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•HRES 1099 EH 
Security Act (42 U.S.C. 711), the State 
judicial system, and other agencies, as de-
termined by the Secretary, and Indian 
Tribes and tribal organizations, as appro-
priate, to implement the activities under 
this paragraph; 
‘‘(IV) how the State will monitor 
local development and implementation of 
plans of safe care, in accordance with sec-
tion 106(b)(2)(B)(iii)(II), including how 
the State will monitor to ensure plans of 
safe care address differences between sub-
stance use disorder and medically super-
vised substance use, including for the 
treatment of a substance use disorder; 
‘‘(V) if applicable, how the State 
plans to utilize funding authorized under 
part E of title IV of the Social Security 
Act (42 U.S.C. 670 et seq.) to assist in 
carrying out any plan of safe care, includ-
ing such funding authorized under section 
471(e) of such Act (as in effect on Octo-
ber 1, 2018) for mental health and sub-
stance abuse prevention and treatment 
services and in-home parent skill-based
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•HRES 1099 EH 
programs and funding authorized under 
such section 472(j) (as in effect on Octo-
ber 1, 2018) for children with a parent in 
a licensed residential family-based treat-
ment facility for substance abuse; and 
‘‘(VI) an assessment of the treatment 
and other services and programs available 
in the State to effectively carry out any 
plan of safe care developed, including 
identification of needed treatment, and 
other services and programs to ensure the 
well-being of young children and their 
families affected by substance use dis-
order, such as programs carried out under 
part C of the Individuals with Disabilities 
Education Act (20 U.S.C. 1431 et seq.) 
and comprehensive early childhood devel-
opment services and programs such as 
Head Start programs; 
‘‘(ii) a description of how the State plans 
to use funds for activities described in subpara-
graph (D) for the purposes of ensuring State 
compliance with requirements under clauses 
(ii) and (iii) of section 106(b)(2)(B); and
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•HRES 1099 EH 
‘‘(iii) an assurance that the State will 
comply with requirements to refer a child iden-
tified as substance-exposed to early interven-
tion services as required pursuant to a grant 
under part C of the Individuals with Disabil-
ities Education Act (20 U.S.C. 1431 et seq.). 
‘‘(D) USES OF FUNDS.—Funds awarded to a 
State under this paragraph may be used for the fol-
lowing activities, which may be carried out by the 
State directly, or through grants or subgrants, con-
tracts, or cooperative agreements: 
‘‘(i) Improving State and local systems 
with respect to the development and implemen-
tation of plans of safe care, which— 
‘‘(I) shall include parent and care-
giver engagement, as required under sec-
tion 106(b)(2)(B)(iii)(I), regarding avail-
able treatment and service options, which 
may include resources available for preg-
nant, perinatal, and postnatal women; and 
‘‘(II) may include activities such as— 
‘‘(aa) developing policies, proce-
dures, or protocols for the adminis-
tration or development of evidence- 
based and validated screening tools
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•HRES 1099 EH 
for infants who may be affected by 
substance use withdrawal symptoms 
or a fetal alcohol spectrum disorder 
and pregnant, perinatal, and post-
natal women whose infants may be 
affected by substance use withdrawal 
symptoms or a fetal alcohol spectrum 
disorder; 
‘‘(bb) 
improving 
assessments 
used to determine the needs of the 
infant and family; 
‘‘(cc) improving ongoing case 
management services; 
‘‘(dd) improving access to treat-
ment services, which may be prior to 
the pregnant woman’s delivery date; 
and 
‘‘(ee) keeping families safely to-
gether when it is in the best interest 
of the child. 
‘‘(ii) Developing policies, procedures, or 
protocols in consultation and coordination with 
health professionals, public and private health 
facilities, and substance use disorder treatment 
agencies to ensure that—
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•HRES 1099 EH 
‘‘(I) appropriate notification to child 
protective services is made in a timely 
manner, 
as 
required 
under 
section 
106(b)(2)(B)(ii); 
‘‘(II) a plan of safe care is in place, 
in 
accordance 
with 
section 
106(b)(2)(B)(iii), before the infant is dis-
charged from the birth or health care fa-
cility; and 
‘‘(III) such health and related agency 
professionals are trained on how to follow 
such protocols and are aware of the sup-
ports that may be provided under a plan 
of safe care. 
‘‘(iii) Training health professionals and 
health system leaders, child welfare workers, 
substance use disorder treatment agencies, and 
other related professionals such as home vis-
iting agency staff and law enforcement in rel-
evant topics including— 
‘‘(I) State mandatory reporting laws 
established under section 106(b)(2)(B)(i) 
and the referral and process requirements 
for notification to child protective services
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•HRES 1099 EH 
when child abuse or neglect reporting is 
not mandated; 
‘‘(II) the co-occurrence of pregnancy 
and substance use disorder, and implica-
tions of prenatal exposure; 
‘‘(III) the clinical guidance about 
treating substance use disorder in preg-
nant and postpartum women; 
‘‘(IV) 
appropriate 
screening 
and 
interventions for infants affected by sub-
stance use disorder, withdrawal symptoms, 
or a fetal alcohol spectrum disorder and 
the 
requirements 
under 
section 
106(b)(2)(B)(iii); and 
‘‘(V) appropriate multigenerational 
strategies to address the mental health 
needs of the parent and child together. 
‘‘(iv) Establishing partnerships, agree-
ments, or memoranda of understanding be-
tween the lead agency and other entities (in-
cluding health professionals, health facilities, 
child welfare professionals, juvenile and family 
court judges, substance use and mental dis-
order treatment programs, early childhood edu-
cation programs, maternal and child health
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•HRES 1099 EH 
and early intervention professionals (including 
home visiting providers), peer-to-peer recovery 
programs such as parent mentoring programs, 
and housing agencies) to facilitate the imple-
mentation of, and compliance with, section 
106(b)(2) and clause (ii) of this subparagraph, 
in areas which may include— 
‘‘(I) developing a comprehensive, 
multi-disciplinary assessment and inter-
vention process for infants, pregnant 
women, and their families who are af-
fected by substance use disorder, with-
drawal symptoms, or a fetal alcohol spec-
trum disorder, that includes meaningful 
engagement with and takes into account 
the unique needs of each family and ad-
dresses differences between medically su-
pervised substance use, including for the 
treatment of substance use disorder, and 
substance use disorder; 
‘‘(II) ensuring that treatment ap-
proaches for serving infants, pregnant 
women, and perinatal and postnatal 
women whose infants may be affected by 
substance use, withdrawal symptoms, or a
328 
•HRES 1099 EH 
fetal alcohol spectrum disorder, are de-
signed to, where appropriate, keep infants 
with their mothers during both inpatient 
and outpatient treatment; and 
‘‘(III) increasing access to all evi-
dence-based medication-assisted treatment 
approved by the Food and Drug Adminis-
tration, behavioral therapy, and counseling 
services for the treatment of substance 
use disorders, as appropriate. 
‘‘(v) Developing and updating systems of 
technology for improved data collection and 
monitoring under section 106(b)(2)(B)(iii), in-
cluding existing electronic medical records, to 
measure the outcomes achieved through the 
plans of safe care, including monitoring sys-
tems to meet the requirements of this Act and 
submission of performance measures. 
‘‘(E) REPORTING.—Each State that receives 
funds under this paragraph, for each year such 
funds are received, shall submit a report to the Sec-
retary, disaggregated by geographic location, eco-
nomic status, and major racial and ethnic groups, 
except that such disaggregation shall not be re-
quired if the results would reveal personally identifi-
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•HRES 1099 EH 
able information on, with respect to infants identi-
fied under section 106(b)(2)(B)(ii)— 
‘‘(i) the number who experienced removal 
associated with parental substance use; 
‘‘(ii) the number who experienced removal 
and subsequently are reunified with parents, 
and the length of time between such removal 
and reunification; 
‘‘(iii) the number who are referred to com-
munity providers without a child protection 
case; 
‘‘(iv) the number who receive services 
while in the care of their birth parents; 
‘‘(v) the number who receive post-reunifi-
cation services within 1 year after a reunifica-
tion has occurred; and 
‘‘(vi) the number who experienced a re-
turn to out-of-home care within 1 year after 
reunification. 
‘‘(F) SECRETARY’S REPORT TO CONGRESS.— 
The Secretary shall submit an annual report to the 
Committee on Health, Education, Labor, and Pen-
sions and the Committee on Appropriations of the 
Senate and the Committee on Education and the 
Workforce and the Committee on Appropriations of
330 
•HRES 1099 EH 
the House of Representatives that includes the in-
formation described in subparagraph (E) and rec-
ommendations or observations on the challenges, 
successes, and lessons derived from implementation 
of the grant program. 
‘‘(G) ASSISTING STATES’ IMPLEMENTATION.— 
The Secretary shall use the amount reserved under 
subparagraph (B)(i)(I) to provide written guidance 
and technical assistance to support States in com-
plying with and implementing this paragraph, which 
shall include— 
‘‘(i) technical assistance, including pro-
grams of in-depth technical assistance, to addi-
tional States, territories, and Indian Tribes 
and tribal organizations in accordance with the 
substance-exposed infant initiative developed by 
the National Center on Substance Abuse and 
Child Welfare; 
‘‘(ii) guidance on the requirements of this 
Act with respect to infants born with and iden-
tified as being affected by substance use or 
withdrawal symptoms or fetal alcohol spectrum 
disorder, as described in clauses (ii) and (iii) of 
section 106(b)(2)(B), including by—
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•HRES 1099 EH 
‘‘(I) enhancing States’ understanding 
of requirements and flexibilities under the 
law, including by clarifying key terms; 
‘‘(II) addressing state-identified chal-
lenges with developing, implementing, and 
monitoring plans of safe care, including 
those 
reported 
under 
subparagraph 
(C)(i)(II); 
‘‘(III) disseminating best practices on 
implementation of plans of safe care, on 
such topics as differential response, col-
laboration and coordination, and identi-
fication and delivery of services for dif-
ferent 
populations, 
while 
recognizing 
needs of different populations and varying 
community approaches across States; and 
‘‘(IV) helping States improve the 
long-term safety and well-being of young 
children and their families; 
‘‘(iii) supporting State efforts to develop 
information technology systems to manage 
plans of safe care; and 
‘‘(iv) preparing the Secretary’s report to 
Congress described in subparagraph (F).
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•HRES 1099 EH 
‘‘(H) SUNSET.—The authority under this para-
graph shall sunset on September 30, 2023.’’. 
(b) REPEAL.—The Abandoned Infants Assistance Act of 
1988 (42 U.S.C. 5117aa et seq.) is repealed. 
Subtitle H—Substance Use Disorder 
Treatment Workforce 
SEC. 7071. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE 
DISORDER TREATMENT WORKFORCE. 
Title VII of the Public Health Service Act is amended— 
(1) by redesignating part F as part G; and 
(2) by inserting after part E (42 U.S.C. 294n et 
seq.) the following: 
‘‘PART F—SUBSTANCE USE DISORDER TREATMENT 
WORKFORCE 
‘‘SEC. 781. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE 
DISORDER TREATMENT WORKFORCE. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Administrator of the Health Resources and Services Adminis-
tration, shall carry out a program under which— 
‘‘(1) the Secretary enters into agreements with indi-
viduals to make payments in accordance with subsection 
(b) on the principal of and interest on any eligible loan; 
and
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•HRES 1099 EH 
‘‘(2) the individuals each agree to the requirements 
of service in substance use disorder treatment employ-
ment, as described in subsection (d). 
‘‘(b) PAYMENTS.—For each year of obligated service by 
an individual pursuant to an agreement under subsection (a), 
the Secretary shall make a payment to such individual as fol-
lows: 
‘‘(1) SERVICE
IN
A
SHORTAGE
AREA.—The Sec-
retary shall pay— 
‘‘(A) for each year of obligated service by an 
individual pursuant to an agreement under sub-
section (a), 1⁄6 of the principal of and interest on 
each eligible loan of the individual which is out-
standing on the date the individual began service 
pursuant to the agreement; and 
‘‘(B) for completion of the sixth and final year 
of such service, the remainder of such principal and 
interest. 
‘‘(2) MAXIMUM
AMOUNT.—The total amount of 
payments under this section to any individual shall not 
exceed $250,000. 
‘‘(c) ELIGIBLE LOANS.—The loans eligible for repay-
ment under this section are each of the following: 
‘‘(1) Any loan for education or training for a sub-
stance use disorder treatment employment.
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•HRES 1099 EH 
‘‘(2) Any loan under part E of title VIII (relating 
to nursing student loans). 
‘‘(3) Any Federal Direct Stafford Loan, Federal Di-
rect PLUS Loan, Federal Direct Unsubsidized Stafford 
Loan, or Federal Direct Consolidation Loan (as such 
terms are used in section 455 of the Higher Education 
Act of 1965). 
‘‘(4) Any Federal Perkins Loan under part E of 
title I of the Higher Education Act of 1965. 
‘‘(5) Any other Federal loan as determined appro-
priate by the Secretary. 
‘‘(d) REQUIREMENTS OF SERVICE.—Any individual re-
ceiving payments under this program as required by an 
agreement under subsection (a) shall agree to an annual com-
mitment to full-time employment, with no more than 1 year 
passing between any 2 years of covered employment, in sub-
stance use disorder treatment employment in the United 
States in— 
‘‘(1) a Mental Health Professional Shortage Area, 
as designated under section 332; or 
‘‘(2) a county (or a municipality, if not contained 
within any county) where the mean drug overdose death 
rate per 100,000 people over the past 3 years for which 
official data is available from the State, is higher than 
the most recent available national average overdose
335 
•HRES 1099 EH 
death rate per 100,000 people, as reported by the Cen-
ters for Disease Control and Prevention. 
‘‘(e) INELIGIBILITY FOR DOUBLE BENEFITS.—No bor-
rower may, for the same service, receive a reduction of loan 
obligations or a loan repayment under both— 
‘‘(1) this section; and 
‘‘(2) any Federally supported loan forgiveness pro-
gram, including under section 338B, 338I, or 846 of 
this Act, or section 428J, 428L, 455(m), or 460 of the 
Higher Education Act of 1965. 
‘‘(f) BREACH.— 
‘‘(1) LIQUIDATED DAMAGES FORMULA.—The Sec-
retary may establish a liquidated damages formula to be 
used in the event of a breach of an agreement entered 
into under subsection (a). 
‘‘(2) LIMITATION.—The failure by an individual to 
complete the full period of service obligated pursuant to 
such an agreement, taken alone, shall not constitute a 
breach of the agreement, so long as the individual com-
pleted in good faith the years of service for which pay-
ments were made to the individual under this section. 
‘‘(g) ADDITIONAL CRITERIA.—The Secretary— 
‘‘(1) may establish such criteria and rules to carry 
out this section as the Secretary determines are needed
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•HRES 1099 EH 
and in addition to the criteria and rules specified in this 
section; and 
‘‘(2) shall give notice to the committees specified in 
subsection (h) of any criteria and rules so established. 
‘‘(h) REPORT TO CONGRESS.—Not later than 5 years 
after the date of enactment of this section, and every other 
year thereafter, the Secretary shall prepare and submit to the 
Committee on Energy and Commerce of the House of Rep-
resentatives and the Committee on Health, Education, Labor, 
and Pensions of the Senate a report on— 
‘‘(1) the number and location of borrowers who 
have qualified for loan repayments under this section; 
and 
‘‘(2) the impact of this section on the availability of 
substance use disorder treatment employees nationally 
and in shortage areas and counties described in sub-
section (d). 
‘‘(i) DEFINITION.—In this section: 
‘‘(1) The terms ‘Indian tribe’ and ‘tribal organiza-
tion’ have the meanings given those terms in section 4 
of the Indian Self-Determination and Education Assist-
ance Act. 
‘‘(2) The term ‘municipality’ means a city, town, or 
other public body created by or pursuant to State law, 
or an Indian tribe.
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•HRES 1099 EH 
‘‘(3) The term ‘substance use disorder treatment 
employment’ means full-time employment (including a 
fellowship)— 
‘‘(A) where the primary intent and function of 
the position is the direct treatment or recovery sup-
port of patients with or in recovery from a sub-
stance use disorder, including master’s level social 
workers, psychologists, counselors, marriage and 
family therapists, psychiatric mental health practi-
tioners, occupational therapists, psychology doctoral 
interns, and behavioral health paraprofessionals and 
physicians, physician assistants, and nurses, who 
are licensed or certified in accordance with applica-
ble State and Federal laws; and 
‘‘(B) which is located at a substance use dis-
order treatment program, private physician prac-
tice, hospital or health system-affiliated inpatient 
treatment center or outpatient clinic (including an 
academic medical center-affiliated treatment pro-
gram), correctional facility or program, youth de-
tention center or program, inpatient psychiatric fa-
cility, crisis stabilization unit, community health 
center, community mental health or other specialty 
community behavioral health center, recovery cen-
ter, school, community-based organization, tele-
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•HRES 1099 EH 
health platform, migrant health center, health pro-
gram or facility operated by an Indian tribe or trib-
al organization, Federal medical facility, or any 
other facility as determined appropriate for pur-
poses of this section by the Secretary. 
‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated to carry out this section 
$25,000,000 for each of fiscal years 2019 through 2023.’’. 
SEC. 7072. CLARIFICATION REGARDING SERVICE IN SCHOOLS 
AND OTHER COMMUNITY-BASED SETTINGS. 
Subpart III of part D of title III of the Public Health 
Service Act (42 U.S.C. 254 l et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 338N. CLARIFICATION REGARDING SERVICE IN SCHOOLS 
AND OTHER COMMUNITY-BASED SETTINGS. 
‘‘(a) SCHOOLS AND COMMUNITY-BASED SETTINGS.—An 
entity to which a participant in the Scholarship Program or 
the Loan Repayment Program (referred to in this section as 
a ‘participant’) is assigned under section 333 may direct such 
participant to provide service as a behavioral or mental health 
professional at a school or other community-based setting lo-
cated in a health professional shortage area. 
‘‘(b) OBLIGATED SERVICE.— 
‘‘(1) IN GENERAL.—Any service described in sub-
section (a) that a participant provides may count to-
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•HRES 1099 EH 
wards such participant’s completion of any obligated 
service requirements under the Scholarship Program or 
the Loan Repayment Program, subject to any limitation 
imposed under paragraph (2). 
‘‘(2) LIMITATION.—The Secretary may impose a 
limitation on the number of hours of service described in 
subsection (a) that a participant may credit towards 
completing obligated service requirements, provided that 
the limitation allows a member to credit service de-
scribed in subsection (a) for not less than 50 percent of 
the total hours required to complete such obligated serv-
ice requirements. 
‘‘(c) RULE
OF
CONSTRUCTION.—The authorization 
under subsection (a) shall be notwithstanding any other pro-
vision of this subpart or subpart II.’’. 
SEC. 7073. PROGRAMS FOR HEALTH CARE WORKFORCE. 
(a) PROGRAM FOR EDUCATION AND TRAINING IN PAIN 
CARE.—Section 759 of the Public Health Service Act (42 
U.S.C. 294i) is amended— 
(1) in subsection (a), by striking ‘‘hospices, and 
other public and private entities’’ and inserting ‘‘hos-
pices, tribal health programs (as defined in section 4 of 
the Indian Health Care Improvement Act), and other 
public and nonprofit private entities’’; 
(2) in subsection (b)—
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•HRES 1099 EH 
(A) in the matter preceding paragraph (1), by 
striking ‘‘award may be made under subsection (a) 
only if the applicant for the award agrees that the 
program carried out with the award will include’’ 
and inserting ‘‘entity receiving an award under this 
section shall develop a comprehensive education and 
training plan that includes’’; 
(B) in paragraph (1)— 
(i) by inserting ‘‘preventing,’’ after ‘‘diag-
nosing,’’; and 
(ii) by inserting ‘‘non-addictive medical 
products and non-pharmacologic treatments 
and’’ after ‘‘including’’; 
(C) in paragraph (2)— 
(i) by inserting ‘‘Federal, State, and 
local’’ after ‘‘applicable’’; and 
(ii) by striking ‘‘the degree to which’’ and 
all that follows through ‘‘effective pain care’’ 
and inserting ‘‘opioids’’; 
(D) in paragraph (3), by inserting ‘‘, inte-
grated, evidence-based pain management, and, as 
appropriate, 
non-pharmacotherapy’’ 
before 
the 
semicolon; 
(E) in paragraph (4), by striking ‘‘; and’’ and 
inserting ‘‘;’’; and
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•HRES 1099 EH 
(F) by striking paragraph (5) and inserting the 
following: 
‘‘(5) recent findings, developments, and advance-
ments in pain care research and the provision of pain 
care, which may include non-addictive medical products 
and non-pharmacologic treatments intended to treat 
pain; and 
‘‘(6) the dangers of opioid abuse and misuse, detec-
tion of early warning signs of opioid use disorders 
(which may include best practices related to screening 
for opioid use disorders, training on screening, brief 
intervention, and referral to treatment), and safe dis-
posal options for prescription medications (including 
such options provided by law enforcement or other inno-
vative deactivation mechanisms).’’; 
(3) in subsection (d), by inserting ‘‘prevention,’’ 
after ‘‘diagnosis,’’; and 
(4) in subsection (e), by striking ‘‘2010 through 
2012’’ and inserting ‘‘2019 through 2023’’. 
(b) MENTAL
AND BEHAVIORAL HEALTH EDUCATION 
AND TRAINING PROGRAM.—Section 756 of the Public Health 
Service Act (42 U.S.C. 294e–1) is amended— 
(1) in subsection (a)—
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(A) in paragraph (1), by inserting ‘‘, trauma,’’ 
after ‘‘focus on child and adolescent mental health’’; 
and 
(B) in paragraphs (2) and (3), by inserting 
‘‘trauma-informed care and’’ before ‘‘substance use 
disorder prevention and treatment services’’; and 
(2) in subsection (f), by striking ‘‘2018 through 
2022’’ and inserting ‘‘2019 through 2023’’. 
Subtitle I—Preventing Overdoses 
While in Emergency Rooms 
SEC. 7081. PROGRAM TO SUPPORT COORDINATION AND CON-
TINUATION OF CARE FOR DRUG OVERDOSE PA-
TIENTS. 
(a) IN GENERAL.—The Secretary of Health and Human 
Services (referred to in this section as the ‘‘Secretary’’) shall 
identify or facilitate the development of best practices for— 
(1) emergency treatment of known or suspected 
drug overdose; 
(2) the use of recovery coaches, as appropriate, to 
encourage individuals who experience a non-fatal over-
dose to seek treatment for substance use disorder and to 
support coordination and continuation of care; 
(3) coordination and continuation of care and treat-
ment, including, as appropriate, through referrals, of in-
dividuals after a drug overdose; and
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•HRES 1099 EH 
(4) the provision or prescribing of overdose reversal 
medication, as appropriate. 
