H. R. 6—126 
(1) facilitate communication between substance use dis-
order treatment providers and other health care providers to 
promote and provide the best possible integrated care; 
(2) avoid inappropriate prescribing that can lead to dan-
gerous drug interactions, overdose, or relapse; and 
(3) notify and involve families and caregivers when individ-
uals experience an overdose. 
(c) PERIODIC UPDATES.—The Secretary shall— 
(1) periodically review and update the model program and 
materials identified or developed under subsection (a); and 
(2) disseminate such updated programs and materials to 
the individuals described in subsection (a)(1). 
(d) INPUT OF CERTAIN ENTITIES.—In identifying, reviewing, or 
updating the model programs and materials under this section, 
the Secretary shall solicit the input of relevant stakeholders. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized 
to be appropriated to carry out this section— 
(1) $4,000,000 for fiscal year 2019; 
(2) $2,000,000 for each of fiscal years 2020 and 2021; and 
(3) $1,000,000 for each of fiscal years 2022 and 2023. 
Subtitle G—Protecting Pregnant Women 
and Infants 
SEC. 7061. REPORT ON ADDRESSING MATERNAL AND INFANT HEALTH 
IN THE OPIOID CRISIS. 
(a) IN GENERAL.—Not later than 18 months after the date 
of the enactment of this Act, the Secretary of Health and Human 
Services, in coordination with the Centers for Disease Control and 
Prevention, the National Institutes of Health, the Indian Health 
Service, and the Substance Abuse and Mental Health Services 
Administration, shall develop and submit to the Committee on 
Health, Education, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of Representa-
tives a report that includes— 
(1) information on opioid, non-opioid, and non-pharmaco-
logic pain management practices during pregnancy and after 
pregnancy; 
(2) recommendations for increasing public awareness and 
education about substance use disorders, including opioid use 
disorders, during and after pregnancy, including available treat-
ment resources in urban and rural areas; 
(3) recommendations to prevent, identify, and reduce sub-
stance use disorders, including opioid use disorders, during 
pregnancy to improve care for pregnant women with substance 
use disorders and their infants; and 
(4) an identification of areas in need of further research 
with respect to acute and chronic pain management during 
and after pregnancy. 
(b) NO ADDITIONAL FUNDS.—No additional funds are authorized 
to be appropriated for purposes of carrying out subsection (a). 
SEC. 7062. PROTECTING MOMS AND INFANTS. 
(a) REPORT.— 
(1) IN GENERAL.—Not later than 60 days after the date 
of enactment of this Act, the Secretary of Health and Human
H. R. 6—127 
Services (referred to in this section as 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, and make available 
to the public on the Internet website of the Department of 
Health 
and 
Human 
Services, 
a 
report 
regarding 
the 
implementation of the recommendations in the strategy relating 
to prenatal opioid use, including neonatal abstinence syndrome, 
developed pursuant to section 2 of the Protecting Our Infants 
Act of 2015 (Public Law 114–91). Such report shall include— 
(A) an update on the implementation of the rec-
ommendations in the strategy, including information 
regarding the agencies involved in the implementation; 
and 
(B) information on additional funding or authority the 
Secretary requires, if any, to implement the strategy, which 
may include authorities needed to coordinate implementa-
tion of such strategy across the Department of Health 
and Human Services. 
(2) PERIODIC
UPDATES.—The Secretary shall periodically 
update the report under paragraph (1). 
(b) RESIDENTIAL TREATMENT PROGRAMS
FOR PREGNANT
AND 
POSTPARTUM WOMEN.—Section 508(s) of the Public Health Service 
Act (42 U.S.C. 290bb–1(s)) is amended by striking ‘‘$16,900,000 
for each of fiscal years 2017 through 2021’’ and inserting 
‘‘$29,931,000 for each of fiscal years 2019 through 2023’’. 
SEC. 7063. EARLY INTERVENTIONS FOR PREGNANT WOMEN AND 
INFANTS. 
