II 

117TH CONGRESS 

1ST SESSION S. 3418 

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

local areas affected by substance use disorder, including the use of 

opioids and stimulants, and to make financial assistance available to 

States, territories, Tribal nations, local areas, public or private nonprofit 

entities, and certain health providers, 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 

DECEMBER 16, 2021 

Ms. WARREN (for herself, Ms. BALDWIN, Mr. VAN HOLLEN, Mr. CASEY, Ms. 

KLOBUCHAR, Mr. SANDERS, Mr. MARKEY, Mr. BLUMENTHAL, Mr. 

PADILLA, Mr. BOOKER, Ms. SMITH, Mr. BROWN, Mr. HEINRICH, and 

Mr. MERKLEY) 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 substance use disorder, including the use of opioids and stimulants, and 

to make financial assistance available to States, territories, Tribal nations, local areas, public or private nonprofit entities, and certain health providers, 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 2021’’. 

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 RESOURCES 

‘‘Subtitle A—Local Substance Use 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. 

‘‘Sec. 3434. Programs to support employees. 

‘‘Sec. 3435. Improving and expanding care. 


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‘‘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. 

Sec. 5. General limitation on use of funds. 

Sec. 6. Federal drug demand reduction activities. 

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 substance use 

5 disorder, including the use of opioids and stimulants, and 

6 to make financial assistance available to States, terri7 tories, Tribal nations, local areas, public or private non8 profit entities, and certain health providers, to provide for 

9 the development, organization, coordination, and operation 

10 of more effective and cost efficient systems for the delivery 

11 of essential services to individuals with substance use dis12 order, including with co-occurring mental health and sub13 stance use disorders, and their families. 

14 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

15 ACT. 

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

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


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1 ‘‘TITLE XXXIV—SUBSTANCE USE 

2 RESOURCES 

3 ‘‘Subtitle A—Local Substance Use 

4 Emergency Relief Grant Program 

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

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

7 grants to eligible localities for the purpose of addressing 

8 substance use within such localities. 

9 ‘‘(b) ELIGIBILITY.— 

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

11 grant under subsection (a) a locality shall— 

12 ‘‘(A) be— 

13 ‘‘(i) a county that can demonstrate 

14 that the rate of drug overdose deaths per 

15 100,000 population in the county during 

16 the most recent 3-year period for which 

17 such data are available was not less than 

18 the rate of such deaths for the county that 

19 ranked at the 67th percentile of all coun20 ties, as determined by the Secretary; 

21 ‘‘(ii) a county that can demonstrate 

22 that the number of drug overdose deaths 

23 during the most recent 3-year period for 

24 which such data are available was not less 

25 than the number of such deaths for the 


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1 county that ranked at the 90th percentile 

2 of all counties, as determined by the Sec3 retary; 

4 ‘‘(iii) a county that encompasses an 

5 undeserved area, defined as a health pro6 fessional shortage area (as defined in sec7 tion 332(a)(1)(A)) and a medically under8 served area (according to a designation 

9 under section 330(b)(3)(A)), that can dem10 onstrate a high burden of both fatal and 

11 non-fatal drug overdoses in a manner de12 termined by the Secretary; or 

13 ‘‘(iv) a city that is located within a 

14 county described in clause (i), (ii), or (iii) 

15 that meets the requirements of paragraph 

16 (3); and 

17 ‘‘(B) submit to the Secretary an applica18 tion in accordance with section 3404. 

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

20 the case of an eligible county that is contiguous to 

21 one or more other eligible counties within the same 

22 State, the group of counties shall— 

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

24 county for purposes of a grant under this sec25 tion; 


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1 ‘‘(B) submit a single application under sec2 tion 3404; 

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

4 purposes of section 3402); and 

5 ‘‘(D) establish, through intergovernmental 

6 agreements, an administrative mechanism to al7 locate funds and substance use disorder treat8 ment services under the grant based on— 

9 ‘‘(i) the number and rate of drug 

10 overdose deaths and nonfatal drug 

11 overdoses in each of the counties that com12 pose the eligible county; 

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

14 in each such county; and 

15 ‘‘(iii) the health and support per16 sonnel needs of each such county. 

17 ‘‘(3) CITIES AND COUNTIES WITHIN MULTIPLE

18 CONTIGUOUS COUNTIES.— 

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

20 an eligible county described in paragraph (1), 

21 or a county or group of counties that is within 

22 a group of counties determined to be an eligible 

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

24 receive a grant under section 3401 if such city 


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1 or county or group of counties meets the re2 quirements of subparagraph (B). 

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

4 meets the requirements of this subparagraph if 

5 such city or county— 

6 ‘‘(i) except as provided in subpara7 graph (C), has a population of not less 

8 than 50,000 residents; 

9 ‘‘(ii) meets the requirements of para10 graph (1)(A); 

11 ‘‘(iii) submits an application under 

12 section 3404; 

13 ‘‘(iv) establishes a planning council 

14 (for purposes of section 3402); and 

15 ‘‘(v) establishes an administrative 

16 mechanism to allocate funds and services 

17 under the grant based on— 

18 ‘‘(I) the number and rate of drug 

19 overdose deaths and nonfatal drug 

20 overdoses in the city or county; 

21 ‘‘(II) the severity of need for sub22 stance use disorder treatment services 

23 in the city or county; and 

24 ‘‘(III) the health and support 

25 personnel needs of the city or county. 


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

2 county or group of counties that does not meet 

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

4 apply to the Secretary for a waiver of such re5 quirement. Such application shall dem6 onstrate— 

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

8 to be served are distinct or that addressing 

9 substance use in the service area would be 

10 best served by the formation of an inde11 pendent council; and 

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

13 of counties has the capacity to administer 

14 the funding received under this subtitle. 

15 ‘‘(D) MINIMUM FUNDING.—A city or coun16 ty that meets the requirement of this paragraph 

17 and receives a grant under section 3401 shall 

18 be entitled to an amount of funding under the 

19 grant in an amount that is not less than the 

20 amount determined under section 3403(a) with 

21 respect to such city or county. 

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

23 that are not located within the territory of a county 

24 shall be treated as eligible counties for purposes of 

25 this subtitle. 


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

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

3 governance, the Secretary shall determine the local 

4 political subdivisions within such States that are eli5 gible to receive a grant under section 3401 and such 

6 subdivisions shall be treated as eligible counties for 

7 purposes of this subtitle. 

8 ‘‘(6) DETERMINATIONS WHERE THERE IS A

9 LACK OF DATA.—The Secretary shall establish eligi10 bility and allocation criteria related to the prevalence 

11 of drug overdose deaths, the mortality rate from 

12 drug overdoses, and that provides an equivalent 

13 measure of need for funding for cities and counties 

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

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

16 ‘‘(7) DATA FROM TRIBAL AREAS.—The Sec17 retary, acting through the Indian Health Service, 

18 shall consult with Indian Tribes and confer with 

19 urban Indian organizations to establish eligibility 

20 and allocation criteria that provide an equivalent 

21 measure of need for Tribal and urban Indian areas 

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

23 (2)(D)(i) are not available or do not apply. 

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

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1 eral shall conduct a study to determine whether the 

2 data utilized for purposes of paragraph (1)(A) pro3 vide the most precise measure of local area need re4 lated to substance use and addiction prevalence and 

5 whether additional data would provide more precise 

6 measures of substance use and addiction prevalence 

7 in local areas. Such study shall identify barriers to 

8 collecting or analyzing such data, and make rec9 ommendations for revising the indicators used under 

10 such paragraph to determine eligibility in order to 

11 direct funds to the local areas in most need of fund12 ing to provide assistance related to substance use 

13 and addiction. 

14 ‘‘(9) REFERENCE.—For purposes of this sub15 title, the term ‘eligible local area’ includes— 

16 ‘‘(A) a city or county described in para17 graph (1); 

18 ‘‘(B) multiple contiguous counties de19 scribed in paragraph (2); 

20 ‘‘(C) cities or counties within multiple con21 tiguous counties described in paragraph (3); 

22 ‘‘(D) an independent city described in 

23 paragraph (4); and 

24 ‘‘(E) a political subdivision described in 

25 paragraph (5). 


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1 ‘‘(c) ADMINISTRATION.— 

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

3 under a grant awarded under this section shall be 

4 directed to the chief elected official of the eligible 

5 local area who shall administer the grant funds. 

6 ‘‘(2) MULTIPLE CONTIGUOUS COUNTIES.— 

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

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

9 county described in subsection (b)(2), assist10 ance made available under a grant awarded 

11 under this section shall be directed to the chief 

12 elected official of the particular county des13 ignated in the application submitted for the 

14 grant under section 3404. Such chief elected of15 ficial shall be the administrator of the grant. 

16 ‘‘(B) STATE ADMINISTRATION.—Notwith17 standing subparagraph (A), the eligible county 

18 described in subsection (b)(2) may elect to des19 ignate the chief elected State official of the 

20 State in which the eligible county is located as 

21 the administrator of the grant funds. 

22 ‘‘SEC. 3402. PLANNING COUNCIL. 

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

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

25 eligible local area shall establish or designate a substance 


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1 use disorder treatment and services planning council that 

2 shall, to the maximum extent practicable— 

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

4 the population of individuals with substance use dis5 order in the area; and 

6 ‘‘(2) include representatives of— 

7 ‘‘(A) health care providers, including Fed8 erally-qualified health centers, rural health clin9 ics, Indian health programs as defined in sec10 tion 4 of the Indian Health Care Improvement 

11 Act, urban Indian organizations as defined in 

12 section 4 of the Indian Health Care Improve13 ment Act, and facilities operated by the Depart14 ment of Veterans Affairs; 

15 ‘‘(B) Native Hawaiian organizations as de16 fined in section 11 of the Native Hawaiian 

17 Health Care Act of 1988; 

18 ‘‘(C) community-based health, harm reduc19 tion, or addiction service organizations, includ20 ing, where applicable, representatives of Drug 

21 Free Communities Coalition grantees; 

22 ‘‘(D) social service providers, including 

23 providers of housing and homelessness services 

24 and recovery residence providers; 

25 ‘‘(E) mental health care providers; 


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1 ‘‘(F) local public health agencies; 

2 ‘‘(G) individuals with substance use dis3 order and individuals who use drugs; 

4 ‘‘(H) individuals in recovery from sub5 stance use disorders; 

6 ‘‘(I) State governments, including the 

7 State Medicaid agency and the Single State 

8 Agency for Substance Abuse Services; 

9 ‘‘(J) local governments; 

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

11 ‘‘(L) substance use disorder treatment pro12 viders, including physician addiction specialists; 

13 ‘‘(M) Indian tribes and tribal organizations 

14 as defined in section 4 of the Indian Self-Deter15 mination and Education Assistance Act; 

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

17 4 of the Indian Health Care Improvement Act; 

18 ‘‘(O) historically underserved groups and 

19 subpopulations; 

20 ‘‘(P) individuals who were formerly incar21 cerated; 

22 ‘‘(Q) organizations serving individuals who 

23 are currently incarcerated or in pre-trial deten24 tion or were formerly incarcerated; 

25 ‘‘(R) Federal agencies; 


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1 ‘‘(S) organizations that provide drug pre2 vention programs and services to youth at risk 

3 of substance use; 

4 ‘‘(T) medical examiners or coroners; 

5 ‘‘(U) labor unions and the workplace com6 munity; 

7 ‘‘(V) local fire departments and emergency 

8 medical services; 

9 ‘‘(W) the lesbian, gay, bisexual, 

10 transgender, queer (LGBTQ) community; and 

11 ‘‘(X) certified or accredited addiction re12 covery community organizations. 

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

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

15 for purposes of subsection (a), the chief elected offi16 cial of the eligible local area may establish the coun17 cil directly or designate an existing entity to serve as 

18 the council, subject to paragraph (2). 

19 ‘‘(2) CONSIDERATION REGARDING DESIGNATION

20 OF COUNCIL.—In making a determination of wheth21 er to establish or designate a council under para22 graph (1), the chief elected official shall give priority 

23 to the designation of an existing entity that has 

24 demonstrated experience in the provision of health 

25 and support services to individuals with substance 


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1 use disorder within the eligible local area, that has 

2 a structure that recognizes the Federal trust respon3 sibility when spending Federal health care dollars, 

4 and that has demonstrated a commitment to re5 specting the obligation of government agencies using 

6 Federal dollars to consult with Indian tribes and 

7 confer with urban Indian organizations. 

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

9 an existing entity is designated to serve as the coun10 cil under this section, the membership of the entity 

11 shall comply with the requirements of subsection 

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

13 in subsection (e). 

14 ‘‘(4) JOINT COUNCIL.—The Secretary shall es15 tablish a process to permit an eligible local area that 

16 is not contiguous with any other eligible local area 

17 to form a joint planning council with such other eli18 gible local area or areas, as long as such areas are 

19 located in geographical proximity to each other, as 

20 determined by the Secretary, and submit a joint ap21 plication under section 3404. 

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

23 Eligible local areas may form a joint planning coun24 cil with other eligible local areas across State lines 

25 if such areas are located in geographical proximity 


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1 to each other, as determined by the Secretary, sub2 mit a joint application under section 3404, and es3 tablish intergovernmental agreements to allow the 

4 administration of the grant across State lines. 

5 ‘‘(c) MEMBERSHIP.—Members of the planning coun6 cil established or designated under subsection (a) shall— 

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

8 open process; 

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

10 and vice chair; 

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

12 Indian tribes located within any eligible local area 

13 that receives funding under the grant program es14 tablished in section 3401; 

15 ‘‘(4) include at least 1 individual with a history 

16 of substance use disorder; 

17 ‘‘(5) include at least 1 representative from a 

18 nonprofit substance use disorder service provider, at 

19 least 1 representative of an urban Indian organiza20 tion, at least 1 physician addiction specialist, and at 

21 least 1 representative from an organization pro22 viding harm reduction services; 

23 ‘‘(6) include at least 1 representative of a Na24 tive Hawaiian organization (as defined in section 11 

25 of the Native Hawaiian Health Care Act of 1988) 


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1 when the Native Hawaiian population exceeds 10 

2 percent; and 

3 ‘‘(7) serve not more than 3 consecutive years on 

4 the planning council. 

5 ‘‘(d) MEMBERSHIP TERMS.—Members of the plan6 ning council established or designated under subsection 

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

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

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

10 designated under subsection (a) shall— 

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

12 grant funds within the eligible local area that em13 phasize reducing drug use rates, overdose, substance 

14 use disorder, and health conditions associated with 

15 drug use such as human immunodeficiency virus, 

16 hepatitis B, and hepatitis C through evidence-based 

17 interventions in both community and criminal justice 

18 settings and that are based on— 

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

20 use disorder prevention, intervention, treat21 ment, and recovery strategies that comply with 

22 best practices identified by the Secretary; 

23 ‘‘(B) the demonstrated or probable cost-ef24 fectiveness of proposed substance use disorder 


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1 prevention, intervention, treatment, and recov2 ery services; 

3 ‘‘(C) the health priorities of the commu4 nities within the eligible local area that are af5 fected by substance use; 

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

7 with substance use disorder; and 

8 ‘‘(E) the availability of other governmental 

9 and non-governmental services; 

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

11 any existing State or local plan regarding the provi12 sion of substance use disorder treatment services to 

13 individuals with substance use disorder; 

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

15 work with local public health agencies to develop a 

16 comprehensive plan for the organization and delivery 

17 of substance use disorder prevention and treatment 

18 services; 

19 ‘‘(4) regularly assess the efficiency of the ad20 ministrative mechanism in rapidly allocating funds 

21 to support evidence-based substance use disorder 

22 prevention and treatment services in the areas of 

23 greatest need within the eligible local area; 

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

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1 lation of individuals with substance use disorders 

2 and the types of substance use that are most preva3 lent in the eligible local area; 

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

5 determine the needs of such population, including 

6 the need for substance use disorder prevention, 

7 intervention, treatment, harm reduction, and recov8 ery services; 

9 ‘‘(7) work with local public agencies to deter10 mine the disparities in access to services among af11 fected subpopulations and historically underserved 

12 communities, including infrastructure and capacity 

13 shortcomings of providers that contribute to these 

14 disparities; 

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

16 methods for obtaining input on community needs 

17 and priorities, including by partnering with organi18 zations that serve targeted communities experiencing 

19 high addictive substance-related health disparities to 

20 gather data using culturally attuned data collection 

21 methodologies; 

22 ‘‘(9) coordinate with Federal grantees that pro23 vide substance use disorder prevention and treat24 ment services within the eligible local area; and 


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

2 substance use disorder prevention and treatment 

3 services being supported by the grant received by the 

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

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

6 use, overdose, and death from substance use; 

7 ‘‘(B) rates of discontinuation from sub8 stance use disorder treatment services and rates 

9 of sustained recovery; 

10 ‘‘(C) long-term outcomes among individ11 uals receiving treatment for substance use dis12 orders; and 

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

14 use disorder treatment services needed by indi15 viduals with substance use disorders over their 

16 lifetimes. 

17 ‘‘(f) CONFLICTS OF INTEREST.— 

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

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

20 administration of a grant under section 3401. 

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

22 may serve on the planning council under subsection 

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

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

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


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1 individual is a member of a public or private organi2 zation, and such entity or organization is seeking 

3 amounts from a grant under section 3401, the indi4 vidual will not, with respect to the purpose for which 

5 the entity seeks such amounts, participate (directly 

6 or in an advisory capacity) in the process of select7 ing entities to receive such amounts for such pur8 pose. 

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

10 under subsection (a) shall develop procedures for address11 ing grievances with respect to funding under this subtitle, 

12 including procedures for submitting grievances that can13 not be resolved to binding arbitration. Such procedures 

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

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

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

17 criteria established by the Secretary, the following applies: 

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

19 to the public and shall be held only after adequate 

20 notice to the public. 

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

22 agenda, or other documents which were made avail23 able to or prepared for or by the council shall be 

24 available for public inspection and copying at a sin25 gle location. 


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

2 council shall be kept. The accuracy of all minutes 

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

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

5 disclosure of information of a personal nature that 

6 would constitute a clearly unwarranted invasion of 

7 personal privacy, including any disclosure of medical 

8 information or personnel matters. 

