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 effi-
cient 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. OCASIO- 
CORTEZ, 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 Pennsyl-
vania, Mr. HUFFMAN, Mr. LARSON of Connecticut, Mr. THOMPSON of 
California, Mr. GARCI´A of Illinois, Mr. TONKO, Mr. CARSON, Mr. CART-
WRIGHT, Mr. DANNY K. DAVIS of Illinois, Mr. MORELLE, Ms. BASS, Mrs. 
WATSON COLEMAN, Mr. MEEKS, Mrs. DINGELL, Mr. JOHNSON of Geor-
gia, 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 En-
ergy and Commerce, and in addition to the Committees on Natural Re-
sources, the Judiciary, and Oversight and Reform, for a period to be sub-
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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 dis-
order, including the use of opioids and stimulants, and 
to make financial assistance available to States, terri-
tories, Tribal nations, local areas, public or private non-
profit entities, and certain health providers, to provide 
for the development, organization, coordination, and op-
eration of more effective and cost efficient systems for 
the delivery of essential services to individuals with sub-
stance use disorder and their families. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Comprehensive Addiction Resources Emergency Act of 
2021’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
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. 
SEC. 2. PURPOSE. 
It is the purpose of this Act to provide emergency 
assistance to States, territories, Tribal nations, and local 
areas that are disproportionately affected substance use 
disorder, including the use of opioids and stimulants, and 
to make financial assistance available to States, terri-
tories, Tribal nations, local areas, public or private non-
profit entities, and certain health providers, to provide for 
the development, organization, coordination, and operation 
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of more effective and cost efficient systems for the delivery 
of essential services to individuals with substance use dis-
order, including with co-occurring mental health and sub-
stance use disorders, and their families. 
SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following: 
‘‘TITLE XXXIV—SUBSTANCE USE 
RESOURCES 
‘‘Subtitle A—Local Substance Use 
Emergency Relief Grant Program 
‘‘SEC. 3401. ESTABLISHMENT OF PROGRAM OF GRANTS. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to eligible localities for the purpose of addressing 
substance use within such localities. 
‘‘(b) ELIGIBILITY.— 
‘‘(1) IN GENERAL.—To be eligible to receive a 
grant under subsection (a) a locality shall— 
‘‘(A) be— 
‘‘(i) a county that can demonstrate 
that the rate of drug overdose deaths per 
100,000 population in the county during 
the most recent 3-year period for which 
such data are available was not less than 
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the rate of such deaths for the county that 
ranked at the 67th percentile of all coun-
ties, as determined by the Secretary; 
‘‘(ii) a county that can demonstrate 
that the number of drug overdose deaths 
during the most recent 3-year period for 
which such data are available was not less 
than the number of such deaths for the 
county that ranked at the 90th percentile 
of all counties, as determined by the Sec-
retary; 
‘‘(iii) a county that encompasses an 
undeserved area, defined as a health pro-
fessional shortage area (as defined in sec-
tion 332(a)(1)(A)) and a medically under-
served area (according to a designation 
under section 330(b)(3)(A)), that can dem-
onstrate a high burden of both fatal and 
non-fatal drug overdoses in a manner de-
termined by the Secretary; or 
‘‘(iv) a city that is located within a 
county described in clause (i), (ii), or (iii) 
that meets the requirements of paragraph 
(3); and 
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‘‘(B) submit to the Secretary an applica-
tion in accordance with section 3404. 
‘‘(2) MULTIPLE
CONTIGUOUS
COUNTIES.—In 
the case of an eligible county that is contiguous to 
one or more other eligible counties within the same 
State, the group of counties shall— 
‘‘(A) be considered as a single eligible 
county for purposes of a grant under this sec-
tion; 
‘‘(B) submit a single application under sec-
tion 3404; 
‘‘(C) form a joint planning council (for the 
purposes of section 3402); and 
‘‘(D) establish, through intergovernmental 
agreements, an administrative mechanism to al-
locate funds and substance use disorder treat-
ment services under the grant based on— 
‘‘(i) the number and rate of drug 
overdose 
deaths 
and 
nonfatal 
drug 
overdoses in each of the counties that com-
pose the eligible county; 
‘‘(ii) the severity of need for services 
in each such county; and 
‘‘(iii) the health and support per-
sonnel needs of each such county. 
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‘‘(3) CITIES AND COUNTIES WITHIN MULTIPLE 
CONTIGUOUS COUNTIES.— 
‘‘(A) IN GENERAL.—A city that is within 
an eligible county described in paragraph (1), 
or a county or group of counties that is within 
a group of counties determined to be an eligible 
county under paragraph (2), shall be eligible to 
receive a grant under section 3401 if such city 
or county or group of counties meets the re-
quirements of subparagraph (B). 
‘‘(B) REQUIREMENTS.—A city or county 
meets the requirements of this subparagraph if 
such city or county— 
‘‘(i) except as provided in subpara-
graph (C), has a population of not less 
than 50,000 residents; 
‘‘(ii) meets the requirements of para-
graph (1)(A); 
‘‘(iii) submits an application under 
section 3404; 
‘‘(iv) establishes a planning council 
(for purposes of section 3402); and 
‘‘(v) establishes an administrative 
mechanism to allocate funds and services 
under the grant based on— 
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‘‘(I) the number and rate of drug 
overdose deaths and nonfatal drug 
overdoses in the city or county; 
‘‘(II) the severity of need for sub-
stance use disorder treatment services 
in the city or county; and 
‘‘(III) the health and support 
personnel needs of the city or county. 
‘‘(C) POPULATION EXCEPTION.—A city or 
county or group of counties that does not meet 
the requirements of subparagraph (B)(i) may 
apply to the Secretary for a waiver of such re-
quirement. 
Such 
application 
shall 
dem-
onstrate— 
‘‘(i) that the needs of the population 
to be served are distinct or that addressing 
substance use in the service area would be 
best served by the formation of an inde-
pendent council; and 
‘‘(ii) that the city or county or group 
of counties has the capacity to administer 
the funding received under this subtitle. 
‘‘(D) MINIMUM FUNDING.—A city or coun-
ty that meets the requirement of this paragraph 
and receives a grant under section 3401 shall 
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be entitled to an amount of funding under the 
grant in an amount that is not less than the 
amount determined under section 3403(a) with 
respect to such city or county. 
‘‘(4) INDEPENDENT CITY.—Independent cities 
that are not located within the territory of a county 
shall be treated as eligible counties for purposes of 
this subtitle. 
‘‘(5) POLITICAL
SUBDIVISIONS.—With respect 
to States that do not have a local county system of 
governance, the Secretary shall determine the local 
political subdivisions within such States that are eli-
gible to receive a grant under section 3401 and such 
subdivisions shall be treated as eligible counties for 
purposes of this subtitle. 
‘‘(6) DETERMINATIONS
WHERE
THERE
IS
A 
LACK OF DATA.—The Secretary shall establish eligi-
bility and allocation criteria related to the prevalence 
of drug overdose deaths, the mortality rate from 
drug overdoses, and that provides an equivalent 
measure of need for funding for cities and counties 
for which the data described in paragraph (1)(A) or 
(2)(D)(i) is not available. 
‘‘(7) DATA
FROM
TRIBAL
AREAS.—The Sec-
retary, acting through the Indian Health Service, 
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shall consult with Indian Tribes and confer with 
urban Indian organizations to establish eligibility 
and allocation criteria that provide an equivalent 
measure of need for Tribal and urban Indian areas 
for which the data described in paragraph (1)(A) or 
(2)(D)(i) are not available or do not apply. 
‘‘(8) STUDY.—Not later than 3 years after the 
date of enactment of this title, the Comptroller Gen-
eral shall conduct a study to determine whether the 
data utilized for purposes of paragraph (1)(A) pro-
vide the most precise measure of local area need re-
lated to substance use and addiction prevalence 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 rec-
ommendations for revising the indicators used under 
such paragraph to determine eligibility in order to 
direct funds to the local areas in most need of fund-
ing to provide assistance related to substance use 
and addiction. 
‘‘(9) REFERENCE.—For purposes of this sub-
title, the term ‘eligible local area’ includes— 
‘‘(A) a city or county described in para-
graph (1); 
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described in subsection (b)(2) may elect to des-
ignate the chief elected State official of the 
State in which the eligible county is located as 
the administrator of the grant funds. 
‘‘SEC. 3402. PLANNING COUNCIL. 
‘‘(a) ESTABLISHMENT.—To be eligible to receive a 
grant under section 3401, the chief elected official of the 
eligible local area shall establish or designate a substance 
use disorder treatment and services planning council that 
shall, to the maximum extent practicable— 
‘‘(1) be representative of the demographics of 
the population of individuals with substance use dis-
order in the area; and 
‘‘(2) include representatives of— 
‘‘(A) health care providers, including Fed-
erally-qualified health centers, rural health clin-
ics, Indian health programs as defined in sec-
tion 4 of the Indian Health Care Improvement 
Act, urban Indian organizations as defined in 
section 4 of the Indian Health Care Improve-
ment Act, and facilities operated by the Depart-
ment of Veterans Affairs; 
‘‘(B) Native Hawaiian organizations as de-
fined in section 11 of the Native Hawaiian 
Health Care Act of 1988; 
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‘‘(C) community-based health, harm reduc-
tion, or addiction service organizations, includ-
ing, where applicable, representatives of Drug 
Free Communities Coalition grantees; 
‘‘(D) social service providers, including 
providers of housing and homelessness services 
and recovery residence providers; 
‘‘(E) mental health care providers; 
‘‘(F) local public health agencies; 
‘‘(G) individuals with substance use dis-
order and individuals who use drugs; 
‘‘(H) individuals in recovery from sub-
stance use disorders; 
‘‘(I) State governments, including the 
State Medicaid agency and the Single State 
Agency for Substance Abuse Services; 
‘‘(J) local governments; 
‘‘(K) non-elected community leaders; 
‘‘(L) substance use disorder treatment pro-
viders, including physician addiction specialists; 
‘‘(M) Indian tribes and tribal organizations 
as defined in section 4 of the Indian Self-Deter-
mination and Education Assistance Act; 
‘‘(N) Urban Indians as defined in section 
4 of the Indian Health Care Improvement Act; 
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‘‘(O) historically underserved groups and 
subpopulations; 
‘‘(P) individuals who were formerly incar-
cerated; 
‘‘(Q) organizations serving individuals who 
are currently incarcerated or in pre-trial deten-
tion or were formerly incarcerated; 
‘‘(R) Federal agencies; 
‘‘(S) organizations that provide drug pre-
vention programs and services to youth at risk 
of substance use; 
‘‘(T) medical examiners or coroners; 
‘‘(U) labor unions and the workplace com-
munity; 
‘‘(V) local fire departments and emergency 
medical services; 
‘‘(W) 
the 
lesbian, 
gay, 
bisexual, 
transgender, queer (LGBTQ) community; and 
‘‘(X) certified or accredited addiction re-
covery community organizations. 
‘‘(b) METHOD OF PROVIDING FOR COUNCIL.— 
‘‘(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-
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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 organizations. 
‘‘(3) DESIGNATION
OF
EXISTING
ENTITY.—If 
an existing entity is designated to serve as the coun-
cil under this section, the membership of the entity 
shall comply with the requirements of subsection 
(a)(1) before it performs any of the duties set forth 
in subsection (e). 
‘‘(4) 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 
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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 
determined by the Secretary, and submit a joint ap-
plication under section 3404. 
