I 

117TH CONGRESS 

1ST SESSION H. R. 6311 

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 HOUSE OF REPRESENTATIVES 

DECEMBER 16, 2021 

Mrs. CAROLYN B. MALONEY of New York (for herself, Ms. KUSTER, Mr. 

TRONE, Mr. LYNCH, Ms. DEAN, Ms. LEE of California, Ms. JACKSON

LEE, Ms. PINGREE, Ms. ROSS, Mr. MOULTON, Mr. MCGOVERN, Mr. 

KEATING, Ms. NORTON, Mr. CONNOLLY, Ms. TLAIB, Mrs. MCBATH, Ms. 

PRESSLEY, Mr. POCAN, Ms. GARCIA of Texas, Mr. CICILLINE, Mr. 

CLEAVER, Ms. TITUS, Ms. UNDERWOOD, Mrs. TRAHAN, Ms. MENG, Mr. 

RASKIN, Mr. DESAULNIER, Mr. CA ́RDENAS, Ms. VELA ́ZQUEZ, Ms. 

SPANBERGER, Mr. RYAN, Ms. MANNING, Ms. MCCOLLUM, Mr. SCHIFF, 

Ms. KELLY of Illinois, Ms. MATSUI, Ms. BROWNLEY, Mr. PERLMUTTER, 

Mr. WELCH, Ms. SCANLON, Ms. CLARK of Massachusetts, Ms. OCASIOCORTEZ, Mr. TAKANO, Mrs. HAYES, Mr. COOPER, Mr. NEGUSE, Mr. 

KILMER, Mr. CASE, Mr. BLUMENAUER, Mr. LIEU, Mr. GRIJALVA, Mr. 

O’HALLERAN, Ms. WASSERMAN SCHULTZ, Mr. GOMEZ, Mr. 

KRISHNAMOORTHI, Mr. SUOZZI, Mr. NADLER, Ms. BUSH, Mr. KHANNA, 

Ms. SEWELL, Mr. JONES, Mr. GALLEGO, Mr. ESPAILLAT, Ms. JAYAPAL, 

Mr. MFUME, Ms. BARRAGA ́N, Ms. SCHAKOWSKY, Mr. TORRES of New 

York, Ms. MOORE of Wisconsin, Mr. MICHAEL F. DOYLE of Pennsylvania, Mr. HUFFMAN, Mr. LARSON of Connecticut, Mr. THOMPSON of 

California, Mr. GARCI ́A of Illinois, Mr. TONKO, Mr. CARSON, Mr. CARTWRIGHT, Mr. DANNY K. DAVIS of Illinois, Mr. MORELLE, Ms. BASS, Mrs. 

WATSON COLEMAN, Mr. MEEKS, Mrs. DINGELL, Mr. JOHNSON of Georgia, Ms. BROWN of Ohio, Ms. CHU, Mr. YARMUTH, Ms. BONAMICI, Mr. 

SARBANES, Mr. CUELLAR, Ms. ESCOBAR, Mr. PAPPAS, Mr. BOWMAN, 

Mr. PANETTA, Ms. SA ́NCHEZ, Ms. DEGETTE, and Ms. ROYBAL-ALLARD) 

introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Natural Resources, the Judiciary, and Oversight and Reform, for a period to be subVerDate Sep 11 2014 21:25 Dec 22, 2021 Jkt 029200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H6311.IH H6311

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sequently determined by the Speaker, in each case for consideration of 

such provisions as fall within the jurisdiction of the committee concerned 

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. 

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. 


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‘‘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. 

‘‘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 


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1 of more effective and cost efficient systems for the delivery 

2 of essential services to individuals with substance use dis3 order, including with co-occurring mental health and sub4 stance use disorders, and their families. 

5 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

6 ACT. 

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

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

9 ‘‘TITLE XXXIV—SUBSTANCE USE 

10 RESOURCES 

11 ‘‘Subtitle A—Local Substance Use 

12 Emergency Relief Grant Program 

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

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

15 grants to eligible localities for the purpose of addressing 

16 substance use within such localities. 

17 ‘‘(b) ELIGIBILITY.— 

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

19 grant under subsection (a) a locality shall— 

20 ‘‘(A) be— 

21 ‘‘(i) a county that can demonstrate 

22 that the rate of drug overdose deaths per 

23 100,000 population in the county during 

24 the most recent 3-year period for which 

25 such data are available was not less than 


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1 the rate of such deaths for the county that 

2 ranked at the 67th percentile of all coun3 ties, as determined by the Secretary; 

4 ‘‘(ii) a county that can demonstrate 

5 that the number of drug overdose deaths 

6 during the most recent 3-year period for 

7 which such data are available was not less 

8 than the number of such deaths for the 

9 county that ranked at the 90th percentile 

10 of all counties, as determined by the Sec11 retary; 

12 ‘‘(iii) a county that encompasses an 

13 undeserved area, defined as a health pro14 fessional shortage area (as defined in sec15 tion 332(a)(1)(A)) and a medically under16 served area (according to a designation 

17 under section 330(b)(3)(A)), that can dem18 onstrate a high burden of both fatal and 

19 non-fatal drug overdoses in a manner de20 termined by the Secretary; or 

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

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

23 that meets the requirements of paragraph 

24 (3); and 


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1 ‘‘(B) submit to the Secretary an applica2 tion in accordance with section 3404. 

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

4 the case of an eligible county that is contiguous to 

5 one or more other eligible counties within the same 

6 State, the group of counties shall— 

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

8 county for purposes of a grant under this sec9 tion; 

10 ‘‘(B) submit a single application under sec11 tion 3404; 

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

13 purposes of section 3402); and 

14 ‘‘(D) establish, through intergovernmental 

15 agreements, an administrative mechanism to al16 locate funds and substance use disorder treat17 ment services under the grant based on— 

18 ‘‘(i) the number and rate of drug 

19 overdose deaths and nonfatal drug 

20 overdoses in each of the counties that com21 pose the eligible county; 

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

23 in each such county; and 

24 ‘‘(iii) the health and support per25 sonnel needs of each such county. 


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1 ‘‘(3) CITIES AND COUNTIES WITHIN MULTIPLE

2 CONTIGUOUS COUNTIES.— 

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

4 an eligible county described in paragraph (1), 

5 or a county or group of counties that is within 

6 a group of counties determined to be an eligible 

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

8 receive a grant under section 3401 if such city 

9 or county or group of counties meets the re10 quirements of subparagraph (B). 

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

12 meets the requirements of this subparagraph if 

13 such city or county— 

14 ‘‘(i) except as provided in subpara15 graph (C), has a population of not less 

16 than 50,000 residents; 

17 ‘‘(ii) meets the requirements of para18 graph (1)(A); 

19 ‘‘(iii) submits an application under 

20 section 3404; 

21 ‘‘(iv) establishes a planning council 

22 (for purposes of section 3402); and 

23 ‘‘(v) establishes an administrative 

24 mechanism to allocate funds and services 

25 under the grant based on— 


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1 ‘‘(I) the number and rate of drug 

2 overdose deaths and nonfatal drug 

3 overdoses in the city or county; 

4 ‘‘(II) the severity of need for sub5 stance use disorder treatment services 

6 in the city or county; and 

7 ‘‘(III) the health and support 

8 personnel needs of the city or county. 

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

10 county or group of counties that does not meet 

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

12 apply to the Secretary for a waiver of such re13 quirement. Such application shall dem14 onstrate— 

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

16 to be served are distinct or that addressing 

17 substance use in the service area would be 

18 best served by the formation of an inde19 pendent council; and 

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

21 of counties has the capacity to administer 

22 the funding received under this subtitle. 

23 ‘‘(D) MINIMUM FUNDING.—A city or coun24 ty that meets the requirement of this paragraph 

25 and receives a grant under section 3401 shall 


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1 be entitled to an amount of funding under the 

2 grant in an amount that is not less than the 

3 amount determined under section 3403(a) with 

4 respect to such city or county. 

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

6 that are not located within the territory of a county 

7 shall be treated as eligible counties for purposes of 

8 this subtitle. 

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

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

11 governance, the Secretary shall determine the local 

12 political subdivisions within such States that are eli13 gible to receive a grant under section 3401 and such 

14 subdivisions shall be treated as eligible counties for 

15 purposes of this subtitle. 

16 ‘‘(6) DETERMINATIONS WHERE THERE IS A

17 LACK OF DATA.—The Secretary shall establish eligi18 bility and allocation criteria related to the prevalence 

19 of drug overdose deaths, the mortality rate from 

20 drug overdoses, and that provides an equivalent 

21 measure of need for funding for cities and counties 

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

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

24 ‘‘(7) DATA FROM TRIBAL AREAS.—The Sec25 retary, acting through the Indian Health Service, 


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1 shall consult with Indian Tribes and confer with 

2 urban Indian organizations to establish eligibility 

3 and allocation criteria that provide an equivalent 

4 measure of need for Tribal and urban Indian areas 

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

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

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

8 date of enactment of this title, the Comptroller Gen9 eral shall conduct a study to determine whether the 

10 data utilized for purposes of paragraph (1)(A) pro11 vide the most precise measure of local area need re12 lated to substance use and addiction prevalence and 

13 whether additional data would provide more precise 

14 measures of substance use and addiction prevalence 

15 in local areas. Such study shall identify barriers to 

16 collecting or analyzing such data, and make rec17 ommendations for revising the indicators used under 

18 such paragraph to determine eligibility in order to 

19 direct funds to the local areas in most need of fund20 ing to provide assistance related to substance use 

21 and addiction. 

22 ‘‘(9) REFERENCE.—For purposes of this sub23 title, the term ‘eligible local area’ includes— 

24 ‘‘(A) a city or county described in para25 graph (1); 


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1 ‘‘(B) multiple contiguous counties de2 scribed in paragraph (2); 

3 ‘‘(C) cities or counties within multiple con4 tiguous counties described in paragraph (3); 

5 ‘‘(D) an independent city described in 

6 paragraph (4); and 

7 ‘‘(E) a political subdivision described in 

8 paragraph (5). 

9 ‘‘(c) ADMINISTRATION.— 

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

11 under a grant awarded under this section shall be 

12 directed to the chief elected official of the eligible 

13 local area who shall administer the grant funds. 

14 ‘‘(2) MULTIPLE CONTIGUOUS COUNTIES.— 

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

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

17 county described in subsection (b)(2), assist18 ance made available under a grant awarded 

19 under this section shall be directed to the chief 

20 elected official of the particular county des21 ignated in the application submitted for the 

22 grant under section 3404. Such chief elected of23 ficial shall be the administrator of the grant. 

24 ‘‘(B) STATE ADMINISTRATION.—Notwith25 standing subparagraph (A), the eligible county 


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1 described in subsection (b)(2) may elect to des2 ignate the chief elected State official of the 

3 State in which the eligible county is located as 

4 the administrator of the grant funds. 

5 ‘‘SEC. 3402. PLANNING COUNCIL. 

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

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

8 eligible local area shall establish or designate a substance 

9 use disorder treatment and services planning council that 

10 shall, to the maximum extent practicable— 

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

12 the population of individuals with substance use dis13 order in the area; and 

14 ‘‘(2) include representatives of— 

15 ‘‘(A) health care providers, including Fed16 erally-qualified health centers, rural health clin17 ics, Indian health programs as defined in sec18 tion 4 of the Indian Health Care Improvement 

19 Act, urban Indian organizations as defined in 

20 section 4 of the Indian Health Care Improve21 ment Act, and facilities operated by the Depart22 ment of Veterans Affairs; 

23 ‘‘(B) Native Hawaiian organizations as de24 fined in section 11 of the Native Hawaiian 

25 Health Care Act of 1988; 


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1 ‘‘(C) community-based health, harm reduc2 tion, or addiction service organizations, includ3 ing, where applicable, representatives of Drug 

4 Free Communities Coalition grantees; 

5 ‘‘(D) social service providers, including 

6 providers of housing and homelessness services 

7 and recovery residence providers; 

8 ‘‘(E) mental health care providers; 

9 ‘‘(F) local public health agencies; 

10 ‘‘(G) individuals with substance use dis11 order and individuals who use drugs; 

12 ‘‘(H) individuals in recovery from sub13 stance use disorders; 

14 ‘‘(I) State governments, including the 

15 State Medicaid agency and the Single State 

16 Agency for Substance Abuse Services; 

17 ‘‘(J) local governments; 

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

19 ‘‘(L) substance use disorder treatment pro20 viders, including physician addiction specialists; 

21 ‘‘(M) Indian tribes and tribal organizations 

22 as defined in section 4 of the Indian Self-Deter23 mination and Education Assistance Act; 

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

25 4 of the Indian Health Care Improvement Act; 


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1 ‘‘(O) historically underserved groups and 

2 subpopulations; 

3 ‘‘(P) individuals who were formerly incar4 cerated; 

5 ‘‘(Q) organizations serving individuals who 

6 are currently incarcerated or in pre-trial deten7 tion or were formerly incarcerated; 

8 ‘‘(R) Federal agencies; 

9 ‘‘(S) organizations that provide drug pre10 vention programs and services to youth at risk 

11 of substance use; 

12 ‘‘(T) medical examiners or coroners; 

13 ‘‘(U) labor unions and the workplace com14 munity; 

15 ‘‘(V) local fire departments and emergency 

16 medical services; 

17 ‘‘(W) the lesbian, gay, bisexual, 

18 transgender, queer (LGBTQ) community; and 

19 ‘‘(X) certified or accredited addiction re20 covery community organizations. 

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

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

23 for purposes of subsection (a), the chief elected offi24 cial of the eligible local area may establish the counVerDate Sep 11 2014 21:25 Dec 22, 2021 Jkt 029200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H6311.IH H6311

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1 cil directly or designate an existing entity to serve as 

2 the council, subject to paragraph (2). 

3 ‘‘(2) CONSIDERATION REGARDING DESIGNATION

4 OF COUNCIL.—In making a determination of wheth5 er to establish or designate a council under para6 graph (1), the chief elected official shall give priority 

7 to the designation of an existing entity that has 

8 demonstrated experience in the provision of health 

9 and support services to individuals with substance 

10 use disorder within the eligible local area, that has 

11 a structure that recognizes the Federal trust respon12 sibility when spending Federal health care dollars, 

13 and that has demonstrated a commitment to re14 specting the obligation of government agencies using 

15 Federal dollars to consult with Indian tribes and 

16 confer with urban Indian organizations. 

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

18 an existing entity is designated to serve as the coun19 cil under this section, the membership of the entity 

20 shall comply with the requirements of subsection 

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

22 in subsection (e). 

23 ‘‘(4) JOINT COUNCIL.—The Secretary shall es24 tablish a process to permit an eligible local area that 

25 is not contiguous with any other eligible local area 


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1 to form a joint planning council with such other eli2 gible local area or areas, as long as such areas are 

3 located in geographical proximity to each other, as 

4 determined by the Secretary, and submit a joint ap5 plication under section 3404. 

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

7 Eligible local areas may form a joint planning coun8 cil with other eligible local areas across State lines 

9 if such areas are located in geographical proximity 

10 to each other, as determined by the Secretary, sub11 mit a joint application under section 3404, and es12 tablish intergovernmental agreements to allow the 

13 administration of the grant across State lines. 

14 ‘‘(c) MEMBERSHIP.—Members of the planning coun15 cil established or designated under subsection (a) shall— 

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

17 open process; 

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

19 and vice chair; 

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

21 Indian tribes located within any eligible local area 

22 that receives funding under the grant program es23 tablished in section 3401; 

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

25 of substance use disorder; 


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

2 nonprofit substance use disorder service provider, at 

3 least 1 representative of an urban Indian organiza4 tion, at least 1 physician addiction specialist, and at 

5 least 1 representative from an organization pro6 viding harm reduction services; 

7 ‘‘(6) include at least 1 representative of a Na8 tive Hawaiian organization (as defined in section 11 

9 of the Native Hawaiian Health Care Act of 1988) 

10 when the Native Hawaiian population exceeds 10 

11 percent; and 

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

13 the planning council. 

14 ‘‘(d) MEMBERSHIP TERMS.—Members of the plan15 ning council established or designated under subsection 

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

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

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

19 designated under subsection (a) shall— 

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

21 grant funds within the eligible local area that em22 phasize reducing drug use rates, overdose, substance 

23 use disorder, and health conditions associated with 

24 drug use such as human immunodeficiency virus, 

25 hepatitis B, and hepatitis C through evidence-based 


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1 interventions in both community and criminal justice 

2 settings and that are based on— 

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

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

6 best practices identified by the Secretary; 

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

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

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

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

15 with substance use disorder; and 

16 ‘‘(E) the availability of other governmental 

17 and non-governmental services; 

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

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

21 individuals with substance use disorder; 

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

23 work with local public health agencies to develop a 

24 comprehensive plan for the organization and delivery 


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1 of substance use disorder prevention and treatment 

2 services; 

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

5 to support evidence-based substance use disorder 

6 prevention and treatment services in the areas of 

7 greatest need within the eligible local area; 

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

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

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

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

14 determine the needs of such population, including 

15 the need for substance use disorder prevention, 

16 intervention, treatment, harm reduction, and recov17 ery services; 

18 ‘‘(7) work with local public agencies to deter19 mine the disparities in access to services among af20 fected subpopulations and historically underserved 

21 communities, including infrastructure and capacity 

22 shortcomings of providers that contribute to these 

23 disparities; 

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

25 methods for obtaining input on community needs 


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1 and priorities, including by partnering with organi2 zations that serve targeted communities experiencing 

3 high addictive substance-related health disparities to 

4 gather data using culturally attuned data collection 

5 methodologies; 

6 ‘‘(9) coordinate with Federal grantees that pro7 vide substance use disorder prevention and treat8 ment services within the eligible local area; and 

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

10 substance use disorder prevention and treatment 

11 services being supported by the grant received by the 

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

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

14 use, overdose, and death from substance use; 

15 ‘‘(B) rates of discontinuation from sub16 stance use disorder treatment services and rates 

17 of sustained recovery; 

18 ‘‘(C) long-term outcomes among individ19 uals receiving treatment for substance use dis20 orders; and 

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

22 use disorder treatment services needed by indi23 viduals with substance use disorders over their 

24 lifetimes. 

25 ‘‘(f) CONFLICTS OF INTEREST.— 


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

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

3 administration of a grant under section 3401. 

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

5 may serve on the planning council under subsection 

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

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

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

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

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

13 the entity seeks such amounts, participate (directly 

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

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

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

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

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

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

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

25 criteria established by the Secretary, the following applies: 


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

2 to the public and shall be held only after adequate 

3 notice to the public. 

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

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

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

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

10 council shall be kept. The accuracy of all minutes 

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

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

13 disclosure of information of a personal nature that 

14 would constitute a clearly unwarranted invasion of 

15 personal privacy, including any disclosure of medical 

16 information or personnel matters. 

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

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

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

20 extent practicable, prioritize the distribution of grant 

21 funds to grantees that have— 

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

23 or 

24 ‘‘(ii) an explicit policy not to deter employ25 ees with respect to— 


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1 ‘‘(I) labor organizing for the employ2 ees engaged in the covered activities; and 

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

4 and join labor organizations; and 

5 ‘‘(B) policies that require— 

6 ‘‘(i) the posting and maintenance of 

7 notices in the workplace to such employees 

8 of their rights under the National Labor 

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

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

11 beginning of their employment, provided 

12 notice and information regarding the em13 ployees’ rights under such Act; and 

14 ‘‘(iii) the employer to voluntarily rec15 ognize a union in cases where a majority 

16 of such workers of the employer have 

17 joined and requested representation. 