(b) GRANT ESTABLISHMENT AND PARTICIPATION.— 
(1) IN
GENERAL.—The Secretary shall award 
grants on a competitive basis to eligible entities to sup-
port implementation of voluntary programs for care and 
treatment of individuals after a drug overdose, as appro-
priate, which may include implementation of the best 
practices described in subsection (a). 
(2) ELIGIBLE ENTITY.—In this section, the term 
‘‘eligible entity’’ means— 
(A) a State substance abuse agency; 
(B) an Indian Tribe or tribal organization; or 
(C) an entity that offers treatment or other 
services for individuals in response to, or following, 
drug overdoses or a drug overdose, such as an 
emergency department, in consultation with a State 
substance abuse agency. 
(3) APPLICATION.—An eligible entity desiring a 
grant under this section shall submit an application to 
the Secretary, at such time and in such manner as the 
Secretary may require, that includes— 
(A) evidence that such eligible entity carries 
out, or is capable of contracting and coordinating
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•HRES 1099 EH 
with other community entities to carry out, the ac-
tivities described in paragraph (4); 
(B) evidence that such eligible entity will work 
with a recovery community organization to recruit, 
train, hire, mentor, and supervise recovery coaches 
and fulfill the requirements described in paragraph 
(4)(A); and 
(C) such additional information as the Sec-
retary may require. 
(4) USE
OF
GRANT
FUNDS.—An eligible entity 
awarded a grant under this section shall use such grant 
funds to— 
(A) hire or utilize recovery coaches to help sup-
port recovery, including by— 
(i) connecting patients to a continuum of 
care services, such as— 
(I) treatment and recovery support 
programs; 
(II) programs that provide non-clin-
ical recovery support services; 
(III) peer support networks; 
(IV) recovery community organiza-
tions;
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•HRES 1099 EH 
(V) health care providers, including 
physicians and other providers of behav-
ioral health and primary care; 
(VI) education and training pro-
viders; 
(VII) employers; 
(VIII) housing services; and 
(IX) child welfare agencies; 
(ii) providing education on overdose pre-
vention and overdose reversal to patients and 
families, as appropriate; 
(iii) providing follow-up services for pa-
tients after an overdose to ensure continued re-
covery and connection to support services; 
(iv) collecting and evaluating outcome 
data for patients receiving recovery coaching 
services; and 
(v) providing other services the Secretary 
determines necessary to help ensure continued 
connection with recovery support services, in-
cluding culturally appropriate services, as ap-
plicable; 
(B) establish policies and procedures, pursuant 
to Federal and State law, that address the provision 
of overdose reversal medication, the administration
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•HRES 1099 EH 
of all drugs or devices approved or cleared under 
the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 301 et seq.) and all biological products li-
censed under section 351 of the Public Health Serv-
ice Act (42 U.S.C. 262) to treat substance use dis-
order, and subsequent continuation of, or referral 
to, evidence-based treatment for patients with a 
substance use disorder who have experienced a non- 
fatal drug overdose, in order to support long-term 
treatment, prevent relapse, and reduce recidivism 
and future overdose; and 
(C) establish integrated models of care for in-
dividuals who have experienced a non-fatal drug 
overdose which may include patient assessment, fol-
low up, and transportation to and from treatment 
facilities. 
(5) ADDITIONAL PERMISSIBLE USES.—In addition 
to the uses described in paragraph (4), a grant awarded 
under this section may be used, directly or through con-
tractual arrangements, to provide— 
(A) all drugs or devices approved or cleared 
under the Federal Food, Drug, and Cosmetic Act 
(21 U.S.C. 301 et seq.) and all biological products 
licensed under section 351 of the Public Health 
Service Act (42 U.S.C. 262) to treat substance use
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•HRES 1099 EH 
disorders or reverse overdose, pursuant to Federal 
and State law; 
(B) withdrawal and detoxification services that 
include patient evaluation, stabilization, and prepa-
ration for treatment of substance use disorder, in-
cluding treatment described in subparagraph (A), 
as appropriate; or 
(C) mental health services provided by a cer-
tified professional who is licensed and qualified by 
education, training, or experience to assess the psy-
chosocial background of patients, to contribute to 
the appropriate treatment plan for patients with 
substance use disorder, and to monitor patient 
progress. 
(6) PREFERENCE.—In awarding grants under this 
section, the Secretary shall give preference to eligible en-
tities that meet any or all of the following criteria: 
(A) The eligible entity is a critical access hos-
pital (as defined in section 1861(mm)(1) of the So-
cial Security Act (42 U.S.C. 1395x(mm)(1))), a low 
volume 
hospital 
(as 
defined 
in 
section 
1886(d)(12)(C)(i) 
of 
such 
Act 
(42 
U.S.C. 
1395ww(d)(12)(C)(i))), a sole community hospital 
(as defined in section 1886(d)(5)(D)(iii) of such Act 
(42 U.S.C. 1395ww(d)(5)(D)(iii))), or a hospital
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that receives disproportionate share hospital pay-
ments under section 1886(d)(5)(F) of the Social Se-
curity Act (42 U.S.C. 1395ww(d)(5)(F)). 
(B) The eligible entity is located in a State 
with an age-adjusted rate of drug overdose deaths 
that is above the national overdose mortality rate, 
as determined by the Director of the Centers for 
Disease Control and Prevention, or under the juris-
diction of an Indian Tribe with an age-adjusted rate 
of drug overdose deaths that is above the national 
overdose mortality rate, as determined through ap-
propriate mechanisms as determined by the Sec-
retary in consultation with Indian Tribes. 
(C) The eligible entity demonstrates that recov-
ery coaches will be placed in both health care set-
tings and community settings. 
(7) PERIOD OF GRANT.—A grant awarded to an eli-
gible entity under this section shall be for a period of not 
more than 5 years. 
(c) DEFINITIONS.—In this section: 
(1) INDIAN
TRIBE; TRIBAL
ORGANIZATION.—The 
terms ‘‘Indian Tribe’’ and ‘‘tribal organization’’ have the 
meanings given the terms ‘‘Indian tribe’’ and ‘‘tribal or-
ganization’’ in section 4 of the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 5304).
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(2) RECOVERY COACH.—the term ‘‘recovery coach’’ 
means an individual— 
(A) with knowledge of, or experience with, re-
covery from a substance use disorder; and 
(B) who has completed training from, and is 
determined to be in good standing by, a recovery 
services organization capable of conducting such 
training and making such determination. 
(3) RECOVERY
COMMUNITY
ORGANIZATION.—The 
term ‘‘recovery community organization’’ has the mean-
ing given such term in section 547(a) of the Public 
Health Service Act (42 U.S.C. 290ee–2(a)). 
(d) REPORTING REQUIREMENTS.— 
(1) REPORTS BY GRANTEES.—Each eligible entity 
awarded a grant under this section shall submit to the 
Secretary an annual report for each year for which the 
entity has received such grant that includes information 
on— 
(A) the number of individuals treated by the 
entity for non-fatal overdoses, including the number 
of non-fatal overdoses where overdose reversal medi-
cation was administered; 
(B) the number of individuals administered 
medication-assisted treatment by the entity;
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(C) the number of individuals referred by the 
entity to other treatment facilities after a non-fatal 
overdose, the types of such other facilities, and the 
number of such individuals admitted to such other 
facilities pursuant to such referrals; and 
(D) the frequency and number of patients with 
reoccurrences, including readmissions for non-fatal 
overdoses and evidence of relapse related to sub-
stance use disorder. 
(2) REPORT
BY
SECRETARY.—Not later than 5 
years after the date of enactment of this Act, the Sec-
retary shall submit to Congress a report that includes an 
evaluation of the effectiveness of the grant program car-
ried out under this section with respect to long term 
health outcomes of the population of individuals who 
have experienced a drug overdose, the percentage of pa-
tients treated or referred to treatment by grantees, and 
the frequency and number of patients who experienced 
relapse, were readmitted for treatment, or experienced 
another overdose. 
(e) PRIVACY.—The requirements of this section, includ-
ing with respect to data reporting and program oversight, 
shall be subject to all applicable Federal and State privacy 
laws.
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(f) AUTHORIZATION OF APPROPRIATIONS.—There is au-
thorized to be appropriated to carry out this section 
$10,000,000 for each of fiscal years 2019 through 2023. 
Subtitle J—Alternatives to Opioids in 
the Emergency Department 
SEC. 
7091. 
EMERGENCY 
DEPARTMENT 
ALTERNATIVES 
TO 
OPIOIDS DEMONSTRATION PROGRAM. 
(a) DEMONSTRATION PROGRAM GRANTS.— 
(1) IN
GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall carry out a demonstration program for 
purposes of awarding grants to hospitals and emergency 
departments, including freestanding emergency depart-
ments, to develop, implement, enhance, or study alter-
natives to opioids for pain management in such settings. 
(2) ELIGIBILITY.—To be eligible to receive a grant 
under paragraph (1), a hospital or emergency depart-
ment shall submit an application to the Secretary at 
such time, in such manner, and containing such informa-
tion as the Secretary may require. 
(3) 
GEOGRAPHIC
DISTRIBUTION.—In 
awarding 
grants under this section, the Secretary shall seek to en-
sure geographical distribution among grant recipients. 
(4) USE OF FUNDS.—Grants under paragraph (1) 
shall be used to—
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(A) target treatment approaches for painful 
conditions frequently treated in such settings; 
(B) train providers and other hospital per-
sonnel on protocols or best practices related to the 
use and prescription of opioids and alternatives to 
opioids for pain management in the emergency de-
partment; and 
(C) develop or continue strategies to provide 
alternatives to opioids, as appropriate. 
(b) ADDITIONAL DEMONSTRATION PROGRAM.—The Sec-
retary may carry out a demonstration program similar to the 
program under subsection (a) for other acute care settings. 
(c) CONSULTATION.—The Secretary shall implement a 
process for recipients of grants under subsection (a) or (b) 
to share evidence-based and best practices and promote con-
sultation with persons having robust knowledge, including 
emergency departments and physicians that have successfully 
implemented programs that use alternatives to opioids for 
pain management, as appropriate, such as approaches studied 
through the National Center for Complimentary and Integra-
tive Health or other institutes and centers at the National In-
stitutes of Health, as appropriate. The Secretary shall offer 
to each recipient of a grant under subsection (a) or (b) tech-
nical assistance as necessary.
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(d) TECHNICAL ASSISTANCE.—The Secretary shall iden-
tify or facilitate the development of best practices on alter-
natives to opioids for pain management and provide technical 
assistance to hospitals and other acute care settings on alter-
natives to opioids for pain management. The technical assist-
ance provided shall be for the purpose of— 
(1) utilizing information from recipients of a grant 
under subsection (a) or (b) that have successfully imple-
mented alternatives to opioids programs; 
(2) identifying or facilitating the development of 
best practices on the use of alternatives to opioids, which 
may include pain-management strategies that involve 
non-addictive medical products, non-pharmacologic treat-
ments, and technologies or techniques to identify pa-
tients at risk for opioid use disorder; 
(3) identifying or facilitating the development of 
best practices on the use of alternatives to opioids that 
target common painful conditions and include certain 
patient populations, such as geriatric patients, pregnant 
women, and children; and 
(4) disseminating information on the use of alter-
natives to opioids to providers in acute care settings, 
which may include emergency departments, outpatient 
clinics, critical access hospitals, Federally qualified
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•HRES 1099 EH 
health centers, Indian Health Service health facilities, 
and tribal hospitals. 
(e) REPORT TO THE SECRETARY.—Each recipient of a 
grant under this section shall submit to the Secretary (during 
the period of such grant) annual reports on the progress of 
the program funded through the grant. These reports shall 
include, in accordance with all applicable State and Federal 
privacy laws— 
(1) a description of and specific information about 
the opioid alternative pain management programs, in-
cluding the demographic characteristics of patients who 
were treated with an alternative pain management pro-
tocol, implemented in hospitals, emergency departments, 
and other acute care settings; 
(2) data on the opioid alternative pain management 
strategies used, including the number of opioid prescrip-
tions written— 
(A) during a baseline period before the pro-
gram began; or 
(B) at various stages of the program; and 
(3) data on patients who were eventually prescribed 
opioids after alternative pain management protocols and 
treatments were utilized; and 
(4) any other information the Secretary determines 
appropriate.
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(f) REPORT TO CONGRESS.—Not later than 1 year after 
completion of the demonstration program under this section, 
the Secretary shall submit a report to the Congress on the 
results of the demonstration program and include in the re-
port— 
(1) the number of applications received and the 
number funded; 
(2) a summary of the reports described in sub-
section (e), including data that allows for comparison of 
programs; and 
(3) recommendations for broader implementation of 
pain management strategies that encourage the use of 
alternatives to opioids in hospitals, emergency depart-
ments, or other acute care settings. 
(g) AUTHORIZATION
OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated 
$10,000,000 for each of fiscal years 2019 through 2021.
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Subtitle 
K—Treatment, 
Education, 
and Community Help To Combat 
Addiction 
SEC. 7101. ESTABLISHMENT OF REGIONAL CENTERS OF EXCEL-
LENCE 
IN 
SUBSTANCE 
USE 
DISORDER 
EDU-
CATION. 
Part D of title V of the Public Health Service Act, as 
amended by section 7031, is further amended by adding at 
the end the following new section: 
‘‘SEC. 551. REGIONAL CENTERS OF EXCELLENCE IN SUBSTANCE 
USE DISORDER EDUCATION. 
‘‘(a) IN GENERAL.—The Secretary, in consultation with 
appropriate agencies, shall award cooperative agreements to 
eligible entities for the designation of such entities as Re-
gional Centers of Excellence in Substance Use Disorder Edu-
cation for purposes of improving health professional training 
resources with respect to substance use disorder prevention, 
treatment, and recovery. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a coopera-
tive agreement under subsection (a), an entity shall— 
‘‘(1) be an accredited entity that offers education to 
students in various health professions, which may in-
clude— 
‘‘(A) a teaching hospital; 
‘‘(B) a medical school;
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‘‘(C) a certified behavioral health clinic; or 
‘‘(D) any other health professions school, 
school of public health, or Cooperative Extension 
Program at institutions of higher education, as de-
fined in section 101 of the Higher Education Act of 
1965, engaged in the prevention, treatment, or re-
covery of substance use disorders; 
‘‘(2) demonstrate community engagement and part-
nerships with community stakeholders, including entities 
that train health professionals, mental health counselors, 
social workers, peer recovery specialists, substance use 
treatment programs, community health centers, physi-
cian offices, certified behavioral health clinics, research 
institutions, and law enforcement; and 
‘‘(3) submit to the Secretary an application con-
taining such information, at such time, and in such 
manner, as the Secretary may require. 
‘‘(c) ACTIVITIES.—An entity receiving an award under 
this section shall develop, evaluate, and distribute evidence- 
based resources regarding the prevention and treatment of, 
and recovery from, substance use disorders. Such resources 
may include information on— 
‘‘(1) the neurology and pathology of substance use 
disorders;
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‘‘(2) advancements in the treatment of substance 
use disorders; 
‘‘(3) techniques and best practices to support recov-
ery from substance use disorders; 
‘‘(4) strategies for the prevention and treatment of, 
and recovery from substance use disorders across patient 
populations; and 
‘‘(5) other topic areas that are relevant to the objec-
tives described in subsection (a). 
‘‘(d) GEOGRAPHIC DISTRIBUTION.—In awarding cooper-
ative agreements under subsection (a), the Secretary shall 
take into account regional differences among eligible entities 
and shall make an effort to ensure geographic distribution. 
‘‘(e) EVALUATION.—The Secretary shall evaluate each 
project carried out by an entity receiving an award under this 
section and shall disseminate the findings with respect to 
each such evaluation to appropriate public and private enti-
ties. 
‘‘(f) FUNDING.—There is authorized to be appropriated 
to carry out this section, $4,000,000 for each of fiscal years 
2019 through 2023.’’. 
SEC. 7102. YOUTH PREVENTION AND RECOVERY. 
(a) SUBSTANCE ABUSE TREATMENT SERVICES
FOR 
CHILDREN, ADOLESCENTS, AND YOUNG ADULTS.—Section
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514 of the Public Health Service Act (42 U.S.C. 290bb–7) 
is amended— 
(1) in the section heading, by striking ‘‘CHILDREN 
AND
ADOLESCENTS’’ and inserting ‘‘CHILDREN, 
ADOLESCENTS, AND YOUNG ADULTS’’; 
(2) in subsection (a)(2), by striking ‘‘children, in-
cluding’’ and inserting ‘‘children, adolescents, and young 
adults, including’’; and 
(3) by striking ‘‘children and adolescents’’ each 
place it appears and inserting ‘‘children, adolescents, 
and young adults’’. 
(b) RESOURCE CENTER.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’, except as otherwise provided), in consultation with 
the Secretary of Education and other heads of agencies, in-
cluding the Assistant Secretary for Mental Health and Sub-
stance Use and the Administrator of the Health Resources 
and Services Administration, as appropriate, shall establish a 
resource center to provide technical support to recipients of 
grants under subsection (c). 
(c) YOUTH PREVENTION AND RECOVERY INITIATIVE.— 
(1) IN GENERAL.—The Secretary, in consultation 
with the Secretary of Education, shall administer a pro-
gram to provide support for communities to support the 
prevention of, treatment of, and recovery from, sub-
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stance use disorders for children, adolescents, and young 
adults. 
(2) DEFINITIONS.—In this subsection: 
(A) ELIGIBLE ENTITY.—The term ‘‘eligible en-
tity’’ means— 
(i) a local educational agency that is seek-
ing to establish or expand substance use pre-
vention or recovery support services at one or 
more high schools; 
(ii) a State educational agency; 
(iii) an institution of higher education (or 
consortia of such institutions), which may in-
clude a recovery program at an institution of 
higher education; 
(iv) a local board or one-stop operator; 
(v) a nonprofit organization with appro-
priate expertise in providing services or pro-
grams for children, adolescents, or young 
adults, excluding a school; 
(vi) a State, political subdivision of a 
State, Indian tribe, or tribal organization; or 
(vii) a high school or dormitory serving 
high school students that receives funding from 
the Bureau of Indian Education.
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(B) FOSTER CARE.—The term ‘‘foster care’’ 
has the meaning given such term in section 
1355.20(a) of title 45, Code of Federal Regulations 
(or any successor regulations). 
(C) HIGH SCHOOL.—The term ‘‘high school’’ 
has the meaning given such term in section 8101 of 
the Elementary and Secondary Education Act of 
1965 (20 U.S.C. 7801). 
(D) HOMELESS YOUTH.—The term ‘‘homeless 
youth’’ has the meaning given the term ‘‘homeless 
children or youths’’ in section 725 of the McKinney- 
Vento 
Homeless 
Assistance 
Act 
(42 
U.S.C. 
11434a). 
(E) INDIAN TRIBE; TRIBAL ORGANIZATION.— 
The terms ‘‘Indian tribe’’ and ‘‘tribal organization’’ 
have the meanings given such terms in section 4 of 
the Indian Self-Determination and Education As-
sistance Act (25 U.S.C. 5304). 
(F) INSTITUTION
OF
HIGHER
EDUCATION.— 
The term ‘‘institution of higher education’’ has the 
meaning given such term in section 101 of the 
Higher Education Act of 1965 (20 U.S.C. 1001) 
and includes a ‘‘postsecondary vocational institu-
tion’’ as defined in section 102(c) of such Act (20 
U.S.C. 1002(c)).
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(G) LOCAL EDUCATIONAL AGENCY.—The term 
‘‘local educational agency’’ has the meaning given 
such term in section 8101 of the Elementary and 
Secondary Education Act of 1965 (20 U.S.C. 
7801). 
(H) LOCAL
BOARD; ONE-STOP
OPERATOR.— 
The terms ‘‘local board’’ and ‘‘one-stop operator’’ 
have the meanings given such terms in section 3 of 
the Workforce Innovation and Opportunity Act (29 
U.S.C. 3102). 
(I) OUT-OF-SCHOOL YOUTH.—The term ‘‘out- 
of-school youth’’ has the meaning given such term 
in section 129(a)(1)(B) of the Workforce Innovation 
and Opportunity Act (29 U.S.C. 3164(a)(1)(B)). 
(J) RECOVERY PROGRAM.—The term ‘‘recovery 
program’’ means a program— 
(i) to help children, adolescents, or young 
adults who are recovering from substance use 
disorders to initiate, stabilize, and maintain 
healthy and productive lives in the community; 
and 
(ii) that includes peer-to-peer support de-
livered by individuals with lived experience in 
recovery, and communal activities to build re-
covery skills and supportive social networks.
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(K) STATE EDUCATIONAL AGENCY.—The term 
‘‘State educational agency’’ has the meaning given 
such term in section 8101 of the Elementary and 
Secondary Education Act (20 U.S.C. 7801). 
(3) BEST PRACTICES.—The Secretary, in consulta-
tion with the Secretary of Education, shall— 
(A) identify or facilitate the development of 
evidence-based best practices for prevention of sub-
stance misuse and abuse by children, adolescents, 
and young adults, including for specific populations 
such as youth in foster care, homeless youth, out- 
of-school youth, and youth who are at risk of or 
have experienced trafficking that address— 
(i) primary prevention; 
(ii) appropriate recovery support services; 
(iii) appropriate use of medication-assisted 
treatment for such individuals, if applicable, 
and ways of overcoming barriers to the use of 
medication-assisted treatment in such popu-
lation; and 
(iv) efficient and effective communication, 
which may include the use of social media, to 
maximize outreach efforts; 
(B) disseminate such best practices to State 
educational agencies, local educational agencies,
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•HRES 1099 EH 
schools and dormitories funded by the Bureau of 
Indian Education, institutions of higher education, 
recovery programs at institutions of higher edu-
cation, local boards, one-stop operators, family and 
youth homeless providers, and nonprofit organiza-
tions, as appropriate; 
(C) conduct a rigorous evaluation of each grant 
funded under this subsection, particularly its impact 
on the indicators described in paragraph (7)(B); 
and 
(D) provide technical assistance for grantees 
under this subsection. 
(4) GRANTS AUTHORIZED.—The Secretary, in con-
sultation with the Secretary of Education, shall award 3- 
year grants, on a competitive basis, to eligible entities to 
enable such entities, in coordination with Indian tribes, 
if applicable, and State agencies responsible for carrying 
out substance use disorder prevention and treatment 
programs, to carry out evidence-based programs for— 
(A) prevention of substance misuse and abuse 
by children, adolescents, and young adults, which 
may include primary prevention; 
(B) recovery support services for children, ado-
lescents, and young adults, which may include coun-
seling, job training, linkages to community-based
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•HRES 1099 EH 
services, family support groups, peer mentoring, 
and recovery coaching; or 
(C) treatment or referrals for treatment of 
substance use disorders, which may include the use 
of medication-assisted treatment, as appropriate. 
(5) SPECIAL CONSIDERATION.—In awarding grants 
under this subsection, the Secretary shall give special 
consideration to the unique needs of tribal, urban, sub-
urban, and rural populations. 