‘‘(5) 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; 
‘‘(4) include at least 1 individual with a history 
of substance use disorder; 
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‘‘(5) include at least 1 representative from a 
nonprofit substance use disorder service provider, at 
least 1 representative of an urban Indian organiza-
tion, at least 1 physician addiction specialist, and at 
least 1 representative from an organization pro-
viding harm reduction services; 
‘‘(6) include at least 1 representative of a Na-
tive Hawaiian organization (as defined in section 11 
of the Native Hawaiian Health Care Act of 1988) 
when the Native Hawaiian population exceeds 10 
percent; and 
‘‘(7) serve not more than 3 consecutive years on 
the planning council. 
‘‘(d) MEMBERSHIP TERMS.—Members of the plan-
ning council established or designated under subsection 
(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 use rates, overdose, substance 
use disorder, and health conditions associated with 
drug use such as human immunodeficiency virus, 
hepatitis B, and hepatitis C through evidence-based 
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and priorities, including by partnering with organi-
zations that serve targeted communities experiencing 
high addictive substance-related health disparities to 
gather data using culturally attuned data collection 
methodologies; 
‘‘(9) coordinate with Federal grantees that pro-
vide substance use disorder prevention and treat-
ment services within the eligible local area; and 
‘‘(10) annually assess the effectiveness of the 
substance use disorder prevention and treatment 
services being supported by the grant received by the 
eligible local area, including, to the extent possible— 
‘‘(A) reductions in the rates of substance 
use, overdose, and death from substance use; 
‘‘(B) rates of discontinuation from sub-
stance use disorder treatment services and rates 
of sustained recovery; 
‘‘(C) long-term outcomes among individ-
uals receiving treatment for substance use dis-
orders; and 
‘‘(D) the availability and use of substance 
use disorder treatment services needed by indi-
viduals with substance use disorders over their 
lifetimes. 
‘‘(f) CONFLICTS OF INTEREST.— 
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‘‘(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-
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: 
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‘‘(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. 
‘‘(i) NEUTRALITY TOWARDS ORGANIZED LABOR.— 
‘‘(1) IN
GENERAL.—In carrying out duties 
under subsection (e), planning councils shall, to the 
extent practicable, prioritize the distribution of grant 
funds to grantees that have— 
‘‘(A)(i) a collective bargaining agreement; 
or 
‘‘(ii) an explicit policy not to deter employ-
ees with respect to— 
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‘‘(I) labor organizing for the employ-
ees engaged in the covered activities; and 
‘‘(II) such employees’ choice to form 
and join labor organizations; and 
‘‘(B) policies that require— 
‘‘(i) the posting and maintenance of 
notices in the workplace to such employees 
of their rights under the National Labor 
Relations Act (29 U.S.C. 151 et seq.); 
‘‘(ii) that such employees are, at the 
beginning of their employment, provided 
notice and information regarding the em-
ployees’ rights under such Act; and 
‘‘(iii) the employer to voluntarily rec-
ognize a union in cases where a majority 
of such workers of the employer have 
joined and requested representation. 
‘‘(2) LIMITATION.—This subsection does not 
apply to Indian tribes. 
‘‘SEC. 3403. AMOUNT OF GRANT, USE OF AMOUNTS, AND 
FUNDING AGREEMENT. 
‘‘(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) are 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, 
other emergency medical services for drug- 
related causes, or Overdose Detection Map-
ping Application Program (ODMAP) data 
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-
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ing the distribution factors used under 
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 paragraph (1)(A) or (6) of 
section 3401(b), such area will remain eli-
gible 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 
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 
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counties 
whose 
application 
under 
section 
3404— 
‘‘(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 preventing, 
treating, and managing substance use dis-
order and supporting sustained recovery; 
‘‘(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 
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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 
State plan approved by the Secretary pur-
suant to section 1932(b); 
‘‘(viii) demonstrates success in identi-
fying individuals with substance use dis-
orders; and 
‘‘(ix) demonstrates that support for 
substance use disorder prevention and 
treatment services is organized to maxi-
mize the value to the population to be 
served with an appropriate mix of sub-
stance use disorder prevention and 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-
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retary. In making such determination, the 
Secretary shall consider— 
‘‘(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, or 
recent increases in drug overdoses or 
drug overdose deaths since data were 
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). 
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‘‘(II) Relative rates of increase in 
the number of drug overdoses or drug 
overdose deaths. 
‘‘(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 
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health insurance coverage, and lan-
guage barriers. 
‘‘(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. 
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‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN-
MENTS.— 
‘‘(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
FUNDS.—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 funds 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) PAYMENT OF FUNDS.—At the option 
of an Indian tribe the Secretary shall pay funds 
under this section through a contract, coopera-
tive agreement, or compact under, as applicable, 
title I or V of the Indian Self-Determination 
and Education Assistance Act. 
‘‘(D) USE OF AMOUNTS.—Notwithstanding 
any requirements in this section, an Indian 
tribe may use amounts provided under funds 
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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. An Indian tribe 
shall not be required to allocate funds and serv-
ices in accordance with the goals, priorities, or 
objectives established by a planning council 
under section 3402. 
‘‘(b) USE OF AMOUNTS.— 
‘‘(1) REQUIREMENTS.—The Secretary may not 
make a grant under section 3401 to an eligible local 
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 
planning 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); 
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‘‘(iv) early intervention services de-
scribed 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 (9). 
‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 
‘‘(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 or providers for the pur-
pose of providing prevention services, core med-
ical services, recovery and support services, 
early intervention services, and harm reduction 
services. 
‘‘(B) APPROPRIATE ENTITIES.—Direct fi-
nancial assistance may be provided under sub-
paragraph (A) to public or nonprofit entities, 
other eligible Medicaid providers if more than 
half of their patients are diagnosed with a sub-
stance use disorder and covered by Medicaid, or 
other private for-profit entities if such entities 
are the only available provider of quality sub-
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stance use disorder treatment services in the 
area. 
‘‘(C) LIMITATION.—An eligible local area 
(not including tribal areas) may not provide di-
rect financial assistance to any entity or pro-
vider that provides medication for addiction 
treatment if that entity or provider does not 
also offer mental health services or psycho-
therapy by licensed clinicians through a referral 
or onsite. 
‘‘(D) NEUTRALITY
TOWARDS
ORGANIZED 
LABOR.— 
‘‘(i) IN
GENERAL.—In carrying out 
duties under this section, eligible local 
areas shall, to the extent practicable, 
prioritize the distribution of grant funds to 
grantees that have— 
‘‘(I)(aa) a collective bargaining 
agreement; or 
‘‘(bb) an explicit policy not to 
deter employees with respect to— 
‘‘(AA) labor organizing for 
the employees engaged in the 
covered activities; and 
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‘‘(BB) 
such 
employees’ 
choice to form and join labor or-
ganizations; and 
‘‘(II) policies that require— 
‘‘(aa) the posting and main-
tenance of notices in the work-
place to such employees of their 
rights under the National Labor 
Relations Act (29 U.S.C. 151 et 
seq.); 
‘‘(bb) that such employees 
are, at the beginning of their em-
ployment, provided notice and in-
formation regarding the employ-
ees’ rights under such Act; and 
‘‘(cc) the employer to volun-
tarily recognize a union in cases 
where a majority of such workers 
of the employer have joined and 
requested representation. 
‘‘(ii) LIMITATION.—This subsection 
does not apply to Indian tribes. 
‘‘(3) PREVENTION SERVICES.— 
‘‘(A) IN GENERAL.—For purposes of this 
section, the term ‘prevention services’ means 
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evidence-based services, programs, or multi-sec-
tor strategies to prevent substance use disorder 
(including education campaigns, community- 
based prevention programs, risk identification 
programs, opioid diversion, collection and dis-
posal of unused opioids, services to at-risk pop-
ulations, and trauma support services). 
‘‘(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 section, 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, including 
through the use of telemedicine or a hub and spoke 
model: 
‘‘(A) Substance use disorder treatments, as 
more fully described in section 3439, including 
assessment of disease presence, severity, and 
co-occurring conditions, treatment planning, 
clinical stabilization services, withdrawal man-
agement and detoxification, intensive inpatient 
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treatment, intensive outpatient treatment, out-
patient treatment, residential inpatient services, 
treatment for co-occurring mental health and 
substance use disorders, and all drugs approved 
by the Food and Drug Administration for the 
treatment of substance use disorder. 
‘‘(B) Outpatient and ambulatory health 
services, including those administered by Feder-
ally-qualified health centers, rural health clinics, 
tribal clinics and hospitals, urban Indian orga-
nizations, certified community behavioral health 
clinics (as described in section 223 of the Pro-
tecting Access to Medicare Act), Native Hawai-
ian organizations (as defined in section 11 of 
the Native Hawaiian Health Care Act of 1988), 
and comprehensive opioid recovery centers (as 
described in section 552 of this Act). 
‘‘(C) Hospice services. 
‘‘(D) Mental health services. 
‘‘(E) Opioid overdose reversal drug prod-
ucts procurement, distribution, and training. 
‘‘(F) Pharmaceutical assistance and diag-
nostic testing related to the management of 
substance use disorders and co-morbid condi-
tions. 
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‘‘(G) Home- and community-based health 
services. 
‘‘(H) Comprehensive Case Management 
and care coordination, including substance use 
disorder treatment adherence services. 
‘‘(I) Health insurance enrollment and cost- 
sharing assistance in accordance with para-
graph (8). 
‘‘(J) Programs that hire, employ, train, 
and dispatch licensed health care professionals, 
mental health professionals, harm reduction 
providers, or community health workers to re-
spond in lieu of law enforcement officers in 
emergencies and that ensure a licensed health 
care professional is a member of the team that 
responds in lieu of law enforcement officers in 
emergencies in which— 
‘‘(i) an individual calling 911, the Na-
tional Suicide Hotline, or another emer-
gency hotlines states that a person is expe-
riencing a drug overdose or is otherwise 
under the influence of a legal or illegal 
substance; or 
‘‘(ii) a law enforcement officer, other 
first responder, or other individual identi-
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fies a person as being (or possibly being) 
under the influence of a legal or illegal 
substance. 
‘‘(5) RECOVERY AND SUPPORT SERVICES.—For 
purposes of this section, the term ‘recovery and sup-
port services’ means services that are provided to in-
dividuals with substance use disorder, including resi-
dential recovery housing, mental health services, 
long term recovery services, 24/7 hotline crisis center 
support, medical transportation services, respite care 
for persons caring for individuals with substance use 
disorder, child care and family services while an in-
dividual is receiving inpatient treatment services or 
at the time of outpatient services, outreach services, 
peer recovery services, nutrition services, and refer-
rals for job training and career services, housing, 
legal services, and child care and family services. 
The entities through which such services may be 
provided include local and tribal authorities that 
provide child care, housing, community development, 
and other recovery and support services, so long as 
they do not exclude individuals on the basis that 
such individuals receive medication for addiction 
treatment. 
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‘‘(6) EARLY
INTERVENTION
SERVICES.—For 
purposes of this section, the term ‘early intervention 
services’ means services to provide screening and 
connection to the appropriate level of substance use 
disorder and mental health treatment (including 
same-day connection), counseling provided to indi-
viduals who have misused substances, who have ex-
perienced an overdose, or are at risk of developing 
substance use disorder, the provision of referrals to 
facilitate the access of such individuals to core med-
ical services or recovery and support services for 
substance use disorder, and rapid access to medica-
tion for addiction treatment in the setting of recent 
overdose. The entities through which such services 
may be provided include emergency rooms, fire de-
partments and emergency medical services, detention 
facilities, prisons and jails, homeless shelters, health 
care points of entry specified by eligible local areas, 
Federally-qualified health centers, workforce agen-
cies and job centers, youth development centers, 
tribal clinics and hospitals, urban Indian organiza-
tions, and rural health clinics. 
