of substance use 

8 disorder for which the applicant offers treat9 ment, in accordance with section 3435. 

10 ‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund11 ing agreement for a grant under this section is 

12 that— 

13 ‘‘(A) funds received under the grant will be 

14 utilized to supplement not supplant other Fed15 eral, State, or local funds made available in the 

16 year for which the grant is awarded to provide 

17 substance use disorder treatment services to in18 dividuals with substance use disorder, including 

19 funds for each of prevention services, core med20 ical services, recovery and support services, 

21 early intervention services, harm reduction serv22 ices, mental health services, and administrative 

23 expenses; 

24 ‘‘(B) political subdivisions within the eligi25 ble local area will maintain the level of expendiVerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365

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1 tures by such political subdivisions for sub2 stance use disorder treatment services at a level 

3 that is at least equal to the level of such ex4 penditures by such political subdivisions for the 

5 preceding fiscal year, including expenditures for 

6 each of prevention services, core medical serv7 ices, recovery and support services, early inter8 vention services, harm reduction services, men9 tal health services, and administrative expenses; 

10 ‘‘(C) political subdivisions within the eligi11 ble local area will not use funds received under 

12 a grant awarded under section 3401 in main13 taining the level of substance use disorder treat14 ment services as required in subparagraph (B); 

15 ‘‘(D) substance use disorder treatment 

16 services provided with assistance made available 

17 under the grant will be provided without re18 gard— 

19 ‘‘(i) to the ability of the individual to 

20 pay for such services; and 

21 ‘‘(ii) to the current or past health con22 dition of the individual to be served; 

23 ‘‘(E) substance use disorder treatment 

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1 stance use disorders and to individuals with 

2 substance use disorders residing in rural areas; 

3 ‘‘(F) a program of outreach will be pro4 vided to low-income individuals with substance 

5 use disorders to inform such individuals of sub6 stance use disorder treatment services and to 

7 individuals with substance use disorders resid8 ing in rural areas; 

9 ‘‘(G) Indian tribes are included in planning 

10 for the use of grant funds and the Federal trust 

11 responsibility is upheld at all levels of program 

12 administration; and 

13 ‘‘(H) the confidentiality of individuals re14 ceiving substance use disorder treatment serv15 ices will be maintained in a manner not incon16 sistent with applicable law. 

17 ‘‘SEC. 3404. APPLICATION. 

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

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

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

21 containing such information, as the Secretary shall re22 quire, including— 

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

24 of any prior grants received under this subtitle by 

25 the applicant and the results achieved by these exVerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365

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1 penditures and a demonstration that funds received 

2 from a grant under this subtitle in the prior year 

3 were expended in accordance with local priorities de4 veloped by the local planning council established 

5 under section 3402, except that the planning council 

6 requirement shall not apply with respect to areas re7 ceiving supplemental grant funds under section 

8 3403(a)(2); 

9 ‘‘(2) establishment of goals and objectives to be 

10 achieved with grant funds provided under this sub11 title, including targets and milestones that are in12 tended to be met, the activities that will be under13 taken to achieve those targets, the number of indi14 viduals likely to be served by the funds sought, in15 cluding demographic data on the populations to be 

16 served, and an explanation of how these goals and 

17 objectives advance the State plan approved by the 

18 Secretary pursuant to section 1932(b); 

19 ‘‘(3) a demonstration that the local area will 

20 use funds in a manner that provides substance use 

21 disorder treatment services in compliance with the 

22 evidence-based standards developed in accordance 

23 with section 3435, including providing all drugs ap24 proved by the Food and Drug Administration for the 

25 treatment of substance use disorder; 


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1 ‘‘(4) a demonstration that resources provided 

2 under the grant will be allocated in accordance with 

3 the local demographic incidence of substance use, in4 cluding allocations for services for children, youths, 

5 and women; 

6 ‘‘(5) an explanation of how income, asset, and 

7 medical expense criteria will be established and ap8 plied to those who qualify for assistance under the 

9 program; and 

10 ‘‘(6) for any prior funding received under this 

11 section, data provided in such form as the Secretary 

12 shall require detailing, at a minimum, the extent to 

13 which the activities supported by the funding met 

14 the goals and objectives specified in the application 

15 for the funding, the number of individuals who 

16 accessed medication-assisted treatment by age, gen17 der, race, and other demographic criteria relevant to 

18 the program, and the effect of the program on over19 dose rates and rates of death due to overdose in the 

20 local area served by the program. 

21 ‘‘(b) REQUIREMENTS REGARDING IMPOSITION OF

22 CHARGES FOR SERVICES.— 

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

24 make a grant under section 3401 to an eligible local 

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1 ances that in the provision of substance use disorder 

2 treatment services with assistance provided under 

3 the grant— 

4 ‘‘(A) in the case of individuals with an in5 come less than or equal to 138 percent of the 

6 official poverty level, the provider will not im7 pose charges on any such individual for the 

8 services provided under the grant; 

9 ‘‘(B) in the case of individuals with an in10 come greater than 138 percent of the official 

11 poverty level, the provider will impose a charge 

12 on each such individual according to a schedule 

13 of charges made available to the public; 

14 ‘‘(C) in the case of individuals with an in15 come greater than 138 percent of the official 

16 poverty level but not exceeding 200 percent of 

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

18 calendar year, impose charges in an amount ex19 ceeding 5 percent of the annual gross income of 

20 the individual; 

21 ‘‘(D) in the case of individuals with an in22 come greater than 200 percent of the official 

23 poverty level but not exceeding 300 percent of 

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

25 calendar year, impose charges in an amount exVerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365

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1 ceeding 7 percent of the annual gross income of 

2 the individual involved; 

3 ‘‘(E) in the case of individuals with an in4 come greater than 300 percent of the official 

5 poverty level, the provider will not, for any cal6 endar year, impose charges in an amount ex7 ceeding 15 percent of the annual gross income 

8 of the individual involved; and 

9 ‘‘(F) in the case of eligible American In10 dian and Alaska Native individuals as defined 

11 by section 447.50 of title 42, Code of Federal 

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

13 provider will not impose any charges for sub14 stance use disorder treatment services, includ15 ing any charges or cost-sharing prohibited by 

16 section 1402(d) of the Patient Protection and 

17 Affordable Care Act. 

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

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

20 eligible local area may, in the case of individuals 

21 subject to a charge— 

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

23 the discretion of the area, including imposing 

24 only a nominal charge for the provision of sub25 stance use disorder treatment services, subject 


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1 to the provisions of the paragraph regarding 

2 public schedules and regarding limitations on 

3 the maximum amount of charges; and 

4 ‘‘(B) take into consideration the total med5 ical expenses of individuals in assessing the 

6 amount of the charge, subject to such provi7 sions. 

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

9 may not make a grant under section 3401 to an eli10 gible local area unless the area agrees that the limi11 tations on charges for substance use disorder treat12 ment services under this subsection applies to the 

13 annual aggregate of charges imposed for such serv14 ices, however the charges are characterized, includes 

15 enrollment fees, premiums, deductibles, cost sharing, 

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

17 charges. 

18 ‘‘(c) INDIAN TRIBES.—Any application requirements 

19 for grants distributed in accordance with section 

20 3403(a)(3) shall be developed by the Secretary in con21 sultation with Indian tribes. 

22 ‘‘SEC. 3405. TECHNICAL ASSISTANCE. 

23 ‘‘The Secretary shall, beginning on the date of enact24 ment of this title, provide technical assistance, including 

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1 tors under this title to assist newly eligible local areas in 

2 the establishment of planning councils and, to assist enti3 ties in complying with the requirements of this subtitle 

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

5 under this subtitle. The Secretary may make planning 

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

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

8 eligible for funding under section 3401 in the following 

9 fiscal year. Such grant amounts shall be deducted from 

10 the first year formula award to eligible local areas accept11 ing such grants. 

12 ‘‘SEC. 3406. AUTHORIZATION OF APPROPRIATIONS. 

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

14 this subtitle— 

15 ‘‘(1) $2,700,000,000 for fiscal year 2020; 

16 ‘‘(2) $2,700,000,000 for fiscal year 2021; 

17 ‘‘(3) $2,700,000,000 for fiscal year 2022; 

18 ‘‘(4) $2,700,000,000 for fiscal year 2023; 

19 ‘‘(5) $2,700,000,000 for fiscal year 2024; 

20 ‘‘(6) $2,700,000,000 for fiscal year 2025; 

21 ‘‘(7) $2,700,000,000 for fiscal year 2026; 

22 ‘‘(8) $2,700,000,000 for fiscal year 2027; 

23 ‘‘(9) $2,700,000,000 for fiscal year 2028; and 

24 ‘‘(10) $2,700,000,000 for fiscal year 2029. 


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1 ‘‘Subtitle B—State and Tribal Sub2 stance Use Disorder Prevention 

3 and Intervention Grant Pro4 gram 

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

6 ‘‘The Secretary shall award grants to States, terri7 tories, and tribal governments for the purpose of address8 ing substance use within such States. 

9 ‘‘SEC. 3412. AMOUNT OF GRANT, USE OF AMOUNTS, AND 

10 FUNDING AGREEMENT. 

11 ‘‘(a) AMOUNT OF GRANT TO STATES AND TERRI12 TORIES.— 

13 ‘‘(1) IN GENERAL.— 

14 ‘‘(A) EXPEDITED DISTRIBUTION.—Not 

15 later than 90 days after an appropriation be16 comes available, the Secretary shall disburse 50 

17 percent of the amount made available under 

18 section 3415 for carrying out this subtitle for 

19 such fiscal year through grants to States under 

20 section 3411, in accordance with subparagraphs 

21 (B) and (C). 

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

23 the amount made available under section 3415, 

24 the amount of a grant under section 3411 for— 


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

2 of Columbia, and Puerto Rico for a fiscal 

3 year shall be the greater of— 

4 ‘‘(I) $2,000,000; or 

5 ‘‘(II) an amount determined 

6 under the subparagraph (C); and 

7 ‘‘(ii) each territory other than Puerto 

8 Rico for a fiscal year shall be the greater 

9 of— 

10 ‘‘(I) $500,000; or 

11 ‘‘(II) an amount determined 

12 under the subparagraph (C). 

13 ‘‘(C) DETERMINATION.— 

14 ‘‘(i) FORMULA.—For purposes of sub15 paragraph (B), the amount referred to in 

16 this subparagraph for a State (including a 

17 territory) for a fiscal year is— 

18 ‘‘(I) an amount equal to the 

19 amount made available under section 

20 3415 for the fiscal year involved for 

21 grants pursuant to subparagraph (B); 

22 and 

23 ‘‘(II) the percentage constituted 

24 by the sum of— 


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1 ‘‘(aa) the product of 0.85 

2 and the ratio of the State dis3 tribution factor for the State or 

4 territory to the sum of the re5 spective distribution factors for 

6 all States; and 

7 ‘‘(bb) the product of 0.15 

8 and the ratio of the non-local dis9 tribution factor for the State or 

10 territory (as determined under 

11 clause (iv)) to the sum of the re12 spective non-local distribution 

13 factors for all States or terri14 tories. 

15 ‘‘(ii) STATE DISTRIBUTION FACTOR.— 

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

17 ‘State distribution factor’ means an 

18 amount equal to— 

19 ‘‘(I) the estimated number of 

20 drug overdose deaths in the State, as 

21 determined under clause (iii); or 

22 ‘‘(II) the number of non-fatal 

23 drug overdoses in the State, as deter24 mined under clause (iv); 


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1 as determined by the Secretary based on 

2 which distribution factor (subclause (I) or 

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

4 greatest amount of funds. 

5 ‘‘(iii) NUMBER OF DRUG

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

7 the number of drug overdose deaths deter8 mined under this clause for a State for a 

9 fiscal year is the number of drug overdose 

10 deaths during the most recent 3-year pe11 riod for which such data are available. 

12 ‘‘(iv) NUMBER OF NON-FATAL DRUG

13 OVERDOSES.—The number of non-fatal 

14 drug overdose deaths determined under 

15 this clause for a State for a fiscal year for 

16 purposes of clause (ii) may be determined 

17 by using data including emergency depart18 ment syndromic data, visits, other emer19 gency medical services for drug-related 

20 causes, or Overdose Detection Mapping 

21 Application Program (ODMAP) data dur22 ing the most recent 3-year period for which 

23 such data are available. 

24 ‘‘(v) NON-LOCAL DISTRIBUTION FAC25 TORS.—For purposes of clause (i)(II)(bb), 


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1 the term ‘non-local distribution factor’ 

2 means an amount equal to the sum of— 

3 ‘‘(I) the number of drug overdose 

4 deaths in the State involved, as deter5 mined under clause (iii), or the num6 ber of non-fatal drug overdoses in the 

7 State, based on the criteria used by 

8 the State under clause (ii); less 

9 ‘‘(II) the total number of drug 

10 overdose deaths or non-fatal drug 

11 overdoses that are within areas in 

12 such State or territory that are eligi13 ble counties under section 3401. 

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

15 after the date of enactment of this title, 

16 the Comptroller General shall conduct a 

17 study to determine whether the data uti18 lized for purposes of clause (ii) provide the 

19 most precise measure of State need related 

20 to substance use and addiction prevalence 

21 and whether additional data would provide 

22 more precise measures the levels of sub23 stance use and addiction prevalent in 

24 States. Such study shall identify barriers 

25 to collecting or analyzing such data, and 


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1 make recommendations for revising the 

2 distribution factors used under such clause 

3 to determine funding levels in order to di4 rect funds to the States in most need of 

5 funding to provide substance use disorder 

6 treatment services. 