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

19 apply to Indian tribes. 

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

21 FUNDING AGREEMENT. 

22 ‘‘(a) AMOUNT OF GRANT.— 

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

24 AREA.— 


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

2 subtitle, the Secretary shall make a grant for 

3 each eligible local area for which an application 

4 under section 3404 has been approved. Each 

5 such grant shall be made in an amount deter6 mined in accordance with paragraph (3). 

7 ‘‘(B) EXPEDITED DISTRIBUTION.—Not 

8 later than 90 days after an appropriation be9 comes available to carry out this subtitle for a 

10 fiscal year, the Secretary shall disburse 53 per11 cent of the amount made available under sec12 tion 3406 for carrying out this subtitle for such 

13 fiscal year through grants to eligible local areas 

14 under section 3401, in accordance with sub15 paragraphs (C) and (D). 

16 ‘‘(C) AMOUNT.— 

17 ‘‘(i) IN GENERAL.—Subject to the ex18 tent of amounts made available in appro19 priations Acts, a grant made for purposes 

20 of this subparagraph to an eligible local 

21 area shall be made in an amount equal to 

22 the product of— 

23 ‘‘(I) an amount equal to the 

24 amount available for distribution 


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1 under subparagraph (B) for the fiscal 

2 year involved; and 

3 ‘‘(II) the percentage constituted 

4 by the ratio of the distribution factor 

5 for the eligible local area to the sum 

6 of the respective distribution factors 

7 for all eligible local areas, 

8 which product shall then, as applicable, be 

9 increased under subparagraph (D). 

10 ‘‘(ii) DISTRIBUTION FACTOR.—For 

11 purposes of clause (i)(II), the term ‘dis12 tribution factor’ means— 

13 ‘‘(I) an amount equal to— 

14 ‘‘(aa) the estimated number 

15 of drug overdose deaths in the el16 igible local area, as determined 

17 under clause (iii); or 

18 ‘‘(bb) the estimated number 

19 of non-fatal drug overdoses in the 

20 eligible local area, as determined 

21 under clause (iv), 

22 as determined by the Secretary based 

23 on which distribution factor (item (aa) 

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


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1 area receiving the greatest amount of 

2 funds; or 

3 ‘‘(II) in the case of an eligible 

4 local area for which the data de5 scribed in subclause (I) are not avail6 able, an amount determined by the 

7 Secretary— 

8 ‘‘(aa) based on other data 

9 the Secretary determines appro10 priate; and 

11 ‘‘(bb) that is related to the 

12 prevalence of non-fatal drug 

13 overdoses, drug overdose deaths, 

14 and the mortality rate from drug 

15 overdoses and provides an equiv16 alent measure of need for fund17 ing. 

18 ‘‘(iii) NUMBER OF DRUG OVERDOSE

19 DEATHS.—The number of drug overdose 

20 deaths determined under this clause for an 

21 eligible county for a fiscal year for pur22 poses of clause (ii) is the number of drug 

23 overdose deaths during the most recent 3- 

24 year period for which such data are avail25 able. 


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1 ‘‘(iv) NUMBER OF NON-FATAL DRUG

2 OVERDOSES.—The number of non-fatal 

3 drug overdose deaths determined under 

4 this clause for an eligible county for a fis5 cal year for purposes of clause (ii) may be 

6 determined by using data including emer7 gency department syndromic data, visits, 

8 other emergency medical services for drug9 related causes, or Overdose Detection Map10 ping Application Program (ODMAP) data 

11 during the most recent 3-year period for 

12 which such data are available. 

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

14 after the date of enactment of this title, 

15 the Comptroller General shall conduct a 

16 study to determine whether the data uti17 lized for purposes of clause (ii) provide the 

18 most precise measure of local area need re19 lated to substance use and addiction preva20 lence in local areas and whether additional 

21 data would provide more precise measures 

22 of substance use and addiction prevalence 

23 in local areas. Such study shall identify 

24 barriers to collecting or analyzing such 

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1 ing the distribution factors used under 

2 such clause to determine funding levels in 

3 order to direct funds to the local areas in 

4 most need of funding to provide substance 

5 use disorder treatment services. 

6 ‘‘(vi) REDUCTIONS IN AMOUNTS.—If a 

7 local area that is an eligible local area for 

8 a year loses such eligibility in a subsequent 

9 year based on the failure to meet the re10 quirements of paragraph (1)(A) or (6) of 

11 section 3401(b), such area will remain eli12 gible to receive— 

13 ‘‘(I) for such subsequent year, an 

14 amount equal to 80 percent of the 

15 amount received under the grant in 

16 the previous year; and 

17 ‘‘(II) for the second such subse18 quent year, an amount equal to 50 

19 percent of the amount received in the 

20 previous year. 

21 ‘‘(2) SUPPLEMENTAL GRANTS.— 

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

23 disburse the remainder of amounts not dis24 bursed under paragraph (1) for such fiscal year 

25 for the purpose of making grants to cities and 


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1 counties whose application under section 

2 3404— 

3 ‘‘(i) contains a report concerning the 

4 dissemination of emergency relief funds 

5 under paragraph (1) and the plan for utili6 zation of such funds, if applicable; 

7 ‘‘(ii) demonstrates the need in such 

8 local area, on an objective and quantified 

9 basis, for supplemental financial assistance 

10 to combat substance use disorder; 

11 ‘‘(iii) demonstrates the existing com12 mitment of local resources of the area, 

13 both financial and in-kind, to preventing, 

14 treating, and managing substance use dis15 order and supporting sustained recovery; 

16 ‘‘(iv) demonstrates the ability of the 

17 area to utilize such supplemental financial 

18 resources in a manner that is immediately 

19 responsive and cost effective; 

20 ‘‘(v) demonstrates that resources will 

21 be allocated in accordance with the local 

22 demographic incidence of substance use 

23 disorders and drug overdose mortality; 

24 ‘‘(vi) demonstrates the inclusiveness of 

25 affected communities and individuals with 


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1 substance use disorders, including those 

2 communities and individuals that are dis3 proportionately affected or historically un4 derserved; 

5 ‘‘(vii) demonstrates the manner in 

6 which the proposed services are consistent 

7 with the local needs assessment and the 

8 State plan approved by the Secretary pur9 suant to section 1932(b); 

10 ‘‘(viii) demonstrates success in identi11 fying individuals with substance use dis12 orders; and 

13 ‘‘(ix) demonstrates that support for 

14 substance use disorder prevention and 

15 treatment services is organized to maxi16 mize the value to the population to be 

17 served with an appropriate mix of sub18 stance use disorder prevention and treat19 ment services and attention to transition in 

20 care. 

21 ‘‘(B) AMOUNT.— 

22 ‘‘(i) IN GENERAL.—The amount of 

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1 retary. In making such determination, the 

2 Secretary shall consider— 

3 ‘‘(I) the rate of drug overdose 

4 deaths per 100,000 population in the 

5 eligible local area; and 

6 ‘‘(II) the increasing need for sub7 stance use disorder treatment serv8 ices, including relative rates of in9 crease in the number of drug 

10 overdoses or drug overdose deaths, or 

11 recent increases in drug overdoses or 

12 drug overdose deaths since data were 

13 provided under section 3401(b), if ap14 plicable. 

15 ‘‘(ii) DEMONSTRATED NEED.—The 

16 factors considered by the Secretary in de17 termining whether a local area has a dem18 onstrated need for purposes of clause 

19 (i)(II) may include any or all of the fol20 lowing: 

21 ‘‘(I) The unmet need for sub22 stance use disorder treatment serv23 ices, including factors identified in 

24 subparagraph (B)(i)(II). 


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1 ‘‘(II) Relative rates of increase in 

2 the number of drug overdoses or drug 

3 overdose deaths. 

4 ‘‘(III) The relative rates of in5 crease in the number of drug 

6 overdoses or drug overdose deaths 

7 within new or emerging subpopula8 tions. 

9 ‘‘(IV) The current prevalence of 

10 substance use disorders. 

11 ‘‘(V) Relevant factors related to 

12 the cost and complexity of delivering 

13 substance use disorder treatment serv14 ices to individuals in the eligible local 

15 area. 

16 ‘‘(VI) The impact of co-morbid 

17 factors, including co-occurring condi18 tions, determined relevant by the Sec19 retary. 

20 ‘‘(VII) The prevalence of home21 lessness among individuals with sub22 stance use disorders. 

23 ‘‘(VIII) The relevant factors that 

24 limit access to health care, including 

25 geographic variation, adequacy of 


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1 health insurance coverage, and lan2 guage barriers. 

3 ‘‘(IX) The impact of a decline in 

4 the amount received pursuant to para5 graph (1) on substance use disorder 

6 treatment services available to all in7 dividuals with substance use disorders 

8 identified and eligible under this sub9 title. 

10 ‘‘(X) The increasing incidence in 

11 conditions related to substance use, 

12 including hepatitis C, human immuno13 deficiency virus, hepatitis B and other 

14 infections associated with injection 

15 drug use. 

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

17 local area that receives a grant under this para18 graph— 

19 ‘‘(i) shall use amounts received in ac20 cordance with subsection (b); 

21 ‘‘(ii) shall not have to meet the eligi22 ble criteria in section 3401(b); and 

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

24 planning council under section 3402. 


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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 3406 for each fiscal year to provide for11 mula funds to Indian tribes disproportionately 

12 affected by substance use, in an amount deter13 mined pursuant to a formula and eligibility cri14 teria developed by the Secretary in consultation 

15 with Indian tribes, for the purposes of address16 ing substance use. 

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

18 of an Indian tribe the Secretary shall pay funds 

19 under this section through a contract, coopera20 tive agreement, or compact under, as applicable, 

21 title I or V of the Indian Self-Determination 

22 and Education Assistance Act. 

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

24 any requirements in this section, an Indian 

25 tribe may use amounts provided under funds 


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1 awarded under this paragraph for the uses 

2 identified in subsection (b) and any other activi3 ties determined appropriate by the Secretary, in 

4 consultation with Indian tribes. An Indian tribe 

5 shall not be required to allocate funds and serv6 ices in accordance with the goals, priorities, or 

7 objectives established by a planning council 

8 under section 3402. 

9 ‘‘(b) USE OF AMOUNTS.— 

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

11 make a grant under section 3401 to an eligible local 

12 area unless the chief elected official of the area 

13 agrees that— 

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

15 within the area under the grant will be made in 

16 accordance with the priorities established by the 

17 planning council; and 

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

19 be expended for— 

20 ‘‘(i) prevention services described in 

21 paragraph (3); 

22 ‘‘(ii) core medical services described in 

23 paragraph (4); 

24 ‘‘(iii) recovery and support services 

25 described in paragraph (5); 


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1 ‘‘(iv) early intervention services de2 scribed in paragraph (6); 

3 ‘‘(v) harm reduction services described 

4 in paragraph (7); 

5 ‘‘(vi) financial assistance with health 

6 insurance described in paragraph (8); and 

7 ‘‘(vii) administrative expenses de8 scribed in paragraph (9). 

9 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 

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

11 shall use amounts received under a grant under 

12 section 3401 to provide direct financial assist13 ance to eligible entities or providers for the pur14 pose of providing prevention services, core med15 ical services, recovery and support services, 

16 early intervention services, and harm reduction 

17 services. 

18 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi19 nancial assistance may be provided under sub20 paragraph (A) to public or nonprofit entities, 

21 other eligible Medicaid providers if more than 

22 half of their patients are diagnosed with a sub23 stance use disorder and covered by Medicaid, or 

24 other private for-profit entities if such entities 

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1 stance use disorder treatment services in the 

2 area. 

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

4 (not including tribal areas) may not provide di5 rect financial assistance to any entity or pro6 vider that provides medication for addiction 

7 treatment if that entity or provider does not 

8 also offer mental health services or psycho9 therapy by licensed clinicians through a referral 

10 or onsite. 

11 ‘‘(D) NEUTRALITY TOWARDS ORGANIZED

12 LABOR.— 

13 ‘‘(i) IN GENERAL.—In carrying out 

14 duties under this section, eligible local 

15 areas shall, to the extent practicable, 

16 prioritize the distribution of grant funds to 

17 grantees that have— 

18 ‘‘(I)(aa) a collective bargaining 

19 agreement; or 

20 ‘‘(bb) an explicit policy not to 

21 deter employees with respect to— 

22 ‘‘(AA) labor organizing for 

23 the employees engaged in the 

24 covered activities; and 


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1 ‘‘(BB) such employees’ 

2 choice to form and join labor or3 ganizations; and 

4 ‘‘(II) policies that require— 

5 ‘‘(aa) the posting and main6 tenance of notices in the work7 place to such employees of their 

8 rights under the National Labor 

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

10 seq.); 

11 ‘‘(bb) that such employees 

12 are, at the beginning of their em13 ployment, provided notice and in14 formation regarding the employ15 ees’ rights under such Act; and 

16 ‘‘(cc) the employer to volun17 tarily recognize a union in cases 

18 where a majority of such workers 

19 of the employer have joined and 

20 requested representation. 

21 ‘‘(ii) LIMITATION.—This subsection 

22 does not apply to Indian tribes. 

23 ‘‘(3) PREVENTION SERVICES.— 

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

25 section, the term ‘prevention services’ means 


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1 evidence-based services, programs, or multi-sec2 tor strategies to prevent substance use disorder 

3 (including education campaigns, community4 based prevention programs, risk identification 

5 programs, opioid diversion, collection and dis6 posal of unused opioids, services to at-risk pop7 ulations, and trauma support services). 

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

9 use not to exceed 20 percent of the amount of 

10 the grant under section 3401 for prevention 

11 services. An eligible local area may apply to the 

12 Secretary for a waiver of this subparagraph. 

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

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

15 means the following evidence-based services provided 

16 to individuals with substance use disorder or at risk 

17 for developing substance use disorder, including 

18 through the use of telemedicine or a hub and spoke 

19 model: 

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

21 more fully described in section 3439, including 

22 assessment of disease presence, severity, and 

23 co-occurring conditions, treatment planning, 

24 clinical stabilization services, withdrawal man25 agement and detoxification, intensive inpatient 


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1 treatment, intensive outpatient treatment, out2 patient treatment, residential inpatient services, 

3 treatment for co-occurring mental health and 

4 substance use disorders, and all drugs approved 

5 by the Food and Drug Administration for the 

6 treatment of substance use disorder. 

7 ‘‘(B) Outpatient and ambulatory health 

8 services, including those administered by Feder9 ally-qualified health centers, rural health clinics, 

10 tribal clinics and hospitals, urban Indian orga11 nizations, certified community behavioral health 

12 clinics (as described in section 223 of the Pro13 tecting Access to Medicare Act), Native Hawai14 ian organizations (as defined in section 11 of 

15 the Native Hawaiian Health Care Act of 1988), 

16 and comprehensive opioid recovery centers (as 

17 described in section 552 of this Act). 

18 ‘‘(C) Hospice services. 

19 ‘‘(D) Mental health services. 

20 ‘‘(E) Opioid overdose reversal drug prod21 ucts procurement, distribution, and training. 

22 ‘‘(F) Pharmaceutical assistance and diag23 nostic testing related to the management of 

24 substance use disorders and co-morbid condi25 tions. 


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

2 services. 

3 ‘‘(H) Comprehensive Case Management 

4 and care coordination, including substance use 

5 disorder treatment adherence services. 

6 ‘‘(I) Health insurance enrollment and cost7 sharing assistance in accordance with para8 graph (8). 

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

10 and dispatch licensed health care professionals, 

11 mental health professionals, harm reduction 

12 providers, or community health workers to re13 spond in lieu of law enforcement officers in 

14 emergencies and that ensure a licensed health 

15 care professional is a member of the team that 

16 responds in lieu of law enforcement officers in 

17 emergencies in which— 

18 ‘‘(i) an individual calling 911, the Na19 tional Suicide Hotline, or another emer20 gency hotlines states that a person is expe21 riencing a drug overdose or is otherwise 

22 under the influence of a legal or illegal 

23 substance; or 

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

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1 fies a person as being (or possibly being) 

2 under the influence of a legal or illegal 

3 substance. 

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

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

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

10 support, medical transportation services, respite care 

11 for persons caring for individuals with substance use 

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

14 at the time of outpatient services, outreach services, 

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

17 legal services, and child care and family services. 

18 The entities through which such services may be 

19 provided include local and tribal authorities that 

20 provide child care, housing, community development, 

21 and other recovery and support services, so long as 

22 they do not exclude individuals on the basis that 

23 such individuals receive medication for addiction 

24 treatment. 


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

2 purposes of this section, the term ‘early intervention 

3 services’ means services to provide screening and 

4 connection to the appropriate level of substance use 

5 disorder and mental health treatment (including 

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

9 substance use disorder, the provision of referrals to 

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

12 substance use disorder, and rapid access to medica13 tion for addiction treatment in the setting of recent 

14 overdose. The entities through which such services 

15 may be provided include emergency rooms, fire de16 partments and emergency medical services, detention 

17 facilities, prisons and jails, homeless shelters, health 

18 care points of entry specified by eligible local areas, 

19 Federally-qualified health centers, workforce agen20 cies and job centers, youth development centers, 

21 tribal clinics and hospitals, urban Indian organiza22 tions, and rural health clinics. 

23 ‘‘(7) HARM REDUCTION SERVICES.—For pur24 poses of this section, the term ‘harm reduction serv25 ices’ means services provided to individuals engaging 


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1 in substance use scientifically accepted to reduce the 

2 risk of infectious disease transmission, overdose, or 

3 death, including by increasing access to health care, 

4 housing, and recovery and support services, includ5 ing syringe services programs. Such term includes 

6 evidence-based services. 

7 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV8 ERAGE.—An eligible local area may use amounts 

9 provided under a grant awarded under section 3401 

10 to establish a program of financial assistance to as11 sist eligible individuals with substance use disorder 

12 in— 

13 ‘‘(A) enrolling in health insurance cov14 erage; or 

15 ‘‘(B) affording health care services, includ16 ing assistance paying cost-sharing amounts, in17 cluding premiums. 

18 ‘‘(9) ADMINISTRATION AND PLANNING.—An eli19 gible local area (not including tribal areas) shall not 

20 use in excess of 15 percent of amounts received 

21 under a grant under section 3401 for administra22 tion, accounting, reporting, and program oversight 

23 functions, including the development of systems to 

24 improve data collection and data sharing, in the first 

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1 cess of 10 percent of amounts received under a 

2 grant under section 3401 for such activities in sub3 sequent years. 

4 ‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 

5 received under a grant under section 3401 may be 

6 used to provide substance use disorder treatment 

7 services, including medication for addiction treat8 ment, to individuals who are currently incarcerated 

9 or in pre-trial detention. 