‘‘(7) HARM REDUCTION SERVICES.—For pur-
poses of this section, the term ‘harm reduction serv-
ices’ means services provided to individuals engaging 
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in substance use scientifically accepted to reduce the 
risk of infectious disease transmission, overdose, or 
death, including by increasing access to health care, 
housing, and recovery and support services, includ-
ing syringe services programs. Such term includes 
evidence-based services. 
‘‘(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) ADMINISTRATION AND PLANNING.—An eli-
gible local area (not including tribal areas) shall not 
use in excess of 15 percent of amounts received 
under a grant under section 3401 for administra-
tion, accounting, reporting, and program oversight 
functions, including the development of systems to 
improve data collection and data sharing, in the first 
year of receiving the grant, and shall not use in ex-
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cess of 10 percent of amounts received under a 
grant under section 3401 for such activities in sub-
sequent years. 
‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 
received under a grant under section 3401 may be 
used to provide substance use disorder treatment 
services, including medication for addiction treat-
ment, to individuals who are currently incarcerated 
or in pre-trial detention. 
‘‘(c) REQUIRED TERMS.— 
‘‘(1) REQUIREMENT OF STATUS AS MEDICAID 
PROVIDER.— 
‘‘(A) PROVISION OF SERVICE.—Subject to 
subparagraph (B), 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 
political subdivision has entered into a par-
ticipation agreement under the State plan 
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and is qualified to receive payments under 
such plan; or 
‘‘(ii) the eligible local area involved— 
‘‘(I) will enter into agreements 
with public or nonprofit entities, or 
other Medicaid providers if more than 
half of their patients are diagnosed 
with a substance use disorder and 
covered by Medicaid, under which 
such entities and other providers will 
provide the service, and such entities 
and other providers have entered into 
such a participation agreement and 
are qualified to receive such pay-
ments; and 
‘‘(II) demonstrates that it will 
ensure that such entities and other 
providers providing the service will 
seek payment for each such service 
rendered in accordance with the usual 
payment schedule under the State 
plan. 
‘‘(B) WAIVER.— 
‘‘(i) IN GENERAL.—In the case of an 
entity making an agreement pursuant to 
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subparagraph (A)(ii) regarding the provi-
sion of substance use disorder treatment 
services, the requirement established in 
such subparagraph shall be waived by the 
substance use planning council for the area 
involved if the entity does not, in providing 
health care services, impose a charge or ac-
cept reimbursement available from any 
third-party payor, including reimbursement 
under any insurance policy or under any 
Federal or State health benefits program. 
A waiver under this subparagraph shall 
not be longer than 2 years in duration and 
shall not be renewed. 
‘‘(ii) DETERMINATION.—A determina-
tion by the substance use planning council 
of whether an entity referred to in clause 
(i) meets the criteria for a waiver under 
such clause shall be made without regard 
to whether the entity accepts voluntary do-
nations for the purpose of providing serv-
ices to the public. 
‘‘(2) REQUIRED TERMS FOR EXPANDING AND 
IMPROVING CARE.—A funding agreement for a grant 
under this section shall— 
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‘‘(A) ensure that funds received under the 
grant will not be utilized to make payments for 
any item or service to the extent that payment 
has been made, or can reasonably be expected 
to be made, with respect to that item or service 
under a State compensation program, under an 
insurance policy, or under any Federal or State 
health benefits program (except for a program 
administered by, or providing the services of, 
the Indian Health Service); and 
‘‘(B) ensure that all entities providing sub-
stance use disorder treatment services with as-
sistance made available under the grant offer 
all drugs approved by the Food and Drug Ad-
ministration for the treatment of substance use 
disorder for which the applicant offers treat-
ment, in accordance with section 3435. 
‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund-
ing agreement for a grant under this section is 
that— 
‘‘(A) funds received under the grant will be 
utilized to supplement not supplant other Fed-
eral, State, or local funds made available in the 
year for which the grant is awarded to provide 
substance use disorder treatment services to in-
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dividuals with substance use disorder, including 
funds for each of prevention services, core med-
ical services, recovery and support services, 
early intervention services, harm reduction serv-
ices, mental health services, and administrative 
expenses; 
‘‘(B) political subdivisions within the eligi-
ble local area will maintain the level of expendi-
tures by such political subdivisions for sub-
stance use disorder treatment services at a level 
that is at least equal to the level of such ex-
penditures by such political subdivisions for the 
preceding fiscal year, including expenditures for 
each of prevention services, core medical serv-
ices, recovery and support services, early inter-
vention services, harm reduction services, men-
tal health services, and administrative expenses; 
‘‘(C) political subdivisions within the eligi-
ble local area will not use funds received under 
a grant awarded under section 3401 in main-
taining the level of substance use disorder treat-
ment services as required in subparagraph (B); 
‘‘(D) substance use disorder treatment 
services provided with assistance made available 
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under the grant will be provided without re-
gard— 
‘‘(i) to the ability of the individual to 
pay for such services; and 
‘‘(ii) to the current or past health con-
dition of the individual to be served; 
‘‘(E) substance use disorder treatment 
services will be provided in a setting that is ac-
cessible to low-income individuals with sub-
stance use disorders and to individuals with 
substance use disorders residing in rural areas; 
‘‘(F) a program of outreach will be pro-
vided to low-income individuals with substance 
use disorders to inform such individuals of sub-
stance use disorder treatment services and to 
individuals with substance use disorders resid-
ing in rural areas; 
‘‘(G) Indian tribes are included in planning 
for the use of grant funds and the Federal trust 
responsibility is upheld at all levels of program 
administration; and 
‘‘(H) the confidentiality of individuals re-
ceiving substance use disorder treatment serv-
ices will be maintained in a manner not incon-
sistent with applicable law. 
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‘‘SEC. 3404. APPLICATION. 
‘‘(a) APPLICATION.—To be eligible to receive a grant 
under section 3401, an eligible local area shall prepare and 
submit to the Secretary an application in such form, and 
containing such information, as the Secretary shall re-
quire, including— 
‘‘(1) a complete accounting of the disbursement 
of any prior grants received under this subtitle by 
the applicant and the results achieved by these ex-
penditures and a demonstration that funds received 
from a grant under this subtitle in the prior year 
were expended in accordance with local priorities de-
veloped by the local planning council established 
under section 3402, except that the planning council 
requirement shall not apply with respect to areas re-
ceiving supplemental grant funds under section 
3403(a)(2); 
‘‘(2) establishment of goals and objectives to be 
achieved with grant funds provided under this sub-
title, including targets and milestones that are in-
tended to be met, the activities that will be under-
taken to achieve those targets, the number of indi-
viduals likely to be served by the funds sought, in-
cluding demographic data on the populations to be 
served, and an explanation of how these goals and 
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objectives advance the State plan approved by the 
Secretary pursuant to section 1932(b); 
‘‘(3) a demonstration that the local area will 
use funds in a manner that provides substance use 
disorder treatment services in compliance with the 
evidence-based standards developed in accordance 
with section 3435, including providing all drugs ap-
proved by the Food and Drug Administration for the 
treatment of substance use disorder; 
‘‘(4) a demonstration that resources provided 
under the grant will be allocated in accordance with 
the local demographic incidence of substance use, in-
cluding allocations for services for children, youths, 
and women; 
‘‘(5) an explanation of how income, asset, and 
medical expense criteria will be established and ap-
plied to those who qualify for assistance under the 
program; 
‘‘(6) where practical, an explanation of how an 
eligible local area shall coordinate with local public 
health departments in the distribution of funding; 
and 
‘‘(7) for any prior funding received under this 
section, data provided in such form as the Secretary 
shall require detailing, at a minimum, the extent to 
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which the activities supported by the funding met 
the goals and objectives specified in the application 
for the funding, the number of individuals who 
accessed medication for treatment by age, gender, 
sexual orientation, race, disability status, and other 
demographic criteria relevant to the program, and 
the effect of the program on overdose rates and 
rates of death due to overdose in the local area 
served by the program. 
‘‘(b) REQUIREMENTS REGARDING IMPOSITION
OF 
CHARGES FOR SERVICES.— 
‘‘(1) IN
GENERAL.—The Secretary may not 
make a grant under section 3401 to an eligible local 
area unless the eligible local area provides assur-
ances that in the provision of substance use disorder 
treatment services with assistance provided under 
the grant— 
‘‘(A) in the case of individuals with an in-
come less than or equal to 150 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 150 percent of the official 
poverty level, the provider will impose a charge 
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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 150 percent of the official 
poverty level but not exceeding 200 percent of 
such poverty level, the provider will not, for any 
calendar year, impose charges in an amount ex-
ceeding 2 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 250 percent of 
such poverty level, the provider will not, for any 
calendar year, impose charges in an amount ex-
ceeding 4 percent of the annual gross income of 
the individual involved; 
‘‘(E) in the case of individuals with an in-
come greater than 250 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-
ceeding 6 percent of the annual gross income of 
the individual involved; 
‘‘(F) in the case of individuals with an in-
come greater than 300 percent of the official 
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poverty level but not exceeding 400 percent of 
such poverty level, the provider will not, for any 
calendar year, impose charges in an amount ex-
ceeding 8.5 percent of the annual gross income 
of the individual involved; 
‘‘(G) in the case of individuals with an in-
come greater than 400 percent of the official 
poverty level, the provider will not, for any cal-
endar year, impose charges in an amount ex-
ceeding 8.5 percent of the annual gross income 
of the individual involved; and 
‘‘(H) 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), an 
eligible local area may, in the case of individuals 
subject to a charge— 
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‘‘(A) assess the amount of the charge in 
the discretion of the area, including imposing 
only a nominal charge for the provision of sub-
stance use disorder treatment services, subject 
to the provisions of the paragraph regarding 
public schedules and regarding limitations 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 3401 to an eli-
gible local area unless the area agrees that the limi-
tations on charges for substance use disorder treat-
ment services under this subsection applies to the 
annual aggregate of charges imposed for such serv-
ices, however the charges are characterized, includes 
enrollment fees, premiums, deductibles, cost sharing, 
co-payments, co-insurance costs, or any other 
charges. 
‘‘(c) INDIAN TRIBES.—Any application requirements 
for grants distributed in accordance with section 
3403(a)(3) shall be developed by the Secretary in con-
sultation with Indian tribes. 
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‘‘SEC. 3405. TECHNICAL ASSISTANCE. 
‘‘The Secretary shall, beginning on the date of enact-
ment of this title, provide technical assistance, including 
assistance from other grantees, contractors or subcontrac-
tors under this title to assist newly eligible local areas in 
the establishment of planning councils and, to assist enti-
ties in complying with the requirements of this subtitle 
in order to make such areas eligible to receive a grant 
under this subtitle. The Secretary may make planning 
grants available to eligible local areas, in an amount not 
to exceed $75,000, for any area that is projected to be 
eligible for funding under section 3401 in the following 
fiscal year. Such grant amounts shall be deducted from 
the first year formula award to eligible local areas accept-
ing such grants. 
‘‘SEC. 3406. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated to carry out 
this subtitle— 
‘‘(1) $3,300,000,000 for fiscal year 2022; 
‘‘(2) $3,300,000,000 for fiscal year 2023; 
‘‘(3) $3,300,000,000 for fiscal year 2024; 
‘‘(4) $3,300,000,000 for fiscal year 2025; 
‘‘(5) $3,300,000,000 for fiscal year 2026; 
‘‘(6) $3,300,000,000 for fiscal year 2027; 
‘‘(7) $3,300,000,000 for fiscal year 2028; 
‘‘(8) $3,300,000,000 for fiscal year 2029; 
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‘‘(9) $3,300,000,000 for fiscal year 2030; and 
‘‘(10) $3,300,000,000 for fiscal year 2031. 
‘‘Subtitle B—State and Tribal Sub-
stance Use Disorder Prevention 
and Intervention Grant Pro-
gram 
‘‘SEC. 3411. ESTABLISHMENT OF PROGRAM OF GRANTS. 
