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) serve no more than 3 consecutive years on 
the planning council. 
‘‘(d) MEMBERSHIP TERMS.—Members of the plan-
ning council established or designated under subsection 
(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, and sub-
stance use disorder through evidence-based interven-
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tions in both community and criminal justice set-
tings and that are based on— 
‘‘(A) the use by the grantee of substance 
use disorder prevention, intervention, treat-
ment, and recovery strategies that comply with 
best practices identified by the Secretary; 
‘‘(B) the demonstrated or probable cost-ef-
fectiveness of proposed substance use disorder 
prevention, intervention, treatment, and recov-
ery services; 
‘‘(C) the health priorities of the commu-
nities within the eligible local area that are af-
fected by substance use; 
‘‘(D) the priorities and needs of individuals 
with substance use disorder; and 
‘‘(E) the availability of other governmental 
and non-governmental services; 
‘‘(2) ensure the use of grant funds will advance 
any existing State or local plan regarding the provi-
sion of substance use disorder treatment services to 
individuals with substance use disorder; 
‘‘(3) in the absence of a State or local plan, 
work with local public health agencies to develop a 
comprehensive plan for the organization and delivery 
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of substance use disorder prevention and treatment 
services; 
‘‘(4) regularly assess the efficiency of the ad-
ministrative mechanism in rapidly allocating funds 
to support evidence-based substance use disorder 
prevention and treatment services in the areas of 
greatest need within the eligible local area; 
‘‘(5) work with local public health agencies to 
determine the size and demographics of the popu-
lation of individuals with substance use disorders 
and the types of substance use that are most preva-
lent in the eligible local area; 
‘‘(6) work with local public health agencies to 
determine the needs of such population, including 
the need for substance use disorder prevention, 
intervention, treatment, and recovery services; 
‘‘(7) work with local public agencies to deter-
mine the disparities in access to services among af-
fected subpopulations and historically underserved 
communities, including infrastructure and capacity 
shortcomings of providers that contribute to these 
disparities; 
‘‘(8) work with local public agencies to establish 
methods for obtaining input on community needs 
and priorities, including by partnering with organi-
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zations that serve targeted communities experiencing 
high opioid and other addictive substance-related 
health disparities to gather data using culturally-at-
tuned 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. 
‘‘SEC. 3403. AMOUNT OF GRANT, USE OF AMOUNTS, AND 
FUNDING AGREEMENT. 
‘‘(a) AMOUNT OF GRANT.— 
‘‘(1) GRANTS BASED ON RELATIVE NEED OF 
AREA.— 
‘‘(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 
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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 
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 
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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 
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-
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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. 
‘‘(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 
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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-
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. 
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‘‘(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 
counties 
whose 
application 
under 
section 
3404— 
‘‘(i) contains a report concerning the 
dissemination of emergency relief funds 
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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 
substance use disorders, including those 
communities and individuals that are dis-
proportionately affected or historically un-
derserved; 
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‘‘(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-
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 
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‘‘(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). 
‘‘(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 
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within new or emerging subpopula-
tions. 
‘‘(IV) The current prevalence of 
substance use disorders. 
‘‘(V) Relevant factors related to 
the cost and complexity of delivering 
substance use disorder treatment serv-
ices to individuals in the eligible local 
area. 
‘‘(VI) The impact of co-morbid 
factors, including co-occurring condi-
tions, determined relevant by the Sec-
retary. 
‘‘(VII) The prevalence of home-
lessness among individuals with sub-
stance use disorders. 
‘‘(VIII) The relevant factors that 
limit access to health care, including 
geographic variation, adequacy of 
health insurance coverage, and lan-
guage barriers. 
‘‘(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-
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dividuals with substance use disorders 
identified and eligible under this sub-
title. 
‘‘(X) The increasing incidence in 
conditions related to substance use, 
including hepatitis C, human immuno-
deficiency virus, hepatitis B and other 
infections associated with injection 
drug use. 
‘‘(C) APPLICATION
OF
PROVISIONS.—A 
local area that receives a grant under this para-
graph— 
‘‘(i) shall use amounts received in ac-
cordance with subsection (b); 
‘‘(ii) shall not have to meet the eligi-
ble criteria in section 3401(b); and 
‘‘(iii) shall not have to establish a 
planning council under section 3402. 
‘‘(3) AMOUNT OF GRANT TO TRIBAL GOVERN-
MENTS.— 
‘‘(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. 
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‘‘(B) FORMULA GRANTS.—The Secretary, 
acting through the Indian Health Service, shall 
use 10 percent of the amount available under 
section 3406 for each fiscal year to provide for-
mula grants to Indian tribes disproportionately 
affected by substance use, in an amount deter-
mined pursuant to a formula and eligibility cri-
teria developed by the Secretary in consultation 
with Indian tribes, for the purposes of address-
ing substance use. 
