I 

118TH CONGRESS 

1ST SESSION H. R. 5866 

To ensure comprehensive wraparound services for families impacted by 

substance use disorders, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 2, 2023 

Ms. LEE of California (for herself, Mr. TRONE, Mr. MULLIN, and Mr. 

SCHIFF) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Ways and Means, and Education and the Workforce, for a period to be 

subsequently determined by the Speaker, in each case for consideration 

of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To ensure comprehensive wraparound services for families 

impacted by substance use disorders, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Substance Use Dis5 order and Family Engagement in Recovery Act’’ or the 

6 ‘‘SAFE in Recovery Act’’. 


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1 SEC. 2. ENSURING CARE AND NO UNDUE FAMILY SEPARA2 TION OF FAMILIES IMPACTED BY SUBSTANCE 

3 USE DISORDER. 

4 (a) IN GENERAL.—Section 503 of the Social Security 

5 Act (42 U.S.C. 703) is amended by adding at the end the 

6 following new subsection: 

7 ‘‘(d) LIMITATIONS ON TOXICOLOGY TESTING TO DE8 TECT SUBSTANCE USE.— 

9 ‘‘(1) IN GENERAL.—As a condition of receiving 

10 payments under this section, each State— 

11 ‘‘(A) shall not require the birthing parent 

12 of an infant who is identified as being affected 

13 by substance abuse or withdrawal symptoms re14 sulting from prenatal drug exposure or a Fetal 

15 Alcohol Spectrum Disorder to undergo toxi16 cology testing to detect substance use unless the 

17 parent— 

18 ‘‘(i) gives clear and informed consent 

19 prior to such testing; and 

20 ‘‘(ii) is able to access, if necessary for 

21 purposes of giving such consent, interpre22 tation services and reasonable accommoda23 tions for disabilities; 

24 ‘‘(B) shall ensure that a pregnant or 

25 postpartum individual taking a prescription 

26 drug, including a prescription drug for the 


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1 treatment of a substance use disorder, in ac2 cordance with the recommendations of the pre3 scribing practitioner, shall not be subject to in4 vestigations of child abuse and neglect on the 

5 basis that such individual is taking such pre6 scription drug; 

7 ‘‘(C) shall ensure that— 

8 ‘‘(i) any toxicology testing to detect 

9 substance use that is provided to a preg10 nant or postpartum individual taking a 

11 prescription drug, including a prescription 

12 drug for the treatment of a substance use 

13 disorder, in accordance with the rec14 ommendations of the prescribing practi15 tioner is consented to by the pregnant or 

16 postpartum individual in accordance with 

17 subparagraph (A); and 

18 ‘‘(ii) such testing (and the results of 

19 such testing) shall not affect the individ20 ual’s access to care or public assistance 

21 and shall not be the sole factor in a family 

22 separation determination involving the in23 dividual; and 

24 ‘‘(D) shall ensure that any health care pro25 vider involved in the delivery or care of an inVerDate Sep 11 2014 18:08 Nov 18, 2023 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5866.IH H5866

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1 fant identified as being affected by substance 

2 abuse or withdrawal symptoms resulting from 

3 prenatal drug exposure, or a Fetal Alcohol 

4 Spectrum Disorder, is not required to notify the 

5 child protective services system of the State or 

6 any unit of local government of the State of the 

7 occurrence of such condition in such infant if 

8 such condition is the result of the birthing par9 ent of the infant taking a prescription drug, in10 cluding a prescription drug for the treatment of 

11 a substance use disorder, in accordance with 

12 the recommendations of the prescribing practi13 tioner, and such provider has no other reason 

14 to suspect that the infant is in imminent dan15 ger of abuse or neglect. 

16 ‘‘(2) DEFINITION OF PRESCRIPTION DRUG.—In 

17 this subsection, the term ‘prescription drug’ means 

18 a drug approved under section 505 of the Federal 

19 Food, Drug, and Cosmetic Act (21 U.S.C. 355) or 

20 licensed under section 351 of the Public Health 

21 Service Act (42 U.S.C. 262) that is subject to sec22 tion 503(b)(1) of the Federal Food, Drug, and Cos23 metic Act (21 U.S.C. 353(b)(1)).’’. 