‘‘The Secretary shall award grants to States, terri-
tories, and tribal governments for the purpose of address-
ing substance use within such States. 
‘‘SEC. 3412. AMOUNT OF GRANT, USE OF AMOUNTS, AND 
FUNDING AGREEMENT. 
‘‘(a) AMOUNT OF GRANT TO STATES AND TERRI-
TORIES.— 
‘‘(1) IN GENERAL.— 
‘‘(A) 
EXPEDITED
DISTRIBUTION.—Not 
later than 90 days after an appropriation be-
comes available, the Secretary shall disburse 50 
percent of the amount made available under 
section 3415 for carrying out this subtitle for 
such fiscal year through grants to States under 
section 3411, in accordance with subparagraphs 
(B) and (C). 
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‘‘(B) MINIMUM
ALLOTMENT.—Subject to 
the amount made available under section 3415, 
the amount of a grant under section 3411 for— 
‘‘(i) each of the 50 States, the District 
of Columbia, and Puerto Rico for a fiscal 
year shall be the greater of— 
‘‘(I) $2,000,000; or 
‘‘(II) 
an 
amount 
determined 
under the subparagraph (C); and 
‘‘(ii) each territory other than Puerto 
Rico for a fiscal year shall be the greater 
of— 
‘‘(I) $500,000; or 
‘‘(II) 
an 
amount 
determined 
under the subparagraph (C). 
‘‘(C) DETERMINATION.— 
‘‘(i) FORMULA.—For purposes of sub-
paragraph (B), the amount referred to in 
this subparagraph for a State (including a 
territory) for a fiscal year is— 
‘‘(I) an amount equal to the 
amount made available under section 
3415 for the fiscal year involved for 
grants pursuant to subparagraph (B); 
and 
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‘‘(II) the percentage constituted 
by the sum of— 
‘‘(aa) the product of 0.85 
and the ratio of the State dis-
tribution factor for the State or 
territory to the sum of the re-
spective distribution factors for 
all States; and 
‘‘(bb) the product of 0.15 
and the ratio of the non-local dis-
tribution factor for the State or 
territory (as determined under 
clause (iv)) to the sum of the re-
spective 
non-local 
distribution 
factors for all States or terri-
tories. 
‘‘(ii) STATE DISTRIBUTION FACTOR.— 
For purposes of clause (i)(II)(aa), the term 
‘State 
distribution 
factor’ 
means 
an 
amount equal to— 
‘‘(I) the estimated number of 
drug overdose deaths in the State, as 
determined under clause (iii); or 
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‘‘(II) the number of non-fatal 
drug overdoses in the State, as deter-
mined under clause (iv), 
as determined by the Secretary based on 
which distribution factor (subclause (I) or 
(II)) will result in the State receiving the 
greatest amount of funds. 
‘‘(iii) 
NUMBER
OF
DRUG 
OVERDOSES.—For purposes of clause (ii), 
the number of drug overdose deaths deter-
mined under this clause for a State for a 
fiscal year is the number of drug overdose 
deaths during the most recent 3-year pe-
riod for which such data are available. 
‘‘(iv) NUMBER OF NON-FATAL DRUG 
OVERDOSES.—The number of non-fatal 
drug overdose deaths determined under 
this clause for a State for a fiscal year for 
purposes of clause (ii) may be determined 
by using data including emergency depart-
ment syndromic data, visits, other emer-
gency medical services for drug-related 
causes, or Overdose Detection Mapping 
Application Program (ODMAP) data dur-
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ing the most recent 3-year period for which 
such data are available. 
‘‘(v) NON-LOCAL DISTRIBUTION FAC-
TORS.—For purposes of clause (i)(II)(bb), 
the term ‘non-local distribution factor’ 
means an amount equal to the sum of— 
‘‘(I) the number of drug overdose 
deaths in the State involved, as deter-
mined under clause (iii), or the num-
ber of non-fatal drug overdoses in the 
State, based on the criteria used by 
the State under clause (ii); less 
‘‘(II) the total number of drug 
overdose deaths or non-fatal drug 
overdoses that are within areas in 
such State or territory that are eligi-
ble counties under section 3401. 
‘‘(vi) 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 State need related 
to substance use and addiction prevalence 
and whether additional data would provide 
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more precise measures the levels of sub-
stance use and addiction prevalent in 
States. Such study shall identify barriers 
to collecting or analyzing such data, and 
make recommendations for revising the 
distribution factors used under such clause 
to determine funding levels in order to di-
rect funds to the States in most need of 
funding to provide substance use disorder 
treatment services. 
‘‘(2) SUPPLEMENTAL GRANTS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (C), the Secretary shall disburse the re-
mainder of amounts not disbursed under para-
graph (1) for such fiscal year for the purpose 
of making grants to States whose application— 
‘‘(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 
State, on an objective and quantified basis, 
for supplemental financial assistance to 
combat substance use disorder; 
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‘‘(iii) demonstrates the existing com-
mitment of local resources of the State, 
both financial and in-kind, to preventing, 
treating, and managing substance use dis-
order and supporting sustained recovery; 
‘‘(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 
State plan approved by the Secretary pur-
suant to section 1932(b); 
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‘‘(viii) demonstrates success in identi-
fying individuals with substance use dis-
orders; and 
‘‘(ix) demonstrates that support for 
substance use disorder prevention and 
treatment services is organized to maxi-
mize the value to the population to be 
served with an appropriate mix of sub-
stance use disorder treatment 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— 
‘‘(I) the rate of drug overdose 
deaths per 100,000 population in the 
State; 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, or 
recent increases in drug overdoses or 
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drug overdose deaths since the data 
were reported under section 3413, if 
applicable. 
‘‘(ii) 
DEMONSTRATED
NEED.—The 
factors considered by the Secretary in de-
termining whether a State has a dem-
onstrated need for purposes of subpara-
graph (A)(ii) may include any or all of the 
following: 
‘‘(I) The unmet need for such 
services, including the factors identi-
fied in clause (i)(II). 
‘‘(II) Relative rates of increase in 
the number of drug overdoses or drug 
overdose deaths. 
‘‘(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 
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substance use disorder treatment serv-
ices to individuals in the State. 
‘‘(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 disorder. 
‘‘(VIII) The relevant factors that 
limit access to health care, including 
geographic variation, adequacy of 
health insurance coverage, and lan-
guage barriers. 
‘‘(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 
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infections associated with injection 
drug use. 
‘‘(C) MODEL STANDARDS.— 
‘‘(i) PREFERENCE.—In determining 
whether a State will receive funds under 
this paragraph, except as provided in 
clause (ii), the Secretary shall give pref-
erence to States that have adopted the 
model standards for each substance use 
disorder treatment service and recovery 
residence developed in accordance with 
subsections (a) and (b) of section 3435. 
‘‘(ii) REQUIREMENT.—Effective begin-
ning in fiscal year 2024, the Secretary 
shall not award a grant under this para-
graph to a State unless that State has 
adopted the model standards for each of 
substance use disorder treatment services 
and recovery residences developed in ac-
cordance with subsections (a) and (b) of 
section 3435. 
‘‘(D) CONTINUUM OF CARE.— 
‘‘(i) PREFERENCE.—In determining 
whether a State will receive funds under 
this paragraph, except as provided in 
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clause (ii), the Secretary shall give pref-
erence to States that have carried out the 
requirements to ensure a continuum of 
services 
in 
accordance 
with 
section 
3435(d). 
‘‘(ii) REQUIREMENT.—Effective begin-
ning in fiscal year 2024, the Secretary 
shall not award a grant under this para-
graph to a State unless that State has car-
ried out the requirements to ensure a con-
tinuum of services in accordance with sec-
tion 3435(d). 
‘‘(E) 
UTILIZATION
MANAGEMENT
FOR 
MEDICATION FOR ADDICTION TREATMENT.— 
‘‘(i) PREFERENCE.—In determining 
whether a State will receive funds under 
this paragraph, the Secretary shall give 
preference to States that have prohibited 
prior authorization and step therapy re-
quirements for at least 1 drug in each 
class approved by the Food and Drug Ad-
ministration for the treatment of substance 
use disorder. 
‘‘(ii) ADDITIONAL
PREFERENCES.— 
Additional preference shall be given to 
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States that have prohibited prior author-
ization and step therapy requirements for 
2 or more drugs in each class approved by 
the Food and Drug Administration for the 
treatment of substance use disorder. 
‘‘(iii) DEFINITIONS.—In this subpara-
graph: 
‘‘(I) PRIOR
AUTHORIZATION.— 
The term ‘prior authorization’ means 
the process by which a health insur-
ance issuer or pharmacy benefit man-
agement 
company 
determines 
the 
medical necessity of otherwise covered 
health care services prior to the ren-
dering of such health care services. 
Such term includes any health insur-
ance issuer’s or utilization review enti-
ty’s requirement that a subscriber or 
health care provider notify the issuer 
or entity prior to providing a health 
care service. 
‘‘(II) STEP THERAPY.—The term 
‘step therapy’ means a protocol or 
program that establishes the specific 
sequence in which prescription drugs 
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for a medical condition that are medi-
cally appropriate for a particular pa-
tient are authorized by a health insur-
ance issuer or prescription drug man-
agement company. 
‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN-
MENTS.— 
‘‘(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
FUNDS.—The Secretary, 
acting through the Indian Health Service, shall 
use 10 percent of the amount available under 
section 3415 for each fiscal year to provide for-
mula funds to Indian tribes in an amount de-
termined pursuant to a formula and eligibility 
criteria developed by the Secretary in consulta-
tion with Indian tribes, for the purposes of ad-
dressing substance use. 
‘‘(C) PAYMENT OF FUNDS.—At the option 
of an Indian tribe the Secretary shall pay funds 
under this section through a contract, coopera-
tive agreement, or compact under, as applicable, 
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title I or V of the Indian Self-Determination 
and Education Assistance Act. 
‘‘(D) USE OF AMOUNTS.—Notwithstanding 
any requirements in this section, an Indian 
tribe may use amounts provided under funds 
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) IN GENERAL.—A State or tribe may use 
amounts provided under grants awarded under sec-
tion 3411 for— 
‘‘(A) prevention services described in para-
graph (3); 
‘‘(B) core medical services described in 
paragraph (4); 
‘‘(C) recovery and support services de-
scribed in paragraph (5); 
‘‘(D) early intervention services described 
in paragraph (6); 
‘‘(E) harm reduction services described in 
paragraph (7); 
‘‘(F) financial assistance with health insur-
ance as described in paragraph (8); and 
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‘‘(G) administrative expenses described in 
paragraph (9). 
‘‘(2) DIRECT FINANCIAL ASSISTANCE.— 
‘‘(A) IN GENERAL.—A State or tribe may 
use amounts received under a grant under sec-
tion 3411 to provide direct financial assistance 
to eligible entities or other eligible Medicaid 
providers for the purpose of providing preven-
tion services, core medical services, recovery 
and support services, early intervention services, 
and harm reduction services. 
‘‘(B) APPROPRIATE ENTITIES.—Direct fi-
nancial assistance may be provided under sub-
paragraph (A) to public or nonprofit entities, 
other Medicaid providers if more than half of 
their patients are diagnosed with a substance 
use disorder and covered by Medicaid, or other 
private for-profit entities if such entities are the 
only available provider of quality substance use 
disorder treatment services in the area. 
‘‘(C) LIMITATION.—A State may not pro-
vide direct financial assistance to any entity or 
provider that provides medication for addiction 
treatment if that entity or provider does not 
also offer mental health services or psycho-
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therapy by licensed clinicians through a referral 
or onsite. 
