by or providing the services of the Indian Health 
Service). 
‘‘(c) MEDICAID IMD WAIVER APPLICATION RE-
QUIREMENT.—A State shall not be eligible to receive a 
grant under this subtitle for a fiscal year unless the 
State— 
‘‘(1) has in effect for the year a waiver under 
section 1115 of the Social Security Act (42 U.S.C. 
1315) to provide medical assistance under the State 
plan under title XIX of such Act to individuals 
who— 
‘‘(A) have not attained age 65 (or, if the 
State provides the medical assistance described 
in section 1905(a)(16) of such Act, have at-
tained age 21 but have not attained age 65); 
‘‘(B) are patients in an institution for 
mental diseases; and 
‘‘(C) are eligible for medical assistance 
under the State plan; or 
‘‘(2) has submitted an application for the year 
for such a waiver. 
‘‘(d) REQUIREMENTS REGARDING IMPOSITION
OF 
CHARGES FOR SERVICES.— 
‘‘(1) IN
GENERAL.—The Secretary may not 
make a grant under section 3411 to a State unless 
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the State provides assurances that in the provision 
of services with assistance provided under the 
grant— 
‘‘(A) in the case of individuals with an in-
come less than or equal to 138 percent of the 
official poverty level, the provider will not im-
pose charges on any such individual for the 
services provided under the grant; 
‘‘(B) in the case of individuals with an in-
come greater than 138 percent of the official 
poverty level, the provider will impose a charge 
on each such individual according to a schedule 
of charges made available to the public; 
‘‘(C) in the case of individuals with an in-
come greater than 138 percent of the official 
poverty level but not exceeding 200 percent of 
such poverty level, the provider will not, for an 
calendar year, impose charges in an amount ex-
ceeding 5 percent of the annual gross income of 
the individual; 
‘‘(D) in the case of individuals with an in-
come greater than 200 percent of the official 
poverty level but not exceeding 300 percent of 
such poverty level, the provider will not, for any 
calendar year, impose charges in an amount ex-
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ceeding 7 percent of the annual gross income of 
the individual involved; 
‘‘(E) in the case of individuals with an in-
come greater than 300 percent of the official 
poverty level, the provider will not, for any cal-
endar year, impose charges in an amount ex-
ceeding 15 percent of the annual gross income 
of the individual involved; and 
‘‘(F) in the case of eligible American In-
dian and Alaska Native individuals as defined 
by section 447.50 of title 42, Code of Federal 
Regulations (as in effect on July 1, 2010), the 
provider will not impose any charges for sub-
stance use disorder treatment services, includ-
ing any charges or cost-sharing prohibited by 
section 1402(d) of the Patient Protection and 
Affordable Care Act. 
‘‘(2) CHARGES.—With respect to compliance 
with the assurances made under paragraph (1), a 
State may, in the case of individuals subject to a 
charge— 
‘‘(A) assess the amount of the charge in 
the discretion of the State, including imposing 
only a nominal charge for the provision of serv-
ices, subject to the provisions of the paragraph 
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regarding public schedules and regarding limi-
tations on the maximum amount of charges; 
and 
‘‘(B) take into consideration the total med-
ical expenses of individuals in assessing the 
amount of the charge, subject to such provi-
sions. 
‘‘(3) AGGREGATE
CHARGES.—The Secretary 
may not make a grant under section 3411 to a State 
unless the State agrees that the limitations on 
charges for substance use disorder treatment serv-
ices under this subsection applies to the annual ag-
gregate of charges imposed for such services, how-
ever the charges are characterized, includes enroll-
ment fees, premiums, deductibles, cost sharing, co- 
payments, co-insurance costs, or any other charges. 
‘‘(e) STATEWIDE
COORDINATED
STATEMENT
OF 
NEED.—A State shall not be eligible to receive a grant 
under this subtitle for a fiscal year unless the State devel-
ops and publishes a statewide coordinated statement of 
need, including a demonstration of the extent of State 
need for assistance in addressing addiction and substance 
use disorder in the State and identifying priorities for the 
delivery of essential services to individuals with substance 
use disorder and their families. 
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‘‘(f) INDIAN TRIBES.—Any application requirements 
applying to grants distributed in accordance with section 
3412(c) shall be developed by the Secretary in consulta-
tion with Indian tribes. 
‘‘SEC. 3414. TECHNICAL ASSISTANCE. 