(6) APPLICATION.—To be eligible for a grant under 
this subsection, an entity shall submit to the Secretary 
an application at such time, in such manner, and con-
taining such information as the Secretary may require. 
Such application shall include— 
(A) a description of— 
(i) the impact of substance use disorders 
in the population that will be served by the 
grant program; 
(ii) how the eligible entity has solicited 
input from relevant stakeholders, which may 
include faculty, teachers, staff, families, stu-
dents, and experts in substance use disorder 
prevention, treatment, and recovery in devel-
oping such application;
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•HRES 1099 EH 
(iii) the goals of the proposed project, in-
cluding the intended outcomes; 
(iv) how the eligible entity plans to use 
grant funds for evidence-based activities, in ac-
cordance with this subsection to prevent, pro-
vide recovery support for, or treat substance 
use disorders amongst such individuals, or a 
combination of such activities; and 
(v) how the eligible entity will collaborate 
with relevant partners, which may include 
State educational agencies, local educational 
agencies, institutions of higher education, juve-
nile justice agencies, prevention and recovery 
support providers, local service providers, in-
cluding substance use disorder treatment pro-
grams, providers of mental health services, 
youth serving organizations, family and youth 
homeless providers, child welfare agencies, and 
primary care providers, in carrying out the 
grant program; and 
(B) an assurance that the eligible entity will 
participate in the evaluation described in paragraph 
(3)(C). 
(7) REPORTS TO THE SECRETARY.—Each eligible 
entity awarded a grant under this subsection shall sub-
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•HRES 1099 EH 
mit to the Secretary a report at such time and in such 
manner as the Secretary may require. Such report shall 
include— 
(A) a description of how the eligible entity used 
grant funds, in accordance with this subsection, in-
cluding the number of children, adolescents, and 
young adults reached through programming; and 
(B) a description, including relevant data, of 
how the grant program has made an impact on the 
intended 
outcomes 
described 
in 
paragraph 
(6)(A)(iii), including— 
(i) indicators of student success, which, if 
the eligible entity is an educational institution, 
shall include student well-being and academic 
achievement; 
(ii) substance use disorders amongst chil-
dren, adolescents, and young adults, including 
the number of overdoses and deaths amongst 
children, adolescents, and young adults served 
by the grant during the grant period; and 
(iii) other indicators, as the Secretary de-
termines appropriate. 
(8) REPORT TO CONGRESS.—The Secretary shall, 
not later than October 1, 2022, submit a report to the 
Committee on Health, Education, Labor, and Pensions
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•HRES 1099 EH 
of the Senate and the Committee on Energy and Com-
merce and the Committee on Education and the Work-
force of the House of Representatives a report summa-
rizing the effectiveness of the grant program under this 
subsection, based on the information submitted in re-
ports required under paragraph (7). 
(9) AUTHORIZATION
OF
APPROPRIATIONS.—There 
is authorized to be appropriated $10,000,000 to carry 
out this subsection for each of fiscal years 2019 through 
2023. 
Subtitle L—Information From Na-
tional Mental Health and Sub-
stance Use Policy Laboratory 
SEC. 7111. INFORMATION FROM NATIONAL MENTAL HEALTH 
AND SUBSTANCE USE POLICY LABORATORY. 
Section 501A(b) of the Public Health Service Act (42 
U.S.C. 290aa–0(b)) is amended— 
(1) in paragraph (5)(C), by striking ‘‘; and’’ at the 
end and inserting a semicolon; 
(2) by redesignating paragraph (6) as paragraph 
(7); and 
(3) by inserting after paragraph (5) the following: 
‘‘(6) issue and periodically update information for 
entities applying for grants or cooperative agreements
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•HRES 1099 EH 
from the Substance Abuse and Mental Health Services 
Administration in order to— 
‘‘(A) encourage the implementation and rep-
lication of evidence-based practices; and 
‘‘(B) provide technical assistance to applicants 
for funding, including with respect to justifications 
for such programs and activities; and’’. 
Subtitle M—Comprehensive Opioid 
Recovery Centers 
SEC. 7121. COMPREHENSIVE OPIOID RECOVERY CENTERS. 
(a) IN GENERAL.—Part D of title V of the Public 
Health Service Act (42 U.S.C. 290dd et seq.), as amended 
by sections 7031 and 7101, is further amended by adding at 
the end the following new section: 
‘‘SEC. 552. COMPREHENSIVE OPIOID RECOVERY CENTERS. 
‘‘(a) IN GENERAL.—The Secretary shall award grants 
on a competitive basis to eligible entities to establish or oper-
ate a comprehensive opioid recovery center (referred to in this 
section as a ‘Center’). A Center may be a single entity or an 
integrated delivery network. 
‘‘(b) GRANT PERIOD.— 
‘‘(1) IN GENERAL.—A grant awarded under sub-
section (a) shall be for a period of not less than 3 years 
and not more than 5 years.
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•HRES 1099 EH 
‘‘(2) RENEWAL.—A grant awarded under sub-
section (a) may be renewed, on a competitive basis, for 
additional periods of time, as determined by the Sec-
retary. In determining whether to renew a grant under 
this paragraph, the Secretary shall consider the data 
submitted under subsection (h). 
‘‘(c) MINIMUM NUMBER OF CENTERS.—The Secretary 
shall allocate the amounts made available under subsection 
(j) such that not fewer than 10 grants may be awarded. Not 
more than one grant shall be made to entities in a single 
State for any one period. 
‘‘(d) APPLICATION.— 
‘‘(1) ELIGIBLE ENTITY.—An entity is eligible for a 
grant under this section if the entity offers treatment 
and other services for individuals with a substance use 
disorder. 
‘‘(2) SUBMISSION OF APPLICATION.—In order to be 
eligible for a grant under subsection (a), an entity shall 
submit an application to the Secretary at such time and 
in such manner as the Secretary may require. Such ap-
plication shall include— 
‘‘(A) evidence that such entity carries out, or 
is capable of coordinating with other entities to 
carry out, the activities described in subsection (g); 
and
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‘‘(B) such other information as the Secretary 
may require. 
‘‘(e) PRIORITY.—In awarding grants under subsection 
(a), the Secretary shall give priority to eligible entities— 
‘‘(1) located in a State with an age-adjusted rate of 
drug overdose deaths that is above the national overdose 
mortality rate, as determined by the Director of the Cen-
ters for Disease Control and Prevention; or 
‘‘(2) serving an Indian Tribe (as defined in section 
4 of the Indian Self-Determination and Education As-
sistance Act) with an age-adjusted rate of drug overdose 
deaths that is above the national overdose mortality rate, 
as determined through appropriate mechanisms deter-
mined by the Secretary in consultation with Indian 
Tribes. 
‘‘(f) PREFERENCE.—In awarding grants under sub-
section (a), the Secretary may give preference to eligible enti-
ties utilizing technology-enabled collaborative learning and ca-
pacity building models, including such models as defined in 
section 2 of the Expanding Capacity for Health Outcomes 
Act (Public Law 114–270; 130 Stat. 1395), to conduct the 
activities described in this section. 
‘‘(g) CENTER ACTIVITIES.—Each Center shall, at a min-
imum, carry out the following activities directly, through re-
ferral, or through contractual arrangements, which may in-
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•HRES 1099 EH 
clude carrying out such activities through technology-enabled 
collaborative learning and capacity building models described 
in subsection (f): 
‘‘(1) TREATMENT AND RECOVERY SERVICES.—Each 
Center shall— 
‘‘(A) Ensure that intake, evaluations, and peri-
odic patient assessments meet the individualized 
clinical needs of patients, including by reviewing pa-
tient placement in treatment settings to support 
meaningful recovery. 
‘‘(B) Provide the full continuum of treatment 
services, including— 
‘‘(i) all drugs and devices approved or 
cleared under the Federal Food, Drug, and 
Cosmetic Act and all biological products li-
censed under section 351 of this Act to treat 
substance use disorders or reverse overdoses, 
pursuant to Federal and State law; 
‘‘(ii) 
medically 
supervised 
withdrawal 
management, that includes patient evaluation, 
stabilization, and readiness for and entry into 
treatment; 
‘‘(iii) counseling provided by a program 
counselor or other certified professional who is 
licensed and qualified by education, training,
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•HRES 1099 EH 
or experience to assess the psychological and 
sociological background of patients, to con-
tribute to the appropriate treatment plan for 
the patient, and to monitor patient progress; 
‘‘(iv) treatment, as appropriate, for pa-
tients with co-occurring substance use and 
mental disorders; 
‘‘(v) testing, as appropriate, for infections 
commonly associated with illicit drug use; 
‘‘(vi) residential rehabilitation, and out-
patient and intensive outpatient programs; 
‘‘(vii) recovery housing; 
‘‘(viii) community-based and peer recovery 
support services; 
‘‘(ix) job training, job placement assist-
ance, and continuing education assistance to 
support reintegration into the workforce; and 
‘‘(x) other best practices to provide the 
full continuum of treatment and services, as 
determined by the Secretary. 
‘‘(C) Ensure that all programs covered by the 
Center include medication-assisted treatment, as 
appropriate, and do not exclude individuals receiv-
ing medication-assisted treatment from any service.
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‘‘(D) Periodically conduct patient assessments 
to support sustained and clinically significant recov-
ery, as defined by the Assistant Secretary for Men-
tal Health and Substance Use. 
‘‘(E) Provide onsite access to medication, as 
appropriate, and toxicology services; for purposes of 
carrying out this section. 
‘‘(F) Operate a secure, confidential, and inter-
operable electronic health information system. 
‘‘(G) Offer family support services such as 
child care, family counseling, and parenting inter-
ventions to help stabilize families impacted by sub-
stance use disorder, as appropriate. 
‘‘(2) OUTREACH.—Each Center shall carry out out-
reach activities regarding the services offered through 
the Centers, which may include— 
‘‘(A) training and supervising outreach staff, 
as appropriate, to work with State and local health 
departments, health care providers, the Indian 
Health Service, State and local educational agen-
cies, schools funded by the Indian Bureau of Edu-
cation, institutions of higher education, State and 
local workforce development boards, State and local 
community action agencies, public safety officials, 
first responders, Indian Tribes, child welfare agen-
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cies, as appropriate, and other community partners 
and the public, including patients, to identify and 
respond to community needs; 
‘‘(B) ensuring that the entities described in 
subparagraph (A) are aware of the services of the 
Center; and 
‘‘(C) disseminating and making publicly avail-
able, including through the internet, evidence-based 
resources that educate professionals and the public 
on opioid use disorder and other substance use dis-
orders, including co-occurring substance use and 
mental disorders. 
‘‘(h) DATA REPORTING AND PROGRAM OVERSIGHT.— 
With respect to a grant awarded under subsection (a), not 
later than 90 days after the end of the first year of the grant 
period, and annually thereafter for the duration of the grant 
period (including the duration of any renewal period for such 
grant), the entity shall submit data, as appropriate, to the 
Secretary regarding— 
‘‘(1) the programs and activities funded by the 
grant; 
‘‘(2) health outcomes of the population of individ-
uals with a substance use disorder who received services 
from the Center, evaluated by an independent program
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evaluator through the use of outcomes measures, as de-
termined by the Secretary; 
‘‘(3) the retention rate of program participants; and 
‘‘(4) any other information that the Secretary may 
require for the purpose of—ensuring that the Center is 
complying with all the requirements of the grant, includ-
ing providing the full continuum of services described in 
subsection (g)(1)(B). 
‘‘(i) PRIVACY.—The provisions of this section, including 
with respect to data reporting and program oversight, shall 
be subject to all applicable Federal and State privacy laws. 
‘‘(j) AUTHORIZATION
OF APPROPRIATIONS.—There is 
authorized to be appropriated $10,000,000 for each of fiscal 
years 2019 through 2023 for purposes of carrying out this 
section.’’. 
(b) REPORTS TO CONGRESS.— 
(1) PRELIMINARY REPORT.—Not later than 3 years 
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall submit to 
Congress a preliminary report that analyzes data sub-
mitted under section 552(h) of the Public Health Service 
Act, as added by subsection (a). 
(2) FINAL REPORT.—Not later than 2 years after 
submitting the preliminary report required under para-
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graph (1), the Secretary of Health and Human Services 
shall submit to Congress a final report that includes— 
(A) an evaluation of the effectiveness of the 
comprehensive services provided by the Centers es-
tablished or operated pursuant to section 552 of the 
Public Health Service Act, as added by subsection 
(a), with respect to health outcomes of the popu-
lation of individuals with substance use disorder 
who receive services from the Center, which shall in-
clude an evaluation of the effectiveness of services 
for treatment and recovery support and to reduce 
relapse, recidivism, and overdose; and 
(B) recommendations, as appropriate, regard-
ing ways to improve Federal programs related to 
substance use disorders, which may include dissemi-
nation of best practices for the treatment of sub-
stance use disorders to health care professionals. 
Subtitle N—Trauma-Informed Care 
SEC. 7131. CDC SURVEILLANCE AND DATA COLLECTION FOR 
CHILD, YOUTH, AND ADULT TRAUMA. 
(a) DATA COLLECTION.—The Director of the Centers 
for Disease Control and Prevention (referred to in this sec-
tion as the ‘‘Director’’) may, in cooperation with the States, 
collect and report data on adverse childhood experiences 
through the Behavioral Risk Factor Surveillance System, the
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Youth Risk Behavior Surveillance System, and other relevant 
public health surveys or questionnaires. 
(b) TIMING.—The collection of data under subsection (a) 
may occur biennially. 
(c) DATA FROM RURAL AREAS.—The Director shall en-
courage each State that participates in collecting and report-
ing data under subsection (a) to collect and report data from 
rural areas within such State, in order to generate a statis-
tically reliable representation of such areas. 
(d) DATA FROM TRIBAL AREAS.—The Director may, in 
cooperation with Indian Tribes (as defined in section 4 of the 
Indian Self-Determination and Education Assistance Act) 
and pursuant to a written request from an Indian Tribe, pro-
vide technical assistance to such Indian Tribe to collect and 
report data on adverse childhood experiences through the Be-
havioral Risk Factor Surveillance System, the Youth Risk 
Behavior Surveillance System, or another relevant public 
health survey or questionnaire. 
(e) AUTHORIZATION OF APPROPRIATIONS.—To carry out 
this section, there is authorized to be appropriated 
$2,000,000 for each of fiscal years 2019 through 2023.
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SEC. 7132. TASK FORCE TO DEVELOP BEST PRACTICES FOR 
TRAUMA-INFORMED IDENTIFICATION, REFERRAL, 
AND SUPPORT. 
(a) ESTABLISHMENT.—There is established a task force, 
to be known as the Interagency Task Force on Trauma-In-
formed Care (in this section referred to as the ‘‘task force’’) 
that shall identify, evaluate, and make recommendations re-
garding— 
(1) best practices with respect to children and 
youth, and their families as appropriate, who have expe-
rienced or are at risk of experiencing trauma; and 
(2) ways in which Federal agencies can better co-
ordinate to improve the Federal response to families im-
pacted by substance use disorders and other forms of 
trauma. 
(b) MEMBERSHIP.— 
(1) COMPOSITION.—The task force shall be com-
posed of the heads of the following Federal departments 
and agencies, or their designees: 
(A) The Centers for Medicare & Medicaid 
Services. 
(B) The Substance Abuse and Mental Health 
Services Administration. 
(C) The Agency for Healthcare Research and 
Quality.
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(D) The Centers for Disease Control and Pre-
vention. 
(E) The Indian Health Service. 
(F) The Department of Veterans Affairs. 
(G) The National Institutes of Health. 
(H) The Food and Drug Administration. 
(I) The Health Resources and Services Admin-
istration. 
(J) The Department of Defense. 
(K) The Office of Minority Health of the De-
partment of Health and Human Services. 
(L) The Administration for Children and Fam-
ilies. 
(M) The Office of the Assistant Secretary for 
Planning and Evaluation of the Department of 
Health and Human Services. 
(N) The Office for Civil Rights of the Depart-
ment of Health and Human Services. 
(O) The Office of Juvenile Justice and Delin-
quency Prevention of the Department of Justice. 
(P) The Office of Community Oriented Polic-
ing Services of the Department of Justice. 
(Q) The Office on Violence Against Women of 
the Department of Justice.
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(R) The National Center for Education Eval-
uation and Regional Assistance of the Department 
of Education. 
(S) The National Center for Special Education 
Research of the Institute of Education Science. 
(T) The Office of Elementary and Secondary 
Education of the Department of Education. 
(U) The Office for Civil Rights of the Depart-
ment of Education. 
(V) The Office of Special Education and Reha-
bilitative Services of the Department of Education. 
(W) The Bureau of Indian Affairs of the De-
partment of the Interior. 
(X) The Veterans Health Administration of the 
Department of Veterans Affairs. 
(Y) The Office of Special Needs Assistance 
Programs of the Department of Housing and Urban 
Development. 
(Z) The Office of Head Start of the Adminis-
tration for Children and Families. 
(AA) The Children’s Bureau of the Adminis-
tration for Children and Families. 
(BB) The Bureau of Indian Education of the 
Department of the Interior.
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(CC) Such other Federal agencies as the Secre-
taries determine to be appropriate. 
(2) DATE OF APPOINTMENTS.—The heads of Fed-
eral departments and agencies shall appoint the cor-
responding members of the task force not later than 60 
days after the date of enactment of this Act. 
(3) CHAIRPERSON.—The task force shall be chaired 
by the Assistant Secretary for Mental Health and Sub-
stance Use, or the Assistant Secretary’s designee. 
(c) TASK FORCE DUTIES.—The task force shall— 
(1) solicit input from stakeholders, including front-
line service providers, educators, mental health profes-
sionals, researchers, experts in infant, child, and youth 
trauma, child welfare professionals, and the public, in 
order to inform the activities under paragraph (2); and 
(2) identify, evaluate, make recommendations, and 
update such recommendations not less than annually, to 
the general public, the Secretary of Education, the Sec-
retary of Health and Human Services, the Secretary of 
Labor, the Secretary of the Interior, the Attorney Gen-
eral, and other relevant cabinet Secretaries, and Con-
gress regarding— 
(A) a set of evidence-based, evidence-informed, 
and promising best practices with respect to—
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(i) prevention strategies for individuals at 
risk of experiencing or being exposed to trau-
ma, including trauma as a result of exposure 
to substance use; 
(ii) the identification of infants, children 
and youth, and their families as appropriate, 
who have experienced or are at risk of experi-
encing trauma; 
(iii) the expeditious referral to and imple-
mentation of trauma-informed practices and 
supports that prevent and mitigate the effects 
of trauma, which may include whole-family and 
multi-generational approaches; and 
(iv) 
community 
based 
or 
multi- 
generational practices that support children 
and their families; 
(B) a national strategy on how the task force 
and member agencies will collaborate, prioritize op-
tions for, and implement a coordinated approach, 
which may include— 
(i) data sharing; 
(ii) providing support to infants, children, 
and youth, and their families as appropriate, 
who have experienced or are at risk of experi-
encing trauma;
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(iii) identifying options for coordinating 
existing grants that support infants, children, 
and youth, and their families as appropriate, 
who have experienced, or are at risk of experi-
encing, exposure to substance use or other 
trauma, including trauma related to substance 
use; and 
(iv) other ways to improve coordination, 
planning, and communication within and 
across Federal agencies, offices, and programs, 
to better serve children and families impacted 
by substance use disorders; and 
(C) existing Federal authorities at the Depart-
ment of Education, Department of Health and 
Human Services, Department of Justice, Depart-
ment of Labor, Department of the Interior, and 
other relevant agencies, and specific Federal grant 
programs to disseminate best practices on, provide 
training in, or deliver services through, trauma-in-
formed practices, and disseminate such informa-
tion— 
(i) in writing to relevant program offices 
at such agencies to encourage grant applicants 
in writing to use such funds, where appro-
priate, for trauma-informed practices; and
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(ii) to the general public through the 
internet website of the task force. 
(d) BEST PRACTICES.—In identifying, evaluating, and 
recommending the set of best practices under subsection (c), 
the task force shall— 
(1) include guidelines for providing professional de-
velopment and education for front-line services providers, 
including school personnel, early childhood education 
program providers, providers from child- or youth-serv-
ing organizations, housing and homeless providers, pri-
mary and behavioral health care providers, child welfare 
and social services providers, juvenile and family court 
personnel, health care providers, individuals who are 
mandatory reporters of child abuse or neglect, trained 
nonclinical providers (including peer mentors and cler-
gy), and first responders, in— 
(A) understanding and identifying early signs 
and risk factors of trauma in infants, children, and 
youth, and their families as appropriate, including 
through screening processes and services; 
(B) providing practices to prevent and mitigate 
the impact of trauma, including by fostering safe 
and stable environments and relationships; and 
(C) developing and implementing policies, pro-
cedures, or systems that—
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•HRES 1099 EH 
(i) are designed to quickly refer infants, 
children, youth, and their families as appro-
priate, who have experienced or are at risk of 
experiencing trauma to the appropriate trau-
ma-informed screening and support and age- 
appropriate treatment, and to ensure such in-
fants, children, youth, and family members re-
ceive such support; 
(ii) utilize and develop partnerships with 
early childhood education programs, local social 
services organizations, such as organizations 
serving youth, and clinical mental health or 
other health care providers with expertise in 
providing support services and age-appropriate 
trauma-informed and evidence-based treatment 
aimed at preventing or mitigating the effects of 
trauma; 
(iii) educate children and youth to— 
(I) understand and identify the signs, 
effects, or symptoms of trauma; and 
(II) build the resilience and coping 
skills to mitigate the effects of experi-
encing trauma; 
(iv) 
promote 
and 
support 
multi- 
generational practices that assist parents, fos-
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•HRES 1099 EH 
ter parents, and kinship and other caregivers 
in accessing resources related to, and devel-
oping environments conducive to, the preven-
tion and mitigation of trauma; and 
(v) 
collect 
and 
utilize 
data 
from 
screenings, referrals, or the provision of serv-
ices and supports to evaluate outcomes and im-
prove processes for trauma-informed services 
and supports that are culturally sensitive, lin-
guistically appropriate, and specific to age 
ranges and sex, as applicable; 
(2) recommend best practices that are designed to 
avoid unwarranted custody loss or criminal penalties for 
parents or guardians in connection with infants, chil-
dren, and youth who have experienced or are at risk of 
experiencing trauma; and 
(3) recommend opportunities for local- and State- 
level partnerships that— 
(A) are designed to quickly identify and refer 
children and families, as appropriate, who have ex-
perienced or are at risk of experiencing exposure to 
trauma, including related to substance use; 
(B) utilize and develop partnerships with early 
childhood education programs, local social services 
organizations, and health care services aimed at
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preventing or mitigating the effects of exposure to 
trauma, including related to substance use; 
(C) offer community-based prevention activi-
ties, including educating families and children on 
the effects of exposure to trauma, such as trauma 
related to substance use, and how to build resilience 
and coping skills to mitigate those effects; 
(D) in accordance with Federal privacy protec-
tions, utilize non-personally-identifiable data from 
screenings, referrals, or the provision of services 
and supports to evaluate and improve processes ad-
dressing exposure to trauma, including related to 
substance use; and 
(E) are designed to prevent separation and 
support reunification of families if in the best inter-
est of the child. 