‘‘(D) NEUTRALITY
TOWARDS
ORGANIZED 
LABOR.— 
‘‘(i) IN
GENERAL.—In carrying out 
duties under this section, States shall, to 
the extent practicable, prioritize the dis-
tribution of grant funds to grantees that 
have— 
‘‘(I)(aa) a collective bargaining 
agreement; or 
‘‘(bb) an explicit policy not to 
deter employees with respect to— 
‘‘(AA) labor organizing for 
the employees engaged in the 
covered activities; and 
‘‘(BB) 
such 
employees’ 
choice to form and join labor or-
ganizations; and 
‘‘(II) policies that require— 
‘‘(aa) the posting and main-
tenance of notices in the work-
place to such employees of their 
rights under the National Labor 
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Relations Act (29 U.S.C. 151 et 
seq.); 
‘‘(bb) that such employees 
are, at the beginning of their em-
ployment, provided notice and in-
formation regarding the employ-
ees’ rights under such Act; and 
‘‘(cc) the employer to volun-
tarily recognize a union in cases 
where a majority of such workers 
of the employer have joined and 
requested representation. 
‘‘(ii) LIMITATION.—This subsection 
does not apply to Indian tribes. 
‘‘(3) PREVENTION SERVICES.— 
‘‘(A) IN GENERAL.—For purposes of this 
section, the term ‘prevention services’ means 
evidence-based services, programs, or multi-sec-
tor strategies to prevent substance use disorder 
(including education campaigns, community- 
based prevention programs, risk-identification 
programs, opioid diversion, collection and dis-
posal of unused opioids, services to at-risk pop-
ulations, and trauma support services). 
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‘‘(B) LIMIT.—A State may use not to ex-
ceed 20 percent of the amount of the grant 
under section 3411 for prevention services. A 
State may apply to the Secretary for a waiver 
of this subparagraph. 
‘‘(4) CORE MEDICAL SERVICES.—For purposes 
of this section, the term ‘core medical services’ 
means the following evidence-based services when 
provided to individuals with substance use disorder 
or at risk for developing substance use disorder, in-
cluding through the use of telemedicine or a hub and 
spoke model: 
‘‘(A) Substance use disorder treatment, as 
described in section 3439(4), including assess-
ment of disease presence, severity, and co-oc-
curring conditions, treatment planning, clinical 
stabilization services, withdrawal management 
and detoxification, intensive inpatient treat-
ment, intensive outpatient treatment, outpatient 
treatment, residential inpatient services, treat-
ment for co-occurring mental health and sub-
stance use disorders, and all drugs approved by 
the Food and Drug Administration for the 
treatment of substance use disorder. 
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‘‘(B) Outpatient and ambulatory health 
services, including those administered by Feder-
ally-qualified health centers, rural health clinics, 
tribal clinics and hospitals, urban Indian orga-
nizations, certified community behavioral health 
clinics (as described in section 223 of the Pro-
tecting Access to Medicare Act), and com-
prehensive opioid recovery centers (as described 
in section 552 of this Act). 
‘‘(C) Hospice services. 
‘‘(D) Mental health services. 
‘‘(E) Opioid overdose reversal drug prod-
ucts procurement, distribution, and training. 
‘‘(F) Pharmaceutical assistance related to 
the management of substance-use disorders and 
co-morbid conditions. 
‘‘(G) Home- and community-based health 
services. 
‘‘(H) Comprehensive Case Management 
and care coordination, including substance use 
disorder treatment adherence services. 
‘‘(I) Health insurance enrollment and cost- 
sharing assistance in accordance with para-
graph (8). 
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‘‘(J) Programs that hire, employ, train, 
and dispatch licensed health care professionals, 
mental health professionals, harm reduction 
providers, or community health workers to re-
spond in lieu of law enforcement officers in 
emergencies and that ensure a licensed health 
care professional is a member of the team that 
responds in lieu of law enforcement officers in 
emergencies in which— 
‘‘(i) an individual calling 911, the Na-
tional Suicide Hotline, or another emer-
gency hotlines states that a person is expe-
riencing a drug overdose or is otherwise 
under the influence of a legal or illegal 
substance; or 
‘‘(ii) a law enforcement officer, other 
first responder, or other individual identi-
fies a person as being (or possibly being) 
under the influence of a legal or illegal 
substance. 
‘‘(5) RECOVERY AND SUPPORT SERVICES.—For 
purposes of this section, the term ‘recovery and sup-
port services’ means services including residential re-
covery housing, mental health services, long term re-
covery services, 24/7 hotline crisis center services, 
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medical transportation services, respite care for per-
sons caring for individuals with substance use dis-
order, child care and family services while an indi-
vidual is receiving inpatient treatment services or at 
the time of outpatient services, outreach services, 
peer recovery services, nutrition services, and refer-
rals for job training and career services, housing, 
legal services, and child care and family services. 
The entities through which such services may be 
provided include State, local, and tribal authorities 
that provide child care, housing, community develop-
ment, and other recovery and support services, so 
long as they do not exclude individuals on the basis 
that such individuals receive medication for addic-
tion treatment. 
‘‘(6) EARLY
INTERVENTION
SERVICES.—For 
purposes of this section, the term ‘early intervention 
services’ means services to provide screening and 
connection to the appropriate level of substance use 
disorder and mental health treatment (including 
same-day connection), counseling provided to indi-
viduals who have misused substances, who have ex-
perienced an overdose, or are at risk of developing 
substance use disorder, the provision of referrals to 
facilitate the access of such individuals to core med-
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ical services or recovery and support services for 
substance use disorder, and rapid access to medica-
tion for addiction treatment in the setting of recent 
overdose. The entities through which such services 
may be provided include emergency rooms, fire de-
partments and emergency medical services, detention 
facilities, prisons and jails, homeless shelters, health 
care points of entry specified by eligible local areas, 
Federally-qualified health centers, workforce agen-
cies and job centers, youth development centers, 
tribal clinics and hospitals, urban Indian organiza-
tions, and rural health clinics. 
‘‘(7) HARM REDUCTION SERVICES.—For pur-
poses of this section, the term ‘harm reduction serv-
ices’ means services provided to individuals engaging 
in substance use scientifically accepted to reduce the 
risk of infectious disease transmission, overdose, or 
death, including by increasing access to health care, 
housing, recovery, and support services, including sy-
ringe services programs. Such term includes evi-
dence-based services. 
‘‘(8) AFFORDABLE
HEALTH
INSURANCE
COV-
ERAGE.—A State may use amounts provided under 
a grant awarded under section 3411 to establish a 
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program of financial assistance to assist eligible indi-
viduals 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) 
ADMINISTRATION
AND
PLANNING.—A 
State shall not use in excess of 10 percent of 
amounts received under a grant under section 3411 
for administration, accounting, reporting, and pro-
gram oversight functions, including the development 
of systems to improve data collection and data shar-
ing. 
‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 
received under a grant under section 3411 may be 
used to provide substance use disorder treatment 
services, including medication for addiction treat-
ment, to individuals who are currently incarcerated 
or in pre-trial detention. 
‘‘(c) REQUIRED TERMS.— 
‘‘(1) REQUIREMENT OF STATUS AS MEDICAID 
PROVIDER.— 
‘‘(A) PROVISION OF SERVICE.—Subject to 
subparagraph (B), the Secretary may not make 
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a grant under section 3411 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 So-
cial Security Act for the State— 
‘‘(i)(I) the State will enter into an 
agreement with a political subdivision, 
under which the political subdivision will 
provide the service directly, and the polit-
ical subdivision has entered into a partici-
pation agreement under the State plan and 
is qualified to receive payments under such 
plan; or 
‘‘(II) the State will enter into agree-
ments with public or nonprofit entities, or 
other Medicaid providers if more than half 
of their patients are diagnosed with a sub-
stance use disorder and covered by Med-
icaid, under which such entities and other 
providers will provide the service, and such 
entities and other providers have entered 
into such a participation agreement and 
are qualified to receive such payments; and 
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‘‘(III) the State ensures the political 
subdivision under clause (i)(I) or the pub-
lic or nonprofit private entities and other 
providers under clause (i)(II) will seek pay-
ment for each such service rendered in ac-
cordance with the usual payment schedule 
under the State plan. 
‘‘(B) WAIVER.— 
‘‘(i) IN GENERAL.—In the case of an 
entity making an agreement pursuant to 
subparagraph (A)(ii) regarding the provi-
sion of substance use disorder treatment 
services, the requirement established in 
such subparagraph shall be waived by the 
State if the entity does not, in providing 
health care services, impose a charge or ac-
cept reimbursement available from any 
third-party payor, including reimbursement 
under any insurance policy or under any 
Federal or State health benefits program. 
A waiver under this subparagraph shall 
not be longer than 2 years in duration and 
shall not be renewed. 
‘‘(ii) DETERMINATION.—A determina-
tion by the State of whether an entity re-
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ferred to in clause (i) meets the criteria for 
a waiver under such clause shall be made 
without regard to whether the entity ac-
cepts voluntary donations for the purpose 
of providing services to the public. 
‘‘(2) REQUIRED TERMS FOR EXPANDING AND 
IMPROVING CARE.—A funding agreement for a grant 
under this section shall— 
‘‘(A) ensure that funds received under the 
grant will not be utilized to make payments for 
any item or service to the extent that payment 
has been made, or can reasonably be expected 
to be made, with respect to that item or service 
under a State compensation program, under an 
insurance policy, or under any Federal or State 
health benefits program (except for a program 
administered by, or providing the services of, 
the Indian Health Service); and 
‘‘(B) ensure that all entities providing sub-
stance use disorder treatment services with as-
sistance made available under the grant shall 
offer all drugs approved by the Food and Drug 
Administration for the treatment of substance 
use disorder for which the applicant offers 
treatment, in accordance with section 3435. 
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‘‘(3) ADDITIONAL REQUIRED TERMS.—A fund-
ing agreement for a grant under this section is 
that— 
‘‘(A) funds received under the grant will be 
utilized to supplement not supplant other Fed-
eral, State, or local funds made available in the 
year for which the grant is awarded to provide 
substance use disorder treatment services to in-
dividuals with substance use disorder, including 
funds for each of prevention services, core med-
ical services, recovery and support services, 
early intervention services, harm reduction serv-
ices, mental health services, and administrative 
expenses; 
‘‘(B) political subdivisions within the State 
will maintain the level of expenditures by such 
political subdivisions for substance use disorder 
treatment services at a level that is at least 
equal to the level of such expenditures by such 
political subdivisions for the preceding fiscal 
year including expenditures for each of preven-
tion services, core medical services, recovery 
and support services, early intervention services, 
harm reduction services, mental health services, 
and administrative expenses; 
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‘‘(C) political subdivisions within the State 
will not use funds received under a grant 
awarded under section 3411 in maintaining the 
level of substance use disorder treatment serv-
ices as required in subparagraph (B); 
‘‘(D) substance use disorder treatment 
services provided with assistance made available 
under the grant will be provided without re-
gard— 
‘‘(i) to the ability of the individual to 
pay for such services; and 
‘‘(ii) to the current or past health con-
dition of the individual to be served; 
‘‘(E) substance use disorder treatment 
services will be provided in a setting that is ac-
cessible to low-income individuals with sub-
stance use disorders and to individuals with 
substance use disorders residing in rural areas; 
‘‘(F) a program of outreach will be pro-
vided to low-income individuals with substance 
use disorders to inform such individuals of sub-
stance use disorder treatment services and to 
individuals with substance use disorders resid-
ing in rural areas; 
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‘‘(G) Indian tribes are included in planning 
for the use of grant funds and the Federal trust 
responsibility is upheld at all levels of program 
administration; and 
‘‘(H) the confidentiality of individuals re-
ceiving substance use disorder treatment serv-
ices will be maintained in a manner not incon-
sistent with applicable law. 