‘‘The Secretary shall provide technical assistance in 
administering and coordinating the activities authorized 
under section 3412, including technical assistance for the 
development of State applications for supplementary 
grants authorized in section 3212(a)(2). 
‘‘SEC. 3415. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated to carry out 
this subtitle— 
‘‘(1) $4,000,000,000 for fiscal year 2019; 
‘‘(2) $4,000,000,000 for fiscal year 2020; 
‘‘(3) $4,000,000,000 for fiscal year 2021; 
‘‘(4) $4,000,000,000 for fiscal year 2022; 
‘‘(5) $4,000,000,000 for fiscal year 2023; 
‘‘(6) $4,000,000,000 for fiscal year 2024; 
‘‘(7) $4,000,000,000 for fiscal year 2025; 
‘‘(8) $4,000,000,000 for fiscal year 2026; 
‘‘(9) $4,000,000,000 for fiscal year 2027; and 
‘‘(10) $4,000,000,000 for fiscal year 2028. 
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‘‘Subtitle C—Other Grant Program 
‘‘SEC. 3421. ESTABLISHMENT OF GRANT PROGRAM. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to public, nonprofit, and Native entities for the 
purpose of funding core medical services, recovery and 
support services, harm reduction services, administrative 
expenses, and early intervention and engagement services 
in accordance with this section. 
‘‘(b) ELIGIBILITY.— 
‘‘(1) ENTITIES.—Public, nonprofit, or Native 
entities eligible to receive a grant under subsection 
(a) may include— 
‘‘(A) federally qualified health centers 
under section 1905(l)(2)(B) of the Social Secu-
rity Act; 
‘‘(B) family planning clinics; 
‘‘(C) rural health clinics; 
‘‘(D) Native entities, including Indian 
health programs as defined in section 4 of the 
Indian Health Care Improvement Act, urban 
Indian organizations as defined in section 4 of 
the Indian Health Care Improvement Act, and 
Native Hawaiian organizations as defined in 
section 12 of the Native Hawaiian Health Care 
Act of 1988; 
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‘‘(E) community-based organizations, clin-
ics, hospitals, and other health facilities that 
provide substance use disorder treatment serv-
ices; 
‘‘(F) other nonprofit entities that provide 
substance use disorder treatment services; and 
‘‘(G) faith based organizations that provide 
substance use disorder treatment services. 
‘‘(2) UNDERSERVED
POPULATIONS.—Entities 
described in paragraph (1) shall serve underserved 
populations which may include minority populations 
and Indian populations, ex-offenders, individuals 
with comorbidities including HIV/AIDS, hepatitis B 
or C, mental illness, or other behavioral health dis-
orders, low-income populations, inner city popu-
lations, and rural populations. 
‘‘(3) APPLICATION.—To be eligible to receive a 
grant under this section, a public or nonprofit entity 
described in this subsection shall prepare and submit 
to the Secretary an application in such form, and 
containing such information, as the Secretary shall 
require, including— 
‘‘(A) a complete accounting of the dis-
bursement of any prior grants received under 
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this subtitle by the applicant and the results 
achieved by these expenditures; 
‘‘(B) a comprehensive plan for the use of 
the grant, including a demonstration of the ex-
tent of local need for the funds sought and a 
plan for proposed substance use disorder treat-
ment services that is consistent with local 
needs; 
‘‘(C) a demonstration that the grantee will 
use funds in a manner that provides substance 
use disorder treatment services compliant with 
the evidence-based standards developed in ac-
cordance with section 3434, including all Feder-
ally-approved medication-assisted treatments; 
‘‘(D) information on the number of individ-
uals likely to be served by the funds sought, in-
cluding demographic data on the populations to 
be served; 
‘‘(E) an identification of key outcomes that 
will be measured by all entities that receive as-
sistance, as well as an explanation of how the 
outcomes will be measured; 
‘‘(F) a demonstration that resources pro-
vided under the grant will be allocated in ac-
cordance with the local demographic incidence 
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of substance use, including allocations for serv-
ices for children, youths, and women; 
‘‘(G) a demonstration that the confiden-
tiality of individuals receiving substance use dis-
order treatment services will be maintained in a 
manner not inconsistent with applicable law; 
and 
‘‘(H) an explanation of how income, asset, 
and medical expense criteria will be established 
and applied to those who qualify for assistance 
under the program. 