(e) OPERATING PLAN.—Not later than 120 days after 
the date of enactment of this Act, the task force shall hold 
the first meeting. Not later than 2 years after such date of 
enactment, the task force shall submit to the Secretary of 
Education, Secretary of Health and Human Services, Sec-
retary of Labor, Secretary of the Interior, the Attorney Gen-
eral, and Congress an operating plan for carrying out the ac-
tivities of the task force described in subsection (c)(2). Such 
operating plan shall include—
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(1) a list of specific activities that the task force 
plans to carry out for purposes of carrying out duties de-
scribed in subsection (c)(2), which may include public 
engagement; 
(2) a plan for carrying out the activities under sub-
section (c)(2); 
(3) a list of members of the task force and other 
individuals who are not members of the task force that 
may be consulted to carry out such activities; 
(4) an explanation of Federal agency involvement 
and coordination needed to carry out such activities, in-
cluding any statutory or regulatory barriers to such co-
ordination; 
(5) a budget for carrying out such activities; 
(6) a proposed timeline for implementing rec-
ommendations and efforts identified under subsection 
(c); and 
(7) other information that the task force determines 
appropriate as related to its duties. 
(f) FINAL REPORT.—Not later than 3 years after the 
date of the first meeting of the task force, the task force shall 
submit to the general public, Secretary of Education, Sec-
retary of Health and Human Services, Secretary of Labor, 
Secretary of the Interior, the Attorney General, other rel-
evant cabinet Secretaries, the Committee on Energy and
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Commerce and the Committee on Education and the Work-
force of the House of Representatives and the Committee on 
Health, Education, Labor, and Pensions of the Senate, and 
Congress, a final report containing all of the findings and 
recommendations required under this section, and shall make 
such report available online in an accessible format. 
(g) ADDITIONAL REPORTS.—In addition to the final re-
port under subsection (f). the task force shall submit— 
(1) a report to Congress identifying any rec-
ommendations identified under subsection (c) that re-
quire additional legislative authority to implement; and 
(2) a report to the Governors describing the oppor-
tunities for local- and State-level partnerships, profes-
sional development, or best practices recommended 
under subsection (d)(3). 
(h) DEFINITIONS.—In this section— 
(1) the term ‘‘early childhood education program’’ 
has the meaning given such term in section 103 of the 
Higher Education Act of 1965 (20 U.S.C. 1003); 
(2) The term ‘‘Governor’’ means the chief executive 
officer of a State; and 
(3) the term ‘‘State’’ means each of the several 
States, the District of Columbia, the Commonwealth of 
Puerto Rico, the Virgin Islands, Guam, American
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Samoa, and the Commonwealth of the Northern Mariana 
Islands. 
(i) SUNSET.—The task force shall sunset on the date 
that is 60 days after the submission of the final report under 
subsection (f), but not later than September 30, 2023. 
SEC. 7133. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE. 
Section 582(j) of the Public Health Service Act (42 
U.S.C. 290hh–1(j)) (relating to grants to address the prob-
lems of persons who experience violence-related stress) is 
amended by striking ‘‘$46,887,000 for each of fiscal years 
2018 through 2022’’ and inserting ‘‘$63,887,000 for each of 
fiscal years 2019 through 2023’’. 
SEC. 7134. GRANTS TO IMPROVE TRAUMA SUPPORT SERVICES 
AND MENTAL HEALTH CARE FOR CHILDREN AND 
YOUTH IN EDUCATIONAL SETTINGS. 
(a) GRANTS, CONTRACTS, AND COOPERATIVE AGREE-
MENTS AUTHORIZED.—The Secretary, in coordination with 
the Assistant Secretary for Mental Health and Substance 
Use, is authorized to award grants to, or enter into contracts 
or cooperative agreements with, State educational agencies, 
local educational agencies, Indian Tribes (as defined in sec-
tion 4 of the Indian Self-Determination and Education As-
sistance Act) or their tribal educational agencies, a school op-
erated by the Bureau of Indian Education, a Regional Cor-
poration, or a Native Hawaiian educational organization, for
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the purpose of increasing student access to evidence-based 
trauma support services and mental health care by developing 
innovative initiatives, activities, or programs to link local 
school systems with local trauma-informed support and men-
tal health systems, including those under the Indian Health 
Service. 
(b) DURATION.—With respect to a grant, contract, or 
cooperative agreement awarded or entered into under this 
section, the period during which payments under such grant, 
contract or agreement are made to the recipient may not ex-
ceed 4 years. 
(c) USE OF FUNDS.—An entity that receives a grant, 
contract, or cooperative agreement under this section shall 
use amounts made available through such grant, contract, or 
cooperative agreement for evidence-based activities, which 
shall include any of the following: 
(1) Collaborative efforts between school-based serv-
ice systems and trauma-informed support and mental 
health service systems to provide, develop, or improve 
prevention, screening, referral, and treatment and sup-
port services to students, such as providing trauma 
screenings to identify students in need of specialized 
support.
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•HRES 1099 EH 
(2) To implement schoolwide positive behavioral 
interventions and supports, or other trauma-informed 
models of support. 
(3) To provide professional development to teachers, 
teacher assistants, school leaders, specialized instruc-
tional support personnel, and mental health professionals 
that— 
(A) fosters safe and stable learning environ-
ments that prevent and mitigate the effects of trau-
ma, including through social and emotional learn-
ing; 
(B) improves school capacity to identify, refer, 
and provide services to students in need of trauma 
support or behavioral health services; or 
(C) reflects the best practices for trauma-in-
formed identification, referral, and support devel-
oped by the Task Force under section 7132. 
(4) Services at a full-service community school that 
focuses on trauma-informed supports, which may include 
a full-time site coordinator, or other activities consistent 
with section 4625 of the Elementary and Secondary 
Education Act of 1965 (20 U.S.C. 7275). 
(5) Engaging families and communities in efforts to 
increase awareness of child and youth trauma, which 
may include sharing best practices with law enforcement
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•HRES 1099 EH 
regarding trauma-informed care and working with men-
tal health professionals to provide interventions, as well 
as longer term coordinated care within the community 
for children and youth who have experienced trauma and 
their families. 
(6) To provide technical assistance to school sys-
tems and mental health agencies. 
(7) To evaluate the effectiveness of the program 
carried out under this section in increasing student ac-
cess to evidence-based trauma support services and men-
tal health care. 
(8) To establish partnerships with or provide sub-
grants to Head Start agencies (including Early Head 
Start agencies), public and private preschool programs, 
child care programs (including home-based providers), or 
other entities described in subsection (a), to include such 
entities described in this paragraph in the evidence-based 
trauma initiatives, activities, support services, and men-
tal health systems established under this section in order 
to provide, develop, or improve prevention, screening, re-
ferral, and treatment and support services to young chil-
dren and their families. 
(d) APPLICATIONS.—To be eligible to receive a grant, 
contract, or cooperative agreement under this section, an en-
tity described in subsection (a) shall submit an application to
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the Secretary at such time, in such manner, and containing 
such information as the Secretary may reasonably require, 
which shall include the following: 
(1) A description of the innovative initiatives, activi-
ties, or programs to be funded under the grant, contract, 
or cooperative agreement, including how such program 
will increase access to evidence-based trauma support 
services and mental health care for students, and, as ap-
plicable, the families of such students. 
(2) A description of how the program will provide 
linguistically appropriate and culturally competent serv-
ices. 
(3) A description of how the program will support 
students and the school in improving the school climate 
in order to support an environment conducive to learn-
ing. 
(4) An assurance that— 
(A) persons providing services under the grant, 
contract, or cooperative agreement are adequately 
trained to provide such services; and 
(B) teachers, school leaders, administrators, 
specialized instructional support personnel, rep-
resentatives of local Indian Tribes or tribal organi-
zations as appropriate, other school personnel, and 
parents or guardians of students participating in
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•HRES 1099 EH 
services under this section will be engaged and in-
volved in the design and implementation of the serv-
ices. 
(5) A description of how the applicant will support 
and integrate existing school-based services with the pro-
gram in order to provide mental health services for stu-
dents, as appropriate. 
(6) A description of the entities in the community 
with which the applicant will partner or to which the ap-
plicant will provide subgrants in accordance with sub-
section (c)(8). 
(e) INTERAGENCY AGREEMENTS.— 
(1) LOCAL
INTERAGENCY
AGREEMENTS.—To en-
sure the provision of the services described in subsection 
(c), a recipient of a grant, contract, or cooperative agree-
ment under this section, or their designee, shall establish 
a local interagency agreement among local educational 
agencies, agencies responsible for early childhood edu-
cation programs, Head Start agencies (including Early 
Head Start agencies), juvenile justice authorities, mental 
health agencies, child welfare agencies, and other rel-
evant agencies, authorities, or entities in the community 
that will be involved in the provision of such services. 
(2) CONTENTS.—In ensuring the provision of the 
services described in subsection (c), the local interagency
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•HRES 1099 EH 
agreement shall specify with respect to each agency, au-
thority, or entity that is a party to such agreement— 
(A) the financial responsibility for the services; 
(B) the conditions and terms of responsibility 
for the services, including quality, accountability, 
and coordination of the services; and 
(C) the conditions and terms of reimbursement 
among such agencies, authorities, or entities, in-
cluding procedures for dispute resolution. 
(f) EVALUATION.—The Secretary shall reserve not more 
than 3 percent of the funds made available under subsection 
(l) for each fiscal year to— 
(1) conduct a rigorous, independent evaluation of 
the activities funded under this section; and 
(2) disseminate and promote the utilization of evi-
dence-based practices regarding trauma support services 
and mental health care. 
(g) DISTRIBUTION
OF AWARDS.—The Secretary shall 
ensure that grants, contracts, and cooperative agreements 
awarded or entered into under this section are equitably dis-
tributed among the geographical regions of the United States 
and among tribal, urban, suburban, and rural populations. 
(h) RULE OF CONSTRUCTION.—Nothing in this section 
shall be construed—
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(1) to prohibit an entity involved with a program 
carried out under this section from reporting a crime 
that is committed by a student to appropriate authori-
ties; or 
(2) to prevent Federal, State, and tribal law en-
forcement and judicial authorities from exercising their 
responsibilities with regard to the application of Federal, 
tribal, and State law to crimes committed by a student. 
(i) SUPPLEMENT, NOT SUPPLANT.—Any services pro-
vided through programs carried out under this section shall 
supplement, and not supplant, existing mental health serv-
ices, including any special education and related services pro-
vided under the Individuals with Disabilities Education Act 
(20 U.S.C. 1400 et seq.). 
(j) CONSULTATION WITH INDIAN TRIBES.—In carrying 
out subsection (a), the Secretary shall, in a timely manner, 
meaningfully consult with Indian Tribes and their representa-
tives to ensure notice of eligibility. 
(k) DEFINITIONS.—In this section: 
(1) ELEMENTARY SCHOOL.—The term ‘‘elementary 
school’’ has the meaning given such term in section 8101 
of the Elementary and Secondary Education Act of 1965 
(20 U.S.C. 7801). 
(2) EVIDENCE-BASED.—The term ‘‘evidence-based’’ 
has 
the 
meaning 
given 
such 
term 
in 
section
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•HRES 1099 EH 
8101(21)(A)(i) of the Elementary and Secondary Edu-
cation Act of 1965 (20 U.S.C. 7801(21)(A)(i)). 
(3) NATIVE
HAWAIIAN
EDUCATIONAL
ORGANIZA-
TION.—The term ‘‘Native Hawaiian educational organi-
zation’’ has the meaning given such term in section 6207 
of the Elementary and Secondary Education Act of 1965 
(20 U.S.C. 7517). 
(4) LOCAL
EDUCATIONAL
AGENCY.—The term 
‘‘local educational agency’’ has the meaning given such 
term in section 8101 of the Elementary and Secondary 
Education Act of 1965 (20 U.S.C. 7801). 
(5) REGIONAL CORPORATION.—The term ‘‘Regional 
Corporation’’ has the meaning given the term in section 
3 of the Alaska Native Claims Settlement Act (43 
U.S.C. 1602)). 
(6) SCHOOL.—The term ‘‘school’’ means a public 
elementary school or public secondary school. 
(7) SCHOOL LEADER.—The term ‘‘school leader’’ 
has the meaning given such term in section 8101 of the 
Elementary and Secondary Education Act of 1965 (20 
U.S.C. 7801). 
(8) SECONDARY
SCHOOL.—The term ‘‘secondary 
school’’ has the meaning given such term in section 8101 
of the Elementary and Secondary Education Act of 1965 
(20 U.S.C. 7801).
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(9) SECRETARY.—The term ‘‘Secretary’’ means the 
Secretary of Education. 
(10) SPECIALIZED INSTRUCTIONAL SUPPORT PER-
SONNEL.—The term ‘‘specialized instructional support 
personnel’’ has the meaning given such term in section 
8101 of the Elementary and Secondary Education Act of 
1965 (20 U.S.C. 7801). 
(11) STATE
EDUCATIONAL
AGENCY.—The term 
‘‘State educational agency’’ has the meaning given such 
term in section 8101 of the Elementary and Secondary 
Education Act of 1965 (20 U.S.C. 7801). 
(l) AUTHORIZATION OF APPROPRIATIONS.—There is au-
thorized to be appropriated to carry out this section, 
$50,000,000 for each of fiscal years 2019 through 2023. 
SEC. 7135. RECOGNIZING EARLY CHILDHOOD TRAUMA RE-
LATED TO SUBSTANCE ABUSE. 
(a) DISSEMINATION OF INFORMATION.—The Secretary 
of Health and Human Services shall disseminate information, 
resources, and, if requested, technical assistance to early 
childhood care and education providers and professionals 
working with young children on— 
(1) ways to properly recognize children who may be 
impacted by trauma, including trauma related to sub-
stance use by a family member or other adult; and
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(2) how to respond appropriately in order to provide 
for the safety and well-being of young children and their 
families. 
(b) GOALS.—The information, resources, and technical 
assistance provided under subsection (a) shall— 
(1) educate early childhood care and education pro-
viders and professionals working with young children on 
understanding and identifying the early signs and risk 
factors of children who might be impacted by trauma, 
including trauma due to exposure to substance use; 
(2) suggest age-appropriate communication tools, 
procedures, and practices for trauma-informed care, in-
cluding ways to prevent or mitigate the effects of trau-
ma; 
(3) provide options for responding to children im-
pacted by trauma, including due to exposure to sub-
stance use, that consider the needs of the child and fam-
ily, including recommending resources and referrals for 
evidence-based services to support such family; and 
(4) promote whole-family and multi-generational ap-
proaches to keep families safely together when it is in 
the best interest of the child. 
(c) COORDINATION.—The Secretary of Health and 
Human Services shall coordinate with the task force to de-
velop best practices for trauma-informed identification, refer-
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ral, and support authorized under section 7132 in dissemi-
nating the information, resources, and technical assistance 
described under subsection (b). 
(d) RULE
OF CONSTRUCTION.—Such information, re-
sources, and if applicable, technical assistance, shall not be 
construed to amend the requirements under— 
(1) the Child Care and Development Block Grant 
Act of 1990 (42 U.S.C. 9858 et seq.); 
(2) the Head Start Act (42 U.S.C. 9831 et seq.); 
or 
(3) the Individuals with Disabilities Education Act 
(20 U.S.C. 1400 et seq.). 
Subtitle O—Eliminating Opioid 
Related Infectious Diseases 
SEC. 7141. REAUTHORIZATION AND EXPANSION OF PROGRAM 
OF SURVEILLANCE AND EDUCATION REGARDING 
INFECTIONS ASSOCIATED WITH ILLICIT DRUG USE 
AND OTHER RISK FACTORS. 
Section 317N of the Public Health Service Act (42 
U.S.C. 247b–15) is amended to read as follows: 
‘‘SEC. 317N. SURVEILLANCE AND EDUCATION REGARDING IN-
FECTIONS ASSOCIATED WITH ILLICIT DRUG USE 
AND OTHER RISK FACTORS. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention,
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may (directly or through grants to public and nonprofit pri-
vate entities) provide for programs for the following: 
‘‘(1) To cooperate with States and Indian tribes in 
implementing or maintaining a national system to deter-
mine the incidence of infections commonly associated 
with illicit drug use, such as viral hepatitis, human im-
munodeficiency virus, and infective endocarditis, and to 
assist the States in determining the prevalence of such 
infections, which may include the reporting of cases of 
such infections. 
‘‘(2) To identify, counsel, and offer testing to indi-
viduals who are at risk of infections described in para-
graph (1) resulting from illicit drug use, receiving blood 
transfusions prior to July 1992, or other risk factors. 
‘‘(3) To provide appropriate referrals for coun-
seling, testing, and medical treatment of individuals 
identified under paragraph (2) and to ensure, to the ex-
tent practicable, the provision of appropriate follow-up 
services. 
‘‘(4) To develop and disseminate public information 
and education programs for the detection and control of 
infections described in paragraph (1), with priority given 
to high-risk populations as determined by the Secretary. 
‘‘(5) To improve the education, training, and skills 
of health professionals in the detection and control of in-
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fections described in paragraph (1), including to improve 
coordination of treatment of substance use disorders and 
infectious diseases, with priority given to substance use 
disorder treatment providers, pediatricians and other 
primary care providers, obstetrician-gynecologists, and 
infectious disease clinicians, including HIV clinicians. 
‘‘(b) LABORATORY PROCEDURES.—The Secretary may 
(directly or through grants to public and nonprofit private 
entities) carry out programs to provide for improvements in 
the quality of clinical-laboratory procedures regarding infec-
tions described in subsection (a)(1). 
‘‘(c) DEFINITION.—In this section, the term ‘Indian 
tribe’ has the meaning given that term in section 4 of the In-
dian Self-Determination and Education Assistance Act. 
‘‘(d) AUTHORIZATION
OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized to 
be appropriated $40,000,000 for each of the fiscal years 
2019 through 2023.’’. 
Subtitle P—Peer Support 
Communities of Recovery 
SEC. 7151. BUILDING COMMUNITIES OF RECOVERY. 
Section 547 of the Public Health Service Act (42 U.S.C. 
290ee–2) is amended to read as follows:
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‘‘SEC. 547. BUILDING COMMUNITIES OF RECOVERY. 
‘‘(a) DEFINITION.—In this section, the term ‘recovery 
community organization’ means an independent nonprofit or-
ganization that— 
‘‘(1) mobilizes resources within and outside of the 
recovery community, which may include through a peer 
support network, to increase the prevalence and quality 
of long-term recovery from substance use disorders; and 
‘‘(2) is wholly or principally governed by people in 
recovery for substance use disorders who reflect the com-
munity served. 
‘‘(b) GRANTS AUTHORIZED.—The Secretary shall award 
grants to recovery community organizations to enable such 
organizations to develop, expand, and enhance recovery serv-
ices. 
‘‘(c) FEDERAL SHARE.—The Federal share of the costs 
of a program funded by a grant under this section may not 
exceed 85 percent. 
‘‘(d) USE OF FUNDS.—Grants awarded under subsection 
(b)— 
‘‘(1) shall be used to develop, expand, and enhance 
community and statewide recovery support services; and 
‘‘(2) may be used to— 
‘‘(A) build connections between recovery net-
works, including between recovery community orga-
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nizations and peer support networks, and with other 
recovery support services, including— 
‘‘(i) behavioral health providers; 
‘‘(ii) primary care providers and physi-
cians; 
‘‘(iii) educational and vocational schools; 
‘‘(iv) employers; 
‘‘(v) housing services; 
‘‘(vi) child welfare agencies; and 
‘‘(vii) other recovery support services that 
facilitate recovery from substance use dis-
orders, including non-clinical community serv-
ices; 
‘‘(B) reduce stigma associated with substance 
use disorders; and 
‘‘(C) conduct outreach on issues relating to 
substance use disorders and recovery, including— 
‘‘(i) identifying the signs of substance use 
disorder; 
‘‘(ii) the resources available to individuals 
with substance use disorder and to families of 
an individual with a substance use disorder, in-
cluding programs that mentor and provide sup-
port services to children;
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‘‘(iii) the resources available to help sup-
port individuals in recovery; and 
‘‘(iv) related medical outcomes of sub-
stance use disorders, the potential of acquiring 
an infection commonly associated with illicit 
drug use, and neonatal abstinence syndrome 
among infants exposed to opioids during preg-
nancy. 
‘‘(e) SPECIAL CONSIDERATION.—In carrying out this 
section, the Secretary shall give special consideration to the 
unique needs of rural areas, including areas with an age-ad-
justed rate of drug overdose deaths that is above the national 
average and areas with a shortage of prevention and treat-
ment services. 
‘‘(f) AUTHORIZATION
OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2019 through 2023.’’. 
SEC. 7152. PEER SUPPORT TECHNICAL ASSISTANCE CENTER. 
Title V of the Public Health Service Act (42 U.S.C. 
290dd et seq.) is amended by inserting after section 547 the 
following: 
‘‘SEC. 547A. PEER SUPPORT TECHNICAL ASSISTANCE CENTER. 
‘‘(a) ESTABLISHMENT.—The Secretary, acting through 
the Assistant Secretary, shall establish or operate a National 
Peer-Run Training and Technical Assistance Center for Ad-
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diction Recovery Support (referred to in this section as the 
‘Center’). 
‘‘(b) FUNCTIONS.—The Center established under sub-
section (a) shall provide technical assistance and support to 
recovery community organizations and peer support networks, 
including such assistance and support related to— 
‘‘(1) training on identifying— 
‘‘(A) signs of substance use disorder; 
‘‘(B) resources to assist individuals with a sub-
stance use disorder, or resources for families of an 
individual with a substance use disorder; and 
‘‘(C) best practices for the delivery of recovery 
support services; 
‘‘(2) the provision of translation services, interpre-
tation, or other such services for clients with limited 
English speaking proficiency; 
‘‘(3) data collection to support research, including 
for translational research; 
‘‘(4) capacity building; and 
‘‘(5) evaluation and improvement, as necessary, of 
the effectiveness of such services provided by recovery 
community organizations. 
‘‘(c) BEST PRACTICES.—The Center established under 
subsection (a) shall periodically issue best practices for use
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by recovery community organizations and peer support net-
works. 
‘‘(d) RECOVERY COMMUNITY ORGANIZATION.—In this 
section, the term ‘recovery community organization’ has the 
meaning given such term in section 547. 
‘‘(e) AUTHORIZATION
OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
$1,000,000 for each of fiscal years 2019 through 2023.’’. 
Subtitle Q—Creating Opportunities 
That Necessitate New and En-
hanced Connections That Improve 
Opioid Navigation Strategies 
SEC. 7161. PREVENTING OVERDOSES OF CONTROLLED SUB-
STANCES. 