(a) DEVELOPMENT OF EDUCATIONAL MATERIALS BY CENTER FOR 
SUBSTANCE
ABUSE
PREVENTION.—Section 515(b) of the Public 
Health Service Act (42 U.S.C. 290bb–21(b)) is amended— 
(1) in paragraph (13), by striking ‘‘and’’ at the end; 
(2) in paragraph (14), by striking the period at the end 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(15) in consultation with relevant stakeholders and in 
collaboration with the Director of the Centers for Disease Con-
trol and Prevention, develop educational materials for clinicians 
to use with pregnant women for shared decision making 
regarding pain management and the prevention of substance 
use disorders during pregnancy.’’. 
(b) GUIDELINES AND RECOMMENDATIONS BY CENTER FOR SUB-
STANCE ABUSE TREATMENT.—Section 507(b) of the Public Health 
Service Act (42 U.S.C. 290bb(b)) is amended— 
(1) in paragraph (13), by striking ‘‘and’’ at the end; 
(2) in paragraph (14), by striking the period at the end 
and inserting a semicolon; and 
(3) by adding at the end the following: 
‘‘(15) in cooperation with the Secretary, implement and 
disseminate, as appropriate, the recommendations in the report 
entitled ‘Protecting Our Infants Act: Final Strategy’ issued 
by the Department of Health and Human Services in 2017; 
and’’. 
(c) SUPPORT
OF PARTNERSHIPS
BY CENTER
FOR SUBSTANCE 
ABUSE TREATMENT.—Section 507(b) of the Public Health Service
H. R. 6—128 
Act (42 U.S.C. 290bb(b)), as amended by subsection (b), is further 
amended by adding at the end the following: 
‘‘(16) in cooperation with relevant stakeholders, and 
through public-private partnerships, encourage education about 
substance use disorders for pregnant women and health care 
providers who treat pregnant women and babies.’’. 
SEC. 7064. PRENATAL AND POSTNATAL HEALTH. 
Section 317L of the Public Health Service Act (42 U.S.C. 247b– 
13) is amended— 
(1) in subsection (a)— 
(A) by amending paragraph (1) to read as follows: 
‘‘(1) to collect, analyze, and make available data on prenatal 
smoking and alcohol and other substance abuse and misuse, 
including— 
‘‘(A) data on— 
‘‘(i) the incidence, prevalence, and implications of 
such activities; and 
‘‘(ii) the incidence and prevalence of implications 
and outcomes, including neonatal abstinence syndrome 
and other maternal and child health outcomes associ-
ated with such activities; and 
‘‘(B) additional information or data, as appropriate, 
on family health history, medication exposures during preg-
nancy, demographic information, such as race, ethnicity, 
geographic location, and family history, and other relevant 
information, to inform such analysis;’’; 
(B) in paragraph (2)— 
(i) by striking ‘‘prevention of’’ and inserting 
‘‘prevention and long-term outcomes associated with’’; 
and 
(ii) by striking ‘‘illegal drug use’’ and inserting 
‘‘other substance abuse and misuse’’; 
(C) in paragraph (3), by striking ‘‘and cessation pro-
grams; and’’ and inserting ‘‘, treatment, and cessation pro-
grams;’’; 
(D) in paragraph (4), by striking ‘‘illegal drug use.’’ 
