‘‘(1) IN GENERAL.—In providing for a council 
for purposes of subsection (a), the chief elected offi-
cial of the eligible local area may establish the coun-
cil directly or designate an existing entity to serve as 
the council, subject to paragraph (2). 
‘‘(2) CONSIDERATION REGARDING DESIGNATION 
OF COUNCIL.—In making a determination of wheth-
er to establish or designate a council under para-
graph (1), the chief elected official shall give priority 
to the designation of an existing entity that has 
demonstrated experience in the provision of health 
and support services to individuals with substance 
use disorder within the eligible local area, that has 
a structure that recognizes the Federal trust respon-
sibility when spending Federal health care dollars, 
and that has demonstrated a commitment to re-
specting the obligation of government agencies using 
Federal dollars to consult with Indian tribes and 
confer with Urban Indian health programs. 
‘‘(3) JOINT COUNCIL.—The Secretary shall es-
tablish a process to permit an eligible local area that 
is not contiguous with any other eligible local area 
to form a joint planning council with such other eli-
gible local area or areas, as long as such areas are 
located in geographical proximity to each other, as 
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determined by the Secretary, and submit a joint ap-
plication under section 3404. 
‘‘(4) JOINT COUNCIL ACROSS STATE LINES.— 
Eligible local areas may form a joint planning coun-
cil with other eligible local areas across State lines 
if such areas are located in geographical proximity 
to each other, as determined by the Secretary, sub-
mit a joint application under section 3404, and es-
tablish intergovernmental agreements to allow the 
administration of the grant across State lines. 
‘‘(c) MEMBERSHIP.—Members of the planning coun-
cil established or designated under subsection (a) shall— 
‘‘(1) be nominated and selected through an 
open process; 
‘‘(2) elect from among their membership a chair 
and vice chair; 
‘‘(3) include at least one representative from 
Indian tribes located within any eligible local area 
that receives funding under the grant program es-
tablished in section 3401; and 
‘‘(4) serve no more than 3 consecutive years on 
the planning council. 
‘‘(d) MEMBERSHIP TERMS.—Members of the plan-
ning council established or designated under subsection 
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(a) may serve additional terms if nominated and selected 
through the process established in subsection (c)(1). 
‘‘(e) DUTIES.—The planning council established or 
designated under subsection (a) shall— 
‘‘(1) establish priorities for the allocation of 
grant funds within the eligible local area that em-
phasize reducing drug overdose and substance use 
disorder through evidence-based interventions in 
both community and criminal justice settings and 
that are based on— 
‘‘(A) the use by the grantee of substance 
use disorder treatment and intervention strate-
gies that comply with best practices identified 
by the Secretary; 
‘‘(B) the demonstrated or probable cost-ef-
fectiveness of proposed substance use disorder 
treatment services; 
‘‘(C) the health priorities of the commu-
nities within the eligible local area that are af-
fected by substance use; 
‘‘(D) the priorities and needs of individuals 
with substance use disorder; and 
‘‘(E) the availability of other governmental 
and nongovernmental services; 
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‘‘(2) ensure the use of grant funds are con-
sistent with any existing State or local plan regard-
ing the provision of substance use disorder treat-
ment services to individuals with substance use dis-
order; 
‘‘(3) in the absence of a State or local plan, 
work with local public health agencies to develop a 
comprehensive plan for the organization and delivery 
of substance use disorder treatment services; 
‘‘(4) regularly assess the efficiency of the ad-
ministrative mechanism in rapidly allocating funds 
to support evidence-based substance use disorder 
treatment services in the areas of greatest need 
within the eligible local area; 
‘‘(5) work with local public health agencies to 
determine the size and demographics of the popu-
lation of individuals with substance use disorders 
and the types of substance use that are most preva-
lent in the eligible local area; 
‘‘(6) work with local public health agencies to 
determine the needs of such population, including 
the need for substance use disorder treatment serv-
ices; 
‘‘(7) work with local public agencies to deter-
mine the disparities in access to services among af-
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fected subpopulations and historically underserved 
communities, including infrastructure and capacity 
shortcomings of providers that contribute to these 
disparities; 
‘‘(8) work with local public agencies to establish 
methods for obtaining input on community needs 
and priorities, including by partnering with organi-
zations that serve targeted communities experiencing 
high opioid related health disparities to gather data 
using culturally attuned data collection methodolo-
gies; 
‘‘(9) coordinate with Federal grantees that pro-
vide substance use disorder treatment services within 
the eligible local area; and 
‘‘(10) annually assess the effectiveness of the 
substance use disorder treatment services being sup-
ported by the grant received by the eligible local 
area, including— 
‘‘(A) reductions in the rates of overdose 
and death from substance use disorders; 
‘‘(B) rates of discontinuation from sub-
stance use disorder treatment services; 
‘‘(C) long-term outcomes among individ-
uals receiving treatment for substance use dis-
orders; and 
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‘‘(D) the availability of substance use dis-
order treatment services needed by individuals 
with substance use disorders over their life-
times. 