9 ‘‘(i) NEUTRALITY TOWARDS ORGANIZED LABOR.— 

10 ‘‘(1) IN GENERAL.—In carrying out duties 

11 under subsection (e), planning councils shall, to the 

12 extent practicable, prioritize the distribution of grant 

13 funds to grantees that have— 

14 ‘‘(A)(i) a collective bargaining agreement; 

15 or 

16 ‘‘(ii) an explicit policy not to deter employ17 ees with respect to— 

18 ‘‘(I) labor organizing for the employ19 ees engaged in the covered activities; and 

20 ‘‘(II) such employees’ choice to form 

21 and join labor organizations; and 

22 ‘‘(B) policies that require— 

23 ‘‘(i) the posting and maintenance of 

24 notices in the workplace to such employees 


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1 of their rights under the National Labor 

2 Relations Act (29 U.S.C. 151 et seq.); 

3 ‘‘(ii) that such employees are, at the 

4 beginning of their employment, provided 

5 notice and information regarding the em6 ployees’ rights under such Act; and 

7 ‘‘(iii) the employer to voluntarily rec8 ognize a union in cases where a majority 

9 of such workers of the employer have 

10 joined and requested representation. 

11 ‘‘(2) LIMITATION.—This subsection does not 

12 apply to Indian tribes. 

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

14 FUNDING AGREEMENT. 

15 ‘‘(a) AMOUNT OF GRANT.— 

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

17 AREA.— 

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

19 subtitle, the Secretary shall make a grant for 

20 each eligible local area for which an application 

21 under section 3404 has been approved. Each 

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

24 ‘‘(B) EXPEDITED DISTRIBUTION.—Not 

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1 comes available to carry out this subtitle for a 

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

5 fiscal year through grants to eligible local areas 

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

8 ‘‘(C) AMOUNT.— 

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

12 of this subparagraph to an eligible local 

13 area shall be made in an amount equal to 

14 the product of— 

15 ‘‘(I) an amount equal to the 

16 amount available for distribution 

17 under subparagraph (B) for the fiscal 

18 year involved; and 

19 ‘‘(II) the percentage constituted 

20 by the ratio of the distribution factor 

21 for the eligible local area to the sum 

22 of the respective distribution factors 

23 for all eligible local areas, 

24 which product shall then, as applicable, be 

25 increased under subparagraph (D). 


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1 ‘‘(ii) DISTRIBUTION FACTOR.—For 

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

4 ‘‘(I) an amount equal to— 

5 ‘‘(aa) the estimated number 

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

8 under clause (iii); or 

9 ‘‘(bb) the estimated number 

10 of non-fatal drug overdoses in the 

11 eligible local area, as determined 

12 under clause (iv), 

13 as determined by the Secretary based 

14 on which distribution factor (item (aa) 

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

16 area receiving the greatest amount of 

17 funds; or 

18 ‘‘(II) in the case of an eligible 

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

22 Secretary— 

23 ‘‘(aa) based on other data 

24 the Secretary determines appro25 priate; and 


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1 ‘‘(bb) that is related to the 

2 prevalence of non-fatal drug 

3 overdoses, drug overdose deaths, 

4 and the mortality rate from drug 

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

8 ‘‘(iii) NUMBER OF DRUG OVERDOSE

9 DEATHS.—The number of drug overdose 

10 deaths determined under this clause for an 

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

13 overdose deaths during the most recent 3- 

14 year period for which such data are avail15 able. 

16 ‘‘(iv) NUMBER OF NON-FATAL DRUG

17 OVERDOSES.—The number of non-fatal 

18 drug overdose deaths determined under 

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

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

23 other emergency medical services for drug24 related causes, or Overdose Detection Map25 ping Application Program (ODMAP) data 


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1 during the most recent 3-year period for 

2 which such data are available. 

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

4 after the date of enactment of this title, 

5 the Comptroller General shall conduct a 

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

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

11 data would provide more precise measures 

12 of substance use and addiction prevalence 

13 in local areas. Such study shall identify 

14 barriers to collecting or analyzing such 

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

17 such clause to determine funding levels in 

18 order to direct funds to the local areas in 

19 most need of funding to provide substance 

20 use disorder treatment services. 

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

22 local area that is an eligible local area for 

23 a year loses such eligibility in a subsequent 

24 year based on the failure to meet the re25 quirements of paragraph (1)(A) or (6) of 


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1 section 3401(b), such area will remain eli2 gible to receive— 

3 ‘‘(I) for such subsequent year, an 

4 amount equal to 80 percent of the 

5 amount received under the grant in 

6 the previous year; and 

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

9 percent of the amount received in the 

10 previous year. 

11 ‘‘(2) SUPPLEMENTAL GRANTS.— 

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

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

15 for the purpose of making grants to cities and 

16 counties whose application under section 

17 3404— 

18 ‘‘(i) contains a report concerning the 

19 dissemination of emergency relief funds 

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

22 ‘‘(ii) demonstrates the need in such 

23 local area, on an objective and quantified 

24 basis, for supplemental financial assistance 

25 to combat substance use disorder; 


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

3 both financial and in-kind, to preventing, 

4 treating, and managing substance use dis5 order and supporting sustained recovery; 

6 ‘‘(iv) demonstrates the ability of the 

7 area to utilize such supplemental financial 

8 resources in a manner that is immediately 

9 responsive and cost effective; 

10 ‘‘(v) demonstrates that resources will 

11 be allocated in accordance with the local 

12 demographic incidence of substance use 

13 disorders and drug overdose mortality; 

14 ‘‘(vi) demonstrates the inclusiveness of 

15 affected communities and individuals with 

16 substance use disorders, including those 

17 communities and individuals that are dis18 proportionately affected or historically un19 derserved; 

20 ‘‘(vii) demonstrates the manner in 

21 which the proposed services are consistent 

22 with the local needs assessment and the 

23 State plan approved by the Secretary pur24 suant to section 1932(b); 


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

4 ‘‘(ix) demonstrates that support for 

5 substance use disorder prevention and 

6 treatment services is organized to maxi7 mize the value to the population to be 

8 served with an appropriate mix of sub9 stance use disorder prevention and treat10 ment services and attention to transition in 

11 care. 

12 ‘‘(B) AMOUNT.— 

13 ‘‘(i) IN GENERAL.—The amount of 

14 each grant made for purposes of this para15 graph shall be determined by the Sec16 retary. In making such determination, the 

17 Secretary shall consider— 

18 ‘‘(I) the rate of drug overdose 

19 deaths per 100,000 population in the 

20 eligible local area; and 

21 ‘‘(II) the increasing need for sub22 stance use disorder treatment serv23 ices, including relative rates of in24 crease in the number of drug 

25 overdoses or drug overdose deaths, or 


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1 recent increases in drug overdoses or 

2 drug overdose deaths since data were 

3 provided under section 3401(b), if ap4 plicable. 

5 ‘‘(ii) DEMONSTRATED NEED.—The 

6 factors considered by the Secretary in de7 termining whether a local area has a dem8 onstrated need for purposes of clause 

9 (i)(II) may include any or all of the fol10 lowing: 

11 ‘‘(I) The unmet need for sub12 stance use disorder treatment serv13 ices, including factors identified in 

14 subparagraph (B)(i)(II). 

15 ‘‘(II) Relative rates of increase in 

16 the number of drug overdoses or drug 

17 overdose deaths. 

18 ‘‘(III) The relative rates of in19 crease in the number of drug 

20 overdoses or drug overdose deaths 

21 within new or emerging subpopula22 tions. 

23 ‘‘(IV) The current prevalence of 

24 substance use disorders. 


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1 ‘‘(V) Relevant factors related to 

2 the cost and complexity of delivering 

3 substance use disorder treatment serv4 ices to individuals in the eligible local 

5 area. 

6 ‘‘(VI) The impact of co-morbid 

7 factors, including co-occurring condi8 tions, determined relevant by the Sec9 retary. 

10 ‘‘(VII) The prevalence of home11 lessness among individuals with sub12 stance use disorders. 

13 ‘‘(VIII) The relevant factors that 

14 limit access to health care, including 

15 geographic variation, adequacy of 

16 health insurance coverage, and lan17 guage barriers. 

18 ‘‘(IX) The impact of a decline in 

19 the amount received pursuant to para20 graph (1) on substance use disorder 

21 treatment services available to all in22 dividuals with substance use disorders 

23 identified and eligible under this sub24 title. 


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1 ‘‘(X) The increasing incidence in 

2 conditions related to substance use, 

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

5 infections associated with injection 

6 drug use. 

7 ‘‘(C) APPLICATION OF PROVISIONS.—A 

8 local area that receives a grant under this para9 graph— 

10 ‘‘(i) shall use amounts received in ac11 cordance with subsection (b); 

12 ‘‘(ii) shall not have to meet the eligi13 ble criteria in section 3401(b); and 

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

15 planning council under section 3402. 

16 ‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN17 MENTS.— 

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

19 term ‘Indian tribe’ has the meaning given such 

20 term in section 4 of the Indian Self-Determina21 tion and Education Assistance Act. 

22 ‘‘(B) FORMULA FUNDS.—The Secretary, 

23 acting through the Indian Health Service, shall 

24 use 10 percent of the amount available under 

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1 mula funds to Indian tribes disproportionately 

2 affected by substance use, in an amount deter3 mined pursuant to a formula and eligibility cri4 teria developed by the Secretary in consultation 

5 with Indian tribes, for the purposes of address6 ing substance use. 

7 ‘‘(C) PAYMENT OF FUNDS.—At the option 

8 of an Indian tribe the Secretary shall pay funds 

9 under this section through a contract, coopera10 tive agreement, or compact under, as applicable, 

11 title I or V of the Indian Self-Determination 

12 and Education Assistance Act. 

13 ‘‘(D) USE OF AMOUNTS.—Notwithstanding 

14 any requirements in this section, an Indian 

15 tribe may use amounts provided under funds 

16 awarded under this paragraph for the uses 

17 identified in subsection (b) and any other activi18 ties determined appropriate by the Secretary, in 

19 consultation with Indian tribes. An Indian tribe 

20 shall not be required to allocate funds and serv21 ices in accordance with the goals, priorities, or 

22 objectives established by a planning council 

23 under section 3402. 

24 ‘‘(b) USE OF AMOUNTS.— 


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

2 make a grant under section 3401 to an eligible local 

3 area unless the chief elected official of the area 

4 agrees that— 

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

6 within the area under the grant will be made in 

7 accordance with the priorities established by the 

8 planning council; and 

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

10 be expended for— 

11 ‘‘(i) prevention services described in 

12 paragraph (3); 

13 ‘‘(ii) core medical services described in 

14 paragraph (4); 

15 ‘‘(iii) recovery and support services 

16 described in paragraph (5); 

17 ‘‘(iv) early intervention services de18 scribed in paragraph (6); 

19 ‘‘(v) harm reduction services described 

20 in paragraph (7); 

21 ‘‘(vi) financial assistance with health 

22 insurance described in paragraph (8); and 

23 ‘‘(vii) administrative expenses de24 scribed in paragraph (9). 

25 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 


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

2 shall use amounts received under a grant under 

3 section 3401 to provide direct financial assist4 ance to eligible entities or providers for the pur5 pose of providing prevention services, core med6 ical services, recovery and support services, 

7 early intervention services, and harm reduction 

8 services. 

9 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi10 nancial assistance may be provided under sub11 paragraph (A) to public or nonprofit entities, 

12 other eligible Medicaid providers if more than 

13 half of their patients are diagnosed with a sub14 stance use disorder and covered by Medicaid, or 

15 other private for-profit entities if such entities 

16 are the only available provider of quality sub17 stance use disorder treatment services in the 

18 area. 

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

20 (not including tribal areas) may not provide di21 rect financial assistance to any entity or pro22 vider that provides medication for addiction 

23 treatment if that entity or provider does not 

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1 therapy by licensed clinicians through a referral 

2 or onsite. 

3 ‘‘(D) NEUTRALITY TOWARDS ORGANIZED

4 LABOR.— 

5 ‘‘(i) IN GENERAL.—In carrying out 

6 duties under this section, eligible local 

7 areas shall, to the extent practicable, 

8 prioritize the distribution of grant funds to 

9 grantees that have— 

10 ‘‘(I)(aa) a collective bargaining 

11 agreement; or 

12 ‘‘(bb) an explicit policy not to 

13 deter employees with respect to— 

14 ‘‘(AA) labor organizing for 

15 the employees engaged in the 

16 covered activities; and 

17 ‘‘(BB) such employees’ 

18 choice to form and join labor or19 ganizations; and 

20 ‘‘(II) policies that require— 

21 ‘‘(aa) the posting and main22 tenance of notices in the work23 place to such employees of their 

24 rights under the National Labor 


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1 Relations Act (29 U.S.C. 151 et 

2 seq.); 

3 ‘‘(bb) that such employees 

4 are, at the beginning of their em5 ployment, provided notice and in6 formation regarding the employ7 ees’ rights under such Act; and 

8 ‘‘(cc) the employer to volun9 tarily recognize a union in cases 

10 where a majority of such workers 

11 of the employer have joined and 

12 requested representation. 

13 ‘‘(ii) LIMITATION.—This subsection 

14 does not apply to Indian tribes. 

15 ‘‘(3) PREVENTION SERVICES.— 

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

17 section, the term ‘prevention services’ means 

18 evidence-based services, programs, or multi-sec19 tor strategies to prevent substance use disorder 

20 (including education campaigns, community21 based prevention programs, risk identification 

22 programs, opioid diversion, collection and dis23 posal of unused opioids, services to at-risk pop24 ulations, and trauma support services). 


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

2 use not to exceed 20 percent of the amount of 

3 the grant under section 3401 for prevention 

4 services. An eligible local area may apply to the 

5 Secretary for a waiver of this subparagraph. 

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

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

8 means the following evidence-based services provided 

9 to individuals with substance use disorder or at risk 

10 for developing substance use disorder, including 

11 through the use of telemedicine or a hub and spoke 

12 model: 

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

14 more fully described in section 3439, including 

15 assessment of disease presence, severity, and 

16 co-occurring conditions, treatment planning, 

17 clinical stabilization services, withdrawal man18 agement and detoxification, intensive inpatient 

19 treatment, intensive outpatient treatment, out20 patient treatment, residential inpatient services, 

21 treatment for co-occurring mental health and 

22 substance use disorders, and all drugs approved 

23 by the Food and Drug Administration for the 

24 treatment of substance use disorder. 


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1 ‘‘(B) Outpatient and ambulatory health 

2 services, including those administered by Feder3 ally-qualified health centers, rural health clinics, 

4 tribal clinics and hospitals, urban Indian orga5 nizations, certified community behavioral health 

6 clinics (as described in section 223 of the Pro7 tecting Access to Medicare Act), Native Hawai8 ian organizations (as defined in section 11 of 

9 the Native Hawaiian Health Care Act of 1988), 

10 and comprehensive opioid recovery centers (as 

11 described in section 552 of this Act). 

12 ‘‘(C) Hospice services. 

13 ‘‘(D) Mental health services. 

14 ‘‘(E) Opioid overdose reversal drug prod15 ucts procurement, distribution, and training. 

16 ‘‘(F) Pharmaceutical assistance and diag17 nostic testing related to the management of 

18 substance use disorders and co-morbid condi19 tions. 

20 ‘‘(G) Home- and community-based health 

21 services. 

22 ‘‘(H) Comprehensive Case Management 

23 and care coordination, including substance use 

24 disorder treatment adherence services. 


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

4 ‘‘(J) Programs that hire, employ, train, 

5 and dispatch licensed health care professionals, 

6 mental health professionals, harm reduction 

7 providers, or community health workers to re8 spond in lieu of law enforcement officers in 

9 emergencies and that ensure a licensed health 

10 care professional is a member of the team that 

11 responds in lieu of law enforcement officers in 

12 emergencies in which— 

13 ‘‘(i) an individual calling 911, the Na14 tional Suicide Hotline, or another emer15 gency hotlines states that a person is expe16 riencing a drug overdose or is otherwise 

17 under the influence of a legal or illegal 

18 substance; or 

19 ‘‘(ii) a law enforcement officer, other 

20 first responder, or other individual identi21 fies a person as being (or possibly being) 

22 under the influence of a legal or illegal 

23 substance. 

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

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1 port services’ means services that are provided to in2 dividuals with substance use disorder, including resi3 dential recovery housing, mental health services, 

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

5 support, medical transportation services, respite care 

6 for persons caring for individuals with substance use 

7 disorder, child care and family services while an in8 dividual is receiving inpatient treatment services or 

9 at the time of outpatient services, outreach services, 

10 peer recovery services, nutrition services, and refer11 rals for job training and career services, housing, 

12 legal services, and child care and family services. 

13 The entities through which such services may be 

14 provided include local and tribal authorities that 

15 provide child care, housing, community development, 

16 and other recovery and support services, so long as 

17 they do not exclude individuals on the basis that 

18 such individuals receive medication for addiction 

19 treatment. 

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

21 purposes of this section, the term ‘early intervention 

22 services’ means services to provide screening and 

23 connection to the appropriate level of substance use 

24 disorder and mental health treatment (including 

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1 viduals who have misused substances, who have ex2 perienced an overdose, or are at risk of developing 

3 substance use disorder, the provision of referrals to 

4 facilitate the access of such individuals to core med5 ical services or recovery and support services for 

6 substance use disorder, and rapid access to medica7 tion for addiction treatment in the setting of recent 

8 overdose. The entities through which such services 

9 may be provided include emergency rooms, fire de10 partments and emergency medical services, detention 

11 facilities, prisons and jails, homeless shelters, health 

12 care points of entry specified by eligible local areas, 

13 Federally-qualified health centers, workforce agen14 cies and job centers, youth development centers, 

15 tribal clinics and hospitals, urban Indian organiza16 tions, and rural health clinics. 

17 ‘‘(7) HARM REDUCTION SERVICES.—For pur18 poses of this section, the term ‘harm reduction serv19 ices’ means services provided to individuals engaging 

20 in substance use scientifically accepted to reduce the 

21 risk of infectious disease transmission, overdose, or 

22 death, including by increasing access to health care, 

23 housing, and recovery and support services, includ24 ing syringe services programs. Such term includes 

25 evidence-based services. 


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1 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV2 ERAGE.—An eligible local area may use amounts 

3 provided under a grant awarded under section 3401 

4 to establish a program of financial assistance to as5 sist eligible individuals with substance use disorder 

6 in— 

7 ‘‘(A) enrolling in health insurance cov8 erage; or 

9 ‘‘(B) affording health care services, includ10 ing assistance paying cost-sharing amounts, in11 cluding premiums. 