10 ‘‘(c) REQUIRED TERMS.— 

11 ‘‘(1) REQUIREMENT OF STATUS AS MEDICAID

12 PROVIDER.— 

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

14 subparagraph (B), the Secretary may not make 

15 a grant under section 3401 for the provision of 

16 substance use disorder treatment services under 

17 this section in an eligible local area unless, in 

18 the case of any such service that is available 

19 pursuant to the State plan approved under title 

20 XIX of the Social Security Act for the State— 

21 ‘‘(i) the political subdivision involved 

22 will provide the service directly, and the 

23 political subdivision has entered into a par24 ticipation agreement under the State plan 


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1 and is qualified to receive payments under 

2 such plan; or 

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

4 ‘‘(I) will enter into agreements 

5 with public or nonprofit entities, or 

6 other Medicaid providers if more than 

7 half of their patients are diagnosed 

8 with a substance use disorder and 

9 covered by Medicaid, under which 

10 such entities and other providers will 

11 provide the service, and such entities 

12 and other providers have entered into 

13 such a participation agreement and 

14 are qualified to receive such pay15 ments; and 

16 ‘‘(II) demonstrates that it will 

17 ensure that such entities and other 

18 providers providing the service will 

19 seek payment for each such service 

20 rendered in accordance with the usual 

21 payment schedule under the State 

22 plan. 

23 ‘‘(B) WAIVER.— 

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

25 entity making an agreement pursuant to 


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1 subparagraph (A)(ii) regarding the provi2 sion of substance use disorder treatment 

3 services, the requirement established in 

4 such subparagraph shall be waived by the 

5 substance use planning council for the area 

6 involved if the entity does not, in providing 

7 health care services, impose a charge or ac8 cept reimbursement available from any 

9 third-party payor, including reimbursement 

10 under any insurance policy or under any 

11 Federal or State health benefits program. 

12 A waiver under this subparagraph shall 

13 not be longer than 2 years in duration and 

14 shall not be renewed. 

15 ‘‘(ii) DETERMINATION.—A determina16 tion by the substance use planning council 

17 of whether an entity referred to in clause 

18 (i) meets the criteria for a waiver under 

19 such clause shall be made without regard 

20 to whether the entity accepts voluntary do21 nations for the purpose of providing serv22 ices to the public. 

23 ‘‘(2) REQUIRED TERMS FOR EXPANDING AND

24 IMPROVING CARE.—A funding agreement for a grant 

25 under this section shall— 


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

2 grant will not be utilized to make payments for 

3 any item or service to the extent that payment 

4 has been made, or can reasonably be expected 

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

6 under a State compensation program, under an 

7 insurance policy, or under any Federal or State 

8 health benefits program (except for a program 

9 administered by, or providing the services of, 

10 the Indian Health Service); and 

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

14 all drugs approved by the Food and Drug Ad15 ministration for the treatment of substance use 

16 disorder for which the applicant offers treat17 ment, in accordance with section 3435. 

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

20 that— 

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

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

24 year for which the grant is awarded to provide 

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1 dividuals with substance use disorder, including 

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

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

6 expenses; 

7 ‘‘(B) political subdivisions within the eligi8 ble local area will maintain the level of expendi9 tures by such political subdivisions for sub10 stance use disorder treatment services at a level 

11 that is at least equal to the level of such ex12 penditures by such political subdivisions for the 

13 preceding fiscal year, including expenditures for 

14 each of prevention services, core medical serv15 ices, recovery and support services, early inter16 vention services, harm reduction services, men17 tal health services, and administrative expenses; 

18 ‘‘(C) political subdivisions within the eligi19 ble local area will not use funds received under 

20 a grant awarded under section 3401 in main21 taining the level of substance use disorder treat22 ment services as required in subparagraph (B); 

23 ‘‘(D) substance use disorder treatment 

24 services provided with assistance made available 


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1 under the grant will be provided without re2 gard— 

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

4 pay for such services; and 

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

7 ‘‘(E) substance use disorder treatment 

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

11 substance use disorders residing in rural areas; 

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

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

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

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

19 for the use of grant funds and the Federal trust 

20 responsibility is upheld at all levels of program 

21 administration; and 

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


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1 ‘‘SEC. 3404. APPLICATION. 

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

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

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

5 containing such information, as the Secretary shall re6 quire, including— 

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

8 of any prior grants received under this subtitle by 

9 the applicant and the results achieved by these ex10 penditures and a demonstration that funds received 

11 from a grant under this subtitle in the prior year 

12 were expended in accordance with local priorities de13 veloped by the local planning council established 

14 under section 3402, except that the planning council 

15 requirement shall not apply with respect to areas re16 ceiving supplemental grant funds under section 

17 3403(a)(2); 

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

19 achieved with grant funds provided under this sub20 title, including targets and milestones that are in21 tended to be met, the activities that will be under22 taken to achieve those targets, the number of indi23 viduals likely to be served by the funds sought, in24 cluding demographic data on the populations to be 

25 served, and an explanation of how these goals and 


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1 objectives advance the State plan approved by the 

2 Secretary pursuant to section 1932(b); 

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

4 use funds in a manner that provides substance use 

5 disorder treatment services in compliance with the 

6 evidence-based standards developed in accordance 

7 with section 3435, including providing all drugs ap8 proved by the Food and Drug Administration for the 

9 treatment of substance use disorder; 

10 ‘‘(4) a demonstration that resources provided 

11 under the grant will be allocated in accordance with 

12 the local demographic incidence of substance use, in13 cluding allocations for services for children, youths, 

14 and women; 

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

16 medical expense criteria will be established and ap17 plied to those who qualify for assistance under the 

18 program; 

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

20 eligible local area shall coordinate with local public 

21 health departments in the distribution of funding; 

22 and 

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

24 section, data provided in such form as the Secretary 

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


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1 which the activities supported by the funding met 

2 the goals and objectives specified in the application 

3 for the funding, the number of individuals who 

4 accessed medication for treatment by age, gender, 

5 sexual orientation, race, disability status, and other 

6 demographic criteria relevant to the program, and 

7 the effect of the program on overdose rates and 

8 rates of death due to overdose in the local area 

9 served by the program. 

10 ‘‘(b) REQUIREMENTS REGARDING IMPOSITION OF

11 CHARGES FOR SERVICES.— 

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

13 make a grant under section 3401 to an eligible local 

14 area unless the eligible local area provides assur15 ances that in the provision of substance use disorder 

16 treatment services with assistance provided under 

17 the grant— 

18 ‘‘(A) in the case of individuals with an in19 come less than or equal to 150 percent of the 

20 official poverty level, the provider will not im21 pose charges on any such individual for the 

22 services provided under the grant; 

23 ‘‘(B) in the case of individuals with an in24 come greater than 150 percent of the official 

25 poverty level, the provider will impose a charge 


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1 on each such individual according to a schedule 

2 of charges made available to the public; 

3 ‘‘(C) in the case of individuals with an in4 come greater than 150 percent of the official 

5 poverty level but not exceeding 200 percent of 

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

7 calendar year, impose charges in an amount ex8 ceeding 2 percent of the annual gross income of 

9 the individual; 

10 ‘‘(D) in the case of individuals with an in11 come greater than 200 percent of the official 

12 poverty level but not exceeding 250 percent of 

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

14 calendar year, impose charges in an amount ex15 ceeding 4 percent of the annual gross income of 

16 the individual involved; 

17 ‘‘(E) in the case of individuals with an in18 come greater than 250 percent of the official 

19 poverty level but not exceeding 300 percent of 

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

21 calendar year, impose charges in an amount ex22 ceeding 6 percent of the annual gross income of 

23 the individual involved; 

24 ‘‘(F) in the case of individuals with an in25 come greater than 300 percent of the official 


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1 poverty level but not exceeding 400 percent of 

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

3 calendar year, impose charges in an amount ex4 ceeding 8.5 percent of the annual gross income 

5 of the individual involved; 

6 ‘‘(G) in the case of individuals with an in7 come greater than 400 percent of the official 

8 poverty level, the provider will not, for any cal9 endar year, impose charges in an amount ex10 ceeding 8.5 percent of the annual gross income 

11 of the individual involved; and 

12 ‘‘(H) in the case of eligible American In13 dian and Alaska Native individuals as defined 

14 by section 447.50 of title 42, Code of Federal 

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

16 provider will not impose any charges for sub17 stance use disorder treatment services, includ18 ing any charges or cost-sharing prohibited by 

19 section 1402(d) of the Patient Protection and 

20 Affordable Care Act. 

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

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

23 eligible local area may, in the case of individuals 

24 subject to a charge— 


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

2 the discretion of the area, including imposing 

3 only a nominal charge for the provision of sub4 stance use disorder treatment services, subject 

5 to the provisions of the paragraph regarding 

6 public schedules and regarding limitations on 

7 the maximum amount of charges; and 

8 ‘‘(B) take into consideration the total med9 ical expenses of individuals in assessing the 

10 amount of the charge, subject to such provi11 sions. 

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

13 may not make a grant under section 3401 to an eli14 gible local area unless the area agrees that the limi15 tations on charges for substance use disorder treat16 ment services under this subsection applies to the 

17 annual aggregate of charges imposed for such serv18 ices, however the charges are characterized, includes 

19 enrollment fees, premiums, deductibles, cost sharing, 

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

21 charges. 

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

23 for grants distributed in accordance with section 

24 3403(a)(3) shall be developed by the Secretary in con25 sultation with Indian tribes. 


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1 ‘‘SEC. 3405. TECHNICAL ASSISTANCE. 

2 ‘‘The Secretary shall, beginning on the date of enact3 ment of this title, provide technical assistance, including 

4 assistance from other grantees, contractors or subcontrac5 tors under this title to assist newly eligible local areas in 

6 the establishment of planning councils and, to assist enti7 ties in complying with the requirements of this subtitle 

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

9 under this subtitle. The Secretary may make planning 

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

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

12 eligible for funding under section 3401 in the following 

13 fiscal year. Such grant amounts shall be deducted from 

14 the first year formula award to eligible local areas accept15 ing such grants. 

16 ‘‘SEC. 3406. AUTHORIZATION OF APPROPRIATIONS. 

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

18 this subtitle— 

19 ‘‘(1) $3,300,000,000 for fiscal year 2022; 

20 ‘‘(2) $3,300,000,000 for fiscal year 2023; 

21 ‘‘(3) $3,300,000,000 for fiscal year 2024; 

22 ‘‘(4) $3,300,000,000 for fiscal year 2025; 

23 ‘‘(5) $3,300,000,000 for fiscal year 2026; 

24 ‘‘(6) $3,300,000,000 for fiscal year 2027; 

25 ‘‘(7) $3,300,000,000 for fiscal year 2028; 

26 ‘‘(8) $3,300,000,000 for fiscal year 2029; 


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1 ‘‘(9) $3,300,000,000 for fiscal year 2030; and 

2 ‘‘(10) $3,300,000,000 for fiscal year 2031. 

3 ‘‘Subtitle B—State and Tribal Sub4 stance Use Disorder Prevention 

5 and Intervention Grant Pro6 gram 

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

8 ‘‘The Secretary shall award grants to States, terri9 tories, and tribal governments for the purpose of address10 ing substance use within such States. 

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

12 FUNDING AGREEMENT. 

13 ‘‘(a) AMOUNT OF GRANT TO STATES AND TERRI14 TORIES.— 

15 ‘‘(1) IN GENERAL.— 

16 ‘‘(A) EXPEDITED DISTRIBUTION.—Not 

17 later than 90 days after an appropriation be18 comes available, the Secretary shall disburse 50 

19 percent of the amount made available under 

20 section 3415 for carrying out this subtitle for 

21 such fiscal year through grants to States under 

22 section 3411, in accordance with subparagraphs 

23 (B) and (C). 


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

2 the amount made available under section 3415, 

3 the amount of a grant under section 3411 for— 

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

5 of Columbia, and Puerto Rico for a fiscal 

6 year shall be the greater of— 

7 ‘‘(I) $2,000,000; or 

8 ‘‘(II) an amount determined 

9 under the subparagraph (C); and 

10 ‘‘(ii) each territory other than Puerto 

11 Rico for a fiscal year shall be the greater 

12 of— 

13 ‘‘(I) $500,000; or 

14 ‘‘(II) an amount determined 

15 under the subparagraph (C). 

16 ‘‘(C) DETERMINATION.— 

17 ‘‘(i) FORMULA.—For purposes of sub18 paragraph (B), the amount referred to in 

19 this subparagraph for a State (including a 

20 territory) for a fiscal year is— 

21 ‘‘(I) an amount equal to the 

22 amount made available under section 

23 3415 for the fiscal year involved for 

24 grants pursuant to subparagraph (B); 

25 and 


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1 ‘‘(II) the percentage constituted 

2 by the sum of— 

3 ‘‘(aa) the product of 0.85 

4 and the ratio of the State dis5 tribution factor for the State or 

6 territory to the sum of the re7 spective distribution factors for 

8 all States; and 

9 ‘‘(bb) the product of 0.15 

10 and the ratio of the non-local dis11 tribution factor for the State or 

12 territory (as determined under 

13 clause (iv)) to the sum of the re14 spective non-local distribution 

15 factors for all States or terri16 tories. 

17 ‘‘(ii) STATE DISTRIBUTION FACTOR.— 

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

19 ‘State distribution factor’ means an 

20 amount equal to— 

21 ‘‘(I) the estimated number of 

22 drug overdose deaths in the State, as 

23 determined under clause (iii); or 


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1 ‘‘(II) the number of non-fatal 

2 drug overdoses in the State, as deter3 mined under clause (iv), 

4 as determined by the Secretary based on 

5 which distribution factor (subclause (I) or 

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

7 greatest amount of funds. 

8 ‘‘(iii) NUMBER OF DRUG

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

10 the number of drug overdose deaths deter11 mined under this clause for a State for a 

12 fiscal year is the number of drug overdose 

13 deaths during the most recent 3-year pe14 riod for which such data are available. 

15 ‘‘(iv) NUMBER OF NON-FATAL DRUG

16 OVERDOSES.—The number of non-fatal 

17 drug overdose deaths determined under 

18 this clause for a State for a fiscal year for 

19 purposes of clause (ii) may be determined 

20 by using data including emergency depart21 ment syndromic data, visits, other emer22 gency medical services for drug-related 

23 causes, or Overdose Detection Mapping 

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1 ing the most recent 3-year period for which 

2 such data are available. 

3 ‘‘(v) NON-LOCAL DISTRIBUTION FAC4 TORS.—For purposes of clause (i)(II)(bb), 

5 the term ‘non-local distribution factor’ 

6 means an amount equal to the sum of— 

7 ‘‘(I) the number of drug overdose 

8 deaths in the State involved, as deter9 mined under clause (iii), or the num10 ber of non-fatal drug overdoses in the 

11 State, based on the criteria used by 

12 the State under clause (ii); less 

13 ‘‘(II) the total number of drug 

14 overdose deaths or non-fatal drug 

15 overdoses that are within areas in 

16 such State or territory that are eligi17 ble counties under section 3401. 

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

19 after the date of enactment of this title, 

20 the Comptroller General shall conduct a 

21 study to determine whether the data uti22 lized for purposes of clause (ii) provide the 

23 most precise measure of State need related 

24 to substance use and addiction prevalence 

25 and whether additional data would provide 


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1 more precise measures the levels of sub2 stance use and addiction prevalent in 

3 States. Such study shall identify barriers 

4 to collecting or analyzing such data, and 

5 make recommendations for revising the 

6 distribution factors used under such clause 

7 to determine funding levels in order to di8 rect funds to the States in most need of 

9 funding to provide substance use disorder 

10 treatment services. 

11 ‘‘(2) SUPPLEMENTAL GRANTS.— 

12 ‘‘(A) IN GENERAL.—Subject to subpara13 graph (C), the Secretary shall disburse the re14 mainder of amounts not disbursed under para15 graph (1) for such fiscal year for the purpose 

16 of making grants to States whose application— 

17 ‘‘(i) contains a report concerning the 

18 dissemination of emergency relief funds 

19 under paragraph (1) and the plan for utili20 zation of such funds, if applicable; 

21 ‘‘(ii) demonstrates the need in such 

22 State, on an objective and quantified basis, 

23 for supplemental financial assistance to 

24 combat substance use disorder; 


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

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 State 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 substances 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 treatment services and 

10 attention to transition in care. 

11 ‘‘(B) AMOUNT.— 

12 ‘‘(i) IN GENERAL.—The amount of 

13 each grant made for purposes of this para14 graph shall be determined by the Sec15 retary. In making such determination, the 

16 Secretary shall consider— 

17 ‘‘(I) the rate of drug overdose 

18 deaths per 100,000 population in the 

19 State; and 

20 ‘‘(II) the increasing need for sub21 stance use disorder treatment serv22 ices, including relative rates of in23 crease in the number of drug 

24 overdoses or drug overdose deaths, or 

25 recent increases in drug overdoses or 


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1 drug overdose deaths since the data 

2 were reported under section 3413, if 

3 applicable. 

4 ‘‘(ii) DEMONSTRATED NEED.—The 

5 factors considered by the Secretary in de6 termining whether a State has a dem7 onstrated need for purposes of subpara8 graph (A)(ii) may include any or all of the 

9 following: 

10 ‘‘(I) The unmet need for such 

11 services, including the factors identi12 fied in clause (i)(II). 

13 ‘‘(II) Relative rates of increase in 

14 the number of drug overdoses or drug 

15 overdose deaths. 

16 ‘‘(III) The relative rates of in17 crease in the number of drug 

18 overdoses or drug overdose deaths 

19 within new or emerging subpopula20 tions. 

21 ‘‘(IV) The current prevalence of 

22 substance use disorders. 

23 ‘‘(V) Relevant factors related to 

24 the cost and complexity of delivering 


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1 substance use disorder treatment serv2 ices to individuals in the State. 

3 ‘‘(VI) The impact of co-morbid 

4 factors, including co-occurring condi5 tions, determined relevant by the Sec6 retary. 

7 ‘‘(VII) The prevalence of home8 lessness among individuals with sub9 stance use disorder. 

10 ‘‘(VIII) The relevant factors that 

11 limit access to health care, including 

12 geographic variation, adequacy of 

13 health insurance coverage, and lan14 guage barriers. 

15 ‘‘(IX) The impact of a decline in 

16 the amount received pursuant to para17 graph (1) on substance use disorder 

18 treatment services available to all in19 dividuals with substance use disorders 

20 identified and eligible under this sub21 title. 

22 ‘‘(X) The increasing incidence in 

23 conditions related to substance use, 

24 including hepatitis C, human immuno25 deficiency virus, hepatitis B and other 


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1 infections associated with injection 

2 drug use. 

3 ‘‘(C) MODEL STANDARDS.— 

4 ‘‘(i) PREFERENCE.—In determining 

5 whether a State will receive funds under 

6 this paragraph, except as provided in 

7 clause (ii), the Secretary shall give pref8 erence to States that have adopted the 

9 model standards for each substance use 

10 disorder treatment service and recovery 

11 residence developed in accordance with 

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

13 ‘‘(ii) REQUIREMENT.—Effective begin14 ning in fiscal year 2024, the Secretary 

15 shall not award a grant under this para16 graph to a State unless that State has 

17 adopted the model standards for each of 

18 substance use disorder treatment services 

19 and recovery residences developed in ac20 cordance with subsections (a) and (b) of 

21 section 3435. 

22 ‘‘(D) CONTINUUM OF CARE.— 

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 carried out the 

3 requirements to ensure a continuum of 

4 services in accordance with section 

5 3435(d). 

6 ‘‘(ii) REQUIREMENT.—Effective begin7 ning in fiscal year 2024, the Secretary 

8 shall not award a grant under this para9 graph to a State unless that State has car10 ried out the requirements to ensure a con11 tinuum of services in accordance with sec12 tion 3435(d). 