‘‘(c) REQUIREMENT OF STATUS AS MEDICAID PRO-
VIDER.— 
‘‘(1) PROVISION OF SERVICE.—Subject to para-
graph (2), the Secretary may not make a grant 
under this section for the provision of substance use 
disorder treatment services under this section in a 
State 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— 
‘‘(A) the political subdivision involved will 
provide the substance use disorder treatment 
service directly, and the political subdivision has 
entered into a participation agreement under 
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the State plan and is qualified to receive pay-
ments under such plan; or 
‘‘(B) the political subdivision involved will 
enter into an agreement with a public or non-
profit private entity under which the entity will 
provide the substance use disorder treatment 
service, and the entity has entered into such a 
participation agreement and is qualified to re-
ceive such payments. 
‘‘(2) WAIVER.— 
‘‘(A) IN GENERAL.—In the case of an enti-
ty making an agreement pursuant to paragraph 
(1)(B) regarding the provision of substance use 
disorder treatment services, the requirement es-
tablished in such paragraph shall be waived by 
the State if the entity does not, in providing 
such services, impose a charge or accept reim-
bursement available from any third-party payor, 
including reimbursement under any insurance 
policy or under any Federal or State health 
benefits program. 
‘‘(B) DETERMINATION.—A determination 
by the State of whether an entity referred to in 
subparagraph (A) meets the criteria for a waiv-
er under such subparagraph shall be made 
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without regard to whether the entity accepts 
voluntary donations for the purpose of pro-
viding services to the public. 
‘‘(d) AMOUNT OF GRANT TO NATIVE ENTITIES.— 
‘‘(1) INDIAN TRIBES.—In this section, the term 
‘Indian tribe’ has the meaning given such term in 
section 4 of the Indian Self-Determination and Edu-
cation Assistance Act. 
‘‘(2) FORMULA GRANTS.—The Secretary, acting 
through the Indian Health Service, shall use 10 per-
cent of the amount available under section 3425 for 
each fiscal year to provide grants to Native entities 
in an amount determined pursuant to criteria devel-
oped by the Secretary in consultation with Indian 
tribes, for the purposes of addressing substance use. 
‘‘(3) USE OF AMOUNTS.—Notwithstanding any 
requirements in this section, Native entities may use 
amounts provided under grants awarded under this 
section for the uses identified in section 3422 and 
any other activities determined appropriate by the 
Secretary, in consultation with Indian tribes. 
‘‘SEC. 3422. USE OF AMOUNTS. 
‘‘(a) USE OF FUNDS.—An entity shall use amounts 
received under a grant under section 3421 to provide di-
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rect financial assistance to eligible entities for the purpose 
of delivering or enhancing— 
‘‘(1) prevention services described in subsection 
(b); 
‘‘(2) core medical services described in sub-
section (c); 
‘‘(3) recovery and support services described in 
subsection (d); 
‘‘(4) early intervention and engagement services 
described in subsection (e); 
‘‘(5) harm reduction services described in sub-
section (f); and 
‘‘(6) administrative expenses described in sub-
section (g). 
‘‘(b) PREVENTION SERVICES.—For purposes of this 
subsection, the term ‘prevention services’ means services, 
programs, or multi-sector strategies to prevent substance 
use disorder, including evidence-based education cam-
paigns, community-based prevention programs, opioid di-
version, collection and disposal of unused opioids, and 
services to at-risk populations. 
‘‘(c) CORE MEDICAL SERVICES.—For purposes of 
this section, the term ‘core medical services’ means the 
following services when provided to individuals with sub-
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stance use disorder or at risk for developing substance use 
disorder: 
‘‘(1) Substance use disorder treatments, includ-
ing clinical stabilization services, withdrawal man-
agement and detoxification, intensive inpatient treat-
ment, intensive outpatient treatment, all forms of 
Federally-approved medication-assisted treatment, 
and residential recovery treatment. 
‘‘(2) Outpatient and ambulatory health services, 
including those administered by federally qualified 
health centers and rural health clinics. 
‘‘(3) Hospice services. 
‘‘(4) Mental health services. 
‘‘(5) Naloxone procurement, distribution, and 
training. 
‘‘(6) Pharmaceutical assistance and diagnostic 
testing related to the management of substance-use 
disorder and co-morbid conditions. 
‘‘(7) Home and community based health serv-
ices. 
‘‘(8) Comprehensive Case Management and care 
coordination, including treatment adherence services. 