7 ‘‘(2) SUPPLEMENTAL GRANTS.— 

8 ‘‘(A) IN GENERAL.—Subject to subpara9 graph (C), the Secretary shall disburse the re10 mainder of amounts not disbursed under para11 graph (1) for such fiscal year for the purpose 

12 of making grants to States whose application— 

13 ‘‘(i) contains a report concerning the 

14 dissemination of emergency relief funds 

15 under paragraph (1) and the plan for utili16 zation of such funds, if applicable; 

17 ‘‘(ii) demonstrates the need in such 

18 State, on an objective and quantified basis, 

19 for supplemental financial assistance to 

20 combat substance use disorder; 

21 ‘‘(iii) demonstrates the existing com22 mitment of local resources of the State, 

23 both financial and in-kind, to preventing, 

24 treating, and managing substance use dis25 order and supporting sustained recovery; 


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1 ‘‘(iv) demonstrates the ability of the 

2 State to utilize such supplemental financial 

3 resources in a manner that is immediately 

4 responsive and cost effective; 

5 ‘‘(v) demonstrates that resources will 

6 be allocated in accordance with the local 

7 demographic incidence of substances use 

8 disorders and drug overdose mortality; 

9 ‘‘(vi) demonstrates the inclusiveness of 

10 affected communities and individuals with 

11 substance use disorders, including those 

12 communities and individuals that are dis13 proportionately affected or historically un14 derserved; 

15 ‘‘(vii) demonstrates the manner in 

16 which the proposed services are consistent 

17 with the local needs assessment and the 

18 State plan approved by the Secretary pur19 suant to section 1932(b); 

20 ‘‘(viii) demonstrates success in identi21 fying individuals with substance use dis22 orders; and 

23 ‘‘(ix) demonstrates that support for 

24 substance use disorder prevention and 

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1 mize the value to the population to be 

2 served with an appropriate mix of sub3 stance use disorder treatment services and 

4 attention to transition in care. 

5 ‘‘(B) AMOUNT.— 

6 ‘‘(i) IN GENERAL.—The amount of 

7 each grant made for purposes of this para8 graph shall be determined by the Sec9 retary. In making such determination, the 

10 Secretary shall consider: 

11 ‘‘(I) the rate of drug overdose 

12 deaths per 100,000 population in the 

13 State; and 

14 ‘‘(II) the increasing need for sub15 stance use disorder treatment serv16 ices, including relative rates of in17 crease in the number of drug 

18 overdoses or drug overdose deaths, or 

19 recent increases in drug overdoses or 

20 drug overdose deaths since the data 

21 were reported under section 3413, if 

22 applicable. 

23 ‘‘(ii) DEMONSTRATED NEED.—The 

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1 onstrated need for purposes of subpara2 graph (A)(ii) may include any or all of the 

3 following: 

4 ‘‘(I) The unmet need for such 

5 services, including the factors identi6 fied in clause (i)(II). 

7 ‘‘(II) Relative rates of increase in 

8 the number of drug overdoses or drug 

9 overdose deaths. 

10 ‘‘(III) The relative rates of in11 crease in the number of drug 

12 overdoses or drug overdose deaths 

13 within new or emerging subpopula14 tions. 

15 ‘‘(IV) The current prevalence of 

16 substance use disorders. 

17 ‘‘(V) Relevant factors related to 

18 the cost and complexity of delivering 

19 substance use disorder treatment serv20 ices to individuals in the State. 

21 ‘‘(VI) The impact of co-morbid 

22 factors, including co-occurring condi23 tions, determined relevant by the Sec24 retary. 


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1 ‘‘(VII) The prevalence of home2 lessness among individuals with sub3 stance use disorder. 

4 ‘‘(VIII) The relevant factors that 

5 limit access to health care, including 

6 geographic variation, adequacy of 

7 health insurance coverage, and lan8 guage barriers. 

9 ‘‘(IX) The impact of a decline in 

10 the amount received pursuant to para11 graph (1) on substance use disorder 

12 treatment services available to all in13 dividuals with substance use disorders 

14 identified and eligible under this sub15 title. 

16 ‘‘(X) The increasing incidence in 

17 conditions related to substance use, 

18 including hepatitis C, human immuno19 deficiency virus, hepatitis B and other 

20 infections associated with injection 

21 drug use. 

22 ‘‘(C) MODEL STANDARDS.— 

23 ‘‘(i) PREFERENCE.—In determining 

24 whether a State will receive funds under 

25 this paragraph, except as provided in 


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1 clause (ii), the Secretary shall give pref2 erence to States that have adopted the 

3 model standards for each substance use 

4 disorder treatment service and recovery 

5 residence developed in accordance with 

6 subsections (a) and (b) of section 3435. 

7 ‘‘(ii) REQUIREMENT.—Effective begin8 ning in fiscal year 2024, the Secretary 

9 shall not award a grant under this para10 graph to a State unless that State has 

11 adopted the model standards for each of 

12 substance use disorder treatment services 

13 and recovery residences developed in ac14 cordance with subsections (a) and (b) of 

15 section 3435. 

16 ‘‘(D) CONTINUUM OF CARE.— 

17 ‘‘(i) PREFERENCE.—In determining 

18 whether a State will receive funds under 

19 this paragraph, except as provided in 

20 clause (ii), the Secretary shall give pref21 erence to States that have carried out the 

22 requirements to ensure a continuum of 

23 services in accordance with section 

24 3435(d). 


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1 ‘‘(ii) REQUIREMENT.—Effective begin2 ning in fiscal year 2024, the Secretary 

3 shall not award a grant under this para4 graph to a State unless that State has car5 ried out the requirements to ensure a con6 tinuum of services in accordance with sec7 tion 3435(d). 

8 ‘‘(E) UTILIZATION MANAGEMENT FOR

9 MEDICATION-ASSISTED TREATMENT.— 

10 ‘‘(i) PREFERENCE.—In determining 

11 whether a State will receive funds under 

12 this paragraph, the Secretary shall give 

13 preference to States that have prohibited 

14 prior authorization and step therapy re15 quirements for at least 1 drug in each 

16 class approved by the Food and Drug Ad17 ministration for the treatment of substance 

18 use disorder. 

19 ‘‘(ii) ADDITIONAL PREFERENCES.— 

20 Additional preference shall be given to 

21 States that have prohibited prior author22 ization and step therapy requirements for 

23 2 or more drugs in each class approved by 

24 the Food and Drug Administration for the 

25 treatment of substance use disorder. 


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1 ‘‘(iii) DEFINITIONS.—In this subpara2 graph: 

3 ‘‘(I) PRIOR AUTHORIZATION.— 

4 The term ‘prior authorization’ means 

5 the process by which a health insur6 ance issuer or pharmacy benefit man7 agement company determines the 

8 medical necessity of otherwise covered 

9 health care services prior to the ren10 dering of such health care services. 

11 Such term includes any health insur12 ance issuer’s or utilization review enti13 ty’s requirement that a subscriber or 

14 health care provider notify the issuer 

15 or entity prior to providing a health 

16 care service. 

17 ‘‘(II) STEP THERAPY.—The term 

18 ‘step therapy’ means a protocol or 

19 program that establishes the specific 

20 sequence in which prescription drugs 

21 for a medical condition that are medi22 cally appropriate for a particular pa23 tient are authorized by a health insur24 ance issuer or prescription drug man25 agement company. 


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1 ‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN2 MENTS.— 

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

4 term ‘Indian tribe’ has the meaning given such 

5 term in section 4 of the Indian Self-Determina6 tion and Education Assistance Act. 

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

8 acting through the Indian Health Service, shall 

9 use 10 percent of the amount available under 

10 section 3415 for each fiscal year to provide for11 mula grants to Indian tribes in an amount de12 termined pursuant to a formula and eligibility 

13 criteria developed by the Secretary in consulta14 tion with Indian tribes, for the purposes of ad15 dressing substance use. 

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

17 any requirements in this section, an Indian 

18 tribe may use amounts provided under grants 

19 awarded under this paragraph for the uses 

20 identified in subsection (b) and any other activi21 ties determined appropriate by the Secretary, in 

22 consultation with Indian tribes. 

23 ‘‘(b) USE OF AMOUNTS.— 


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1 ‘‘(1) IN GENERAL.—A State or tribe may use 

2 amounts provided under grants awarded under sec3 tion 3411 for— 

4 ‘‘(A) prevention services described in para5 graph (3); 

6 ‘‘(B) core medical services described in 

7 paragraph (4); 

8 ‘‘(C) recovery and support services de9 scribed in paragraph (5); 

10 ‘‘(D) early intervention services described 

11 in paragraph (6); 

12 ‘‘(E) harm reduction services described in 

13 paragraph (7); 

14 ‘‘(F) financial assistance with health insur15 ance as described in paragraph (8); and 

16 ‘‘(G) administrative expenses described in 

17 paragraph (9). 

18 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 

19 ‘‘(A) IN GENERAL.—A State or tribe may 

20 use amounts received under a grant under sec21 tion 3411 to provide direct financial assistance 

22 to eligible entities for the purpose of providing 

23 prevention services, core medical services, recov24 ery and support services, early intervention 

25 services, and harm reduction services. 


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1 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi2 nancial assistance may be provided under sub3 paragraph (A) to public or nonprofit private en4 tities, or private for-profit entities if such enti5 ties are the only available provider of quality 

6 substance use disorder treatment services in the 

7 area. 

8 ‘‘(C) LIMITATION.—A State may not pro9 vide direct financial assistance to any entity 

10 that provides medication-assisted treatment if 

11 that entity does not also offer mental health 

12 services or psychotherapy by licensed clinicians 

13 through a referral or onsite. 

14 ‘‘(3) PREVENTION SERVICES.— 

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

16 section, the term ‘prevention services’ means 

17 evidence-based services, programs, or multi-sec18 tor strategies to prevent substance use disorder 

19 (including education campaigns, community20 based prevention programs, risk-identification 

21 programs, opioid diversion, collection and dis22 posal of unused opioids, services to at-risk pop23 ulations, and trauma support services). 

24 ‘‘(B) LIMIT.—A State may use not to ex25 ceed 20 percent of the amount of the grant 


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1 under section 3411 for prevention services. A 

2 State may apply to the Secretary for a waiver 

3 of this subparagraph. 

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

5 of this section, the term ‘core medical services’ 

6 means the following evidence-based services when 

7 provided to individuals with substance use disorder 

8 or at risk for developing substance use disorder, in9 cluding through the use of telemedicine or a hub and 

10 spoke model: 

11 ‘‘(A) Substance use disorder treatment, as 

12 described in section 3439(4), including assess13 ment of disease presence, severity, and co-oc14 curring conditions, treatment planning, clinical 

15 stabilization services, withdrawal management 

16 and detoxification, intensive inpatient treat17 ment, intensive outpatient treatment, outpatient 

18 treatment, residential inpatient services, treat19 ment for co-occurring mental health and sub20 stance use disorders, and all drugs approved by 

21 the Food and Drug Administration for the 

22 treatment of substance use disorder. 

23 ‘‘(B) Outpatient and ambulatory health 

24 services, including those administered by feder25 ally qualified health centers, rural health clinics, 


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1 tribal clinics and hospitals, urban Indian health 

2 facilities, certified community behavioral health 

3 clinics (as described in section 223 of the Pro4 tecting Access to Medicare Act), and com5 prehensive opioid recovery centers (as described 

6 in section 552 of this Act). 

7 ‘‘(C) Hospice services. 

8 ‘‘(D) Mental health services. 

9 ‘‘(E) Opioid overdose reversal drug prod10 ucts procurement, distribution, and training. 

11 ‘‘(F) Pharmaceutical assistance related to 

12 the management of substance-use disorders and 

13 co-morbid conditions. 

14 ‘‘(G) Home and community based health 

15 services. 

16 ‘‘(H) Comprehensive Case Management 

17 and care coordination, including substance use 

18 disorder treatment adherence services. 

19 ‘‘(I) Health insurance enrollment and cost20 sharing assistance in accordance with para21 graph (8). 

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

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1 covery services, 24/7 hotline crisis center services, 

2 medical transportation services, respite care for per3 sons caring for individuals with substance use dis4 order, child care and family services while an indi5 vidual is receiving inpatient treatment services or at 

6 the time of outpatient services, outreach services, 

7 peer recovery services, nutrition services, and refer8 rals for job training and career services, housing, 

9 legal services, and child care and family services. 

10 The entities through which such services may be 

11 provided include State, local, and tribal authorities 

12 that provide child care, housing, community develop13 ment, and other recovery and support services, so 

14 long as they do not exclude individuals on the basis 

15 that such individuals receive medication-assisted 

16 treatment. 

17 ‘‘(6) EARLY INTERVENTION SERVICES.—For 

18 purposes of this section, the term ‘early intervention 

19 services’ means services to provide screening and 

20 connection to the appropriate level of substance use 

21 disorder and mental health treatment (including 

22 same-day connection), counseling provided to indi23 viduals who have misused substances, who have ex24 perienced an overdose, or are at risk of developing 

25 substance use disorder, the provision of referrals to 


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1 facilitate the access of such individuals to core med2 ical services or recovery and support services for 

3 substance use disorder, and rapid access to medica4 tion-assisted treatment in the setting of recent over5 dose. The entities through which such services may 

6 be provided include emergency rooms, fire depart7 ments and emergency medical services, detention fa8 cilities, prisons and jails, homeless shelters, law en9 forcement agencies, health care points of entry speci10 fied by eligible local areas, federally qualified health 

11 centers, tribal clinics and hospitals, urban Indian 

12 health facilities, and rural health clinics. 

13 ‘‘(7) HARM REDUCTION SERVICES.—For pur14 poses of this section, the term ‘harm reduction serv15 ices’ means evidence-based services provided to indi16 viduals engaging in substance use that reduce the 

17 risk of infectious disease transmission, overdose, or 

18 death, including by increasing access to health care, 

19 housing, recovery, and support services. 

20 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV21 ERAGE.—A State may use amounts provided under 

22 a grant awarded under section 3411 to establish a 

23 program of financial assistance to assist eligible indi24 viduals with substance use disorder in— 


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1 ‘‘(A) enrolling in health insurance cov2 erage; or 

3 ‘‘(B) affording health care services, includ4 ing assistance paying cost-sharing amounts, in5 cluding premiums. 

6 ‘‘(9) ADMINISTRATION AND PLANNING.—A 

7 State shall not use in excess of 10 percent of 

8 amounts received under a grant under section 3411 

9 for administration, accounting, reporting, and pro10 gram oversight functions, including the development 

11 of systems to improve data collection and data shar12 ing. 

13 ‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 

14 received under a grant under section 3411 may be 

15 used to provide substance use disorder treatment 

16 services, including medication-assisted treatment, to 

17 individuals who are currently incarcerated or in pre18 trial detention. 