(a) IN GENERAL.—Part J of title III of the Public 
Health Service Act (42 U.S.C. 280b et seq.) is amended by 
inserting after section 392 (42 U.S.C. 280b–1) the following: 
‘‘SEC. 392A. PREVENTING OVERDOSES OF CONTROLLED SUB-
STANCES. 
‘‘(a) EVIDENCE-BASED PREVENTION GRANTS.— 
‘‘(1) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention may— 
‘‘(A) to the extent practicable, carry out and 
expand any evidence-based prevention activities de-
scribed in paragraph (2);
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‘‘(B) provide training and technical assistance 
to States, localities, and Indian tribes for purposes 
of carrying out such activity; and 
‘‘(C) award grants to States, localities, and In-
dian tribes for purposes of carrying out such activ-
ity. 
‘‘(2) EVIDENCE-BASED PREVENTION ACTIVITIES.— 
An evidence-based prevention activity described in this 
paragraph is any of the following activities: 
‘‘(A) Improving the efficiency and use of a new 
or currently operating prescription drug monitoring 
program, including by— 
‘‘(i) encouraging all authorized users (as 
specified by the State or other entity) to reg-
ister with and use the program; 
‘‘(ii) enabling such users to access any up-
dates to information collected by the program 
in as close to real-time as possible; 
‘‘(iii) improving the ease of use of such 
program; 
‘‘(iv) providing for a mechanism for the 
program to notify authorized users of any po-
tential misuse or abuse of controlled sub-
stances and any detection of inappropriate pre-
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scribing or dispensing practices relating to 
such substances; 
‘‘(v) encouraging the analysis of prescrip-
tion drug monitoring data for purposes of pro-
viding de-identified, aggregate reports based on 
such analysis to State public health agencies, 
State substance abuse agencies, State licensing 
boards, and other appropriate State agencies, 
as permitted under applicable Federal and 
State law and the policies of the prescription 
drug monitoring program and not containing 
any protected health information, to prevent 
inappropriate prescribing, drug diversion, or 
abuse and misuse of controlled substances, and 
to facilitate better coordination among agen-
cies; 
‘‘(vi) enhancing interoperability between 
the program and any health information tech-
nology (including certified health information 
technology), including by integrating program 
data into such technology; 
‘‘(vii) updating program capabilities to re-
spond to technological innovation for purposes 
of appropriately addressing the occurrence and 
evolution of controlled substance overdoses;
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‘‘(viii) facilitating and encouraging data 
exchange between the program and the pre-
scription drug monitoring programs of other 
States; 
‘‘(ix) enhancing data collection and qual-
ity, including improving patient matching and 
proactively monitoring data quality; 
‘‘(x) providing prescriber and dispenser 
practice tools, including prescriber practice in-
sight reports for practitioners to review their 
prescribing patterns in comparison to such pat-
terns of other practitioners in the specialty; 
and 
‘‘(xi) meeting the purpose of the program 
established under section 399O, as described in 
section 399O(a). 
‘‘(B) Promoting community or health system 
interventions. 
‘‘(C) Evaluating interventions to prevent con-
trolled substance overdoses. 
‘‘(D) Implementing projects to advance an in-
novative prevention approach with respect to new 
and emerging public health crises and opportunities 
to address such crises, such as enhancing public
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education and awareness on the risks associated 
with opioids. 
‘‘(3) ADDITIONAL
GRANTS.—The Director may 
award grants to States, localities, and Indian Tribes— 
‘‘(A) to carry out innovative projects for grant-
ees to rapidly respond to controlled substance mis-
use, abuse, and overdoses, including changes in pat-
terns of controlled substance use; and 
‘‘(B) for any other evidence-based activity for 
preventing controlled substance misuse, abuse, and 
overdoses as the Director determines appropriate. 
‘‘(4) RESEARCH.—The Director, in coordination 
with the Assistant Secretary for Mental Health and Sub-
stance Use and the National Mental Health and Sub-
stance Use Policy Laboratory established under section 
501A, as appropriate and applicable, may conduct stud-
ies and evaluations to address substance use disorders, 
including preventing substance use disorders or other re-
lated topics the Director determines appropriate. 
‘‘(b) ENHANCED CONTROLLED SUBSTANCE OVERDOSE 
DATA
COLLECTION, 
ANALYSIS, 
AND
DISSEMINATION 
GRANTS.— 
‘‘(1) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention may—
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‘‘(A) to the extent practicable, carry out any 
controlled substance overdose data collection activi-
ties described in paragraph (2); 
‘‘(B) provide training and technical assistance 
to States, localities, and Indian tribes for purposes 
of carrying out such activity; 
‘‘(C) award grants to States, localities, and In-
dian tribes for purposes of carrying out such activ-
ity; and 
‘‘(D) coordinate with the Assistant Secretary 
for Mental Health and Substance Use to collect 
data pursuant to section 505(d)(1)(A) (relating to 
the number of individuals admitted to emergency 
departments as a result of the abuse of alcohol or 
other drugs). 
‘‘(2) CONTROLLED
SUBSTANCE
OVERDOSE
DATA 
COLLECTION AND ANALYSIS ACTIVITIES.—A controlled 
substance overdose data collection, analysis, and dissemi-
nation activity described in this paragraph is any of the 
following activities: 
‘‘(A) Improving the timeliness of reporting 
data to the public, including data on fatal and 
nonfatal overdoses of controlled substances. 
‘‘(B) Enhancing the comprehensiveness of con-
trolled substance overdose data by collecting infor-
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mation on such overdoses from appropriate sources 
such as toxicology reports, autopsy reports, death 
scene investigations, and emergency departments. 
‘‘(C) Modernizing the system for coding causes 
of death related to controlled substance overdoses to 
use an electronic-based system. 
‘‘(D) Using data to help identify risk factors 
associated with controlled substance overdoses. 
‘‘(E) Supporting entities involved in providing 
information on controlled substance overdoses, such 
as coroners, medical examiners, and public health 
laboratories to improve accurate testing and stand-
ardized reporting of causes and contributing factors 
to controlled substances overdoses and analysis of 
various opioid analogues to controlled substance 
overdoses. 
‘‘(F) Working to enable and encourage the ac-
cess, exchange, and use of information regarding 
controlled substance overdoses among data sources 
and entities. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) CONTROLLED
SUBSTANCE.—The term ‘con-
trolled substance’ has the meaning given that term in 
section 102 of the Controlled Substances Act.
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‘‘(2) INDIAN TRIBE.—The term ‘Indian tribe’ has 
the meaning given that term in section 4 of the Indian 
Self-Determination and Education Assistance Act. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For pur-
poses of carrying out this section, section 399O of this Act, 
and section 102 of the Comprehensive Addiction and Recov-
ery Act of 2016 (Public Law 114–198), there is authorized 
to be appropriated $496,000,000 for each of fiscal years 
2019 through 2023.’’. 
(b) EDUCATION AND AWARENESS.—Section 102 of the 
Comprehensive Addiction and Recovery Act of 2016 (Public 
Law 114–198) is amended— 
(1) by amending subsection (a) to read as follows: 
‘‘(a) IN
GENERAL.—The Secretary of Health and 
Human Services, acting through the Director of the Centers 
for Disease Control and Prevention and in coordination with 
the heads of other departments and agencies, shall advance 
education and awareness regarding the risks related to mis-
use and abuse of opioids, as appropriate, which may include 
developing or improving existing programs, conducting activi-
ties, and awarding grants that advance the education and 
awareness of— 
‘‘(1) the public, including patients and consumers— 
‘‘(A) generally; and
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‘‘(B) regarding such risks related to unused 
opioids and the dispensing options under section 
309(f) of the Controlled Substances Act, as applica-
ble; and 
‘‘(2) providers, which may include— 
‘‘(A) providing for continuing education on ap-
propriate prescribing practices; 
‘‘(B) education related to applicable State or 
local prescriber limit laws, information on the use of 
non-addictive alternatives for pain management, 
and the use of overdose reversal drugs, as appro-
priate; 
‘‘(C) disseminating and improving the use of 
evidence-based opioid prescribing guidelines across 
relevant health care settings, as appropriate, and 
updating guidelines as necessary; 
‘‘(D) implementing strategies, such as best 
practices, to encourage and facilitate the use of pre-
scriber guidelines, in accordance with State and 
local law; 
‘‘(E) disseminating information to providers 
about prescribing options for controlled substances, 
including such options under section 309(f) of the 
Controlled Substances Act, as applicable; and
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‘‘(F) disseminating information, as appro-
priate, on the National Pain Strategy developed by 
or in consultation with the Assistant Secretary for 
Health; and 
‘‘(3) other appropriate entities.’’; and 
(2) in subsection (b)— 
(A) by striking ‘‘opioid abuse’’ each place such 
term appears and inserting ‘‘opioid misuse and 
abuse’’; and 
(B) in paragraph (2), by striking ‘‘safe dis-
posal of prescription medications and other’’ and in-
serting ‘‘non-addictive treatment options, safe dis-
posal options for prescription medications, and 
other applicable’’. 
SEC. 7162. PRESCRIPTION DRUG MONITORING PROGRAM. 
Section 399O of the Public Health Service Act (42 
U.S.C. 280g–3) is amended to read as follows: 
‘‘SEC. 399O. PRESCRIPTION DRUG MONITORING PROGRAM. 
‘‘(a) PROGRAM.— 
‘‘(1) IN GENERAL.—Each fiscal year, the Secretary, 
acting through the Director of the Centers for Disease 
Control and Prevention, in coordination with the heads 
of other departments and agencies as appropriate, shall 
support States or localities for the purpose of improving 
the efficiency and use of PDMPs, including—
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‘‘(A) establishment and implementation of a 
PDMP; 
‘‘(B) maintenance of a PDMP; 
‘‘(C) improvements to a PDMP by— 
‘‘(i) enhancing functional components to 
work toward— 
‘‘(I) universal use of PDMPs among 
providers and their delegates, to the ex-
tent that State laws allow; 
‘‘(II) more timely inclusion of data 
within a PDMP; 
‘‘(III) active management of the 
PDMP, in part by sending proactive or 
unsolicited reports to providers to inform 
prescribing; and 
‘‘(IV) ensuring the highest level of 
ease in use of and access to PDMPs by 
providers and their delegates, to the ex-
tent that State laws allow; 
‘‘(ii) in consultation with the Office of the 
National Coordinator for Health Information 
Technology, improving the intrastate interoper-
ability of PDMPs by— 
‘‘(I) making PDMPs more actionable 
by integrating PDMPs within electronic
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health records and health information 
technology infrastructure; and 
‘‘(II) linking PDMP data to other 
data systems within the State, including— 
‘‘(aa) the data of pharmacy ben-
efit managers, medical examiners and 
coroners, and the State’s Medicaid 
program; 
‘‘(bb) 
worker’s 
compensation 
data; and 
‘‘(cc) prescribing data of pro-
viders of the Department of Veterans 
Affairs and the Indian Health Service 
within the State; 
‘‘(iii) in consultation with the Office of the 
National Coordinator for Health Information 
Technology, improving the interstate interoper-
ability of PDMPs through— 
‘‘(I) sharing of dispensing data in 
near-real time across State lines; and 
‘‘(II) integration of automated que-
ries for multistate PDMP data and ana-
lytics into clinical workflow to improve the 
use of such data and analytics by practi-
tioners and dispensers; or
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‘‘(iv) improving the ability to include 
treatment availability resources and referral 
capabilities within the PDMP. 
‘‘(2) LEGISLATION.—As a condition on the receipt 
of support under this section, the Secretary shall require 
a State or locality to demonstrate that it has enacted 
legislation or regulations— 
‘‘(A) to provide for the implementation of the 
PDMP; and 
‘‘(B) to permit the imposition of appropriate 
penalties for the unauthorized use and disclosure of 
information maintained by the PDMP. 
‘‘(b) PDMP STRATEGIES.—The Secretary shall encour-
age a State or locality, in establishing, improving, or main-
taining a PDMP, to implement strategies that improve— 
‘‘(1) the reporting of dispensing in the State or lo-
cality of a controlled substance to an ultimate user so 
the reporting occurs not later than 24 hours after the 
dispensing event; 
‘‘(2) the consultation of the PDMP by each pre-
scribing practitioner, or their designee, in the State or 
locality before initiating treatment with a controlled sub-
stance, or any substance as required by the State to be 
reported to the PDMP, and over the course of ongoing 
treatment for each prescribing event;
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‘‘(3) the consultation of the PDMP before dis-
pensing a controlled substance, or any substance as re-
quired by the State to be reported to the PDMP; 
‘‘(4) the proactive notification to a practitioner 
when patterns indicative of controlled substance misuse 
by a patient, including opioid misuse, are detected; 
‘‘(5) the availability of data in the PDMP to other 
States, as allowable under State law; and 
‘‘(6) the availability of nonidentifiable information 
to the Centers for Disease Control and Prevention for 
surveillance, epidemiology, statistical research, or edu-
cational purposes. 
‘‘(c) DRUG MISUSE AND ABUSE.—In consultation with 
practitioners, dispensers, and other relevant and interested 
stakeholders, a State receiving support under this section— 
‘‘(1) shall establish a program to notify practi-
tioners and dispensers of information that will help to 
identify and prevent the unlawful diversion or misuse of 
controlled substances; 
‘‘(2) may, to the extent permitted under State law, 
notify the appropriate authorities responsible for car-
rying out drug diversion investigations if the State deter-
mines that information in the PDMP maintained by the 
State indicates an unlawful diversion or abuse of a con-
trolled substance;
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‘‘(3) may conduct analyses of controlled substance 
program data for purposes of providing appropriate 
State agencies with aggregate reports based on such 
analyses in as close to real-time as practicable, regarding 
prescription patterns flagged as potentially presenting a 
risk of misuse, abuse, addiction, overdose, and other ag-
gregate information, as appropriate and in compliance 
with applicable Federal and State laws and provided 
that such reports shall not include protected health in-
formation; and 
‘‘(4) may access information about prescriptions, 
such as claims data, to ensure that such prescribing and 
dispensing history is updated in as close to real-time as 
practicable, in compliance with applicable Federal and 
State laws and provided that such information shall not 
include protected health information. 
‘‘(d) EVALUATION AND REPORTING.—As a condition on 
receipt of support under this section, the State shall report 
on interoperability with PDMPs of other States and Federal 
agencies, where appropriate, intrastate interoperability with 
health information technology systems such as electronic 
health records, health information exchanges, and e-pre-
scribing, where appropriate, and whether or not the State 
provides automatic, up-to-date, or daily information about a
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patient when a practitioner (or the designee of a practitioner, 
where permitted) requests information about such patient. 
‘‘(e) EVALUATION AND REPORTING.—A State receiving 
support under this section shall provide the Secretary with 
aggregate nonidentifiable information, as permitted by State 
law, to enable the Secretary— 
‘‘(1) to evaluate the success of the State’s program 
in achieving the purpose described in subsection (a); or 
‘‘(2) to prepare and submit to the Congress the re-
port required by subsection (i)(2). 
‘‘(f) EDUCATION
AND ACCESS
TO
THE MONITORING 
SYSTEM.—A State receiving support under this section shall 
take steps to— 
‘‘(1) facilitate prescribers and dispensers, and their 
delegates, as permitted by State law, to use the PDMP, 
to the extent practicable; and 
‘‘(2) educate prescribers and dispensers, and their 
delegates on the benefits of the use of PDMPs. 
‘‘(g) ELECTRONIC FORMAT.—The Secretary may issue 
guidelines specifying a uniform electronic format for the re-
porting, sharing, and disclosure of information pursuant to 
PDMPs. To the extent possible, such guidelines shall be con-
sistent with standards recognized by the Office of the Na-
tional Coordinator for Health Information Technology. 
‘‘(h) RULES OF CONSTRUCTION.—
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‘‘(1) FUNCTIONS
OTHERWISE
AUTHORIZED
BY 
LAW.—Nothing in this section shall be construed to re-
strict the ability of any authority, including any local, 
State, or Federal law enforcement, narcotics control, li-
censure, disciplinary, or program authority, to perform 
functions otherwise authorized by law. 
‘‘(2) ADDITIONAL PRIVACY PROTECTIONS.—Nothing 
in this section shall be construed as preempting any 
State from imposing any additional privacy protections. 
‘‘(3) FEDERAL PRIVACY REQUIREMENTS.—Nothing 
in this section shall be construed to supersede any Fed-
eral privacy or confidentiality requirement, including the 
regulations promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act of 
1996 (Public Law 104–191; 110 Stat. 2033) and section 
543 of this Act. 
‘‘(4) NO FEDERAL PRIVATE CAUSE OF ACTION.— 
Nothing in this section shall be construed to create a 
Federal private cause of action. 
‘‘(i) PROGRESS REPORT.—Not later than 3 years after 
the date of enactment of this section, the Secretary shall— 
‘‘(1) complete a study that— 
‘‘(A) determines the progress of grantees in es-
tablishing and implementing PDMPs consistent 
with this section;
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‘‘(B) provides an analysis of the extent to 
which the operation of PDMPs has— 
‘‘(i) reduced inappropriate use, abuse, di-
version of, and overdose with, controlled sub-
stances; 
‘‘(ii) established or strengthened initiatives 
to ensure linkages to substance use disorder 
treatment services; or 
‘‘(iii) affected patient access to appro-
priate care in States operating PDMPs; 
‘‘(C) determine the progress of grantees in 
achieving interstate interoperability and intrastate 
interoperability of PDMPs, including an assessment 
of technical, legal, and financial barriers to such 
progress and recommendations for addressing these 
barriers; 
‘‘(D) determines the progress of grantees in 
implementing near real-time electronic PDMPs; 
‘‘(E) provides an analysis of the privacy protec-
tions in place for the information reported to the 
PDMP in each State or locality receiving support 
under this section and any recommendations of the 
Secretary for additional Federal or State require-
ments for protection of this information;
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‘‘(F) determines the progress of States or lo-
calities in implementing technological alternatives to 
centralized data storage, such as peer-to-peer file 
sharing or data pointer systems, in PDMPs and the 
potential for such alternatives to enhance the pri-
vacy and security of individually identifiable data; 
and 
‘‘(G) evaluates the penalties that States or lo-
calities have enacted for the unauthorized use and 
disclosure of information maintained in PDMPs, 
and the criteria used by the Secretary to determine 
whether such penalties qualify as appropriate for 
purposes of subsection (a)(2); and 
‘‘(2) submit a report to the Congress on the results 
of the study. 
‘‘(j) ADVISORY COUNCIL.— 
‘‘(1) ESTABLISHMENT.—A State or locality may es-
tablish an advisory council to assist in the establishment, 
improvement, or maintenance of a PDMP consistent 
with this section. 
‘‘(2) LIMITATION.—A State or locality may not use 
Federal funds for the operations of an advisory council 
to assist in the establishment, improvement, or mainte-
nance of a PDMP.
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‘‘(3) SENSE OF CONGRESS.—It is the sense of the 
Congress that, in establishing an advisory council to as-
sist in the establishment, improvement, or maintenance 
of a PDMP, a State or locality should consult with ap-
propriate professional boards and other interested par-
ties. 
‘‘(k) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘controlled substance’ means a con-
trolled substance (as defined in section 102 of the Con-
trolled Substances Act) in schedule II, III, or IV of sec-
tion 202 of such Act. 
‘‘(2) The term ‘dispense’ means to deliver a con-
trolled substance to an ultimate user by, or pursuant to 
the lawful order of, a practitioner, irrespective of wheth-
er the dispenser uses the Internet or other means to ef-
fect such delivery. 
‘‘(3) The term ‘dispenser’ means a physician, phar-
macist, or other person that dispenses a controlled sub-
stance to an ultimate user. 
‘‘(4) The term ‘interstate interoperability’ with re-
spect to a PDMP means the ability of the PDMP to 
electronically share reported information with another 
State if the information concerns either the dispensing 
of a controlled substance to an ultimate user who resides 
in such other State, or the dispensing of a controlled
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substance prescribed by a practitioner whose principal 
place of business is located in such other State. 
‘‘(5) The term ‘intrastate interoperability’ with re-
spect to a PDMP means the integration of PDMP data 
within electronic health records and health information 
technology infrastructure or linking of a PDMP to other 
data systems within the State, including the State’s 
Medicaid program, workers’ compensation programs, 
and medical examiners or coroners. 
‘‘(6) The term ‘nonidentifiable information’ means 
information that does not identify a practitioner, dis-
penser, or an ultimate user and with respect to which 
there is no reasonable basis to believe that the informa-
tion can be used to identify a practitioner, dispenser, or 
an ultimate user. 
‘‘(7) The term ‘PDMP’ means a prescription drug 
monitoring program that is State-controlled. 
‘‘(8) The term ‘practitioner’ means a physician, 
dentist, veterinarian, scientific investigator, pharmacy, 
hospital, or other person licensed, registered, or other-
wise permitted, by the United States or the jurisdiction 
in which the individual practices or does research, to dis-
tribute, dispense, conduct research with respect to, ad-
minister, or use in teaching or chemical analysis, a con-
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trolled substance in the course of professional practice or 
research. 
‘‘(9) The term ‘State’ means each of the 50 States, 
the District of Columbia, and any commonwealth or ter-
ritory of the United States. 
‘‘(10) The term ‘ultimate user’ means a person who 
has obtained from a dispenser, and who possesses, a con-
trolled substance for the person’s own use, for the use 
of a member of the person’s household, or for the use 
of an animal owned by the person or by a member of 
the person’s household. 
‘‘(11) The term ‘clinical workflow’ means the inte-
gration of automated queries for prescription drug moni-
toring programs data and analytics into health informa-
tion technologies such as electronic health record sys-
tems, health information exchanges, and/or pharmacy 
dispensing software systems, thus streamlining provider 
access through automated queries.’’. 
Subtitle R—Review of Substance Use 
Disorder Treatment Providers Re-
ceiving Federal Funding 
SEC. 7171. REVIEW OF SUBSTANCE USE DISORDER TREATMENT 
PROVIDERS RECEIVING FEDERAL FUNDING. 
(a) IN GENERAL.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) shall
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conduct a review of entities that receive Federal funding for 
the provision of substance use disorder treatment services. 
The review shall include: 
(1) The length of time the entity has provided sub-
stance use disorder treatment services and the geo-
graphic area served by the entity. 
(2) A detailed analysis of the patient population 
served by the entity, including but not limited to the 
number of patients, types of diagnosed substance use 
disorders and the demographic information of such pa-
tients, including sex, race, ethnicity, and socioeconomic 
status. 
(3) Detailed information on the types of substance 
use disorders for which the entity has the experience, ca-
pability, and capacity to provide such services. 
(4) An analysis of how the entity handles patients 
requiring treatment for a substance use disorder that 
the organization is not able to treat. 
(5) An analysis of what is needed in order to im-
prove the entity’s ability to meet the addiction treatment 
needs of the communities served by that entity. 