12 ‘‘(9) ADMINISTRATION AND PLANNING.—An eli13 gible local area (not including tribal areas) shall not 

14 use in excess of 15 percent of amounts received 

15 under a grant under section 3401 for administra16 tion, accounting, reporting, and program oversight 

17 functions, including the development of systems to 

18 improve data collection and data sharing, in the first 

19 year of receiving the grant, and shall not use in ex20 cess of 10 percent of amounts received under a 

21 grant under section 3401 for such activities in sub22 sequent years. 

23 ‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 

24 received under a grant under section 3401 may be 

25 used to provide substance use disorder treatment 


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1 services, including medication for addiction treat2 ment, to individuals who are currently incarcerated 

3 or in pre-trial detention. 

4 ‘‘(c) REQUIRED TERMS.— 

5 ‘‘(1) REQUIREMENT OF STATUS AS MEDICAID

6 PROVIDER.— 

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

8 subparagraph (B), the Secretary may not make 

9 a grant under section 3401 for the provision of 

10 substance use disorder treatment services under 

11 this section in an eligible local area unless, in 

12 the case of any such service that is available 

13 pursuant to the State plan approved under title 

14 XIX of the Social Security Act for the State— 

15 ‘‘(i) the political subdivision involved 

16 will provide the service directly, and the 

17 political subdivision has entered into a par18 ticipation agreement under the State plan 

19 and is qualified to receive payments under 

20 such plan; or 

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

22 ‘‘(I) will enter into agreements 

23 with public or nonprofit entities, or 

24 other Medicaid providers if more than 

25 half of their patients are diagnosed 


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1 with a substance use disorder and 

2 covered by Medicaid, under which 

3 such entities and other providers will 

4 provide the service, and such entities 

5 and other providers have entered into 

6 such a participation agreement and 

7 are qualified to receive such pay8 ments; and 

9 ‘‘(II) demonstrates that it will 

10 ensure that such entities and other 

11 providers providing the service will 

12 seek payment for each such service 

13 rendered in accordance with the usual 

14 payment schedule under the State 

15 plan. 

16 ‘‘(B) WAIVER.— 

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

18 entity making an agreement pursuant to 

19 subparagraph (A)(ii) regarding the provi20 sion of substance use disorder treatment 

21 services, the requirement established in 

22 such subparagraph shall be waived by the 

23 substance use planning council for the area 

24 involved if the entity does not, in providing 

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1 cept reimbursement available from any 

2 third-party payor, including reimbursement 

3 under any insurance policy or under any 

4 Federal or State health benefits program. 

5 A waiver under this subparagraph shall 

6 not be longer than 2 years in duration and 

7 shall not be renewed. 

8 ‘‘(ii) DETERMINATION.—A determina9 tion by the substance use planning council 

10 of whether an entity referred to in clause 

11 (i) meets the criteria for a waiver under 

12 such clause shall be made without regard 

13 to whether the entity accepts voluntary do14 nations for the purpose of providing serv15 ices to the public. 

16 ‘‘(2) REQUIRED TERMS FOR EXPANDING AND

17 IMPROVING CARE.—A funding agreement for a grant 

18 under this section shall— 

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

20 grant will not be utilized to make payments for 

21 any item or service to the extent that payment 

22 has been made, or can reasonably be expected 

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

24 under a State compensation program, under an 

25 insurance 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); and 

4 ‘‘(B) ensure that all entities providing sub5 stance use disorder treatment services with as6 sistance made available under the grant offer 

7 all drugs approved by the Food and Drug Ad8 ministration for the treatment of substance use 

9 disorder for which the applicant offers treat10 ment, in accordance with section 3435. 

11 ‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund12 ing agreement for a grant under this section is 

13 that— 

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

15 utilized to supplement not supplant other Fed16 eral, State, or local funds made available in the 

17 year for which the grant is awarded to provide 

18 substance use disorder treatment services to in19 dividuals with substance use disorder, including 

20 funds for each of prevention services, core med21 ical services, recovery and support services, 

22 early intervention services, harm reduction serv23 ices, mental health services, and administrative 

24 expenses; 


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1 ‘‘(B) political subdivisions within the eligi2 ble local area will maintain the level of expendi3 tures by such political subdivisions for sub4 stance use disorder treatment services at a level 

5 that is at least equal to the level of such ex6 penditures by such political subdivisions for the 

7 preceding fiscal year, including expenditures for 

8 each of prevention services, core medical serv9 ices, recovery and support services, early inter10 vention services, harm reduction services, men11 tal health services, and administrative expenses; 

12 ‘‘(C) political subdivisions within the eligi13 ble local area will not use funds received under 

14 a grant awarded under section 3401 in main15 taining the level of substance use disorder treat16 ment services as required in subparagraph (B); 

17 ‘‘(D) substance use disorder treatment 

18 services provided with assistance made available 

19 under the grant will be provided without re20 gard— 

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

22 pay for such services; and 

23 ‘‘(ii) to the current or past health con24 dition of the individual to be served; 


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1 ‘‘(E) substance use disorder treatment 

2 services will be provided in a setting that is ac3 cessible to low-income individuals with sub4 stance use disorders and to individuals with 

5 substance use disorders residing in rural areas; 

6 ‘‘(F) a program of outreach will be pro7 vided to low-income individuals with substance 

8 use disorders to inform such individuals of sub9 stance use disorder treatment services and to 

10 individuals with substance use disorders resid11 ing in rural areas; 

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

13 for the use of grant funds and the Federal trust 

14 responsibility is upheld at all levels of program 

15 administration; and 

16 ‘‘(H) the confidentiality of individuals re17 ceiving substance use disorder treatment serv18 ices will be maintained in a manner not incon19 sistent with applicable law. 

20 ‘‘SEC. 3404. APPLICATION. 

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

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

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

24 containing such information, as the Secretary shall re25 quire, including— 


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

2 of any prior grants received under this subtitle by 

3 the applicant and the results achieved by these ex4 penditures and a demonstration that funds received 

5 from a grant under this subtitle in the prior year 

6 were expended in accordance with local priorities de7 veloped by the local planning council established 

8 under section 3402, except that the planning council 

9 requirement shall not apply with respect to areas re10 ceiving supplemental grant funds under section 

11 3403(a)(2); 

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

13 achieved with grant funds provided under this sub14 title, including targets and milestones that are in15 tended to be met, the activities that will be under16 taken to achieve those targets, the number of indi17 viduals likely to be served by the funds sought, in18 cluding demographic data on the populations to be 

19 served, and an explanation of how these goals and 

20 objectives advance the State plan approved by the 

21 Secretary pursuant to section 1932(b); 

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

23 use funds in a manner that provides substance use 

24 disorder treatment services in compliance with the 

25 evidence-based standards developed in accordance 


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1 with section 3435, including providing all drugs ap2 proved by the Food and Drug Administration for the 

3 treatment of substance use disorder; 

4 ‘‘(4) a demonstration that resources provided 

5 under the grant will be allocated in accordance with 

6 the local demographic incidence of substance use, in7 cluding allocations for services for children, youths, 

8 and women; 

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

10 medical expense criteria will be established and ap11 plied to those who qualify for assistance under the 

12 program; 

13 ‘‘(6) where practical, an explanation of how an 

14 eligible local area shall coordinate with local public 

15 health departments in the distribution of funding; 

16 and 

17 ‘‘(7) for any prior funding received under this 

18 section, data provided in such form as the Secretary 

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

20 which the activities supported by the funding met 

21 the goals and objectives specified in the application 

22 for the funding, the number of individuals who 

23 accessed medication for treatment by age, gender, 

24 sexual orientation, race, disability status, and other 

25 demographic criteria relevant to the program, and 


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1 the effect of the program on overdose rates and 

2 rates of death due to overdose in the local area 

3 served by the program. 

4 ‘‘(b) REQUIREMENTS REGARDING IMPOSITION OF

5 CHARGES FOR SERVICES.— 

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

7 make a grant under section 3401 to an eligible local 

8 area unless the eligible local area provides assur9 ances that in the provision of substance use disorder 

10 treatment services with assistance provided under 

11 the grant— 

12 ‘‘(A) in the case of individuals with an in13 come less than or equal to 150 percent of the 

14 official poverty level, the provider will not im15 pose charges on any such individual for the 

16 services provided under the grant; 

17 ‘‘(B) in the case of individuals with an in18 come greater than 150 percent of the official 

19 poverty level, the provider will impose a charge 

20 on each such individual according to a schedule 

21 of charges made available to the public; 

22 ‘‘(C) in the case of individuals with an in23 come greater than 150 percent of the official 

24 poverty level but not exceeding 200 percent of 

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


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1 calendar year, impose charges in an amount ex2 ceeding 2 percent of the annual gross income of 

3 the individual; 

4 ‘‘(D) in the case of individuals with an in5 come greater than 200 percent of the official 

6 poverty level but not exceeding 250 percent of 

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

8 calendar year, impose charges in an amount ex9 ceeding 4 percent of the annual gross income of 

10 the individual involved; 

11 ‘‘(E) in the case of individuals with an in12 come greater than 250 percent of the official 

13 poverty level but not exceeding 300 percent of 

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

15 calendar year, impose charges in an amount ex16 ceeding 6 percent of the annual gross income of 

17 the individual involved; 

18 ‘‘(F) in the case of individuals with an in19 come greater than 300 percent of the official 

20 poverty level but not exceeding 400 percent of 

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

22 calendar year, impose charges in an amount ex23 ceeding 8.5 percent of the annual gross income 

24 of the individual involved; 


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1 ‘‘(G) in the case of individuals with an in2 come greater than 400 percent of the official 

3 poverty level, the provider will not, for any cal4 endar year, impose charges in an amount ex5 ceeding 8.5 percent of the annual gross income 

6 of the individual involved; and 

7 ‘‘(H) in the case of eligible American In8 dian and Alaska Native individuals as defined 

9 by section 447.50 of title 42, Code of Federal 

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

11 provider will not impose any charges for sub12 stance use disorder treatment services, includ13 ing any charges or cost-sharing prohibited by 

14 section 1402(d) of the Patient Protection and 

15 Affordable Care Act. 

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

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

18 eligible local area may, in the case of individuals 

19 subject to a charge— 

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

21 the discretion of the area, including imposing 

22 only a nominal charge for the provision of sub23 stance use disorder treatment services, subject 

24 to the provisions of the paragraph regarding 


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1 public schedules and regarding limitations on 

2 the maximum amount of charges; and 

3 ‘‘(B) take into consideration the total med4 ical expenses of individuals in assessing the 

5 amount of the charge, subject to such provi6 sions. 

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

8 may not make a grant under section 3401 to an eli9 gible local area unless the area agrees that the limi10 tations on charges for substance use disorder treat11 ment services under this subsection applies to the 

12 annual aggregate of charges imposed for such serv13 ices, however the charges are characterized, includes 

14 enrollment fees, premiums, deductibles, cost sharing, 

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

16 charges. 

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

18 for grants distributed in accordance with section 

19 3403(a)(3) shall be developed by the Secretary in con20 sultation with Indian tribes. 

21 ‘‘SEC. 3405. TECHNICAL ASSISTANCE. 

22 ‘‘The Secretary shall, beginning on the date of enact23 ment of this title, provide technical assistance, including 

24 assistance from other grantees, contractors or subcontrac25 tors under this title to assist newly eligible local areas in 


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1 the establishment of planning councils and, to assist enti2 ties in complying with the requirements of this subtitle 

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

4 under this subtitle. The Secretary may make planning 

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

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

7 eligible for funding under section 3401 in the following 

8 fiscal year. Such grant amounts shall be deducted from 

9 the first year formula award to eligible local areas accept10 ing such grants. 

11 ‘‘SEC. 3406. AUTHORIZATION OF APPROPRIATIONS. 

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

13 this subtitle— 

14 ‘‘(1) $3,300,000,000 for fiscal year 2022; 

15 ‘‘(2) $3,300,000,000 for fiscal year 2023; 

16 ‘‘(3) $3,300,000,000 for fiscal year 2024; 

17 ‘‘(4) $3,300,000,000 for fiscal year 2025; 

18 ‘‘(5) $3,300,000,000 for fiscal year 2026; 

19 ‘‘(6) $3,300,000,000 for fiscal year 2027; 

20 ‘‘(7) $3,300,000,000 for fiscal year 2028; 

21 ‘‘(8) $3,300,000,000 for fiscal year 2029; 

22 ‘‘(9) $3,300,000,000 for fiscal year 2030; and 

23 ‘‘(10) $3,300,000,000 for fiscal year 2031. 


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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 

25 treatment services is organized to maxiVerDate Sep 11 2014 21:43 Dec 22, 2021 Jkt 029200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\S3418.IS S3418

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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 

24 factors considered by the Secretary in de25 termining whether a State has a demVerDate Sep 11 2014 21:43 Dec 22, 2021 Jkt 029200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\S3418.IS S3418

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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 FOR ADDICTION 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 FUNDS.—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 funds 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) PAYMENT OF FUNDS.—At the option 

17 of an Indian tribe the Secretary shall pay funds 

18 under this section through a contract, coopera19 tive agreement, or compact under, as applicable, 

20 title I or V of the Indian Self-Determination 

21 and Education Assistance Act. 

22 ‘‘(D) USE OF AMOUNTS.—Notwithstanding 

23 any requirements in this section, an Indian 

24 tribe may use amounts provided under funds 

25 awarded under this paragraph for the uses 


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1 identified in subsection (b) and any other activi2 ties determined appropriate by the Secretary, in 

3 consultation with Indian tribes. 

4 ‘‘(b) USE OF AMOUNTS.— 

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

6 amounts provided under grants awarded under sec7 tion 3411 for— 

8 ‘‘(A) prevention services described in para9 graph (3); 

10 ‘‘(B) core medical services described in 

11 paragraph (4); 

12 ‘‘(C) recovery and support services de13 scribed in paragraph (5); 

14 ‘‘(D) early intervention services described 

15 in paragraph (6); 

16 ‘‘(E) harm reduction services described in 

17 paragraph (7); 

18 ‘‘(F) financial assistance with health insur19 ance as described in paragraph (8); and 

20 ‘‘(G) administrative expenses described in 

21 paragraph (9). 

22 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 

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

24 use amounts received under a grant under sec25 tion 3411 to provide direct financial assistance 


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1 to eligible entities or other eligible Medicaid 

2 providers for the purpose of providing preven3 tion services, core medical services, recovery 

4 and support services, early intervention services, 

5 and harm reduction services. 

6 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi7 nancial assistance may be provided under sub8 paragraph (A) to public or nonprofit entities, 

9 other Medicaid providers if more than half of 

10 their patients are diagnosed with a substance 

11 use disorder and covered by Medicaid, or other 

12 private for-profit entities if such entities are the 

13 only available provider of quality substance use 

14 disorder treatment services in the area. 

15 ‘‘(C) LIMITATION.—A State may not pro16 vide direct financial assistance to any entity or 

17 provider that provides medication for addiction 

18 treatment if that entity or provider does not 

19 also offer mental health services or psycho20 therapy by licensed clinicians through a referral 

21 or onsite. 

22 ‘‘(D) NEUTRALITY TOWARDS ORGANIZED

23 LABOR.— 

24 ‘‘(i) IN GENERAL.—In carrying out 

25 duties under this section, States shall, to 


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1 the extent practicable, prioritize the dis2 tribution of grant funds to grantees that 

3 have— 

4 ‘‘(I)(aa) a collective bargaining 

5 agreement; or 

6 ‘‘(bb) an explicit policy not to 

7 deter employees with respect to— 

8 ‘‘(AA) labor organizing for 

9 the employees engaged in the 

10 covered activities; and 

11 ‘‘(BB) such employees’ 

12 choice to form and join labor or13 ganizations; and 

14 ‘‘(II) policies that require— 

15 ‘‘(aa) the posting and main16 tenance of notices in the work17 place to such employees of their 

18 rights under the National Labor 

19 Relations Act (29 U.S.C. 151 et 

20 seq.); 

21 ‘‘(bb) that such employees 

22 are, at the beginning of their em23 ployment, provided notice and in24 formation regarding the employ25 ees’ rights under such Act; and 


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1 ‘‘(cc) the employer to volun2 tarily recognize a union in cases 

3 where a majority of such workers 

4 of the employer have joined and 

5 requested representation. 

6 ‘‘(ii) LIMITATION.—This subsection 

7 does not apply to Indian tribes. 

8 ‘‘(3) PREVENTION SERVICES.— 

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

10 section, the term ‘prevention services’ means 

11 evidence-based services, programs, or multi-sec12 tor strategies to prevent substance use disorder 

13 (including education campaigns, community14 based prevention programs, risk-identification 

15 programs, opioid diversion, collection and dis16 posal of unused opioids, services to at-risk pop17 ulations, and trauma support services). 

18 ‘‘(B) LIMIT.—A State may use not to ex19 ceed 20 percent of the amount of the grant 

20 under section 3411 for prevention services. A 

21 State may apply to the Secretary for a waiver 

22 of this subparagraph. 

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

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

25 means the following evidence-based services when 


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1 provided to individuals with substance use disorder 

2 or at risk for developing substance use disorder, in3 cluding through the use of telemedicine or a hub and 

4 spoke model: 

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

6 described in section 3439(4), including assess7 ment of disease presence, severity, and co-oc8 curring conditions, treatment planning, clinical 

9 stabilization services, withdrawal management 

10 and detoxification, intensive inpatient treat11 ment, intensive outpatient treatment, outpatient 

12 treatment, residential inpatient services, treat13 ment for co-occurring mental health and sub14 stance use disorders, and all drugs approved by 

15 the Food and Drug Administration for the 

16 treatment of substance use disorder. 

17 ‘‘(B) Outpatient and ambulatory health 

18 services, including those administered by Feder19 ally-qualified health centers, rural health clinics, 

20 tribal clinics and hospitals, urban Indian orga21 nizations, certified community behavioral health 

22 clinics (as described in section 223 of the Pro23 tecting Access to Medicare Act), and com24 prehensive opioid recovery centers (as described 

25 in section 552 of this Act). 


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1 ‘‘(C) Hospice services. 

2 ‘‘(D) Mental health services. 

3 ‘‘(E) Opioid overdose reversal drug prod4 ucts procurement, distribution, and training. 

5 ‘‘(F) Pharmaceutical assistance related to 

6 the management of substance-use disorders and 

7 co-morbid conditions. 

8 ‘‘(G) Home- and community-based health 

9 services. 

10 ‘‘(H) Comprehensive Case Management 

11 and care coordination, including substance use 

12 disorder treatment adherence services. 

13 ‘‘(I) Health insurance enrollment and cost14 sharing assistance in accordance with para15 graph (8). 