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1 (b) EFFECTIVE DATE.—The amendment made by 

2 this section shall take effect on the date that is 2 years 

3 after the date of enactment of this Act. 

4 SEC. 3. ENSURING A WHOLE-OF-GOVERNMENT APPROACH 

5 THROUGH A FEDERAL INTERAGENCY TASK 

6 FORCE TO SUPPORT FAMILIES IMPACTED BY 

7 SUBSTANCE USE DISORDERS. 

8 (a) ESTABLISHMENT.—There is established within 

9 the Federal Government an interagency task force to im10 prove— 

11 (1) efforts, resources, and services of the Fed12 eral Government to support families impacted by 

13 substance use disorders; 

14 (2) the utilization of such efforts, resources, 

15 and services; and 

16 (3) strategies to streamline the provision of 

17 comprehensive wraparound care for families im18 pacted by substance use disorders. 

19 (b) MEMBERSHIP.— 

20 (1) COMPOSITION.—The task force shall be 

21 composed of the heads of the following Federal de22 partments and agencies, or their designees: 

23 (A) The Centers for Medicare & Medicaid 

24 Services. 


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1 (B) The Substance Abuse and Mental 

2 Health Services Administration. 

3 (C) The Agency for Healthcare Research 

4 and Quality. 

5 (D) The Centers for Disease Control and 

6 Prevention. 

7 (E) The Indian Health Service. 

8 (F) The Department of Veterans Affairs. 

9 (G) The National Institutes of Health. 

10 (H) The Food and Drug Administration. 

11 (I) The Health Resources and Services Ad12 ministration. 

13 (J) The Department of Defense. 

14 (K) The Office of Minority Health of the 

15 Department of Health and Human Services. 

16 (L) The Administration for Children and 

17 Families. 

18 (M) The Office of the Assistant Secretary 

19 for Planning and Evaluation of the Department 

20 of Health and Human Services. 

21 (N) The Office for Civil Rights of the De22 partment of Health and Human Services. 

23 (O) The Office of Juvenile Justice and De24 linquency Prevention of the Department of Jus25 tice. 


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1 (P) The Office of Community Oriented Po2 licing Services of the Department of Justice. 

3 (Q) The National Center for Education 

4 Evaluation and Regional Assistance of the De5 partment of Education. 

6 (R) The National Center for Special Edu7 cation Research of the Institute of Education 

8 Science. 

9 (S) The Office of Elementary and Sec10 ondary Education of the Department of Edu11 cation. 

12 (T) The Office for Civil Rights of the De13 partment of Education. 

14 (U) The Office of Special Education and 

15 Rehabilitative Services of the Department of 

16 Education. 

17 (V) The Bureau of Indian Affairs of the 

18 Department of the Interior. 

19 (W) The Veterans Health Administration 

20 of the Department of Veterans Affairs. 

21 (X) The Office of Special Needs Assistance 

22 Programs of the Department of Housing and 

23 Urban Development. 

24 (Y) The Office of Head Start of the Ad25 ministration for Children and Families. 


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1 (Z) The Children’s Bureau of the Adminis2 tration for Children and Families. 

3 (AA) The Bureau of Indian Education of 

4 the Department of the Interior. 

5 (BB) Such other Federal agencies as the 

6 Secretaries determine to be appropriate. 

7 (2) DATE OF APPOINTMENTS.—The heads of 

8 Federal departments and agencies shall appoint the 

9 corresponding members of the task force not later 

10 than 60 days after the date of enactment of this 

11 Act. 

12 (3) CHAIRPERSON.—The task force shall be 

13 chaired by the Secretary of Health and Human 

14 Services. 

15 (c) DUTIES.—The interagency task force shall carry 

16 out each of the following activities: 

17 (1) Solicit input from stakeholders, including 

18 frontline service providers, educators, mental health 

19 professionals, researchers, experts in infant, child, 

20 and youth trauma, child welfare professionals, people 

21 in recovery, and the public, in order to inform the 

22 activities under this subsection. 