(6) Based on the identified needs of the commu-
nities served, a description of unmet needs and inad-
equate services and how such needs and services could 
be better addressed to treat individuals with meth-
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amphetamine, cocaine, including crack cocaine, heroin, 
opioid, and other substance use disorders. 
(b) REPORT.—Not later than 2 years after the date of 
the enactment of this Act, the Secretary shall develop and 
submit to Congress a plan to direct appropriate resources to 
entities that provide substance use disorder treatment serv-
ices in order to address inadequacies in services or funding 
identified through the survey described in subsection (a). 
Subtitle S—Other Health Provisions 
SEC. 7181. STATE RESPONSE TO THE OPIOID ABUSE CRISIS. 
(a) IN GENERAL.—Section 1003 of the 21st Century 
Cures Act (Public Law 114–255) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘the authorization of appro-
priations under subsection (b) to carry out the 
grant program described in subsection (c)’’ and in-
serting ‘‘subsection (h) to carry out the grant pro-
gram described in subsection (b)’’; and 
(B) by inserting ‘‘and Indian Tribes’’ after 
‘‘States’’; 
(2) by striking subsection (b); 
(3) by redesignating subsections (c) through (e) as 
subsections (b) through (d), respectively; 
(4) by redesignating subsection (f) as subsection (j); 
(5) in subsection (b), as so redesignated—
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(A) in paragraph (1)— 
(i) in the paragraph heading, by inserting 
‘‘AND TRIBAL’’ after ‘‘STATE’’; 
(ii) by striking ‘‘States for the purpose of 
addressing the opioid abuse crisis within such 
States’’ and inserting ‘‘States and Indian 
Tribes for the purpose of addressing the opioid 
abuse crisis within such States and Indian 
Tribes’’; 
(iii) by inserting ‘‘or Indian Tribes’’ after 
‘‘preference to States’’; and 
(iv) by inserting before the period of the 
second sentence ‘‘or other Indian Tribes, as 
applicable’’; and 
(B) in paragraph (2)— 
(i) in the matter preceding subparagraph 
(A), by striking ‘‘to a State’’; 
(ii) in subparagraph (A), by striking ‘‘Im-
proving State’’ and inserting ‘‘Establishing or 
improving’’; 
(iii) in subparagraph (C), by inserting 
‘‘preventing 
diversion 
of 
controlled 
sub-
stances,’’ after ‘‘treatment programs,’’; and 
(iv) in subparagraph (E), by striking ‘‘as 
the State determines appropriate, related to
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addressing the opioid abuse crisis within the 
State’’ and inserting ‘‘as the State or Indian 
Tribe determines appropriate, related to ad-
dressing the opioid abuse crisis within the 
State or Indian Tribe, including directing re-
sources in accordance with local needs related 
to substance use disorders’’; 
(6) in subsection (c), as so redesignated, by striking 
‘‘subsection (c)’’ and inserting ‘‘subsection (b)’’; 
(7) in subsection (d), as so redesignated— 
(A) in the matter preceding paragraph (1), by 
striking ‘‘the authorization of appropriations under 
subsection (b)’’ and inserting ‘‘subsection (h)’’; and 
(B) in paragraph (1), by striking ‘‘subsection 
(c)’’ and inserting ‘‘subsection (b)’’; and 
(8) by inserting after subsection (d), as so redesig-
nated, the following: 
‘‘(e) INDIAN TRIBES.— 
‘‘(1) DEFINITION.—For purposes of this section, 
the term ‘Indian Tribe’ has the meaning given the term 
‘Indian tribe’ in section 4 of the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 5304). 
‘‘(2) APPROPRIATE MECHANISMS.—The Secretary, 
in consultation with Indian Tribes, shall identify and es-
tablish appropriate mechanisms for Tribes to dem-
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onstrate or report the information as required under 
subsections (b), (c), and (d). 
‘‘(f) REPORT
TO CONGRESS.—Not later than 1 year 
after the date on which amounts are first awarded after the 
date of enactment of this subsection, pursuant to subsection 
(b), and annually thereafter, the Secretary shall submit to the 
Committee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Energy and Commerce of the 
House of Representatives a report summarizing the informa-
tion provided to the Secretary in reports made pursuant to 
subsection (c), including the purposes for which grant funds 
are awarded under this section and the activities of such 
grant recipients. 
‘‘(g) TECHNICAL ASSISTANCE.—The Secretary, includ-
ing through the Tribal Training and Technical Assistance 
Center of the Substance Abuse and Mental Health Services 
Administration, shall provide State agencies and Indian 
Tribes, as applicable, with technical assistance concerning 
grant application and submission procedures under this sec-
tion, award management activities, and enhancing outreach 
and direct support to rural and underserved communities and 
providers in addressing the opioid crisis. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For pur-
poses of carrying out the grant program under subsection (b), 
there is authorized to be appropriated $500,000,000 for each
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of fiscal years 2019 through 2021, to remain available until 
expended. 
‘‘(i) SET ASIDE.—Of the amounts made available for 
each fiscal year to award grants under subsection (b) for a 
fiscal year, 5 percent of such amount for such fiscal year 
shall be made available to Indian Tribes, and up to 15 per-
cent of such amount for such fiscal year may be set aside for 
States with the highest age-adjusted rate of drug overdose 
death based on the ordinal ranking of States according to the 
Director of the Centers for Disease Control and Prevention.’’. 
(b) CONFORMING AMENDMENT.—Section 1004(c) of the 
21st Century Cures Act (Public Law 114–255) is amended 
by striking ‘‘, the FDA Innovation Account, or the Account 
For the State Response to the Opioid Abuse Crisis’’ and in-
serting ‘‘or the FDA Innovation Account’’. 
SEC. 7182. REPORT ON INVESTIGATIONS REGARDING PARITY IN 
MENTAL HEALTH AND SUBSTANCE USE DISORDER 
BENEFITS. 
(a) IN GENERAL.—Section 13003 of the 21st Century 
Cures Act (Public Law 114–255) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘with findings of any serious 
violation regarding’’ and inserting ‘‘concerning’’; 
and
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(B) by inserting ‘‘and the Committee on Edu-
cation and the Workforce’’ after ‘‘Energy and Com-
merce’’; and 
(2) in subsection (b)(1)— 
(A) by inserting ‘‘complaints received and 
number of’’ before ‘‘closed’’; and 
(B) by inserting before the period ‘‘, and, for 
each such investigation closed, which agency con-
ducted the investigation, whether the health plan 
that is the subject of the investigation is fully in-
sured or not fully insured and a summary of any 
coordination between the applicable State regulators 
and the Department of Labor, the Department of 
Health and Human Services, or the Department of 
the Treasury, and references to any guidance pro-
vided by the agencies addressing the category of 
violation committed’’. 
(b) APPLICABILITY.—The amendments made by sub-
section (a) shall apply with respect to the second annual re-
port required under such section 13003 and each such annual 
report thereafter. 
SEC. 7183. CAREER ACT. 
(a) IN GENERAL.—The Secretary of Health and Human 
Services (referred to in this section as the ‘‘Secretary’’), in 
consultation with the Secretary of Labor, shall continue or
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(2) RATES.—The rates described in this paragraph 
are the following: 
(A) The amount by which the rate of drug 
overdose deaths in the State, adjusted for age, is 
above the national overdose mortality rate, as deter-
mined by the Director of the Centers for Disease 
Control and Prevention. 
(B) The amount by which the rate of unem-
ployment for the State, based on data provided by 
the Bureau of Labor Statistics for the preceding 5 
calendar years for which there is available data, is 
above the national average. 
(C) The amount by which rate of labor force 
participation in the State, based on data provided 
by the Bureau of Labor Statistics for the preceding 
5 calendar years for which there is available data, 
is below the national average. 
(3) WEIGHTING.—The rates described in paragraph 
(2) shall be weighted as follows: 
(A) The rate described in paragraph (2)(A) 
shall be weighted 70 percent. 
(B) The rate described in paragraph (2)(B) 
shall be weighted 15 percent. 
(C) The rate described in paragraph (2)(C) 
shall be weighted 15 percent.
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(d) PREFERENCE.—In awarding grants under this sec-
tion, the Secretary shall give preference to entities located in 
areas within States with the greatest need, with such need 
based on the highest mortality rate related to substance use 
disorder. 
(e) DEFINITIONS.—In this section: 
(1) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’ 
means an entity that offers treatment or recovery serv-
ices for individuals with substance use disorders, and 
partners with one or more local or State stakeholders, 
which may include local employers, community organiza-
tions, the local workforce development board, local and 
State governments, and Indian Tribes or tribal organiza-
tions, to support recovery, independent living, and par-
ticipation in the workforce. 
(2) INDIAN TRIBES; TRIBAL ORGANIZATION.—The 
terms ‘‘Indian Tribe’’ and ‘‘tribal organization’’ have the 
meanings given the terms ‘‘Indian tribe’’ and ‘‘tribal or-
ganization’’ in section 4 of the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 5304). 
(3) STATE.—The term ‘‘State’’ includes only the 
several States and the District of Columbia. 
(f) APPLICATIONS.—An eligible entity shall submit an 
application at such time and in such manner as the Secretary 
may require. In submitting an application, the entity shall
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demonstrate the ability to partner with local stakeholders, 
which may include local employers, community stakeholders, 
the local workforce development board, local and State gov-
ernments, and Indian Tribes or tribal organizations, as appli-
cable, to— 
(1) identify gaps in the workforce due to the preva-
lence of substance use disorders; 
(2) in coordination with statewide employment and 
training activities, including coordination and alignment 
of activities carried out by entities provided grant funds 
under section 8041, help individuals in recovery from a 
substance use disorder transition into the workforce, in-
cluding by providing career services, training services as 
described in paragraph (2) of section 134(c) of the 
Workforce Innovation and Opportunity Act (29 U.S.C. 
3174(c)), and related services described in section 
134(a)(3) of such Act (42 U.S.C. 3174(a)); and 
(3) assist employers with informing their employees 
of the resources, such as resources related to substance 
use disorders that are available to their employees. 
(g) USE OF FUNDS.—An entity receiving a grant under 
this section shall use the funds to conduct one or more of the 
following activities: 
(1) Hire case managers, care coordinators, pro-
viders of peer recovery support services, as described in
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•HRES 1099 EH 
section 547(a) of the Public Health Service Act (42 
U.S.C. 290ee–2(a)), or other professionals, as appro-
priate, to provide services that support treatment, recov-
ery, and rehabilitation, and prevent relapse, recidivism, 
and overdose, including by encouraging— 
(A) the development and strengthening of daily 
living skills; and 
(B) the use of counseling, care coordination, 
and other services, as appropriate, to support recov-
ery from substance use disorders. 
(2) Implement or utilize innovative technologies, 
which may include the use of telemedicine. 
(3) In coordination with the lead State agency with 
responsibility for a workforce investment activity or local 
board described in subsection (b), provide— 
(A) short-term prevocational training services; 
and 
(B) training services that are directly linked to 
the employment opportunities in the local area or 
the planning region. 
(h) SUPPORT FOR STATE STRATEGY.—An eligible entity 
shall include in its application under subsection (f) informa-
tion describing how the services and activities proposed in 
such application are aligned with the State, outlying area, or 
Tribal strategy, as applicable, for addressing issues described
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in such application and how such entity will coordinate with 
existing systems to deliver services as described in such appli-
cation. 
(i) DATA REPORTING
AND PROGRAM OVERSIGHT.— 
Each eligible entity awarded a grant under this section shall 
submit to the Secretary a report at such time and in such 
manner as the Secretary may require. Such report shall in-
clude a description of— 
(1) the programs and activities funded by the grant; 
(2) outcomes of the population of individuals with 
a substance use disorder the grantee served through ac-
tivities described in subsection (g); and 
(3) any other information that the Secretary may 
require for the purpose of ensuring that the grantee is 
complying with all of the requirements of the grant. 
(j) REPORTS TO CONGRESS.— 
(1) PRELIMINARY REPORT.—Not later than 2 years 
after the end of the first year of the grant period under 
this section, the Secretary shall submit to Congress a 
preliminary report that analyzes reports submitted under 
subsection (i). 
(2) FINAL REPORT.—Not later than 2 years after 
submitting the preliminary report required under para-
graph (1), the Secretary shall submit to Congress a final 
report that includes—
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(A) a description of how the grant funding was 
used, including the number of individuals who re-
ceived services under subsection (g)(3) and an eval-
uation of the effectiveness of the activities con-
ducted by the grantee with respect to outcomes of 
the population of individuals with substance use dis-
order who receive services from the grantee; and 
(B) recommendations related to best practices 
for health care professionals to support individuals 
in substance use disorder treatment or recovery to 
live independently and participate in the workforce. 
(k) AUTHORIZATION OF APPROPRIATIONS.—There is au-
thorized to be appropriated $5,000,000 for each of fiscal 
years 2019 through 2023 for purposes of carrying out this 
section. 
TITLE VIII—MISCELLANEOUS 
Subtitle A—Synthetics Trafficking 
and Overdose Prevention 
SEC. 8001. SHORT TITLE. 
This subtitle may be cited as the ‘‘Synthetics Trafficking 
and Overdose Prevention Act of 2018’’ or ‘‘STOP Act of 
2018’’.
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SEC. 8002. CUSTOMS FEES. 
(a) IN GENERAL.—Section 13031(b)(9) of the Consoli-
dated Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 
58c(b)(9)) is amended by adding at the end the following: 
‘‘(D)(i) With respect to the processing of items that 
are sent to the United States through the international 
postal network by ‘Inbound Express Mail service’ or ‘In-
bound EMS’ (as that service is described in the mail 
classification schedule referred to in section 3631 of title 
39, United States Code), the following payments are re-
quired: 
‘‘(I) $1 per Inbound EMS item. 
‘‘(II) If an Inbound EMS item is formally en-
tered, the fee provided for under subsection (a)(9), 
if applicable. 
‘‘(ii) Notwithstanding section 451 of the Tariff Act 
of 1930 (19 U.S.C. 1451), the payments required by 
clause (i), as allocated pursuant to clause (iii)(I), shall 
be the only payments required for reimbursement of 
U.S. Customs and Border Protection for customs serv-
ices provided in connection with the processing of an In-
bound EMS item. 
‘‘(iii)(I) The payments required by clause (i)(I) 
shall be allocated as follows: 
‘‘(aa) 50 percent of the amount of the pay-
ments shall be paid on a quarterly basis by the
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United States Postal Service to the Commissioner 
of U.S. Customs and Border Protection in accord-
ance with regulations prescribed by the Secretary of 
the Treasury to reimburse U.S. Customs and Bor-
der Protection for customs services provided in con-
nection with the processing of Inbound EMS items. 
‘‘(bb) 50 percent of the amount of the pay-
ments shall be retained by the Postal Service to re-
imburse the Postal Service for services provided in 
connection with the customs processing of Inbound 
EMS items. 
‘‘(II) Payments received by U.S. Customs and Bor-
der Protection under subclause (I)(aa) shall, in accord-
ance with section 524 of the Tariff Act of 1930 (19 
U.S.C. 1524), be deposited in the Customs User Fee Ac-
count and used to directly reimburse each appropriation 
for the amount paid out of that appropriation for the 
costs incurred in providing services to international mail 
facilities. Amounts deposited in accordance with the pre-
ceding sentence shall be available until expended for the 
provision of such services. 
‘‘(III) Payments retained by the Postal Service 
under subclause (I)(bb) shall be used to directly reim-
burse the Postal Service for the costs incurred in pro-
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viding services in connection with the customs processing 
of Inbound EMS items. 
‘‘(iv) Beginning in fiscal year 2021, the Secretary, 
in consultation with the Postmaster General, may adjust, 
not more frequently than once each fiscal year, the 
amount described in clause (i)(I) to an amount commen-
surate with the costs of services provided in connection 
with the customs processing of Inbound EMS items, con-
sistent with the obligations of the United States under 
international agreements.’’. 
(b) CONFORMING AMENDMENTS.—Section 13031(a) of 
the Consolidated Omnibus Budget Reconciliation Act of 1985 
(19 U.S.C. 58c(a)) is amended— 
(1) in paragraph (6), by inserting ‘‘(other than an 
item subject to a fee under subsection (b)(9)(D))’’ after 
‘‘customs officer’’; and 
(2) in paragraph (10)— 
(A) in subparagraph (C), in the matter pre-
ceding clause (i), by inserting ‘‘(other than Inbound 
EMS items described in subsection (b)(9)(D))’’ 
after ‘‘release’’; and 
(B) in the flush at the end, by inserting ‘‘or of 
Inbound EMS items described in subsection 
(b)(9)(D),’’ after ‘‘(C),’’.
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(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on January 1, 2020. 
SEC. 8003. MANDATORY ADVANCE ELECTRONIC INFORMATION 
FOR POSTAL SHIPMENTS. 
(a) MANDATORY
ADVANCE
ELECTRONIC
INFORMA-
TION.— 
(1) IN
GENERAL.—Section 343(a)(3)(K) of the 
Trade Act of 2002 (Public Law 107–210; 19 U.S.C. 
2071 note) is amended to read as follows: 
‘‘(K)(i) The Secretary shall prescribe regula-
tions requiring the United States Postal Service to 
transmit the information described in paragraphs 
(1) and (2) to the Commissioner of U.S. Customs 
and Border Protection for international mail ship-
ments by the Postal Service (including shipments to 
the Postal Service from foreign postal operators 
that are transported by private carrier) consistent 
with the requirements of this subparagraph. 
‘‘(ii) In prescribing regulations under clause 
(i), the Secretary shall impose requirements for the 
transmission to the Commissioner of information 
described in paragraphs (1) and (2) for mail ship-
ments described in clause (i) that are comparable to 
the requirements for the transmission of such infor-
mation imposed on similar non-mail shipments of
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cargo, taking into account the parameters set forth 
in subparagraphs (A) through (J). 
‘‘(iii) The regulations prescribed under clause 
(i) shall require the transmission of the information 
described in paragraphs (1) and (2) with respect to 
a shipment as soon as practicable in relation to the 
transportation of the shipment, consistent with sub-
paragraph (H). 
‘‘(iv) Regulations prescribed under clause (i) 
shall allow for the requirements for the trans-
mission to the Commissioner of information de-
scribed in paragraphs (1) and (2) for mail ship-
ments described in clause (i) to be implemented in 
phases, as appropriate, by— 
‘‘(I) setting incremental targets for in-
creasing the percentage of such shipments for 
which information is required to be transmitted 
to the Commissioner; and 
‘‘(II) taking into consideration— 
‘‘(aa) the risk posed by such ship-
ments; 
‘‘(bb) the volume of mail shipped to 
the United States by or through a par-
ticular country; and
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‘‘(cc) the capacities of foreign postal 
operators to provide that information to 
the Postal Service. 
‘‘(v)(I) Notwithstanding clause (iv), the Postal 
Service shall, not later than December 31, 2018, ar-
range for the transmission to the Commissioner of 
the information described in paragraphs (1) and (2) 
for not less than 70 percent of the aggregate num-
ber of mail shipments, including 100 percent of 
mail shipments from the People’s Republic of 
China, described in clause (i). 
‘‘(II) If the requirements of subclause (I) are 
not met, the Comptroller General of the United 
States shall submit to the appropriate congressional 
committees, not later than June 30, 2019, a re-
port— 
‘‘(aa) assessing the reasons for the failure 
to meet those requirements; and 
‘‘(bb) identifying recommendations to im-
prove the collection by the Postal Service of the 
information described in paragraphs (1) and 
(2). 
‘‘(vi)(I) Notwithstanding clause (iv), the Postal 
Service shall, not later than December 31, 2020, ar-
range for the transmission to the Commissioner of
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the information described in paragraphs (1) and (2) 
for 100 percent of the aggregate number of mail 
shipments described in clause (i). 
‘‘(II) The Commissioner, in consultation with 
the Postmaster General, may determine to exclude 
a country from the requirement described in sub-
clause (I) to transmit information for mail ship-
ments described in clause (i) from the country if the 
Commissioner determines that the country— 
‘‘(aa) does not have the capacity to collect 
and transmit such information; 
‘‘(bb) represents a low risk for mail ship-
ments that violate relevant United States laws 
and regulations; and 
‘‘(cc) accounts for low volumes of mail 
shipments that can be effectively screened for 
compliance with relevant United States laws 
and regulations through an alternate means. 
‘‘(III) The Commissioner shall, at a minimum 
on an annual basis, re-evaluate any determination 
made under subclause (II) to exclude a country 
from the requirement described in subclause (I). If, 
at any time, the Commissioner determines that a 
country no longer meets the requirements under 
subclause (II), the Commissioner may not further
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exclude the country from the requirement described 
in subclause (I). 
‘‘(IV) The Commissioner shall, on an annual 
basis, submit to the appropriate congressional com-
mittees— 
‘‘(aa) a list of countries with respect to 
which the Commissioner has made a deter-
mination under subclause (II) to exclude the 
countries from the requirement described in 
subclause (I); and 
‘‘(bb) information used to support such 
determination with respect to such countries. 
‘‘(vii)(I) The Postmaster General shall, in con-
sultation with the Commissioner, refuse any ship-
ments received after December 31, 2020, for which 
the information described in paragraphs (1) and (2) 
is not transmitted as required under this subpara-
graph, except as provided in subclause (II). 
‘‘(II) If remedial action is warranted in lieu of 
refusal of shipments pursuant to subclause (I), the 
Postmaster General and the Commissioner shall 
take remedial action with respect to the shipments, 
including destruction, seizure, controlled delivery or 
other law enforcement initiatives, or correction of 
the failure to provide the information described in
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paragraphs (1) and (2) with respect to the ship-
ments. 
‘‘(viii) Nothing in this subparagraph shall be 
construed to limit the authority of the Secretary to 
obtain information relating to international mail 
shipments from private carriers or other appro-
priate parties. 
‘‘(ix) In this subparagraph, the term ‘appro-
priate congressional committees’ means— 
‘‘(I) the Committee on Finance and the 
Committee on Homeland Security and Govern-
mental Affairs of the Senate; and 
‘‘(II) the Committee on Ways and Means, 
the Committee on Oversight and Government 
Reform, and the Committee on Homeland Se-
curity of the House of Representatives.’’. 
(2) JOINT STRATEGIC PLAN ON MANDATORY AD-
VANCE INFORMATION.—Not later than 60 days after the 
date of the enactment of this Act, the Secretary of 
Homeland Security and the Postmaster General shall de-
velop and submit to the appropriate congressional com-
mittees a joint strategic plan detailing specific perform-
ance measures for achieving—
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(A) the transmission of information as required 
by section 343(a)(3)(K) of the Trade Act of 2002, 
as amended by paragraph (1); and 
(B) the presentation by the Postal Service to 
U.S. Customs and Border Protection of all mail tar-
geted by U.S. Customs and Border Protection for 
inspection. 
