I 
116TH CONGRESS 
1ST SESSION H. R. 2569 
To provide emergency assistance to States, territories, Tribal nations, and 
local areas affected by the opioid epidemic and to make financial assist-
ance available to States, territories, Tribal nations, local areas, and 
public or private nonprofit entities to provide for the development, organi-
zation, coordination, and operation of more effective and cost efficient 
systems for the delivery of essential services to individuals with substance 
use disorder and their families. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 8, 2019 
Mr. CUMMINGS (for himself, Mrs. BEATTY, Mr. BISHOP of Georgia, Ms. 
BONAMICI, Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. BROWN of 
Maryland, Mr. CA´RDENAS, Mr. CISNEROS, Ms. CLARK of Massachusetts, 
Ms. CLARKE of New York, Mr. CLAY, Mr. CONNOLLY, Mr. COOPER, Mr. 
COURTNEY, Mr. COX of California, Mr. DANNY K. DAVIS of Illinois, Ms. 
DEAN, Mrs. DEMINGS, Mr. DESAULNIER, Mr. DOGGETT, Mr. MICHAEL 
F. DOYLE of Pennsylvania, Mr. ENGEL, Mr. ESPAILLAT, Mr. GALLEGO, 
Mr. GOLDEN, Mr. GOMEZ, Mr. GREEN of Texas, Ms. HAALAND, Mr. 
HASTINGS, Ms. HILL of California, Mr. HOYER, Ms. JAYAPAL, Ms. 
JOHNSON of Texas, Ms. KAPTUR, Mr. KEATING, Ms. KELLY of Illinois, 
Mr. KHANNA, Mr. KILMER, Mrs. KIRKPATRICK, Mr. KRISHNAMOORTHI, 
Mrs. LAWRENCE, Ms. LEE of California, Mr. LEVIN of Michigan, Mr. 
LOWENTHAL, Mr. LUJA´N, Mr. LYNCH, Mrs. CAROLYN B. MALONEY of 
New York, Ms. MATSUI, Mr. MCGOVERN, Mr. MEEKS, Ms. MENG, Ms. 
MOORE, Mr. MORELLE, Mr. MOULTON, Ms. NORTON, Ms. OCASIO-COR-
TEZ, Ms. OMAR, Mr. PANETTA, Mr. PAPPAS, Mr. PAYNE, Ms. PINGREE, 
Ms. PLASKETT, Mr. POCAN, Ms. PRESSLEY, Mr. RASKIN, Mr. ROUDA, 
Mr. RUPPERSBERGER, Mr. RUSH, Mr. RYAN, Mr. SARBANES, Ms. SCAN-
LON, Ms. SCHAKOWSKY, Mr. SIRES, Ms. SPANBERGER, Ms. SPEIER, Mr. 
THOMPSON of California, Ms. TLAIB, Mr. TONKO, Mrs. TRAHAN, Mr. 
TRONE, Mr. VAN DREW, Mr. VISCLOSKY, Ms. WASSERMAN SCHULTZ, 
Mr. WELCH, Ms. WILSON of Florida, Mr. GARCI´A of Illinois, Mrs. LEE 
of Nevada, Mrs. NAPOLITANO, and Ms. FUDGE) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committees on Natural Resources, and the Judiciary, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of the 
committee concerned 
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A BILL 
To provide emergency assistance to States, territories, Tribal 
nations, and local areas affected by the opioid epidemic 
and to make financial assistance available to States, ter-
ritories, Tribal nations, local areas, and public or private 
nonprofit entities to provide for the development, organi-
zation, coordination, and operation of more effective and 
cost efficient systems for the delivery of essential services 
to individuals with substance use disorder and their fami-
lies. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Comprehensive Addiction Resources Emergency Act of 
2019’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Purpose. 
Sec. 3. Amendment to the Public Health Service Act. 
‘‘TITLE XXXIV—SUBSTANCE USE AND OPIOID HEALTH 
RESOURCES 
‘‘Subtitle A—Local Substance Use and Opioid Emergency Relief Grant 
Program 
‘‘Sec. 3401. Establishment of program of grants. 
‘‘Sec. 3402. Planning council. 
‘‘Sec. 3403. Amount of grant, use of amounts, and funding agreement. 
‘‘Sec. 3404. Application. 
‘‘Sec. 3405. Technical assistance. 
‘‘Sec. 3406. Authorization of appropriations. 
‘‘Subtitle B—State and Tribal Substance Use Disorder Prevention and 
Intervention Grant Program 
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‘‘Sec. 3411. Establishment of program of grants. 
‘‘Sec. 3412. Amount of grant, use of amounts, and funding agreement. 