19 ‘‘(c) REQUIRED TERMS.— 

20 ‘‘(1) REQUIREMENT OF STATUS AS MEDICAID

21 PROVIDER.— 

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

23 subparagraph (B), the Secretary may not make 

24 a grant under section 3411 for the provision of 

25 substance use disorder treatment services under 


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1 this section in a State unless, in the case of any 

2 such service that is available pursuant to the 

3 State plan approved under title XIX of the So4 cial Security Act for the State— 

5 ‘‘(i)(I) the State will enter into an 

6 agreement with a political subdivision, 

7 under which the political subdivision will 

8 provide the service directly, and the polit9 ical subdivision has entered into a partici10 pation agreement under the State plan and 

11 is qualified to receive payments under such 

12 plan; or 

13 ‘‘(II) the State will enter into agree14 ments with public or nonprofit private enti15 ties under which the entities will provide 

16 the service, and the entities have entered 

17 into such a participation agreement and 

18 are qualified to receive such payments; and 

19 ‘‘(ii) the State ensures the political 

20 subdivision under clause (i)(I) or the pub21 lic or nonprofit private entity under clause 

22 (i)(II) seeks payment for each such service 

23 rendered in accordance with the usual pay24 ment schedule under the State plan. 

25 ‘‘(B) WAIVER.— 


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

2 entity making an agreement pursuant to 

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

5 services, the requirement established in 

6 such subparagraph shall be waived by the 

7 State if the entity does not, in providing 

8 health care services, impose a charge or ac9 cept reimbursement available from any 

10 third-party payor, including reimbursement 

11 under any insurance policy or under any 

12 Federal or State health benefits program. 

13 A waiver under this subparagraph shall 

14 not be longer than 2 years in duration and 

15 shall not be renewed. 

16 ‘‘(ii) DETERMINATION.—A determina17 tion by the State of whether an entity re18 ferred to in clause (i) meets the criteria for 

19 a waiver under such clause shall be made 

20 without regard to whether the entity ac21 cepts voluntary donations for the purpose 

22 of providing services to the public. 

23 ‘‘(2) REQUIRED TERMS FOR EXPANDING AND

24 IMPROVING CARE.—A funding agreement for a grant 

25 under this section shall— 


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1 ‘‘(A) ensure that funds received under the 

2 grant will not be utilized to make payments for 

3 any item or service to the extent that payment 

4 has been made, or can reasonably be expected 

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

6 under a State compensation program, under an 

7 insurance policy, or under any Federal or State 

8 health benefits program (except for a program 

9 administered by, or providing the services of, 

10 the Indian Health Service); and 

11 ‘‘(B) ensure that all entities providing sub12 stance use disorder treatment services with as13 sistance made available under the grant shall 

14 offer all drugs approved by the Food and Drug 

15 Administration for the treatment of substance 

16 use disorder for which the applicant offers 

17 treatment, in accordance with section 3435. 

18 ‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund19 ing agreement for a grant under this section is 

20 that— 

21 ‘‘(A) funds received under the grant will be 

22 utilized to supplement not supplant other Fed23 eral, State, or local funds made available in the 

24 year for which the grant is awarded to provide 

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1 dividuals with substance use disorder, including 

2 funds for each of prevention services, core med3 ical services, recovery and support services, 

4 early intervention services, harm reduction serv5 ices, mental health services, and administrative 

6 expenses; 

7 ‘‘(B) political subdivisions within the State 

8 will maintain the level of expenditures by such 

9 political subdivisions for substance use disorder 

10 treatment services at a level that is at least 

11 equal to the level of such expenditures by such 

12 political subdivisions for the preceding fiscal 

13 year including expenditures for each of preven14 tion services, core medical services, recovery 

15 and support services, early intervention services, 

16 harm reduction services, mental health services, 

17 and administrative expenses; 

18 ‘‘(C) political subdivisions within the State 

19 will not use funds received under a grant 

20 awarded under section 3411 in maintaining the 

21 level of substance use disorder treatment serv22 ices as required in subparagraph (B); 

23 ‘‘(D) substance use disorder treatment 

24 services provided with assistance made available 


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1 under the grant will be provided without re2 gard— 

3 ‘‘(i) to the ability of the individual to 

4 pay for such services; and 

5 ‘‘(ii) to the current or past health con6 dition of the individual to be served; 

7 ‘‘(E) substance use disorder treatment 

8 services will be provided in a setting that is ac9 cessible to low-income individuals with sub10 stance use disorders and to individuals with 

11 substance use disorders residing in rural areas; 

12 ‘‘(F) a program of outreach will be pro13 vided to low-income individuals with substance 

14 use disorders to inform such individuals of sub15 stance use disorder treatment services and to 

16 individuals with substance use disorders resid17 ing in rural areas; 

18 ‘‘(G) Indian tribes are included in planning 

19 for the use of grant funds and the Federal trust 

20 responsibility is upheld at all levels of program 

21 administration; and 

22 ‘‘(H) the confidentiality of individuals re23 ceiving substance use disorder treatment serv24 ices will be maintained in a manner not incon25 sistent with applicable law. 


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1 ‘‘SEC. 3413. APPLICATION. 

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

3 under section 3411, a State shall have in effect a State 

4 plan approved by the Secretary pursuant to section 

5 1932(b), and shall prepare and submit to the Secretary 

6 an application in such form, and containing such informa7 tion, as the Secretary shall require, including— 

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

9 of any prior grants received under this subtitle by 

10 the applicant and the results achieved by these ex11 penditures and a demonstration that funds received 

12 from a grant under this subtitle in the prior year 

13 were expended in accordance with State priorities; 

14 ‘‘(2) establishment of goals and objectives to be 

15 achieved with grant funds provided under this sub16 title, including targets and milestones that are in17 tended to be met, the activities that will be under18 taken to achieve those targets, and the number of 

19 individuals likely to be served by the funds sought, 

20 including demographic data on the populations to be 

21 served; 

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

23 funds in a manner that provides substance use dis24 order treatment services in compliance with the evi25 dence-based standards developed in accordance with 

26 section 3435, including all drugs approved by the 


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1 Food and Drug Administration for the treatment of 

2 substance use disorder; 

3 ‘‘(4) a demonstration that resources provided 

4 under the grant will be allocated in accordance with 

5 the local demographic incidence of substance use, in6 cluding allocations for services for children, youths, 

7 and women; 

8 ‘‘(5) an explanation of how income, asset, and 

9 medical expense criteria will be established and ap10 plied to those who qualify for assistance under the 

11 program; and 

12 ‘‘(6) for any prior funding received under this 

13 section, data provided in such form as the Secretary 

14 shall require detailing, at a minimum, the extent to 

15 which the activities supported by the funding met 

16 the goals and objectives specified in the application 

17 for the funding, the number of individuals who 

18 accessed medication-assisted treatment by age, gen19 der, race, and other demographic criteria relevant to 

20 the program, and the effect of the program on over21 dose rates and rates of death due to overdose in the 

22 region served by the program. 

23 ‘‘(b) REQUIREMENTS REGARDING IMPOSITION OF

24 CHARGES FOR SERVICES.— 


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

2 make a grant under section 3411 to a State unless 

3 the State provides assurances that in the provision 

4 of services with assistance provided under the 

5 grant— 

6 ‘‘(A) in the case of individuals with an in7 come less than or equal to 138 percent of the 

8 official poverty level, the provider will not im9 pose charges on any such individual for the 

10 services provided under the grant; 

11 ‘‘(B) in the case of individuals with an in12 come greater than 138 percent of the official 

13 poverty level, the provider will impose a charge 

14 on each such individual according to a schedule 

15 of charges made available to the public; 

16 ‘‘(C) in the case of individuals with an in17 come greater than 138 percent of the official 

18 poverty level but not exceeding 200 percent of 

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

20 calendar year, impose charges in an amount ex21 ceeding 5 percent of the annual gross income of 

22 the individual; 

23 ‘‘(D) in the case of individuals with an in24 come greater than 200 percent of the official 

25 poverty level but not exceeding 300 percent of 


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

2 calendar year, impose charges in an amount ex3 ceeding 7 percent of the annual gross income of 

4 the individual involved; 

5 ‘‘(E) in the case of individuals with an in6 come greater than 300 percent of the official 

7 poverty level, the provider will not, for any cal8 endar year, impose charges in an amount ex9 ceeding 15 percent of the annual gross income 

10 of the individual involved; and 

11 ‘‘(F) in the case of eligible American In12 dian and Alaska Native individuals as defined 

13 by section 447.50 of title 42, Code of Federal 

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

15 provider will not impose any charges for sub16 stance use disorder treatment services, includ17 ing any charges or cost-sharing prohibited by 

18 section 1402(d) of the Patient Protection and 

19 Affordable Care Act. 

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

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

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

23 charge— 

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

25 the discretion of the State, including imposing 


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1 only a nominal charge for the provision of serv2 ices, subject to the provisions of the paragraph 

3 regarding public schedules and regarding limi4 tations on the maximum amount of charges 

5 and; 

6 ‘‘(B) take into consideration the total med7 ical expenses of individuals in assessing the 

8 amount of the charge, subject to such provi9 sions. 

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

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

12 unless the State agrees that the limitations on 

13 charges for substance use disorder treatment serv14 ices under this subsection applies to the annual ag15 gregate of charges imposed for such services, how16 ever the charges are characterized, includes enroll17 ment fees, premiums, deductibles, cost sharing, co18 payments, co-insurance costs, or any other charges. 

19 ‘‘(c) INDIAN TRIBES.—Any application requirements 

20 applying to grants distributed in accordance with section 

21 3412(b) shall be developed by the Secretary in consulta22 tion with Indian tribes. 

23 ‘‘SEC. 3414. TECHNICAL ASSISTANCE. 

24 ‘‘The Secretary shall provide technical assistance in 

25 administering and coordinating the activities authorized 


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1 under section 3412, including technical assistance for the 

2 development of State applications for supplementary 

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

4 ‘‘SEC. 3415. AUTHORIZATION OF APPROPRIATIONS. 

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

6 this subtitle— 

7 ‘‘(1) $4,000,000,000 for fiscal year 2020; 

8 ‘‘(2) $4,000,000,000 for fiscal year 2021; 

9 ‘‘(3) $4,000,000,000 for fiscal year 2022; 

10 ‘‘(4) $4,000,000,000 for fiscal year 2023; 

11 ‘‘(5) $4,000,000,000 for fiscal year 2024; 

12 ‘‘(6) $4,000,000,000 for fiscal year 2025; 

13 ‘‘(7) $4,000,000,000 for fiscal year 2026; 

14 ‘‘(8) $4,000,000,000 for fiscal year 2027; 

15 ‘‘(9) $4,000,000,000 for fiscal year 2028; and 

16 ‘‘(10) $4,000,000,000 for fiscal year 2029. 

17 ‘‘Subtitle C—Other Grant Program 

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

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

20 grants to public, nonprofit, and Indian entities for the 

21 purpose of funding prevention services, core medical serv22 ices, recovery and support services, early intervention serv23 ices, harm reduction services, and administrative expenses 

24 in accordance with this section. 

25 ‘‘(b) ELIGIBILITY.— 


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1 ‘‘(1) ENTITIES.—Public, nonprofit, or Indian 

2 entities eligible to receive a grant under subsection 

3 (a) may include— 

4 ‘‘(A) federally qualified health centers 

5 under section 1905(l)(2)(B) of the Social Secu6 rity Act; 

7 ‘‘(B) family planning clinics; 

8 ‘‘(C) rural health clinics; 

9 ‘‘(D) Indian entities, including Indian 

10 health programs as defined in section 4 of the 

11 Indian Health Care Improvement Act, urban 

12 Indian organizations as defined in section 4 of 

13 the Indian Health Care Improvement Act, and 

14 Native Hawaiian organizations as defined in 

15 section 11 of the Native Hawaiian Health Care 

16 Act of 1988; 

17 ‘‘(E) community-based organizations, clin18 ics, hospitals, and other health facilities that 

19 provide substance use disorder treatment serv20 ices; and 

21 ‘‘(F) other nonprofit entities that provide 

22 substance use disorder treatment services. 

23 ‘‘(2) UNDERSERVED POPULATIONS.—Entities 

24 described in paragraph (1) shall serve underserved 

25 populations which may include— 


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1 ‘‘(A) minority populations and Indian pop2 ulations; 

3 ‘‘(B) ex-offenders; 

4 ‘‘(C) individuals with comorbidities includ5 ing HIV/AIDS, hepatitis B or C, mental health 

6 disorder or other behavioral health disorders; 

7 ‘‘(D) low-income populations; 

8 ‘‘(E) inner city populations; and 

9 ‘‘(F) rural populations. 

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

11 grant under this section, a public or nonprofit entity 

12 described in this subsection shall prepare and submit 

13 to the Secretary an application in such form, and 

14 containing such information, as the Secretary shall 

15 require, including— 

16 ‘‘(A) a complete accounting of the dis17 bursement of any prior grants received under 

18 this subtitle by the applicant and the results 

19 achieved by these expenditures; 

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

21 the grant, including— 

22 ‘‘(i) a demonstration of the extent of 

23 local need for the funds sought; 


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1 ‘‘(ii) a plan for providing substance 

2 use disorder treatment services that is con3 sistent with local needs; and 

4 ‘‘(iii) goals and objectives to be 

5 achieved with grant funds provided under 

6 this section, including targets and mile7 stones that are intended to be met and a 

8 description of the activities that will be un9 dertaken to achieve those targets; 

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

11 use funds in a manner that provides substance 

12 use disorder treatment services compliant with 

13 the evidence-based standards developed in ac14 cordance with section 3435, including all drugs 

15 approved by the Food and Drug Administration 

16 for the treatment of substance use disorder for 

17 which the applicant offers treatment, in accord18 ance with section 3435(c); 

19 ‘‘(D) information on the number of individ20 uals to be served by the funds sought, including 

21 demographic data on the populations to be 

22 served; 

23 ‘‘(E) a demonstration that resources pro24 vided under the grant will be allocated in ac25 cordance with the local demographic incidence 


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1 of substance use, including allocations for serv2 ices for children, youths, and women; 

3 ‘‘(F) an explanation of how income, asset, 

4 and medical expense criteria will be established 

5 and applied to those who qualify for assistance 

6 under the program; and 

7 ‘‘(G) for any prior funding received under 

8 this section, data provided in such form as the 

9 Secretary shall require detailing, at a minimum, 

10 the extent to which the activities supported by 

11 the funding met the goals and objectives speci12 fied in the application for the funding, the num13 ber of individuals who accessed medication-as14 sisted treatment by age, gender, race, and other 

15 demographic criteria relevant to the program, 

16 and the effect of the program on overdose rates 

17 and rates of death due to overdose in the region 

18 served by the program. 