(b) CAPACITY BUILDING.— 
(1) IN GENERAL.—Section 343(a) of the Trade Act 
of 2002 (Public Law 107–210; 19 U.S.C. 2071 note) is 
amended by adding at the end the following: 
‘‘(5) CAPACITY BUILDING.— 
‘‘(A) IN GENERAL.—The Secretary, with the 
concurrence of the Secretary of State, and in co-
ordination with the Postmaster General and the 
heads of other Federal agencies, as appropriate, 
may provide technical assistance, equipment, tech-
nology, and training to enhance the capacity of for-
eign postal operators— 
‘‘(i) to gather and provide the information 
required by paragraph (3)(K); and 
‘‘(ii) to otherwise gather and provide post-
al shipment information related to— 
‘‘(I) terrorism;
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‘‘(II) items the importation or intro-
duction of which into the United States is 
prohibited or restricted, including con-
trolled substances; and 
‘‘(III) such other concerns as the 
Secretary determines appropriate. 
‘‘(B) PROVISION OF EQUIPMENT AND TECH-
NOLOGY.—With respect to the provision of equip-
ment and technology under subparagraph (A), the 
Secretary may lease, loan, provide, or otherwise as-
sist in the deployment of such equipment and tech-
nology under such terms and conditions as the Sec-
retary may prescribe, including nonreimbursable 
loans or the transfer of ownership of equipment and 
technology.’’. 
(2) JOINT STRATEGIC PLAN ON CAPACITY BUILD-
ING.—Not later than 1 year after the date of the enact-
ment of this Act, the Secretary of Homeland Security 
and the Postmaster General shall, in consultation with 
the Secretary of State, jointly develop and submit to the 
appropriate congressional committees a joint strategic 
plan— 
(A) detailing the extent to which U.S. Customs 
and Border Protection and the United States Postal 
Service are engaged in capacity building efforts
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under section 343(a)(5) of the Trade Act of 2002, 
as added by paragraph (1); 
(B) describing plans for future capacity build-
ing efforts; and 
(C) assessing how capacity building has in-
creased the ability of U.S. Customs and Border 
Protection and the Postal Service to advance the 
goals of this subtitle and the amendments made by 
this subtitle. 
(c) REPORT AND CONSULTATIONS BY SECRETARY OF 
HOMELAND SECURITY AND POSTMASTER GENERAL.— 
(1) REPORT.—Not later than 180 days after the 
date of the enactment of this Act, and annually there-
after until 3 years after the Postmaster General has met 
the requirement under clause (vi) of subparagraph (K) 
of section 343(a)(3) of the Trade Act of 2002, as 
amended by subsection (a)(1), the Secretary of Home-
land Security and the Postmaster General shall, in con-
sultation with the Secretary of State, jointly submit to 
the appropriate congressional committees a report on 
compliance with that subparagraph that includes the fol-
lowing: 
(A) An assessment of the status of the regula-
tions required to be promulgated under that sub-
paragraph.
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(B) An update regarding new and existing 
agreements reached with foreign postal operators 
for the transmission of the information required by 
that subparagraph. 
(C) A summary of deliberations between the 
United States Postal Service and foreign postal op-
erators with respect to issues relating to the trans-
mission of that information. 
(D) A summary of the progress made in 
achieving the transmission of that information for 
the percentage of shipments required by that sub-
paragraph. 
(E) An assessment of the quality of that infor-
mation being received by foreign postal operators, 
as determined by the Secretary of Homeland Secu-
rity, and actions taken to improve the quality of 
that information. 
(F) A summary of policies established by the 
Universal Postal Union that may affect the ability 
of the Postmaster General to obtain the trans-
mission of that information. 
(G) A summary of the use of technology to de-
tect illicit synthetic opioids and other illegal sub-
stances in international mail parcels and planned 
acquisitions and advancements in such technology.
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(H) Such other information as the Secretary of 
Homeland Security and the Postmaster General 
consider appropriate with respect to obtaining the 
transmission of information required by that sub-
paragraph. 
(2) CONSULTATIONS.—Not later than 180 days 
after the date of the enactment of this Act, and every 
180 days thereafter until the Postmaster General has 
met the requirement under clause (vi) of section 
343(a)(3)(K) of the Trade Act of 2002, as amended by 
subsection (a)(1), to arrange for the transmission of in-
formation with respect to 100 percent of the aggregate 
number of mail shipments described in clause (i) of that 
section, the Secretary of Homeland Security and the 
Postmaster General shall provide briefings to the appro-
priate congressional committees on the progress made in 
achieving the transmission of that information for that 
percentage of shipments. 
(d) GOVERNMENT ACCOUNTABILITY OFFICE REPORT.— 
Not later than June 30, 2019, the Comptroller General of the 
United States shall submit to the appropriate congressional 
committees a report— 
(1) assessing the progress of the United States 
Postal Service in achieving the transmission of the infor-
mation required by subparagraph (K) of section
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343(a)(3) of the Trade Act of 2002, as amended by sub-
section (a)(1), for the percentage of shipments required 
by that subparagraph; 
(2) assessing the quality of the information received 
from foreign postal operators for targeting purposes; 
(3) assessing the specific percentage of targeted 
mail presented by the Postal Service to U.S. Customs 
and Border Protection for inspection; 
(4) describing the costs of collecting the information 
required by such subparagraph (K) from foreign postal 
operators and the costs of implementing the use of that 
information; 
(5) assessing the benefits of receiving that informa-
tion with respect to international mail shipments; 
(6) assessing the feasibility of assessing a customs 
fee under section 13031(b)(9) of the Consolidated Omni-
bus Budget Reconciliation Act of 1985, as amended by 
section 8002, on international mail shipments other than 
Inbound Express Mail service in a manner consistent 
with the obligations of the United States under inter-
national agreements; and 
(7) identifying recommendations, including rec-
ommendations for legislation, to improve the compliance 
of the Postal Service with such subparagraph (K), in-
cluding an assessment of whether the detection of illicit
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synthetic opioids in the international mail would be im-
proved by— 
(A) requiring the Postal Service to serve as the 
consignee for international mail shipments con-
taining goods; or 
(B) designating a customs broker to act as an 
importer of record for international mail shipments 
containing goods. 
(e) TECHNICAL CORRECTION.—Section 343 of the Trade 
Act of 2002 (Public Law 107–210; 19 U.S.C. 2071 note) is 
amended in the section heading by striking ‘‘ADVANCED’’ 
and inserting ‘‘ADVANCE’’. 
(f) APPROPRIATE CONGRESSIONAL COMMITTEES DE-
FINED.—In this section, the term ‘‘appropriate congressional 
committees’’ means— 
(1) the Committee on Finance and the Committee 
on Homeland Security and Governmental Affairs of the 
Senate; and 
(2) the Committee on Ways and Means, the Com-
mittee on Oversight and Government Reform, and the 
Committee on Homeland Security of the House of Rep-
resentatives. 
SEC. 8004. INTERNATIONAL POSTAL AGREEMENTS. 
(a) EXISTING AGREEMENTS.—
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(1) IN GENERAL.—In the event that any provision 
of this subtitle, or any amendment made by this subtitle, 
is determined to be in violation of obligations of the 
United States under any postal treaty, convention, or 
other international agreement related to international 
postal services, or any amendment to such an agreement, 
the Secretary of State should negotiate to amend the rel-
evant provisions of the agreement so that the United 
States is no longer in violation of the agreement. 
(2) RULE OF CONSTRUCTION.—Nothing in this sub-
section shall be construed to permit delay in the imple-
mentation of this subtitle or any amendment made by 
this subtitle. 
(b) FUTURE AGREEMENTS.— 
(1) CONSULTATIONS.—Before entering into, on or 
after the date of the enactment of this Act, any postal 
treaty, convention, or other international agreement re-
lated to international postal services, or any amendment 
to such an agreement, that is related to the ability of the 
United States to secure the provision of advance elec-
tronic information by foreign postal operators, the Sec-
retary of State should consult with the appropriate con-
gressional committees (as defined in section 8003(f)). 
(2) EXPEDITED
NEGOTIATION
OF
NEW
AGREE-
MENT.—To the extent that any new postal treaty, con-
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vention, or other international agreement related to 
international postal services would improve the ability of 
the United States to secure the provision of advance 
electronic information by foreign postal operators as re-
quired 
by 
regulations 
prescribed 
under 
section 
343(a)(3)(K) of the Trade Act of 2002, as amended by 
section 8003(a)(1), the Secretary of State should expedi-
tiously conclude such an agreement. 
SEC. 8005. COST RECOUPMENT. 
(a) IN GENERAL.—The United States Postal Service 
shall, to the extent practicable and otherwise recoverable by 
law, ensure that all costs associated with complying with this 
subtitle and amendments made by this subtitle are charged 
directly to foreign shippers or foreign postal operators. 
(b) COSTS NOT CONSIDERED REVENUE.—The recovery 
of costs under subsection (a) shall not be deemed revenue for 
purposes of subchapter I and II of chapter 36 of title 39, 
United States Code, or regulations prescribed under that 
chapter. 
SEC. 8006. DEVELOPMENT OF TECHNOLOGY TO DETECT ILLICIT 
NARCOTICS. 
(a) IN GENERAL.—The Postmaster General and the 
Commissioner of U.S. Customs and Border Protection, in co-
ordination with the heads of other agencies as appropriate, 
shall collaborate to identify and develop technology for the
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detection of illicit fentanyl, other synthetic opioids, and other 
narcotics and psychoactive substances entering the United 
States by mail. 
(b) OUTREACH TO PRIVATE SECTOR.—The Postmaster 
General and the Commissioner shall conduct outreach to pri-
vate sector entities to gather information regarding the cur-
rent state of technology to identify areas for innovation relat-
ing to the detection of illicit fentanyl, other synthetic opioids, 
and other narcotics and psychoactive substances entering the 
United States. 
SEC. 8007. CIVIL PENALTIES FOR POSTAL SHIPMENTS. 
Section 436 of the Tariff Act of 1930 (19 U.S.C. 1436) 
is amended by adding at the end the following new sub-
section: 
‘‘(e) CIVIL PENALTIES FOR POSTAL SHIPMENTS.— 
‘‘(1) CIVIL PENALTY.—A civil penalty shall be im-
posed against the United States Postal Service if the 
Postal Service accepts a shipment in violation of section 
343(a)(3)(K)(vii)(I) of the Trade Act of 2002. 
‘‘(2) MODIFICATION OF CIVIL PENALTY.— 
‘‘(A) IN GENERAL.—U.S. Customs and Border 
Protection shall reduce or dismiss a civil penalty 
imposed pursuant to paragraph (1) if U.S. Customs 
and Border Protection determines that the United 
States Postal Service—
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‘‘(i) has a low error rate in compliance 
with section 343(a)(3)(K) of the Trade Act of 
2002; 
‘‘(ii) is cooperating with U.S. Customs 
and Border Protection with respect to the vio-
lation of section 343(a)(3)(K)(vii)(I) of the 
Trade Act of 2002; or 
‘‘(iii) has taken remedial action to prevent 
future violations of section 343(a)(3)(K)(vii)(I) 
of the Trade Act of 2002. 
‘‘(B) WRITTEN NOTIFICATION.—U.S. Customs 
and Border Protection shall issue a written notifica-
tion to the Postal Service with respect to each exer-
cise of the authority of subparagraph (A) to reduce 
or dismiss a civil penalty imposed pursuant to para-
graph (1). 
‘‘(3) ONGOING
LACK
OF
COMPLIANCE.—If U.S. 
Customs and Border Protection determines that the 
United States Postal Service— 
‘‘(A) has repeatedly committed violations of 
section 343(a)(3)(K)(vii)(I) of the Trade Act of 
2002, 
‘‘(B) has failed to cooperate with U.S. Customs 
and Border Protection with respect to violations of
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section 343(a)(3)(K)(vii)(I) of the Trade Act of 
2002, and 
‘‘(C) has an increasing error rate in compliance 
with section 343(a)(3)(K) of the Trade Act of 2002, 
civil penalties may be imposed against the United States 
Postal Service until corrective action, satisfactory to 
U.S. Customs and Border Protection, is taken.’’. 
SEC. 8008. REPORT ON VIOLATIONS OF ARRIVAL, REPORTING, 
ENTRY, AND CLEARANCE REQUIREMENTS AND 
FALSITY OR LACK OF MANIFEST. 
(a) IN GENERAL.—The Commissioner of U.S. Customs 
and Border Protection shall submit to the appropriate con-
gressional committees an annual report that contains the in-
formation described in subsection (b) with respect to each 
violation of section 436 of the Tariff Act of 1930 (19 U.S.C. 
1436), as amended by section 8007, and section 584 of such 
Act (19 U.S.C. 1584) that occurred during the previous year. 
(b) INFORMATION DESCRIBED.—The information de-
scribed in this subsection is the following: 
(1) The name and address of the violator. 
(2) The specific violation that was committed. 
(3) The location or port of entry through which the 
items were transported. 
(4) An inventory of the items seized, including a de-
scription of the items and the quantity seized.
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•HRES 1099 EH 
(5) The location from which the items originated. 
(6) The entity responsible for the apprehension or 
seizure, organized by location or port of entry. 
(7) The amount of penalties assessed by U.S. Cus-
toms and Border Protection, organized by name of the 
violator and location or port of entry. 
(8) The amount of penalties that U.S. Customs and 
Border Protection could have levied, organized by name 
of the violator and location or port of entry. 
(9) The rationale for negotiating lower penalties, or-
ganized by name of the violator and location or port of 
entry. 
(c) APPROPRIATE CONGRESSIONAL COMMITTEES DE-
FINED.—In this section, the term ‘‘appropriate congressional 
committees’’ means— 
(1) the Committee on Finance and the Committee 
on Homeland Security and Governmental Affairs of the 
Senate; and 
(2) the Committee on Ways and Means, the Com-
mittee on Oversight and Government Reform, and the 
Committee on Homeland Security of the House of Rep-
resentatives. 
SEC. 8009. EFFECTIVE DATE; REGULATIONS. 
(a) EFFECTIVE DATE.—This subtitle and the amend-
ments made by this subtitle (other than the amendments
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made by section 8002) shall take effect on the date of the 
enactment of this Act. 
(b) REGULATIONS.—Not later than 1 year after the date 
of the enactment of this Act, such regulations as are nec-
essary to carry out this subtitle and the amendments made 
by this subtitle shall be prescribed. 
Subtitle B—Opioid Addiction 
Recovery Fraud Prevention 
SEC. 8021. SHORT TITLE. 
This subtitle may be cited as the ‘‘Opioid Addiction Re-
covery Fraud Prevention Act of 2018’’. 
SEC. 8022. DEFINITIONS. 
For purposes of this subtitle only, and not be construed 
or applied as to challenge or affect the characterization, defi-
nition, or treatment under any other statute, regulation, or 
rule: 
(1) SUBSTANCE USE DISORDER TREATMENT PROD-
UCT.—The term ‘‘substance use disorder treatment 
product’’ means a product for use or marketed for use 
in the treatment, cure, or prevention of a substance use 
disorder, including an opioid use disorder. 
(2) SUBSTANCE USE DISORDER TREATMENT SERV-
ICE.—The term ‘‘substance use disorder treatment serv-
ice’’ means a service that purports to provide referrals 
to treatment, treatment, or recovery housing for people
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•HRES 1099 EH 
diagnosed with, having, or purporting to have a sub-
stance use disorder, including an opioid use disorder. 
SEC. 8023. UNFAIR OR DECEPTIVE ACTS OR PRACTICES WITH 
RESPECT TO SUBSTANCE USE DISORDER TREAT-
MENT SERVICE AND PRODUCTS. 
(a) UNLAWFUL ACTIVITY.—It is unlawful to engage in 
an unfair or deceptive act or practice with respect to any sub-
stance use disorder treatment service or substance use dis-
order treatment product. 
(b) ENFORCEMENT BY THE FEDERAL TRADE COMMIS-
SION.— 
(1) UNFAIR OR DECEPTIVE ACTS OR PRACTICES.— 
A violation of subsection (a) shall be treated as a viola-
tion of a rule under section 18 of the Federal Trade 
Commission Act (15 U.S.C. 57a) regarding unfair or de-
ceptive acts or practices. 
(2) POWERS
OF
THE
FEDERAL
TRADE
COMMIS-
SION.— 
(A) IN GENERAL.—The Federal Trade Com-
mission shall enforce this section in the same man-
ner, by the same means, and with the same jurisdic-
tion, powers, and duties as though all applicable 
terms and provisions of the Federal Trade Commis-
sion Act (15 U.S.C. 41 et seq.) were incorporated 
into and made a part of this section.
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(B) PRIVILEGES AND IMMUNITIES.—Any per-
son who violates subsection (a) shall be subject to 
the penalties and entitled to the privileges and im-
munities provided in the Federal Trade Commission 
Act as though all applicable terms and provisions of 
the Federal Trade Commission Act (15 U.S.C. 41 
et seq.) were incorporated and made part of this 
section. 
(c) AUTHORITY PRESERVED.—Nothing in this subtitle 
shall be construed to limit the authority of the Federal Trade 
Commission or the Food and Drug Administration under any 
other provision of law. 
Subtitle C—Addressing Economic and 
Workforce Impacts of the Opioid 
Crisis 
SEC. 8041. ADDRESSING ECONOMIC AND WORKFORCE IMPACTS 
OF THE OPIOID CRISIS. 
(a) DEFINITIONS.—Except as otherwise expressly pro-
vided, in this section: 
(1) WIOA DEFINITIONS.—The terms ‘‘core pro-
gram’’, ‘‘individual with a barrier to employment’’, ‘‘local 
area’’, ‘‘local board’’, ‘‘one-stop operator’’, ‘‘outlying 
area’’, ‘‘State’’, ‘‘State board’’, and ‘‘supportive services’’ 
have the meanings given the terms in section 3 of the
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Workforce Innovation and Opportunity Act (29 U.S.C. 
3102). 
(2) EDUCATION PROVIDER.—The term ‘‘education 
provider’’ means— 
(A) an institution of higher education, as de-
fined in section 101 of the Higher Education Act of 
1965 (20 U.S.C. 1001); or 
(B) a postsecondary vocational institution, as 
defined in section 102(c) of such Act (20 U.S.C. 
1002(c)). 
(3) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’ 
means— 
(A) a State workforce agency; 
(B) an outlying area; or 
(C) a Tribal entity. 
(4) PARTICIPATING PARTNERSHIP.—The term ‘‘par-
ticipating partnership’’ means a partnership— 
(A) evidenced by a written contract or agree-
ment; and 
(B) including, as members of the partnership, 
a local board receiving a subgrant under subsection 
(d) and 1 or more of the following: 
(i) The eligible entity. 
(ii) A treatment provider. 
(iii) An employer or industry organization.
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•HRES 1099 EH 
(iv) An education provider. 
(v) A legal service or law enforcement or-
ganization. 
(vi) A faith-based or community-based or-
ganization. 
(vii) Other State or local agencies, includ-
ing counties or local governments. 
(viii) Other organizations, as determined 
to be necessary by the local board. 
(ix) Indian Tribes or tribal organizations. 
(5) PROGRAM PARTICIPANT.—The term ‘‘program 
participant’’ means an individual who— 
(A) is a member of a population of workers de-
scribed in subsection (e)(2) that is served by a par-
ticipating partnership through the pilot program 
under this section; and 
(B) enrolls with the applicable participating 
partnership to receive any of the services described 
in subsection (e)(3). 
(6) PROVIDER OF PEER RECOVERY SUPPORT SERV-
ICES.—The term ‘‘provider of peer recovery support 
services’’ means a provider that delivers peer recovery 
support services through an organization described in 
section 547(a) of the Public Health Service Act (42 
U.S.C. 290ee–2(a)).
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(7) SECRETARY.—The term ‘‘Secretary’’ means the 
Secretary of Labor. 
(8) STATE WORKFORCE AGENCY.—The term ‘‘State 
workforce agency’’ means the lead State agency with re-
sponsibility for the administration of a program under 
chapter 2 or 3 of subtitle B of title I of the Workforce 
Innovation and Opportunity Act (29 U.S.C. 3161 et 
seq., 3171 et seq.). 
(9) SUBSTANCE USE DISORDER.—The term ‘‘sub-
stance use disorder’’ has the meaning given such term 
by the Assistant Secretary for Mental Health and Sub-
stance Use. 
(10) TREATMENT
PROVIDER.—The term ‘‘treat-
ment provider’’— 
(A) means a health care provider that— 
(i) offers services for treating substance 
use disorders and is licensed in accordance 
with applicable State law to provide such serv-
ices; and 
(ii) accepts health insurance for such serv-
ices, including coverage under title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.); 
and 
(B) may include—
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•HRES 1099 EH 
(i) a nonprofit provider of peer recovery 
support services; 
(ii) a community health care provider; 
(iii) a Federally qualified health center (as 
defined in section 1861(aa) of the Social Secu-
rity Act (42 U.S.C. 1395x)); 
(iv) an Indian health program (as defined 
in section 3 of the Indian Health Care Im-
provement Act (25 U.S.C. 1603)), including an 
Indian health program that serves an urban 
center (as defined in such section); and 
(v) a Native Hawaiian health center (as 
defined in section 12 of the Native Hawaiian 
Health Care Improvement Act (42 U.S.C. 
11711)). 
(11) TRIBAL ENTITY.—The term ‘‘Tribal entity’’ 
includes any Indian Tribe, tribal organization, Indian- 
controlled organization serving Indians, Native Hawaiian 
organization, or Alaska Native entity, as such terms are 
defined or used in section 166 of the Workforce Innova-
tion and Opportunity Act (29 U.S.C. 3221). 
(b) PILOT PROGRAM AND GRANTS AUTHORIZED.— 
(1) IN GENERAL.—The Secretary, in consultation 
with the Secretary of Health and Human Services, shall 
carry out a pilot program to address economic and work-
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•HRES 1099 EH 
force impacts associated with a high rate of a substance 
use disorder. In carrying out the pilot program, the Sec-
retary shall make grants, on a competitive basis, to eligi-
ble entities to enable such entities to make subgrants to 
local boards to address the economic and workforce im-
pacts associated with a high rate of a substance use dis-
order. 
(2) GRANT AMOUNTS.—The Secretary shall make 
each such grant in an amount that is not less than 
$500,000, and not more than $5,000,000, for a fiscal 
year. 
(c) GRANT APPLICATIONS.— 
(1) IN GENERAL.—An eligible entity applying for a 
grant under this section shall submit an application to 
the Secretary at such time and in such form and manner 
as the Secretary may reasonably require, including the 
information described in this subsection. 
(2) SIGNIFICANT IMPACT ON COMMUNITY BY OPIOID 
AND SUBSTANCE USE DISORDER-RELATED PROBLEMS.— 
(A) DEMONSTRATION.—An eligible entity shall 
include in the application— 
(i) information that demonstrates signifi-
cant impact on the community by problems re-
lated to opioid abuse or another substance use 
disorder, by—
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•HRES 1099 EH 
(I) identifying the counties, commu-
nities, regions, or local areas that have 
been significantly impacted and will be 
served through the grant (each referred to 
in this section as a ‘‘service area’’); and 
(II) demonstrating for each such 
service area, an increase equal to or great-
er than the national increase in such prob-
lems, between— 
(aa) 1999; and 
(bb) 2016 or the latest year for 
which data are available; and 
(ii) a description of how the eligible entity 
will prioritize support for significantly im-
pacted service areas described in clause (i)(I). 