23 (2) Compile a comprehensive list of all Federal 

24 Government efforts, resources, and services to sup25 port families impacted by substance use disorders. 


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1 (3) Assess the effectiveness of care, services, 

2 and resources available to families impacted by sub3 stance use disorders. 

4 (4) Analyze and make recommendations for 

5 means of eliminating barriers that prevent individ6 uals with substance use disorders from entering and 

7 remaining in care for the disorder involved. 

8 (5) Analyze and make recommendations for 

9 means of eliminating barriers to social services for 

10 individuals with substance use disorders and their 

11 families. 

12 (6) Provide recommendations for effectively 

13 streamlining the provision of comprehensive wrap14 around care for families impacted by substance use 

15 disorders. 

16 (7) Recommend a plan for addressing the com17 prehensive wraparound care needs of families im18 pacted by substance use disorders and specifically 

19 address in the plan the needs of populations most 

20 disproportionately affected. 

21 (8) Other activities as determined appropriate 

22 by the Secretary. 

23 (d) OPERATING PLAN.—Not later than 120 days 

24 after the date of enactment of this Act, the task force shall 

25 hold the first meeting. Not later than 2 years after such 


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1 date of enactment, the task force shall submit to the Sec2 retary of Education, the Secretary of Health and Human 

3 Services, the Secretary of Labor, the Secretary of the Inte4 rior, the Attorney General, and Congress an operating 

5 plan for carrying out the activities of the task force de6 scribed in subsection (c). Such operating plan shall in7 clude— 

8 (1) a list of specific activities that the task 

9 force plans to carry out for purposes of carrying out 

10 duties described in subsection (c), which may include 

11 public engagement; 

12 (2) a plan for carrying out the activities under 

13 subsection (c); 

14 (3) a list of members of the task force and 

15 other individuals who are not members of the task 

16 force that may be consulted to carry out such activi17 ties; 

18 (4) an explanation of Federal agency involve19 ment and coordination needed to carry out such ac20 tivities, including any statutory or regulatory bar21 riers to such coordination; 

22 (5) a budget for carrying out such activities; 

23 (6) a proposed timeline for implementing rec24 ommendations and efforts identified under sub25 section (c); and 


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1 (7) other information that the task force deter2 mines appropriate as related to its duties. 

3 (e) FINAL REPORT.—Not later than 3 years after the 

4 date of enactment of this Act, the Secretary shall submit 

5 to Congress and the general public a final report that con6 tains the findings and recommendations (including the 

7 recommended plan described in subsection (c)(7)) of the 

8 task force. 

9 (f) ADDITIONAL REPORTS.—In addition to the final 

10 report under subsection (e), the task force shall submit— 

11 (1) a report to Congress identifying any rec12 ommendations identified under subsection (c) that 

13 require additional legislative authority to implement; 

14 and 

15 (2) a report to the Governors describing oppor16 tunities for local- and State-level partnerships, pro17 fessional development, or best practices to support 

18 families impacted by substance use disorders. 

19 (g) SUNSET.—The task force shall sunset on the date 

20 that is 60 days after the submission of the report under 

21 subsection (e), but not later than September 30, 2028. 

22 (h) DEFINITION OF COMPREHENSIVE WRAPAROUND

23 CARE.—In this section, the term ‘‘comprehensive wrap24 around care’’ includes clinical, ancillary health, mental 


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1 health, substance use disorder, and social support services, 

2 to address a substance use disorder. 

3 SEC. 4. INCREASING ACCESS TO BEHAVIORAL HEALTH 

4 CARE THROUGH COMMUNITY HEALTH CEN5 TERS. 

6 (a) REQUIRED PRIMARY HEALTH SERVICES.— 

7 (1) IN GENERAL.—Section 330(b) of the Public 

8 Health Service Act (42 U.S.C. 254b(b)) is amend9 ed— 

10 (A) in paragraph (1)(A)(i)— 

11 (i) in subclause (IV), by striking ‘‘; 

12 and’’ and inserting a semicolon; 

13 (ii) in subclause (V), by striking the 

14 semicolon and inserting ‘‘; and’’; and 

15 (iii) by adding at the end the fol16 lowing: 

17 ‘‘(VI) behavioral and mental 

18 health and substance use disorder 

19 services;’’; 

20 (B) in paragraph (1)(A)(ii), by inserting ‘‘, 

21 including such referrals to certified community 

22 behavioral health centers’’ before the semicolon; 

23 and 

24 (C) in paragraph (2)— 

25 (i) by striking subparagraph (A); and 


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1 (ii) by redesignating subparagraphs 

2 (B) through (D) as subparagraphs (A) 

3 through (C), respectively. 