19 ‘‘(4) REQUIREMENT OF STATUS AS MEDICAID

20 PROVIDER.— 

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

22 subparagraph (B), the Secretary may not make 

23 a grant under this section for the provision of 

24 substance use disorder treatment services under 

25 this section in a State unless, in the case of any 


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1 such service that is available pursuant to the 

2 State plan approved under title XIX of the So3 cial Security Act for the State— 

4 ‘‘(i)(I) the applicant for the grant will 

5 provide the service directly, and the appli6 cant has entered into a participation agree7 ment under the State plan and is qualified 

8 to receive payments under such plan; or 

9 ‘‘(II) the applicant for the grant will 

10 enter into an agreement with a public or 

11 nonprofit private entity under which the 

12 entity will provide the substance use dis13 order treatment service, and the entity has 

14 entered into such a participation agree15 ment and is qualified to receive such pay16 ments; and 

17 ‘‘(ii) the applicant ensures that pay18 ment will be sought for each such service 

19 rendered in accordance with the usual pay20 ment schedule under the State plan. 

21 ‘‘(B) WAIVER.—In the case of an entity 

22 making an agreement pursuant to subpara23 graph (A) regarding the provision of substance 

24 use disorder treatment services, the require25 ment established in such paragraph shall be 


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1 waived by the State if the entity does not, in 

2 providing such services, impose a charge or ac3 cept reimbursement available from any third4 party payor, including reimbursement under 

5 any insurance policy or under any Federal or 

6 State health benefits program. A waiver under 

7 this subparagraph shall not be longer than 2 

8 years in duration and shall not be renewed. 

9 ‘‘(C) DETERMINATION.—A determination 

10 by the State of whether an entity referred to in 

11 subparagraph (A) meets the criteria for a waiv12 er under such subparagraph shall be made 

13 without regard to whether the entity accepts 

14 voluntary donations for the purpose of pro15 viding services to the public. 

16 ‘‘(5) REQUIRED TERMS FOR EXPANDING AND

17 IMPROVING CARE.—A funding agreement for a grant 

18 under this section is that— 

19 ‘‘(A) funds received under the grant will 

20 not be utilized to make payments for any item 

21 or service to the extent that payment has been 

22 made, or can reasonably be expected to be 

23 made, with respect to that item or service under 

24 a State compensation program, under an insur25 ance policy, or under any Federal or State 


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1 health benefits program (except for a program 

2 administered by, or providing the services of, 

3 the Indian Health Service); 

4 ‘‘(B) entities providing substance use dis5 order treatment services with assistance made 

6 available under the grant shall offer all drugs 

7 approved by the Food and Drug Administration 

8 for the treatment of substance use disorder for 

9 which the applicant offers treatment, in accord10 ance with section 3435(c); 

11 ‘‘(C) substance use disorder treatment 

12 services provided with assistance made available 

13 under the grant will be provided without re14 gard— 

15 ‘‘(i) to the ability of the individual to 

16 pay for such services; and 

17 ‘‘(ii) to the current or past health con18 dition of the individual to be served; 

19 ‘‘(D) substance use disorder treatment 

20 services will be provided in a setting that is ac21 cessible to low-income individuals with sub22 stance use disorders and to individuals with 

23 substance use disorders residing in rural areas; 

24 and 


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1 ‘‘(E) the confidentiality of individuals re2 ceiving substance use disorder treatment serv3 ices will be maintained in a manner not incon4 sistent with applicable law. 

5 ‘‘(c) AMOUNT OF GRANT TO INDIAN ENTITIES.— 

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

7 ‘Indian Tribe’ has the meaning given such term in 

8 section 4 of the Indian Self-Determination and Edu9 cation Assistance Act. 

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

11 through the Indian Health Service, shall use 10 per12 cent of the amount available under section 3435 for 

13 each fiscal year to provide grants to Indian entities 

14 in an amount determined pursuant to criteria devel15 oped by the Secretary in consultation with Indian 

16 Tribes, for the purposes of addressing substance use. 

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

18 requirements in this section, Native entities may use 

19 amounts provided under grants awarded under this 

20 section for the uses identified in section 3422 and 

21 any other activities determined appropriate by the 

22 Secretary, in consultation with Indian Tribes. 

23 ‘‘SEC. 3422. USE OF AMOUNTS. 

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

25 received under a grant under section 3421 to provide diVerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365

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1 rect financial assistance to eligible entities for the purpose 

2 of delivering or enhancing— 

3 ‘‘(1) prevention services described in subsection 

4 (b); 

5 ‘‘(2) core medical services described in sub6 section (c); 

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

8 subsection (d); 

9 ‘‘(4) early intervention and engagement services 

10 described in subsection (e); 

11 ‘‘(5) harm reduction services described in sub12 section (f); and 

13 ‘‘(6) administrative expenses described in sub14 section (g). 

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

16 section, the term ‘prevention services’ means evidence17 based services, programs, or multi-sector strategies to pre18 vent substance use disorder (including education cam19 paigns, community-based prevention programs, risk iden20 tification programs, opioid diversion, collection and dis21 posal of unused opioids, services to at-risk populations, 

22 and trauma support services). 

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

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

25 following evidence-based services provided to individuals 


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1 with substance use disorder or at risk for developing sub2 stance use disorder, including through the use of telemedi3 cine or a hub and spoke model: 

4 ‘‘(1) Substance use disorder treatment, as more 

5 fully described in section 3439(4), including assess6 ment of disease presence, severity, and co-occurring 

7 conditions, treatment planning, clinical stabilization 

8 services, withdrawal management and detoxification, 

9 intensive inpatient treatment, intensive outpatient 

10 treatment, outpatient treatment, residential inpa11 tient services, treatment for co-occurring mental 

12 health and substance use disorders, and all drugs 

13 approved by the Food and Drug Administration for 

14 the treatment of substance use disorder. 

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

16 including those administered by federally qualified 

17 health centers, rural health clinics, tribal clinics and 

18 hospitals, urban Indian health facilities, certified 

19 community behavioral health clinics (as described in 

20 section 223 of the Protecting Access to Medicare 

21 Act), and comprehensive opioid recovery centers (as 

22 described in section 552 of this Act). 

23 ‘‘(3) Hospice services. 

24 ‘‘(4) Mental health services. 


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1 ‘‘(5) Opioid overdose reversal drug products 

2 procurement, distribution, and training. 

3 ‘‘(6) Pharmaceutical assistance related to the 

4 management of substance-use disorder and co-mor5 bid conditions. 

6 ‘‘(7) Home and community based health serv7 ices. 

8 ‘‘(8) Comprehensive Case Management and care 

9 coordination, including substance use disorder treat10 ment adherence services. 

11 ‘‘(9) Health insurance enrollment and cost12 sharing assistance in accordance with section 3412. 

13 ‘‘(d) RECOVERY AND SUPPORT SERVICES.—For pur14 poses of this section, the term ‘recovery and support serv15 ices’ means services that are provided to individuals with 

16 substance use disorder, including residential recovery 

17 housing, mental health services, long term recovery serv18 ices, 24/7 hotline crisis center support, medical transpor19 tation services, respite care for persons caring for individ20 uals with substance use disorder, child care and family 

21 services while an individual is receiving inpatient treat22 ment services or at the time of outpatient services, out23 reach services, peer recovery services, nutrition services, 

24 and referrals for job training and career services, housing, 

25 legal services, and child care and family services. The entiVerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365

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1 ties through which such services may be provided include 

2 local and tribal authorities that provide child care, hous3 ing, community development, and other recovery and sup4 port services, so long as they do not exclude individuals 

5 on the basis that such individuals receive medication-as6 sisted treatment. 

7 ‘‘(e) EARLY INTERVENTION SERVICES.—For pur8 poses of this section, the term ‘early intervention services’ 

9 means services to provide screening and connection to the 

10 appropriate level of substance use disorder and mental 

11 health treatment (including same-day connection), coun12 seling provided to individuals who have misused sub13 stances, who have experienced an overdose, or are at risk 

14 of developing substance use disorder, the provision of re15 ferrals to facilitate the access of such individuals to core 

16 medical services or recovery and support services for sub17 stance use disorder, and rapid access to medication-as18 sisted treatment in the setting of recent overdose. The en19 tities through which such services may be provided include 

20 emergency rooms, fire departments and emergency med21 ical services, detention facilities, prisons and jails homeless 

22 shelters, law enforcement agencies, health care points of 

23 entry specified by eligible local areas, federally qualified 

24 health centers, tribal clinics and hospitals, urban Indian 

25 health facilities, and rural health clinics. 


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

2 this section, the term ‘harm reduction services’ means evi3 dence-based services provided to individuals engaging in 

4 substance use that reduce the risk of infectious disease 

5 transmission, overdose, or death, including by increasing 

6 access to health care, housing, and recovery and support 

7 services. 

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

9 (not including tribal entities) shall not use in excess of 

10 10 percent of amounts received under a grant under sec11 tion 3421 for administration, accounting, reporting, and 

12 program oversight functions, including for the purposes of 

13 developing systems to improve data collection and data 

14 sharing. 

15 ‘‘SEC. 3423. TECHNICAL ASSISTANCE. 

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

17 contracts, provide technical assistance to nonprofit private 

18 entities and Indian entities regarding the process of sub19 mitting to the Secretary applications for grants under sec20 tion 3421, and may provide technical assistance with re21 spect to the planning, development, and operation of any 

22 program or service carried out pursuant to such section. 

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

24 ‘‘(a) IN GENERAL.—The Secretary may provide plan25 ning grants to public, nonprofit private, and Indian entiVerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365

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1 ties for purposes of assisting such entities in expanding 

2 their capacity to provide substance use disorder treatment 

3 services in low-income communities and affected sub4 populations that are underserviced with respect to such 

5 services. 

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

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

8 ‘‘SEC. 3425. AUTHORIZATION OF APPROPRIATIONS. 

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

10 this subtitle— 

11 ‘‘(1) $500,000,000 for fiscal year 2020; 

12 ‘‘(2) $500,000,000 for fiscal year 2021; 

13 ‘‘(3) $500,000,000 for fiscal year 2022; 

14 ‘‘(4) $500,000,000 for fiscal year 2023; 

15 ‘‘(5) $500,000,000 for fiscal year 2024; 

16 ‘‘(6) $500,000,000 for fiscal year 2025; 

17 ‘‘(7) $500,000,000 for fiscal year 2026; 

18 ‘‘(8) $500,000,000 for fiscal year 2027; 

19 ‘‘(9) $500,000,000 for fiscal year 2028; and 

20 ‘‘(10) $500,000,000 for fiscal year 2029. 


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1 ‘‘Subtitle D—Innovation, Training, 

2 and Health Systems Strengthening 

3 ‘‘SEC. 3431. SPECIAL PROJECTS OF NATIONAL SIGNIFI4 CANCE. 

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

6 grants to entities to administer special projects of national 

7 significance to support the development of innovative and 

8 original models for the delivery of substance use disorder 

9 treatment services. 

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

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

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

13 emerging needs of individuals receiving assistance under 

14 this title. 

15 ‘‘(c) REPLICATION.—The Secretary shall make infor16 mation concerning successful models or programs devel17 oped under this section available to grantees under this 

18 title for the purpose of coordination, replication, and inte19 gration. To facilitate efforts under this section, the Sec20 retary may provide for peer-based technical assistance for 

21 grantees funded under this section. 

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

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

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


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1 section 4 of the Indian Self-Determination and Edu2 cation Assistance Act. 

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

4 through the Indian Health Service, shall use 10 per5 cent of the amount available under this section for 

6 each fiscal year to provide grants to Indian tribes 

7 for the purposes of supporting the development of 

8 innovative and original models for the delivery of 

9 substance use disorder treatment services, including 

10 the development of culturally-informed care models. 

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

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

13 ‘‘(1) $500,000,000 for fiscal year 2020; 

14 ‘‘(2) $500,000,000 for fiscal year 2021; 

15 ‘‘(3) $500,000,000 for fiscal year 2022; 

16 ‘‘(4) $500,000,000 for fiscal year 2023; 

17 ‘‘(5) $500,000,000 for fiscal year 2024; 

18 ‘‘(6) $500,000,000 for fiscal year 2025; 

19 ‘‘(7) $500,000,000 for fiscal year 2026; 

20 ‘‘(8) $500,000,000 for fiscal year 2027; 

21 ‘‘(9) $500,000,000 for fiscal year 2028; and 

22 ‘‘(10) $500,000,000 for fiscal year 2029. 

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

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

25 and enter into contracts to assist public and nonprofit priVerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365

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1 vate entities, public and nonprofit schools, and academic 

2 health centers in meeting the cost of projects— 

3 ‘‘(1) to train health professionals, including 

4 practitioners in programs under this title and other 

5 community providers, including physician addiction 

6 specialists, psychologists, counselors, case managers, 

7 social workers, peer recovery coaches, harm reduc8 tion workers, public health workers, and community 

9 health workers, in the diagnosis, treatment, and pre10 vention of substance use disorders, including meas11 ures for the prevention and treatment of co-occur12 ring infectious diseases, mental health disorders, and 

13 other conditions, and including (as applicable to the 

14 type of health professional involved), care for 

15 women, pregnant women, and children; 

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

17 nursing, public health, osteopathic medicine, den18 tistry, allied health, and mental health practice to 

19 teach health professions students to screen for and 

20 provide for the needs of individuals with substance 

21 use disorders or at risk of substance use; and 

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

23 resource materials relating to evidence-based prac24 tices for the screening, prevention, and treatment of 

25 substance use disorders, including information about 


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1 combating stigma, prescribing best practices, alter2 native pain therapies, and all drugs approved by the 

3 Food and Drug Administration for the treatment of 

4 substance use disorders, including for the purposes 

5 authorized under the amendments made by section 

6 3203 of the SUPPORT for Patients and Commu7 nities Act. 