16 ‘‘(J) Programs that hire, employ, train, 

17 and dispatch licensed health care professionals, 

18 mental health professionals, harm reduction 

19 providers, or community health workers to re20 spond in lieu of law enforcement officers in 

21 emergencies and that ensure a licensed health 

22 care professional is a member of the team that 

23 responds in lieu of law enforcement officers in 

24 emergencies in which— 


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1 ‘‘(i) an individual calling 911, the Na2 tional Suicide Hotline, or another emer3 gency hotlines states that a person is expe4 riencing a drug overdose or is otherwise 

5 under the influence of a legal or illegal 

6 substance; or 

7 ‘‘(ii) a law enforcement officer, other 

8 first responder, or other individual identi9 fies a person as being (or possibly being) 

10 under the influence of a legal or illegal 

11 substance. 

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

13 purposes of this section, the term ‘recovery and sup14 port services’ means services including residential re15 covery housing, mental health services, long term re16 covery services, 24/7 hotline crisis center services, 

17 medical transportation services, respite care for per18 sons caring for individuals with substance use dis19 order, child care and family services while an indi20 vidual is receiving inpatient treatment services or at 

21 the time of outpatient services, outreach services, 

22 peer recovery services, nutrition services, and refer23 rals for job training and career services, housing, 

24 legal services, and child care and family services. 

25 The entities through which such services may be 


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1 provided include State, local, and tribal authorities 

2 that provide child care, housing, community develop3 ment, and other recovery and support services, so 

4 long as they do not exclude individuals on the basis 

5 that such individuals receive medication for addic6 tion treatment. 

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

8 purposes of this section, the term ‘early intervention 

9 services’ means services to provide screening and 

10 connection to the appropriate level of substance use 

11 disorder and mental health treatment (including 

12 same-day connection), counseling provided to indi13 viduals who have misused substances, who have ex14 perienced an overdose, or are at risk of developing 

15 substance use disorder, the provision of referrals to 

16 facilitate the access of such individuals to core med17 ical services or recovery and support services for 

18 substance use disorder, and rapid access to medica19 tion for addiction treatment in the setting of recent 

20 overdose. The entities through which such services 

21 may be provided include emergency rooms, fire de22 partments and emergency medical services, detention 

23 facilities, prisons and jails, homeless shelters, health 

24 care points of entry specified by eligible local areas, 

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1 cies and job centers, youth development centers, 

2 tribal clinics and hospitals, urban Indian organiza3 tions, and rural health clinics. 

4 ‘‘(7) HARM REDUCTION SERVICES.—For pur5 poses of this section, the term ‘harm reduction serv6 ices’ means services provided to individuals engaging 

7 in substance use scientifically accepted to reduce the 

8 risk of infectious disease transmission, overdose, or 

9 death, including by increasing access to health care, 

10 housing, recovery, and support services, including sy11 ringe services programs. Such term includes evi12 dence-based services. 

13 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV14 ERAGE.—A State may use amounts provided under 

15 a grant awarded under section 3411 to establish a 

16 program of financial assistance to assist eligible indi17 viduals with substance use disorder in— 

18 ‘‘(A) enrolling in health insurance cov19 erage; or 

20 ‘‘(B) affording health care services, includ21 ing assistance paying cost-sharing amounts, in22 cluding premiums. 

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

24 State shall not use in excess of 10 percent of 

25 amounts received under a grant under section 3411 


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1 for administration, accounting, reporting, and pro2 gram oversight functions, including the development 

3 of systems to improve data collection and data shar4 ing. 

5 ‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 

6 received under a grant under section 3411 may be 

7 used to provide substance use disorder treatment 

8 services, including medication for addiction treat9 ment, to individuals who are currently incarcerated 

10 or in pre-trial detention. 

11 ‘‘(c) REQUIRED TERMS.— 

12 ‘‘(1) REQUIREMENT OF STATUS AS MEDICAID

13 PROVIDER.— 

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

15 subparagraph (B), the Secretary may not make 

16 a grant under section 3411 for the provision of 

17 substance use disorder treatment services under 

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

19 such service that is available pursuant to the 

20 State plan approved under title XIX of the So21 cial Security Act for the State— 

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

23 agreement with a political subdivision, 

24 under which the political subdivision will 

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1 ical subdivision has entered into a partici2 pation agreement under the State plan and 

3 is qualified to receive payments under such 

4 plan; or 

5 ‘‘(II) the State will enter into agree6 ments with public or nonprofit entities, or 

7 other Medicaid providers if more than half 

8 of their patients are diagnosed with a sub9 stance use disorder and covered by Med10 icaid, under which such entities and other 

11 providers will provide the service, and such 

12 entities and other providers have entered 

13 into such a participation agreement and 

14 are qualified to receive such payments; and 

15 ‘‘(III) the State ensures the political 

16 subdivision under clause (i)(I) or the pub17 lic or nonprofit private entities and other 

18 providers under clause (i)(II) will seek pay19 ment for each such service rendered in ac20 cordance with the usual payment schedule 

21 under the State plan. 

22 ‘‘(B) WAIVER.— 

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

24 entity making an agreement pursuant to 

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1 sion of substance use disorder treatment 

2 services, the requirement established in 

3 such subparagraph shall be waived by the 

4 State if the entity does not, in providing 

5 health care services, impose a charge or ac6 cept reimbursement available from any 

7 third-party payor, including reimbursement 

8 under any insurance policy or under any 

9 Federal or State health benefits program. 

10 A waiver under this subparagraph shall 

11 not be longer than 2 years in duration and 

12 shall not be renewed. 

13 ‘‘(ii) DETERMINATION.—A determina14 tion by the State of whether an entity re15 ferred to in clause (i) meets the criteria for 

16 a waiver under such clause shall be made 

17 without regard to whether the entity ac18 cepts voluntary donations for the purpose 

19 of providing services to the public. 

20 ‘‘(2) REQUIRED TERMS FOR EXPANDING AND

21 IMPROVING CARE.—A funding agreement for a grant 

22 under this section shall— 

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

24 grant will not be utilized to make payments for 

25 any item or service to the extent that payment 


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1 has been made, or can reasonably be expected 

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

3 under a State compensation program, under an 

4 insurance policy, or under any Federal or State 

5 health benefits program (except for a program 

6 administered by, or providing the services of, 

7 the Indian Health Service); and 

8 ‘‘(B) ensure that all entities providing sub9 stance use disorder treatment services with as10 sistance made available under the grant shall 

11 offer all drugs approved by the Food and Drug 

12 Administration for the treatment of substance 

13 use disorder for which the applicant offers 

14 treatment, in accordance with section 3435. 

15 ‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund16 ing agreement for a grant under this section is 

17 that— 

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

19 utilized to supplement not supplant other Fed20 eral, State, or local funds made available in the 

21 year for which the grant is awarded to provide 

22 substance use disorder treatment services to in23 dividuals with substance use disorder, including 

24 funds for each of prevention services, core med25 ical services, recovery and support services, 


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1 early intervention services, harm reduction serv2 ices, mental health services, and administrative 

3 expenses; 

4 ‘‘(B) political subdivisions within the State 

5 will maintain the level of expenditures by such 

6 political subdivisions for substance use disorder 

7 treatment services at a level that is at least 

8 equal to the level of such expenditures by such 

9 political subdivisions for the preceding fiscal 

10 year including expenditures for each of preven11 tion services, core medical services, recovery 

12 and support services, early intervention services, 

13 harm reduction services, mental health services, 

14 and administrative expenses; 

15 ‘‘(C) political subdivisions within the State 

16 will not use funds received under a grant 

17 awarded under section 3411 in maintaining the 

18 level of substance use disorder treatment serv19 ices as required in subparagraph (B); 

20 ‘‘(D) substance use disorder treatment 

21 services provided with assistance made available 

22 under the grant will be provided without re23 gard— 

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

25 pay for such services; and 


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1 ‘‘(ii) to the current or past health con2 dition of the individual to be served; 

3 ‘‘(E) substance use disorder treatment 

4 services will be provided in a setting that is ac5 cessible to low-income individuals with sub6 stance use disorders and to individuals with 

7 substance use disorders residing in rural areas; 

8 ‘‘(F) a program of outreach will be pro9 vided to low-income individuals with substance 

10 use disorders to inform such individuals of sub11 stance use disorder treatment services and to 

12 individuals with substance use disorders resid13 ing in rural areas; 

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

15 for the use of grant funds and the Federal trust 

16 responsibility is upheld at all levels of program 

17 administration; and 

18 ‘‘(H) the confidentiality of individuals re19 ceiving substance use disorder treatment serv20 ices will be maintained in a manner not incon21 sistent with applicable law. 

22 ‘‘SEC. 3413. APPLICATION. 

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

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

25 plan approved by the Secretary pursuant to section 


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1 1932(b), and shall prepare and submit to the Secretary 

2 an application in such form, and containing such informa3 tion, as the Secretary shall require, including— 

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

5 of any prior grants received under this subtitle by 

6 the applicant and the results achieved by these ex7 penditures and a demonstration that funds received 

8 from a grant under this subtitle in the prior year 

9 were expended in accordance with State priorities; 

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

11 achieved with grant funds provided under this sub12 title, including targets and milestones that are in13 tended to be met, the activities that will be under14 taken to achieve those targets, and the number of 

15 individuals likely to be served by the funds sought, 

16 including demographic data on the populations to be 

17 served; 

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

19 funds in a manner that provides substance use dis20 order treatment services in compliance with the evi21 dence-based standards developed in accordance with 

22 section 3435, including all drugs approved by the 

23 Food and Drug Administration for the treatment of 

24 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 for addiction treatment by age, 

17 gender, sexual orientation, race, disability status, 

18 and other demographic criteria relevant to the pro19 gram, and the effect of the program on overdose 

20 rates and rates of death due to overdose in the re21 gion served by the program. 

22 ‘‘(b) REQUIREMENTS REGARDING IMPOSITION OF

23 CHARGES FOR SERVICES.— 

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

25 make a grant under section 3411 to a State unless 


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1 the State provides assurances that in the provision 

2 of services with assistance provided under the 

3 grant— 

4 ‘‘(A) in the case of individuals with an in5 come less than or equal to 150 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 150 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 150 percent of the official 

16 poverty level but not exceeding 200 percent of 

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

18 calendar year, impose charges in an amount ex19 ceeding 2 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 250 percent of 

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

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1 ceeding 4 percent of the annual gross income of 

2 the individual involved; 

3 ‘‘(E) in the case of individuals with an in4 come greater than 250 percent of the official 

5 poverty level but not exceeding 300 percent of 

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

7 calendar year, impose charges in an amount ex8 ceeding 6 percent of the annual gross income of 

9 the individual involved; 

10 ‘‘(F) in the case of individuals with an in11 come greater than 300 percent of the official 

12 poverty level but not exceeding 400 percent of 

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

14 calendar year, impose charges in an amount ex15 ceeding 8.5 percent of the annual gross income 

16 of the individual involved; 

17 ‘‘(G) in the case of individuals with an in18 come greater than 400 percent of the official 

19 poverty level, the provider will not, for any cal20 endar year, impose charges in an amount ex21 ceeding 8.5 percent of the annual gross income 

22 of the individual involved; and 

23 ‘‘(H) in the case of eligible American In24 dian and Alaska Native and urban Indian indi25 viduals as defined by section 447.50 of title 42, 


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1 Code of Federal Regulations (as in effect on 

2 July 1, 2010), the provider will not impose any 

3 charges for substance use disorder treatment 

4 services, including any charges or cost-sharing 

5 prohibited by section 1402(d) of the Patient 

6 Protection and Affordable Care Act. 

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

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

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

10 charge— 

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

12 the discretion of the State, including imposing 

13 only a nominal charge for the provision of serv14 ices, subject to the provisions of the paragraph 

15 regarding public schedules and regarding limi16 tations on the maximum amount of charges; 

17 and 

18 ‘‘(B) take into consideration the total med19 ical expenses of individuals in assessing the 

20 amount of the charge, subject to such provi21 sions. 

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

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

24 unless the State agrees that the limitations on 

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1 ices under this subsection applies to the annual ag2 gregate of charges imposed for such services, how3 ever the charges are characterized, includes enroll4 ment fees, premiums, deductibles, cost sharing, co5 payments, co-insurance costs, or any other charges. 

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

7 applying to grants distributed in accordance with section 

8 3412(b) shall be developed by the Secretary in consulta9 tion with Indian tribes. 

10 ‘‘SEC. 3414. TECHNICAL ASSISTANCE. 

11 ‘‘The Secretary shall, directly or through grants or 

12 contracts, provide technical assistance in administering 

13 and coordinating the activities authorized under section 

14 3412, including technical assistance for the development 

15 of State applications for supplementary grants authorized 

16 in section 3412(a)(2). 

17 ‘‘SEC. 3415. AUTHORIZATION OF APPROPRIATIONS. 

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

19 this subtitle— 

20 ‘‘(1) $4,600,000,000 for fiscal year 2022; 

21 ‘‘(2) $4,600,000,000 for fiscal year 2023; 

22 ‘‘(3) $4,600,000,000 for fiscal year 2024; 

23 ‘‘(4) $4,600,000,000 for fiscal year 2025; 

24 ‘‘(5) $4,600,000,000 for fiscal year 2026; 

25 ‘‘(6) $4,600,000,000 for fiscal year 2027; 


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1 ‘‘(7) $4,600,000,000 for fiscal year 2028; 

2 ‘‘(8) $4,600,000,000 for fiscal year 2029; 

3 ‘‘(9) $4,600,000,000 for fiscal year 2030; and 

4 ‘‘(10) $4,600,000,000 for fiscal year 2031. 

5 ‘‘Subtitle C—Other Grant Program 

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

7 ‘‘(a) GRANTS.— 

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

9 grants to public entities, nonprofit entities, Indian 

10 entities, and other eligible Medicaid providers for the 

11 purpose of funding prevention services, core medical 

12 services, recovery and support services, early inter13 vention services, harm reduction services, and ad14 ministrative expenses in accordance with this sec15 tion. 

16 ‘‘(2) PRIORITIZATION.— 

17 ‘‘(A) IN GENERAL.—In awarding grants 

18 under this section, the Secretary shall, to the 

19 extent practicable, prioritize the distribution of 

20 grant funds to grantees that have— 

21 ‘‘(i) an explicit policy not to deter em22 ployees with respect to— 

23 ‘‘(I) labor organizing for the em24 ployees engaged in the covered activi25 ties; and 


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1 ‘‘(II) such employees’ choice to 

2 form and join labor organizations; or 

3 ‘‘(ii) policies that require— 

4 ‘‘(I) the posting and maintenance 

5 of notices in the workplace to such 

6 employees of their rights under the 

7 National Labor Relations Act (29 

8 U.S.C. 151 et seq.); 

9 ‘‘(II) that such employees are, at 

10 the beginning of their employment, 

11 provided notice and information re12 garding the employees’ rights under 

13 such Act; and 

14 ‘‘(III) the employer to voluntarily 

15 recognize a union in cases where such 

16 workers of the employer have joined 

17 and requested representation. 

18 ‘‘(B) EXCEPTION.—This paragraph shall 

19 not apply to Indian tribes. 

20 ‘‘(b) ELIGIBILITY.— 

21 ‘‘(1) ENTITIES.—Public entities, nonprofit enti22 ties, urban Indian organizations, and other Medicaid 

23 providers eligible to receive a grant under subsection 

24 (a) may include— 


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1 ‘‘(A) Federally-qualified health centers 

2 under section 1905(l)(2)(B) of the Social Secu3 rity Act; 

4 ‘‘(B) family planning clinics; 

5 ‘‘(C) rural health clinics; 

6 ‘‘(D) Indian entities, including Indian 

7 health programs as defined in section 4 of the 

8 Indian Health Care Improvement Act, urban 

9 Indian organizations as defined in section 4 of 

10 the Indian Health Care Improvement Act, and 

11 Native Hawaiian organizations as defined in 

12 section 11 of the Native Hawaiian Health Care 

13 Act of 1988; 

14 ‘‘(E) community-based organizations, clin15 ics, hospitals, and other health facilities that 

16 provide substance use disorder treatment serv17 ices; 

18 ‘‘(F) other nonprofit entities that provide 

19 substance use disorder treatment services; 

20 ‘‘(G) certified community behavioral health 

21 clinics and certified community behavioral 

22 health clinic expansion grant recipients, under 

23 section 223 of the Protecting Access to Medi24 care Act (42 U.S.C. 1396a note); and 


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1 ‘‘(H) other Medicaid providers if more 

2 than half of their patients are diagnosed with a 

3 substance use disorder and covered by Med4 icaid. 

5 ‘‘(2) UNDERSERVED POPULATIONS.—Entities 

6 described in paragraph (1) shall serve underserved 

7 populations which may include— 

8 ‘‘(A) minority populations and Indian pop9 ulations; 

10 ‘‘(B) formerly incarcerated individuals; 

11 ‘‘(C) individuals with comorbidities includ12 ing human immunodeficiency virus, hepatitis B, 

13 hepatitis C, mental health disorder or other be14 havioral health disorders; 

15 ‘‘(D) low-income populations; 

16 ‘‘(E) people with disabilities; 

17 ‘‘(F) urban populations; 

18 ‘‘(G) rural populations; 

19 ‘‘(H) the lesbian, gay, bisexual, 

20 transgender, queer (LGBTQ) community; and 

21 ‘‘(I) pregnant individuals with, or at risk 

22 of developing, substance use disorder and in23 fants with neonatal abstinence syndrome. 

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

25 grant under this section, public entities, nonprofit 


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1 entities, and other Medicaid providers described in 

2 this subsection shall prepare and submit to the Sec3 retary an application in such form, and containing 

4 such information, as the Secretary shall require, in5 cluding— 

6 ‘‘(A) a complete accounting of the dis7 bursement of any prior grants received under 

8 this subtitle by the applicant and the results 

9 achieved by these expenditures; 

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

11 the grant, including— 

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

13 local need for the funds sought; 

14 ‘‘(ii) a plan for providing substance 

15 use disorder treatment services that is con16 sistent with local needs; and 

17 ‘‘(iii) goals and objectives to be 

18 achieved with grant funds provided under 

19 this section, including targets and mile20 stones that are intended to be met and a 

21 description of the activities that will be un22 dertaken to achieve those targets; 

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

24 use funds in a manner that provides substance 

25 use disorder treatment services compliant with 


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1 the evidence-based standards developed in ac2 cordance with section 3435, including all drugs 

3 approved by the Food and Drug Administration 

4 for the treatment of substance use disorder for 

5 which the applicant offers treatment, in accord6 ance with section 3435(c); 

7 ‘‘(D) information on the number of individ8 uals to be served by the funds sought, including 

9 demographic data on the populations to be 

10 served; 

11 ‘‘(E) a demonstration that resources pro12 vided under the grant will be allocated in ac13 cordance with the local demographic incidence 

14 of substance use, including allocations for serv15 ices for children, youths, and women; 

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

17 and medical expense criteria will be established 

18 and applied to those who qualify for assistance 

19 under the program; and 

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

21 this section, data provided in such form as the 

22 Secretary shall require detailing, at a minimum, 

23 the extent to which the activities supported by 

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1 ber of individuals who accessed medication for 

2 addiction treatment by age, gender, race, sexual 

3 orientation, disability status, and other demo4 graphic criteria relevant to the program, and 

5 the effect of the program on overdose rates and 

6 rates of death due to overdose in the region 

7 served by the program. 