‘‘(9) Health insurance enrollment and cost- 
sharing assistance in accordance with section 3412. 
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‘‘(d) RECOVERY AND SUPPORT SERVICES.—For pur-
poses of subsection (a)(3), the term ‘recovery and support 
services’ means services, subject to the approval of the 
Secretary, that are provided to individuals with substance 
use disorder, including residential recovery treatment and 
housing, including for individuals receiving medication-as-
sisted treatment, long term recovery services, 24/7 hotline 
services, medical transportation services, respite care for 
persons caring for individuals with substance use disorder, 
child care and family services while an individual is receiv-
ing inpatient treatment services or at the time of out-
patient services, outreach services, peer recovery services, 
nutrition services, and referrals for job training and career 
services, housing, legal services, and child care and family 
services. 
‘‘(e) 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 disorder treatment 
services, counseling provided to individuals who have mis-
used substances, who have experienced an overdose, or are 
at risk of developing substance use disorder and the provi-
sion of referrals to facilitate the access of such individuals 
to core medical services or recovery and support services. 
The entities through which such services may be provided 
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include emergency rooms, fire departments and emergency 
medical services, detention facilities, homeless shelters, 
law enforcement agencies, health care points of entry spec-
ified by eligible areas, Federally qualified health centers, 
and rural health clinics. 
‘‘(f) HARM REDUCTION SERVICES.—For purposes of 
this subsection, the term ‘harm reduction services’ means 
evidence-based services provided to individuals engaging in 
substance use that reduce the risk of infectious disease 
transmission, overdose, or death, including by increasing 
access to health care. 
‘‘(g) ADMINISTRATION AND PLANNING.—An entity 
shall not use in excess of 10 percent of amounts received 
under a grant under section 3421 for administration, ac-
counting, reporting, and program oversight functions, in-
cluding for the purposes of developing systems to improve 
data collection and data sharing. 
‘‘SEC. 3423. TECHNICAL ASSISTANCE. 
‘‘The Secretary may, directly or through grants or 
contracts, provide technical assistance to nonprofit private 
entities and Native entities regarding the process of sub-
mitting to the Secretary applications for grants under sec-
tion 3421, and may provide technical assistance with re-
spect to the planning, development, and operation of any 
program or service carried out pursuant to such section. 
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‘‘SEC. 3424. PLANNING AND DEVELOPMENT GRANTS. 
‘‘(a) IN GENERAL.—The Secretary may provide plan-
ning grants to public, nonprofit private, and Native enti-
ties for purposes of assisting such entities in expanding 
their capacity to provide substance use disorder treatment 
services in low-income communities and affected sub-
populations that are underserviced with respect to such 
services. 
‘‘(b) AMOUNT.—A grant under this section may be 
made in an amount not to exceed $150,000. 
‘‘SEC. 3425. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated to carry out 
this subtitle— 
‘‘(1) $500,000,000 for fiscal year 2019; 
‘‘(2) $500,000,000 for fiscal year 2020; 
‘‘(3) $500,000,000 for fiscal year 2021; 
‘‘(4) $500,000,000 for fiscal year 2022; 
‘‘(5) $500,000,000 for fiscal year 2023; 
‘‘(6) $500,000,000 for fiscal year 2024; 
‘‘(7) $500,000,000 for fiscal year 2025; 
‘‘(8) $500,000,000 for fiscal year 2026; 
‘‘(9) $500,000,000 for fiscal year 2027; and 
‘‘(10) $500,000,000 for fiscal year 2028. 
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‘‘Subtitle D—Miscellaneous 
Provisions 
‘‘SEC. 3431. SPECIAL PROJECTS OF NATIONAL SIGNIFI-
CANCE. 
‘‘(a) IN GENERAL.—The Secretary, acting in con-
sultation with the Director of the Office of National Drug 
Control Policy, shall award grants to entities to administer 
special projects of national significance to support the de-
velopment of innovative and original models for the deliv-
ery of substance use disorder treatment services. 
‘‘(b) GRANTS.—The Secretary shall award grants 
under a project under subsection (a) to entities eligible 
for grants under subtitles A, B, and C based on newly 
emerging needs of individuals receiving assistance under 
this title. 
‘‘(c) REPLICATION.—The Secretary shall make infor-
mation concerning successful models or programs devel-
oped under this section available to grantees under this 
title for the purpose of coordination, replication, and inte-
gration. To facilitate efforts under this subsection, the 
Secretary may provide for peer-based technical assistance 
for grantees funded under this section. 