and inserting ‘‘other substance abuse and misuse; and’’; 
and 
(E) by adding at the end the following: 
‘‘(5) to issue public reports on the analysis of data described 
in paragraph (1), including analysis of— 
‘‘(A) long-term outcomes of children affected by neo-
natal abstinence syndrome; 
‘‘(B) health outcomes associated with prenatal smoking, 
alcohol, and substance abuse and misuse; and 
‘‘(C) relevant studies, evaluations, or information the 
Secretary determines to be appropriate.’’; 
(2) in subsection (b), by inserting ‘‘tribal entities,’’ after 
‘‘local governments,’’; 
(3) by redesignating subsection (c) as subsection (d); 
(4) by inserting after subsection (b) the following: 
‘‘(c) COORDINATING ACTIVITIES.—To carry out this section, the 
Secretary may— 
‘‘(1) provide technical and consultative assistance to entities 
receiving grants under subsection (b);
H. R. 6—129 
‘‘(2) ensure a pathway for data sharing between States, 
tribal entities, and the Centers for Disease Control and Preven-
tion; 
‘‘(3) ensure data collection under this section is consistent 
with applicable State, Federal, and Tribal privacy laws; and 
‘‘(4) coordinate with the National Coordinator for Health 
Information Technology, as appropriate, to assist States and 
Tribes in implementing systems that use standards recognized 
by such National Coordinator, as such recognized standards 
are available, in order to facilitate interoperability between 
such systems and health information technology systems, 
including certified health information technology.’’; and 
(5) in subsection (d), as so redesignated, by striking ‘‘2001 
through 2005’’ and inserting ‘‘2019 through 2023’’. 
SEC. 7065. PLANS OF SAFE CARE. 
(a) IN GENERAL.—Section 105(a) of the Child Abuse Prevention 
and Treatment Act (42 U.S.C. 5106(a)) is amended by adding at 
the end the following: 
‘‘(7) GRANTS TO STATES TO IMPROVE AND COORDINATE THEIR 
RESPONSE TO ENSURE THE SAFETY, PERMANENCY, AND WELL- 
BEING OF INFANTS AFFECTED BY SUBSTANCE USE.— 
‘‘(A) PROGRAM AUTHORIZED.—The Secretary is author-
ized to make grants to States for the purpose of assisting 
child welfare agencies, social services agencies, substance 
use disorder treatment agencies, hospitals with labor and 
delivery units, medical staff, public health and mental 
health agencies, and maternal and child health agencies 
to facilitate collaboration in developing, updating, imple-
menting, and monitoring plans of safe care described in 
section 106(b)(2)(B)(iii). Section 112(a)(2) shall not apply 
to the program authorized under this paragraph. 
‘‘(B) DISTRIBUTION OF FUNDS.— 
‘‘(i) RESERVATIONS.—Of the amounts made avail-
able to carry out subparagraph (A), the Secretary shall 
reserve— 
‘‘(I) no more than 3 percent for the purposes 
described in subparagraph (G); and 
‘‘(II) up to 3 percent for grants to Indian Tribes 
and tribal organizations to address the needs of 
infants born with, and identified as being affected 
by, substance abuse or withdrawal symptoms 
resulting from prenatal drug exposure or a fetal 
alcohol spectrum disorder and their families or 
caregivers, which to the extent practicable, shall 
be consistent with the uses of funds described 
under subparagraph (D). 
‘‘(ii) ALLOTMENTS TO STATES AND TERRITORIES.— 
The Secretary shall allot the amount made available 
to carry out subparagraph (A) that remains after 
application of clause (i) to each State that applies 
for such a grant, in an amount equal to the sum 
of— 
‘‘(I) $500,000; and 
‘‘(II) an amount that bears the same relation-
ship to any funds made available to carry out 
subparagraph (A) and remaining after application
H. R. 6—130 
of clause (i), as the number of live births in the 
State in the previous calendar year bears to the 
number of live births in all States in such year. 
‘‘(iii) RATABLE REDUCTION.—If the amount made 
available to carry out subparagraph (A) is insufficient 
to satisfy the requirements of clause (ii), the Secretary 
shall ratably reduce each allotment to a State. 