13 ‘‘(E) UTILIZATION MANAGEMENT FOR

14 MEDICATION FOR ADDICTION TREATMENT.— 

15 ‘‘(i) PREFERENCE.—In determining 

16 whether a State will receive funds under 

17 this paragraph, the Secretary shall give 

18 preference to States that have prohibited 

19 prior authorization and step therapy re20 quirements for at least 1 drug in each 

21 class approved by the Food and Drug Ad22 ministration for the treatment of substance 

23 use disorder. 

24 ‘‘(ii) ADDITIONAL PREFERENCES.— 

25 Additional preference shall be given to 


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1 States that have prohibited prior author2 ization and step therapy requirements for 

3 2 or more drugs in each class approved by 

4 the Food and Drug Administration for the 

5 treatment of substance use disorder. 

6 ‘‘(iii) DEFINITIONS.—In this subpara7 graph: 

8 ‘‘(I) PRIOR AUTHORIZATION.— 

9 The term ‘prior authorization’ means 

10 the process by which a health insur11 ance issuer or pharmacy benefit man12 agement company determines the 

13 medical necessity of otherwise covered 

14 health care services prior to the ren15 dering of such health care services. 

16 Such term includes any health insur17 ance issuer’s or utilization review enti18 ty’s requirement that a subscriber or 

19 health care provider notify the issuer 

20 or entity prior to providing a health 

21 care service. 

22 ‘‘(II) STEP THERAPY.—The term 

23 ‘step therapy’ means a protocol or 

24 program that establishes the specific 

25 sequence in which prescription drugs 


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1 for a medical condition that are medi2 cally appropriate for a particular pa3 tient are authorized by a health insur4 ance issuer or prescription drug man5 agement company. 

6 ‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN7 MENTS.— 

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

9 term ‘Indian tribe’ has the meaning given such 

10 term in section 4 of the Indian Self-Determina11 tion and Education Assistance Act. 

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

13 acting through the Indian Health Service, shall 

14 use 10 percent of the amount available under 

15 section 3415 for each fiscal year to provide for16 mula funds to Indian tribes in an amount de17 termined pursuant to a formula and eligibility 

18 criteria developed by the Secretary in consulta19 tion with Indian tribes, for the purposes of ad20 dressing substance use. 

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

22 of an Indian tribe the Secretary shall pay funds 

23 under this section through a contract, coopera24 tive agreement, or compact under, as applicable, 


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1 title I or V of the Indian Self-Determination 

2 and Education Assistance Act. 

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

4 any requirements in this section, an Indian 

5 tribe may use amounts provided under funds 

6 awarded under this paragraph for the uses 

7 identified in subsection (b) and any other activi8 ties determined appropriate by the Secretary, in 

9 consultation with Indian tribes. 

10 ‘‘(b) USE OF AMOUNTS.— 

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

12 amounts provided under grants awarded under sec13 tion 3411 for— 

14 ‘‘(A) prevention services described in para15 graph (3); 

16 ‘‘(B) core medical services described in 

17 paragraph (4); 

18 ‘‘(C) recovery and support services de19 scribed in paragraph (5); 

20 ‘‘(D) early intervention services described 

21 in paragraph (6); 

22 ‘‘(E) harm reduction services described in 

23 paragraph (7); 

24 ‘‘(F) financial assistance with health insur25 ance as described in paragraph (8); and 


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1 ‘‘(G) administrative expenses described in 

2 paragraph (9). 

3 ‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 

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

5 use amounts received under a grant under sec6 tion 3411 to provide direct financial assistance 

7 to eligible entities or other eligible Medicaid 

8 providers for the purpose of providing preven9 tion services, core medical services, recovery 

10 and support services, early intervention services, 

11 and harm reduction services. 

12 ‘‘(B) APPROPRIATE ENTITIES.—Direct fi13 nancial assistance may be provided under sub14 paragraph (A) to public or nonprofit entities, 

15 other Medicaid providers if more than half of 

16 their patients are diagnosed with a substance 

17 use disorder and covered by Medicaid, or other 

18 private for-profit entities if such entities are the 

19 only available provider of quality substance use 

20 disorder treatment services in the area. 

21 ‘‘(C) LIMITATION.—A State may not pro22 vide direct financial assistance to any entity or 

23 provider that provides medication for addiction 

24 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, States shall, to 

7 the extent practicable, prioritize the dis8 tribution of grant funds to grantees that 

9 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.—A State may use not to ex2 ceed 20 percent of the amount of the grant 

3 under section 3411 for prevention services. A 

4 State may apply to the Secretary for a waiver 

5 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 when 

9 provided to individuals with substance use disorder 

10 or at risk for developing substance use disorder, in11 cluding through the use of telemedicine or a hub and 

12 spoke model: 

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

14 described in section 3439(4), including assess15 ment of disease presence, severity, and co-oc16 curring conditions, treatment planning, clinical 

17 stabilization services, withdrawal management 

18 and detoxification, intensive inpatient treat19 ment, intensive outpatient treatment, outpatient 

20 treatment, residential inpatient services, treat21 ment for co-occurring mental health and sub22 stance use disorders, and all drugs approved by 

23 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), and com8 prehensive opioid recovery centers (as described 

9 in section 552 of this Act). 

10 ‘‘(C) Hospice services. 

11 ‘‘(D) Mental health services. 

12 ‘‘(E) Opioid overdose reversal drug prod13 ucts procurement, distribution, and training. 

14 ‘‘(F) Pharmaceutical assistance related to 

15 the management of substance-use disorders and 

16 co-morbid conditions. 

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

18 services. 

19 ‘‘(H) Comprehensive Case Management 

20 and care coordination, including substance use 

21 disorder treatment adherence services. 

22 ‘‘(I) Health insurance enrollment and cost23 sharing assistance in accordance with para24 graph (8). 


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

2 and dispatch licensed health care professionals, 

3 mental health professionals, harm reduction 

4 providers, or community health workers to re5 spond in lieu of law enforcement officers in 

6 emergencies and that ensure a licensed health 

7 care professional is a member of the team that 

8 responds in lieu of law enforcement officers in 

9 emergencies in which— 

10 ‘‘(i) an individual calling 911, the Na11 tional Suicide Hotline, or another emer12 gency hotlines states that a person is expe13 riencing a drug overdose or is otherwise 

14 under the influence of a legal or illegal 

15 substance; or 

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

17 first responder, or other individual identi18 fies a person as being (or possibly being) 

19 under the influence of a legal or illegal 

20 substance. 

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

22 purposes of this section, the term ‘recovery and sup23 port services’ means services including residential re24 covery housing, mental health services, long term re25 covery services, 24/7 hotline crisis center services, 


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1 medical transportation services, respite care for per2 sons caring for individuals with substance use dis3 order, child care and family services while an indi4 vidual is receiving inpatient treatment services or at 

5 the time of outpatient services, outreach services, 

6 peer recovery services, nutrition services, and refer7 rals for job training and career services, housing, 

8 legal services, and child care and family services. 

9 The entities through which such services may be 

10 provided include State, local, and tribal authorities 

11 that provide child care, housing, community develop12 ment, and other recovery and support services, so 

13 long as they do not exclude individuals on the basis 

14 that such individuals receive medication for addic15 tion treatment. 

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

17 purposes of this section, the term ‘early intervention 

18 services’ means services to provide screening and 

19 connection to the appropriate level of substance use 

20 disorder and mental health treatment (including 

21 same-day connection), counseling provided to indi22 viduals who have misused substances, who have ex23 perienced an overdose, or are at risk of developing 

24 substance use disorder, the provision of referrals to 

25 facilitate the access of such individuals to core medVerDate Sep 11 2014 21:25 Dec 22, 2021 Jkt 029200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H6311.IH H6311

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1 ical services or recovery and support services for 

2 substance use disorder, and rapid access to medica3 tion for addiction treatment in the setting of recent 

4 overdose. The entities through which such services 

5 may be provided include emergency rooms, fire de6 partments and emergency medical services, detention 

7 facilities, prisons and jails, homeless shelters, health 

8 care points of entry specified by eligible local areas, 

9 Federally-qualified health centers, workforce agen10 cies and job centers, youth development centers, 

11 tribal clinics and hospitals, urban Indian organiza12 tions, and rural health clinics. 

13 ‘‘(7) HARM REDUCTION SERVICES.—For pur14 poses of this section, the term ‘harm reduction serv15 ices’ means services provided to individuals engaging 

16 in substance use scientifically accepted to reduce the 

17 risk of infectious disease transmission, overdose, or 

18 death, including by increasing access to health care, 

19 housing, recovery, and support services, including sy20 ringe services programs. Such term includes evi21 dence-based services. 

22 ‘‘(8) AFFORDABLE HEALTH INSURANCE COV23 ERAGE.—A State may use amounts provided under 

24 a grant awarded under section 3411 to establish a 


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1 program of financial assistance to assist eligible indi2 viduals with substance use disorder in— 

3 ‘‘(A) enrolling in health insurance cov4 erage; or 

5 ‘‘(B) affording health care services, includ6 ing assistance paying cost-sharing amounts, in7 cluding premiums. 

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

9 State shall not use in excess of 10 percent of 

10 amounts received under a grant under section 3411 

11 for administration, accounting, reporting, and pro12 gram oversight functions, including the development 

13 of systems to improve data collection and data shar14 ing. 

15 ‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 

16 received under a grant under section 3411 may be 

17 used to provide substance use disorder treatment 

18 services, including medication for addiction treat19 ment, to individuals who are currently incarcerated 

20 or in pre-trial detention. 

21 ‘‘(c) REQUIRED TERMS.— 

22 ‘‘(1) REQUIREMENT OF STATUS AS MEDICAID

23 PROVIDER.— 

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

25 subparagraph (B), the Secretary may not make 


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1 a grant under section 3411 for the provision of 

2 substance use disorder treatment services under 

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

4 such service that is available pursuant to the 

5 State plan approved under title XIX of the So6 cial Security Act for the State— 

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

8 agreement with a political subdivision, 

9 under which the political subdivision will 

10 provide the service directly, and the polit11 ical subdivision has entered into a partici12 pation agreement under the State plan and 

13 is qualified to receive payments under such 

14 plan; or 

15 ‘‘(II) the State will enter into agree16 ments with public or nonprofit entities, or 

17 other Medicaid providers if more than half 

18 of their patients are diagnosed with a sub19 stance use disorder and covered by Med20 icaid, under which such entities and other 

21 providers will provide the service, and such 

22 entities and other providers have entered 

23 into such a participation agreement and 

24 are qualified to receive such payments; and 


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1 ‘‘(III) the State ensures the political 

2 subdivision under clause (i)(I) or the pub3 lic or nonprofit private entities and other 

4 providers under clause (i)(II) will seek pay5 ment for each such service rendered in ac6 cordance with the usual payment schedule 

7 under the State plan. 

8 ‘‘(B) WAIVER.— 

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

10 entity making an agreement pursuant to 

11 subparagraph (A)(ii) regarding the provi12 sion of substance use disorder treatment 

13 services, the requirement established in 

14 such subparagraph shall be waived by the 

15 State if the entity does not, in providing 

16 health care services, impose a charge or ac17 cept reimbursement available from any 

18 third-party payor, including reimbursement 

19 under any insurance policy or under any 

20 Federal or State health benefits program. 

21 A waiver under this subparagraph shall 

22 not be longer than 2 years in duration and 

23 shall not be renewed. 

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1 ferred to in clause (i) meets the criteria for 

2 a waiver under such clause shall be made 

3 without regard to whether the entity ac4 cepts voluntary donations for the purpose 

5 of providing services to the public. 

6 ‘‘(2) REQUIRED TERMS FOR EXPANDING AND

7 IMPROVING CARE.—A funding agreement for a grant 

8 under this section shall— 

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

10 grant will not be utilized to make payments for 

11 any item or service to the extent that payment 

12 has been made, or can reasonably be expected 

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

14 under a State compensation program, under an 

15 insurance policy, or under any Federal or State 

16 health benefits program (except for a program 

17 administered by, or providing the services of, 

18 the Indian Health Service); and 

19 ‘‘(B) ensure that all entities providing sub20 stance use disorder treatment services with as21 sistance made available under the grant shall 

22 offer all drugs approved by the Food and Drug 

23 Administration for the treatment of substance 

24 use disorder for which the applicant offers 

25 treatment, in accordance with section 3435. 


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1 ‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund2 ing agreement for a grant under this section is 

3 that— 

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

5 utilized to supplement not supplant other Fed6 eral, State, or local funds made available in the 

7 year for which the grant is awarded to provide 

8 substance use disorder treatment services to in9 dividuals with substance use disorder, including 

10 funds for each of prevention services, core med11 ical services, recovery and support services, 

12 early intervention services, harm reduction serv13 ices, mental health services, and administrative 

14 expenses; 

15 ‘‘(B) political subdivisions within the State 

16 will maintain the level of expenditures by such 

17 political subdivisions for substance use disorder 

18 treatment services at a level that is at least 

19 equal to the level of such expenditures by such 

20 political subdivisions for the preceding fiscal 

21 year including expenditures for each of preven22 tion services, core medical services, recovery 

23 and support services, early intervention services, 

24 harm reduction services, mental health services, 

25 and administrative expenses; 


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1 ‘‘(C) political subdivisions within the State 

2 will not use funds received under a grant 

3 awarded under section 3411 in maintaining the 

4 level of substance use disorder treatment serv5 ices as required in subparagraph (B); 

6 ‘‘(D) substance use disorder treatment 

7 services provided with assistance made available 

8 under the grant will be provided without re9 gard— 

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

11 pay for such services; and 

12 ‘‘(ii) to the current or past health con13 dition of the individual to be served; 

14 ‘‘(E) substance use disorder treatment 

15 services will be provided in a setting that is ac16 cessible to low-income individuals with sub17 stance use disorders and to individuals with 

18 substance use disorders residing in rural areas; 

19 ‘‘(F) a program of outreach will be pro20 vided to low-income individuals with substance 

21 use disorders to inform such individuals of sub22 stance use disorder treatment services and to 

23 individuals with substance use disorders resid24 ing in rural areas; 


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

2 for the use of grant funds and the Federal trust 

3 responsibility is upheld at all levels of program 

4 administration; and 

5 ‘‘(H) the confidentiality of individuals re6 ceiving substance use disorder treatment serv7 ices will be maintained in a manner not incon8 sistent with applicable law. 

9 ‘‘SEC. 3413. APPLICATION. 

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

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

12 plan approved by the Secretary pursuant to section 

13 1932(b), and shall prepare and submit to the Secretary 

14 an application in such form, and containing such informa15 tion, as the Secretary shall require, including— 

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

17 of any prior grants received under this subtitle by 

18 the applicant and the results achieved by these ex19 penditures and a demonstration that funds received 

20 from a grant under this subtitle in the prior year 

21 were expended in accordance with State priorities; 

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

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1 taken to achieve those targets, and the number of 

2 individuals likely to be served by the funds sought, 

3 including demographic data on the populations to be 

4 served; 

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

6 funds in a manner that provides substance use dis7 order treatment services in compliance with the evi8 dence-based standards developed in accordance with 

9 section 3435, including all drugs approved by the 

10 Food and Drug Administration for the treatment of 

11 substance use disorder; 

12 ‘‘(4) a demonstration that resources provided 

13 under the grant will be allocated in accordance with 

14 the local demographic incidence of substance use, in15 cluding allocations for services for children, youths, 

16 and women; 

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

18 medical expense criteria will be established and ap19 plied to those who qualify for assistance under the 

20 program; and 

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

22 section, data provided in such form as the Secretary 

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

24 which the activities supported by the funding met 

25 the goals and objectives specified in the application 


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1 for the funding, the number of individuals who 

2 accessed medication for addiction treatment by age, 

3 gender, sexual orientation, race, disability status, 

4 and other demographic criteria relevant to the pro5 gram, and the effect of the program on overdose 

6 rates and rates of death due to overdose in the re7 gion served by the program. 

8 ‘‘(b) REQUIREMENTS REGARDING IMPOSITION OF

9 CHARGES FOR SERVICES.— 

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

11 make a grant under section 3411 to a State unless 

12 the State provides assurances that in the provision 

13 of services with assistance provided under the 

14 grant— 

15 ‘‘(A) in the case of individuals with an in16 come less than or equal to 150 percent of the 

17 official poverty level, the provider will not im18 pose charges on any such individual for the 

19 services provided under the grant; 

20 ‘‘(B) in the case of individuals with an in21 come greater than 150 percent of the official 

22 poverty level, the provider will impose a charge 

23 on each such individual according to a schedule 

24 of charges made available to the public; 


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1 ‘‘(C) in the case of individuals with an in2 come greater than 150 percent of the official 

3 poverty level but not exceeding 200 percent of 

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

5 calendar year, impose charges in an amount ex6 ceeding 2 percent of the annual gross income of 

7 the individual; 

8 ‘‘(D) in the case of individuals with an in9 come greater than 200 percent of the official 

10 poverty level but not exceeding 250 percent of 

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

12 calendar year, impose charges in an amount ex13 ceeding 4 percent of the annual gross income of 

14 the individual involved; 

15 ‘‘(E) in the case of individuals with an in16 come greater than 250 percent of the official 

17 poverty level but not exceeding 300 percent of 

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

19 calendar year, impose charges in an amount ex20 ceeding 6 percent of the annual gross income of 

21 the individual involved; 

22 ‘‘(F) in the case of individuals with an in23 come greater than 300 percent of the official 

24 poverty level but not exceeding 400 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 8.5 percent of the annual gross income 

3 of the individual involved; 

4 ‘‘(G) in the case of individuals with an in5 come greater than 400 percent of the official 

6 poverty level, the provider will not, for any cal7 endar year, impose charges in an amount ex8 ceeding 8.5 percent of the annual gross income 

9 of the individual involved; and 

10 ‘‘(H) in the case of eligible American In11 dian and Alaska Native and urban Indian indi12 viduals as defined by section 447.50 of title 42, 

13 Code of Federal Regulations (as in effect on 

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

15 charges for substance use disorder treatment 

16 services, including any charges or cost-sharing 

17 prohibited by section 1402(d) of the Patient 

18 Protection and Affordable Care Act. 

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

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

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

22 charge— 

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

24 the discretion of the State, including imposing 

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1 ices, subject to the provisions of the paragraph 

2 regarding public schedules and regarding limi3 tations on the maximum amount of charges; 

4 and 

5 ‘‘(B) take into consideration the total med6 ical expenses of individuals in assessing the 

7 amount of the charge, subject to such provi8 sions. 

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

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

11 unless the State agrees that the limitations on 

12 charges for substance use disorder treatment serv13 ices under this subsection applies to the annual ag14 gregate of charges imposed for such services, how15 ever the charges are characterized, includes enroll16 ment fees, premiums, deductibles, cost sharing, co17 payments, co-insurance costs, or any other charges. 

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

19 applying to grants distributed in accordance with section 

20 3412(b) shall be developed by the Secretary in consulta21 tion with Indian tribes. 

22 ‘‘SEC. 3414. TECHNICAL ASSISTANCE. 

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

24 contracts, provide technical assistance in administering 

25 and coordinating the activities authorized under section 


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1 3412, including technical assistance for the development 

2 of State applications for supplementary grants authorized 

3 in section 3412(a)(2). 

4 ‘‘SEC. 3415. AUTHORIZATION OF APPROPRIATIONS. 