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

9 grants under subsection (a), the Secretary shall give pref10 erence to qualified projects that will— 

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

12 professionals and other community providers de13 scribed in subsection (a)(1), to provide substance 

14 use disorder treatments for underserved groups, in15 cluding minority individuals and Indians with sub16 stance use disorder and other individuals who are at 

17 a high risk of substance use; 

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

19 health professionals and minority allied health pro20 fessionals, to provide substance use disorder treat21 ment for individuals with such disease; 

22 ‘‘(3) train or result in the training of individ23 uals who will provide substance use disorder treat24 ment in rural or other areas that are underserved by 

25 current treatment structures; 


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

2 professionals and allied health professionals, includ3 ing counselors, case managers, social workers, peer 

4 recovery coaches, and harm reduction workers, pub5 lic health workers, and community health workers, 

6 to provide treatment for infectious diseases and 

7 mental health disorders co-occurring with substance 

8 use disorder; and 

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

10 professionals and other community providers to pro11 vide substance use disorder treatments for pregnant 

12 women, children, and adolescents. 

13 ‘‘(c) NATIVE EDUCATION AND TRAINING CEN14 TERS.—The Secretary shall use 10 percent of the amount 

15 available under subsection (d) for each fiscal year to pro16 vide grants authorized under this subtitle to— 

17 ‘‘(1) tribal colleges and universities; 

18 ‘‘(2) Indian Health Service grant funded insti19 tutions; and 

20 ‘‘(3) Native partner institutions, including insti21 tutions of higher education with medical training 

22 programs that partner with one or more Indian 

23 tribes, tribal organizations, Native Hawaiian organi24 zations, or tribal colleges and universities to train 

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1 stance use disorder treatment services in Native 

2 communities. 

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

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

5 ‘‘(1) $500,000,000 for fiscal year 2020; 

6 ‘‘(2) $500,000,000 for fiscal year 2021; 

7 ‘‘(3) $500,000,000 for fiscal year 2022; 

8 ‘‘(4) $500,000,000 for fiscal year 2023; 

9 ‘‘(5) $500,000,000 for fiscal year 2024; 

10 ‘‘(6) $500,000,000 for fiscal year 2025; 

11 ‘‘(7) $500,000,000 for fiscal year 2026; 

12 ‘‘(8) $500,000,000 for fiscal year 2027; 

13 ‘‘(9) $500,000,000 for fiscal year 2028; and 

14 ‘‘(10) $500,000,000 for fiscal year 2029. 

15 ‘‘SEC. 3433. SUBSTANCE USE DISORDER TREATMENT PRO16 VIDER CAPACITY UNDER THE MEDICAID PRO17 GRAM. 

18 ‘‘(a) IN GENERAL.—The Secretary shall use amounts 

19 appropriated under this section to provide funding for 

20 projects in any State or territory to increase substance use 

21 provider capacity, as provided for in section 1903(aa) of 

22 the Social Security Act. 

23 ‘‘(b) AMOUNT OF GRANT TO INDIAN ENTITIES.— 

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

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


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1 section 4 of the Indian Self-Determination and Edu2 cation Assistance Act. 

3 ‘‘(2) GRANTS.—The Secretary, acting through 

4 the Indian Health Service, shall use 10 percent of 

5 the amount appropriated under this section for each 

6 fiscal year to award grants to Indian tribes in an 

7 amount determined pursuant to criteria developed by 

8 the Secretary in consultation with Indian tribes. 

9 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

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

11 ‘‘(1) $50,000,000 for fiscal year 2020; 

12 ‘‘(2) $50,000,000 for fiscal year 2021; 

13 ‘‘(3) $50,000,000 for fiscal year 2022; 

14 ‘‘(4) $50,000,000 for fiscal year 2023; 

15 ‘‘(5) $50,000,000 for fiscal year 2024; 

16 ‘‘(6) $50,000,000 for fiscal year 2025; 

17 ‘‘(7) $50,000,000 for fiscal year 2026; 

18 ‘‘(8) $50,000,000 for fiscal year 2027; 

19 ‘‘(9) $50,000,000 for fiscal year 2028; and 

20 ‘‘(10) $50,000,000 for fiscal year 2029. 

21 ‘‘SEC. 3434. PROGRAMS TO SUPPORT EMPLOYEES. 

22 ‘‘(a) GRANT PROGRAM FOR WORKERS.— 

23 ‘‘(1) IN GENERAL.—The Secretary, acting 

24 through the Director of the National Institute for 

25 Occupational Safety and Health, shall award grants 


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1 to non-profit entities that meet the requirements of 

2 this section to fund programs and projects to assist 

3 workers who are at risk of substance use disorder, 

4 who have substance use disorder, or who are recov5 ering from substance use disorder to maintain or 

6 gain employment. 

7 ‘‘(2) GRANTS FOR WORKERS.— 

8 ‘‘(A) IN GENERAL.—The Secretary shall, 

9 on a competitive basis, award grants for a pe10 riod of not more than 3 years to non-profit en11 tities that submit an application under para12 graph (3) to enable such entities to implement, 

13 conduct, continue, and expand evidence-based 

14 programs and projects to assist individuals de15 scribed in subparagraph (G). 

16 ‘‘(B) USE OF AMOUNTS.—An entity may 

17 use amounts provided under this subsection 

18 for— 

19 ‘‘(i) prevention services described in 

20 subparagraph (C), including providing edu21 cation and information to workers regard22 ing the dangers of illicit and licit drug use, 

23 non-opioid pain management and non-drug 

24 pain management, or occupational injury 

25 and illness prevention; 


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1 ‘‘(ii) early intervention services de2 scribed in subparagraph (D) to enable in3 dividuals to maintain or gain employment; 

4 ‘‘(iii) recovery and support services 

5 described in subparagraph (E) to enable 

6 individuals to maintain or gain employ7 ment; 

8 ‘‘(iv) harm reduction services de9 scribed in subparagraph (F) to enable indi10 viduals to maintain or gain employment; 

11 ‘‘(v) hiring case managers, care coor12 dinators, and peer support specialists to 

13 assist employed individuals who are experi14 encing substance use disorder, or who are 

15 recovering from substance use disorder, in 

16 accessing substance use disorder treatment 

17 services; or 

18 ‘‘(vi) providing vocational, life skills, 

19 and other forms of job training to workers 

20 who are receiving substance use disorder 

21 treatment services to enable such workers 

22 to maintain or gain employment. 

23 ‘‘(C) PREVENTION SERVICES.—For pur24 poses of this section, the term ‘prevention serv25 ices’ means evidence-based services, programs, 


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1 or multi-sector strategies to prevent substance 

2 use disorder (including education campaigns, 

3 community-based prevention programs, risk 

4 identification programs, opioid diversion, collec5 tion and disposal of unused opioids, services to 

6 at-risk populations, and trauma support serv7 ices). 

8 ‘‘(D) RECOVERY AND SUPPORT SERV9 ICES.—For purposes of this section, the term 

10 ‘recovery and support services’ means services 

11 including residential recovery housing, mental 

12 health services, long term recovery services, 24/ 

13 7 hotline crisis center services, medical trans14 portation services, respite care for persons car15 ing for individuals with substance use disorder, 

16 child care and family services while an indi17 vidual is receiving inpatient treatment services 

18 or at the time of outpatient services, outreach 

19 services, peer recovery services, nutrition serv20 ices, and referrals for job training and career 

21 services, housing, legal services, and child care 

22 and family services so long as they do not ex23 clude individuals on the basis that such individ24 uals receive medication-assisted treatment. 


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1 ‘‘(E) EARLY INTERVENTION SERVICES.— 

2 For purposes of this section, the term ‘early 

3 intervention services’ means services to provide 

4 screening and connection to the appropriate 

5 level of substance use disorder and mental 

6 health treatment (including same-day connec7 tion), counseling provided to individuals who 

8 have misused substances, who have experienced 

9 an overdose, or are at risk of developing sub10 stance use disorder, the provision of referrals to 

11 facilitate the access of such individuals to core 

12 medical services or recovery and support serv13 ices for substance use disorder, and rapid ac14 cess to medication-assisted treatment in the set15 ting of recent overdose. 

16 ‘‘(F) HARM REDUCTION SERVICES.—For 

17 purposes of this section, the term ‘harm reduc18 tion services’ means evidence-based services 

19 provided to individuals engaging in substance 

20 use that reduce the risk of infectious disease 

21 transmission, overdose, or death, including by 

22 increasing access to health care, housing, and 

23 recovery and support services. 


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1 ‘‘(G) INDIVIDUALS DESCRIBED.—Individ2 uals described in this subparagraph are individ3 uals who— 

4 ‘‘(i)(I) have been employed in the 12- 

5 month period immediately preceding the 

6 date on which the determination is being 

7 made, or who are participating in an em8 ployee training or apprenticeship program; 

9 and 

10 ‘‘(II) are at high risk of developing 

11 substance use disorder, including as a re12 sult of employment in industries that expe13 rience high rates of occupational injuries 

14 and illness; or 

15 ‘‘(ii) are experiencing a substance use 

16 disorder or are in recovery from a sub17 stance use disorder. 

18 ‘‘(3) APPLICATIONS.—To be eligible for a grant 

19 under this subsection, an entity shall submit to the 

20 Secretary an application at such time, in such man21 ner, and containing such information as the Sec22 retary may require, including— 

23 ‘‘(A) a complete accounting of the dis24 bursement of any prior grants received under 


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1 this title by the applicant and the results 

2 achieved by such expenditures; 

3 ‘‘(B) a description of the population to be 

4 served with grant funds provided under this 

5 section, including a description of the unique 

6 risks the population faces for experiencing occu7 pational injuries or exposure to illicit sub8 stances; 

9 ‘‘(C) the goals and objectives to be 

10 achieved with grant funds provided under this 

11 section, including targets and milestones that 

12 are intended to be met, the activities that will 

13 be undertaken to achieve those targets, and the 

14 number of individuals likely to be served by the 

15 grant funds, including demographic data on the 

16 populations to be served; 

17 ‘‘(D) a demonstration of the ability of the 

18 applicant to reach the individuals described in 

19 paragraph (2)(G) and to provide services de20 scribed in paragraph (2)(B) included in the ap21 plicant’s grant application, including by 

22 partnering with local stakeholders; 

23 ‘‘(E) for any prior funding received under 

24 this subsection, data provided in such form as 

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1 imum, the extent to which the activities sup2 ported by the funding met the goals, objectives, 

3 targets, and milestones specified in the applica4 tion for the funding, and the number of individ5 uals with and without substance use disorder 

6 who received services supported by the funding, 

7 including the services provided to these individ8 uals, the industries in which the individuals 

9 were employed when they received services, and 

10 whether the individuals were still employed in 

11 that same industry or in any industry when the 

12 individuals ceased receiving services supported 

13 by the funding; and 

14 ‘‘(F) any other information the Secretary 

15 shall require. 

16 ‘‘(4) DATA REPORTING AND OVERSIGHT.—An 

17 entity awarded a grant under this subsection shall 

18 submit to the Secretary an annual report at such 

19 time and in such manner as the Secretary shall re20 quire. Such report shall include, at a minimum, a 

21 description of— 

22 ‘‘(A) the activities funded by the grant; 

23 ‘‘(B) the number of individuals with and 

24 without substance use disorder served through 

25 activities funded by the grant, including the 


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1 services provided to those individuals and the 

2 industries in which those individuals were em3 ployed at the time they received services sup4 ported by the grant; 

5 ‘‘(C) for workers experiencing substance 

6 use disorder or recovering from substance use 

7 disorder served by activities funded by the 

8 grant, the number of individuals who main9 tained employment, the number of individuals 

10 who gained employment, and the number of in11 dividuals who failed to maintain employment 

12 over the course of the reporting period; and 

13 ‘‘(D) any other information required by the 

14 Secretary. 

15 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

16 There is authorized to be appropriated to carry out 

17 this subsection— 

18 ‘‘(A) $40,000,000 for fiscal year 2020; 

19 ‘‘(B) $40,000,000 for fiscal year 2021; 

20 ‘‘(C) $40,000,000 for fiscal year 2022; 

21 ‘‘(D) $40,000,000 for fiscal year 2023; 

22 ‘‘(E) $40,000,000 for fiscal year 2024; 

23 ‘‘(F) $40,000,000 for fiscal year 2025; 

24 ‘‘(G) $40,000,000 for fiscal year 2026; 

25 ‘‘(H) $40,000,000 for fiscal year 2027; 


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1 ‘‘(I) $40,000,000 for fiscal year 2028; and 

2 ‘‘(J) $40,000,000 for fiscal year 2029. 

3 ‘‘(b) RESEARCH ON THE IMPACT OF SUBSTANCE USE

4 DISORDER IN THE WORKPLACE AND ON DIRECT SERVICE

5 PROVIDERS.— 

6 ‘‘(1) RISKS OF SUBSTANCE USE DISORDER.— 

7 The Secretary, in consultation with the Director of 

8 the National Institute for Occupational Safety and 

9 Health, shall conduct (directly or through grants or 

10 contracts) research, experiments, and demonstra11 tions, and publish studies relating to— 

12 ‘‘(A) the risks faced by employees in var13 ious occupations of developing substance use 

14 disorder and of drug overdose deaths and non15 fatal drug overdoses, and the formulation of 

16 prevention activities tailored to the risks identi17 fied in these occupations, including occupational 

18 injury and illness prevention; 

19 ‘‘(B) the prevalence of substance use dis20 order among employees in various occupations; 

21 ‘‘(C) efforts that employers may undertake 

22 to assist employees who are undergoing sub23 stance use disorder treatment services in main24 taining employment while ensuring workplaces 

25 are safe and healthful; 


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1 ‘‘(D) risks of occupational exposure to 

2 opioids and other illicit substances and the for3 mulation of prevention activities tailored to the 

4 risks identified; and 

5 ‘‘(E) other subjects related to substance 

6 use disorder in the workplace as the Secretary 

7 determines. 