8 ‘‘(4) 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 this section for the provision of 

13 substance use disorder treatment services under 

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

15 such service that is available pursuant to the 

16 State plan approved under title XIX of the So17 cial Security Act for the State— 

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

19 provide the service directly, and the appli20 cant has entered into a participation agree21 ment under the State plan and is qualified 

22 to receive payments under such plan; or 

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

24 enter into an agreement with public or 

25 nonprofit entities, Indian entities, or other 


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1 Medicaid providers if more than half of 

2 their patients are diagnosed with a sub3 stance use disorder and covered by Med4 icaid, under which such entities and other 

5 providers will provide the substance use 

6 disorder treatment service, and such enti7 ties and other providers have entered into 

8 such a participation agreement and are 

9 qualified to receive such payments; and 

10 ‘‘(ii) the applicant ensures that pay11 ment will be sought for each such service 

12 rendered in accordance with the usual pay13 ment schedule under the State plan. 

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

15 making an agreement pursuant to subpara16 graph (A) regarding the provision of substance 

17 use disorder treatment services, the require18 ment established in such paragraph shall be 

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

20 providing such services, impose a charge or ac21 cept reimbursement available from any third22 party payor, including reimbursement under 

23 any insurance policy or under any Federal or 

24 State health benefits program. A waiver under 


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1 this subparagraph shall not be longer than 2 

2 years in duration and shall not be renewed. 

3 ‘‘(C) DETERMINATION.—A determination 

4 by the State of whether an entity referred to in 

5 subparagraph (A) meets the criteria for a waiv6 er under such subparagraph shall be made 

7 without regard to whether the entity accepts 

8 voluntary donations for the purpose of pro9 viding services to the public. 

10 ‘‘(5) REQUIRED TERMS FOR EXPANDING AND

11 IMPROVING CARE.—A funding agreement for a grant 

12 under this section is that— 

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

14 not be utilized to make payments for any item 

15 or service to the extent that payment has been 

16 made, or can reasonably be expected to be 

17 made, with respect to that item or service under 

18 a State compensation program, under an insur19 ance policy, or under any Federal or State 

20 health benefits program (except for a program 

21 administered by, or providing the services of, 

22 the Indian Health Service); 

23 ‘‘(B) entities providing substance use dis24 order treatment services with assistance made 

25 available under the grant shall offer all drugs 


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1 approved by the Food and Drug Administration 

2 for the treatment of substance use disorder for 

3 which the applicant offers treatment, in accord4 ance with section 3435(c); 

5 ‘‘(C) substance use disorder treatment 

6 services provided with assistance made available 

7 under the grant will be provided without re8 gard— 

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

10 pay for such services; and 

11 ‘‘(ii) to the current or past health con12 dition of the individual to be served; 

13 ‘‘(D) substance use disorder treatment 

14 services will be provided in a setting that is ac15 cessible to low-income individuals with sub16 stance use disorders and to individuals with 

17 substance use disorders residing in rural areas; 

18 and 

19 ‘‘(E) the confidentiality of individuals re20 ceiving substance use disorder treatment serv21 ices will be maintained in a manner not incon22 sistent with applicable law. 

23 ‘‘(c) 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) FORMULA GRANTS.—The Secretary, acting 

4 through the Indian Health Service, shall use 10 per5 cent of the amount available under section 3425 for 

6 each fiscal year to provide grants to Indian entities 

7 in an amount determined pursuant to criteria devel8 oped by the Secretary in consultation with Indian 

9 Tribes and after conferring with urban Indian orga10 nizations, for the purposes of addressing substance 

11 use. 

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

13 requirements in this section, Native entities may use 

14 amounts provided under grants awarded under this 

15 section for the uses identified in section 3422 and 

16 any other activities determined appropriate by the 

17 Secretary, in consultation with Indian Tribes. 

18 ‘‘SEC. 3422. USE OF AMOUNTS. 

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

20 received under a grant under section 3421 to provide di21 rect financial assistance to eligible entities for the purpose 

22 of delivering or enhancing— 

23 ‘‘(1) prevention services described in subsection 

24 (b); 


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1 ‘‘(2) core medical services described in sub2 section (c); 

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

4 subsection (d); 

5 ‘‘(4) early intervention and engagement services 

6 described in subsection (e); 

7 ‘‘(5) harm reduction services described in sub8 section (f); and 

9 ‘‘(6) administrative expenses described in sub10 section (g). 

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

12 section, the term ‘prevention services’ means evidence13 based services, programs, or multi-sector strategies to pre14 vent substance use disorder (including education cam15 paigns, community-based prevention programs, risk iden16 tification programs, opioid diversion, collection and dis17 posal of unused opioids, services to at-risk populations, 

18 and trauma support services). 

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

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

21 following evidence-based services provided to individuals 

22 with substance use disorder or at risk for developing sub23 stance use disorder, including through the use of telemedi24 cine or a hub and spoke model: 


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

2 fully described in section 3439(4), including assess3 ment of disease presence, severity, and co-occurring 

4 conditions, treatment planning, clinical stabilization 

5 services, withdrawal management and detoxification, 

6 intensive inpatient treatment, intensive outpatient 

7 treatment, outpatient treatment, residential inpa8 tient services, treatment for co-occurring mental 

9 health and substance use disorders, and all drugs 

10 approved by the Food and Drug Administration for 

11 the treatment of substance use disorder. 

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

13 including those administered by Federally-qualified 

14 health centers, rural health clinics, tribal clinics and 

15 hospitals, urban Indian organizations, certified com16 munity behavioral health clinics (as described in sec17 tion 223 of the Protecting Access to Medicare Act), 

18 and comprehensive opioid recovery centers (as de19 scribed in section 552 of this Act). 

20 ‘‘(3) Hospice services. 

21 ‘‘(4) Mental health services. 

22 ‘‘(5) Opioid overdose reversal drug products 

23 procurement, distribution, and training. 


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1 ‘‘(6) Pharmaceutical assistance related to the 

2 management of substance-use disorder and co-mor3 bid conditions. 

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

6 ‘‘(8) Comprehensive Case Management and care 

7 coordination, including substance use disorder treat8 ment adherence services. 

9 ‘‘(9) Health insurance enrollment and cost10 sharing assistance in accordance with section 3412. 

11 ‘‘(10) Programs that hire, employ, train, and 

12 dispatch mental health professionals, harm reduction 

13 providers, or community health workers to respond 

14 in lieu of law enforcement officers in emergencies in 

15 which— 

16 ‘‘(A) an individual calling 911, the Na17 tional Suicide Hotline, or another emergency 

18 hotlines states that a person is experiencing a 

19 drug overdose or is otherwise under the influ20 ence of a legal or illegal substance; and 

21 ‘‘(B) a law enforcement officer, other first 

22 responder, or other individual identifies a per23 son as being (or possibly being) under the influ24 ence of a legal or illegal substance. 


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1 ‘‘(d) RECOVERY AND SUPPORT SERVICES.—For pur2 poses of this section, the term ‘recovery and support serv3 ices’ means services that are provided to individuals with 

4 substance use disorder, including residential recovery 

5 housing, mental health services, long term recovery serv6 ices, 24/7 hotline crisis center support, medical transpor7 tation services, respite care for persons caring for individ8 uals with substance use disorder, child care and family 

9 services while an individual is receiving inpatient treat10 ment services or at the time of outpatient services, out11 reach services, peer recovery services, nutrition services, 

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

13 legal services, and child care and family services. The enti14 ties through which such services may be provided include 

15 local and tribal authorities that provide child care, hous16 ing, community development, and other recovery and sup17 port services, so long as they do not exclude individuals 

18 on the basis that such individuals receive medication for 

19 addiction treatment. 

20 ‘‘(e) EARLY INTERVENTION SERVICES.—For pur21 poses of this section, the term ‘early intervention services’ 

22 means services to provide screening and connection to the 

23 appropriate level of substance use disorder and mental 

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1 stances, who have experienced an overdose, or are at risk 

2 of developing substance use disorder, the provision of re3 ferrals to facilitate the access of such individuals to core 

4 medical services or recovery and support services for sub5 stance use disorder, and rapid access to medication for 

6 addiction treatment in the setting of recent overdose. The 

7 entities through which such services may be provided in8 clude emergency rooms, fire departments and emergency 

9 medical services, detention facilities, prisons and jails 

10 homeless shelters, health care points of entry specified by 

11 eligible local areas, Federally-qualified health centers, 

12 workforce agencies and job centers, youth development 

13 centers, tribal clinics and hospitals, urban Indian organi14 zations, and rural health clinics. 

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

16 this section, the term ‘harm reduction services’ means 

17 services provided to individuals engaging in substance use 

18 that are scientifically accepted to reduce the risk of infec19 tious disease transmission, overdose, or death, including 

20 by increasing access to health care, housing, and recovery 

21 and support services, including syringe services programs. 

22 Such term includes evidence-based services. 

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

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

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1 tion 3421 for administration, accounting, reporting, and 

2 program oversight functions, including for the purposes of 

3 developing systems to improve data collection and data 

4 sharing. 

5 ‘‘(h) RELATION TO EXISTING EMERGENCY MEDICAL

6 SERVICES.—Nothing in this section shall be construed to 

7 diminish or alter the rights, privileges, remedies, or obliga8 tions of any provider or any Federal, State, or local gov9 ernment to provide emergency medical services. 

10 ‘‘SEC. 3423. TECHNICAL ASSISTANCE. 

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

12 contracts, provide technical assistance to public or non13 profit entities, Indian entities, and other eligible Medicaid 

14 providers regarding the process of submitting to the Sec15 retary applications for grants under section 3421, and 

16 may provide technical assistance with respect to the plan17 ning, development, and operation of any program or serv18 ice carried out pursuant to such section. 

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

20 ‘‘(a) IN GENERAL.—The Secretary may provide plan21 ning grants to public or nonprofit entities, Indian entities, 

22 and other eligible Medicaid providers for purposes of as23 sisting such entities and providers in expanding their ca24 pacity to provide substance use disorder treatment services 


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1 in low-income communities and affected subpopulations 

2 that are underserviced with respect to such services. 

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

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

5 ‘‘SEC. 3425. AUTHORIZATION OF APPROPRIATIONS. 

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

7 this subtitle— 

8 ‘‘(1) $1,000,000,000 for fiscal year 2022; 

9 ‘‘(2) $1,000,000,000 for fiscal year 2023; 

10 ‘‘(3) $1,000,000,000 for fiscal year 2024; 

11 ‘‘(4) $1,000,000,000 for fiscal year 2025; 

12 ‘‘(5) $1,000,000,000 for fiscal year 2026; 

13 ‘‘(6) $1,000,000,000 for fiscal year 2027; 

14 ‘‘(7) $1,000,000,000 for fiscal year 2028; 

15 ‘‘(8) $1,000,000,000 for fiscal year 2029; 

16 ‘‘(9) $1,000,000,000 for fiscal year 2030; and 

17 ‘‘(10) $1,000,000,000 for fiscal year 2031. 

18 ‘‘Subtitle D—Innovation, Training, 

19 and Health Systems Strengthening 

20 ‘‘SEC. 3431. SPECIAL PROJECTS OF NATIONAL SIGNIFI21 CANCE. 

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

23 grants to entities to administer special projects of national 

24 significance to support the development of innovative and 


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1 original models for the delivery of substance use disorder 

2 treatment and harm reduction services. 

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

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

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

6 emerging needs of individuals receiving assistance under 

7 this title. 

8 ‘‘(c) REPLICATION.—The Secretary shall make infor9 mation concerning successful models or programs devel10 oped under this section available to grantees under this 

11 title for the purpose of coordination, replication, and inte12 gration. To facilitate efforts under this section, the Sec13 retary may provide for peer-based technical assistance for 

14 grantees funded under this section. 

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

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

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

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

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

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

23 each fiscal year to provide grants to Indian tribes 

24 for the purposes of supporting the development of 

25 innovative and original models for the delivery of 


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1 substance use disorder treatment services, including 

2 the development of culturally informed care models. 

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

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

5 ‘‘(1) $500,000,000 for fiscal year 2022; 

6 ‘‘(2) $500,000,000 for fiscal year 2023; 

7 ‘‘(3) $500,000,000 for fiscal year 2024; 

8 ‘‘(4) $500,000,000 for fiscal year 2025; 

9 ‘‘(5) $500,000,000 for fiscal year 2026; 

10 ‘‘(6) $500,000,000 for fiscal year 2027; 

11 ‘‘(7) $500,000,000 for fiscal year 2028; 

12 ‘‘(8) $500,000,000 for fiscal year 2029; 

13 ‘‘(9) $500,000,000 for fiscal year 2030; and 

14 ‘‘(10) $500,000,000 for fiscal year 2031. 

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

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

17 and enter into contracts to assist public or nonprofit enti18 ties, public or nonprofit schools, and academic health cen19 ters in meeting the cost of projects— 

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

21 practitioners in programs under this title and other 

22 community providers, including physician addiction 

23 specialists, psychologists, counselors, case managers, 

24 social workers, peer recovery coaches, harm reduc25 tion workers, public health workers, and community 


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1 health workers, and paraprofessionals, such as peer 

2 support specialists and recovery coaches, in the diag3 nosis, treatment, and prevention of substance use 

4 disorders and drug use-related health issues, includ5 ing measures for the prevention and treatment of co6 occurring infectious diseases, mental health dis7 orders, and other conditions, and including (as appli8 cable to the type of health professional involved), 

9 care for women, pregnant women, and children; 

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

11 nursing, public health, osteopathic medicine, den12 tistry, allied health, social work, and mental health 

13 practice to teach health professions students to 

14 screen for and provide for the needs of individuals 

15 with substance use disorders or at risk of substance 

16 use; and 

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

18 resource materials relating to evidence-based prac19 tices for the screening, prevention, and treatment of 

20 substance use disorders and drug use-related health 

21 issues, including information about combating stig22 ma, prescribing best practices, overdose reversal, al23 ternative pain therapies, and all drugs approved by 

24 the Food and Drug Administration for the treat25 ment of substance use disorders, including for the 


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1 purposes authorized under the amendments made by 

2 section 3203 of the SUPPORT for Patients and 

3 Communities Act. 

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

5 grants under subsection (a), the Secretary shall give pref6 erence to qualified projects that will— 

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

8 professionals and other community providers de9 scribed in subsection (a)(1), to provide substance 

10 use disorder treatments for underserved groups, in11 cluding minority individuals and Indians with sub12 stance use disorder and other individuals who are at 

13 a high risk of substance use; 

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

15 health professionals and minority allied health pro16 fessionals, to provide substance use disorder treat17 ment for individuals with such disease; 

18 ‘‘(3) train or result in the training of individ19 uals who will provide substance use disorder treat20 ment in rural or other areas that are underserved by 

21 current treatment structures; 

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

23 professionals and allied health professionals, includ24 ing counselors, case managers, social workers, peer 

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1 lic health workers, and community health workers, 

2 to provide treatment for infectious diseases and 

3 mental health disorders co-occurring with substance 

4 use disorder; and 

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

6 professionals and other community providers to pro7 vide substance use disorder treatments for pregnant 

8 women, children, and adolescents. 

9 ‘‘(c) NATIVE EDUCATION AND TRAINING CEN10 TERS.—The Secretary shall use 10 percent of the amount 

11 available under subsection (d) for each fiscal year to pro12 vide grants authorized under this subtitle to— 

13 ‘‘(1) tribal colleges and universities; 

14 ‘‘(2) Indian Health Service grant funded insti15 tutions; and 

16 ‘‘(3) Native partner institutions, including insti17 tutions of higher education with medical training 

18 programs that partner with one or more Indian 

19 tribes, tribal organizations, Native Hawaiian organi20 zations, or tribal colleges and universities to train 

21 Native health professionals that will provide sub22 stance use disorder treatment services in Native 

23 communities. 

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

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


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1 ‘‘(1) $500,000,000 for fiscal year 2022; 

2 ‘‘(2) $500,000,000 for fiscal year 2023; 

3 ‘‘(3) $500,000,000 for fiscal year 2024; 

4 ‘‘(4) $500,000,000 for fiscal year 2025; 

5 ‘‘(5) $500,000,000 for fiscal year 2026; 

6 ‘‘(6) $500,000,000 for fiscal year 2027; 

7 ‘‘(7) $500,000,000 for fiscal year 2028; 

8 ‘‘(8) $500,000,000 for fiscal year 2029; 

9 ‘‘(9) $500,000,000 for fiscal year 2030; and 

10 ‘‘(10) $500,000,000 for fiscal year 2031. 

11 ‘‘SEC. 3433. SUBSTANCE USE DISORDER TREATMENT PRO12 VIDER CAPACITY UNDER THE MEDICAID PRO13 GRAM. 

14 ‘‘(a) PROJECTS.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall use 

16 amounts appropriated under this section to provide 

17 funding for projects in any State or territory to in18 crease substance use provider capacity, as provided 

19 for in section 1903(aa) of the Social Security Act. 

20 ‘‘(2) PRIORITIZATIONS.— 

21 ‘‘(A) IN GENERAL.—In awarding grants 

22 under this section, the Secretary shall, to the 

23 extent practicable, prioritize the distribution of 

24 grant funds to grantees that have— 


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1 ‘‘(i) an explicit policy not to deter em2 ployees with respect to— 

3 ‘‘(I) labor organizing for the em4 ployees engaged in the covered activi5 ties; and 

6 ‘‘(II) such employees’ choice to 

7 form and join labor organizations; and 

8 ‘‘(ii) policies that require— 

9 ‘‘(I) the posting and maintenance 

10 of notices in the workplace to such 

11 employees of their rights under the 

12 National Labor Relations Act (29 

13 U.S.C. 151 et seq.); 

14 ‘‘(II) that such employees are, at 

15 the beginning of their employment, 

16 provided notice and information re17 garding the employees’ rights under 

18 such Act; and 

19 ‘‘(III) the employer to voluntarily 

20 recognize a union in cases where such 

21 workers of the employer have joined 

22 and requested representation. 

