I 
117TH CONGRESS 
1ST SESSION H. R. 4341 
To provide support with respect to the prevention of, treatment for, and 
recovery from, substance use disorder. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 1, 2021 
Mr. TRONE (for himself, Mr. RYAN, Mr. MCKINLEY, Ms. KUSTER, Mr. 
FITZPATRICK, Mr. TONKO, Mr. JOYCE of Ohio, Ms. HERRERA BEUTLER, 
Ms. WILD, Mrs. MCBATH, Mr. TURNER, Ms. CRAIG, Ms. DEAN, Mr. 
LEVIN of California, Mr. MOONEY, Mrs. TRAHAN, Ms. SPANBERGER, Mr. 
KATKO, Mr. RUTHERFORD, Mr. WOMACK, Mr. MICHAEL F. DOYLE of 
Pennsylvania, Ms. BLUNT ROCHESTER, Mr. PAPPAS, Mrs. DINGELL, Mr. 
CARTER of Louisiana, Mr. BUTTERFIELD, Mr. MORELLE, Ms. DEGETTE, 
Ms. KELLY of Illinois, Mr. CRIST, Mrs. LEE of Nevada, Ms. BARRAGA´N, 
and Mr. CA´RDENAS) introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Commit-
tees on the Judiciary, Ways and Means, Education and Labor, Financial 
Services, and Agriculture, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
A BILL 
To provide support with respect to the prevention of, 
treatment for, and recovery from, substance use disorder. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘CARA 3.0 Act of 2021’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
TITLE I—EDUCATION, PREVENTION, AND RESEARCH 
Sec. 101. National Education Campaign. 
Sec. 102. Research into non-opioid pain management. 
Sec. 103. Long-term treatment and recovery support services research. 
Sec. 104. National Commission for Excellence on Post-Overdose Response. 
Sec. 105. Workforce for prevention, treatment, and recovery support services. 
Sec. 106. Reauthorization of community-based coalition enhancement grants to 
address local drug crises. 
Sec. 107. Access to non-opioid treatments for pain. 
TITLE II—TREATMENT 
Sec. 201. Evidence-based substance use disorder treatment and intervention 
demonstrations. 
Sec. 202. Improving treatment for pregnant, postpartum, and parenting 
women. 
Sec. 203. Require the use of prescription drug monitoring programs. 
Sec. 204. Prescriber education. 
Sec. 205. Prohibition of utilization control policies or procedures for medica-
tion-assisted treatment under Medicaid. 
Sec. 206. Medication-assisted treatment for recovery from substance use dis-
order. 
Sec. 207. Telehealth response for e-prescribing addiction therapy services. 
Sec. 208. Pilot program on expanding access to treatment. 
Sec. 209. Reauthorization of PRAC Ed grant program. 
Sec. 210. GAO study on parity. 
Sec. 211. Improving substance use disorder prevention workforce act. 
TITLE III—RECOVERY 
Subtitle A—General Provisions 
Sec. 301. Building communities of recovery. 
Sec. 302. Recovery in the workplace. 
Sec. 303. National youth and young adult recovery initiative. 
Subtitle B—Recovery Housing 
Sec. 311. Clarifying the role of SAMHSA in promoting the availability of high- 
quality recovery housing. 
Sec. 312. Developing guidelines for States to promote the availability of high- 
quality recovery housing. 
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Sec. 313. Coordination of Federal activities to promote the availability of high- 
quality recovery housing. 
Sec. 314. NAS study and report. 
Sec. 315. Filling research and data gaps. 
Sec. 316. Grants for States to promote the availability of high-quality recovery 
housing. 
Sec. 317. Reputable providers and analysts of recovery housing services defini-
tion. 
Sec. 318. Technical correction. 
TITLE IV—CRIMINAL JUSTICE 
Sec. 401. Medication-Assisted Treatment Corrections and Community Reentry 
Program. 
Sec. 402. Deflection and pre-arrest diversion. 
Sec. 403. Housing. 