8 ‘‘(2) DIRECT SERVICE PROVIDERS.—The Sec9 retary shall conduct (directly or through grants or 

10 contracts) research, experiments, and demonstra11 tions, and publish studies relating to the occupa12 tional health and safety, recruitment, and retention 

13 of behavioral health providers who, as part of their 

14 job responsibilities, provide direct services to individ15 uals who are at risk of experiencing substance use 

16 disorder or who are experiencing or recovering from 

17 substance use disorder, including— 

18 ‘‘(A) identifying factors that the Secretary 

19 believes may endanger the health or safety of 

20 such workers, including factors that affect the 

21 risks such workers face of developing substance 

22 use disorder; 

23 ‘‘(B) motivational and behavioral factors 

24 relating to the field of behavioral health pro25 viders; 


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1 ‘‘(C) strategies to support the recruitment 

2 and retention of behavioral health providers; 

3 and 

4 ‘‘(D) other subjects related to behavioral 

5 health providers engaged in direct provision of 

6 substance use disorder prevention and treat7 ment services as the Secretary determines ap8 propriate. 

9 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

10 There is authorized to be appropriated to carry out 

11 this subsection— 

12 ‘‘(A) $10,000,000 for fiscal year 2020; 

13 ‘‘(B) $10,000,000 for fiscal year 2021; 

14 ‘‘(C) $10,000,000 for fiscal year 2022; 

15 ‘‘(D) $10,000,000 for fiscal year 2023; 

16 ‘‘(E) $10,000,000 for fiscal year 2024; 

17 ‘‘(F) $10,000,000 for fiscal year 2025; 

18 ‘‘(G) $10,000,000 for fiscal year 2026; 

19 ‘‘(H) $10,000,000 for fiscal year 2027; 

20 ‘‘(I) $10,000,000 for fiscal year 2028; and 

21 ‘‘(J) $10,000,000 for fiscal year 2029. 

22 ‘‘SEC. 3435. IMPROVING AND EXPANDING CARE. 

23 ‘‘(a) LEVEL OF CARE STANDARDS FOR SUBSTANCE

24 USE DISORDER TREATMENT SERVICES.— 


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1 ‘‘(1) IN GENERAL.—Not later than 1 year after 

2 the date of enactment of this title, the Secretary, in 

3 consultation with the American Society of Addiction 

4 Medicine and with State and tribal officials as the 

5 Secretary determines necessary, shall promulgate 

6 model standards for the regulation of substance use 

7 disorder treatment services. 

8 ‘‘(2) SUBSTANCE USE DISORDER TREATMENT

9 SERVICES.—The model standards promulgated 

10 under paragraph (1) shall, at a minimum— 

11 ‘‘(A) identify the types of substance use 

12 disorder treatment services intended to be cov13 ered without regard to whether they participate 

14 in any Federal health care program (as defined 

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

16 and shall not include— 

17 ‘‘(i) a private practitioner who is al18 ready licensed by a State licensing board 

19 and whose practice is limited to non-inten20 sive outpatient care; or 

21 ‘‘(ii) any substance use disorder treat22 ment service provided on a non-intensive 

23 outpatient basis in the office of a private 

24 practitioner who is licensed by a State li25 censing board; 


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1 ‘‘(B) require the designation of a single 

2 State agency to serve as the primary regulator 

3 in the State for substance use disorder treat4 ment services; 

5 ‘‘(C) subject to paragraph (3), require that 

6 substance use disorder treatment services iden7 tified in accordance with subparagraph (A), be 

8 licensed by the respective States according to 

9 the standards for levels of care set forth by the 

10 American Society of Addiction Medicine in 

11 2013 or an equivalent set of standards; 

12 ‘‘(D) require implementation of a process 

13 to ensure that substance use disorder treatment 

14 program qualifications are verified by means of 

15 an onsite inspection not less frequently than 

16 every 3 years by the State agency serving as 

17 the primary regulator in the State for substance 

18 use disorder treatment services or by an inde19 pendent third party that is approved by the 

20 State’s primary regulator; and 

21 ‘‘(E) require that all patients leaving a res22 idential treatment program receive a written 

23 transition plan prior to discharge from that 

24 level of care. 


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1 ‘‘(3) ANNUAL ASSESSMENT.—Beginning with 

2 respect to fiscal year 2022, the Secretary shall make 

3 a determination with respect to each State on 

4 whether the State has adopted, for each of the sub5 stance use disorder treatment services identified in 

6 accordance with paragraph (2)(A), licensure stand7 ards that are in compliance in all material respects 

8 with the model standards promulgated in accordance 

9 with this subsection. In the event the American Soci10 ety of Addiction Medicine revises its criteria, the 

11 Secretary shall revise the national model level of 

12 care standards accordingly and disseminate any such 

13 update to the States, and the States may adopt any 

14 such updates to be in compliance with this sub15 section. 

16 ‘‘(b) STANDARDS FOR OTHER SPECIFIED MATTERS

17 RELATED TO SUBSTANCE USE DISORDER TREATMENT

18 SERVICES AND RECOVERY RESIDENCES.— 

19 ‘‘(1) IN GENERAL.—Not later than 2 year after 

20 the date of enactment of this title, the Secretary, in 

21 consultation with representatives of nonprofit service 

22 providers and State and tribal officials as the Sec23 retary determines necessary, shall promulgate model 

24 standards for the regulation of— 


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1 ‘‘(A) other specified matters related to sub2 stance use disorder treatment services; and 

3 ‘‘(B) recovery residences. 

4 ‘‘(2) OTHER SPECIFIED MATTERS RELATED TO

5 SUBSTANCE USE DISORDER TREATMENT SERV6 ICES.—The model standards promulgated under 

7 paragraph (1)(A) shall, at a minimum— 

8 ‘‘(A) identify the professional credentials 

9 needed by each type of substance use disorder 

10 treatment professional; 

11 ‘‘(B) include standards for data reporting 

12 and require compilation of statewide reports; 

13 ‘‘(C) require the establishment and mainte14 nance within each State of a toll-free telephone 

15 number to receive complaints from the public 

16 regarding substance use disorder treatment 

17 service providers; and 

18 ‘‘(D) require the establishment and main19 tenance on a publicly accessible internet website 

20 of a list of all substance use disorder treatment 

21 services in the State that have a certification in 

22 effect in accordance with this section. 

23 ‘‘(3) RECOVERY RESIDENCES.— 

24 ‘‘(A) ECONOMIC RELATIONSHIP.—The 

25 model standards promulgated under paragraph 


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1 (1)(B) shall, at a minimum, be applied to recov2 ery residences that have an ongoing economic 

3 relationship with any commercial substance use 

4 disorder treatment service. 

5 ‘‘(B) MINIMUM REQUIREMENTS.—The 

6 model standards promulgated under paragraph 

7 (1)(B), which may include any model laws de8 veloped under section 550(a) shall, at a min9 imum, identify requirements for— 

10 ‘‘(i) the designation of a single State 

11 agency to certify recovery residences; 

12 ‘‘(ii) the implementation of a process 

13 to ensure that the qualifications of recov14 ery residences in which not fewer than 10 

15 individuals may lawfully reside are verified 

16 by means of an onsite inspection not less 

17 frequently than every 3 years by the State 

18 agency serving as the primary regulator in 

19 the State or by an independent third party 

20 that is approved by the State’s primary 

21 regulator; 

22 ‘‘(iii) fire, safety, and health stand23 ards; 

24 ‘‘(iv) equipping residences with opioid 

25 overdose reversal drug products, such as 


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1 naloxone and training residence owners, 

2 operators, and employees in the adminis3 tration of naloxone; 

4 ‘‘(v) recovery residence owners and 

5 operators; 

6 ‘‘(vi) a written policy that prohibits 

7 the exclusion of individuals on the basis 

8 that such individuals receive drugs ap9 proved by the Food and Drug Administra10 tion for the treatment of substance use dis11 order; 

12 ‘‘(vii) the establishment and mainte13 nance within each State of a toll-free tele14 phone number to receive complaints from 

15 the public regarding recovery residences; 

16 and 

17 ‘‘(viii) the establishment and mainte18 nance on a publicly accessible internet 

19 website of a list of all recovery residences 

20 in the State that have a certification in ef21 fect in accordance with this section. 

22 ‘‘(4) ANNUAL ASSESSMENT.—Beginning with 

23 respect to fiscal year 2023, the Secretary shall make 

24 a determination with respect to each State on 

25 whether the State has adopted, for each of the other 


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1 specified substance use disorder treatment services 

2 identified in this section and for recovery residences, 

3 standards that are in compliance in all material re4 spects with the model standards promulgated in ac5 cordance with this subsection. 

6 ‘‘(c) ENSURING ACCESS TO MEDICATION-ASSISTED

7 TREATMENT.— 

8 ‘‘(1) MEDICATION-ASSISTED TREATMENT.—The 

9 Secretary may not make a grant under this section 

10 unless the applicant for the grant agrees to require 

11 all entities offering substance use disorder treatment 

12 services under the grant to offer all drugs approved 

13 by the Food and Drug Administration for the treat14 ment of substance use disorder for which the appli15 cant offers treatment. 

16 ‘‘(2) WAIVER.—The Secretary may grant a 

17 waiver with respect to any requirement of this sec18 tion if the grant applicant involved— 

19 ‘‘(A) submits to the Secretary a justifica20 tion for such waiver containing such informa21 tion as the Secretary shall require; and 

22 ‘‘(B) agrees to require all entities offering 

23 substance use disorder treatment services under 

24 the grant to— 


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1 ‘‘(i) offer, on site, at least 2 drugs ap2 proved by the Food and Drug Administra3 tion for the treatment of substance use dis4 order; 

5 ‘‘(ii) provide counseling to patients on 

6 the benefits and risks of all drugs ap7 proved by the Food and Drug Administra8 tion for the treatment of substance use dis9 order; and 

10 ‘‘(iii) maintain an affiliation agree11 ment with a provider that can prescribe or 

12 otherwise dispense all other forms of drugs 

13 approved by the Food and Drug Adminis14 tration for the treatment of substance use 

15 disorder. 

16 ‘‘(3) GAO STUDY.—Not later than 1 year after 

17 the date of enactment of this title, the Comptroller 

18 General of the United States shall submit to Con19 gress a comprehensive report describing any rela20 tionship between substance use rates, pain manage21 ment practices of the Indian Health Service, and pa22 tient request denials through the purchased/referred 

23 care program of the Indian Health Service. 

24 ‘‘(d) ENSURING A FULL CONTINUUM OF SERV25 ICES.— 


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1 ‘‘(1) IN GENERAL.—Not later than 6 months 

2 after the date of the enactment of this title, the Ad3 ministrator of the Centers for Medicare & Medicaid 

4 Services shall issue a State Medicaid Director letter 

5 and tribal leader letter explaining how States and 

6 tribes can ensure access to a continuum of services 

7 for adults with substance use disorders who are re8 ceiving medical assistance under title XIX of the So9 cial Security Act. Such letter shall describe how 

10 States can cover the continuum of community-based, 

11 residential, and inpatient substance use disorder 

12 services and care coordination between different lev13 els of care as medical assistance, as defined in sec14 tion 1905(a) of such Act, including through section 

15 1915 of such Act and through demonstration 

16 projects under section 1115 of such Act. 

17 ‘‘(2) MACPAC ANALYSIS.—Not later than 1 

18 year after the date of the enactment of this title, the 

19 Medicaid and CHIP Payment and Access Commis20 sion shall conduct an analysis, and make publicly 

21 available a report containing the results of such 

22 analysis, of States’ coverage of substance use serv23 ices for Medicaid beneficiaries. Such report shall in24 clude examples of promising strategies States use to 


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1 cover a continuum of community-based substance 

2 use services. 

3 ‘‘(3) ANNUAL ASSESSMENT.—Beginning with 

4 respect to fiscal year 2022, the Secretary shall make 

5 a determination with respect to each State on 

6 whether the State has carried out the requirements 

7 to ensure a continuum of services as described in 

8 section 1915(l)(4)(C) of the Social Security Act. 

9 ‘‘SEC. 3436. NALOXONE DISTRIBUTION PROGRAM. 

10 ‘‘(a) ESTABLISHMENT OF PROGRAM.— 

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

12 for the purchase and delivery of federally approved 

13 opioid overdose reversal drug products on behalf of 

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

15 of the Indian Health Care Improvement Act) that 

16 receives a grant under subtitle B. This paragraph 

17 constitutes budget authority in advance of appro18 priations Acts, and represents the obligation of the 

19 Federal Government to provide for the purchase and 

20 delivery to States and Indian tribes of the opioid 

21 overdose reversal drug products in accordance with 

22 this paragraph. 

23 ‘‘(2) SPECIAL RULES WHERE OPIOID OVERDOSE

24 REVERSAL DRUG PRODUCTS ARE UNAVAILABLE.—To 

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1 dose reversal drug products are not available for 

2 purchase or delivery under paragraph (1), the Sec3 retary shall provide for the purchase and delivery of 

4 the available opioid overdose reversal drug products 

5 in accordance with priorities established by the Sec6 retary, with priority given to States with at least one 

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

8 ‘‘(b) NEGOTIATION OF CONTRACTS WITH MANUFAC9 TURERS.— 

10 ‘‘(1) IN GENERAL.—For the purpose of car11 rying out this section, the Secretary shall negotiate 

12 and enter into contracts with manufacturers of 

13 opioid overdose reversal drug products consistent 

14 with the requirements of this subsection and, to the 

15 maximum extent practicable, consolidate such con16 tracting with any other contracting activities con17 ducted by the Secretary to purchase opioid overdose 

18 reversal drug products. The Secretary may enter 

19 into such contracts under which the Federal Govern20 ment is obligated to make outlays, the budget au21 thority for which is not provided for in advance in 

22 appropriations Acts, for the purchase and delivery of 

23 opioid overdose reversal drug products under sub24 section (a). 


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

2 The Secretary may decline to enter into contracts 

3 under this subsection and may modify or extend 

4 such contracts. 

5 ‘‘(3) CONTRACT PRICE.— 

6 ‘‘(A) IN GENERAL.—The Secretary, in ne7 gotiating the prices at which opioid overdose re8 versal drug products will be purchased and de9 livered from a manufacturer under this sub10 section, shall take into account quantities of 

11 opioid overdose reversal drug products to be 

12 purchased by States under the option under 

13 paragraph (4)(B). 