‘‘(d) GRANTS TO TRIBAL GOVERNMENTS.— 
‘‘(1) INDIAN TRIBES.—In this section, the term 
‘Indian tribe’ has the meaning given such term in 
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section 4 of the Indian Self-Determination and Edu-
cation Assistance Act. 
‘‘(2) USE OF FUNDS.—The Secretary, acting 
through the Indian Health Service, shall use 10 per-
cent of the amount available under this section for 
each fiscal year to provide grants to Indian tribes 
for the purposes of supporting the development of 
innovative and original models for the delivery of 
substance use disorder treatment and services, in-
cluding the development of culturally-informed care 
models. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section— 
‘‘(1) $500,000,000 for fiscal year 2019; 
‘‘(2) $500,000,000 for fiscal year 2020; 
‘‘(3) $500,000,000 for fiscal year 2021; 
‘‘(4) $500,000,000 for fiscal year 2022; 
‘‘(5) $500,000,000 for fiscal year 2023; 
‘‘(6) $500,000,000 for fiscal year 2024; 
‘‘(7) $500,000,000 for fiscal year 2025; 
‘‘(8) $500,000,000 for fiscal year 2026; 
‘‘(9) $500,000,000 for fiscal year 2027; and 
‘‘(10) $500,000,000 for fiscal year 2028. 
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‘‘SEC. 3432. EDUCATION AND TRAINING CENTERS. 
‘‘(a) IN GENERAL.—The Secretary may make grants 
and enter into contracts to assist public and nonprofit pri-
vate entities, and schools, and academic health centers in 
meeting the cost of projects— 
‘‘(1) to train health personnel, including practi-
tioners in programs under this title and other com-
munity providers, including counselors, case man-
agers, social workers, peer recovery coaches, and 
harm reduction workers, in the diagnosis, treatment, 
and prevention of substance use disorders, including 
measures for the prevention and treatment of co-oc-
curring infectious diseases and other conditions, and 
including (as applicable to the type of health profes-
sional involved), care for women, pregnant women, 
and children; 
‘‘(2) to train the faculty of schools of medicine, 
nursing, public health, osteopathic medicine, den-
tistry, allied health, and mental health practice to 
teach health professions students to screen for and 
provide for the needs of individuals with substance 
use disorders or at risk of substance use; and 
‘‘(3) to develop and disseminate curricula and 
resource materials relating to evidence-based prac-
tices for the screening, prevention, and treatment of 
substance use disorders, including information about 
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prescribing best practices, alternative pain therapies, 
and Federally-approved medication-assisted treat-
ment options. 
‘‘(b) PREFERENCE IN MAKING GRANTS.—In making 
grants under subsection (a), the Secretary shall give pref-
erence to qualified projects that will— 
‘‘(1) train, or result in the training of, health 
professionals, including counselors, case managers, 
social workers, peer recovery coaches, and harm re-
duction workers, who will provide substance use dis-
order treatments for underserved groups, including 
minority individuals and Indians with substance use 
disorder and other individuals who are at a high risk 
of substance use; 
‘‘(2) train, or result in the training of, minority 
health professionals and minority allied health pro-
fessionals, including counselors, case managers, so-
cial workers, peer recovery coaches, and harm reduc-
tion workers, to provide substance use disorder 
treatment for individuals with such disease; 
‘‘(3) train or result in the training of individ-
uals, including counselors, case managers, social 
workers, peer recovery coaches, and harm reduction 
workers, who will provide substance use disorder 
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treatment in rural or other areas that are under-
served by current treatment structures; and 
‘‘(4) train or result in the training of health 
professionals and allied health professionals, includ-
ing counselors, case managers, social workers, peer 
recovery coaches, and harm reduction workers, to 
provide treatment for infectious diseases and mental 
health conditions co-occurring with substance use 
disorder. 
‘‘(c) NATIVE
EDUCATION
AND
TRAINING
CEN-
TERS.—The Secretary shall use 10 percent of the amount 
available under subsection (d) for each fiscal year to pro-
vide grants authorized under this subtitle to— 
‘‘(1) tribal colleges and universities; 
‘‘(2) Indian Health Service grant funded insti-
tutions; and 
‘‘(3) Native partner institutions, including insti-
tutions of higher education with medical training 
programs that partner with one or more Indian 
tribes, tribal organizations, Native Hawaiian organi-
zations, or tribal colleges and universities to train 
Native health professionals that will provide sub-
stance use disorder treatment services in Native 
communities. 
