I 
118TH CONGRESS 
1ST SESSION H. R. 4489 
To amend the 21st Century Cures Act to clarify that grants for State 
and Tribal response to opioid use disorders may, at the discretion of 
the Secretary of Health and Human Services, also be used to address 
associated health conditions, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 6, 2023 
Mr. GUTHRIE (for himself and Ms. KUSTER) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the 21st Century Cures Act to clarify that grants 
for State and Tribal response to opioid use disorders 
may, at the discretion of the Secretary of Health and 
Human Services, also be used to address associated 
health conditions, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. ADDRESSING ASSOCIATED HEALTH CONDI-
TIONS 
THROUGH 
GRANT 
PROGRAM 
FOR 
STATE AND TRIBAL RESPONSE TO OPIOID 
USE DISORDERS. 
(a) ADDITIONAL USE OF FUNDS.—Section 1003(b) 
of the 21st Century Cures Act (42 U.S.C. 290ee–3 note) 
is amended by adding at the end the following: 
‘‘(5) ASSOCIATED HEALTH CONDITIONS.—The 
Secretary may authorize the recipient of a grant 
under this subsection, in addition to using the grant 
for activities described in paragraph (4) with respect 
to opioid misuse and use disorders and stimulant 
misuse and use disorders, to use the grant to for 
similar activities with respect to associated health 
conditions.’’. 
(b) ANNUAL
REPORT
TO
CONGRESS.—Section 
1003(f) of the 21st Century Cures Act (42 U.S.C. 290ee– 
3 note) is amended— 
(1) in paragraph (2), strike ‘‘and’’ at the end; 
(2) in paragraph (3), strike the period at the 
end and insert a semicolon; and 
(3) by adding at the end the following: 
‘‘(4) the amount of funds each State that re-
ceiving a grant under subsection (b) received for the 
12-month grant cycle covered by the report; 
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‘‘(5) the amount of grant funds each such State 
spent for such grant cycle, disaggregated by the uses 
for which such funds were spent, including each al-
lowable use under paragraphs (4) and (5) of sub-
section (b); 
‘‘(6) how many such States for such grant cycle 
did not spend all of the grant funds before such 
grant cycle expired; 
‘‘(7) how many such States for such grant cycle 
requested waivers to extend the grant cycle; and 
‘‘(8) challenges for such States to spend all of 
the funds allocated and the reason for such chal-
lenges, including to what extent reporting require-
ments or other requirements placed an increased 
burden on the ability of such States to spend all of 
the funds.’’. 
(c) TECHNICAL ASSISTANCE.—Section 1003(g) of 
the 21st Century Cures Act (42 U.S.C. 290ee–3 note) is 
amended by inserting after ‘‘substance use disorders’’ the 
following: ‘‘(including associated health conditions)’’. 
(d) ASSOCIATED HEALTH CONDITIONS DEFINED.— 
Section 1003(h) of the 21st Century Cures Act (42 U.S.C. 
290ee–3 note) is amended— 
(1) by redesignating paragraphs (1) through 
(4) as paragraphs (2) through (5); and 
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(2) by inserting before paragraph (2), as redes-
ignated, the following: 
‘‘(1) ASSOCIATED HEALTH CONDITIONS.—The 
term ‘associated health conditions’ includes any dis-
order or health condition that is co-occurring with 
opioid misuse and use disorders and stimulant mis-
use and use disorders, including polydrug use and 
alcohol use disorder.’’. 
(e) RULE OF CONSTRUCTION.—Nothing in this Act 
or the amendments made by this Act shall be construed 
to change the allocation of funds among grantees pursuant 
to the minimum allocations and formula methodology 
under section 1003 of the 21st Century Cures Act (42 
U.S.C. 290ee–3 note). 
Æ 
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