14 ‘‘(B) NEGOTIATION OF DISCOUNTED PRICE

15 FOR OPIOID OVERDOSE REVERSAL DRUG PROD16 UCTS.—With respect to contracts entered into 

17 for the purchase of opioid overdose reversal 

18 drug products on behalf of States under this 

19 subsection, the price for the purchase of such 

20 drug product shall be a discounted price nego21 tiated by the Secretary. 

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

23 reversal products purchased under this section shall 

24 contain— 


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

2 of active pharmaceutical ingredient that acts as 

3 an opioid receptor antagonist as recommended 

4 by the Food and Drug Administration as an 

5 initial dose when administered by one of the ap6 proved, labeled routes of administration in 

7 adults; and 

8 ‘‘(B) a minimum of two doses packaged to9 gether. 

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

11 Under contracts under this subsection— 

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

13 with paragraph (6), for the purchase and deliv14 ery on behalf of States and Indian tribes of 

15 quantities of opioid overdose reversal drug 

16 products; and 

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

18 option of the State or tribe, shall be permitted 

19 to obtain additional quantities of opioid over20 dose reversal drug products (subject to amounts 

21 specified to the Secretary by the State or tribe 

22 in advance of negotiations) through purchasing 

23 the opioid overdose reversal drug products from 

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1 graph (3), if the State or tribe provides to the 

2 Secretary such information (at a time and man3 ner specified by the Secretary, including in ad4 vance of negotiations under paragraph (1)) as 

5 the Secretary determines to be necessary, to 

6 provide for quantities of opioid overdose rever7 sal drug products for the State or tribe to pur8 chase pursuant to this subsection and to deter9 mine annually the percentage of the opioid over10 dose reversal drug market that is purchased 

11 pursuant to this section and this subparagraph. 

12 The Secretary shall enter into the initial negotia13 tions not later than 180 days after the date of the 

14 enactment of this title. 

15 ‘‘(6) CHARGES FOR SHIPPING AND HAN16 DLING.—The Secretary may enter into a contract 

17 referred to in paragraph (1) only if the manufac18 turer involved agrees to submit to the Secretary 

19 such reports as the Secretary determines to be ap20 propriate to assure compliance with the contract and 

21 if, with respect to a State program under this sec22 tion that does not provide for the direct delivery of 

23 qualified opioid overdose reversal drug products, the 

24 manufacturer involved agrees that the manufacturer 

25 will provide for the delivery of the opioid overdose 


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1 reversal drug products on behalf of the State in ac2 cordance with such program and will not impose any 

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

4 extent such costs are provided for in the price estab5 lished under paragraph (3)). 

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

7 opioid overdose reversal drug product involved, the 

8 Secretary may, as appropriate, enter into a contract 

9 referred to in paragraph (1) with each manufacturer 

10 of the opioid overdose reversal drug product that 

11 meets the terms and conditions of the Secretary for 

12 an award of such a contract (including terms and 

13 conditions regarding safety and quality). With re14 spect to multiple contracts entered into pursuant to 

15 this paragraph, the Secretary may have in effect dif16 ferent prices under each of such contracts and, with 

17 respect to a purchase by States pursuant to para18 graph (4)(B), each eligible State may choose which 

19 of such contracts will be applicable to the purchase. 

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

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

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

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

24 delivery, and administration of opioid overdose reversal 

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


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

2 advisory committee, established by the Secretary and lo3 cated within the Centers for Disease Control and Preven4 tion, which considers the cost effectiveness of each opioid 

5 overdose reversal drug product. 

6 ‘‘(d) STATE DISTRIBUTION OF OPIOID OVERDOSE

7 REVERSAL DRUG PRODUCTS.—States shall distribute 

8 opioid overdose reversal drug products received under this 

9 section to the following: 

10 ‘‘(1) First responders, including— 

11 ‘‘(A) all State, county, and local law en12 forcement departments; 

13 ‘‘(B) all local fire departments, including 

14 career fire departments, combination fire de15 partments, and volunteer fire departments; and 

16 ‘‘(C) all local emergency medical services 

17 organizations, including volunteer emergency 

18 medical services organizations. 

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

20 local public health services, including all local health 

21 departments, for the purposes of making opioid over22 dose reversal drug products available to— 

23 ‘‘(A) public and nonprofit entities, includ24 ing— 


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1 ‘‘(i) community-based organizations 

2 that provide substance use disorder treat3 ments or harm reduction services; 

4 ‘‘(ii) nonprofit entities that provide 

5 substance use disorder treatments or harm 

6 reduction services; and 

7 ‘‘(iii) faith based organizations that 

8 provide substance use disorder treatments 

9 or harm reduction services; 

10 ‘‘(B) other areas of high need; and 

11 ‘‘(C) the general public. 

12 ‘‘(e) STATE REQUIREMENTS.—To be eligible to re13 ceive opioid overdose reversal drugs under this section, 

14 each State shall— 

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

16 overdose reversal drug products to first responders 

17 and entities with authority to administer local public 

18 health services, including local health departments; 

19 ‘‘(2) beginning in the second year of the pro20 gram, demonstrate a distribution rate of a minimum 

21 of 90 percent of the opioid overdose reversal drug 

22 products received under this program; and 

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

24 in place a Good Samaritan Law that ensures immu25 nity from prosecution, including from parole and 


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1 probation violations, except that the State may apply 

2 to the Secretary for a waiver of the requirement of 

3 this paragraph, and such waiver if granted shall not 

4 be longer than 3 years in duration and may not be 

5 renewed; and 

6 ‘‘(4) certify to the Secretary that the State has 

7 in place additional measures that enhance access to 

8 opioid overdose reversal drug products, such as laws 

9 that provide civil or disciplinary immunity for med10 ical personnel who prescribe an opioid overdose re11 versal drug product, Third Party Prescription Laws, 

12 Collaborative Practice Agreements, and Standing 

13 Orders. 

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

15 Health Service, in consultation with Indian tribes, shall 

16 determine any requirements that shall apply to Indian 

17 tribes receiving opioid overdose reversal drug products 

18 made available under this section. 

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

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

21 ‘career fire department’ means a fire department 

22 that has an all-paid force of firefighting personnel 

23 other than paid-on-call firefighters. 

24 ‘‘(2) COLLABORATIVE PRACTICE AGREEMENT.— 

25 The term ‘Collaborative Practice Agreement’ means 


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1 an agreement under which a pharmacist operates 

2 under authority delegated by another licensed practi3 tioner with prescribing authority. 

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

5 term ‘combination fire department’ means a fire de6 partment that has paid firefighting personnel and 

7 volunteer firefighting personnel. 

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

9 term ‘emergency medical service’ means resources 

10 used by a public or private nonprofit licensed entity 

11 to deliver medical care outside of a medical facility 

12 under emergency conditions that occur as a result of 

13 the condition of the patient and includes services de14 livered (either on a compensated or volunteer basis) 

15 by an emergency medical services provider or other 

16 provider that is licensed or certified by the State in17 volved as an emergency medical technician, a para18 medic, or an equivalent professional (as determined 

19 by the State). 

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

21 Samaritan Law’ means a law that provides criminal 

22 immunity for a person who administers an opioid 

23 overdose reversal drug product, a person who, in 

24 good faith, seeks medical assistance for someone ex25 periencing a drug-related overdose, or a person who 


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

2 medical assistance and, in good faith, seeks such 

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

4 faith request for medical assistance. 

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

6 tribe’, ‘tribal organization’, and ‘Urban Indian 

7 Health Program’ have the meanings given such 

8 terms in section 4 of the Indian Health Care Im9 provement Act. 

10 ‘‘(7) MANUFACTURER.—The term ‘manufac11 turer’ means any corporation, organization, or insti12 tution, whether public or private (including Federal, 

13 State, and local departments, agencies, and instru14 mentalities), which manufactures, imports, proc15 esses, or distributes under its label any opioid over16 dose reversal drug product. The term ‘manufacture’ 

17 means to manufacture, import, process, or distribute 

18 an opioid overdose reversal drug. 

19 ‘‘(8) OPIOID OVERDOSE REVERSAL DRUG PROD20 UCT.—The term ‘opioid overdose reversal drug prod21 uct’ means a finished dosage form that has been ap22 proved by the Food and Drug Administration and 

23 that contains an active pharmaceutical ingredient 

24 that acts as an opioid receptor antagonist. The term 

25 ‘opioid overdose reversal drug product’ includes a 


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1 combination product, as defined in section 3.2(e) of 

2 title 21, Code of Federal Regulations. 

3 ‘‘(9) STANDING ORDER.—The term ‘standing 

4 order’ means a non-patient-specific order covering 

5 administration of medication by others to a patient 

6 who may be unknown to the prescriber at the time 

7 of the order. 

8 ‘‘(10) THIRD PARTY PRESCRIPTION.—The term 

9 ‘third party prescription’ means an order written for 

10 medication dispensed to one person with the inten11 tion that it will be administered to another person. 

12 ‘‘(11) VOLUNTEER FIRE DEPARTMENT.—The 

13 term ‘volunteer fire department’ means a fire de14 partment that has an all-volunteer force of fire15 fighting personnel. 

16 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

17 is authorized to be appropriated to carry out this suc18 tion— 

19 ‘‘(1) $500,000,000 for fiscal year 2020; 

20 ‘‘(2) $500,000,000 for fiscal year 2021; 

21 ‘‘(3) $500,000,000 for fiscal year 2022; 

22 ‘‘(4) $500,000,000 for fiscal year 2023; 

23 ‘‘(5) $500,000,000 for fiscal year 2024; 

24 ‘‘(6) $500,000,000 for fiscal year 2025; 

25 ‘‘(7) $500,000,000 for fiscal year 2026; 


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1 ‘‘(8) $500,000,000 for fiscal year 2027; 

2 ‘‘(9) $500,000,000 for fiscal year 2028; and 

3 ‘‘(10) $500,000,000 for fiscal year 2029. 

4 ‘‘SEC. 3437. ADDITIONAL FUNDING FOR THE NATIONAL IN5 STITUTES OF HEALTH. 

6 ‘‘There is authorized to be appropriated to the Na7 tional Institutes of Health for the purpose of conducting 

8 research on addiction and pain, including research to de9 velop overdose reversal drug products, non-opioid drug 

10 products and non-pharmacological treatments for address11 ing pain and substance use disorder, and drug products 

12 used to treat substance use disorder— 

13 ‘‘(1) $700,000,000 for fiscal year 2020; 

14 ‘‘(2) $700,000,000 for fiscal year 2021; 

15 ‘‘(3) $700,000,000 for fiscal year 2022; 

16 ‘‘(4) $700,000,000 for fiscal year 2023; 

17 ‘‘(5) $700,000,000 for fiscal year 2024; 

18 ‘‘(6) $700,000,000 for fiscal year 2025; 

19 ‘‘(7) $700,000,000 for fiscal year 2026; 

20 ‘‘(8) $700,000,000 for fiscal year 2027; 

21 ‘‘(9) $700,000,000 for fiscal year 2028; and 

22 ‘‘(10) $700,000,000 for fiscal year 2029. 


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1 ‘‘SEC. 3438. ADDITIONAL FUNDING FOR THE CENTERS FOR 

2 DISEASE CONTROL AND PREVENTION. 

3 ‘‘(a) IMPROVED DATA COLLECTION AND PREVEN4 TION OF INFECTIOUS DISEASE TRANSMISSION.— 

5 ‘‘(1) DATA COLLECTION.—The Centers for Dis6 ease Control and Prevention shall use a portion of 

7 the funding appropriated under this section to en8 sure that all States participate in the Enhanced 

9 State Opioid Overdose Surveillance program and to 

10 provide technical assistance to medical examiners 

11 and coroners to facilitate improved data collection on 

12 fatal overdoses through such program. 

13 ‘‘(2) CENTERS FOR DISEASE CONTROL AND

14 PREVENTION.—The Centers for Disease Control and 

15 Prevention shall use amounts appropriated under 

16 this section for the purpose of improving data on 

17 drug overdose deaths and non-fatal drug overdoses, 

18 surveillance related to addiction and substance use 

19 disorder, and the prevention of transmission of infec20 tious diseases related to substance use. 

21 ‘‘(3) TRIBAL DATA.—Not later than 6 months 

22 after the date of enactment of this title, the Director 

23 of the Centers for Disease Control and Prevention 

24 shall consult with Indian tribes to develop and im25 plement strategies that improve surveillance and re26 porting of fatal overdose deaths among American InVerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365

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1 dians and Alaska Natives, including strategies that 

2 reduce the underestimation of fatal overdose deaths 

3 among American Indians and Alaska Natives due to 

4 undersampling or racial misclassification in State 

5 and Federal public health surveillance systems. 

6 ‘‘(b) CHILDHOOD TRAUMA.—The Centers for Disease 

7 Control and Prevention shall use a portion of the funding 

8 appropriated under this section to fund the surveillance 

9 and data collection activities described in section 7131 of 

10 the SUPPORT for Patients and Communities Act, includ11 ing to encourage all States to participate in collecting and 

12 reporting data on adverse childhood experiences through 

13 the Behavioral Risk Factor Surveillance System, the 

14 Youth Risk Behavior Surveillance System, and other rel15 evant public health surveys or questionnaires. 

16 ‘‘(c) WORKER HEALTH RISKS.—The Centers for Dis17 ease Control and Prevention shall use a portion of the 

18 funding appropriated under this section for data collection 

19 and surveillance activities on substance use, substance use 

20 disorders, drug overdose deaths, and non-fatal drug 

21 overdoses among workers, and the factors and practices 

22 that contribute to such use, disorders, and overdoses, in23 cluding occupational injuries and illness as well as occupa24 tional exposure to opioids and other illicit and licit drugs. 


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1 ‘‘(d) TRIBAL EPIDEMIOLOGY CENTERS.—There shall 

2 be made available to the Indian Health Service for the 

3 purpose of funding efforts by Indian tribes and tribal epi4 demiology centers to improve data on drug overdose 

5 deaths and non-fatal drug overdoses, surveillance related 

6 to addiction and substance use disorder, and prevention 

7 of childhood trauma, not less than 1.5 percent of the total 

8 amount appropriated under this section for each fiscal 

9 year. 