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

6 this subtitle— 

7 ‘‘(1) $4,600,000,000 for fiscal year 2022; 

8 ‘‘(2) $4,600,000,000 for fiscal year 2023; 

9 ‘‘(3) $4,600,000,000 for fiscal year 2024; 

10 ‘‘(4) $4,600,000,000 for fiscal year 2025; 

11 ‘‘(5) $4,600,000,000 for fiscal year 2026; 

12 ‘‘(6) $4,600,000,000 for fiscal year 2027; 

13 ‘‘(7) $4,600,000,000 for fiscal year 2028; 

14 ‘‘(8) $4,600,000,000 for fiscal year 2029; 

15 ‘‘(9) $4,600,000,000 for fiscal year 2030; and 

16 ‘‘(10) $4,600,000,000 for fiscal year 2031. 

17 ‘‘Subtitle C—Other Grant Program 

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

19 ‘‘(a) GRANTS.— 

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

21 grants to public entities, nonprofit entities, Indian 

22 entities, and other eligible Medicaid providers for the 

23 purpose of funding prevention services, core medical 

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1 ministrative expenses in accordance with this sec2 tion. 

3 ‘‘(2) PRIORITIZATION.— 

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

5 under this section, the Secretary shall, to the 

6 extent practicable, prioritize the distribution of 

7 grant funds to grantees that have— 

8 ‘‘(i) an explicit policy not to deter em9 ployees with respect to— 

10 ‘‘(I) labor organizing for the em11 ployees engaged in the covered activi12 ties; and 

13 ‘‘(II) such employees’ choice to 

14 form and join labor organizations; or 

15 ‘‘(ii) policies that require— 

16 ‘‘(I) the posting and maintenance 

17 of notices in the workplace to such 

18 employees of their rights under the 

19 National Labor Relations Act (29 

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

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

22 the beginning of their employment, 

23 provided notice and information re24 garding the employees’ rights under 

25 such Act; and 


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1 ‘‘(III) the employer to voluntarily 

2 recognize a union in cases where such 

3 workers of the employer have joined 

4 and requested representation. 

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

6 not apply to Indian tribes. 

7 ‘‘(b) ELIGIBILITY.— 

8 ‘‘(1) ENTITIES.—Public entities, nonprofit enti9 ties, urban Indian organizations, and other Medicaid 

10 providers eligible to receive a grant under subsection 

11 (a) may include— 

12 ‘‘(A) Federally-qualified health centers 

13 under section 1905(l)(2)(B) of the Social Secu14 rity Act; 

15 ‘‘(B) family planning clinics; 

16 ‘‘(C) rural health clinics; 

17 ‘‘(D) Indian entities, including Indian 

18 health programs as defined in section 4 of the 

19 Indian Health Care Improvement Act, urban 

20 Indian organizations as defined in section 4 of 

21 the Indian Health Care Improvement Act, and 

22 Native Hawaiian organizations as defined in 

23 section 11 of the Native Hawaiian Health Care 

24 Act of 1988; 


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1 ‘‘(E) community-based organizations, clin2 ics, hospitals, and other health facilities that 

3 provide substance use disorder treatment serv4 ices; 

5 ‘‘(F) other nonprofit entities that provide 

6 substance use disorder treatment services; 

7 ‘‘(G) certified community behavioral health 

8 clinics and certified community behavioral 

9 health clinic expansion grant recipients, under 

10 section 223 of the Protecting Access to Medi11 care Act (42 U.S.C. 1396a note); and 

12 ‘‘(H) other Medicaid providers if more 

13 than half of their patients are diagnosed with a 

14 substance use disorder and covered by Med15 icaid. 

16 ‘‘(2) UNDERSERVED POPULATIONS.—Entities 

17 described in paragraph (1) shall serve underserved 

18 populations which may include— 

19 ‘‘(A) minority populations and Indian pop20 ulations; 

21 ‘‘(B) formerly incarcerated individuals; 

22 ‘‘(C) individuals with comorbidities includ23 ing human immunodeficiency virus, hepatitis B, 

24 hepatitis C, mental health disorder or other be25 havioral health disorders; 


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1 ‘‘(D) low-income populations; 

2 ‘‘(E) people with disabilities; 

3 ‘‘(F) urban populations; 

4 ‘‘(G) rural populations; 

5 ‘‘(H) the lesbian, gay, bisexual, 

6 transgender, queer (LGBTQ) community; and 

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

8 of developing, substance use disorder and in9 fants with neonatal abstinence syndrome. 

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

11 grant under this section, public entities, nonprofit 

12 entities, and other Medicaid providers described in 

13 this subsection shall prepare and submit to the Sec14 retary an application in such form, and containing 

15 such information, as the Secretary shall require, in16 cluding— 

17 ‘‘(A) a complete accounting of the dis18 bursement of any prior grants received under 

19 this subtitle by the applicant and the results 

20 achieved by these expenditures; 

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

22 the grant, including— 

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

24 local need for the funds sought; 


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1 ‘‘(ii) a plan for providing substance 

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

4 ‘‘(iii) goals and objectives to be 

5 achieved with grant funds provided under 

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

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

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

11 use funds in a manner that provides substance 

12 use disorder treatment services compliant with 

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

15 approved by the Food and Drug Administration 

16 for the treatment of substance use disorder for 

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

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

21 demographic data on the populations to be 

22 served; 

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


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

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

4 and medical expense criteria will be established 

5 and applied to those who qualify for assistance 

6 under the program; and 

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

8 this section, data provided in such form as the 

9 Secretary shall require detailing, at a minimum, 

10 the extent to which the activities supported by 

11 the funding met the goals and objectives speci12 fied in the application for the funding, the num13 ber of individuals who accessed medication for 

14 addiction treatment by age, gender, race, sexual 

15 orientation, disability status, and other demo16 graphic criteria relevant to the program, and 

17 the effect of the program on overdose rates and 

18 rates of death due to overdose in the region 

19 served by the program. 

20 ‘‘(4) REQUIREMENT OF STATUS AS MEDICAID

21 PROVIDER.— 

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

23 subparagraph (B), the Secretary may not make 

24 a grant under this section for the provision of 

25 substance use disorder treatment services under 


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

2 such service that is available pursuant to the 

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

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

6 provide the service directly, and the appli7 cant has entered into a participation agree8 ment under the State plan and is qualified 

9 to receive payments under such plan; or 

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

11 enter into an agreement with public or 

12 nonprofit entities, Indian entities, or other 

13 Medicaid providers if more than half of 

14 their patients are diagnosed with a sub15 stance use disorder and covered by Med16 icaid, under which such entities and other 

17 providers will provide the substance use 

18 disorder treatment service, and such enti19 ties and other providers have entered into 

20 such a participation agreement and are 

21 qualified to receive such payments; and 

22 ‘‘(ii) the applicant ensures that pay23 ment will be sought for each such service 

24 rendered in accordance with the usual pay25 ment schedule under the State plan. 


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

2 making an agreement pursuant to subpara3 graph (A) regarding the provision of substance 

4 use disorder treatment services, the require5 ment established in such paragraph shall be 

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

7 providing such services, impose a charge or ac8 cept reimbursement available from any third9 party payor, including reimbursement under 

10 any insurance policy or under any Federal or 

11 State health benefits program. A waiver under 

12 this subparagraph shall not be longer than 2 

13 years in duration and shall not be renewed. 

14 ‘‘(C) DETERMINATION.—A determination 

15 by the State of whether an entity referred to in 

16 subparagraph (A) meets the criteria for a waiv17 er under such subparagraph shall be made 

18 without regard to whether the entity accepts 

19 voluntary donations for the purpose of pro20 viding services to the public. 

21 ‘‘(5) REQUIRED TERMS FOR EXPANDING AND

22 IMPROVING CARE.—A funding agreement for a grant 

23 under this section is that— 

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

25 not be utilized to make payments for any item 


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1 or service to the extent that payment has been 

2 made, or can reasonably be expected to be 

3 made, with respect to that item or service under 

4 a State compensation program, under an insur5 ance policy, or under any Federal or State 

6 health benefits program (except for a program 

7 administered by, or providing the services of, 

8 the Indian Health Service); 

9 ‘‘(B) entities providing substance use dis10 order treatment services with assistance made 

11 available under the grant shall offer all drugs 

12 approved by the Food and Drug Administration 

13 for the treatment of substance use disorder for 

14 which the applicant offers treatment, in accord15 ance with section 3435(c); 

16 ‘‘(C) substance use disorder treatment 

17 services provided with assistance made available 

18 under the grant will be provided without re19 gard— 

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

21 pay for such services; and 

22 ‘‘(ii) to the current or past health con23 dition of the individual to be served; 

24 ‘‘(D) substance use disorder treatment 

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1 cessible to low-income individuals with sub2 stance use disorders and to individuals with 

3 substance use disorders residing in rural areas; 

4 and 

5 ‘‘(E) the confidentiality of individuals re6 ceiving substance use disorder treatment serv7 ices will be maintained in a manner not incon8 sistent with applicable law. 

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

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

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

12 section 4 of the Indian Self-Determination and Edu13 cation Assistance Act. 

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

15 through the Indian Health Service, shall use 10 per16 cent of the amount available under section 3425 for 

17 each fiscal year to provide grants to Indian entities 

18 in an amount determined pursuant to criteria devel19 oped by the Secretary in consultation with Indian 

20 Tribes and after conferring with urban Indian orga21 nizations, for the purposes of addressing substance 

22 use. 

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

24 requirements in this section, Native entities may use 

25 amounts provided under grants awarded under this 


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1 section for the uses identified in section 3422 and 

2 any other activities determined appropriate by the 

3 Secretary, in consultation with Indian Tribes. 

4 ‘‘SEC. 3422. USE OF AMOUNTS. 

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

6 received under a grant under section 3421 to provide di7 rect financial assistance to eligible entities for the purpose 

8 of delivering or enhancing— 

9 ‘‘(1) prevention services described in subsection 

10 (b); 

11 ‘‘(2) core medical services described in sub12 section (c); 

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

14 subsection (d); 

15 ‘‘(4) early intervention and engagement services 

16 described in subsection (e); 

17 ‘‘(5) harm reduction services described in sub18 section (f); and 

19 ‘‘(6) administrative expenses described in sub20 section (g). 

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

22 section, the term ‘prevention services’ means evidence23 based services, programs, or multi-sector strategies to pre24 vent substance use disorder (including education cam25 paigns, community-based prevention programs, risk idenVerDate Sep 11 2014 21:25 Dec 22, 2021 Jkt 029200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H6311.IH H6311

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1 tification programs, opioid diversion, collection and dis2 posal of unused opioids, services to at-risk populations, 

3 and trauma support services). 

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

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

6 following evidence-based services provided to individuals 

7 with substance use disorder or at risk for developing sub8 stance use disorder, including through the use of telemedi9 cine or a hub and spoke model: 

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

11 fully described in section 3439(4), including assess12 ment of disease presence, severity, and co-occurring 

13 conditions, treatment planning, clinical stabilization 

14 services, withdrawal management and detoxification, 

15 intensive inpatient treatment, intensive outpatient 

16 treatment, outpatient treatment, residential inpa17 tient services, treatment for co-occurring mental 

18 health and substance use disorders, and all drugs 

19 approved by the Food and Drug Administration for 

20 the treatment of substance use disorder. 

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

22 including those administered by Federally-qualified 

23 health centers, rural health clinics, tribal clinics and 

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1 tion 223 of the Protecting Access to Medicare Act), 

2 and comprehensive opioid recovery centers (as de3 scribed in section 552 of this Act). 

4 ‘‘(3) Hospice services. 

5 ‘‘(4) Mental health services. 

6 ‘‘(5) Opioid overdose reversal drug products 

7 procurement, distribution, and training. 

8 ‘‘(6) Pharmaceutical assistance related to the 

9 management of substance-use disorder and co-mor10 bid conditions. 

11 ‘‘(7) Home- and community-based health serv12 ices. 

13 ‘‘(8) Comprehensive Case Management and care 

14 coordination, including substance use disorder treat15 ment adherence services. 

16 ‘‘(9) Health insurance enrollment and cost17 sharing assistance in accordance with section 3412. 

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

19 dispatch mental health professionals, harm reduction 

20 providers, or community health workers to respond 

21 in lieu of law enforcement officers in emergencies in 

22 which— 

23 ‘‘(A) an individual calling 911, the Na24 tional Suicide Hotline, or another emergency 

25 hotlines states that a person is experiencing a 


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1 drug overdose or is otherwise under the influ2 ence of a legal or illegal substance; and 

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

4 responder, or other individual identifies a per5 son as being (or possibly being) under the influ6 ence of a legal or illegal substance. 

7 ‘‘(d) RECOVERY AND SUPPORT SERVICES.—For pur8 poses of this section, the term ‘recovery and support serv9 ices’ means services that are provided to individuals with 

10 substance use disorder, including residential recovery 

11 housing, mental health services, long term recovery serv12 ices, 24/7 hotline crisis center support, medical transpor13 tation services, respite care for persons caring for individ14 uals with substance use disorder, child care and family 

15 services while an individual is receiving inpatient treat16 ment services or at the time of outpatient services, out17 reach services, peer recovery services, nutrition services, 

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

19 legal services, and child care and family services. The enti20 ties through which such services may be provided include 

21 local and tribal authorities that provide child care, hous22 ing, community development, and other recovery and sup23 port services, so long as they do not exclude individuals 

24 on the basis that such individuals receive medication for 

25 addiction treatment. 


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1 ‘‘(e) EARLY INTERVENTION SERVICES.—For pur2 poses of this section, the term ‘early intervention services’ 

3 means services to provide screening and connection to the 

4 appropriate level of substance use disorder and mental 

5 health treatment (including same-day connection), coun6 seling provided to individuals who have misused sub7 stances, who have experienced an overdose, or are at risk 

8 of developing substance use disorder, the provision of re9 ferrals to facilitate the access of such individuals to core 

10 medical services or recovery and support services for sub11 stance use disorder, and rapid access to medication for 

12 addiction treatment in the setting of recent overdose. The 

13 entities through which such services may be provided in14 clude emergency rooms, fire departments and emergency 

15 medical services, detention facilities, prisons and jails 

16 homeless shelters, health care points of entry specified by 

17 eligible local areas, Federally-qualified health centers, 

18 workforce agencies and job centers, youth development 

19 centers, tribal clinics and hospitals, urban Indian organi20 zations, and rural health clinics. 

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

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

23 services provided to individuals engaging in substance use 

24 that are scientifically accepted to reduce the risk of infec25 tious disease transmission, overdose, or death, including 


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

2 and support services, including syringe services programs. 

3 Such term includes evidence-based services. 

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

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

6 10 percent of amounts received under a grant under sec7 tion 3421 for administration, accounting, reporting, and 

8 program oversight functions, including for the purposes of 

9 developing systems to improve data collection and data 

10 sharing. 

11 ‘‘(h) RELATION TO EXISTING EMERGENCY MEDICAL

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

13 diminish or alter the rights, privileges, remedies, or obliga14 tions of any provider or any Federal, State, or local gov15 ernment to provide emergency medical services. 

16 ‘‘SEC. 3423. TECHNICAL ASSISTANCE. 

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

18 contracts, provide technical assistance to public or non19 profit entities, Indian entities, and other eligible Medicaid 

20 providers regarding the process of submitting to the Sec21 retary applications for grants under section 3421, and 

22 may provide technical assistance with respect to the plan23 ning, development, and operation of any program or serv24 ice carried out pursuant to such section. 


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

2 ‘‘(a) IN GENERAL.—The Secretary may provide plan3 ning grants to public or nonprofit entities, Indian entities, 

4 and other eligible Medicaid providers for purposes of as5 sisting such entities and providers in expanding their ca6 pacity to provide substance use disorder treatment services 

7 in low-income communities and affected subpopulations 

8 that are underserviced with respect to such services. 

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

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

11 ‘‘SEC. 3425. AUTHORIZATION OF APPROPRIATIONS. 

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

13 this subtitle— 

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

15 ‘‘(2) $1,000,000,000 for fiscal year 2023; 

16 ‘‘(3) $1,000,000,000 for fiscal year 2024; 

17 ‘‘(4) $1,000,000,000 for fiscal year 2025; 

18 ‘‘(5) $1,000,000,000 for fiscal year 2026; 

19 ‘‘(6) $1,000,000,000 for fiscal year 2027; 

20 ‘‘(7) $1,000,000,000 for fiscal year 2028; 

21 ‘‘(8) $1,000,000,000 for fiscal year 2029; 

22 ‘‘(9) $1,000,000,000 for fiscal year 2030; and 

23 ‘‘(10) $1,000,000,000 for fiscal year 2031. 


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1 ‘‘Subtitle D—Innovation, Training, 

2 and Health Systems Strengthening 

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

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

6 grants to entities to administer special projects of national 

7 significance to support the development of innovative and 

8 original models for the delivery of substance use disorder 

9 treatment and harm reduction services. 

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

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

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

13 emerging needs of individuals receiving assistance under 

14 this title. 

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

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

21 grantees funded under this section. 

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

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

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


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

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

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

6 each fiscal year to provide grants to Indian tribes 

7 for the purposes of supporting the development of 

8 innovative and original models for the delivery of 

9 substance use disorder treatment services, including 

10 the development of culturally informed care models. 

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

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

13 ‘‘(1) $500,000,000 for fiscal year 2022; 

14 ‘‘(2) $500,000,000 for fiscal year 2023; 

15 ‘‘(3) $500,000,000 for fiscal year 2024; 

16 ‘‘(4) $500,000,000 for fiscal year 2025; 

17 ‘‘(5) $500,000,000 for fiscal year 2026; 

18 ‘‘(6) $500,000,000 for fiscal year 2027; 

19 ‘‘(7) $500,000,000 for fiscal year 2028; 

20 ‘‘(8) $500,000,000 for fiscal year 2029; 

21 ‘‘(9) $500,000,000 for fiscal year 2030; and 

22 ‘‘(10) $500,000,000 for fiscal year 2031. 

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

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

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1 ties, public or nonprofit schools, and academic health cen2 ters in meeting the cost of projects— 

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

4 practitioners in programs under this title and other 

5 community providers, including physician addiction 

6 specialists, psychologists, counselors, case managers, 

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

9 health workers, and paraprofessionals, such as peer 

10 support specialists and recovery coaches, in the diag11 nosis, treatment, and prevention of substance use 

12 disorders and drug use-related health issues, includ13 ing measures for the prevention and treatment of co14 occurring infectious diseases, mental health dis15 orders, and other conditions, and including (as appli16 cable to the type of health professional involved), 

17 care for women, pregnant women, and children; 

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

19 nursing, public health, osteopathic medicine, den20 tistry, allied health, social work, and mental health 

21 practice to teach health professions students to 

22 screen for and provide for the needs of individuals 

23 with substance use disorders or at risk of substance 

24 use; and 


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

2 resource materials relating to evidence-based prac3 tices for the screening, prevention, and treatment of 

4 substance use disorders and drug use-related health 

5 issues, including information about combating stig6 ma, prescribing best practices, overdose reversal, al7 ternative pain therapies, and all drugs approved by 

8 the Food and Drug Administration for the treat9 ment of substance use disorders, including for the 

10 purposes authorized under the amendments made by 

11 section 3203 of the SUPPORT for Patients and 

12 Communities Act. 

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

14 grants under subsection (a), the Secretary shall give pref15 erence to qualified projects that will— 

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

17 professionals and other community providers de18 scribed in subsection (a)(1), to provide substance 

19 use disorder treatments for underserved groups, in20 cluding minority individuals and Indians with sub21 stance use disorder and other individuals who are at 

22 a high risk of substance use; 

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

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1 fessionals, to provide substance use disorder treat2 ment for individuals with such disease; 

3 ‘‘(3) train or result in the training of individ4 uals who will provide substance use disorder treat5 ment in rural or other areas that are underserved by 

6 current treatment structures; 

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

8 professionals and allied health professionals, includ9 ing counselors, case managers, social workers, peer 

10 recovery coaches, and harm reduction workers, pub11 lic health workers, and community health workers, 

12 to provide treatment for infectious diseases and 

13 mental health disorders co-occurring with substance 

14 use disorder; and 

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

16 professionals and other community providers to pro17 vide substance use disorder treatments for pregnant 

18 women, children, and adolescents. 