‘‘Sec. 3413. Application. 
‘‘Sec. 3414. Technical assistance. 
‘‘Sec. 3415. Authorization of appropriations. 
‘‘Subtitle C—Other Grant Program 
‘‘Sec. 3421. Establishment of grant program. 
‘‘Sec. 3422. Use of amounts. 
‘‘Sec. 3423. Technical assistance. 
‘‘Sec. 3424. Planning and development grants. 
‘‘Sec. 3425. Authorization of appropriations. 
‘‘Subtitle D—Innovation, Training, and Health Systems Strengthening 
‘‘Sec. 3431. Special projects of national significance. 
‘‘Sec. 3432. Education and training centers. 
‘‘Sec. 3433. Substance use disorder treatment provider capacity under the 
Medicaid program. 
‘‘Sec. 3434. Programs to support employees. 
‘‘Sec. 3435. Improving and expanding care. 
‘‘Sec. 3436. Naloxone distribution program. 
‘‘Sec. 3437. Additional funding for the National Institutes of Health. 
‘‘Sec. 3438. Additional funding for the Centers for Disease Control and 
Prevention. 
‘‘Sec. 3439. Definitions. 
Sec. 4. Amendments to the Controlled Substances Act. 
SEC. 2. PURPOSE. 
It is the purpose of this Act to provide emergency 
assistance to States, territories, Tribal nations, and local 
areas that are disproportionately affected by the opioid 
epidemic and to make financial assistance available to 
States, territories, Tribal nations, local areas, and other 
public or private nonprofit entities to provide for the devel-
opment, organization, coordination, and operation of more 
effective and cost efficient systems for the delivery of es-
sential services to individuals with substance use disorder, 
including with co-occurring mental health and substance 
use disorders, and their families. 
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SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following: 
‘‘TITLE XXXIV—SUBSTANCE USE 
AND 
OPIOID 
HEALTH 
RE-
SOURCES 
‘‘Subtitle A—Local Substance Use 
and Opioid Emergency Relief 
Grant Program 
‘‘SEC. 3401. ESTABLISHMENT OF PROGRAM OF GRANTS. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to eligible localities for the purpose of addressing 
substance use within such localities. 
‘‘(b) ELIGIBILITY.— 
‘‘(1) IN GENERAL.—To be eligible to receive a 
grant under subsection (a) a locality shall— 
‘‘(A) be— 
‘‘(i) a county that can demonstrate 
that the rate of drug overdose deaths per 
100,000 population in the county during 
the most recent 3-year period for which 
such data are available was not less than 
the rate of such deaths for the county that 
ranked at the 67th percentile of all coun-
ties, as determined by the Secretary; 
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‘‘(ii) a county that can demonstrate 
that the number of drug overdose deaths 
during the most recent 3-year period for 
which such data are available was not less 
than the number of such deaths for the 
county that ranked at the 90th percentile 
of all counties, as determined by the Sec-
retary; or 
‘‘(iii) a city that is located within a 
county described in clause (i) or (ii), that 
meets the requirements of paragraph (3); 
and 
‘‘(B) submit to the Secretary an applica-
tion in accordance with section 3404. 
‘‘(2) MULTIPLE
CONTIGUOUS
COUNTIES.—In 
the case of an eligible county that is contiguous to 
one or more other eligible counties within the same 
State, the group of counties shall— 
‘‘(A) be considered as a single eligible 
county for purposes of a grant under this sec-
tion; 
‘‘(B) submit a single application under sec-
tion 3404; 
‘‘(C) form a joint planning council (for the 
purposes of section 3402); and 
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‘‘(D) establish, through intergovernmental 
agreements, an administrative mechanism to al-
locate funds and substance use disorder treat-
ment services under the grant based on— 
‘‘(i) the number and rate of drug 
overdose 
deaths 
and 
nonfatal 
drug 
overdoses in each of the counties that com-
pose the eligible county; 
‘‘(ii) the severity of need for services 
in each such county; and 
‘‘(iii) the health and support per-
sonnel needs of each such county. 
‘‘(3) CITIES AND COUNTIES WITHIN MULTIPLE 
CONTIGUOUS COUNTIES.— 
‘‘(A) IN GENERAL.—A city that is within 
an eligible county described in paragraph (1), 
or a county or group of counties that is within 
a group of counties determined to be an eligible 
county under paragraph (2), shall be eligible to 
receive a grant under section 3401 if such city 
or county or group of counties meets the re-
quirements of subparagraph (B). 