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

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

12 ‘‘(1) $500,000,000 for fiscal year 2020; 

13 ‘‘(2) $500,000,000 for fiscal year 2021; 

14 ‘‘(3) $500,000,000 for fiscal year 2022; 

15 ‘‘(4) $500,000,000 for fiscal year 2023; 

16 ‘‘(5) $500,000,000 for fiscal year 2024; 

17 ‘‘(6) $500,000,000 for fiscal year 2025; 

18 ‘‘(7) $500,000,000 for fiscal year 2026; 

19 ‘‘(8) $500,000,000 for fiscal year 2027; 

20 ‘‘(9) $500,000,000 for fiscal year 2028; and 

21 ‘‘(10) $500,000,000 for fiscal year 2029. 

22 ‘‘SEC. 3439. DEFINITIONS. 

23 ‘‘In this title: 


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1 ‘‘(1) PLANNING COUNCIL.—The term ‘planning 

2 council’ means the substance use planning council 

3 established under section 3402. 

4 ‘‘(2) RECOVERY RESIDENCE.—The term ‘recov5 ery residence’ means a residential dwelling unit, or 

6 other form of group housing, that is offered or ad7 vertised through any means, including oral, written, 

8 electronic, or printed means, by any individual or en9 tity as a residence that provides an evidence-based, 

10 peer-supported living environment for individuals un11 dergoing any type of substance use disorder treat12 ment or who have received any type of substance use 

13 disorder treatment in the past 3 years, including 

14 medication assisted treatment. 

15 ‘‘(3) STATE.— 

16 ‘‘(A) IN GENERAL.—The term ‘State’ 

17 means each of the 50 States, the District of Co18 lumbia, and each of the territories. 

19 ‘‘(B) TERRITORIES.—The term ‘territory’ 

20 means each of American Samoa, Guam, the 

21 Commonwealth of Puerto Rico, the Common22 wealth of the Northern Mariana Islands, the 

23 Virgin Islands, the Republic of the Marshall Is24 lands, the Federated States of Micronesia, and 

25 Palau. 


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1 ‘‘(4) SUBSTANCE USE DISORDER TREAT2 MENT.— 

3 ‘‘(A) IN GENERAL.—The term ‘substance 

4 use disorder treatment’ means an evidence5 based, professionally directed, deliberate, and 

6 planned regimen including evaluation, observa7 tion, medical monitoring, and rehabilitative 

8 services and interventions such as 

9 pharmacotherapy, mental health services, and 

10 individual and group counseling, on an inpa11 tient or outpatient basis, to help patients with 

12 substance use disorder reach remission and 

13 maintain recovery. 

14 ‘‘(B) TYPES OF TREATMENT.—Substance 

15 use disorder treatments shall include the fol16 lowing: 

17 ‘‘(i) Clinical stabilization services, 

18 which are evidence-based services provided 

19 in secure, acute care facilities (which may 

20 be referred to as ‘addictions receiving fa21 cilities’) that, at a minimum— 

22 ‘‘(I) provide intoxication manage23 ment and stabilization services; 

24 ‘‘(II) are operated 24 hours per 

25 day, 7 days per week; and 


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1 ‘‘(III) that serve individuals 

2 found to be substance use impaired. 

3 These can also be referred to as ‘Ad4 dictions receiving facilities’. 

5 ‘‘(ii) Withdrawal management and de6 toxification, which is a medical service that 

7 is provided on an inpatient or an out8 patient basis to assist an individual in 

9 managing the process of withdrawal from 

10 the physiological and psychological effects 

11 of substance use disorder. 

12 ‘‘(iii) All outpatient, residential, and 

13 inpatient services described in section 

14 1915(l)(4)(c) of the Social Security Act. 

15 ‘‘(C) LIMITATION.—Substance use disorder 

16 treatment providers shall not include— 

17 ‘‘(i) prevention only providers; and 

18 ‘‘(ii) a private practitioner who is li19 censed by a State licensing board and 

20 whose practice is limited to non-intensive 

21 outpatient care. 

22 ‘‘(5) SUBSTANCE USE DISORDER TREATMENT

23 SERVICES.—The term ‘substance use disorder treat24 ment services’ means any prevention services, core 

25 medical services, recovery and support services, early 


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1 intervention services, and harm reduction services 

2 authorized under this title.’’. 

3 SEC. 4. AMENDMENTS TO THE CONTROLLED SUBSTANCES 

4 ACT. 

5 (a) CERTIFICATIONS.—Part C of the Controlled Sub6 stances Act (21 U.S.C. 821 et seq.) is amended by adding 

7 at the end the following: 

8 ‘‘CERTIFICATIONS RELATING TO DIVERSION CONTROLS

9 AND MISBRANDING

10 ‘‘SEC. 313. (a) DEFINITIONS.—In this section— 

11 ‘‘(1) the term ‘covered dispenser’— 

12 ‘‘(A) means a dispenser— 

13 ‘‘(i) that is required to register under 

14 section 302(a)(2); and 

15 ‘‘(ii) dispenses a controlled substance 

16 in schedule II; and 

17 ‘‘(B) does not include a dispenser that is— 

18 ‘‘(i) registered to dispense opioid 

19 agonist treatment medication under section 

20 303(g)(1); and 

21 ‘‘(ii) operating in that capacity; 

22 ‘‘(2) the term ‘covered distributor’ means a dis23 tributor— 

24 ‘‘(A) that is required to register under sec25 tion 302(a)(1); and 


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1 ‘‘(B) distributes a controlled substance in 

2 schedule II; 

3 ‘‘(3) the term ‘covered manufacturer’ means a 

4 manufacturer— 

5 ‘‘(A) that is required to register under sec6 tion 302(a)(1); and 

7 ‘‘(B) manufactures a controlled substance 

8 in schedule II; 

9 ‘‘(4) the term ‘covered officer’, with respect to 

10 a covered person means— 

11 ‘‘(A) in the case of a covered person that 

12 is not an individual— 

13 ‘‘(i) the chief executive officer of the 

14 covered person; 

15 ‘‘(ii) the president of the covered per16 son; 

17 ‘‘(iii) the chief medical officer of the 

18 covered person; or 

19 ‘‘(iv) the chief counsel of the covered 

20 person; and 

21 ‘‘(B) in the case of a covered person that 

22 is an individual, that individual; and 

23 ‘‘(5) the term ‘covered person’ means— 

24 ‘‘(A) a covered dispenser; 

25 ‘‘(B) a covered distributor; or 


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1 ‘‘(C) a covered manufacturer. 

2 ‘‘(b) CERTIFICATIONS RELATING TO DIVERSION

3 CONTROLS.—Not later than 180 days after the date of 

4 enactment of this section, and each year thereafter, each 

5 covered officer of a covered person shall submit to the At6 torney General, for each controlled substance in schedule 

7 II dispensed, distributed, or manufactured by the covered 

8 person, a certification— 

9 ‘‘(1) signed by the covered officer; and 

10 ‘‘(2) certifying that— 

11 ‘‘(A) the covered person maintains effective 

12 controls against diversion of the controlled sub13 stance into channels other than legitimate med14 ical, scientific, research, or industrial channels; 

15 ‘‘(B) all information contained in any 

16 record, inventory, or report required to be kept 

17 or submitted to the Attorney General by the 

18 covered person under section 307, or under any 

19 regulation issued under that section, is accu20 rate; and 

21 ‘‘(C) the covered person is in compliance 

22 with all applicable requirements under Federal 

23 law relating to reporting suspicious orders for 

24 controlled substances. 


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1 ‘‘(c) CERTIFICATIONS RELATING TO MIS2 BRANDING.— 

3 ‘‘(1) IN GENERAL.—Not later than 180 days 

4 after the date of enactment of this section, and each 

5 year thereafter, each covered officer of a covered 

6 manufacturer shall submit to the Secretary, for each 

7 controlled substance in schedule II manufactured by 

8 the covered manufacturer, a certification— 

9 ‘‘(A) signed by the covered officer; and 

10 ‘‘(B) certifying that the controlled sub11 stance is not misbranded, as described in sec12 tion 502 of the Federal Food, Drug, and Cos13 metic Act (21 U.S.C. 352). 

14 ‘‘(2) NOTIFICATION TO THE ATTORNEY GEN15 ERAL.— 

16 ‘‘(A) FAILURE TO SUBMIT CERTIFI17 CATIONS.—Not later than 30 days after the 

18 date on which a covered officer of a covered 

19 manufacturer is required to submit a certifi20 cation under paragraph (1) and fails to do so, 

21 the Secretary shall notify the Attorney General 

22 of the failure by the covered officer to submit 

23 the certification. 

24 ‘‘(B) FALSE CERTIFICATIONS RELATING

25 TO MISBRANDING.—Not later than 30 days 


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1 after the date on which the Secretary becomes 

2 aware that a certification submitted under 

3 paragraph (1) contains a materially false state4 ment or representation relating to the mis5 branding of a controlled substance with respect 

6 to the year for which the certification is sub7 mitted, the Secretary shall notify the Attorney 

8 General that the certification contains the ma9 terially false statement or representation.’’. 

10 (b) OFFENSES.—Part D of title II of the Controlled 

11 Substances Act (21 U.S.C. 841 et seq.) is amended by 

12 adding at the end the following: 

13 ‘‘CERTIFICATIONS BY COVERED OFFICERS

14 ‘‘SEC. 424. (a) DEFINITIONS.—In this section, the 

15 terms ‘covered dispenser’, ‘covered distributor’, ‘covered 

16 manufacturer’, ‘covered officer’, and ‘covered person’ have 

17 the meanings given those terms in section 313. 

18 ‘‘(b) OFFENSES.— 

19 ‘‘(1) FAILURE TO SUBMIT CERTIFICATIONS.— 

20 ‘‘(A) CERTIFICATIONS RELATING TO DI21 VERSION CONTROLS.—It shall be unlawful for a 

22 covered officer of a covered person to fail to 

23 submit a certification required under section 

24 313(b), without regard to the state of mind of 

25 the covered officer. 


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1 ‘‘(B) CERTIFICATIONS RELATING TO MIS2 BRANDING.—It shall be unlawful for a covered 

3 officer of a covered manufacturer to fail to sub4 mit a certification required under section 

5 313(c)(1), without regard to the state of mind 

6 of the covered officer. 

7 ‘‘(2) SUBMISSION OF FALSE CERTIFICATIONS.— 

8 ‘‘(A) FALSE CERTIFICATIONS RELATING TO

9 DIVERSION CONTROLS.—It shall be unlawful for 

10 a covered officer of a covered person to submit 

11 a certification required under section 313(b), 

12 without regard to the state of mind of the cov13 ered officer, that contains a materially false 

14 statement or representation relating to the in15 formation required to be certified under that 

16 section for the year for which the certification 

17 is submitted. 

18 ‘‘(B) FALSE CERTIFICATIONS RELATING

19 TO MISBRANDING.—It shall be unlawful for a 

20 covered officer of a covered manufacturer to 

21 submit a certification required under section 

22 313(c)(1), without regard to the state of mind 

23 of the covered officer, that contains a materially 

24 false statement or representation relating to the 

25 misbranding of a controlled substance with reVerDate Sep 11 2014 15:40 May 12, 2019 Jkt 089200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\S1365.IS S1365

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1 spect to the year for which the certification is 

2 submitted. 

3 ‘‘(c) PENALTIES.— 

4 ‘‘(1) CIVIL PENALTIES.—Except as provided in 

5 paragraph (2), a covered officer who violates sub6 section (b) shall be subject to a civil penalty of not 

7 more than $25,000. 

8 ‘‘(2) CRIMINAL PENALTIES.—A covered officer 

9 who knowingly violates subsection (b)(2) shall be 

10 subject to criminal penalties under section 403(d). 

11 ‘‘(d) COMPREHENSIVE ADDICTION RESOURCES

12 FUND.— 

13 ‘‘(1) ESTABLISHMENT.—There is established in 

14 the Treasury a fund to be known as the ‘Com15 prehensive Addiction Resources Fund’. 

16 ‘‘(2) TRANSFER OF AMOUNTS.—There shall be 

17 transferred to the Comprehensive Addiction Re18 sources Fund 100 percent of— 

19 ‘‘(A) any civil penalty paid to the United 

20 States under this section; and 

21 ‘‘(B) any fine paid to the United States 

22 under section 403(d) for a knowing violation of 

23 subsection (b)(2) of this section. 


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1 ‘‘(3) AVAILABILITY AND USE OF FUNDS.— 

2 Amounts transferred to the Comprehensive Addic3 tion Fund under paragraph (2) shall— 

4 ‘‘(A) remain available until expended; and 

5 ‘‘(B) be made available to supplement 

6 amounts appropriated to carry out title XXXIV 

7 of the Public Health Service Act.’’. 

8 (c) CRIMINAL PENALTIES.—Section 403 of the Con9 trolled Substances Act (21 U.S.C. 843) is amended— 

10 (1) in subsection (d)(1)— 

11 (A) by inserting ‘‘or knowingly violates sec12 tion 424(b)(2)’’ after ‘‘any person who violates 

13 this section’’; and 

14 (B) by striking ‘‘violation of this section’’ 

15 and inserting ‘‘such a violation’’; and 

16 (2) in subsection (f)— 

17 (A) in paragraph (1), by striking ‘‘or 416’’ 

18 and inserting ‘‘or section 416, or knowing viola19 tions of section 424(b)(2)’’; and 

20 (B) in paragraph (3), by inserting ‘‘or 

21 knowing violations of section 424(b)(2)’’ before 

22 the period at the end. 

23 (d) TECHNICAL AND CONFORMING AMENDMENTS.— 

24 The table of contents for the Comprehensive Drug Abuse 


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1 Prevention and Control Act of 1970 (Public Law 91–513; 

2 84 Stat. 1236) is amended— 

3 (1) by inserting after the item relating to sec4 tion 311 the following: 

‘‘Sec. 312. Suspicious orders. 

‘‘Sec. 313. Certifications relating to diversion controls and misbranding.’’; 

5 and 

6 (2) by inserting after the item relating to sec7 tion 423 the following: 

‘‘Sec. 424. Certifications by covered officers.’’. 

8 (e) EFFECTIVE DATE.—The amendments made by 

9 subsections (b) and (c) of this section shall take effect on 

10 the date that is 180 days after the date of enactment of 

11 this Act. 

Æ 


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