(B) INFORMATION.—To meet the requirements 
described in subparagraph (A)(i)(II), the eligible en-
tity may use information including data on— 
(i) the incidence or prevalence of opioid 
abuse and other substance use disorders; 
(ii) the age-adjusted rate of drug overdose 
deaths, as determined by the Director of the 
Centers for Disease Control and Prevention;
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•HRES 1099 EH 
(iii) the rate of non-fatal hospitalizations 
related to opioid abuse or other substance use 
disorders; 
(iv) the number of arrests or convictions, 
or a relevant law enforcement statistic, that 
reasonably shows an increase in opioid abuse 
or another substance use disorder; or 
(v) in the case of an eligible entity de-
scribed in subsection (a)(3)(C), other alter-
native relevant data as determined appropriate 
by the Secretary. 
(C) SUPPORT FOR STATE STRATEGY.—The eli-
gible entity may include in the application informa-
tion describing how the proposed services and ac-
tivities are aligned with the State, outlying area, or 
Tribal strategy, as applicable, for addressing prob-
lems described in subparagraph (A) in specific serv-
ice areas or across the State, outlying area, or Trib-
al land. 
(3) ECONOMIC
AND
EMPLOYMENT
CONDITIONS 
DEMONSTRATE ADDITIONAL FEDERAL SUPPORT NEED-
ED.— 
(A) DEMONSTRATION.—An eligible entity shall 
include in the application information that dem-
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onstrates that a high rate of a substance use dis-
order has caused, or is coincident to— 
(i) an economic or employment downturn 
in the service area; or 
(ii) persistent economically depressed con-
ditions in such service area. 
(B) INFORMATION.—To meet the requirements 
of subparagraph (A), an eligible entity may use in-
formation including— 
(i) documentation of any layoff, an-
nounced future layoff, legacy industry decline, 
decrease in an employment or labor market 
participation rate, or economic impact, whether 
or not the result described in this clause is 
overtly related to a high rate of a substance 
use disorder; 
(ii) documentation showing decreased eco-
nomic activity related to, caused by, or contrib-
uting to a high rate of a substance use dis-
order, including a description of how the serv-
ice area has been impacted, or will be im-
pacted, by such a decrease; 
(iii) information on economic indicators, 
labor market analyses, information from public
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announcements, and demographic and industry 
data; 
(iv) information on rapid response activi-
ties (as defined in section 3 of the Workforce 
Innovation and Opportunity Act (29 U.S.C. 
3102)) that have been or will be conducted, in-
cluding demographic data gathered by em-
ployer or worker surveys or through other 
methods; 
(v) data or documentation, beyond anec-
dotal evidence, showing that employers face 
challenges filling job vacancies due to a lack of 
skilled workers able to pass a drug test; or 
(vi) any additional relevant data or infor-
mation on the economy, workforce, or another 
aspect of the service area to support the appli-
cation. 
(d) SUBGRANT
AUTHORIZATION
AND
APPLICATION 
PROCESS.— 
(1) SUBGRANTS AUTHORIZED.— 
(A) IN GENERAL.—An eligible entity receiving 
a grant under subsection (b)— 
(i) may use not more than 5 percent of 
the grant funds for the administrative costs of 
carrying out the grant;
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(ii) in the case of an eligible entity de-
scribed in subparagraph (A) or (B) of sub-
section (a)(3), shall use the remaining grant 
funds to make subgrants to local entities in the 
service area to carry out the services and ac-
tivities described in subsection (e); and 
(iii) in the case of an eligible entity de-
scribed in subsection (a)(3)(C), shall use the 
remaining grant funds to carry out the services 
and activities described in subsection (e). 
(B) EQUITABLE
DISTRIBUTION.—In making 
subgrants under this subsection, an eligible entity 
shall ensure, to the extent practicable, the equitable 
distribution of subgrants, based on— 
(i) geography (such as urban and rural 
distribution); and 
(ii) significantly impacted service areas as 
described in subsection (c)(2). 
(C) TIMING OF SUBGRANT FUNDS DISTRIBU-
TION.—An eligible entity making subgrants under 
this subsection shall disburse subgrant funds to a 
local board receiving a subgrant from the eligible 
entity by the later of—
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(i) the date that is 90 days after the date 
on which the Secretary makes the funds avail-
able to the eligible entity; or 
(ii) the date that is 15 days after the date 
that the eligible entity makes the subgrant 
under subparagraph (A)(ii). 
(2) SUBGRANT APPLICATION.— 
(A) IN GENERAL.—A local board desiring to 
receive a subgrant under this subsection from an el-
igible entity shall submit an application at such 
time and in such manner as the eligible entity may 
reasonably require, including the information de-
scribed in this paragraph. 
(B) CONTENTS.—Each application described in 
subparagraph (A) shall include— 
(i) an analysis of the estimated perform-
ance of the local board in carrying out the pro-
posed 
services 
and 
activities 
under 
the 
subgrant— 
(I) based on— 
(aa) primary indicators of per-
formance 
described 
in 
section 
116(c)(1)(A)(i) of the Workforce In-
novation and Opportunity Act (29 
U.S.C. 3141(c)(1)(A)(i), to assess es-
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timated effectiveness of the proposed 
services and activities, including the 
estimated number of individuals with 
a substance use disorder who may be 
served by the proposed services and 
activities; 
(bb) the record of the local 
board in serving individuals with a 
barrier to employment; and 
(cc) the ability of the local board 
to establish a participating partner-
ship; and 
(II) which may include or utilize— 
(aa) data from the National 
Center for Health Statistics of the 
Centers for Disease Control and Pre-
vention; 
(bb) data from the Center for 
Behavioral 
Health 
Statistics 
and 
Quality of the Substance Abuse and 
Mental Health Services Administra-
tion; 
(cc) State vital statistics; 
(dd) municipal police depart-
ment records;
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•HRES 1099 EH 
(ee) reports from local coroners; 
or 
(ff) other relevant data; and 
(ii) in the case of a local board proposing 
to serve a population described in subsection 
(e)(2)(B), a demonstration of the workforce 
shortage in the professional area to be ad-
dressed under the subgrant (which may include 
substance use disorder treatment and related 
services, non-addictive pain therapy and pain 
management services, mental health care treat-
ment services, emergency response services, or 
mental health care), which shall include infor-
mation that can demonstrate such a shortage, 
such as— 
(I) the distance between— 
(aa) communities affected by 
opioid abuse or another substance 
use disorder; and 
(bb) facilities or professionals of-
fering services in the professional 
area; or 
(II) the maximum capacity of facili-
ties or professionals to serve individuals in 
an affected community, or increases in ar-
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rests related to opioid or another sub-
stance use disorder, overdose deaths, or 
nonfatal overdose emergencies in the com-
munity. 
(e) SUBGRANT SERVICES AND ACTIVITIES.— 
(1) IN GENERAL.—Each local board that receives a 
subgrant under subsection (d) shall carry out the serv-
ices and activities described in this subsection through a 
participating partnership. 
(2) SELECTION OF POPULATION TO BE SERVED.— 
A participating partnership shall elect to provide services 
and activities under the subgrant to one or both of the 
following populations of workers: 
(A) Workers, including dislocated workers, in-
dividuals with barriers to employment, new entrants 
in the workforce, or incumbent workers (employed 
or underemployed), each of whom— 
(i) is directly or indirectly affected by a 
high rate of a substance use disorder; and 
(ii) voluntarily confirms that the worker, 
or a friend or family member of the worker, 
has a history of opioid abuse or another sub-
stance use disorder. 
(B) Workers, including dislocated workers, in-
dividuals with barriers to employment, new entrants
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in the workforce, or incumbent workers (employed 
or underemployed), who— 
(i) seek to transition to professions that 
support individuals with a substance use dis-
order or at risk for developing such disorder, 
such as professions that provide— 
(I) substance use disorder treatment 
and related services; 
(II) services offered through pro-
viders of peer recovery support services; 
(III) non-addictive pain therapy and 
pain management services; 
(IV) emergency response services; or 
(V) mental health care; and 
(ii) need new or upgraded skills to better 
serve such a population of struggling or at-risk 
individuals. 
(3) SERVICES AND ACTIVITIES.—Each participating 
partnership shall use funds available through a subgrant 
under this subsection to carry out 1 or more of the fol-
lowing: 
(A) ENGAGING
EMPLOYERS.—Engaging with 
employers to— 
(i) learn about the skill and hiring re-
quirements of employers;
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•HRES 1099 EH 
(ii) learn about the support needed by em-
ployers to hire and retain program partici-
pants, and other individuals with a substance 
use disorder, and the support needed by such 
employers to obtain their commitment to test-
ing creative solutions to employing program 
participants and such individuals; 
(iii) connect employers and workers to on- 
the-job or customized training programs before 
or after layoff to help facilitate reemployment; 
(iv) connect employers with an education 
provider to develop classroom instruction to 
complement on-the-job learning for program 
participants and such individuals; 
(v) help employers develop the curriculum 
design of a work-based learning program for 
program participants and such individuals; 
(vi) help employers employ program par-
ticipants or such individuals engaging in a 
work-based learning program for a transitional 
period before hiring such a program partici-
pant or individual for full-time employment of 
not less than 30 hours a week; or
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•HRES 1099 EH 
(vii) connect employers to program par-
ticipants receiving concurrent outpatient treat-
ment and job training services. 
(B) SCREENING SERVICES.—Providing screen-
ing services, which may include— 
(i) using an evidence-based screening 
method to screen each individual seeking par-
ticipation in the pilot program to determine 
whether the individual has a substance use dis-
order; 
(ii) conducting an assessment of each such 
individual to determine the services needed for 
such individual to obtain or retain employment, 
including an assessment of strengths and gen-
eral work readiness; or 
(iii) accepting walk-ins or referrals from 
employers, labor organizations, or other enti-
ties recommending individuals to participate in 
such program. 
(C) INDIVIDUAL
TREATMENT
AND
EMPLOY-
MENT PLAN.—Developing an individual treatment 
and employment plan for each program partici-
pant— 
(i) in coordination, as appropriate, with 
other programs serving the participant such as
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•HRES 1099 EH 
the core programs within the workforce devel-
opment system under the Workforce Innova-
tion and Opportunity Act (29 U.S.C. 3101 et 
seq.); and 
(ii) which shall include providing a case 
manager to work with each participant to de-
velop the plan, which may include— 
(I) identifying employment and ca-
reer goals; 
(II) exploring career pathways that 
lead to in-demand industries and sectors, 
as determined by the State board and the 
head of the State workforce agency or, as 
applicable, the Tribal entity; 
(III) setting appropriate achievement 
objectives to attain the employment and 
career goals identified under subclause (I); 
or 
(IV) developing the appropriate com-
bination of services to enable the partici-
pant to achieve the employment and ca-
reer goals identified under subclause (I). 
(D) OUTPATIENT TREATMENT AND RECOVERY 
CARE.—In the case of a participating partnership 
serving program participants described in para-
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•HRES 1099 EH 
graph (2)(A) with a substance use disorder, pro-
viding individualized and group outpatient treat-
ment and recovery services for such program par-
ticipants that are offered during the day and 
evening, and on weekends. Such treatment and re-
covery services— 
(i) shall be based on a model that utilizes 
combined behavioral interventions and other 
evidence-based or evidence-informed interven-
tions; and 
(ii) may include additional services such 
as— 
(I) health, mental health, addiction, 
or other forms of outpatient treatment 
that may impact a substance use disorder 
and co-occurring conditions; 
(II) drug testing for a current sub-
stance use disorder prior to enrollment in 
career or training services or prior to em-
ployment; 
(III) linkages to community services, 
including services offered by partner orga-
nizations designed to support program 
participants; or
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•HRES 1099 EH 
(IV) referrals to health care, includ-
ing referrals to substance use disorder 
treatment and mental health services. 
(E) SUPPORTIVE
SERVICES.—Providing sup-
portive services, which shall include services such 
as— 
(i) coordinated wraparound services to 
provide maximum support for program partici-
pants to assist the program participants in 
maintaining employment and recovery for not 
less than 12 months, as appropriate; 
(ii) assistance in establishing eligibility for 
assistance under Federal, State, Tribal, and 
local programs providing health services, men-
tal health services, vocational services, housing 
services, transportation services, social services, 
or services through early childhood education 
programs (as defined in section 103 of the 
Higher Education Act of 1965 (20 U.S.C. 
1003)); 
(iii) services offered through providers of 
peer recovery support services; 
(iv) networking and mentorship opportuni-
ties; or
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•HRES 1099 EH 
(v) any supportive services determined 
necessary by the local board. 
(F) CAREER AND JOB TRAINING SERVICES.— 
Offering career services and training services, and 
related services, concurrently or sequentially with 
the services provided under subparagraphs (B) 
through (E). Such services shall include the fol-
lowing: 
(i) Services provided to program partici-
pants who are in a pre-employment stage of 
the program, which may include— 
(I) initial education and skills assess-
ments; 
(II) traditional classroom training 
funded through individual training ac-
counts under chapter 3 of subtitle B of 
title I of the Workforce Innovation and 
Opportunity Act (29 U.S.C. 3171 et seq.); 
(III) services to promote employ-
ability skills such as punctuality, personal 
maintenance skills, and professional con-
duct; 
(IV) in-depth interviewing and eval-
uation to identify employment barriers
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•HRES 1099 EH 
and to develop individual employment 
plans; 
(V) career planning that includes— 
(aa) career pathways leading to 
in-demand, high-wage jobs; and 
(bb) job coaching, job matching, 
and job placement services; 
(VI) provision of payments and fees 
for employment and training-related appli-
cations, tests, and certifications; or 
(VII) any other appropriate career 
service or training service described in sec-
tion 134(c) of the Workforce Innovation 
and Opportunity Act (29 U.S.C. 3174(c)). 
(ii) Services provided to program partici-
pants during their first 6 months of employ-
ment to ensure job retention, which may in-
clude— 
(I) case management and support 
services, including a continuation of the 
services described in clause (i); 
(II) a continuation of skills training, 
and career and technical education, de-
scribed in clause (i) that is conducted in
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•HRES 1099 EH 
collaboration with the employers of such 
participants; 
(III) mentorship services and job re-
tention support for such participants; or 
(IV) targeted training for managers 
and workers working with such partici-
pants (such as mentors), and human re-
source representatives in the business in 
which such participants are employed. 
(iii) Services to assist program partici-
pants in maintaining employment for not less 
than 12 months, as appropriate. 
(G) PROVEN
AND
PROMISING
PRACTICES.— 
Leading efforts in the service area to identify and 
promote proven and promising strategies and initia-
tives for meeting the needs of employers and pro-
gram participants. 
(4) LIMITATIONS.—A participating partnership may 
not use— 
(A) more than 10 percent of the funds received 
under a subgrant under subsection (d) for the ad-
ministrative costs of the partnership; 
(B) more than 10 percent of the funds received 
under such subgrant for the provision of treatment
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•HRES 1099 EH 
and recovery services, as described in paragraph 
(3)(D); and 
(C) more than 10 percent of the funds received 
under such subgrant for the provision of supportive 
services described in paragraph (3)(E) to program 
participants. 
(f) PERFORMANCE ACCOUNTABILITY.— 
(1) REPORTS.—The Secretary shall establish quar-
terly reporting requirements for recipients of grants and 
subgrants under this section that, to the extent prac-
ticable, are based on the performance accountability sys-
tem under section 116 of the Workforce Innovation and 
Opportunity Act (29 U.S.C. 3141) and, in the case of 
a grant awarded to an eligible entity described in sub-
section (a)(3)(C), section 166(h) of such Act (29 U.S.C. 
3221(h)), including the indicators described in sub-
section (c)(1)(A)(i) of such section 116 and the require-
ments for local area performance reports under sub-
section (d) of such section 116. 
(2) EVALUATIONS.— 
(A) AUTHORITY
TO
ENTER
INTO
AGREE-
MENTS.—The Secretary shall ensure that an inde-
pendent evaluation is conducted on the pilot pro-
gram carried out under this section to determine 
the impact of the program on employment of indi-
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•HRES 1099 EH 
viduals with substance use disorders. The Secretary 
shall enter into an agreement with eligible entities 
receiving grants under this section to pay for all or 
part of such evaluation. 
(B) METHODOLOGIES TO BE USED.—The inde-
pendent evaluation required under this paragraph 
shall use experimental designs using random assign-
ment or, when random assignment is not feasible, 
other reliable, evidence-based research methodolo-
gies that allow for the strongest possible causal in-
ferences. 
(g) FUNDING.— 
(1) COVERED FISCAL YEAR.—In this subsection, the 
term ‘‘covered fiscal year’’ means any of fiscal years 
2019 through 2023. 
(2) USING FUNDING FOR NATIONAL DISLOCATED 
WORKER GRANTS.—Subject to paragraph (4) and not-
withstanding section 132(a)(2)(A) and subtitle D of the 
Workforce Innovation and Opportunity Act (29 U.S.C. 
3172(a)(2)(A), 3221 et seq.), the Secretary may use, to 
carry out the pilot program under this section for a cov-
ered fiscal year— 
(A) funds made available to carry out section 
170 of such Act (29 U.S.C. 3225) for that fiscal 
year;
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•HRES 1099 EH 
(B) funds made available to carry out section 
170 of such Act that remain available for that fiscal 
year; and 
(C) funds that remain available under section 
172(f) of such Act (29 U.S.C. 3227(f)). 
(3) AVAILABILITY OF FUNDS.—Funds appropriated 
under section 136(c) of such Act (29 U.S.C. 3181(c)) 
and made available to carry out section 170 of such Act 
for a fiscal year shall remain available for use under 
paragraph (2) for a subsequent fiscal year until ex-
pended. 
(4) LIMITATION.—The Secretary may not use more 
than $100,000,000 of the funds described in paragraph 
(2) for any covered fiscal year under this section. 
Subtitle D—Peer Support Counseling 
Program for Women Veterans 
SEC. 8051. PEER SUPPORT COUNSELING PROGRAM FOR WOMEN 
VETERANS. 
(a) IN GENERAL.—Section 1720F(j) of title 38, United 
States Code, is amended by adding at the end the following 
new paragraph: 
‘‘(4)(A) As part of the counseling program under this 
subsection, the Secretary shall emphasize appointing peer 
support counselors for women veterans. To the degree prac-
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•HRES 1099 EH 
ticable, the Secretary shall seek to recruit women peer sup-
port counselors with expertise in— 
‘‘(i) female gender-specific issues and services; 
‘‘(ii) the provision of information about services and 
benefits provided under laws administered by the Sec-
retary; or 
‘‘(iii) employment mentoring. 
‘‘(B) To the degree practicable, the Secretary shall em-
phasize facilitating peer support counseling for women vet-
erans who are eligible for counseling and services under sec-
tion 1720D of this title, have post-traumatic stress disorder 
or suffer from another mental health condition, are homeless 
or at risk of becoming homeless, or are otherwise at increased 
risk of suicide, as determined by the Secretary. 
‘‘(C) The Secretary shall conduct outreach to inform 
women veterans about the program and the assistance avail-
able under this paragraph. 
‘‘(D) In carrying out this paragraph, the Secretary shall 
coordinate with such community organizations, State and 
local governments, institutions of higher education, chambers 
of commerce, local business organizations, organizations that 
provide legal assistance, and other organizations as the Sec-
retary considers appropriate. 
‘‘(E) In carrying out this paragraph, the Secretary shall 
provide adequate training for peer support counselors, includ-
497 
•HRES 1099 EH 
ing training carried out under the national program of train-
ing required by section 304(c) of the Caregivers and Veterans 
Omnibus Health Services Act of 2010 (38 U.S.C. 1712A 
note).’’. 
(b) FUNDING.—The Secretary of Veterans Affairs shall 
carry out paragraph (4) of section 1720F(j) of title 38, 
United States Code, as added by subsection (a), using funds 
otherwise made available to the Secretary. No additional 
funds are authorized to be appropriated by reason of such 
paragraph. 
(c) REPORT
TO CONGRESS.—Not later than 2 years 
after the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall submit to the Committees on Veterans’ 
Affairs of the Senate and House of Representatives a report 
on the peer support counseling program under section 
1720F(j) of title 38, United States Code, as amended by this 
section. Such report shall include— 
(1) the number of peer support counselors in the 
program; 
(2) an assessment of the effectiveness of the pro-
gram; and 
(3) a description of the oversight of the program.
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Subtitle E—Treating Barriers to 
Prosperity 
SEC. 8061. SHORT TITLE. 
This subtitle may be cited as the ‘‘Treating Barriers to 
Prosperity Act of 2018’’. 
SEC. 8062. DRUG ABUSE MITIGATION INITIATIVE. 
(a) IN GENERAL.—Chapter 145 of title 40, United 
States Code, is amended by inserting after section 14509 the 
following: 
‘‘§ 14510. Drug abuse mitigation initiative 
‘‘(a) IN GENERAL.—The Appalachian Regional Commis-
sion may provide technical assistance to, make grants to, 
enter into contracts with, or otherwise provide amounts to in-
dividuals or entities in the Appalachian region for projects 
and activities to address drug abuse, including opioid abuse, 
in the region, including projects and activities— 
‘‘(1) to facilitate the sharing of best practices 
among States, counties, and other experts in the region 
with respect to reducing such abuse; 
‘‘(2) to initiate or expand programs designed to 
eliminate or reduce the harm to the workforce and eco-
nomic growth of the region that results from such abuse; 
‘‘(3) to attract and retain relevant health care serv-
ices, businesses, and workers; and
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‘‘(4) to develop relevant infrastructure, including 
broadband infrastructure that supports the use of tele-
medicine. 
‘‘(b) LIMITATION
ON AVAILABLE AMOUNTS.—Of the 
cost of any activity eligible for a grant under this section— 
‘‘(1) not more than 50 percent may be provided 
from amounts appropriated to carry out this section; and 
‘‘(2) notwithstanding paragraph (1)— 
‘‘(A) in the case of a project to be carried out 
in a county for which a distressed county designa-
tion is in effect under section 14526, not more than 
80 percent may be provided from amounts appro-
priated to carry out this section; and 
‘‘(B) in the case of a project to be carried out 
in a county for which an at-risk designation is in 
effect under section 14526, not more than 70 per-
cent may be provided from amounts appropriated to 
carry out this section. 
‘‘(c) SOURCES OF ASSISTANCE.—Subject to subsection 
(b), a grant provided under this section may be provided from 
amounts made available to carry out this section in combina-
tion with amounts made available— 
‘‘(1) under any other Federal program (subject to 
the availability of subsequent appropriations); or 
‘‘(2) from any other source.