4 (2) FUNDING.—For purposes of assisting 

5 health centers in incorporating behavioral and men6 tal health and substance use disorder services into 

7 the required primary health services offered by such 

8 centers, there is appropriated to the Secretary of 

9 Health and Human Services, out of amounts in the 

10 Treasury not otherwise appropriated, $500,000,000 

11 for fiscal year 2025, to remain available until ex12 pended. 

13 (3) REPORT.—Not later than 1 year after the 

14 date that is 3 years after the date of enactment of 

15 this Act, the Secretary of Health and Human Serv16 ices shall submit a report to Congress on— 

17 (A) the impact that the amendments made 

18 by paragraph (1) has had on access to behav19 ioral and mental health and substance use dis20 order services; and 

21 (B) employee recruitment and retention for 

22 behavioral and mental health and substance use 

23 disorder providers, including for health centers, 

24 certified community behavioral health centers, 

25 and other community care settings. 


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1 (b) ENVIRONMENTAL JUSTICE COMMUNITIES.—Sec2 tion 10503 of the Patient Protection and Affordable Care 

3 Act (42 U.S.C. 254b–2) is amended— 

4 (1) in subsection (b)(1)— 

5 (A) in subparagraph (E), by striking 

6 ‘‘and’’ at the end; and 

7 (B) by adding at the end the following: 

8 ‘‘(G) $130,000,000,000 for the period of 

9 fiscal years 2024 through 2028. 

10 ‘‘(f) ENVIRONMENTAL JUSTICE COMMUNITIES.—The 

11 Secretary shall ensure that not less than 50 percent of 

12 the amounts appropriated under subsection (b)(1) for fis13 cal year 2024 or any fiscal year thereafter are awarded 

14 to entities for use with respect to projects or sites located 

15 in or serving communities with significant representation 

16 of communities of color, low-income communities, or Trib17 al and Indigenous communities that experience, or are at 

18 risk of experiencing, higher or more adverse human health 

19 or environmental effects. 

20 ‘‘(g) PROHIBITION.—No amounts made available 

21 under this section may be used for any activity that is 

22 subject to the reporting requirements set forth in section 

23 203(a) of the Labor-Management Reporting and Disclo24 sure Act of 1959 (29 U.S.C. 433(a)).’’. 


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1 SEC. 5. IMPROVING OUTCOMES FOR PREGNANT AND 

2 POSTPARTUM PATIENTS WITH SUBSTANCE 

3 USE DISORDER AND PAYMENTS TO 

4 INCENTIVIZE CARE FOR OPIOID USE DIS5 ORDER. 

6 (a) IN GENERAL.—Section 1866F(b)(1) of the Social 

7 Security Act (42 U.S.C. 1395cc–6(b)(1) is amended by 

8 adding at the end the following new subparagraph: 

9 ‘‘(G) Improves outcomes for pregnant and 

10 postpartum individuals with opioid use dis11 order.’’. 

12 (b) PAYMENTS.—Section 1866F(e)(1) of the Social 

13 Security Act (42 U.S.C. 1395cc–6(e)(1)) is amended— 

14 (1) in subparagraph (A), by inserting ‘‘preg15 nancy and postpartum services and’’ after ‘‘includ16 ing’’; and 

17 (2) in subparagraph (B)— 

18 (A) in clause (iii), by striking ‘‘and’’; 

19 (B) in clause (iv), by striking the period 

20 and inserting ‘‘; and’’; and 

21 (C) by adding at the end the following new 

22 clause: 

23 ‘‘(v) pay a higher per applicable bene24 ficiary per month care management fee for 

25 an applicable beneficiary who receives 


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1 pregnancy or postpartum services from a 

2 participant.’’. 