‘‘(C) APPLICATION.—A State desiring a grant under this 
paragraph shall submit an application to the Secretary 
at such time and in such manner as the Secretary may 
require. Such application shall include— 
‘‘(i) a description of— 
‘‘(I) the impact of substance use disorder in 
such State, including with respect to the substance 
or class of substances with the highest incidence 
of abuse in the previous year in such State, 
including— 
‘‘(aa) the prevalence of substance use dis-
order in such State; 
‘‘(bb) the aggregate rate of births in the 
State of infants affected by substance abuse 
or withdrawal symptoms or a fetal alcohol 
spectrum disorder (as determined by hospitals, 
insurance claims, claims submitted to the 
State Medicaid program, or other records), if 
available and to the extent practicable; and 
‘‘(cc) the number of infants identified, for 
whom a plan of safe care was developed, and 
for whom a referral was made for appropriate 
services, as reported under section 106(d)(18); 
‘‘(II) the challenges the State faces in devel-
oping, implementing, and monitoring plans of safe 
care in accordance with section 106(b)(2)(B)(iii); 
‘‘(III) the State’s lead agency for the grant 
program and how that agency will coordinate with 
relevant State entities and programs, including 
the child welfare agency, the substance use dis-
order treatment agency, hospitals with labor and 
delivery units, health care providers, the public 
health and mental health agencies, programs 
funded by the Substance Abuse and Mental Health 
Services Administration that provide substance 
use disorder treatment for women, the State Med-
icaid program, the State agency administering the 
block grant program under title V of the Social 
Security Act (42 U.S.C. 701 et seq.), the State 
agency administering the programs funded under 
part C of the Individuals with Disabilities Edu-
cation Act (20 U.S.C. 1431 et seq.), the maternal, 
infant, and early childhood home visiting program 
under section 511 of the Social Security Act (42 
U.S.C. 711), the State judicial system, and other 
agencies, as determined by the Secretary, and 
Indian Tribes and tribal organizations, as appro-
priate, to implement the activities under this para-
graph;
H. R. 6—131 
‘‘(IV) how the State will monitor local develop-
ment and implementation of plans of safe care, 
in accordance with section 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 supervised sub-
stance use, including for the treatment of a sub-
stance use disorder; 
‘‘(V) if applicable, how the State plans to uti-
lize 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, 
including such funding authorized under section 
471(e) of such Act (as in effect on October 1, 2018) 
for mental health and substance abuse prevention 
and treatment services and in-home parent skill- 
based programs and funding authorized under 
such section 472(j) (as in effect on October 1, 2018) 
for children with a parent in a licensed residential 
family-based treatment 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 devel-
oped, 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 disorder, such as pro-
grams carried out under part C of the Individuals 
with Disabilities Education Act (20 U.S.C. 1431 
et seq.) and comprehensive early childhood 
development services and programs such as Head 
Start programs; 
‘‘(ii) a description of how the State plans to use 
funds for activities described in subparagraph (D) for 
the purposes of ensuring State compliance with 
requirements under clauses (ii) and (iii) of section 
106(b)(2)(B); and 
‘‘(iii) an assurance that the State will comply with 
requirements to refer a child identified as substance- 
exposed to early intervention services as required 
pursuant to a grant under part C of the Individuals 
with Disabilities 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 following activities, 
which may be carried out by the State directly, or through 
grants or subgrants, contracts, or cooperative agreements: 
‘‘(i) Improving State and local systems with respect 
to the development and implementation of plans of 
safe care, which— 
‘‘(I) shall include parent and caregiver engage-
ment, as required under section 106(b)(2)(B)(iii)(I), 
regarding available treatment and service options, 
which may include resources available for preg-
nant, perinatal, and postnatal women; and 
‘‘(II) may include activities such as—
H. R. 6—132 
‘‘(aa) developing policies, procedures, or 
protocols for the administration or develop-
ment 
of 
evidence-based 
and 
validated 
screening tools for infants who may be affected 
by substance use withdrawal symptoms or a 
fetal alcohol spectrum disorder and pregnant, 
perinatal, and postnatal 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 treatment serv-
ices, which may be prior to the pregnant 
woman’s delivery date; and 
‘‘(ee) keeping families safely together 
when it is in the best interest of the child. 