23 ‘‘(B) EXCEPTION.—This paragraph shall 

24 not apply to Indian tribes. 

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


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

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

3 section 4 of the Indian Self-Determination and Edu4 cation Assistance Act. 

5 ‘‘(2) URBAN INDIAN ORGANIZATION.—In this 

6 section, the term ‘urban Indian organization’ has the 

7 meaning given such in section 4 of the Indian 

8 Health Care Improvement Act. 

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

10 the Indian Health Service, shall use 10 percent of 

11 the amount appropriated under this section for each 

12 fiscal year to award grants to Indian tribes and 

13 urban Indian organizations in an amount deter14 mined pursuant to criteria developed by the Sec15 retary in consultation with Indian tribes and in con16 ference with urban Indian organizations. 

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

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

19 ‘‘(1) $50,000,000 for fiscal year 2022; 

20 ‘‘(2) $50,000,000 for fiscal year 2023; 

21 ‘‘(3) $50,000,000 for fiscal year 2024; 

22 ‘‘(4) $50,000,000 for fiscal year 2025; 

23 ‘‘(5) $50,000,000 for fiscal year 2026; 

24 ‘‘(6) $50,000,000 for fiscal year 2027; 

25 ‘‘(7) $50,000,000 for fiscal year 2028; 


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1 ‘‘(8) $50,000,000 for fiscal year 2029; 

2 ‘‘(9) $50,000,000 for fiscal year 2030; and 

3 ‘‘(10) $50,000,000 for fiscal year 2031. 

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

5 ‘‘(a) GRANT PROGRAM FOR WORKERS.— 

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

7 through the Director of the National Institute for 

8 Occupational Safety and Health, shall award grants 

9 to non-profit entities that meet the requirements of 

10 this section to fund programs and projects to assist 

11 workers who are at risk of substance use disorder, 

12 who have substance use disorder, or who are recov13 ering from substance use disorder to maintain or 

14 gain employment. 

15 ‘‘(2) GRANTS FOR WORKERS.— 

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

17 on a competitive basis, award grants for a pe18 riod of not more than 3 years to non-profit en19 tities that submit an application under para20 graph (3) to enable such entities to implement, 

21 conduct, continue, and expand evidence-based 

22 programs and projects to assist individuals de23 scribed in subparagraph (G). 


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

2 use amounts provided under this subsection 

3 for— 

4 ‘‘(i) prevention services described in 

5 subparagraph (C), including providing edu6 cation and information to workers regard7 ing the dangers of illicit and licit drug use, 

8 non-opioid pain management and non-drug 

9 pain management, or occupational injury 

10 and illness prevention; 

11 ‘‘(ii) early intervention services de12 scribed in subparagraph (D) to enable in13 dividuals to maintain or gain employment; 

14 ‘‘(iii) recovery and support services 

15 described in subparagraph (E) to enable 

16 individuals to maintain or gain employ17 ment; 

18 ‘‘(iv) harm reduction services de19 scribed in subparagraph (F) to enable indi20 viduals to maintain or gain employment; 

21 ‘‘(v) hiring case managers, care coor22 dinators, and peer support specialists to 

23 assist employed individuals who are experi24 encing substance use disorder, or who are 

25 recovering from substance use disorder, in 


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1 accessing substance use disorder treatment 

2 services; or 

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

4 and other forms of job training to workers 

5 who are receiving substance use disorder 

6 treatment services to enable such workers 

7 to maintain or gain employment. 

8 ‘‘(C) PREVENTION SERVICES.—For pur9 poses of this section, the term ‘prevention serv10 ices’ means evidence-based services, programs, 

11 or multi-sector strategies to prevent substance 

12 use disorder (including education campaigns, 

13 community-based prevention programs, risk 

14 identification programs, opioid diversion, collec15 tion and disposal of unused opioids, services to 

16 at-risk populations, and trauma support serv17 ices). 

18 ‘‘(D) RECOVERY AND SUPPORT SERV19 ICES.—For purposes of this section, the term 

20 ‘recovery and support services’ means services 

21 including residential recovery housing, mental 

22 health services, long term recovery services, 24/ 

23 7 hotline crisis center services, medical trans24 portation services, respite care for persons car25 ing for individuals with substance use disorder, 


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1 child care and family services while an indi2 vidual is receiving inpatient treatment services 

3 or at the time of outpatient services, outreach 

4 services, peer recovery services, nutrition serv5 ices, and referrals for job training and career 

6 services, housing, legal services, and child care 

7 and family services so long as they do not ex8 clude individuals on the basis that such individ9 uals receive medication for addiction treatment. 

10 ‘‘(E) EARLY INTERVENTION SERVICES.— 

11 For purposes of this section, the term ‘early 

12 intervention services’ means services to provide 

13 screening and connection to the appropriate 

14 level of substance use disorder and mental 

15 health treatment (including same-day connec16 tion), counseling provided to individuals who 

17 have misused substances, who have experienced 

18 an overdose, or are at risk of developing sub19 stance use disorder, the provision of referrals to 

20 facilitate the access of such individuals to core 

21 medical services or recovery and support serv22 ices for substance use disorder, and rapid ac23 cess to medication for addiction treatment in 

24 the setting of recent overdose. 


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1 ‘‘(F) HARM REDUCTION SERVICES.—For 

2 purposes of this section, the term ‘harm reduc3 tion services’ means services provided to indi4 viduals engaging in substance use scientifically 

5 accepted to reduce the risk of infectious disease 

6 transmission, overdose, or death, including by 

7 increasing access to health care, housing, and 

8 recovery and support services, including syringe 

9 services programs. Such term includes evidence10 based services. 

11 ‘‘(G) INDIVIDUALS DESCRIBED.—Individ12 uals described in this subparagraph are individ13 uals who— 

14 ‘‘(i)(I) have been employed in the 12- 

15 month period immediately preceding the 

16 date on which the determination is being 

17 made, or who are participating in an em18 ployee training or apprenticeship program; 

19 and 

20 ‘‘(II) are at high risk of developing 

21 substance use disorder, including as a re22 sult of employment in industries that expe23 rience high rates of occupational injuries 

24 and illness; or 


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1 ‘‘(ii) are experiencing a substance use 

2 disorder or are in recovery from a sub3 stance use disorder. 

4 ‘‘(3) APPLICATIONS.—To be eligible for a grant 

5 under this subsection, an entity shall submit to the 

6 Secretary an application at such time, in such man7 ner, and containing such information as the Sec8 retary may require, including— 

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

11 this title by the applicant and the results 

12 achieved by such expenditures; 

13 ‘‘(B) a description of the population to be 

14 served with grant funds provided under this 

15 section, including a description of the unique 

16 risks the population faces for experiencing occu17 pational injuries or exposure to illicit sub18 stances; 

19 ‘‘(C) the goals and objectives to be 

20 achieved with grant funds provided under this 

21 section, including targets and milestones that 

22 are intended to be met, the activities that will 

23 be undertaken to achieve those targets, and the 

24 number of individuals likely to be served by the 


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1 grant funds, including demographic data on the 

2 populations to be served; 

3 ‘‘(D) a demonstration of the ability of the 

4 applicant to reach the individuals described in 

5 paragraph (2)(G) and to provide services de6 scribed in paragraph (2)(B) included in the ap7 plicant’s grant application, including by 

8 partnering with local stakeholders; 

9 ‘‘(E) for any prior funding received under 

10 this subsection, data provided in such form as 

11 the Secretary shall require detailing, at a min12 imum, the extent to which the activities sup13 ported by the funding met the goals, objectives, 

14 targets, and milestones specified in the applica15 tion for the funding, and the number of individ16 uals with and without substance use disorder 

17 who received services supported by the funding, 

18 including the services provided to these individ19 uals, the industries in which the individuals 

20 were employed when they received services, and 

21 whether the individuals were still employed in 

22 that same industry or in any industry when the 

23 individuals ceased receiving services supported 

24 by the funding; and 


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1 ‘‘(F) any other information the Secretary 

2 shall require. 

3 ‘‘(4) DATA REPORTING AND OVERSIGHT.—An 

4 entity awarded a grant under this subsection shall 

5 submit to the Secretary an annual report at such 

6 time and in such manner as the Secretary shall re7 quire. Such report shall include, at a minimum, a 

8 description of— 

9 ‘‘(A) the activities funded by the grant; 

10 ‘‘(B) the number of individuals with and 

11 without substance use disorder served through 

12 activities funded by the grant, including the 

13 services provided to those individuals and the 

14 industries in which those individuals were em15 ployed at the time they received services sup16 ported by the grant; 

17 ‘‘(C) for workers experiencing substance 

18 use disorder or recovering from substance use 

19 disorder served by activities funded by the 

20 grant, the number of individuals who main21 tained employment, the number of individuals 

22 who gained employment, and the number of in23 dividuals who failed to maintain employment 

24 over the course of the reporting period; and 


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1 ‘‘(D) any other information required by the 

2 Secretary. 

3 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

4 There is authorized to be appropriated to carry out 

5 this subsection— 

6 ‘‘(A) $40,000,000 for fiscal year 2022; 

7 ‘‘(B) $40,000,000 for fiscal year 2023; 

8 ‘‘(C) $40,000,000 for fiscal year 2024; 

9 ‘‘(D) $40,000,000 for fiscal year 2025; 

10 ‘‘(E) $40,000,000 for fiscal year 2026; 

11 ‘‘(F) $40,000,000 for fiscal year 2027; 

12 ‘‘(G) $40,000,000 for fiscal year 2028; 

13 ‘‘(H) $40,000,000 for fiscal year 2029; 

14 ‘‘(I) $40,000,000 for fiscal year 2030; and 

15 ‘‘(J) $40,000,000 for fiscal year 2031. 

16 ‘‘(b) RESEARCH ON THE IMPACT OF SUBSTANCE USE

17 DISORDER IN THE WORKPLACE AND ON DIRECT SERVICE

18 PROVIDERS.— 

19 ‘‘(1) RISKS OF SUBSTANCE USE DISORDER.— 

20 The Secretary, in consultation with the Director of 

21 the National Institute for Occupational Safety and 

22 Health, shall conduct (directly or through grants or 

23 contracts) research, experiments, and demonstra24 tions, and publish studies relating to— 


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1 ‘‘(A) the risks faced by employees in var2 ious occupations of developing substance use 

3 disorder and of drug overdose deaths and non4 fatal drug overdoses, and the formulation of 

5 prevention activities tailored to the risks identi6 fied in these occupations, including occupational 

7 injury and illness prevention; 

8 ‘‘(B) the prevalence of substance use dis9 order among employees in various occupations; 

10 ‘‘(C) efforts that employers may undertake 

11 to assist employees who are undergoing sub12 stance use disorder treatment services in main13 taining employment while ensuring workplaces 

14 are safe and healthful; 

15 ‘‘(D) risks of occupational exposure to 

16 opioids and other illicit substances and the for17 mulation of prevention activities tailored to the 

18 risks identified; and 

19 ‘‘(E) other subjects related to substance 

20 use disorder in the workplace as the Secretary 

21 determines. 

22 ‘‘(2) DIRECT SERVICE PROVIDERS.—The Sec23 retary shall conduct (directly or through grants or 

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1 tional health and safety, recruitment, and retention 

2 of behavioral health providers who, as part of their 

3 job responsibilities, provide direct services to individ4 uals who are at risk of experiencing substance use 

5 disorder or who are experiencing or recovering from 

6 substance use disorder, including— 

7 ‘‘(A) identifying factors that the Secretary 

8 believes may endanger the health or safety of 

9 such workers, including factors that affect the 

10 risks such workers face of developing substance 

11 use disorder; 

12 ‘‘(B) motivational and behavioral factors 

13 relating to the field of behavioral health pro14 viders; 

15 ‘‘(C) strategies to support the recruitment 

16 and retention of behavioral health providers; 

17 and 

18 ‘‘(D) other subjects related to behavioral 

19 health providers engaged in direct provision of 

20 substance use disorder prevention and treat21 ment services as the Secretary determines ap22 propriate. 

23 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

24 There is authorized to be appropriated to carry out 

25 this subsection— 


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1 ‘‘(A) $10,000,000 for fiscal year 2022; 

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

3 ‘‘(C) $10,000,000 for fiscal year 2024; 

4 ‘‘(D) $10,000,000 for fiscal year 2025; 

5 ‘‘(E) $10,000,000 for fiscal year 2026; 

6 ‘‘(F) $10,000,000 for fiscal year 2027; 

7 ‘‘(G) $10,000,000 for fiscal year 2028; 

8 ‘‘(H) $10,000,000 for fiscal year 2029; 

9 ‘‘(I) $10,000,000 for fiscal year 2030; and 

10 ‘‘(J) $10,000,000 for fiscal year 2031. 

11 ‘‘SEC. 3435. IMPROVING AND EXPANDING CARE. 

12 ‘‘(a) LEVEL OF CARE STANDARDS FOR SUBSTANCE

13 USE DISORDER TREATMENT SERVICES.— 

14 ‘‘(1) IN GENERAL.—Not later than 1 year after 

15 the date of enactment of this title, the Secretary, in 

16 consultation with the American Society of Addiction 

17 Medicine, State and tribal officials selected by the 

18 Secretary, and other stakeholders as the Secretary 

19 determines necessary, and after seeking public input, 

20 shall promulgate model standards for the regulation 

21 of substance use disorder treatment services. 

22 ‘‘(2) SUBSTANCE USE DISORDER TREATMENT

23 SERVICES.—The model standards promulgated 

24 under paragraph (1) shall, at a minimum— 


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1 ‘‘(A) identify the types of substance use 

2 disorder treatment services intended to be cov3 ered without regard to whether they participate 

4 in any Federal health care program (as defined 

5 in section 1128B(f) of the Social Security Act) 

6 and shall not include— 

7 ‘‘(i) a private practitioner who is al8 ready licensed by a State licensing board 

9 and whose practice is limited to non-inten10 sive outpatient care; or 

11 ‘‘(ii) any substance use disorder treat12 ment service provided on a non-intensive 

13 outpatient basis in the office of a private 

14 practitioner who is licensed by a State li15 censing board; 

16 ‘‘(B) require the designation of a single 

17 State agency to serve as the primary regulator 

18 in the State for substance use disorder treat19 ment services; 

20 ‘‘(C) subject to paragraph (3), require that 

21 substance use disorder treatment services iden22 tified in accordance with subparagraph (A), be 

23 licensed by the respective States according to 

24 the standards for levels of care set forth by the 


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1 American Society of Addiction Medicine in 

2 2013 or an equivalent set of standards; 

3 ‘‘(D) require implementation of a process 

4 to ensure that substance use disorder treatment 

5 program qualifications are verified by means of 

6 an onsite inspection not less frequently than 

7 every 3 years by the State agency serving as 

8 the primary regulator in the State for substance 

9 use disorder treatment services or by an inde10 pendent third party that is approved by the 

11 State’s primary regulator; and 

12 ‘‘(E) require that all patients leaving a res13 idential treatment program receive a written 

14 transition plan prior to discharge from that 

15 level of care. 

16 ‘‘(3) ANNUAL ASSESSMENT.—Beginning with 

17 respect to fiscal year 2022, the Secretary shall make 

18 a determination with respect to each State on 

19 whether the State has adopted, for each of the sub20 stance use disorder treatment services identified in 

21 accordance with paragraph (2)(A), licensure stand22 ards that are in compliance in all material respects 

23 with the model standards promulgated in accordance 

24 with this subsection. In the event the American Soci25 ety of Addiction Medicine revises its criteria, the 


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1 Secretary shall revise the national model level of 

2 care standards accordingly and disseminate any such 

3 update to the States, and the States may adopt any 

4 such updates to be in compliance with this sub5 section. 

6 ‘‘(b) STANDARDS FOR OTHER SPECIFIED MATTERS

7 RELATED TO SUBSTANCE USE DISORDER TREATMENT

8 SERVICES AND RECOVERY RESIDENCES.— 

9 ‘‘(1) IN GENERAL.—Not later than 2 years 

10 after the date of enactment of this title, the Sec11 retary, in consultation with representatives of non12 profit service providers and State and tribal officials 

13 as the Secretary determines necessary, shall promul14 gate model standards for the regulation of— 

15 ‘‘(A) other specified matters related to sub16 stance use disorder treatment services; and 

17 ‘‘(B) recovery residences. 

18 ‘‘(2) OTHER SPECIFIED MATTERS RELATED TO

19 SUBSTANCE USE DISORDER TREATMENT SERV20 ICES.—The model standards promulgated under 

21 paragraph (1)(A) shall, at a minimum— 

22 ‘‘(A) identify the professional credentials 

23 needed by each type of substance use disorder 

24 treatment professional; 


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1 ‘‘(B) include standards for data reporting 

2 and require compilation of statewide reports; 

3 ‘‘(C) require the establishment and mainte4 nance within each State of a toll-free telephone 

5 number to receive complaints from the public 

6 regarding substance use disorder treatment 

7 service providers; and 

8 ‘‘(D) require the establishment and main9 tenance on a publicly accessible internet website 

10 of a list of all substance use disorder treatment 

11 services in the State that have a certification in 

12 effect in accordance with this section. 

13 ‘‘(3) RECOVERY RESIDENCES.— 

14 ‘‘(A) ECONOMIC RELATIONSHIP.—The 

15 model standards promulgated under paragraph 

16 (1)(B) shall, at a minimum, be applied to recov17 ery residences that have an ongoing economic 

18 relationship with any commercial substance use 

19 disorder treatment service. 