19 ‘‘(c) NATIVE EDUCATION AND TRAINING CEN20 TERS.—The Secretary shall use 10 percent of the amount 

21 available under subsection (d) for each fiscal year to pro22 vide grants authorized under this subtitle to— 

23 ‘‘(1) tribal colleges and universities; 

24 ‘‘(2) Indian Health Service grant funded insti25 tutions; and 


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1 ‘‘(3) Native partner institutions, including insti2 tutions of higher education with medical training 

3 programs that partner with one or more Indian 

4 tribes, tribal organizations, Native Hawaiian organi5 zations, or tribal colleges and universities to train 

6 Native health professionals that will provide sub7 stance use disorder treatment services in Native 

8 communities. 

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

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

11 ‘‘(1) $500,000,000 for fiscal year 2022; 

12 ‘‘(2) $500,000,000 for fiscal year 2023; 

13 ‘‘(3) $500,000,000 for fiscal year 2024; 

14 ‘‘(4) $500,000,000 for fiscal year 2025; 

15 ‘‘(5) $500,000,000 for fiscal year 2026; 

16 ‘‘(6) $500,000,000 for fiscal year 2027; 

17 ‘‘(7) $500,000,000 for fiscal year 2028; 

18 ‘‘(8) $500,000,000 for fiscal year 2029; 

19 ‘‘(9) $500,000,000 for fiscal year 2030; and 

20 ‘‘(10) $500,000,000 for fiscal year 2031. 

21 ‘‘SEC. 3433. SUBSTANCE USE DISORDER TREATMENT PRO22 VIDER CAPACITY UNDER THE MEDICAID PRO23 GRAM. 

24 ‘‘(a) PROJECTS.— 


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

2 amounts appropriated under this section to provide 

3 funding for projects in any State or territory to in4 crease substance use provider capacity, as provided 

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

6 ‘‘(2) PRIORITIZATIONS.— 

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

8 under this section, the Secretary shall, to the 

9 extent practicable, prioritize the distribution of 

10 grant funds to grantees that have— 

11 ‘‘(i) an explicit policy not to deter em12 ployees with respect to— 

13 ‘‘(I) labor organizing for the em14 ployees engaged in the covered activi15 ties; and 

16 ‘‘(II) such employees’ choice to 

17 form and join labor organizations; and 

18 ‘‘(ii) policies that require— 

19 ‘‘(I) the posting and maintenance 

20 of notices in the workplace to such 

21 employees of their rights under the 

22 National Labor Relations Act (29 

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

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

25 the beginning of their employment, 


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1 provided notice and information re2 garding the employees’ rights under 

3 such Act; and 

4 ‘‘(III) the employer to voluntarily 

5 recognize a union in cases where such 

6 workers of the employer have joined 

7 and requested representation. 

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

9 not apply to Indian tribes. 

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

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

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

13 section 4 of the Indian Self-Determination and Edu14 cation Assistance Act. 

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

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

17 meaning given such in section 4 of the Indian 

18 Health Care Improvement Act. 

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

20 the Indian Health Service, shall use 10 percent of 

21 the amount appropriated under this section for each 

22 fiscal year to award grants to Indian tribes and 

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1 retary in consultation with Indian tribes and in con2 ference with urban Indian organizations. 

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

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

5 ‘‘(1) $50,000,000 for fiscal year 2022; 

6 ‘‘(2) $50,000,000 for fiscal year 2023; 

7 ‘‘(3) $50,000,000 for fiscal year 2024; 

8 ‘‘(4) $50,000,000 for fiscal year 2025; 

9 ‘‘(5) $50,000,000 for fiscal year 2026; 

10 ‘‘(6) $50,000,000 for fiscal year 2027; 

11 ‘‘(7) $50,000,000 for fiscal year 2028; 

12 ‘‘(8) $50,000,000 for fiscal year 2029; 

13 ‘‘(9) $50,000,000 for fiscal year 2030; and 

14 ‘‘(10) $50,000,000 for fiscal year 2031. 

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

16 ‘‘(a) GRANT PROGRAM FOR WORKERS.— 

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

18 through the Director of the National Institute for 

19 Occupational Safety and Health, shall award grants 

20 to non-profit entities that meet the requirements of 

21 this section to fund programs and projects to assist 

22 workers who are at risk of substance use disorder, 

23 who have substance use disorder, or who are recov24 ering from substance use disorder to maintain or 

25 gain employment. 


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1 ‘‘(2) GRANTS FOR WORKERS.— 

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

3 on a competitive basis, award grants for a pe4 riod of not more than 3 years to non-profit en5 tities that submit an application under para6 graph (3) to enable such entities to implement, 

7 conduct, continue, and expand evidence-based 

8 programs and projects to assist individuals de9 scribed in subparagraph (G). 

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

11 use amounts provided under this subsection 

12 for— 

13 ‘‘(i) prevention services described in 

14 subparagraph (C), including providing edu15 cation and information to workers regard16 ing the dangers of illicit and licit drug use, 

17 non-opioid pain management and non-drug 

18 pain management, or occupational injury 

19 and illness prevention; 

20 ‘‘(ii) early intervention services de21 scribed in subparagraph (D) to enable in22 dividuals to maintain or gain employment; 

23 ‘‘(iii) recovery and support services 

24 described in subparagraph (E) to enable 


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1 individuals to maintain or gain employ2 ment; 

3 ‘‘(iv) harm reduction services de4 scribed in subparagraph (F) to enable indi5 viduals to maintain or gain employment; 

6 ‘‘(v) hiring case managers, care coor7 dinators, and peer support specialists to 

8 assist employed individuals who are experi9 encing substance use disorder, or who are 

10 recovering from substance use disorder, in 

11 accessing substance use disorder treatment 

12 services; or 

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

14 and other forms of job training to workers 

15 who are receiving substance use disorder 

16 treatment services to enable such workers 

17 to maintain or gain employment. 

18 ‘‘(C) PREVENTION SERVICES.—For pur19 poses of this section, the term ‘prevention serv20 ices’ means evidence-based services, programs, 

21 or multi-sector strategies to prevent substance 

22 use disorder (including education campaigns, 

23 community-based prevention programs, risk 

24 identification programs, opioid diversion, collec25 tion and disposal of unused opioids, services to 


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1 at-risk populations, and trauma support serv2 ices). 

3 ‘‘(D) RECOVERY AND SUPPORT SERV4 ICES.—For purposes of this section, the term 

5 ‘recovery and support services’ means services 

6 including residential recovery housing, mental 

7 health services, long term recovery services, 24/ 

8 7 hotline crisis center services, medical trans9 portation services, respite care for persons car10 ing for individuals with substance use disorder, 

11 child care and family services while an indi12 vidual is receiving inpatient treatment services 

13 or at the time of outpatient services, outreach 

14 services, peer recovery services, nutrition serv15 ices, and referrals for job training and career 

16 services, housing, legal services, and child care 

17 and family services so long as they do not ex18 clude individuals on the basis that such individ19 uals receive medication for addiction treatment. 

20 ‘‘(E) EARLY INTERVENTION SERVICES.— 

21 For purposes of this section, the term ‘early 

22 intervention services’ means services to provide 

23 screening and connection to the appropriate 

24 level of substance use disorder and mental 

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1 tion), counseling provided to individuals who 

2 have misused substances, who have experienced 

3 an overdose, or are at risk of developing sub4 stance use disorder, the provision of referrals to 

5 facilitate the access of such individuals to core 

6 medical services or recovery and support serv7 ices for substance use disorder, and rapid ac8 cess to medication for addiction treatment in 

9 the setting of recent overdose. 

10 ‘‘(F) HARM REDUCTION SERVICES.—For 

11 purposes of this section, the term ‘harm reduc12 tion services’ means services provided to indi13 viduals engaging in substance use scientifically 

14 accepted to reduce the risk of infectious disease 

15 transmission, overdose, or death, including by 

16 increasing access to health care, housing, and 

17 recovery and support services, including syringe 

18 services programs. Such term includes evidence19 based services. 

20 ‘‘(G) INDIVIDUALS DESCRIBED.—Individ21 uals described in this subparagraph are individ22 uals who— 

23 ‘‘(i)(I) have been employed in the 12- 

24 month period immediately preceding the 

25 date on which the determination is being 


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1 made, or who are participating in an em2 ployee training or apprenticeship program; 

3 and 

4 ‘‘(II) are at high risk of developing 

5 substance use disorder, including as a re6 sult of employment in industries that expe7 rience high rates of occupational injuries 

8 and illness; or 

9 ‘‘(ii) are experiencing a substance use 

10 disorder or are in recovery from a sub11 stance use disorder. 

12 ‘‘(3) APPLICATIONS.—To be eligible for a grant 

13 under this subsection, an entity shall submit to the 

14 Secretary an application at such time, in such man15 ner, and containing such information as the Sec16 retary may require, including— 

17 ‘‘(A) a complete accounting of the dis18 bursement of any prior grants received under 

19 this title by the applicant and the results 

20 achieved by such expenditures; 

21 ‘‘(B) a description of the population to be 

22 served with grant funds provided under this 

23 section, including a description of the unique 

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1 pational injuries or exposure to illicit sub2 stances; 

3 ‘‘(C) the goals and objectives to be 

4 achieved with grant funds provided under this 

5 section, including targets and milestones that 

6 are intended to be met, the activities that will 

7 be undertaken to achieve those targets, and the 

8 number of individuals likely to be served by the 

9 grant funds, including demographic data on the 

10 populations to be served; 

11 ‘‘(D) a demonstration of the ability of the 

12 applicant to reach the individuals described in 

13 paragraph (2)(G) and to provide services de14 scribed in paragraph (2)(B) included in the ap15 plicant’s grant application, including by 

16 partnering with local stakeholders; 

17 ‘‘(E) for any prior funding received under 

18 this subsection, data provided in such form as 

19 the Secretary shall require detailing, at a min20 imum, the extent to which the activities sup21 ported by the funding met the goals, objectives, 

22 targets, and milestones specified in the applica23 tion for the funding, and the number of individ24 uals with and without substance use disorder 

25 who received services supported by the funding, 


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1 including the services provided to these individ2 uals, the industries in which the individuals 

3 were employed when they received services, and 

4 whether the individuals were still employed in 

5 that same industry or in any industry when the 

6 individuals ceased receiving services supported 

7 by the funding; and 

8 ‘‘(F) any other information the Secretary 

9 shall require. 

10 ‘‘(4) DATA REPORTING AND OVERSIGHT.—An 

11 entity awarded a grant under this subsection shall 

12 submit to the Secretary an annual report at such 

13 time and in such manner as the Secretary shall re14 quire. Such report shall include, at a minimum, a 

15 description of— 

16 ‘‘(A) the activities funded by the grant; 

17 ‘‘(B) the number of individuals with and 

18 without substance use disorder served through 

19 activities funded by the grant, including the 

20 services provided to those individuals and the 

21 industries in which those individuals were em22 ployed at the time they received services sup23 ported by the grant; 

24 ‘‘(C) for workers experiencing substance 

25 use disorder or recovering from substance use 


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1 disorder served by activities funded by the 

2 grant, the number of individuals who main3 tained employment, the number of individuals 

4 who gained employment, and the number of in5 dividuals who failed to maintain employment 

6 over the course of the reporting period; and 

7 ‘‘(D) any other information required by the 

8 Secretary. 

9 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

10 There is authorized to be appropriated to carry out 

11 this subsection— 

12 ‘‘(A) $40,000,000 for fiscal year 2022; 

13 ‘‘(B) $40,000,000 for fiscal year 2023; 

14 ‘‘(C) $40,000,000 for fiscal year 2024; 

15 ‘‘(D) $40,000,000 for fiscal year 2025; 

16 ‘‘(E) $40,000,000 for fiscal year 2026; 

17 ‘‘(F) $40,000,000 for fiscal year 2027; 

18 ‘‘(G) $40,000,000 for fiscal year 2028; 

19 ‘‘(H) $40,000,000 for fiscal year 2029; 

20 ‘‘(I) $40,000,000 for fiscal year 2030; and 

21 ‘‘(J) $40,000,000 for fiscal year 2031. 

22 ‘‘(b) RESEARCH ON THE IMPACT OF SUBSTANCE USE

23 DISORDER IN THE WORKPLACE AND ON DIRECT SERVICE

24 PROVIDERS.— 


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1 ‘‘(1) RISKS OF SUBSTANCE USE DISORDER.— 

2 The Secretary, in consultation with the Director of 

3 the National Institute for Occupational Safety and 

4 Health, shall conduct (directly or through grants or 

5 contracts) research, experiments, and demonstra6 tions, and publish studies relating to— 

7 ‘‘(A) the risks faced by employees in var8 ious occupations of developing substance use 

9 disorder and of drug overdose deaths and non10 fatal drug overdoses, and the formulation of 

11 prevention activities tailored to the risks identi12 fied in these occupations, including occupational 

13 injury and illness prevention; 

14 ‘‘(B) the prevalence of substance use dis15 order among employees in various occupations; 

16 ‘‘(C) efforts that employers may undertake 

17 to assist employees who are undergoing sub18 stance use disorder treatment services in main19 taining employment while ensuring workplaces 

20 are safe and healthful; 

21 ‘‘(D) risks of occupational exposure to 

22 opioids and other illicit substances and the for23 mulation of prevention activities tailored to the 

24 risks identified; and 


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1 ‘‘(E) other subjects related to substance 

2 use disorder in the workplace as the Secretary 

3 determines. 

4 ‘‘(2) DIRECT SERVICE PROVIDERS.—The Sec5 retary shall conduct (directly or through grants or 

6 contracts) research, experiments, and demonstra7 tions, and publish studies relating to the occupa8 tional health and safety, recruitment, and retention 

9 of behavioral health providers who, as part of their 

10 job responsibilities, provide direct services to individ11 uals who are at risk of experiencing substance use 

12 disorder or who are experiencing or recovering from 

13 substance use disorder, including— 

14 ‘‘(A) identifying factors that the Secretary 

15 believes may endanger the health or safety of 

16 such workers, including factors that affect the 

17 risks such workers face of developing substance 

18 use disorder; 

19 ‘‘(B) motivational and behavioral factors 

20 relating to the field of behavioral health pro21 viders; 

22 ‘‘(C) strategies to support the recruitment 

23 and retention of behavioral health providers; 

24 and 


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1 ‘‘(D) other subjects related to behavioral 

2 health providers engaged in direct provision of 

3 substance use disorder prevention and treat4 ment services as the Secretary determines ap5 propriate. 

6 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

7 There is authorized to be appropriated to carry out 

8 this subsection— 

9 ‘‘(A) $10,000,000 for fiscal year 2022; 

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

11 ‘‘(C) $10,000,000 for fiscal year 2024; 

12 ‘‘(D) $10,000,000 for fiscal year 2025; 

13 ‘‘(E) $10,000,000 for fiscal year 2026; 

14 ‘‘(F) $10,000,000 for fiscal year 2027; 

15 ‘‘(G) $10,000,000 for fiscal year 2028; 

16 ‘‘(H) $10,000,000 for fiscal year 2029; 

17 ‘‘(I) $10,000,000 for fiscal year 2030; and 

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

19 ‘‘SEC. 3435. IMPROVING AND EXPANDING CARE. 

20 ‘‘(a) LEVEL OF CARE STANDARDS FOR SUBSTANCE

21 USE DISORDER TREATMENT SERVICES.— 

22 ‘‘(1) IN GENERAL.—Not later than 1 year after 

23 the date of enactment of this title, the Secretary, in 

24 consultation with the American Society of Addiction 

25 Medicine, State and tribal officials selected by the 


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1 Secretary, and other stakeholders as the Secretary 

2 determines necessary, and after seeking public input, 

3 shall promulgate model standards for the regulation 

4 of substance use disorder treatment services. 

5 ‘‘(2) SUBSTANCE USE DISORDER TREATMENT

6 SERVICES.—The model standards promulgated 

7 under paragraph (1) shall, at a minimum— 

8 ‘‘(A) identify the types of substance use 

9 disorder treatment services intended to be cov10 ered without regard to whether they participate 

11 in any Federal health care program (as defined 

12 in section 1128B(f) of the Social Security Act) 

13 and shall not include— 

14 ‘‘(i) a private practitioner who is al15 ready licensed by a State licensing board 

16 and whose practice is limited to non-inten17 sive outpatient care; or 

18 ‘‘(ii) any substance use disorder treat19 ment service provided on a non-intensive 

20 outpatient basis in the office of a private 

21 practitioner who is licensed by a State li22 censing board; 

23 ‘‘(B) require the designation of a single 

24 State agency to serve as the primary regulator 


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1 in the State for substance use disorder treat2 ment services; 

3 ‘‘(C) subject to paragraph (3), require that 

4 substance use disorder treatment services iden5 tified in accordance with subparagraph (A), be 

6 licensed by the respective States according to 

7 the standards for levels of care set forth by the 

8 American Society of Addiction Medicine in 

9 2013 or an equivalent set of standards; 

10 ‘‘(D) require implementation of a process 

11 to ensure that substance use disorder treatment 

12 program qualifications are verified by means of 

13 an onsite inspection not less frequently than 

14 every 3 years by the State agency serving as 

15 the primary regulator in the State for substance 

16 use disorder treatment services or by an inde17 pendent third party that is approved by the 

18 State’s primary regulator; and 

19 ‘‘(E) require that all patients leaving a res20 idential treatment program receive a written 

21 transition plan prior to discharge from that 

22 level of care. 

23 ‘‘(3) ANNUAL ASSESSMENT.—Beginning with 

24 respect to fiscal year 2022, the Secretary shall make 

25 a determination with respect to each State on 


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1 whether the State has adopted, for each of the sub2 stance use disorder treatment services identified in 

3 accordance with paragraph (2)(A), licensure stand4 ards that are in compliance in all material respects 

5 with the model standards promulgated in accordance 

6 with this subsection. In the event the American Soci7 ety of Addiction Medicine revises its criteria, the 

8 Secretary shall revise the national model level of 

9 care standards accordingly and disseminate any such 

10 update to the States, and the States may adopt any 

11 such updates to be in compliance with this sub12 section. 

13 ‘‘(b) STANDARDS FOR OTHER SPECIFIED MATTERS

14 RELATED TO SUBSTANCE USE DISORDER TREATMENT

15 SERVICES AND RECOVERY RESIDENCES.— 

16 ‘‘(1) IN GENERAL.—Not later than 2 years 

17 after the date of enactment of this title, the Sec18 retary, in consultation with representatives of non19 profit service providers and State and tribal officials 

20 as the Secretary determines necessary, shall promul21 gate model standards for the regulation of— 

22 ‘‘(A) other specified matters related to sub23 stance use disorder treatment services; and 

24 ‘‘(B) recovery residences. 