‘‘(B) REQUIREMENTS.—A city or county 
meets the requirements of this subparagraph if 
such city or county— 
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‘‘(i) except as provided in subpara-
graph (C), has a population of not less 
than 50,000 residents; 
‘‘(ii) meets the requirements of para-
graph (1)(A); 
‘‘(iii) submits an application under 
section 3404; 
‘‘(iv) establishes a planning council 
(for purposes of section 3402); and 
‘‘(v) establishes an administrative 
mechanism to allocate funds and services 
under the grant based on— 
‘‘(I) the number and rate of drug 
overdose deaths and nonfatal drug 
overdoses in the city or county; 
‘‘(II) the severity of need for sub-
stance use disorder treatment services 
in the city or county; and 
‘‘(III) the health and support 
personnel needs of the city or county. 
‘‘(C) POPULATION EXCEPTION.—A city or 
county or group of counties that does not meet 
the requirements of subparagraph (B)(i) may 
apply to the Secretary for a waiver of such re-
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quirement. 
Such 
application 
shall 
dem-
onstrate— 
‘‘(i) that the needs of the population 
to be served are distinct or that addressing 
substance use in the service area would be 
best served by the formation of an inde-
pendent council; and 
‘‘(ii) that the city or county or group 
of counties has the capacity to administer 
the funding received under this subtitle. 
‘‘(D) MINIMUM FUNDING.—A city or coun-
ty that meets the requirement of this paragraph 
and receives a grant under section 3401 shall 
be entitled to an amount of funding under the 
grant in an amount that is not less than the 
amount determined under section 3403(a) with 
respect to such city or county. 
‘‘(4) INDEPENDENT CITY.—Independent cities 
that are not located within the territory of a county 
shall be treated as eligible counties for purposes of 
this subtitle. 
‘‘(5) POLITICAL
SUBDIVISIONS.—With respect 
to States that do not have a local county system of 
governance, the Secretary shall determine the local 
political subdivisions within such States that are eli-
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gible to receive a grant under section 3401 and such 
subdivisions shall be treated as eligible counties for 
purposes of this subtitle. 
‘‘(6) DETERMINATIONS
WHERE
THERE
IS
A 
LACK OF DATA.—The Secretary shall establish eligi-
bility and allocation criteria related to the prevalence 
of drug overdose deaths, the mortality rate from 
drug overdoses, and that provides an equivalent 
measure of need for funding for cities and counties 
for which the data described in paragraph (1)(A) or 
(2)(D)(i) is not available. 
‘‘(7) DATA
FROM
TRIBAL
AREAS.—The Sec-
retary, acting through the Indian Health Service, 
shall consult with Indian tribes to establish eligibility 
and allocation criteria that provide an equivalent 
measure of need for Tribal areas for which the data 
described in paragraph (1)(A) or (2)(D)(i) are not 
available or do not apply. 
‘‘(8) STUDY.—Not later than 3 years after the 
date of enactment of this title, the Comptroller Gen-
eral shall conduct a study to determine whether the 
data utilized for purposes of paragraph (1)(A) pro-
vide the most precise measure of local area need re-
lated to substance use and addiction prevalence and 
whether additional data would provide more precise 
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measures of substance use and addiction prevalence 
in local areas. Such study shall identify barriers to 
collecting or analyzing such data, and make rec-
ommendations for revising the indicators used under 
such paragraph to determine eligibility in order to 
direct funds to the local areas in most need of fund-
ing to provide assistance related to substance use 
and addiction. 
‘‘(9) REFERENCE.—For purposes of this sub-
title, the term ‘eligible local area’ includes— 
‘‘(A) a city or county described in para-
graph (1); 
‘‘(B) multiple contiguous counties de-
scribed in paragraph (2); 
‘‘(C) cities or counties within multiple con-
tiguous counties described in paragraph (3); 
‘‘(D) an independent city described in 
paragraph (4); and 
‘‘(E) a political subdivision described in 
paragraph (5). 
‘‘(c) ADMINISTRATION.— 
‘‘(1) IN GENERAL.—Assistance made available 
under a grant awarded under this section shall be 
directed to the chief elected official of the eligible 
local area who shall administer the grant funds. 
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‘‘(2) MULTIPLE CONTIGUOUS COUNTIES.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), in the case of an eligible 
county described in subsection (b)(2), assist-
ance made available under a grant awarded 
under this section shall be directed to the chief 
elected official of the particular county des-
ignated in the application submitted for the 
grant under section 3404. Such chief elected of-
ficial shall be the administrator of the grant. 
‘‘(B) STATE
ADMINISTRATION.—Notwith-
standing subparagraph (A), the eligible county 
described in subsection (b)(2) may elect to des-
ignate the chief elected State official of the 
State in which the eligible county is located as 
the administrator of the grant funds. 