‘‘(f) CONFLICTS OF INTEREST.— 
‘‘(1) IN GENERAL.—The planning council under 
subsection (a) may not be directly involved in the 
administration of a grant under section 3401. 
‘‘(2) REQUIRED AGREEMENTS.—An individual 
may serve on the planning council under subsection 
(a) only if the individual agrees that if the individual 
has a financial interest in an entity, if the individual 
is an employee of a public or private entity, or if the 
individual is a member of a public or private organi-
zation, and such entity or organization is seeking 
amounts from a grant under section 3401, the indi-
vidual will not, with respect to the purpose for which 
the entity seeks such amounts, participate (directly 
or in an advisory capacity) in the process of select-
ing entities to receive such amounts for such pur-
pose. 
‘‘(g) GRIEVANCE PROCEDURES.—A planning council 
under subsection (a) shall develop procedures for address-
ing grievances with respect to funding under this subtitle, 
including procedures for submitting grievances that can-
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not be resolved to binding arbitration. Such procedures 
shall be described in the by-laws of the planning council. 
‘‘(h) PUBLIC DELIBERATIONS.—With respect to a 
planning council under subsection (a), in accordance with 
criteria established by the Secretary, the following applies: 
‘‘(1) The meetings of the council shall be open 
to the public and shall be held only after adequate 
notice to the public. 
‘‘(2) The records, reports, transcripts, minutes, 
agenda, or other documents which were made avail-
able to or prepared for or by the council shall be 
available for public inspection and copying at a sin-
gle location. 
‘‘(3) Detailed minutes of each meeting of the 
council shall be kept. The accuracy of all minutes 
shall be certified to by the chair of the council. 
‘‘(4) This subparagraph does not apply to any 
disclosure of information of a personal nature that 
would constitute a clearly unwarranted invasion of 
personal privacy, including any disclosure of medical 
information or personnel matters. 
‘‘SEC. 3403. AMOUNT OF GRANT AND USE OF AMOUNTS. 
‘‘(a) AMOUNT OF GRANT.— 
‘‘(1) GRANTS BASED ON RELATIVE NEED OF 
AREA.— 
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‘‘(A) IN GENERAL.—In carrying out this 
subtitle, the Secretary shall make a grant for 
each eligible local area for which an application 
under section 3404 has been approved. Each 
such grant shall be made in an amount deter-
mined in accordance with paragraph (3). 
‘‘(B) 
EXPEDITED
DISTRIBUTION.—Not 
later than 90 days after an appropriation be-
comes available to carry out this subtitle for a 
fiscal year, the Secretary shall disburse 53 per-
cent of the amount made available under sec-
tion 3406 for carrying out this subtitle for such 
fiscal year through grants to eligible local areas 
under section 3401, in accordance with sub-
paragraphs (C) and (D). 