‘‘(C) USE OF AMOUNTS.—Notwithstanding 
any requirements in this section, an Indian 
tribe may use amounts provided under grants 
awarded under this paragraph for the uses 
identified in subsection (b) and any other activi-
ties determined appropriate by the Secretary, in 
consultation with Indian tribes. 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 
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area unless the chief elected official of the area 
agrees that— 
‘‘(A) the allocation of funds and services 
within the area under the grant will be made in 
accordance with the priorities established by the 
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); 
‘‘(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 
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section 3401 to provide direct financial assist-
ance to eligible entities for the purpose of pro-
viding prevention services, core medical services, 
recovery and support services, 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 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.—An eligible local area 
(not including tribal areas) may not provide di-
rect financial assistance to any entity that pro-
vides medication-assisted treatment if that enti-
ty 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- 
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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 
treatment, intensive outpatient treatment, out-
patient treatment, residential inpatient services, 
treatment for co-occurring mental health and 
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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 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 and diag-
nostic testing related to the management of 
substance use disorders and co-morbid condi-
tions. 
‘‘(G) Home and community based health 
services. 
‘‘(H) Comprehensive Case Management 
and care coordination, including substance use 
disorder treatment adherence services. 
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‘‘(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 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-assisted treat-
ment. 
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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-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 
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risk of infectious disease transmission, overdose, or 
death, including by increasing access to health care, 
housing, and recovery and support 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-
cess of 10 percent of amounts received under a 
grant under section 3401 for such activities in sub-
sequent years. 
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‘‘(10) INCARCERATED INDIVIDUALS.—Amounts 
received under a grant under section 3401 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 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 
and is qualified to receive payments under 
such plan; or 
‘‘(ii) the eligible local area involved— 
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‘‘(I) will enter into agreements 
with public or nonprofit private enti-
ties under which the entities will pro-
vide the service, and the entities have 
entered into such a participation 
agreement and are qualified to receive 
such payments; and 
‘‘(II) demonstrates that it will 
ensure that the entities 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 
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 
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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— 
‘‘(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 
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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-
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-
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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 
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-
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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. 
‘‘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-
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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 
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; 
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‘‘(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 
for the funding, the number of individuals who 
accessed medication-assisted treatment by age, gen-
der, race, and other demographic criteria relevant to 
the program, and the effect of the program on over-
dose 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-
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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 138 percent of the 
official poverty level, the provider will not im-
pose charges on any such individual for the 
services provided under the grant; 
‘‘(B) in the case of individuals with an in-
come greater than 138 percent of the official 
poverty level, the provider will impose a charge 
on each such individual according to a schedule 
of charges made available to the public; 
‘‘(C) in the case of individuals with an in-
come greater than 138 percent of the official 
poverty level but not exceeding 200 percent of 
such poverty level, the provider will not, for an 
calendar year, impose charges in an amount ex-
ceeding 5 percent of the annual gross income of 
the individual; 
‘‘(D) in the case of individuals with an in-
come greater than 200 percent of the official 
poverty level but not exceeding 300 percent of 
such poverty level, the provider will not, for any 
calendar year, impose charges in an amount ex-
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ceeding 7 percent of the annual gross income of 
the individual involved; 
‘‘(E) in the case of individuals with an in-
come greater than 300 percent of the official 
poverty level, the provider will not, for any cal-
endar year, impose charges in an amount ex-
ceeding 15 percent of the annual gross income 
of the individual involved; and 
‘‘(F) in the case of eligible American In-
dian and Alaska Native individuals as defined 
by section 447.50 of title 42, Code of Federal 
Regulations (as in effect on July 1, 2010), the 
provider will not impose any charges for sub-
stance use disorder treatment services, includ-
ing any charges or cost-sharing prohibited by 
section 1402(d) of the Patient Protection and 
Affordable Care Act. 
‘‘(2) CHARGES.—With respect to compliance 
with the assurances made under paragraph (1), an 
eligible local area may, in the case of individuals 
subject to a charge— 
‘‘(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 
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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. 
‘‘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-
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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) $2,700,000,000 for fiscal year 2020; 
‘‘(2) $2,700,000,000 for fiscal year 2021; 
‘‘(3) $2,700,000,000 for fiscal year 2022; 
‘‘(4) $2,700,000,000 for fiscal year 2023; 
‘‘(5) $2,700,000,000 for fiscal year 2024; 
‘‘(6) $2,700,000,000 for fiscal year 2025; 
‘‘(7) $2,700,000,000 for fiscal year 2026; 
‘‘(8) $2,700,000,000 for fiscal year 2027; 
‘‘(9) $2,700,000,000 for fiscal year 2028; and 
‘‘(10) $2,700,000,000 for fiscal year 2029. 
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‘‘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). 
‘‘(B) MINIMUM
ALLOTMENT.—Subject to 
the amount made available under section 3415, 
the amount of a grant under section 3411 for— 
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covery services, 24/7 hotline crisis center services, 
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-assisted 
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 
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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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