‘‘(ii) Developing policies, procedures, or protocols 
in consultation and coordination with health profes-
sionals, public and private health facilities, and sub-
stance use disorder treatment agencies to ensure 
that— 
‘‘(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 accord-
ance with section 106(b)(2)(B)(iii), before the infant 
is discharged from the birth or health care facility; 
and 
‘‘(III) such health and related agency profes-
sionals are trained on how to follow such protocols 
and are aware of the supports that may be pro-
vided 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 profes-
sionals such as home visiting agency staff and law 
enforcement in relevant topics including— 
‘‘(I) State mandatory reporting laws estab-
lished under section 106(b)(2)(B)(i) and the referral 
and process requirements for notification to child 
protective services when child abuse or neglect 
reporting is not mandated; 
‘‘(II) the co-occurrence of pregnancy and sub-
stance use disorder, and implications of prenatal 
exposure; 
‘‘(III) the clinical guidance about treating sub-
stance use disorder in pregnant and postpartum 
women; 
‘‘(IV) appropriate screening and interventions 
for infants affected by substance use disorder, 
withdrawal symptoms, or a fetal alcohol spectrum 
disorder and the requirements under section 
106(b)(2)(B)(iii); and
H. R. 6—133 
‘‘(V) appropriate multigenerational strategies 
to address the mental health needs of the parent 
and child together. 
‘‘(iv) Establishing partnerships, agreements, or 
memoranda of understanding between the lead agency 
and other entities (including health professionals, 
health facilities, child welfare professionals, juvenile 
and family court judges, substance use and mental 
disorder treatment programs, early childhood edu-
cation programs, maternal and child health and early 
intervention professionals (including home visiting pro-
viders), peer-to-peer recovery programs such as parent 
mentoring programs, and housing agencies) to facilitate 
the implementation of, and compliance with, section 
106(b)(2) and clause (ii) of this subparagraph, in areas 
which may include— 
‘‘(I) developing a comprehensive, multi-discipli-
nary assessment and intervention process for 
infants, pregnant women, and their families who 
are affected by substance use disorder, withdrawal 
symptoms, or a fetal alcohol spectrum disorder, 
that includes meaningful engagement with and 
takes into account the unique needs of each family 
and addresses differences between medically 
supervised substance use, including for the treat-
ment of substance use disorder, and substance use 
disorder; 
‘‘(II) ensuring that treatment approaches for 
serving infants, pregnant women, and perinatal 
and postnatal women whose infants may be 
affected by substance use, withdrawal symptoms, 
or a fetal alcohol spectrum disorder, are designed 
to, where appropriate, keep infants with their 
mothers during both inpatient and outpatient 
treatment; and 
‘‘(III) increasing access to all evidence-based 
medication-assisted treatment approved by the 
Food 
and 
Drug 
Administration, 
behavioral 
therapy, and counseling services for the treatment 
of substance use disorders, as appropriate. 
‘‘(v) Developing and updating systems of tech-
nology for improved data collection and monitoring 
under section 106(b)(2)(B)(iii), including existing elec-
tronic medical records, to measure the outcomes 
achieved through the plans of safe care, including mon-
itoring systems 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 Secretary, disaggregated by 
geographic location, economic status, and major racial and 
ethnic groups, except that such disaggregation shall not 
be required if the results would reveal personally identifi-
able information on, with respect to infants identified under 
section 106(b)(2)(B)(ii)— 
‘‘(i) the number who experienced removal associ-
ated with parental substance use;
H. R. 6—134 
‘‘(ii) the number who experienced removal and sub-
sequently are reunified with parents, and the length 
of time between such removal and reunification; 
‘‘(iii) the number who are referred to community 
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-reunification 
services within 1 year after a reunification has 
occurred; and 
‘‘(vi) the number who experienced a return 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 Pensions and the Committee on 
Appropriations of the Senate and the Committee on Edu-
cation and the Workforce and the Committee on Appropria-
tions of the House of Representatives that includes the 
information described in subparagraph (E) and rec-
ommendations or observations on the challenges, successes, 
and lessons derived from implementation of the grant pro-
gram. 