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1 ‘‘(2) OTHER SPECIFIED MATTERS RELATED TO

2 SUBSTANCE USE DISORDER TREATMENT SERV3 ICES.—The model standards promulgated under 

4 paragraph (1)(A) shall, at a minimum— 

5 ‘‘(A) identify the professional credentials 

6 needed by each type of substance use disorder 

7 treatment professional; 

8 ‘‘(B) include standards for data reporting 

9 and require compilation of statewide reports; 

10 ‘‘(C) require the establishment and mainte11 nance within each State of a toll-free telephone 

12 number to receive complaints from the public 

13 regarding substance use disorder treatment 

14 service providers; and 

15 ‘‘(D) require the establishment and main16 tenance on a publicly accessible internet website 

17 of a list of all substance use disorder treatment 

18 services in the State that have a certification in 

19 effect in accordance with this section. 

20 ‘‘(3) RECOVERY RESIDENCES.— 

21 ‘‘(A) ECONOMIC RELATIONSHIP.—The 

22 model standards promulgated under paragraph 

23 (1)(B) shall, at a minimum, be applied to recov24 ery residences that have an ongoing economic 


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1 relationship with any commercial substance use 

2 disorder treatment service. 

3 ‘‘(B) MINIMUM REQUIREMENTS.—The 

4 model standards promulgated under paragraph 

5 (1)(B), which may include any model laws de6 veloped under section 550(a) shall, at a min7 imum, identify requirements for— 

8 ‘‘(i) the designation of a single State 

9 agency to certify recovery residences; 

10 ‘‘(ii) the implementation of a process 

11 to ensure that the qualifications of recov12 ery residences in which not fewer than 10 

13 individuals may lawfully reside are verified 

14 by means of an onsite inspection not less 

15 frequently than every 3 years by the State 

16 agency serving as the primary regulator in 

17 the State or by an independent third party 

18 that is approved by the State’s primary 

19 regulator; 

20 ‘‘(iii) fire, safety, and health stand21 ards; 

22 ‘‘(iv) equipping residences with opioid 

23 overdose reversal drug products, such as 

24 naloxone and training residence owners, 


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1 operators, and employees in the adminis2 tration of naloxone; 

3 ‘‘(v) recovery residence owners and 

4 operators; 

5 ‘‘(vi) a written policy that prohibits 

6 the exclusion of individuals on the basis 

7 that such individuals receive drugs ap8 proved by the Food and Drug Administra9 tion for the treatment of substance use dis10 order; 

11 ‘‘(vii) the establishment and mainte12 nance within each State of a toll-free tele13 phone number to receive complaints from 

14 the public regarding recovery residences; 

15 and 

16 ‘‘(viii) the establishment and mainte17 nance on a publicly accessible internet 

18 website of a list of all recovery residences 

19 in the State that have a certification in ef20 fect in accordance with this section. 

21 ‘‘(4) ANNUAL ASSESSMENT.—Beginning with 

22 respect to fiscal year 2023, the Secretary shall make 

23 a determination with respect to each State on 

24 whether the State has adopted, for each of the other 

25 specified substance use disorder treatment services 


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1 identified in this section and for recovery residences, 

2 standards that are in compliance in all material re3 spects with the model standards promulgated in ac4 cordance with this subsection. 

5 ‘‘(c) ENSURING ACCESS TO MEDICATION FOR ADDIC6 TION TREATMENT.— 

7 ‘‘(1) MEDICATION FOR ADDICTION TREAT8 MENT.—The Secretary may not make a grant under 

9 this section unless the applicant for the grant agrees 

10 to require all entities offering substance use disorder 

11 treatment services under the grant to offer all drugs 

12 approved by the Food and Drug Administration for 

13 the treatment of substance use disorder for which 

14 the applicant offers treatment. 

15 ‘‘(2) WAIVER.—The Secretary may grant a 

16 waiver with respect to any requirement of this sec17 tion if the grant applicant involved— 

18 ‘‘(A) submits to the Secretary a justifica19 tion for such waiver containing such informa20 tion as the Secretary shall require; and 

21 ‘‘(B) agrees to require all entities offering 

22 substance use disorder treatment services under 

23 the grant to— 

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1 tion for the treatment of substance use dis2 order; 

3 ‘‘(ii) provide counseling to patients on 

4 the benefits and risks of all drugs ap5 proved by the Food and Drug Administra6 tion for the treatment of substance use dis7 order; and 

8 ‘‘(iii) maintain an affiliation agree9 ment with a provider that can prescribe or 

10 otherwise dispense all other forms of drugs 

11 approved by the Food and Drug Adminis12 tration for the treatment of substance use 

13 disorder. 

14 ‘‘(3) GAO STUDY.—Not later than 1 year after 

15 the date of enactment of this title, the Comptroller 

16 General of the United States shall submit to Con17 gress a comprehensive report describing any rela18 tionship between substance use rates, pain manage19 ment practices of the Indian Health Service, and pa20 tient request denials through the purchased/referred 

21 care program of the Indian Health Service. 

22 ‘‘(d) ENSURING A FULL CONTINUUM OF SERV23 ICES.— 

24 ‘‘(1) IN GENERAL.—Not later than 6 months 

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1 ministrator of the Centers for Medicare & Medicaid 

2 Services shall issue a State Medicaid Director letter 

3 and tribal leader letter explaining how States and 

4 tribes can ensure access to a continuum of services 

5 for adults with substance use disorders who are re6 ceiving medical assistance under title XIX of the So7 cial Security Act. Such letter shall describe how 

8 States can cover the continuum of community-based, 

9 residential, and inpatient substance use disorder 

10 services and care coordination between different lev11 els of care as medical assistance, as defined in sec12 tion 1905(a) of such Act, including through section 

13 1915 of such Act and through demonstration 

14 projects under section 1115 of such Act. 

15 ‘‘(2) MACPAC ANALYSIS.—Not later than 1 

16 year after the date of the enactment of this title, the 

17 Medicaid and CHIP Payment and Access Commis18 sion shall conduct an analysis, and make publicly 

19 available a report containing the results of such 

20 analysis, of States’ coverage of substance use serv21 ices for Medicaid beneficiaries. Such report shall in22 clude examples of promising strategies States use to 

23 cover a continuum of community-based substance 

24 use services. 


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1 ‘‘(3) ANNUAL ASSESSMENT.—Beginning with 

2 respect to fiscal year 2022, the Secretary shall make 

3 a determination with respect to each State on 

4 whether the State has carried out the requirements 

5 to ensure a continuum of services as described in 

6 section 1915(l)(4)(C) of the Social Security Act. 

7 ‘‘SEC. 3436. NALOXONE DISTRIBUTION PROGRAM. 

8 ‘‘(a) ESTABLISHMENT OF PROGRAM.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall provide 

10 for the purchase and delivery of federally approved 

11 opioid overdose reversal drug products on behalf of 

12 each State (or Indian tribe as defined in section 4 

13 of the Indian Health Care Improvement Act) that 

14 receives a grant under subtitle B. This paragraph 

15 constitutes budget authority in advance of appro16 priations Acts, and represents the obligation of the 

17 Federal Government to provide for the purchase and 

18 delivery to States and Indian tribes of the opioid 

19 overdose reversal drug products in accordance with 

20 this paragraph. 

21 ‘‘(2) SPECIAL RULES WHERE OPIOID OVERDOSE

22 REVERSAL DRUG PRODUCTS ARE UNAVAILABLE.—To 

23 the extent that a sufficient quantity of opioid over24 dose reversal drug products are not available for 

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1 retary shall provide for the purchase and delivery of 

2 the available opioid overdose reversal drug products 

3 in accordance with priorities established by the Sec4 retary, with priority given to States with at least one 

5 local area eligible for funding under section 3401(a). 

6 ‘‘(b) NEGOTIATION OF CONTRACTS WITH MANUFAC7 TURERS.— 

8 ‘‘(1) IN GENERAL.—For the purpose of car9 rying out this section, the Secretary shall negotiate 

10 and enter into contracts with manufacturers of 

11 opioid overdose reversal drug products consistent 

12 with the requirements of this subsection and, to the 

13 maximum extent practicable, consolidate such con14 tracting with any other contracting activities con15 ducted by the Secretary to purchase opioid overdose 

16 reversal drug products. The Secretary may enter 

17 into such contracts under which the Federal Govern18 ment is obligated to make outlays, the budget au19 thority for which is not provided for in advance in 

20 appropriations Acts, for the purchase and delivery of 

21 opioid overdose reversal drug products under sub22 section (a). 

23 ‘‘(2) AUTHORITY TO DECLINE CONTRACTS.— 

24 The Secretary may decline to enter into contracts 


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1 under this subsection and may modify or extend 

2 such contracts. 

3 ‘‘(3) CONTRACT PRICE.— 

4 ‘‘(A) IN GENERAL.—The Secretary, in ne5 gotiating the prices at which opioid overdose re6 versal drug products will be purchased and de7 livered from a manufacturer under this sub8 section, shall take into account quantities of 

9 opioid overdose reversal drug products to be 

10 purchased by States under the option under 

11 paragraph (4)(B). 

12 ‘‘(B) NEGOTIATION OF DISCOUNTED PRICE

13 FOR OPIOID OVERDOSE REVERSAL DRUG PROD14 UCTS.—With respect to contracts entered into 

15 for the purchase of opioid overdose reversal 

16 drug products on behalf of States under this 

17 subsection, the price for the purchase of such 

18 drug product shall be a discounted price nego19 tiated by the Secretary. 

20 ‘‘(4) PRODUCT DOSAGE.—All opioid overdose 

21 reversal products purchased under this section shall 

22 contain— 

23 ‘‘(A) for each dose, the maximum amount 

24 of active pharmaceutical ingredient that acts as 

25 an opioid receptor antagonist as recommended 


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1 by the Food and Drug Administration as an 

2 initial dose when administered by one of the ap3 proved, labeled routes of administration in 

4 adults; and 

5 ‘‘(B) a minimum of two doses packaged to6 gether. 

7 ‘‘(5) QUANTITIES AND TERMS OF DELIVERY.— 

8 Under contracts under this subsection— 

9 ‘‘(A) the Secretary shall provide, consistent 

10 with paragraph (6), for the purchase and deliv11 ery on behalf of States and Indian tribes of 

12 quantities of opioid overdose reversal drug 

13 products; and 

14 ‘‘(B) each State and Indian tribe, at the 

15 option of the State or tribe, shall be permitted 

16 to obtain additional quantities of opioid over17 dose reversal drug products (subject to amounts 

18 specified to the Secretary by the State or tribe 

19 in advance of negotiations) through purchasing 

20 the opioid overdose reversal drug products from 

21 the manufacturers at the applicable price nego22 tiated by the Secretary consistent with para23 graph (3), if the State or tribe provides to the 

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1 vance of negotiations under paragraph (1)) as 

2 the Secretary determines to be necessary, to 

3 provide for quantities of opioid overdose rever4 sal drug products for the State or tribe to pur5 chase pursuant to this subsection and to deter6 mine annually the percentage of the opioid over7 dose reversal drug market that is purchased 

8 pursuant to this section and this subparagraph. 

9 The Secretary shall enter into the initial negotia10 tions not later than 180 days after the date of the 

11 enactment of this title. 

12 ‘‘(6) CHARGES FOR SHIPPING AND HAN13 DLING.—The Secretary may enter into a contract 

14 referred to in paragraph (1) only if the manufac15 turer involved agrees to submit to the Secretary 

16 such reports as the Secretary determines to be ap17 propriate to assure compliance with the contract and 

18 if, with respect to a State program under this sec19 tion that does not provide for the direct delivery of 

20 qualified opioid overdose reversal drug products, the 

21 manufacturer involved agrees that the manufacturer 

22 will provide for the delivery of the opioid overdose 

23 reversal drug products on behalf of the State in ac24 cordance with such program and will not impose any 

25 charges for the costs of such delivery (except to the 


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1 extent such costs are provided for in the price estab2 lished under paragraph (3)). 

3 ‘‘(7) MULTIPLE SUPPLIERS.—In the case of the 

4 opioid overdose reversal drug product involved, the 

5 Secretary may, as appropriate, enter into a contract 

6 referred to in paragraph (1) with each manufacturer 

7 of the opioid overdose reversal drug product that 

8 meets the terms and conditions of the Secretary for 

9 an award of such a contract (including terms and 

10 conditions regarding safety and quality). With re11 spect to multiple contracts entered into pursuant to 

12 this paragraph, the Secretary may have in effect dif13 ferent prices under each of such contracts and, with 

14 respect to a purchase by States pursuant to para15 graph (4)(B), each eligible State may choose which 

16 of such contracts will be applicable to the purchase. 

17 ‘‘(c) USE OF OPIOID OVERDOSE REVERSAL DRUG

18 PRODUCT LIST.—Beginning not later than one year after 

19 the first contract has been entered into under this section, 

20 the Secretary shall use, for the purpose of the purchase, 

21 delivery, and administration of opioid overdose reversal 

22 drug products under this section, the list established (and 

23 periodically reviewed and, as appropriate, revised) by an 

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1 tion, which considers the cost effectiveness of each opioid 

2 overdose reversal drug product. 

3 ‘‘(d) STATE DISTRIBUTION OF OPIOID OVERDOSE

4 REVERSAL DRUG PRODUCTS.—States shall distribute 

5 opioid overdose reversal drug products received under this 

6 section to the following: 

7 ‘‘(1) First responders and local emergency med8 ical services organizations, including volunteer emer9 gency medical services organizations. 

10 ‘‘(2) Public entities with authority to administer 

11 local public health services, including all local health 

12 departments, for the purposes of making opioid over13 dose reversal drug products available to— 

14 ‘‘(A) nonprofit entities, including— 

15 ‘‘(i) community-based organizations 

16 that provide substance use disorder treat17 ments or harm reduction services; 

18 ‘‘(ii) nonprofit entities that provide 

19 substance use disorder treatments or harm 

20 reduction services; and 

21 ‘‘(iii) faith based organizations that 

22 provide substance use disorder treatments 

23 or harm reduction services; 

24 ‘‘(B) other areas of high need; and 

25 ‘‘(C) the general public. 


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1 ‘‘(e) STATE REQUIREMENTS.—To be eligible to re2 ceive opioid overdose reversal drugs under this section, 

3 each State shall— 

4 ‘‘(1) establish a program for distributing opioid 

5 overdose reversal drug products to first responders, 

6 the general public, and entities with authority to ad7 minister local public health services, including local 

8 health departments; 

9 ‘‘(2) beginning in the second year of the pro10 gram, demonstrate a distribution rate of a minimum 

11 of 90 percent of the opioid overdose reversal drug 

12 products received under this program; 

13 ‘‘(3) certify to the Secretary that the State has 

14 in place a Good Samaritan Law that ensures immu15 nity from arrest and prosecution, including from pa16 role and probation violations, except that the State 

17 may apply to the Secretary for a waiver of the re18 quirement of this paragraph, and such waiver if 

19 granted shall not be longer than 3 years in duration 

20 and may not be renewed unless the State can show 

21 progress being made towards instituting a Good Sa22 maritan Law; and 

23 ‘‘(4) certify to the Secretary that the State has 

24 in place additional measures that enhance access to 

25 opioid overdose reversal drug products, such as laws 


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1 that provide civil or disciplinary immunity for med2 ical personnel who prescribe an opioid overdose re3 versal drug product, Third Party Prescription Laws, 

4 Collaborative Practice Agreements, and Standing 

5 Orders. 

6 ‘‘(f) INDIAN TRIBE REQUIREMENTS.—The Indian 

7 Health Service, in consultation with Indian tribes, shall 

8 determine any requirements that shall apply to Indian 

9 tribes receiving opioid overdose reversal drug products 

10 made available under this section. 

11 ‘‘(g) DEFINITIONS.—For purposes of this section: 

12 ‘‘(1) COLLABORATIVE PRACTICE AGREEMENT.— 

13 The term ‘Collaborative Practice Agreement’ means 

14 an agreement under which a pharmacist operates 

15 under authority delegated by another licensed practi16 tioner with prescribing authority. 

17 ‘‘(2) EMERGENCY MEDICAL SERVICE.—The 

18 term ‘emergency medical service’ means resources 

19 used by a public or private licensed entity to deliver 

20 medical care outside of a medical facility under 

21 emergency conditions that occur as a result of the 

22 condition of the patient and includes services deliv23 ered (either on a compensated or volunteer basis) by 

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1 volved as an emergency medical technician, a para2 medic, or an equivalent professional (as determined 

3 by the State). 

4 ‘‘(3) GOOD SAMARITAN LAW.—The term ‘Good 

5 Samaritan Law’ means a law that provides criminal 

6 immunity for a person who administers an opioid 

7 overdose reversal drug product, a person who, in 

8 good faith, seeks medical assistance for someone ex9 periencing a drug-related overdose, or a person who 

10 experiences a drug-related overdose and is in need of 

11 medical assistance and, in good faith, seeks such 

12 medical assistance, or is the subject of such a good 

13 faith request for medical assistance. 

14 ‘‘(4) INDIANS.—The terms ‘Indian’, ‘Indian 

15 tribe’, ‘tribal organization’, and ‘urban Indian orga16 nization’ have the meanings given such terms in sec17 tion 4 of the Indian Health Care Improvement Act. 

18 ‘‘(5) MANUFACTURER.—The term ‘manufac19 turer’ means any corporation, organization, or insti20 tution, whether public or private (including Federal, 

21 State, and local departments, agencies, and instru22 mentalities), which manufactures, imports, proc23 esses, or distributes under its label any opioid over24 dose reversal drug product. The term ‘manufacture’ 


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1 means to manufacture, import, process, or distribute 

2 an opioid overdose reversal drug. 

3 ‘‘(6) OPIOID OVERDOSE REVERSAL DRUG PROD4 UCT.—The term ‘opioid overdose reversal drug prod5 uct’ means a finished dosage form that has been ap6 proved by the Food and Drug Administration and 

7 that contains an active pharmaceutical ingredient 

8 that acts as an opioid receptor antagonist. The term 

9 ‘opioid overdose reversal drug product’ includes a 

10 combination product, as defined in section 3.2(e) of 

11 title 21, Code of Federal Regulations. 

12 ‘‘(7) STANDING ORDER.—The term ‘standing 

13 order’ means a non-patient-specific order covering 

14 administration of medication by others to a patient 

15 who may be unknown to the prescriber at the time 

16 of the order. 

17 ‘‘(8) THIRD PARTY PRESCRIPTION.—The term 

18 ‘third party prescription’ means an order written for 

19 medication dispensed to one person with the inten20 tion that it will be administered to another person. 

21 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

22 is authorized to be appropriated to carry out this suc23 tion— 

24 ‘‘(1) $1,000,000,000 for fiscal year 2022; 

25 ‘‘(2) $1,000,000,000 for fiscal year 2023; 


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

2 ‘‘(4) $1,000,000,000 for fiscal year 2025; 

3 ‘‘(5) $1,000,000,000 for fiscal year 2026; 

4 ‘‘(6) $1,000,000,000 for fiscal year 2027; 

5 ‘‘(7) $1,000,000,000 for fiscal year 2028; 

6 ‘‘(8) $1,000,000,000 for fiscal year 2029; 

7 ‘‘(9) $1,000,000,000 for fiscal year 2030; and 

8 ‘‘(10) $1,000,000,000 for fiscal year 2031. 

9 ‘‘SEC. 3437. ADDITIONAL FUNDING FOR THE NATIONAL IN10 STITUTES OF HEALTH. 