‘‘SEC. 3413. APPLICATION. 
‘‘(a) APPLICATION.—To be eligible to receive a grant 
under section 3411, a State shall have in effect a State 
plan approved by the Secretary pursuant to section 
1932(b), and shall prepare and submit to the Secretary 
an application in such form, and containing such informa-
tion, as the Secretary shall require, including— 
‘‘(1) a complete accounting of the disbursement 
of any prior grants received under this subtitle by 
the applicant and the results achieved by these ex-
penditures and a demonstration that funds received 
from a grant under this subtitle in the prior year 
were expended in accordance with State priorities; 
‘‘(2) establishment of goals and objectives to be 
achieved with grant funds provided under this sub-
title, including targets and milestones that are in-
tended to be met, the activities that will be under-
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taken to achieve those targets, and the number of 
individuals likely to be served by the funds sought, 
including demographic data on the populations to be 
served; 
‘‘(3) a demonstration that the State will use 
funds in a manner that provides substance use dis-
order treatment services in compliance with the evi-
dence-based standards developed in accordance with 
section 3435, including all drugs approved by the 
Food and Drug Administration for the treatment of 
substance use disorder; 
‘‘(4) a demonstration that resources provided 
under the grant will be allocated in accordance with 
the local demographic incidence of substance use, in-
cluding allocations for services for children, youths, 
and women; 
‘‘(5) an explanation of how income, asset, and 
medical expense criteria will be established and ap-
plied to those who qualify for assistance under the 
program; and 
‘‘(6) for any prior funding received under this 
section, data provided in such form as the Secretary 
shall require detailing, at a minimum, the extent to 
which the activities supported by the funding met 
the goals and objectives specified in the application 
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for the funding, the number of individuals who 
accessed medication for addiction treatment by age, 
gender, sexual orientation, race, disability status, 
and other demographic criteria relevant to the pro-
gram, and the effect of the program on overdose 
rates and rates of death due to overdose in the re-
gion served by the program. 
‘‘(b) REQUIREMENTS REGARDING IMPOSITION
OF 
CHARGES FOR SERVICES.— 
‘‘(1) IN
GENERAL.—The Secretary may not 
make a grant under section 3411 to a State unless 
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 150 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 150 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; 
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‘‘(C) in the case of individuals with an in-
come greater than 150 percent of the official 
poverty level but not exceeding 200 percent of 
such poverty level, the provider will not, for any 
calendar year, impose charges in an amount ex-
ceeding 2 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 250 percent of 
such poverty level, the provider will not, for any 
calendar year, impose charges in an amount ex-
ceeding 4 percent of the annual gross income of 
the individual involved; 
‘‘(E) in the case of individuals with an in-
come greater than 250 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-
ceeding 6 percent of the annual gross income of 
the individual involved; 
‘‘(F) in the case of individuals with an in-
come greater than 300 percent of the official 
poverty level but not exceeding 400 percent of 
such poverty level, the provider will not, for any 
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calendar year, impose charges in an amount ex-
ceeding 8.5 percent of the annual gross income 
of the individual involved; 
‘‘(G) in the case of individuals with an in-
come greater than 400 percent of the official 
poverty level, the provider will not, for any cal-
endar year, impose charges in an amount ex-
ceeding 8.5 percent of the annual gross income 
of the individual involved; and 
‘‘(H) in the case of eligible American In-
dian and Alaska Native and urban Indian indi-
viduals 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 substance use disorder treatment 
services, including 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-
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ices, subject to the provisions of the paragraph 
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. 
‘‘(c) INDIAN TRIBES.—Any application requirements 
applying to grants distributed in accordance with section 
3412(b) shall be developed by the Secretary in consulta-
tion with Indian tribes. 
‘‘SEC. 3414. TECHNICAL ASSISTANCE. 
‘‘The Secretary shall, directly or through grants or 
contracts, provide technical assistance in administering 
and coordinating the activities authorized under section 
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3412, including technical assistance for the development 
of State applications for supplementary grants authorized 
in section 3412(a)(2). 
‘‘SEC. 3415. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated to carry out 
this subtitle— 
‘‘(1) $4,600,000,000 for fiscal year 2022; 
‘‘(2) $4,600,000,000 for fiscal year 2023; 
‘‘(3) $4,600,000,000 for fiscal year 2024; 
‘‘(4) $4,600,000,000 for fiscal year 2025; 
‘‘(5) $4,600,000,000 for fiscal year 2026; 
‘‘(6) $4,600,000,000 for fiscal year 2027; 
‘‘(7) $4,600,000,000 for fiscal year 2028; 
‘‘(8) $4,600,000,000 for fiscal year 2029; 
‘‘(9) $4,600,000,000 for fiscal year 2030; and 
‘‘(10) $4,600,000,000 for fiscal year 2031. 
‘‘Subtitle C—Other Grant Program 
‘‘SEC. 3421. ESTABLISHMENT OF GRANT PROGRAM. 
‘‘(a) GRANTS.— 
‘‘(1) IN GENERAL.—The Secretary shall award 
grants to public entities, nonprofit entities, Indian 
entities, and other eligible Medicaid providers for the 
purpose of funding prevention services, core medical 
services, recovery and support services, early inter-
vention services, harm reduction services, and ad-
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ministrative expenses in accordance with this sec-
tion. 
‘‘(2) PRIORITIZATION.— 
‘‘(A) IN
GENERAL.—In awarding grants 
under this section, the Secretary shall, to the 
extent practicable, prioritize the distribution of 
grant funds to grantees that have— 
‘‘(i) an explicit policy not to deter em-
ployees with respect to— 
‘‘(I) labor organizing for the em-
ployees engaged in the covered activi-
ties; and 
‘‘(II) such employees’ choice to 
form and join labor organizations; or 
‘‘(ii) policies that require— 
‘‘(I) the posting and maintenance 
of notices in the workplace to such 
employees of their rights under the 
National Labor Relations Act (29 
U.S.C. 151 et seq.); 
‘‘(II) that such employees are, at 
the beginning of their employment, 
provided notice and information re-
garding the employees’ rights under 
such Act; and 
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‘‘(III) the employer to voluntarily 
recognize a union in cases where such 
workers of the employer have joined 
and requested representation. 
‘‘(B) EXCEPTION.—This paragraph shall 
not apply to Indian tribes. 
‘‘(b) ELIGIBILITY.— 
‘‘(1) ENTITIES.—Public entities, nonprofit enti-
ties, urban Indian organizations, and other Medicaid 
providers 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) Indian 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 11 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; 
‘‘(G) certified community behavioral health 
clinics and certified community behavioral 
health clinic expansion grant recipients, under 
section 223 of the Protecting Access to Medi-
care Act (42 U.S.C. 1396a note); and 
‘‘(H) other Medicaid providers if more 
than half of their patients are diagnosed with a 
substance use disorder and covered by Med-
icaid. 
‘‘(2) UNDERSERVED
POPULATIONS.—Entities 
described in paragraph (1) shall serve underserved 
populations which may include— 
‘‘(A) minority populations and Indian pop-
ulations; 
‘‘(B) formerly incarcerated individuals; 
‘‘(C) individuals with comorbidities includ-
ing human immunodeficiency virus, hepatitis B, 
hepatitis C, mental health disorder or other be-
havioral health disorders; 
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‘‘(D) low-income populations; 
‘‘(E) people with disabilities; 
‘‘(F) urban populations; 
‘‘(G) rural populations; 
‘‘(H) 
the 
lesbian, 
gay, 
bisexual, 
transgender, queer (LGBTQ) community; and 
‘‘(I) pregnant individuals with, or at risk 
of developing, substance use disorder and in-
fants with neonatal abstinence syndrome. 
‘‘(3) APPLICATION.—To be eligible to receive a 
grant under this section, public entities, nonprofit 
entities, and other Medicaid providers described in 
this subsection shall prepare and submit to the Sec-
retary an application in such form, and containing 
such information, as the Secretary shall require, in-
cluding— 
‘‘(A) a complete accounting of the dis-
bursement of any prior grants received under 
this subtitle by the applicant and the results 
achieved by these expenditures; 
‘‘(B) a comprehensive plan for the use of 
the grant, including— 
‘‘(i) a demonstration of the extent of 
local need for the funds sought; 
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‘‘(ii) a plan for providing substance 
use disorder treatment services that is con-
sistent with local needs; and 
‘‘(iii) goals and objectives to be 
achieved with grant funds provided under 
this section, including targets and mile-
stones that are intended to be met and a 
description of the activities that will be un-
dertaken to achieve those targets; 
‘‘(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 3435, including all drugs 
approved by the Food and Drug Administration 
for the treatment of substance use disorder for 
which the applicant offers treatment, in accord-
ance with section 3435(c); 
‘‘(D) information on the number of individ-
uals to be served by the funds sought, including 
demographic data on the populations to be 
served; 
‘‘(E) 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; 
‘‘(F) an explanation of how income, asset, 
and medical expense criteria will be established 
and applied to those who qualify for assistance 
under the program; and 
‘‘(G) for any prior funding received under 
this section, data provided in such form as the 
Secretary shall require detailing, at a minimum, 
the extent to which the activities supported by 
the funding met the goals and objectives speci-
fied in the application for the funding, the num-
ber of individuals who accessed medication for 
addiction treatment by age, gender, race, sexual 
orientation, disability status, and other demo-
graphic criteria relevant to the program, and 
the effect of the program on overdose rates and 
rates of death due to overdose in the region 
served by the program. 
‘‘(4) REQUIREMENT OF STATUS AS MEDICAID 
PROVIDER.— 
‘‘(A) PROVISION OF SERVICE.—Subject to 
subparagraph (B), the Secretary may not make 
a grant under this section for the provision of 
substance use disorder treatment services under 
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100 
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 So-
cial Security Act for the State— 
‘‘(i)(I) the applicant for the grant will 
provide the service directly, and the appli-
cant has entered into a participation agree-
ment under the State plan and is qualified 
to receive payments under such plan; or 
‘‘(II) the applicant for the grant will 
enter into an agreement with public or 
nonprofit entities, Indian entities, or other 
Medicaid providers if more than half of 
their patients are diagnosed with a sub-
stance use disorder and covered by Med-
icaid, under which such entities and other 
providers will provide the substance use 
disorder treatment service, and such enti-
ties and other providers have entered into 
such a participation agreement and are 
qualified to receive such payments; and 
‘‘(ii) the applicant ensures that pay-
ment will be sought for each such service 
rendered in accordance with the usual pay-
ment schedule under the State plan. 
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101 
‘‘(B) WAIVER.—In the case of an entity 
making an agreement pursuant to subpara-
graph (A) regarding the provision of substance 
use disorder treatment services, the require-
ment established in such paragraph shall be 
waived by the State if the entity does not, in 
providing such services, impose a charge or ac-
cept reimbursement available from any third- 
party payor, including reimbursement under 
any insurance policy or under any Federal or 
State health benefits program. A waiver under 
this subparagraph shall not be longer than 2 
years in duration and shall not be renewed. 
‘‘(C) 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 
without regard to whether the entity accepts 
voluntary donations for the purpose of pro-
viding services to the public. 