‘‘SEC. 3402. PLANNING COUNCIL. 
‘‘(a) ESTABLISHMENT.—To be eligible to receive a 
grant under section 3401, the chief elected official of the 
eligible local area shall establish or designate a substance 
use disorder treatment and services planning council that 
shall, to the maximum extent practicable— 
‘‘(1) be representative of the demographics of 
the population of individuals with substance use dis-
order in the area; 
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‘‘(2) include representatives of— 
‘‘(A) health care providers, including feder-
ally qualified health centers, rural health clinics, 
Indian health programs as defined in section 4 
of the Indian Health Care Improvement Act, 
urban Indian organizations as defined in section 
4 of the Indian Health Care Improvement Act, 
Native Hawaiian organizations as defined in 
section 11 of the Native Hawaiian Health Care 
Act of 1988, and facilities operated by the De-
partment of Veterans Affairs; 
‘‘(B) community-based health, harm reduc-
tion, or addiction service organizations, includ-
ing, where applicable, representatives of Drug 
Free Communities Coalition grantees; 
‘‘(C) social service providers, including pro-
viders of housing and homelessness services and 
recovery residence providers; 
‘‘(D) mental health care providers; 
‘‘(E) local public health agencies; 
‘‘(F) law enforcement officials, including 
officials from the High Intensity Drug Traf-
ficking Area program, where applicable; 
‘‘(G) individuals with substance use dis-
order; 
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‘‘(H) individuals in recovery from sub-
stance use disorders; 
‘‘(I) State governments, including the 
State Medicaid agency and the Single State 
Agency for Substance Abuse Services; 
‘‘(J) local governments; 
‘‘(K) non-elected community leaders; 
‘‘(L) substance use disorder treatment pro-
viders; 
‘‘(M) Indian tribes and tribal organizations 
as defined in section 4 of the Indian Self-Deter-
mination and Education Assistance Act; 
‘‘(N) Urban Indians as defined in section 
4 of the Indian Health Care Improvement Act; 
‘‘(O) historically underserved groups and 
subpopulations; 
‘‘(P) individuals who were formerly incar-
cerated; 
‘‘(Q) organizations serving individuals who 
are currently incarcerated or in pre-trial deten-
tion or were formerly incarcerated; 
‘‘(R) Federal agencies; 
‘‘(S) organizations that provide drug pre-
vention programs and services to youth at risk 
of substance use; 
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‘‘(T) medical examiners or coroners; 
‘‘(U) labor unions and the workplace com-
munity; 
‘‘(V) local fire departments and emergency 
medical services; 
‘‘(W) 
the 
lesbian, 
gay, 
bisexual, 
transgender, queer or questioning (LGBTQ) 
community; and 
‘‘(X) certified or accredited addiction re-
covery community organizations. 
‘‘(b) METHOD OF PROVIDING FOR COUNCIL.— 
‘‘(1) IN GENERAL.—In providing for a council 
for purposes of subsection (a), the chief elected offi-
cial of the eligible local area may establish the coun-
cil directly or designate an existing entity to serve as 
the council, subject to paragraph (2). 
‘‘(2) CONSIDERATION REGARDING DESIGNATION 
OF COUNCIL.—In making a determination of wheth-
er to establish or designate a council under para-
graph (1), the chief elected official shall give priority 
to the designation of an existing entity that has 
demonstrated experience in the provision of health 
and support services to individuals with substance 
use disorder within the eligible local area, that has 
a structure that recognizes the Federal trust respon-
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sibility when spending Federal health care dollars, 
and that has demonstrated a commitment to re-
specting the obligation of government agencies using 
Federal dollars to consult with Indian tribes and 
confer with Urban Indian health programs. 
‘‘(3) DESIGNATION
OF
EXISTING
ENTITY.—If 
an existing entity is designated to serve as the coun-
cil under this section, the membership of the entity 
shall comply with the requirements of subsection 
(a)(1) before it performs any of the duties set forth 
in subsection (e). 
‘‘(4) JOINT COUNCIL.—The Secretary shall es-
tablish a process to permit an eligible local area that 
is not contiguous with any other eligible local area 
to form a joint planning council with such other eli-
gible local area or areas, as long as such areas are 
located in geographical proximity to each other, as 
determined by the Secretary, and submit a joint ap-
plication under section 3404. 
‘‘(5) JOINT COUNCIL ACROSS STATE LINES.— 
Eligible local areas may form a joint planning coun-
cil with other eligible local areas across State lines 
if such areas are located in geographical proximity 
to each other, as determined by the Secretary, sub-
mit a joint application under section 3404, and es-
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