‘‘(G) ASSISTING
STATES’ IMPLEMENTATION.—The Sec-
retary shall use the amount reserved under subparagraph 
(B)(i)(I) to provide written guidance and technical assist-
ance to support States in complying with and implementing 
this paragraph, which shall include— 
‘‘(i) technical assistance, including programs of in- 
depth technical assistance, to additional States, terri-
tories, 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 identified 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— 
‘‘(I) 
enhancing 
States’ 
understanding 
of 
requirements and flexibilities under the law, 
including by clarifying key terms; 
‘‘(II) addressing state-identified challenges 
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, 
collaboration 
and 
coordination, and identification and delivery of 
services for different populations, while recog-
nizing 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;
H. R. 6—135 
‘‘(iii) supporting State efforts to develop informa-
tion technology systems to manage plans of safe care; 
and 
‘‘(iv) preparing the Secretary’s report to Congress 
described in subparagraph (F). 
‘‘(H) SUNSET.—The authority under this paragraph 
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 DIS-
ORDER 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 DIS-
ORDER TREATMENT WORKFORCE. 
‘‘(a) IN GENERAL.—The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration, shall 
carry out a program under which— 
‘‘(1) the Secretary enters into agreements with individuals 
to make payments in accordance with subsection (b) on the 
principal of and interest on any eligible loan; and 
‘‘(2) the individuals each agree to the requirements of 
service in substance use disorder treatment employment, as 
described in subsection (d). 
‘‘(b) PAYMENTS.—For each year of obligated service by an indi-
vidual pursuant to an agreement under subsection (a), the Secretary 
shall make a payment to such individual as follows: 
‘‘(1) SERVICE IN A SHORTAGE AREA.—The Secretary shall 
pay— 
‘‘(A) for each year of obligated service by an individual 
pursuant to an agreement under subsection (a), 1⁄6 of the 
principal of and interest on each eligible loan of the indi-
vidual which is outstanding 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 repayment under 
this section are each of the following: 
‘‘(1) Any loan for education or training for a substance 
use disorder treatment employment. 
‘‘(2) Any loan under part E of title VIII (relating to nursing 
student loans).
H. R. 6—136 
‘‘(3) Any Federal Direct Stafford Loan, Federal Direct 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 appropriate 
by the Secretary. 
‘‘(d) REQUIREMENTS OF SERVICE.—Any individual receiving pay-
ments under this program as required by an agreement under 
subsection (a) shall agree to an annual commitment to full-time 
employment, with no more than 1 year passing between any 2 
years of covered employment, in substance use disorder treatment 
employment in the United States in— 
‘‘(1) a Mental Health Professional Shortage Area, as des-
ignated 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 death rate per 100,000 
people, as reported by the Centers for Disease Control and 
Prevention. 
‘‘(e) INELIGIBILITY FOR DOUBLE BENEFITS.—No borrower 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 program, 
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 Secretary 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 agree-
ment, taken alone, shall not constitute a breach of the agree-
ment, so long as the individual completed in good faith the 
years of service for which payments 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 and in 
addition to the criteria and rules specified in this section; 
and 
‘‘(2) shall give notice to the committees specified in sub-
section (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 Representatives and the Committee 
on Health, Education, Labor, and Pensions of the Senate a report 
on— 
‘‘(1) the number and location of borrowers who have quali-
fied for loan repayments under this section; and
H. R. 6—137 
‘‘(2) the impact of this section on the availability of sub-
stance use disorder treatment employees nationally and in 
shortage areas and counties described in subsection (d). 
‘‘(i) DEFINITION.—In this section: 
‘‘(1) The terms ‘Indian tribe’ and ‘tribal organization’ have 
the meanings given those terms in section 4 of the Indian 
Self-Determination and Education Assistance Act. 