‘‘(5) REQUIRED TERMS FOR EXPANDING AND 
IMPROVING CARE.—A funding agreement for a grant 
under this section is that— 
‘‘(A) funds received under the grant will 
not be utilized to make payments for any item 
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102 
or service to the extent that payment has been 
made, or can reasonably be expected to be 
made, with respect to that item or service under 
a State compensation program, under an insur-
ance policy, or under any Federal or State 
health benefits program (except for a program 
administered by, or providing the services of, 
the Indian Health Service); 
‘‘(B) entities providing substance use dis-
order treatment services with assistance made 
available under the grant shall offer all drugs 
approved by the Food and Drug Administration 
for the treatment of substance use disorder for 
which the applicant offers treatment, in accord-
ance with section 3435(c); 
‘‘(C) substance use disorder treatment 
services provided with assistance made available 
under the grant will be provided without re-
gard— 
‘‘(i) to the ability of the individual to 
pay for such services; and 
‘‘(ii) to the current or past health con-
dition of the individual to be served; 
‘‘(D) substance use disorder treatment 
services will be provided in a setting that is ac-
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103 
cessible to low-income individuals with sub-
stance use disorders and to individuals with 
substance use disorders residing in rural areas; 
and 
‘‘(E) the confidentiality of individuals re-
ceiving substance use disorder treatment serv-
ices will be maintained in a manner not incon-
sistent with applicable law. 
‘‘(c) AMOUNT OF GRANT TO INDIAN 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 Indian entities 
in an amount determined pursuant to criteria devel-
oped by the Secretary in consultation with Indian 
Tribes and after conferring with urban Indian orga-
nizations, 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 
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104 
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-
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 
section, the term ‘prevention services’ means evidence- 
based services, programs, or multi-sector strategies to pre-
vent substance use disorder (including education cam-
paigns, community-based prevention programs, risk iden-
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105 
tification programs, opioid diversion, collection and dis-
posal of unused opioids, services to at-risk populations, 
and trauma support services). 
‘‘(c) CORE MEDICAL SERVICES.—For purposes of 
this section, the term ‘core medical services’ means the 
following evidence-based services provided to individuals 
with substance use disorder or at risk for developing sub-
stance use disorder, including through the use of telemedi-
cine or a hub and spoke model: 
‘‘(1) Substance use disorder treatment, as more 
fully described in section 3439(4), including assess-
ment of disease presence, severity, and co-occurring 
conditions, treatment planning, clinical stabilization 
services, withdrawal management and detoxification, 
intensive inpatient treatment, intensive outpatient 
treatment, outpatient treatment, residential inpa-
tient services, treatment for co-occurring mental 
health and substance use disorders, and all drugs 
approved by the Food and Drug Administration for 
the treatment of substance use disorder. 
‘‘(2) Outpatient and ambulatory health services, 
including those administered by Federally-qualified 
health centers, rural health clinics, tribal clinics and 
hospitals, urban Indian organizations, certified com-
munity behavioral health clinics (as described in sec-
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106 
tion 223 of the Protecting Access to Medicare Act), 
and comprehensive opioid recovery centers (as de-
scribed in section 552 of this Act). 
‘‘(3) Hospice services. 
‘‘(4) Mental health services. 
‘‘(5) Opioid overdose reversal drug products 
procurement, distribution, and training. 
‘‘(6) Pharmaceutical assistance related to the 
management of substance-use disorder and co-mor-
bid conditions. 
‘‘(7) Home- and community-based health serv-
ices. 
‘‘(8) Comprehensive Case Management and care 
coordination, including substance use disorder treat-
ment adherence services. 
‘‘(9) Health insurance enrollment and cost- 
sharing assistance in accordance with section 3412. 
‘‘(10) Programs that hire, employ, train, and 
dispatch mental health professionals, harm reduction 
providers, or community health workers to respond 
in lieu of law enforcement officers in emergencies in 
which— 
‘‘(A) an individual calling 911, the Na-
tional Suicide Hotline, or another emergency 
hotlines states that a person is experiencing a 
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107 
drug overdose or is otherwise under the influ-
ence of a legal or illegal substance; and 
‘‘(B) a law enforcement officer, other first 
responder, or other individual identifies a per-
son as being (or possibly being) under the influ-
ence of a legal or illegal substance. 
‘‘(d) RECOVERY AND SUPPORT SERVICES.—For pur-
poses of this section, the term ‘recovery and support serv-
ices’ means services that are provided to individuals with 
substance use disorder, including residential recovery 
housing, mental health services, long term recovery serv-
ices, 24/7 hotline crisis center support, medical transpor-
tation services, respite care for persons caring for individ-
uals with substance use disorder, child care and family 
services while an individual is receiving inpatient treat-
ment services or at the time of outpatient services, out-
reach services, peer recovery services, nutrition services, 
and referrals for job training and career services, housing, 
legal services, and child care and family services. The enti-
ties through which such services may be provided include 
local and tribal authorities that provide child care, hous-
ing, community development, and other recovery and sup-
port services, so long as they do not exclude individuals 
on the basis that such individuals receive medication for 
addiction treatment. 
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108 
‘‘(e) EARLY INTERVENTION SERVICES.—For pur-
poses of this section, the term ‘early intervention services’ 
means services to provide screening and connection to the 
appropriate level of substance use disorder and mental 
health treatment (including same-day connection), coun-
seling provided to individuals who have misused sub-
stances, who have experienced an overdose, or are at risk 
of developing substance use disorder, the provision of re-
ferrals to facilitate the access of such individuals to core 
medical services or recovery and support services for sub-
stance use disorder, and rapid access to medication for 
addiction treatment in the setting of recent overdose. The 
entities through which such services may be provided in-
clude emergency rooms, fire departments and emergency 
medical services, detention facilities, prisons and jails 
homeless shelters, health care points of entry specified by 
eligible local areas, Federally-qualified health centers, 
workforce agencies and job centers, youth development 
centers, tribal clinics and hospitals, urban Indian organi-
zations, and rural health clinics. 
‘‘(f) HARM REDUCTION SERVICES.—For purposes of 
this section, the term ‘harm reduction services’ means 
services provided to individuals engaging in substance use 
that are scientifically accepted to reduce the risk of infec-
tious disease transmission, overdose, or death, including 
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109 
by increasing access to health care, housing, and recovery 
and support services, including syringe services programs. 
Such term includes evidence-based services. 
‘‘(g) ADMINISTRATION AND PLANNING.—An entity 
(not including tribal entities) shall not use in excess of 
10 percent of amounts received under a grant under sec-
tion 3421 for administration, accounting, reporting, and 
program oversight functions, including for the purposes of 
developing systems to improve data collection and data 
sharing. 
‘‘(h) RELATION TO EXISTING EMERGENCY MEDICAL 
SERVICES.—Nothing in this section shall be construed to 
diminish or alter the rights, privileges, remedies, or obliga-
tions of any provider or any Federal, State, or local gov-
ernment to provide emergency medical services. 
‘‘SEC. 3423. TECHNICAL ASSISTANCE. 
‘‘The Secretary may, directly or through grants or 
contracts, provide technical assistance to public or non-
profit entities, Indian entities, and other eligible Medicaid 
providers regarding the process of submitting to the Sec-
retary applications for grants under section 3421, and 
may provide technical assistance with respect to the plan-
ning, development, and operation of any program or serv-
ice carried out pursuant to such section. 
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110 
‘‘SEC. 3424. PLANNING AND DEVELOPMENT GRANTS. 
‘‘(a) IN GENERAL.—The Secretary may provide plan-
ning grants to public or nonprofit entities, Indian entities, 
and other eligible Medicaid providers for purposes of as-
sisting such entities and providers in expanding their ca-
pacity to provide substance use disorder treatment services 
in low-income communities and affected subpopulations 
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) $1,000,000,000 for fiscal year 2022; 
‘‘(2) $1,000,000,000 for fiscal year 2023; 
‘‘(3) $1,000,000,000 for fiscal year 2024; 
‘‘(4) $1,000,000,000 for fiscal year 2025; 
‘‘(5) $1,000,000,000 for fiscal year 2026; 
‘‘(6) $1,000,000,000 for fiscal year 2027; 
‘‘(7) $1,000,000,000 for fiscal year 2028; 
‘‘(8) $1,000,000,000 for fiscal year 2029; 
‘‘(9) $1,000,000,000 for fiscal year 2030; and 
‘‘(10) $1,000,000,000 for fiscal year 2031. 
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‘‘Subtitle D—Innovation, Training, 
and Health Systems Strengthening 
‘‘SEC. 3431. SPECIAL PROJECTS OF NATIONAL SIGNIFI-
CANCE. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to entities to administer special projects of national 
significance to support the development of innovative and 
original models for the delivery of substance use disorder 
treatment and harm reduction 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 section, the Sec-
retary 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 services, including 
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 2022; 
‘‘(2) $500,000,000 for fiscal year 2023; 
‘‘(3) $500,000,000 for fiscal year 2024; 
‘‘(4) $500,000,000 for fiscal year 2025; 
‘‘(5) $500,000,000 for fiscal year 2026; 
‘‘(6) $500,000,000 for fiscal year 2027; 
‘‘(7) $500,000,000 for fiscal year 2028; 
‘‘(8) $500,000,000 for fiscal year 2029; 
‘‘(9) $500,000,000 for fiscal year 2030; and 
‘‘(10) $500,000,000 for fiscal year 2031. 
‘‘SEC. 3432. EDUCATION AND TRAINING CENTERS. 
‘‘(a) IN GENERAL.—The Secretary may make grants 
and enter into contracts to assist public or nonprofit enti-
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ties, public or nonprofit schools, and academic health cen-
ters in meeting the cost of projects— 
‘‘(1) to train health professionals, including 
practitioners in programs under this title and other 
community providers, including physician addiction 
specialists, psychologists, counselors, case managers, 
social workers, peer recovery coaches, harm reduc-
tion workers, public health workers, and community 
health workers, and paraprofessionals, such as peer 
support specialists and recovery coaches, in the diag-
nosis, treatment, and prevention of substance use 
disorders and drug use-related health issues, includ-
ing measures for the prevention and treatment of co- 
occurring infectious diseases, mental health dis-
orders, and other conditions, and including (as appli-
cable to the type of health professional 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, social work, 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 
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‘‘(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 and drug use-related health 
issues, including information about combating stig-
ma, prescribing best practices, overdose reversal, al-
ternative pain therapies, and all drugs approved by 
the Food and Drug Administration for the treat-
ment of substance use disorders, including for the 
purposes authorized under the amendments made by 
section 3203 of the SUPPORT for Patients and 
Communities Act. 
‘‘(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 and other community providers de-
scribed in subsection (a)(1), to provide substance 
use disorder treatments for underserved groups, in-
cluding minority individuals and Indians with sub-
stance 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-
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fessionals, to provide substance use disorder treat-
ment for individuals with such disease; 
‘‘(3) train or result in the training of individ-
uals who will provide substance use disorder treat-
ment in rural or other areas that are underserved by 
current treatment structures; 
‘‘(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, pub-
lic health workers, and community health workers, 
to provide treatment for infectious diseases and 
mental health disorders co-occurring with substance 
use disorder; and 
‘‘(5) train or result in the training of health 
professionals and other community providers to pro-
vide substance use disorder treatments for pregnant 
women, children, and adolescents. 
‘‘(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 
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‘‘(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. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section— 
‘‘(1) $500,000,000 for fiscal year 2022; 
‘‘(2) $500,000,000 for fiscal year 2023; 
‘‘(3) $500,000,000 for fiscal year 2024; 
‘‘(4) $500,000,000 for fiscal year 2025; 
‘‘(5) $500,000,000 for fiscal year 2026; 
‘‘(6) $500,000,000 for fiscal year 2027; 
‘‘(7) $500,000,000 for fiscal year 2028; 
‘‘(8) $500,000,000 for fiscal year 2029; 
‘‘(9) $500,000,000 for fiscal year 2030; and 
‘‘(10) $500,000,000 for fiscal year 2031. 
‘‘SEC. 3433. SUBSTANCE USE DISORDER TREATMENT PRO-
VIDER CAPACITY UNDER THE MEDICAID PRO-
GRAM. 