20 ‘‘(B) MINIMUM REQUIREMENTS.—The 

21 model standards promulgated under paragraph 

22 (1)(B), which may include any model laws de23 veloped under section 550(a) shall, at a min24 imum, identify requirements for— 


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1 ‘‘(i) the designation of a single State 

2 agency to certify recovery residences; 

3 ‘‘(ii) the implementation of a process 

4 to ensure that the qualifications of recov5 ery residences in which not fewer than 10 

6 individuals may lawfully reside are verified 

7 by means of an onsite inspection not less 

8 frequently than every 3 years by the State 

9 agency serving as the primary regulator in 

10 the State or by an independent third party 

11 that is approved by the State’s primary 

12 regulator; 

13 ‘‘(iii) fire, safety, and health stand14 ards; 

15 ‘‘(iv) equipping residences with opioid 

16 overdose reversal drug products, such as 

17 naloxone and training residence owners, 

18 operators, and employees in the adminis19 tration of naloxone; 

20 ‘‘(v) recovery residence owners and 

21 operators; 

22 ‘‘(vi) a written policy that prohibits 

23 the exclusion of individuals on the basis 

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1 tion for the treatment of substance use dis2 order; 

3 ‘‘(vii) the establishment and mainte4 nance within each State of a toll-free tele5 phone number to receive complaints from 

6 the public regarding recovery residences; 

7 and 

8 ‘‘(viii) the establishment and mainte9 nance on a publicly accessible internet 

10 website of a list of all recovery residences 

11 in the State that have a certification in ef12 fect in accordance with this section. 

13 ‘‘(4) ANNUAL ASSESSMENT.—Beginning with 

14 respect to fiscal year 2023, the Secretary shall make 

15 a determination with respect to each State on 

16 whether the State has adopted, for each of the other 

17 specified substance use disorder treatment services 

18 identified in this section and for recovery residences, 

19 standards that are in compliance in all material re20 spects with the model standards promulgated in ac21 cordance with this subsection. 

22 ‘‘(c) ENSURING ACCESS TO MEDICATION FOR ADDIC23 TION TREATMENT.— 

24 ‘‘(1) MEDICATION FOR ADDICTION TREAT25 MENT.—The Secretary may not make a grant under 


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1 this section unless the applicant for the grant agrees 

2 to require all entities offering substance use disorder 

3 treatment services under the grant to offer all drugs 

4 approved by the Food and Drug Administration for 

5 the treatment of substance use disorder for which 

6 the applicant offers treatment. 

7 ‘‘(2) WAIVER.—The Secretary may grant a 

8 waiver with respect to any requirement of this sec9 tion if the grant applicant involved— 

10 ‘‘(A) submits to the Secretary a justifica11 tion for such waiver containing such informa12 tion as the Secretary shall require; and 

13 ‘‘(B) agrees to require all entities offering 

14 substance use disorder treatment services under 

15 the grant to— 

16 ‘‘(i) offer, on site, at least 2 drugs ap17 proved by the Food and Drug Administra18 tion for the treatment of substance use dis19 order; 

20 ‘‘(ii) provide counseling to patients on 

21 the benefits and risks of all drugs ap22 proved by the Food and Drug Administra23 tion for the treatment of substance use dis24 order; and 


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1 ‘‘(iii) maintain an affiliation agree2 ment with a provider that can prescribe or 

3 otherwise dispense all other forms of drugs 

4 approved by the Food and Drug Adminis5 tration for the treatment of substance use 

6 disorder. 

7 ‘‘(3) GAO STUDY.—Not later than 1 year after 

8 the date of enactment of this title, the Comptroller 

9 General of the United States shall submit to Con10 gress a comprehensive report describing any rela11 tionship between substance use rates, pain manage12 ment practices of the Indian Health Service, and pa13 tient request denials through the purchased/referred 

14 care program of the Indian Health Service. 

15 ‘‘(d) ENSURING A FULL CONTINUUM OF SERV16 ICES.— 

17 ‘‘(1) IN GENERAL.—Not later than 6 months 

18 after the date of the enactment of this title, the Ad19 ministrator of the Centers for Medicare & Medicaid 

20 Services shall issue a State Medicaid Director letter 

21 and tribal leader letter explaining how States and 

22 tribes can ensure access to a continuum of services 

23 for adults with substance use disorders who are re24 ceiving medical assistance under title XIX of the So25 cial Security Act. Such letter shall describe how 


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1 States can cover the continuum of community-based, 

2 residential, and inpatient substance use disorder 

3 services and care coordination between different lev4 els of care as medical assistance, as defined in sec5 tion 1905(a) of such Act, including through section 

6 1915 of such Act and through demonstration 

7 projects under section 1115 of such Act. 

8 ‘‘(2) MACPAC ANALYSIS.—Not later than 1 

9 year after the date of the enactment of this title, the 

10 Medicaid and CHIP Payment and Access Commis11 sion shall conduct an analysis, and make publicly 

12 available a report containing the results of such 

13 analysis, of States’ coverage of substance use serv14 ices for Medicaid beneficiaries. Such report shall in15 clude examples of promising strategies States use to 

16 cover a continuum of community-based substance 

17 use services. 

18 ‘‘(3) ANNUAL ASSESSMENT.—Beginning with 

19 respect to fiscal year 2022, the Secretary shall make 

20 a determination with respect to each State on 

21 whether the State has carried out the requirements 

22 to ensure a continuum of services as described in 

23 section 1915(l)(4)(C) of the Social Security Act. 

24 ‘‘SEC. 3436. NALOXONE DISTRIBUTION PROGRAM. 

25 ‘‘(a) ESTABLISHMENT OF PROGRAM.— 


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

2 for the purchase and delivery of federally approved 

3 opioid overdose reversal drug products on behalf of 

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

5 of the Indian Health Care Improvement Act) that 

6 receives a grant under subtitle B. This paragraph 

7 constitutes budget authority in advance of appro8 priations Acts, and represents the obligation of the 

9 Federal Government to provide for the purchase and 

10 delivery to States and Indian tribes of the opioid 

11 overdose reversal drug products in accordance with 

12 this paragraph. 

13 ‘‘(2) SPECIAL RULES WHERE OPIOID OVERDOSE

14 REVERSAL DRUG PRODUCTS ARE UNAVAILABLE.—To 

15 the extent that a sufficient quantity of opioid over16 dose reversal drug products are not available for 

17 purchase or delivery under paragraph (1), the Sec18 retary shall provide for the purchase and delivery of 

19 the available opioid overdose reversal drug products 

20 in accordance with priorities established by the Sec21 retary, with priority given to States with at least one 

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

23 ‘‘(b) NEGOTIATION OF CONTRACTS WITH MANUFAC24 TURERS.— 


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1 ‘‘(1) IN GENERAL.—For the purpose of car2 rying out this section, the Secretary shall negotiate 

3 and enter into contracts with manufacturers of 

4 opioid overdose reversal drug products consistent 

5 with the requirements of this subsection and, to the 

6 maximum extent practicable, consolidate such con7 tracting with any other contracting activities con8 ducted by the Secretary to purchase opioid overdose 

9 reversal drug products. The Secretary may enter 

10 into such contracts under which the Federal Govern11 ment is obligated to make outlays, the budget au12 thority for which is not provided for in advance in 

13 appropriations Acts, for the purchase and delivery of 

14 opioid overdose reversal drug products under sub15 section (a). 

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

17 The Secretary may decline to enter into contracts 

18 under this subsection and may modify or extend 

19 such contracts. 

20 ‘‘(3) CONTRACT PRICE.— 

21 ‘‘(A) IN GENERAL.—The Secretary, in ne22 gotiating the prices at which opioid overdose re23 versal drug products will be purchased and de24 livered from a manufacturer under this sub25 section, shall take into account quantities of 


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1 opioid overdose reversal drug products to be 

2 purchased by States under the option under 

3 paragraph (4)(B). 

4 ‘‘(B) NEGOTIATION OF DISCOUNTED PRICE

5 FOR OPIOID OVERDOSE REVERSAL DRUG PROD6 UCTS.—With respect to contracts entered into 

7 for the purchase of opioid overdose reversal 

8 drug products on behalf of States under this 

9 subsection, the price for the purchase of such 

10 drug product shall be a discounted price nego11 tiated by the Secretary. 

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

13 reversal products purchased under this section shall 

14 contain— 

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

16 of active pharmaceutical ingredient that acts as 

17 an opioid receptor antagonist as recommended 

18 by the Food and Drug Administration as an 

19 initial dose when administered by one of the ap20 proved, labeled routes of administration in 

21 adults; and 

22 ‘‘(B) a minimum of two doses packaged to23 gether. 

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

25 Under contracts under this subsection— 


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

2 with paragraph (6), for the purchase and deliv3 ery on behalf of States and Indian tribes of 

4 quantities of opioid overdose reversal drug 

5 products; and 

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

7 option of the State or tribe, shall be permitted 

8 to obtain additional quantities of opioid over9 dose reversal drug products (subject to amounts 

10 specified to the Secretary by the State or tribe 

11 in advance of negotiations) through purchasing 

12 the opioid overdose reversal drug products from 

13 the manufacturers at the applicable price nego14 tiated by the Secretary consistent with para15 graph (3), if the State or tribe provides to the 

16 Secretary such information (at a time and man17 ner specified by the Secretary, including in ad18 vance of negotiations under paragraph (1)) as 

19 the Secretary determines to be necessary, to 

20 provide for quantities of opioid overdose rever21 sal drug products for the State or tribe to pur22 chase pursuant to this subsection and to deter23 mine annually the percentage of the opioid over24 dose reversal drug market that is purchased 

25 pursuant to this section and this subparagraph. 


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1 The Secretary shall enter into the initial negotia2 tions not later than 180 days after the date of the 

3 enactment of this title. 

4 ‘‘(6) CHARGES FOR SHIPPING AND HAN5 DLING.—The Secretary may enter into a contract 

6 referred to in paragraph (1) only if the manufac7 turer involved agrees to submit to the Secretary 

8 such reports as the Secretary determines to be ap9 propriate to assure compliance with the contract and 

10 if, with respect to a State program under this sec11 tion that does not provide for the direct delivery of 

12 qualified opioid overdose reversal drug products, the 

13 manufacturer involved agrees that the manufacturer 

14 will provide for the delivery of the opioid overdose 

15 reversal drug products on behalf of the State in ac16 cordance with such program and will not impose any 

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

18 extent such costs are provided for in the price estab19 lished under paragraph (3)). 

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

21 opioid overdose reversal drug product involved, the 

22 Secretary may, as appropriate, enter into a contract 

23 referred to in paragraph (1) with each manufacturer 

24 of the opioid overdose reversal drug product that 

25 meets the terms and conditions of the Secretary for 


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1 an award of such a contract (including terms and 

2 conditions regarding safety and quality). With re3 spect to multiple contracts entered into pursuant to 

4 this paragraph, the Secretary may have in effect dif5 ferent prices under each of such contracts and, with 

6 respect to a purchase by States pursuant to para7 graph (4)(B), each eligible State may choose which 

8 of such contracts will be applicable to the purchase. 

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

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

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

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

13 delivery, and administration of opioid overdose reversal 

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

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

16 advisory committee, established by the Secretary and lo17 cated within the Centers for Disease Control and Preven18 tion, which considers the cost effectiveness of each opioid 

19 overdose reversal drug product. 

20 ‘‘(d) STATE DISTRIBUTION OF OPIOID OVERDOSE

21 REVERSAL DRUG PRODUCTS.—States shall distribute 

22 opioid overdose reversal drug products received under this 

23 section to the following: 


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1 ‘‘(1) First responders and local emergency med2 ical services organizations, including volunteer emer3 gency medical services organizations. 

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

5 local public health services, including all local health 

6 departments, for the purposes of making opioid over7 dose reversal drug products available to— 

8 ‘‘(A) nonprofit entities, including— 

9 ‘‘(i) community-based organizations 

10 that provide substance use disorder treat11 ments or harm reduction services; 

12 ‘‘(ii) nonprofit entities that provide 

13 substance use disorder treatments or harm 

14 reduction services; and 

15 ‘‘(iii) faith based organizations that 

16 provide substance use disorder treatments 

17 or harm reduction services; 

18 ‘‘(B) other areas of high need; and 

19 ‘‘(C) the general public. 

20 ‘‘(e) STATE REQUIREMENTS.—To be eligible to re21 ceive opioid overdose reversal drugs under this section, 

22 each State shall— 

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

24 overdose reversal drug products to first responders, 

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1 minister local public health services, including local 

2 health departments; 

3 ‘‘(2) beginning in the second year of the pro4 gram, demonstrate a distribution rate of a minimum 

5 of 90 percent of the opioid overdose reversal drug 

6 products received under this program; 

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

8 in place a Good Samaritan Law that ensures immu9 nity from arrest and prosecution, including from pa10 role and probation violations, except that the State 

11 may apply to the Secretary for a waiver of the re12 quirement of this paragraph, and such waiver if 

13 granted shall not be longer than 3 years in duration 

14 and may not be renewed unless the State can show 

15 progress being made towards instituting a Good Sa16 maritan Law; and 

17 ‘‘(4) certify to the Secretary that the State has 

18 in place additional measures that enhance access to 

19 opioid overdose reversal drug products, such as laws 

20 that provide civil or disciplinary immunity for med21 ical personnel who prescribe an opioid overdose re22 versal drug product, Third Party Prescription Laws, 

23 Collaborative Practice Agreements, and Standing 

24 Orders. 


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

2 Health Service, in consultation with Indian tribes, shall 

3 determine any requirements that shall apply to Indian 

4 tribes receiving opioid overdose reversal drug products 

5 made available under this section. 

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

7 ‘‘(1) COLLABORATIVE PRACTICE AGREEMENT.— 

8 The term ‘Collaborative Practice Agreement’ means 

9 an agreement under which a pharmacist operates 

10 under authority delegated by another licensed practi11 tioner with prescribing authority. 

12 ‘‘(2) EMERGENCY MEDICAL SERVICE.—The 

13 term ‘emergency medical service’ means resources 

14 used by a public or private licensed entity to deliver 

15 medical care outside of a medical facility under 

16 emergency conditions that occur as a result of the 

17 condition of the patient and includes services deliv18 ered (either on a compensated or volunteer basis) by 

19 an emergency medical services provider or other pro20 vider that is licensed or certified by the State in21 volved as an emergency medical technician, a para22 medic, or an equivalent professional (as determined 

23 by the State). 

24 ‘‘(3) GOOD SAMARITAN LAW.—The term ‘Good 

25 Samaritan Law’ means a law that provides criminal 


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1 immunity for a person who administers an opioid 

2 overdose reversal drug product, a person who, in 

3 good faith, seeks medical assistance for someone ex4 periencing a drug-related overdose, or a person who 

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

6 medical assistance and, in good faith, seeks such 

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

8 faith request for medical assistance. 

9 ‘‘(4) INDIANS.—The terms ‘Indian’, ‘Indian 

10 tribe’, ‘tribal organization’, and ‘urban Indian orga11 nization’ have the meanings given such terms in sec12 tion 4 of the Indian Health Care Improvement Act. 

13 ‘‘(5) MANUFACTURER.—The term ‘manufac14 turer’ means any corporation, organization, or insti15 tution, whether public or private (including Federal, 

16 State, and local departments, agencies, and instru17 mentalities), which manufactures, imports, proc18 esses, or distributes under its label any opioid over19 dose reversal drug product. The term ‘manufacture’ 

20 means to manufacture, import, process, or distribute 

21 an opioid overdose reversal drug. 

22 ‘‘(6) OPIOID OVERDOSE REVERSAL DRUG PROD23 UCT.—The term ‘opioid overdose reversal drug prod24 uct’ means a finished dosage form that has been ap25 proved by the Food and Drug Administration and 


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1 that contains an active pharmaceutical ingredient 

2 that acts as an opioid receptor antagonist. The term 

3 ‘opioid overdose reversal drug product’ includes a 

4 combination product, as defined in section 3.2(e) of 

5 title 21, Code of Federal Regulations. 

6 ‘‘(7) STANDING ORDER.—The term ‘standing 

7 order’ means a non-patient-specific order covering 

8 administration of medication by others to a patient 

9 who may be unknown to the prescriber at the time 

10 of the order. 

11 ‘‘(8) THIRD PARTY PRESCRIPTION.—The term 

12 ‘third party prescription’ means an order written for 

13 medication dispensed to one person with the inten14 tion that it will be administered to another person. 

15 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

16 is authorized to be appropriated to carry out this suc17 tion— 

18 ‘‘(1) $1,000,000,000 for fiscal year 2022; 

19 ‘‘(2) $1,000,000,000 for fiscal year 2023; 

20 ‘‘(3) $1,000,000,000 for fiscal year 2024; 

21 ‘‘(4) $1,000,000,000 for fiscal year 2025; 

22 ‘‘(5) $1,000,000,000 for fiscal year 2026; 

23 ‘‘(6) $1,000,000,000 for fiscal year 2027; 

24 ‘‘(7) $1,000,000,000 for fiscal year 2028; 

25 ‘‘(8) $1,000,000,000 for fiscal year 2029; 


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1 ‘‘(9) $1,000,000,000 for fiscal year 2030; and 

2 ‘‘(10) $1,000,000,000 for fiscal year 2031. 

3 ‘‘SEC. 3437. ADDITIONAL FUNDING FOR THE NATIONAL IN4 STITUTES OF HEALTH. 

5 ‘‘There is authorized to be appropriated to the Na6 tional Institutes of Health for the purpose of conducting 

7 research on addiction and pain, including research to de8 velop overdose reversal drug products, non-opioid drug 

9 products and non-pharmacological treatments for address10 ing pain and substance use disorder, and drug products 

11 used to treat substance use disorder— 

12 ‘‘(1) $1,000,000,000 for fiscal year 2022; 

13 ‘‘(2) $1,000,000,000 for fiscal year 2023; 

14 ‘‘(3) $1,000,000,000 for fiscal year 2024; 

15 ‘‘(4) $1,000,000,000 for fiscal year 2025; 

16 ‘‘(5) $1,000,000,000 for fiscal year 2026; 

17 ‘‘(6) $1,000,000,000 for fiscal year 2027; 

18 ‘‘(7) $1,000,000,000 for fiscal year 2028; 

19 ‘‘(8) $1,000,000,000 for fiscal year 2029; 

20 ‘‘(9) $1,000,000,000 for fiscal year 2030; and 

21 ‘‘(10) $1,000,000,000 for fiscal year 2031. 

22 ‘‘SEC. 3438. ADDITIONAL FUNDING FOR THE CENTERS FOR 

23 DISEASE CONTROL AND PREVENTION. 

24 ‘‘(a) IMPROVED DATA COLLECTION AND PREVEN25 TION OF INFECTIOUS DISEASE TRANSMISSION.— 


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1 ‘‘(1) DATA COLLECTION.—The Centers for Dis2 ease Control and Prevention shall use a portion of 

3 the funding appropriated under this section to en4 sure that all States participate in the Enhanced 

5 State Opioid Overdose Surveillance program and to 

6 provide technical assistance to medical examiners 

7 and coroners to facilitate improved data collection on 

8 fatal overdoses through such program. 