Sec. 404. Veterans treatment courts. 
Sec. 405. Infrastructure for reentry. 
SEC. 2. FINDINGS. 
Congress finds as follows: 
(1) In the 1980s and 1990s, pharmaceutical 
companies began developing new drugs for pain 
treatment, including extended release oxycodone. 
These companies aggressively marketed these drugs 
to the medical community as a way to address 
‘‘under-treatment’’ of physical pain. Drug companies 
distributed 
76,000,000,000 
oxycodone 
and 
hydrocodone pain pills nationwide from 2006 to 
2012. 
(2) The combination of a rising number of pre-
scriptions, misinformation about the addictive prop-
erties of prescription opioids, and the perception 
that prescription drugs are less harmful than illicit 
drugs has caused an increase in drug misuse. 
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(3) As legitimate production and illegal diver-
sion of opioids skyrocketed, so did the number of 
opioid overdose deaths. From 1999 to 2017, almost 
218,000 people died in the United States from 
overdoses related to prescription opioids. More re-
cently, fentanyl, a powerful synthetic opioid, sur-
passed prescription opioids as the most lethal over-
dose substance and now is linked to nearly 3 times 
as many deaths. 
(4) The scale of the opioid crisis is staggering: 
(A) In 2018, approximately 10,300,000 
people in the United States age 12 and older 
misused opioids. 
(B) On average, 130 people in the United 
States die every day from an opioid overdose. 
(C) The opioid crisis has cost the United 
States economy at least $631,000,000,000. 
(D) From 2013 to 2017, the number of 
children in foster care nationwide increased 10 
percent to nearly 442,995. Parental drug use 
was cited as a factor in 36 percent of cases. 
(5) The opioid crisis has also led to a cascade 
of other negative health impacts. For example, sy-
ringe sharing among people who inject drugs has led 
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to increases in hepatitis C virus infections and infec-
tive endocarditis, as well as localized HIV outbreaks. 
(6) The United States health care system has 
struggled to catch up to the crisis: 
(A) The majority of people in the United 
States with an opioid use disorder do not re-
ceive substance use treatment, and many who 
do receive such treatment do not receive evi-
dence-based treatment. Although medication-as-
sisted treatment has been endorsed by the Na-
tional Institutes of Health and the World 
Health Organization, only one-third of treat-
ment programs offer any of the 3 drugs ap-
proved by the Food and Drug Administration 
for the treatment of opioid use disorder, and 
just 6 percent of medication-offering facilities 
provide all 3. 
(B) Facilities that provide medications for 
the treatment of opioid disorder are con-
centrated in the Northeast and Southwest, leav-
ing many of the areas hit hardest by the opioid 
crisis without access to evidence-based treat-
ment. The need is particularly acute in rural 
areas, which often do not have enough providers 
to meet the demand. 
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(C) Unlike other health care needs, sub-
stance use treatment is largely funded by State 
and local revenues and Federal block grants, 
rather than the Medicare program, the Med-
icaid program, and private insurance. 
(D) While new substances, particularly 
synthetic drugs, continue to make inroads into 
communities in the United States, funding 
streams are often dedicated to particular sub-
stances, limiting providers’ ability to adapt to 
changing needs. 
(E) The stigma associated with substance 
use disorder prevents people from seeking treat-
ment. Too often, people enter substance use 
treatment only after committing a criminal of-
fense, whether through a court mandate, as a 
condition of parole or probation supervision, or 
as a condition of regaining employment after 
conviction. In 2003, 36 percent of all substance 
use treatment admissions, 40 percent of all al-
cohol abuse treatment admissions, and 57 per-
cent of all marijuana use treatment admissions 
were referrals from the criminal justice system. 
(F) The stigma of substance use disorder 
also limits people’s ability to find jobs and 
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housing. These obstacles are exacerbated by the 
criminalization of substance use disorder—even 
convictions for drug possession for personal use 
can create lifelong collateral consequences. The 
absence of stable housing and employment 
make it even more difficult for people to live 
drug free. 