‘‘(a) PROJECTS.— 
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‘‘(1) IN
GENERAL.—The Secretary shall use 
amounts appropriated under this section to provide 
funding for projects in any State or territory to in-
crease substance use provider capacity, as provided 
for in section 1903(aa) of the Social Security Act. 
‘‘(2) PRIORITIZATIONS.— 
‘‘(A) IN
GENERAL.—In awarding grants 
under this section, the Secretary shall, to the 
extent practicable, prioritize the distribution of 
grant funds to grantees that have— 
‘‘(i) an explicit policy not to deter em-
ployees with respect to— 
‘‘(I) labor organizing for the em-
ployees engaged in the covered activi-
ties; and 
‘‘(II) such employees’ choice to 
form and join labor organizations; and 
‘‘(ii) policies that require— 
‘‘(I) the posting and maintenance 
of notices in the workplace to such 
employees of their rights under the 
National Labor Relations Act (29 
U.S.C. 151 et seq.); 
‘‘(II) that such employees are, at 
the beginning of their employment, 
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provided notice and information re-
garding the employees’ rights under 
such Act; and 
‘‘(III) the employer to voluntarily 
recognize a union in cases where such 
workers of the employer have joined 
and requested representation. 
‘‘(B) EXCEPTION.—This paragraph shall 
not apply to Indian tribes. 
‘‘(b) AMOUNT OF GRANT TO INDIAN 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) URBAN
INDIAN
ORGANIZATION.—In this 
section, the term ‘urban Indian organization’ has the 
meaning given such in section 4 of the Indian 
Health Care Improvement Act. 
‘‘(3) GRANTS.—The Secretary, acting through 
the Indian Health Service, shall use 10 percent of 
the amount appropriated under this section for each 
fiscal year to award grants to Indian tribes and 
urban Indian organizations in an amount deter-
mined pursuant to criteria developed by the Sec-
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retary in consultation with Indian tribes and in con-
ference with urban Indian organizations. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section— 
‘‘(1) $50,000,000 for fiscal year 2022; 
‘‘(2) $50,000,000 for fiscal year 2023; 
‘‘(3) $50,000,000 for fiscal year 2024; 
‘‘(4) $50,000,000 for fiscal year 2025; 
‘‘(5) $50,000,000 for fiscal year 2026; 
‘‘(6) $50,000,000 for fiscal year 2027; 
‘‘(7) $50,000,000 for fiscal year 2028; 
‘‘(8) $50,000,000 for fiscal year 2029; 
‘‘(9) $50,000,000 for fiscal year 2030; and 
‘‘(10) $50,000,000 for fiscal year 2031. 
‘‘SEC. 3434. PROGRAMS TO SUPPORT EMPLOYEES. 
‘‘(a) GRANT PROGRAM FOR WORKERS.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the National Institute for 
Occupational Safety and Health, shall award grants 
to non-profit entities that meet the requirements of 
this section to fund programs and projects to assist 
workers who are at risk of substance use disorder, 
who have substance use disorder, or who are recov-
ering from substance use disorder to maintain or 
gain employment. 
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‘‘(2) GRANTS FOR WORKERS.— 
‘‘(A) IN GENERAL.—The Secretary shall, 
on a competitive basis, award grants for a pe-
riod of not more than 3 years to non-profit en-
tities that submit an application under para-
graph (3) to enable such entities to implement, 
conduct, continue, and expand evidence-based 
programs and projects to assist individuals de-
scribed in subparagraph (G). 
‘‘(B) USE OF AMOUNTS.—An entity may 
use amounts provided under this subsection 
for— 
‘‘(i) prevention services described in 
subparagraph (C), including providing edu-
cation and information to workers regard-
ing the dangers of illicit and licit drug use, 
non-opioid pain management and non-drug 
pain management, or occupational injury 
and illness prevention; 
‘‘(ii) early intervention services de-
scribed in subparagraph (D) to enable in-
dividuals to maintain or gain employment; 
‘‘(iii) recovery and support services 
described in subparagraph (E) to enable 
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individuals to maintain or gain employ-
ment; 
‘‘(iv) harm reduction services de-
scribed in subparagraph (F) to enable indi-
viduals to maintain or gain employment; 
‘‘(v) hiring case managers, care coor-
dinators, and peer support specialists to 
assist employed individuals who are experi-
encing substance use disorder, or who are 
recovering from substance use disorder, in 
accessing substance use disorder treatment 
services; or 
‘‘(vi) providing vocational, life skills, 
and other forms of job training to workers 
who are receiving substance use disorder 
treatment services to enable such workers 
to maintain or gain employment. 
‘‘(C) PREVENTION
SERVICES.—For pur-
poses of this section, the term ‘prevention serv-
ices’ means evidence-based services, programs, 
or multi-sector strategies to prevent substance 
use disorder (including education campaigns, 
community-based prevention programs, risk 
identification programs, opioid diversion, collec-
tion and disposal of unused opioids, services to 
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at-risk populations, and trauma support serv-
ices). 
‘‘(D) RECOVERY
AND
SUPPORT
SERV-
ICES.—For purposes of this section, the term 
‘recovery and support services’ means services 
including residential recovery housing, mental 
health services, long term recovery services, 24/ 
7 hotline crisis center services, medical trans-
portation services, respite care for persons car-
ing for individuals with substance use disorder, 
child care and family services while an indi-
vidual is receiving inpatient treatment services 
or at the time of outpatient services, outreach 
services, peer recovery services, nutrition serv-
ices, and referrals for job training and career 
services, housing, legal services, and child care 
and family services so long as they do not ex-
clude individuals on the basis that such individ-
uals receive medication for addiction treatment. 
‘‘(E) EARLY INTERVENTION SERVICES.— 
For purposes of this section, the term ‘early 
intervention services’ means services to provide 
screening and connection to the appropriate 
level of substance use disorder and mental 
health treatment (including same-day connec-
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tion), counseling provided to individuals who 
have misused substances, who have experienced 
an overdose, or are at risk of developing sub-
stance use disorder, the provision of referrals to 
facilitate the access of such individuals to core 
medical services or recovery and support serv-
ices for substance use disorder, and rapid ac-
cess to medication for addiction treatment in 
the setting of recent overdose. 
‘‘(F) HARM
REDUCTION
SERVICES.—For 
purposes of this section, the term ‘harm reduc-
tion services’ means services provided to indi-
viduals engaging in substance use scientifically 
accepted to reduce the risk of infectious disease 
transmission, overdose, or death, including by 
increasing access to health care, housing, and 
recovery and support services, including syringe 
services programs. Such term includes evidence- 
based services. 
‘‘(G) INDIVIDUALS
DESCRIBED.—Individ-
uals described in this subparagraph are individ-
uals who— 
‘‘(i)(I) have been employed in the 12- 
month period immediately preceding the 
date on which the determination is being 
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made, or who are participating in an em-
ployee training or apprenticeship program; 
and 
‘‘(II) are at high risk of developing 
substance use disorder, including as a re-
sult of employment in industries that expe-
rience high rates of occupational injuries 
and illness; or 
‘‘(ii) are experiencing a substance use 
disorder or are in recovery from a sub-
stance use disorder. 
‘‘(3) APPLICATIONS.—To be eligible for a grant 
under this subsection, an entity shall submit to the 
Secretary an application at such time, in such man-
ner, and containing such information as the Sec-
retary may require, including— 
‘‘(A) a complete accounting of the dis-
bursement of any prior grants received under 
this title by the applicant and the results 
achieved by such expenditures; 
‘‘(B) a description of the population to be 
served with grant funds provided under this 
section, including a description of the unique 
risks the population faces for experiencing occu-
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pational injuries or exposure to illicit sub-
stances; 
‘‘(C) the goals and objectives to be 
achieved with grant funds provided under this 
section, including targets and milestones that 
are intended to be met, the activities that will 
be undertaken to achieve those targets, and the 
number of individuals likely to be served by the 
grant funds, including demographic data on the 
populations to be served; 
‘‘(D) a demonstration of the ability of the 
applicant to reach the individuals described in 
paragraph (2)(G) and to provide services de-
scribed in paragraph (2)(B) included in the ap-
plicant’s 
grant 
application, 
including 
by 
partnering with local stakeholders; 
‘‘(E) for any prior funding received under 
this subsection, data provided in such form as 
the Secretary shall require detailing, at a min-
imum, the extent to which the activities sup-
ported by the funding met the goals, objectives, 
targets, and milestones specified in the applica-
tion for the funding, and the number of individ-
uals with and without substance use disorder 
who received services supported by the funding, 
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including the services provided to these individ-
uals, the industries in which the individuals 
were employed when they received services, and 
whether the individuals were still employed in 
that same industry or in any industry when the 
individuals ceased receiving services supported 
by the funding; and 
‘‘(F) any other information the Secretary 
shall require. 
‘‘(4) DATA REPORTING AND OVERSIGHT.—An 
entity awarded a grant under this subsection shall 
submit to the Secretary an annual report at such 
time and in such manner as the Secretary shall re-
quire. Such report shall include, at a minimum, a 
description of— 
‘‘(A) the activities funded by the grant; 
‘‘(B) the number of individuals with and 
without substance use disorder served through 
activities funded by the grant, including the 
services provided to those individuals and the 
industries in which those individuals were em-
ployed at the time they received services sup-
ported by the grant; 
‘‘(C) for workers experiencing substance 
use disorder or recovering from substance use 
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disorder served by activities funded by the 
grant, the number of individuals who main-
tained employment, the number of individuals 
who gained employment, and the number of in-
dividuals who failed to maintain employment 
over the course of the reporting period; and 
‘‘(D) any other information required by the 
Secretary. 
‘‘(5) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection— 
‘‘(A) $40,000,000 for fiscal year 2022; 
‘‘(B) $40,000,000 for fiscal year 2023; 
‘‘(C) $40,000,000 for fiscal year 2024; 
‘‘(D) $40,000,000 for fiscal year 2025; 
‘‘(E) $40,000,000 for fiscal year 2026; 
‘‘(F) $40,000,000 for fiscal year 2027; 
‘‘(G) $40,000,000 for fiscal year 2028; 
‘‘(H) $40,000,000 for fiscal year 2029; 
‘‘(I) $40,000,000 for fiscal year 2030; and 
‘‘(J) $40,000,000 for fiscal year 2031. 
‘‘(b) RESEARCH ON THE IMPACT OF SUBSTANCE USE 
DISORDER IN THE WORKPLACE AND ON DIRECT SERVICE 
PROVIDERS.— 
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‘‘(1) RISKS OF SUBSTANCE USE DISORDER.— 
The Secretary, in consultation with the Director of 
the National Institute for Occupational Safety and 
Health, shall conduct (directly or through grants or 
contracts) research, experiments, and demonstra-
tions, and publish studies relating to— 
‘‘(A) the risks faced by employees in var-
ious occupations of developing substance use 
disorder and of drug overdose deaths and non- 
fatal drug overdoses, and the formulation of 
prevention activities tailored to the risks identi-
fied in these occupations, including occupational 
injury and illness prevention; 
‘‘(B) the prevalence of substance use dis-
order among employees in various occupations; 
‘‘(C) efforts that employers may undertake 
to assist employees who are undergoing sub-
stance use disorder treatment services in main-
taining employment while ensuring workplaces 
are safe and healthful; 
‘‘(D) risks of occupational exposure to 
opioids and other illicit substances and the for-
mulation of prevention activities tailored to the 
risks identified; and 
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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-
thority for which is not provided for in advance in 
appropriations Acts, for the purchase and delivery of 
opioid overdose reversal drug products under sub-
section (a). 
‘‘(2) AUTHORITY
TO
DECLINE
CONTRACTS.— 
The Secretary may decline to enter into contracts 
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