3 (c) EFFECTIVE DATE.—The amendments made by 

4 this section shall take effect on January 1, 2024, and shall 

5 apply to services furnished on or after that date. 

6 SEC. 6. INCREASING ACCESS TO WRAPAROUND SERVICES 

7 FOR CHILDREN FROM FAMILIES IMPACTED 

8 BY SUBSTANCE USE DISORDER. 

9 (a) GRANTS.—The Head Start Act is amended by in10 serting after section 645A (42 U.S.C. 9840a) the fol11 lowing: 

12 ‘‘SEC. 645B. CHILDREN FROM FAMILIES IMPACTED BY SUB13 STANCE USE DISORDER. 

14 ‘‘(a) GRANTS.— 

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

16 grants, in accordance with paragraph (2), to Head 

17 Start and Early Head Start agencies to enable the 

18 agencies to provide comprehensive health, edu19 cational, nutritional, social, and other services to 

20 children in Head Start and Early Head Start pro21 grams, respectively, from families impacted by sub22 stance use disorder, or referring the children to such 

23 services, to assure best outcomes for the health, 

24 wellness, and school readiness of the children. 


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1 ‘‘(2) FORMULA.—The Secretary shall make 

2 those grants, to fund the activities described in para3 graph (1) for a fiscal year, by— 

4 ‘‘(A) using the amount appropriated under 

5 subsection (c) for that fiscal year; and 

6 ‘‘(B) distributing that amount in accord7 ance with clauses (i) (with respect to additional 

8 funding for the comprehensive services de9 scribed in paragraph (1)) and (ii) of section 

10 640(a)(4)(C). 

11 ‘‘(b) CONSTRUCTION.—A reference in this subchapter 

12 (other than this section) to funds appropriated or provided 

13 under this subchapter shall not be considered to include 

14 funds appropriated or provided under this section. 

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

16 is authorized to be appropriated to carry out this section 

17 $60,000,000 for fiscal year 2024 and each subsequent fis18 cal year.’’. 

19 (b) CONFORMING AMENDMENT.—Section 639 of the 

20 Head Start Act (42 U.S.C. 9834) is amended by striking 

21 ‘‘section 657B’’ and inserting ‘‘sections 645B and 657B’’. 


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1 SEC. 7. COORDINATING RESEARCH OF THE NATIONAL IN2 STITUTES OF HEALTH. 

3 Part A of title IV of the Public Health Service Act 

4 (42 U.S.C. 281 et seq.) is amended by adding at the end 

5 the following: 

6 ‘‘SEC. 404P. RESEARCH WITH RESPECT TO CO-OCCURRING 

7 PREGNANCY AND SUBSTANCE USE DIS8 ORDER. 

9 ‘‘The Director of the National Institutes of Health 

10 shall establish a consortium on pregnancy, postpartum re11 covery, and substance use disorder research to establish 

12 research priorities and steward research activities across 

13 the national research institutes and national centers to un14 derstand and mitigate the harms of substance use disorder 

15 for pregnant and postpartum patients and their chil16 dren.’’. 

17 SEC. 8. ENSURING THE USE OF BEST AVAILABLE MEDICAL 

18 PRACTICES THROUGH A GAO REPORT ON 

19 CLINICAL GUIDELINES FOR TREATING PREG20 NANT AND PARENTING PATIENTS WITH SUB21 STANCE USE DISORDER AND THEIR CHIL22 DREN. 

23 The Comptroller General of the United States shall— 

24 (1) conduct a study assessing— 

25 (A) the extent to which clinical guidelines 

26 for treating pregnant and parenting patients 


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1 with substance use disorder and their children 

2 are implemented; 

3 (B) any systemic and other barriers to en4 suring that patients and children described in 

5 subparagraph (A) get access to up-to-date care 

6 that addresses the complexity of co-occurring 

7 substance use disorder and pregnancy; and 

8 (C) access to treatment for pregnant and 

9 postpartum individuals with substance use dis10 order and the impacts of interactions with child 

11 welfare systems; and 

12 (2) not later than 2 years after the date of en13 actment of this Act, submit a report to Congress on 

14 the results of such study. 

Æ 


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