‘‘(C) AMOUNT.— 
‘‘(i) IN GENERAL.—Subject to the ex-
tent of amounts made available in appro-
priations Acts, a grant made for purposes 
of this subparagraph to an eligible local 
area shall be made in an amount equal to 
the product of— 
‘‘(I) an amount equal to the 
amount 
available 
for 
distribution 
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under subparagraph (B) for the fiscal 
year involved; and 
‘‘(II) the percentage constituted 
by the ratio of the distribution factor 
for the eligible local area to the sum 
of the respective distribution factors 
for all eligible local areas; 
which product shall then, as applicable, be 
increased under subparagraph (D). 
‘‘(ii) 
DISTRIBUTION
FACTOR.—For 
purposes of clause (i)(II), the term ‘dis-
tribution factor’ means— 
‘‘(I) an amount equal to— 
‘‘(aa) the estimated number 
of drug overdose deaths in the el-
igible local area, as determined 
under clause (iii); or 
‘‘(bb) the estimated number 
of non-fatal drug overdoses in the 
eligible local area, as determined 
under clause (iv); 
as determined by the Secretary based 
on which distribution factor (item (aa) 
or (bb)) will result in the eligible local 
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area receiving the greatest amount of 
funds; or 
‘‘(II) in the case of an eligible 
local area for which the data de-
scribed in subclause (I) is not avail-
able, an amount determined by the 
Secretary— 
‘‘(aa) based on other data 
the Secretary determines appro-
priate; and 
‘‘(bb) that is related to the 
prevalence 
of 
non-fatal 
drug 
overdoses, drug overdose deaths, 
and the mortality rate from drug 
overdoses and provides an equiv-
alent measure of need for fund-
ing. 
‘‘(iii) NUMBER
OF
DRUG
OVERDOSE 
DEATHS.—The number of drug overdose 
deaths determined under this clause for an 
eligible county for a fiscal year for pur-
poses of clause (ii) is the number of drug 
overdose deaths during the most recent 3- 
year period for which such data are avail-
able. 
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‘‘(iv) NUMBER OF NON-FATAL DRUG 
OVERDOSES.—The number of non-fatal 
drug overdose deaths determined under 
this clause for an eligible county for a fis-
cal year for purposes of clause (ii) may be 
determined by using data including emer-
gency department syndromic data, visits, 
or other emergency medical services for 
drug-related causes during the most recent 
3-year period for which such data are 
available. 
‘‘(v) STUDY.—Not later than 3 years 
after the date of enactment of this title, 
the Comptroller General shall conduct a 
study to determine whether the data uti-
lized for purposes of clause (ii) provide the 
most precise measure of local area need re-
lated to substance use and addiction preva-
lence in local areas and whether additional 
data would provide more precise measures 
of substance use and addiction prevalence 
in local areas. Such study shall identify 
barriers to collecting or analyzing such 
data, and make recommendations for revis-
ing the distribution factors used under 
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such clause to determine funding levels in 
order to direct funds to the local areas in 
most need of funding to provide substance 
use disorder treatment services. 
‘‘(vi) REDUCTIONS IN AMOUNTS.—If a 
local area that is an eligible local area for 
a year loses such eligibility in a subsequent 
year based on the failure to meet the re-
quirements of section 3401(b)(1)(A), such 
area will remain eligible to receive— 
‘‘(I) for such subsequent year, an 
amount equal to 80 percent of the 
amount received under the grant in 
the previous year; and 
‘‘(II) for the second such subse-
quent year, an amount equal to 50 
percent of the amount received in the 
such previous year. 