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‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section— 
‘‘(1) $400,000,000 for fiscal year 2019; 
‘‘(2) $400,000,000 for fiscal year 2020; 
‘‘(3) $400,000,000 for fiscal year 2021; 
‘‘(4) $400,000,000 for fiscal year 2022; 
‘‘(5) $400,000,000 for fiscal year 2023; 
‘‘(6) $400,000,000 for fiscal year 2024; 
‘‘(7) $400,000,000 for fiscal year 2025; 
‘‘(8) $400,000,000 for fiscal year 2026; 
‘‘(9) $400,000,000 for fiscal year 2027; and 
‘‘(10) $400,000,000 for fiscal year 2028. 
‘‘SEC. 3433. OTHER PROVISIONS. 
‘‘(a) MEDICATION-ASSISTED TREATMENT.—The Sec-
retary may not make a grant under this title unless the 
applicant for the grant agrees to require all entities offer-
ing substance use disorder treatment services under the 
grant to offer all Federally-approved forms of medication- 
assisted substance use treatment for the substance use 
disorders for which the applicant offers treatment. 
‘‘(b) WAIVER.—The Secretary may grant a waiver 
with respect to any requirement of this title if the grant 
applicant involved— 
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‘‘(1) submits to the Secretary a justification 
containing such information as the Secretary shall 
require; and 
‘‘(2) agrees to require all entities offering sub-
stance use disorder treatment services under the 
grant— 
‘‘(A) to offer at least two Federally-ap-
proved forms of medication-assisted treatment 
on site; 
‘‘(B) provide counseling to patients on the 
benefits and risks of all forms of Federally-ap-
proved medication-assisted treatments; and 
‘‘(C) maintain an affiliation with a pro-
vider that can prescribe or otherwise dispense 
all other forms of Federally-approved medica-
tion-assisted treatment. 
‘‘(c) GAO STUDY.—Not later than 1 year after the 
date of enactment of this title, the Comptroller General 
of the United States shall submit to Congress a com-
prehensive report describing any relationship between sub-
stance use rates, pain management practices of the Indian 
Health Service, and patient request denials through the 
purchased/referred care program of the Indian Health 
Service. 
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‘‘SEC. 3434. STANDARDS FOR SUBSTANCE USE DISORDER 
TREATMENT AND RECOVERY FACILITIES. 
‘‘(a) IN GENERAL.—Not later than 3 years after the 
date of enactment of this title, the Secretary, in consulta-
tion with the American Society of Addiction Medicine, 
shall promulgate model standards for the regulation of 
substance use disorder treatment services. 
‘‘(b) CONTENTS.—The model standards promulgated 
under subsection (a) shall— 
‘‘(1) identify the types of providers intended to 
be covered without regard to whether such providers 
participate in any Federal health care program (as 
defined in section 1128B(f) of the Social Security 
Act (42 U.S.C. 1320a–7b(f))) and shall not include 
a private practitioner who is already licensed by a 
State medical licensing board and whose practice is 
limited to outpatient care; 
‘‘(2) require that all substance use disorder 
treatment services be licensed by the respective 
States for the levels of care which they provide; 
‘‘(3) identify the professional credentials needed 
by each type of substance use disorder treatment 
professional; 
‘‘(4) require that patients have access to li-
censed substance use disorder treatment services, in-
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cluding health care providers and physicians, for in-
patient and outpatient care; 
‘‘(5) identify and develop strategies for States 
to ensure that all substance use disorder patients re-
ceive a medical assessment, including for co-occur-
ring mental health issues and infectious diseases; 
‘‘(6) require States to implement a process to 
ensure that residential treatment provider qualifica-
tions are verified by the single State agency serving 
as the primary regulator in the State for substance 
use disorder treatment services (as required in para-
graph (13)) or by an independent third party with 
the necessary competencies to use evidence-based pa-
tient placement assessment tools and nationally-rec-
ognized program standards, as applicable; 
‘‘(7) ensure that patients receiving substance 
use disorder treatment have access directly, by refer-
ral, or in such other manner as determined by the 
Secretary, to all Federally-approved medication-as-
sisted treatments for substance use disorder; 
‘‘(8) develop standards for data reporting and 
require compilation of Statewide reports; 
‘‘(9) develop standards for licensed providers to 
ensure all patients receive an outpatient treatment 
and discharge plan; 
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‘‘(10) develop standards for the certification of 
recovery residences that have an ongoing economic 