‘‘(2) The term ‘municipality’ means a city, town, or other 
public body created by or pursuant to State law, or an Indian 
tribe. 
‘‘(3) The term ‘substance use disorder treatment employ-
ment’ means full-time employment (including a fellowship)— 
‘‘(A) where the primary intent and function of the 
position is the direct treatment or recovery support of 
patients with or in recovery from a substance use disorder, 
including master’s level social workers, psychologists, coun-
selors, marriage and family therapists, psychiatric mental 
health practitioners, occupational therapists, psychology 
doctoral interns, and behavioral health paraprofessionals 
and physicians, physician assistants, and nurses, who are 
licensed or certified in accordance with applicable State 
and Federal laws; and 
‘‘(B) which is located at a substance use disorder treat-
ment program, private physician practice, hospital or 
health system-affiliated inpatient treatment center or out-
patient clinic (including an academic medical center-affili-
ated treatment program), correctional facility or program, 
youth detention center or program, inpatient psychiatric 
facility, crisis stabilization unit, community health center, 
community mental health or other specialty community 
behavioral health center, recovery center, school, commu-
nity-based organization, telehealth platform, migrant 
health center, health program or facility operated by an 
Indian tribe or tribal organization, Federal medical facility, 
or any other facility as determined appropriate for purposes 
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 Repay-
ment 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 located in a health professional 
shortage area. 
‘‘(b) OBLIGATED SERVICE.—
H. R. 6—138 
‘‘(1) IN GENERAL.—Any service described in subsection (a) 
that a participant provides may count towards such partici-
pant’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 described in subsection (a) for not 
less than 50 percent of the total hours required to complete 
such obligated service requirements. 
‘‘(c) RULE OF CONSTRUCTION.—The authorization under sub-
section (a) shall be notwithstanding any other provision 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 ‘‘hospices, tribal health pro-
grams (as defined in section 4 of the Indian Health Care 
Improvement Act), and other public and nonprofit private enti-
ties’’; 
(2) in subsection (b)— 
(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 com-
prehensive education and training plan that includes’’; 
(B) in paragraph (1)— 
(i) by inserting ‘‘preventing,’’ after ‘‘diagnosing,’’; 
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 ‘‘, integrated, evi-
dence-based pain management, and, as appropriate, non- 
pharmacotherapy’’ before the semicolon; 
(E) in paragraph (4), by striking ‘‘; and’’ and inserting 
‘‘;’’; and 
(F) by striking paragraph (5) and inserting the fol-
lowing: 
‘‘(5) recent findings, developments, and advancements 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, detection 
of early warning signs of opioid use disorders (which may
H. R. 6—139 
include best practices related to screening for opioid use dis-
orders, training on screening, brief intervention, and referral 
to treatment), and safe disposal options for prescription medica-
tions (including such options provided by law enforcement or 
other innovative deactivation mechanisms).’’; 
(3) in subsection (d), by inserting ‘‘prevention,’’ after ‘‘diag-
nosis,’’; 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)— 
(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 preven-
tion 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 CONTINU-
ATION OF CARE FOR DRUG OVERDOSE PATIENTS. 
(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 over-
dose; 
(2) the use of recovery coaches, as appropriate, to encourage 
individuals who experience a non-fatal overdose to seek treat-
ment for substance use disorder and to support coordination 
and continuation of care; 
(3) coordination and continuation of care and treatment, 
including, as appropriate, through referrals, of individuals after 
a drug overdose; and 
(4) the provision or prescribing of overdose reversal medica-
tion, as appropriate. 
(b) GRANT ESTABLISHMENT AND PARTICIPATION.— 
(1) IN GENERAL.—The Secretary shall award grants on a 
competitive basis to eligible entities to support implementation 
of voluntary programs for care and treatment of individuals 
after a drug overdose, as appropriate, 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.