‘‘(2) SUPPLEMENTAL GRANTS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
disburse the remainder of amounts not dis-
bursed under paragraph (1) for such fiscal year 
for the purpose of making grants to cities and 
counties 
whose 
application 
under 
section 
3404— 
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‘‘(i) contains a report concerning the 
dissemination of emergency relief funds 
under paragraph (1) and the plan for utili-
zation of such funds, if applicable; 
‘‘(ii) demonstrates the need in such 
local area, on an objective and quantified 
basis, for supplemental financial assistance 
to combat substance use disorder; 
‘‘(iii) demonstrates the existing com-
mitment of local resources of the area, 
both financial and in-kind, to combating 
substance use disorder; 
‘‘(iv) demonstrates the ability of the 
area to utilize such supplemental financial 
resources in a manner that is immediately 
responsive and cost effective; 
‘‘(v) demonstrates that resources will 
be allocated in accordance with the local 
demographic incidence of substance use 
disorders and drug overdose mortality; 
‘‘(vi) demonstrates the inclusiveness of 
affected communities and individuals with 
substance use disorders, including those 
communities and individuals that are dis-
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proportionately affected or historically un-
derserved; 
‘‘(vii) demonstrates the manner in 
which the proposed services are consistent 
with the local needs assessment and the 
statewide coordinated statement of need 
required in section 3413(e); 
‘‘(viii) demonstrates success in identi-
fying individuals with substance use dis-
orders; and 
‘‘(ix) demonstrates that support for 
substance use disorder treatment services 
is organized to maximize the value to the 
population to be served with an appro-
priate mix of substance use disorder treat-
ment services and attention to transition in 
care. 
‘‘(B) AMOUNT.— 
‘‘(i) IN
GENERAL.—The amount of 
each grant made for purposes of this para-
graph shall be determined by the Sec-
retary. In making such determination, the 
Secretary shall consider— 
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‘‘(I) the rate of drug overdose 
deaths per 100,000 population in the 
eligible local area; and 
‘‘(II) the increasing need for sub-
stance use disorder treatment serv-
ices, including relative rates of in-
crease 
in 
the 
number 
of 
drug 
overdoses or drug overdose deaths, re-
cent increases in drug overdoses or 
drug overdose deaths since data was 
provided under section 3401(b), if ap-
plicable. 
‘‘(ii) 
DEMONSTRATED
NEED.—The 
factors considered by the Secretary in de-
termining whether a local area has a dem-
onstrated need for purposes of clause 
(i)(II) may include any or all of the fol-
lowing: 
‘‘(I) The unmet need for sub-
stance use disorder treatment serv-
ices, including factors identified in 
subparagraph (B)(i)(II). 
‘‘(II) Relative rates of increase in 
the number of drug overdoses or drug 
overdose deaths. 
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‘‘(III) The relative rates of in-
crease 
in 
the 
number 
of 
drug 
overdoses or drug overdose deaths 
within new or emerging subpopula-
tions. 
‘‘(IV) The current prevalence of 
substance use disorders. 
‘‘(V) Relevant factors related to 
the cost and complexity of delivering 
substance use disorder treatment serv-
ices to individuals in the eligible local 
area. 
‘‘(VI) The impact of co-morbid 
factors, including co-occurring condi-
tions, determined relevant by the Sec-
retary. 
‘‘(VII) The prevalence of home-
lessness among individuals with sub-
stance use disorders. 
‘‘(VIII) The relevant factors that 
limit access to health care, including 
geographic variation, adequacy of 
health insurance coverage, and lan-
guage barriers. 
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‘‘(IX) The impact of a decline in 
the amount received pursuant to para-
graph (1) on substance use disorder 
treatment services available to all in-
dividuals with substance use disorders 
identified and eligible under this sub-
title. 
‘‘(X) The increasing incidence in 
conditions related to substance use, 
including hepatitis C, human immuno-
deficiency virus, hepatitis B and other 
infections associated with injection 
drug use. 
‘‘(C) APPLICATION
OF
PROVISIONS.—A 
local area that receives a grant under this para-
graph— 
‘‘(i) shall use amounts received in ac-
cordance with subsection (b); 
‘‘(ii) shall not have to meet the eligi-
ble criteria in section 3401(b); and 
‘‘(iii) shall not have to establish a 
planning council under section 3402. 
‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN-
MENTS.— 
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‘‘(A) INDIAN TRIBES.—In this section, the 
term ‘Indian tribe’ has the meaning given such 
term in section 4 of the Indian Self-Determina-
tion and Education Assistance Act. 
‘‘(B) FORMULA GRANTS.—The Secretary, 
acting through the Indian Health Service, shall 
use 10 percent of the amount available under 
section 3406 for each fiscal year to provide for-
mula grants to Indian tribes disproportionately 
affected by substance use, in an amount deter-
mined pursuant to a formula and eligibility cri-
teria developed by the Secretary in consultation 
with Indian tribes, for the purposes of address-
ing substance use. 
‘‘(C) USE OF AMOUNTS.—Notwithstanding 
any requirements in this section, an Indian 
tribe may use amounts provided under grants 
awarded under this paragraph for the uses 
identified in subsection (b) and any other activi-
ties determined appropriate by the Secretary, in 
consultation with Indian tribes. 
‘‘(b) USE OF AMOUNTS.— 
‘‘(1) REQUIREMENTS.—The Secretary may not 
make a grant under section 3401 to an eligible local 
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area unless the chief elected official of the area 
agrees that— 
‘‘(A) the allocation of funds and services 
within the area under the grant will be made in 
accordance with the priorities established by the 
substance use disorder treatment services plan-
ning council; and 
‘‘(B) funds provided under this grant will 
be expended for— 
‘‘(i) prevention services described in 
paragraph (3); 
‘‘(ii) core medical services described in 
paragraph (4); 
‘‘(iii) recovery and support services 
described in paragraph (5); 
‘‘(iv) early intervention and engage-
ment services described in paragraph (6); 
‘‘(v) harm reduction services described 
in paragraph (7); 
‘‘(vi) financial assistance with health 
insurance described in paragraph (8); and 
‘‘(vii) administrative expenses de-
scribed in paragraph (10). 
‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 
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‘‘(A) IN GENERAL.—An eligible local area 
shall use amounts received under a grant under 
section 3401 to provide direct financial assist-
ance to eligible entities for the purpose of pro-
viding prevention services, core medical services, 
recovery and support services, harm reduction 
services, and early intervention and engagement 
services. 
‘‘(B) APPROPRIATE ENTITIES.—Direct fi-
nancial assistance may be provided under sub-
paragraph (A) to public or nonprofit private en-
tities, or private for-profit entities if such enti-
ties are the only available provider of quality 
substance use disorder treatment services in the 
area. 
‘‘(3) PREVENTION SERVICES.— 
‘‘(A) IN GENERAL.—For purposes of this 
subsection, the term ‘prevention services’ means 
services, programs, or multi-sector strategies to 
prevent substance use disorder (such as evi-
dence-based education campaigns, community- 
based prevention programs, opioid diversion, 
collection and disposal or unused opioids, and 
services to at-risk populations). 
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‘‘(B) LIMIT.—An eligible local area may 
use not to exceed 20 percent of the amount of 
the grant under section 3401 for prevention 
services. An eligible local area may apply to the 
Secretary for a waiver of this subparagraph. 
‘‘(4) CORE MEDICAL SERVICES.—For purposes 
of this subsection, the term ‘core medical services’ 
means the following evidence-based services provided 
to individuals with substance use disorder or at risk 
for developing substance use disorder: 
‘‘(A) Substance use disorder treatments, 
including clinical stabilization services, with-
drawal management and detoxification, inten-
sive inpatient treatment, intensive outpatient 
treatment, all forms of Federally-approved 
medication-assisted treatment, outpatient treat-
ment, and residential recovery treatment. 
‘‘(B) Outpatient and ambulatory health 
services, including those administered by Feder-
ally qualified health centers and rural health 
clinics. 
‘‘(C) Hospice services. 
‘‘(D) Mental health services. 
‘‘(E) Naloxone procurement, distribution, 
and training. 
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‘‘(F) Pharmaceutical assistance and diag-
nostic testing related to the management of 
substance-use disorders a co-morbid conditions. 