relationship with any commercial substance use dis-
order treatment service, including any relationship 
with any such service that includes receiving or mak-
ing referrals for substance use disorder treatment, 
including— 
‘‘(A) application, inspection, and renewal 
procedures for recovery residences; 
‘‘(B) fire, safety, and health standards; 
‘‘(C) standards for equipping residences 
with naloxone and training residence owners, 
operators, and employees in the administration 
of naloxone; 
‘‘(D) standards for recovery residence own-
ers and operators; and 
‘‘(E) standards to identify, disqualify from 
grant funding, and refer to the appropriate reg-
ulatory authority any entity engaged in the so-
liciting or receiving of a commission, benefit, 
bonus, rebate, kickback, or bribe, directly or in-
directly, in cash or in kind, or engaging in any 
split-fee arrangement, aimed at inducing the re-
ferral of a patient to or from a substance use 
disorder treatment service; 
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‘‘(11) establish a toll-free telephone number to 
handle complaints about recovery residences; 
‘‘(12) establish and maintain on a publicly ac-
cessible internet website a list of all recovery resi-
dences in the State that have a certification in effect 
in accordance with this section; 
‘‘(13) require the designation of a single State 
agency to serve as the primary regulator in the 
State for substance use disorder treatment services; 
‘‘(14) require a single State agency to imple-
ment a process to ensure that treatment provider as-
sessments for all substance use disorder treatment 
services, including levels of care and length-of-stay 
recommendations, are verified by an independent 
third party that has the necessary competencies to 
use evidence-based patient placement assessment 
tools and nationally-recognized program standards, 
as applicable; and 
‘‘(15) consider existing barriers to substance 
use disorder treatment and service access, including 
capacity and infrastructure needs, as well as access 
to culturally attuned services. 
‘‘(c) ANNUAL ASSESSMENT.—Beginning with respect 
to fiscal year 2021, the Secretary shall make a determina-
tion with respect to each State on whether the State has 
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adopted the model standards promulgated in accordance 
with this section. 
‘‘(d) QUALITY MEASURES.—The Secretary shall en-
gage a nonprofit, non-partisan standards development and 
quality measurement organization to convene government 
regulators, State representatives, consumer representa-
tives, substance use disorder treatment providers, recovery 
residence owners and operators, and purchasers of sub-
stance use disorder treatments exercising leadership in 
quality-based purchasing to develop and annually revise 
a set of health care quality measures for substance use 
disorder treatment providers and owners and operators of 
recovery residences. 
‘‘SEC. 3435. NALOXONE DISTRIBUTION PROGRAM. 
‘‘(a) ESTABLISHMENT OF PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
for the purchase and delivery of Federally-approved 
opioid overdose reversal drug products on behalf of 
each State (or Indian tribe as defined in section 4 
of the Indian Health Care Improvement Act) that 
receives a grant under subtitle B. This paragraph 
constitutes budget authority in advance of appro-
priations Acts, and represents the obligation of the 
Federal Government to provide for the purchase and 
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delivery to States of the opioid overdose reversal 
drug products in accordance with this paragraph. 
‘‘(2) SPECIAL RULES WHERE OPIOID OVERDOSE 
REVERSAL DRUG PRODUCTS ARE UNAVAILABLE.—To 
the extent that a sufficient quantity of opioid over-
dose reversal drug products are not available for 
purchase or delivery under paragraph (1), the Sec-
retary shall provide for the purchase and delivery of 
the available opioid overdose reversal drug products 
in accordance with priorities established by the Sec-
retary, with priority given to States with at least one 
local area eligible for funding under section 3401(a). 
‘‘(b) NEGOTIATION OF CONTRACTS WITH MANUFAC-
TURERS.— 
‘‘(1) IN
GENERAL.—For the purpose of car-
rying out this section, the Secretary shall negotiate 
and enter into contracts with manufacturers of 
opioid overdose reversal drug products consistent 
with the requirements of this subsection and, to the 
maximum extent practicable, consolidate such con-
tracting with any other contracting activities con-
ducted by the Secretary to purchase opioid overdose 
reversal drug products. The Secretary may enter 
into such contracts under which the Federal Govern-
ment is obligated to make outlays, the budget au-
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