9 ‘‘(2) CENTERS FOR DISEASE CONTROL AND

10 PREVENTION.—The Centers for Disease Control and 

11 Prevention shall use amounts appropriated under 

12 this section for the purpose of improving data on 

13 drug overdose deaths and non-fatal drug overdoses, 

14 surveillance related to addiction and substance use 

15 disorder, and the prevention of transmission of infec16 tious diseases related to substance use. 

17 ‘‘(3) TRIBAL DATA.—Not later than 6 months 

18 after the date of enactment of this title, the Director 

19 of the Centers for Disease Control and Prevention 

20 shall consult with Indian tribes and confer with 

21 urban Indian organizations to develop and imple22 ment strategies that improve surveillance and re23 porting of fatal overdose deaths among American In24 dians and Alaska Natives, including strategies that 

25 reduce the underestimation of fatal overdose deaths 


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1 among American Indians and Alaska Natives due to 

2 undersampling or racial misclassification in State 

3 and Federal public health surveillance systems. 

4 ‘‘(b) CHILDHOOD TRAUMA.—The Centers for Disease 

5 Control and Prevention shall use a portion of the funding 

6 appropriated under this section to fund the surveillance 

7 and data collection activities described in section 7131 of 

8 the SUPPORT for Patients and Communities Act, includ9 ing to encourage all States to participate in collecting and 

10 reporting data on adverse childhood experiences through 

11 the Behavioral Risk Factor Surveillance System, the 

12 Youth Risk Behavior Surveillance System, and other rel13 evant public health surveys or questionnaires. 

14 ‘‘(c) WORKER HEALTH RISKS.—The Centers for Dis15 ease Control and Prevention shall use a portion of the 

16 funding appropriated under this section for data collection 

17 and surveillance activities on substance use, substance use 

18 disorders, drug overdose deaths, and non-fatal drug 

19 overdoses among workers, and the factors and practices 

20 that contribute to such use, disorders, and overdoses, in21 cluding occupational injuries and illness as well as occupa22 tional exposure to opioids and other illicit and licit drugs. 

23 ‘‘(d) TRIBAL EPIDEMIOLOGY CENTERS.—There shall 

24 be made available to the Indian Health Service for the 

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1 demiology centers to improve data on drug overdose 

2 deaths and non-fatal drug overdoses, surveillance related 

3 to addiction and substance use disorder, and prevention 

4 of childhood trauma, not less than 1.5 percent of the total 

5 amount appropriated under this section for each fiscal 

6 year. 

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

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

9 ‘‘(1) $500,000,000 for fiscal year 2022; 

10 ‘‘(2) $500,000,000 for fiscal year 2023; 

11 ‘‘(3) $500,000,000 for fiscal year 2024; 

12 ‘‘(4) $500,000,000 for fiscal year 2025; 

13 ‘‘(5) $500,000,000 for fiscal year 2026; 

14 ‘‘(6) $500,000,000 for fiscal year 2027; 

15 ‘‘(7) $500,000,000 for fiscal year 2028; 

16 ‘‘(8) $500,000,000 for fiscal year 2029; 

17 ‘‘(9) $500,000,000 for fiscal year 2030; and 

18 ‘‘(10) $500,000,000 for fiscal year 2031. 

19 ‘‘SEC. 3439. DEFINITIONS. 

20 ‘‘In this title: 

21 ‘‘(1) PLANNING COUNCIL.—The term ‘planning 

22 council’ means the substance use planning council 

23 established under section 3402. 

24 ‘‘(2) RECOVERY RESIDENCE.—The term ‘recov25 ery residence’ means a residential dwelling unit, or 


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1 other form of group housing, that is offered or ad2 vertised through any means, including oral, written, 

3 electronic, or printed means, by any individual or en4 tity as a residence that provides an evidence-based, 

5 peer-supported living environment for individuals un6 dergoing any type of substance use disorder treat7 ment or who have received any type of substance use 

8 disorder treatment in the past 3 years, including 

9 medication for addiction treatment. 

10 ‘‘(3) STATE.— 

11 ‘‘(A) IN GENERAL.—The term ‘State’ 

12 means each of the 50 States, the District of Co13 lumbia, and each of the territories. 

14 ‘‘(B) TERRITORIES.—The term ‘territory’ 

15 means each of American Samoa, Guam, the 

16 Commonwealth of Puerto Rico, the Common17 wealth of the Northern Mariana Islands, the 

18 Virgin Islands, the Republic of the Marshall Is19 lands, the Federated States of Micronesia, and 

20 Palau. 

21 ‘‘(4) SUBSTANCE USE DISORDER TREAT22 MENT.— 

23 ‘‘(A) IN GENERAL.—The term ‘substance 

24 use disorder treatment’ means an evidence25 based, professionally directed, deliberate, and 


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1 planned regimen including evaluation, observa2 tion, medical monitoring, and rehabilitative 

3 services and interventions such as 

4 pharmacotherapy, mental health services, and 

5 individual and group counseling, on an inpa6 tient or outpatient basis, to help patients with 

7 substance use disorder reach remission and 

8 maintain recovery. 

9 ‘‘(B) TYPES OF TREATMENT.—Substance 

10 use disorder treatments shall include the fol11 lowing: 

12 ‘‘(i) Clinical stabilization services, 

13 which are evidence-based services provided 

14 in secure, acute care facilities (which may 

15 be referred to as ‘addictions receiving fa16 cilities’) that, at a minimum— 

17 ‘‘(I) provide intoxication manage18 ment and stabilization services; 

19 ‘‘(II) are operated 24 hours per 

20 day, 7 days per week; and 

21 ‘‘(III) that serve individuals 

22 found to be substance use impaired. 

23 These can also be referred to as ‘Ad24 dictions receiving facilities’. 


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1 ‘‘(ii) Withdrawal management and de2 toxification, which is a medical service that 

3 is provided on an inpatient or an out4 patient basis to assist an individual in 

5 managing the process of withdrawal from 

6 the physiological and psychological effects 

7 of substance use disorder. 

8 ‘‘(iii) All outpatient, residential, and 

9 inpatient services described in section 

10 1915(l)(4)(c) of the Social Security Act. 

11 ‘‘(C) LIMITATION.—Substance use disorder 

12 treatment providers shall not include— 

13 ‘‘(i) prevention only providers; and 

14 ‘‘(ii) a private practitioner who is li15 censed by a State licensing board and 

16 whose practice is limited to non-intensive 

17 outpatient care. 

18 ‘‘(5) SUBSTANCE USE DISORDER TREATMENT

19 SERVICES.—The term ‘substance use disorder treat20 ment services’ means any prevention services, core 

21 medical services, recovery and support services, early 

22 intervention services, and harm reduction services 

23 authorized under this title.’’. 


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1 SEC. 4. AMENDMENTS TO THE CONTROLLED SUBSTANCES 

2 ACT. 

3 (a) CERTIFICATIONS.—Part C of the Controlled Sub4 stances Act (21 U.S.C. 821 et seq.) is amended by adding 

5 at the end the following: 

6 ‘‘CERTIFICATIONS RELATING TO DIVERSION CONTROLS

7 AND MISBRANDING

8 ‘‘SEC. 313. (a) DEFINITIONS.—In this section— 

9 ‘‘(1) the term ‘covered dispenser’— 

10 ‘‘(A) means a dispenser— 

11 ‘‘(i) that is required to register under 

12 section 302(a)(2); and 

13 ‘‘(ii) dispenses a controlled substance 

14 in schedule II; and 

15 ‘‘(B) does not include a dispenser that is— 

16 ‘‘(i) registered to dispense opioid 

17 agonist treatment medication under section 

18 303(g)(1); and 

19 ‘‘(ii) operating in that capacity; 

20 ‘‘(2) the term ‘covered distributor’ means a dis21 tributor— 

22 ‘‘(A) that is required to register under sec23 tion 302(a)(1); and 

24 ‘‘(B) distributes a controlled substance in 

25 schedule II; 


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1 ‘‘(3) the term ‘covered manufacturer’ means a 

2 manufacturer— 

3 ‘‘(A) that is required to register under sec4 tion 302(a)(1); and 

5 ‘‘(B) manufactures a controlled substance 

6 in schedule II; 

7 ‘‘(4) the term ‘covered officer’, with respect to 

8 a covered person means— 

9 ‘‘(A) in the case of a covered person that 

10 is not an individual— 

11 ‘‘(i) the chief executive officer of the 

12 covered person; 

13 ‘‘(ii) the president of the covered per14 son; 

15 ‘‘(iii) the chief medical officer of the 

16 covered person; or 

17 ‘‘(iv) the chief counsel of the covered 

18 person; and 

19 ‘‘(B) in the case of a covered person that 

20 is an individual, that individual; and 

21 ‘‘(5) the term ‘covered person’ means— 

22 ‘‘(A) a covered dispenser; 

23 ‘‘(B) a covered distributor; or 

24 ‘‘(C) a covered manufacturer. 


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1 ‘‘(b) CERTIFICATIONS RELATING TO DIVERSION

2 CONTROLS.—Not later than 180 days after the date of 

3 enactment of this section, and each year thereafter, each 

4 covered officer of a covered person shall submit to the At5 torney General, for each controlled substance in schedule 

6 II dispensed, distributed, or manufactured by the covered 

7 person, a certification— 

8 ‘‘(1) signed by the covered officer; and 

9 ‘‘(2) certifying that— 

10 ‘‘(A) the covered person maintains effective 

11 controls against diversion of the controlled sub12 stance into channels other than legitimate med13 ical, scientific, research, or industrial channels; 

14 ‘‘(B) all information contained in any 

15 record, inventory, or report required to be kept 

16 or submitted to the Attorney General by the 

17 covered person under section 307, or under any 

18 regulation issued under that section, is accu19 rate; and 

20 ‘‘(C) the covered person is in compliance 

21 with all applicable requirements under Federal 

22 law relating to reporting suspicious orders for 

23 controlled substances. 

24 ‘‘(c) CERTIFICATIONS RELATING TO MIS25 BRANDING.— 


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1 ‘‘(1) IN GENERAL.—Not later than 180 days 

2 after the date of enactment of this section, and each 

3 year thereafter, each covered officer of a covered 

4 manufacturer shall submit to the Secretary, for each 

5 controlled substance in schedule II manufactured by 

6 the covered manufacturer, a certification— 

7 ‘‘(A) signed by the covered officer; and 

8 ‘‘(B) certifying that the controlled sub9 stance is not misbranded, as described in sec10 tion 502 of the Federal Food, Drug, and Cos11 metic Act (21 U.S.C. 352). 

12 ‘‘(2) NOTIFICATION TO THE ATTORNEY GEN13 ERAL.— 

14 ‘‘(A) FAILURE TO SUBMIT CERTIFI15 CATIONS.—Not later than 30 days after the 

16 date on which a covered officer of a covered 

17 manufacturer is required to submit a certifi18 cation under paragraph (1) and fails to do so, 

19 the Secretary shall notify the Attorney General 

20 of the failure by the covered officer to submit 

21 the certification. 

22 ‘‘(B) FALSE CERTIFICATIONS RELATING

23 TO MISBRANDING.—Not later than 30 days 

24 after the date on which the Secretary becomes 

25 aware that a certification submitted under 


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1 paragraph (1) contains a materially false state2 ment or representation relating to the mis3 branding of a controlled substance with respect 

4 to the year for which the certification is sub5 mitted, the Secretary shall notify the Attorney 

6 General that the certification contains the ma7 terially false statement or representation.’’. 

8 (b) OFFENSES.—Part D of title II of the Controlled 

9 Substances Act (21 U.S.C. 841 et seq.) is amended by 

10 adding at the end the following: 

11 ‘‘CERTIFICATIONS BY COVERED OFFICERS

12 ‘‘SEC. 424. (a) DEFINITIONS.—In this section, the 

13 terms ‘covered dispenser’, ‘covered distributor’, ‘covered 

14 manufacturer’, ‘covered officer’, and ‘covered person’ have 

15 the meanings given those terms in section 313. 

16 ‘‘(b) OFFENSES.— 

17 ‘‘(1) FAILURE TO SUBMIT CERTIFICATIONS.— 

18 ‘‘(A) CERTIFICATIONS RELATING TO DI19 VERSION CONTROLS.—It shall be unlawful for a 

20 covered officer of a covered person to fail to 

21 submit a certification required under section 

22 313(b), without regard to the state of mind of 

23 the covered officer. 

24 ‘‘(B) CERTIFICATIONS RELATING TO MIS25 BRANDING.—It shall be unlawful for a covered 

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1 mit a certification required under section 

2 313(c)(1), without regard to the state of mind 

3 of the covered officer. 

4 ‘‘(2) SUBMISSION OF FALSE CERTIFICATIONS.— 

5 ‘‘(A) FALSE CERTIFICATIONS RELATING TO

6 DIVERSION CONTROLS.—It shall be unlawful for 

7 a covered officer of a covered person to submit 

8 a certification required under section 313(b), 

9 without regard to the state of mind of the cov10 ered officer, that contains a materially false 

11 statement or representation relating to the in12 formation required to be certified under that 

13 section for the year for which the certification 

14 is submitted. 

15 ‘‘(B) FALSE CERTIFICATIONS RELATING

16 TO MISBRANDING.—It shall be unlawful for a 

17 covered officer of a covered manufacturer to 

18 submit a certification required under section 

19 313(c)(1), without regard to the state of mind 

20 of the covered officer, that contains a materially 

21 false statement or representation relating to the 

22 misbranding of a controlled substance with re23 spect to the year for which the certification is 

24 submitted. 

25 ‘‘(c) PENALTIES.— 


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1 ‘‘(1) CIVIL PENALTIES.—Except as provided in 

2 paragraph (2), a covered officer who violates sub3 section (b) shall be subject to a civil penalty of not 

4 more than $25,000. 

5 ‘‘(2) CRIMINAL PENALTIES.—A covered officer 

6 who knowingly violates subsection (b)(2) shall be 

7 subject to criminal penalties under section 403(d). 

8 ‘‘(d) COMPREHENSIVE ADDICTION RESOURCES

9 FUND.— 

10 ‘‘(1) ESTABLISHMENT.—There is established in 

11 the Treasury a fund to be known as the ‘Com12 prehensive Addiction Resources Fund’. 

13 ‘‘(2) TRANSFER OF AMOUNTS.—There shall be 

14 transferred to the Comprehensive Addiction Re15 sources Fund 100 percent of— 

16 ‘‘(A) any civil penalty paid to the United 

17 States under this section; and 

18 ‘‘(B) any fine paid to the United States 

19 under section 403(d) for a knowing violation of 

20 subsection (b)(2) of this section. 

21 ‘‘(3) AVAILABILITY AND USE OF FUNDS.— 

22 Amounts transferred to the Comprehensive Addic23 tion Fund under paragraph (2) shall— 

24 ‘‘(A) remain available until expended; and 


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1 ‘‘(B) be made available to supplement 

2 amounts appropriated to carry out title XXXIV 

3 of the Public Health Service Act.’’. 

4 (c) CRIMINAL PENALTIES.—Section 403 of the Con5 trolled Substances Act (21 U.S.C. 843) is amended— 

6 (1) in subsection (d)(1)— 

7 (A) by inserting ‘‘or knowingly violates sec8 tion 424(b)(2)’’ after ‘‘any person who violates 

9 this section’’; and 

10 (B) by striking ‘‘violation of this section’’ 

11 and inserting ‘‘such a violation’’; and 

12 (2) in subsection (f)— 

13 (A) in paragraph (1), by striking ‘‘or 416’’ 

14 and inserting ‘‘or section 416, or knowing viola15 tions of section 424(b)(2)’’; and 

16 (B) in paragraph (3), by inserting ‘‘or 

17 knowing violations of section 424(b)(2)’’ before 

18 the period at the end. 

19 (d) TECHNICAL AND CONFORMING AMENDMENTS.— 

20 The table of contents for the Comprehensive Drug Abuse 

21 Prevention and Control Act of 1970 (Public Law 91–513; 

22 84 Stat. 1236) is amended— 

23 (1) by inserting after the item relating to sec24 tion 311 the following: 

‘‘Sec. 312. Suspicious orders. 

‘‘Sec. 313. Certifications relating to diversion controls and misbranding.’’; 


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1 and 

2 (2) by inserting after the item relating to sec3 tion 423 the following: 

‘‘Sec. 424. Certifications by covered officers.’’. 

4 (e) EFFECTIVE DATE.—The amendments made by 

5 subsections (b) and (c) of this section shall take effect on 

6 the date that is 180 days after the date of enactment of 

7 this Act. 

8 SEC. 5. GENERAL LIMITATION ON USE OF FUNDS. 

9 Amounts appropriated or provided under this Act, or 

10 an amendment made by this Act, shall be used only for 

11 the public health purposes described in this Act (or 

12 amendments) and shall not be used to increase the incar13 ceration or institutionalization of individuals with sub14 stance use disorder. 

15 SEC. 6. FEDERAL DRUG DEMAND REDUCTION ACTIVITIES. 

16 (a) PUBLICATION OF LIST.— 

17 (1) AMENDMENT.—Section 705(f) of the Office 

18 of National Drug Control Policy Reauthorization Act 

19 of 1998 (21 U.S.C. 1704(f)) is amended by inserting 

20 at the end the following new paragraph: 

21 ‘‘(5) PUBLICATION OF LIST.—The Director 

22 shall publish online a complete list of all drug con23 trol program grant programs and any other relevant 

24 information included in the system developed under 

25 paragraph (1).’’. 


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1 (2) DEADLINE AND FREQUENCY.—Not later 

2 than one year after the date of the enactment of this 

3 Act, and annually thereafter, the Director of Na4 tional Drug Control Policy shall publish the list re5 quired under section 705(f)(5) of the National Drug 

6 Control Act of 1998, as added by paragraph (1). 

7 (b) NATIONAL DRUG CONTROL STRATEGY.—Section 

8 706(c)(1) of the National Drug Control Act of 1998 (21 

9 U.S.C. 1705(c)(1)) is amended by adding at the end the 

10 following new subparagraph: 

11 ‘‘(O) A review of all federally funded de12 mand reduction activities, including an evalua13 tion of— 

14 ‘‘(i) the effectiveness of those activi15 ties; 

16 ‘‘(ii) the contribution of those activi17 ties to demand reduction activities funded 

18 by State, local, and Tribal governments; 

19 and 

20 ‘‘(iii) whether any duplication or inef21 ficiency in federally funded demand reduc22 tion activities needs to be addressed.’’. 

Æ 


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