‘‘(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 
‘‘(II) the percentage constituted 
by the sum of— 
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‘‘(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 
‘‘(II) the number of non-fatal 
drug overdoses in the State, as deter-
mined under clause (iv); 
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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-
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), 
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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 
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 
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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; 
‘‘(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; 
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‘‘(iv) demonstrates the ability of the 
State to utilize such supplemental financial 
resources in a manner that is immediately 
responsive and cost effective; 
‘‘(v) demonstrates that resources will 
be allocated in accordance with the local 
demographic incidence of substances use 
disorders and drug overdose mortality; 
‘‘(vi) demonstrates the inclusiveness of 
affected communities and individuals with 
substance use disorders, including those 
communities and individuals that are dis-
proportionately affected or historically un-
derserved; 
‘‘(vii) demonstrates the manner in 
which the proposed services are consistent 
with the local needs assessment and the 
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-
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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 
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-
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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 
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. 
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‘‘(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 
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 
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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 
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). 
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‘‘(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-ASSISTED 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 
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. 
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‘‘(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 
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. 
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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 GRANTS.—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 grants 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) USE OF AMOUNTS.—Notwithstanding 
any requirements in this section, an Indian 
tribe may use amounts provided under grants 
awarded under this paragraph for the uses 
identified in subsection (b) and any other activi-
ties determined appropriate by the Secretary, in 
consultation with Indian tribes. 
‘‘(b) USE OF AMOUNTS.— 
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‘‘(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 
‘‘(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 for the purpose of providing 
prevention services, core medical services, recov-
ery and support services, early intervention 
services, and harm reduction services. 
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‘‘(B) APPROPRIATE ENTITIES.—Direct fi-
nancial assistance may be provided under sub-
paragraph (A) to public or nonprofit private en-
tities, or private for-profit entities if such enti-
ties are the only available provider of quality 
substance use disorder treatment services in the 
area. 
‘‘(C) LIMITATION.—A State may not pro-
vide direct financial assistance to any entity 
that provides medication-assisted treatment if 
that entity does not also offer mental health 
services or psychotherapy by licensed clinicians 
through a referral or onsite. 
‘‘(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). 
‘‘(B) LIMIT.—A State may use not to ex-
ceed 20 percent of the amount of the grant 
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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. 
‘‘(B) Outpatient and ambulatory health 
services, including those administered by feder-
ally qualified health centers, rural health clinics, 
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tribal clinics and hospitals, urban Indian health 
facilities, 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). 
‘‘(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-
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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-assisted treatment in the setting of recent over-
dose. The entities through which such services may 
be provided include emergency rooms, fire depart-
ments and emergency medical services, detention fa-
cilities, prisons and jails, homeless shelters, law en-
forcement agencies, health care points of entry speci-
fied by eligible local areas, federally qualified health 
centers, tribal clinics and hospitals, urban Indian 
health facilities, and rural health clinics. 
‘‘(7) HARM REDUCTION SERVICES.—For pur-
poses of this section, the term ‘harm reduction serv-
ices’ means evidence-based services provided to indi-
viduals engaging in substance use that reduce the 
risk of infectious disease transmission, overdose, or 
death, including by increasing access to health care, 
housing, recovery, and support services. 
‘‘(8) AFFORDABLE
HEALTH
INSURANCE
COV-
ERAGE.—A State may use amounts provided under 
a grant awarded under section 3411 to establish a 
program of financial assistance to assist eligible indi-
viduals with substance use disorder in— 
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‘‘(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-assisted treatment, 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 3411 for the provision of 
substance use disorder treatment services under 
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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 private enti-
ties under which the entities will provide 
the service, and the entities have entered 
into such a participation agreement and 
are qualified to receive such payments; and 
‘‘(ii) the State ensures the political 
subdivision under clause (i)(I) or the pub-
lic or nonprofit private entity under clause 
(i)(II) seeks payment for each such service 
rendered in accordance with the usual pay-
ment schedule under the State plan. 
‘‘(B) WAIVER.— 
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‘‘(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-
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— 
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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 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. 
‘‘(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 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; 
‘‘(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 
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‘‘(1) ENTITIES.—Public, nonprofit, or Indian 
entities eligible to receive a grant under subsection 
(a) may include— 
‘‘(A) federally qualified health centers 
under section 1905(l)(2)(B) of the Social Secu-
rity Act; 
‘‘(B) family planning clinics; 
‘‘(C) rural health clinics; 
‘‘(D) 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; 
‘‘(E) community-based organizations, clin-
ics, hospitals, and other health facilities that 
provide substance use disorder treatment serv-
ices; and 
‘‘(F) other nonprofit entities that provide 
substance use disorder treatment services. 
‘‘(2) UNDERSERVED
POPULATIONS.—Entities 
described in paragraph (1) shall serve underserved 
populations which may include— 
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