‘‘(G) Home and community based health 
services. 
‘‘(H) Comprehensive Case Management, 
including substance use disorder treatment ad-
herence services. 
‘‘(I) Health insurance enrollment and cost- 
sharing assistance in accordance with para-
graph (8). 
‘‘(5) RECOVERY AND SUPPORT SERVICES.—For 
purposes of paragraph (1)(B)(ii), the term ‘recovery 
and support services’ means services, subject to the 
approval of the Secretary, that are provided to indi-
viduals with substance use disorder, including resi-
dential recovery treatment and housing, including 
for individuals receiving medication-assisted treat-
ment, long term recovery services, 24/7 hotline crisis 
center support, medical transportation services, res-
pite care for persons caring for individuals with sub-
stance use disorder, child care and family services 
while an individual is receiving inpatient treatment 
services or at the time of outpatient services, out-
reach services, peer recovery services, nutrition serv-
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lotter on DSKBCFDHB2PROD with BILLS
ices, and referrals for job training and career serv-
ices, housing, legal services, and child care and fam-
ily services. 
‘‘(6) EARLY INTERVENTION AND ENGAGEMENT 
SERVICES.—For purposes of this section, the term 
‘early intervention and engagement services’ means 
services to provide rapid access to substance use dis-
order treatment, counseling provided to individuals 
who have misused substances, who have experienced 
an overdose, or are at risk of developing substance 
use disorder, and the provision of referrals to facili-
tate the access of such individuals to core medical 
services or recovery and support services. The enti-
ties through which such services may be provided in-
clude emergency rooms, fire departments and emer-
gency medical services, detention facilities, homeless 
shelters, law enforcement agencies, health care 
points of entry specified by eligible local areas, Fed-
erally qualified health centers, and rural health clin-
ics. 
‘‘(7) HARM REDUCTION SERVICES.—For pur-
poses of this section, the term ‘harm reduction serv-
ices’ means evidence-based services provided to indi-
viduals engaging in substance use that reduce the 
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risk of infectious disease transmission, overdose, or 
death, including by increasing access to health care. 
‘‘(8) AFFORDABLE
HEALTH
INSURANCE
COV-
ERAGE.—An eligible local area may use amounts 
provided under a grant awarded under section 3401 
to establish a program of financial assistance to as-
sist eligible individuals with substance use disorder 
in— 
‘‘(A) enrolling in health insurance cov-
erage; or 
‘‘(B) affording health care services, includ-
ing assistance paying cost-sharing amounts, in-
cluding premiums. 
‘‘(9) REQUIREMENT OF STATUS AS MEDICAID 
PROVIDER.— 
‘‘(A) PROVISION OF SERVICE.—Subject to 
paragraph (2), the Secretary may not make a 
grant under section 3401 for the provision of 
substance use disorder treatment services under 
this section in an eligible local area unless, in 
the case of any such service that is available 
pursuant to the State plan approved under title 
XIX of the Social Security Act for the State— 
‘‘(i) the political subdivision involved 
will provide the service directly, and the 
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‘‘(iv) demonstrates the ability of the 
State to utilize such supplemental financial 
resources in a manner that is immediately 
responsive and cost effective; 
‘‘(v) demonstrates that resources will 
be allocated in accordance with the local 
demographic incidence of substances use 
disorders and drug overdose mortality; 
‘‘(vi) demonstrates the inclusiveness of 
affected communities and individuals with 
substance use disorders, including those 
communities and individuals that are dis-
proportionately affected or historically un-
derserved; 
‘‘(vii) demonstrates the manner in 
which the proposed services are consistent 
with the local needs assessment and the 
statewide coordinated statement of need 
required under section 3413(e); 
‘‘(viii) demonstrates success in identi-
fying individuals with substance use dis-
orders; and 
‘‘(ix) demonstrates that support for 
substance use disorder treatment services 
is organized to maximize the value to the 
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