11 ‘‘There is authorized to be appropriated to the Na12 tional Institutes of Health for the purpose of conducting 

13 research on addiction and pain, including research to de14 velop overdose reversal drug products, non-opioid drug 

15 products and non-pharmacological treatments for address16 ing pain and substance use disorder, and drug products 

17 used to treat substance use disorder— 

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. 3438. ADDITIONAL FUNDING FOR THE CENTERS FOR 

4 DISEASE CONTROL AND PREVENTION. 

5 ‘‘(a) IMPROVED DATA COLLECTION AND PREVEN6 TION OF INFECTIOUS DISEASE TRANSMISSION.— 

7 ‘‘(1) DATA COLLECTION.—The Centers for Dis8 ease Control and Prevention shall use a portion of 

9 the funding appropriated under this section to en10 sure that all States participate in the Enhanced 

11 State Opioid Overdose Surveillance program and to 

12 provide technical assistance to medical examiners 

13 and coroners to facilitate improved data collection on 

14 fatal overdoses through such program. 

15 ‘‘(2) CENTERS FOR DISEASE CONTROL AND

16 PREVENTION.—The Centers for Disease Control and 

17 Prevention shall use amounts appropriated under 

18 this section for the purpose of improving data on 

19 drug overdose deaths and non-fatal drug overdoses, 

20 surveillance related to addiction and substance use 

21 disorder, and the prevention of transmission of infec22 tious diseases related to substance use. 

23 ‘‘(3) TRIBAL DATA.—Not later than 6 months 

24 after the date of enactment of this title, the Director 

25 of the Centers for Disease Control and Prevention 


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1 shall consult with Indian tribes and confer with 

2 urban Indian organizations to develop and imple3 ment strategies that improve surveillance and re4 porting of fatal overdose deaths among American In5 dians and Alaska Natives, including strategies that 

6 reduce the underestimation of fatal overdose deaths 

7 among American Indians and Alaska Natives due to 

8 undersampling or racial misclassification in State 

9 and Federal public health surveillance systems. 

10 ‘‘(b) CHILDHOOD TRAUMA.—The Centers for Disease 

11 Control and Prevention shall use a portion of the funding 

12 appropriated under this section to fund the surveillance 

13 and data collection activities described in section 7131 of 

14 the SUPPORT for Patients and Communities Act, includ15 ing to encourage all States to participate in collecting and 

16 reporting data on adverse childhood experiences through 

17 the Behavioral Risk Factor Surveillance System, the 

18 Youth Risk Behavior Surveillance System, and other rel19 evant public health surveys or questionnaires. 

20 ‘‘(c) WORKER HEALTH RISKS.—The Centers for Dis21 ease Control and Prevention shall use a portion of the 

22 funding appropriated under this section for data collection 

23 and surveillance activities on substance use, substance use 

24 disorders, drug overdose deaths, and non-fatal drug 

25 overdoses among workers, and the factors and practices 


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1 that contribute to such use, disorders, and overdoses, in2 cluding occupational injuries and illness as well as occupa3 tional exposure to opioids and other illicit and licit drugs. 

4 ‘‘(d) TRIBAL EPIDEMIOLOGY CENTERS.—There shall 

5 be made available to the Indian Health Service for the 

6 purpose of funding efforts by Indian tribes and tribal epi7 demiology centers to improve data on drug overdose 

8 deaths and non-fatal drug overdoses, surveillance related 

9 to addiction and substance use disorder, and prevention 

10 of childhood trauma, not less than 1.5 percent of the total 

11 amount appropriated under this section for each fiscal 

12 year. 

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

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

15 ‘‘(1) $500,000,000 for fiscal year 2022; 

16 ‘‘(2) $500,000,000 for fiscal year 2023; 

17 ‘‘(3) $500,000,000 for fiscal year 2024; 

18 ‘‘(4) $500,000,000 for fiscal year 2025; 

19 ‘‘(5) $500,000,000 for fiscal year 2026; 

20 ‘‘(6) $500,000,000 for fiscal year 2027; 

21 ‘‘(7) $500,000,000 for fiscal year 2028; 

22 ‘‘(8) $500,000,000 for fiscal year 2029; 

23 ‘‘(9) $500,000,000 for fiscal year 2030; and 

24 ‘‘(10) $500,000,000 for fiscal year 2031. 


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1 ‘‘SEC. 3439. DEFINITIONS. 

2 ‘‘In this title: 

3 ‘‘(1) PLANNING COUNCIL.—The term ‘planning 

4 council’ means the substance use planning council 

5 established under section 3402. 

6 ‘‘(2) RECOVERY RESIDENCE.—The term ‘recov7 ery residence’ means a residential dwelling unit, or 

8 other form of group housing, that is offered or ad9 vertised through any means, including oral, written, 

10 electronic, or printed means, by any individual or en11 tity as a residence that provides an evidence-based, 

12 peer-supported living environment for individuals un13 dergoing any type of substance use disorder treat14 ment or who have received any type of substance use 

15 disorder treatment in the past 3 years, including 

16 medication for addiction treatment. 

17 ‘‘(3) STATE.— 

18 ‘‘(A) IN GENERAL.—The term ‘State’ 

19 means each of the 50 States, the District of Co20 lumbia, and each of the territories. 

21 ‘‘(B) TERRITORIES.—The term ‘territory’ 

22 means each of American Samoa, Guam, the 

23 Commonwealth of Puerto Rico, the Common24 wealth of the Northern Mariana Islands, the 

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1 lands, the Federated States of Micronesia, and 

2 Palau. 

3 ‘‘(4) SUBSTANCE USE DISORDER TREAT4 MENT.— 

5 ‘‘(A) IN GENERAL.—The term ‘substance 

6 use disorder treatment’ means an evidence7 based, professionally directed, deliberate, and 

8 planned regimen including evaluation, observa9 tion, medical monitoring, and rehabilitative 

10 services and interventions such as 

11 pharmacotherapy, mental health services, and 

12 individual and group counseling, on an inpa13 tient or outpatient basis, to help patients with 

14 substance use disorder reach remission and 

15 maintain recovery. 

16 ‘‘(B) TYPES OF TREATMENT.—Substance 

17 use disorder treatments shall include the fol18 lowing: 

19 ‘‘(i) Clinical stabilization services, 

20 which are evidence-based services provided 

21 in secure, acute care facilities (which may 

22 be referred to as ‘addictions receiving fa23 cilities’) that, at a minimum— 

24 ‘‘(I) provide intoxication manage25 ment and stabilization services; 


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1 ‘‘(II) are operated 24 hours per 

2 day, 7 days per week; and 

3 ‘‘(III) that serve individuals 

4 found to be substance use impaired. 

5 These can also be referred to as ‘Ad6 dictions receiving facilities’. 

7 ‘‘(ii) Withdrawal management and de8 toxification, which is a medical service that 

9 is provided on an inpatient or an out10 patient basis to assist an individual in 

11 managing the process of withdrawal from 

12 the physiological and psychological effects 

13 of substance use disorder. 

14 ‘‘(iii) All outpatient, residential, and 

15 inpatient services described in section 

16 1915(l)(4)(c) of the Social Security Act. 

17 ‘‘(C) LIMITATION.—Substance use disorder 

18 treatment providers shall not include— 

19 ‘‘(i) prevention only providers; and 

20 ‘‘(ii) a private practitioner who is li21 censed by a State licensing board and 

22 whose practice is limited to non-intensive 

23 outpatient care. 

24 ‘‘(5) SUBSTANCE USE DISORDER TREATMENT

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1 ment services’ means any prevention services, core 

2 medical services, recovery and support services, early 

3 intervention services, and harm reduction services 

4 authorized under this title.’’. 

5 SEC. 4. AMENDMENTS TO THE CONTROLLED SUBSTANCES 

6 ACT. 

7 (a) CERTIFICATIONS.—Part C of the Controlled Sub8 stances Act (21 U.S.C. 821 et seq.) is amended by adding 

9 at the end the following: 

10 ‘‘CERTIFICATIONS RELATING TO DIVERSION CONTROLS

11 AND MISBRANDING

12 ‘‘SEC. 313. (a) DEFINITIONS.—In this section— 

13 ‘‘(1) the term ‘covered dispenser’— 

14 ‘‘(A) means a dispenser— 

15 ‘‘(i) that is required to register under 

16 section 302(a)(2); and 

17 ‘‘(ii) dispenses a controlled substance 

18 in schedule II; and 

19 ‘‘(B) does not include a dispenser that is— 

20 ‘‘(i) registered to dispense opioid 

21 agonist treatment medication under section 

22 303(g)(1); and 

23 ‘‘(ii) operating in that capacity; 

24 ‘‘(2) the term ‘covered distributor’ means a dis25 tributor— 


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1 ‘‘(A) that is required to register under sec2 tion 302(a)(1); and 

3 ‘‘(B) distributes a controlled substance in 

4 schedule II; 

5 ‘‘(3) the term ‘covered manufacturer’ means a 

6 manufacturer— 

7 ‘‘(A) that is required to register under sec8 tion 302(a)(1); and 

9 ‘‘(B) manufactures a controlled substance 

10 in schedule II; 

11 ‘‘(4) the term ‘covered officer’, with respect to 

12 a covered person means— 

13 ‘‘(A) in the case of a covered person that 

14 is not an individual— 

15 ‘‘(i) the chief executive officer of the 

16 covered person; 

17 ‘‘(ii) the president of the covered per18 son; 

19 ‘‘(iii) the chief medical officer of the 

20 covered person; or 

21 ‘‘(iv) the chief counsel of the covered 

22 person; and 

23 ‘‘(B) in the case of a covered person that 

24 is an individual, that individual; and 

25 ‘‘(5) the term ‘covered person’ means— 


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1 ‘‘(A) a covered dispenser; 

2 ‘‘(B) a covered distributor; or 

3 ‘‘(C) a covered manufacturer. 

4 ‘‘(b) CERTIFICATIONS RELATING TO DIVERSION

5 CONTROLS.—Not later than 180 days after the date of 

6 enactment of this section, and each year thereafter, each 

7 covered officer of a covered person shall submit to the At8 torney General, for each controlled substance in schedule 

9 II dispensed, distributed, or manufactured by the covered 

10 person, a certification— 

11 ‘‘(1) signed by the covered officer; and 

12 ‘‘(2) certifying that— 

13 ‘‘(A) the covered person maintains effective 

14 controls against diversion of the controlled sub15 stance into channels other than legitimate med16 ical, scientific, research, or industrial channels; 

17 ‘‘(B) all information contained in any 

18 record, inventory, or report required to be kept 

19 or submitted to the Attorney General by the 

20 covered person under section 307, or under any 

21 regulation issued under that section, is accu22 rate; and 

23 ‘‘(C) the covered person is in compliance 

24 with all applicable requirements under Federal 


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1 law relating to reporting suspicious orders for 

2 controlled substances. 

3 ‘‘(c) CERTIFICATIONS RELATING TO MIS4 BRANDING.— 

5 ‘‘(1) IN GENERAL.—Not later than 180 days 

6 after the date of enactment of this section, and each 

7 year thereafter, each covered officer of a covered 

8 manufacturer shall submit to the Secretary, for each 

9 controlled substance in schedule II manufactured by 

10 the covered manufacturer, a certification— 

11 ‘‘(A) signed by the covered officer; and 

12 ‘‘(B) certifying that the controlled sub13 stance is not misbranded, as described in sec14 tion 502 of the Federal Food, Drug, and Cos15 metic Act (21 U.S.C. 352). 

16 ‘‘(2) NOTIFICATION TO THE ATTORNEY GEN17 ERAL.— 

18 ‘‘(A) FAILURE TO SUBMIT CERTIFI19 CATIONS.—Not later than 30 days after the 

20 date on which a covered officer of a covered 

21 manufacturer is required to submit a certifi22 cation under paragraph (1) and fails to do so, 

23 the Secretary shall notify the Attorney General 

24 of the failure by the covered officer to submit 

25 the certification. 


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1 ‘‘(B) FALSE CERTIFICATIONS RELATING

2 TO MISBRANDING.—Not later than 30 days 

3 after the date on which the Secretary becomes 

4 aware that a certification submitted under 

5 paragraph (1) contains a materially false state6 ment or representation relating to the mis7 branding of a controlled substance with respect 

8 to the year for which the certification is sub9 mitted, the Secretary shall notify the Attorney 

10 General that the certification contains the ma11 terially false statement or representation.’’. 

12 (b) OFFENSES.—Part D of title II of the Controlled 

13 Substances Act (21 U.S.C. 841 et seq.) is amended by 

14 adding at the end the following: 

15 ‘‘CERTIFICATIONS BY COVERED OFFICERS

16 ‘‘SEC. 424. (a) DEFINITIONS.—In this section, the 

17 terms ‘covered dispenser’, ‘covered distributor’, ‘covered 

18 manufacturer’, ‘covered officer’, and ‘covered person’ have 

19 the meanings given those terms in section 313. 

20 ‘‘(b) OFFENSES.— 

21 ‘‘(1) FAILURE TO SUBMIT CERTIFICATIONS.— 

22 ‘‘(A) CERTIFICATIONS RELATING TO DI23 VERSION CONTROLS.—It shall be unlawful for a 

24 covered officer of a covered person to fail to 

25 submit a certification required under section 


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1 313(b), without regard to the state of mind of 

2 the covered officer. 

3 ‘‘(B) CERTIFICATIONS RELATING TO MIS4 BRANDING.—It shall be unlawful for a covered 

5 officer of a covered manufacturer to fail to sub6 mit a certification required under section 

7 313(c)(1), without regard to the state of mind 

8 of the covered officer. 

9 ‘‘(2) SUBMISSION OF FALSE CERTIFICATIONS.— 

10 ‘‘(A) FALSE CERTIFICATIONS RELATING TO

11 DIVERSION CONTROLS.—It shall be unlawful for 

12 a covered officer of a covered person to submit 

13 a certification required under section 313(b), 

14 without regard to the state of mind of the cov15 ered officer, that contains a materially false 

16 statement or representation relating to the in17 formation required to be certified under that 

18 section for the year for which the certification 

19 is submitted. 

20 ‘‘(B) FALSE CERTIFICATIONS RELATING

21 TO MISBRANDING.—It shall be unlawful for a 

22 covered officer of a covered manufacturer to 

23 submit a certification required under section 

24 313(c)(1), without regard to the state of mind 

25 of the covered officer, that contains a materially 


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1 false statement or representation relating to the 

2 misbranding of a controlled substance with re3 spect to the year for which the certification is 

4 submitted. 

5 ‘‘(c) PENALTIES.— 

6 ‘‘(1) CIVIL PENALTIES.—Except as provided in 

7 paragraph (2), a covered officer who violates sub8 section (b) shall be subject to a civil penalty of not 

9 more than $25,000. 

10 ‘‘(2) CRIMINAL PENALTIES.—A covered officer 

11 who knowingly violates subsection (b)(2) shall be 

12 subject to criminal penalties under section 403(d). 

13 ‘‘(d) COMPREHENSIVE ADDICTION RESOURCES

14 FUND.— 

15 ‘‘(1) ESTABLISHMENT.—There is established in 

16 the Treasury a fund to be known as the ‘Com17 prehensive Addiction Resources Fund’. 

18 ‘‘(2) TRANSFER OF AMOUNTS.—There shall be 

19 transferred to the Comprehensive Addiction Re20 sources Fund 100 percent of— 

21 ‘‘(A) any civil penalty paid to the United 

22 States under this section; and 

23 ‘‘(B) any fine paid to the United States 

24 under section 403(d) for a knowing violation of 

25 subsection (b)(2) of this section. 


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1 ‘‘(3) AVAILABILITY AND USE OF FUNDS.— 

2 Amounts transferred to the Comprehensive Addic3 tion Fund under paragraph (2) shall— 

4 ‘‘(A) remain available until expended; and 

5 ‘‘(B) be made available to supplement 

6 amounts appropriated to carry out title XXXIV 

7 of the Public Health Service Act.’’. 

8 (c) CRIMINAL PENALTIES.—Section 403 of the Con9 trolled Substances Act (21 U.S.C. 843) is amended— 

10 (1) in subsection (d)(1)— 

11 (A) by inserting ‘‘or knowingly violates sec12 tion 424(b)(2)’’ after ‘‘any person who violates 

13 this section’’; and 

14 (B) by striking ‘‘violation of this section’’ 

15 and inserting ‘‘such a violation’’; and 

16 (2) in subsection (f)— 

17 (A) in paragraph (1), by striking ‘‘or 416’’ 

18 and inserting ‘‘or section 416, or knowing viola19 tions of section 424(b)(2)’’; and 

20 (B) in paragraph (3), by inserting ‘‘or 

21 knowing violations of section 424(b)(2)’’ before 

22 the period at the end. 

23 (d) TECHNICAL AND CONFORMING AMENDMENTS.— 

24 The table of contents for the Comprehensive Drug Abuse 


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1 Prevention and Control Act of 1970 (Public Law 91–513; 

2 84 Stat. 1236) is amended— 

3 (1) by inserting after the item relating to sec4 tion 311 the following: 

‘‘Sec. 312. Suspicious orders. 

‘‘Sec. 313. Certifications relating to diversion controls and misbranding.’’; 

5 and 

6 (2) by inserting after the item relating to sec7 tion 423 the following: 

‘‘Sec. 424. Certifications by covered officers.’’. 

8 (e) EFFECTIVE DATE.—The amendments made by 

9 subsections (b) and (c) of this section shall take effect on 

10 the date that is 180 days after the date of enactment of 

11 this Act. 

12 SEC. 5. GENERAL LIMITATION ON USE OF FUNDS. 

13 Amounts appropriated or provided under this Act, or 

14 an amendment made by this Act, shall be used only for 

15 the public health purposes described in this Act (or 

16 amendments) and shall not be used to increase the incar17 ceration or institutionalization of individuals with sub18 stance use disorder. 

19 SEC. 6. FEDERAL DRUG DEMAND REDUCTION ACTIVITIES. 

20 (a) PUBLICATION OF LIST.— 

21 (1) AMENDMENT.—Section 705(f) of the Office 

22 of National Drug Control Policy Reauthorization Act 


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1 of 1998 (21 U.S.C. 1704(f)) is amended by inserting 

2 at the end the following new paragraph: 

3 ‘‘(5) PUBLICATION OF LIST.—The Director 

4 shall publish online a complete list of all drug con5 trol program grant programs and any other relevant 

6 information included in the system developed under 

7 paragraph (1).’’. 

8 (2) DEADLINE AND FREQUENCY.—Not later 

9 than one year after the date of the enactment of this 

10 Act, and annually thereafter, the Director of Na11 tional Drug Control Policy shall publish the list re12 quired under section 705(f)(5) of the National Drug 

13 Control Act of 1998, as added by paragraph (1). 

14 (b) NATIONAL DRUG CONTROL STRATEGY.—Section 

15 706(c)(1) of the National Drug Control Act of 1998 (21 

16 U.S.C. 1705(c)(1)) is amended by adding at the end the 

17 following new subparagraph: 

18 ‘‘(O) A review of all federally funded de19 mand reduction activities, including an evalua20 tion of— 

21 ‘‘(i) the effectiveness of those activi22 ties; 

23 ‘‘(ii) the contribution of those activi24 ties to demand reduction activities funded 


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1 by State, local, and Tribal governments; 

2 and 

3 ‘‘(iii) whether any duplication or inef4 ficiency in federally funded demand reduc5 tion activities needs to be addressed.’’. 

Æ 


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