(7) Not all people in the United States have 
equal access to substance use treatment in the com-
munity. Current research has found that Black and 
Latinx Americans are less likely to receive substance 
use treatment when controlling for other relevant 
factors, like socioeconomic status. 
(8) Inadequate access to substance use treat-
ment can exacerbate other health disparities. Indi-
viduals with substance use disorders have higher 
rates of suicide attempts than individuals in the gen-
eral population, high health care expenses, and sig-
nificant disability. 
(9) A comprehensive public health approach 
that tackles both the causes and the consequences of 
substance use disorder is necessary to stem the tide. 
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TITLE I—EDUCATION, 
PREVENTION, AND RESEARCH 
SEC. 101. NATIONAL EDUCATION CAMPAIGN. 
Section 102 of the Comprehensive Addiction and Re-
covery Act of 2016 (42 U.S.C. 290bb–25g) is amended— 
(1) in subsection (a), by inserting ‘‘or other 
controlled substances (as defined in section 102 of 
the Controlled Substances Act (21 U.S.C. 802))’’ 
after ‘‘opioids’’ each place such term appears; 
(2) in subsection (b), by striking ‘‘opioid’’ each 
place it appears and inserting ‘‘substance’’; 
(3) in subsection (c)— 
(A) in paragraph (2), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (3), by striking the pe-
riod and inserting a semicolon; and 
(C) by adding at the end the following: 
‘‘(4) use destigmatizing language promoting hu-
mane and culturally competent (as defined in section 
102 of the Developmental Disabilities Assistance 
and Bill of Rights Act of 2000 (42 U.S.C. 15002)) 
treatment of all individuals who experience sub-
stance use disorder, including such individuals who 
use medication-assisted treatment for recovery pur-
poses; 
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‘‘(5) educate stakeholders on the evidence base 
and validation of harm reduction and where to ob-
tain harm reduction services; 
‘‘(6) include information about polysubstance 
use; and 
‘‘(7) include information about prevention and 
treatment using medication-assisted treatment and 
recovery support.’’; and 
(4) by adding at the end the following: 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2022 through 2026.’’. 
SEC. 102. RESEARCH INTO NON-OPIOID PAIN MANAGE-
MENT. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Director of the Na-
tional Institutes of Health and the Director of the Centers 
for Disease Control and Prevention, shall carry out re-
search with respect to non-opioid methods of pain manage-
ment, including non-pharmaceutical remedies for pain and 
integrative medicine solutions. 
(b) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
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such sums as may be necessary for each of fiscal years 
2022 through 2026. 
SEC. 103. LONG-TERM TREATMENT AND RECOVERY SUP-
PORT SERVICES RESEARCH. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall award grants to eligible entities to 
carry out evidence-based research, over 5-year periods, for 
different modalities of treatment and recovery support for 
substance use disorder, including culturally competent (as 
defined in section 102 of the Developmental Disabilities 
Assistance and Bill of Rights Act of 2001 (42 U.S.C. 
15002)) treatment. 
(b) RESEARCH REQUIREMENTS.—An eligible entity 
receiving grant funds to carry out evidence-based research 
under subsection (a) shall, with respect to such research— 
(1) measure— 
(A) mortality and morbidity; 
(B) physical and emotional health; 
(C) employment; 
(D) stable housing; 
(E) criminal justice involvement; 
(F) family relationships; and 
(G) other quality-of-life measures; and 
(2) distinguish long-term outcomes based on— 
(A) race; 
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(B) gender; 
(C) socioeconomic status; and 
(D) other relevant characteristics. 
(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary. 
SEC. 104. NATIONAL COMMISSION FOR EXCELLENCE ON 
POST-OVERDOSE RESPONSE. 
(a) ESTABLISHMENT.—The Assistant Secretary of 
Health and Human Services for Mental Health and Sub-
stance Use (referred to in this section as the ‘‘Assistant 
Secretary’’), in consultation with the Director of the Office 
of National Drug Control Policy, and the President of the 
National Academy of Medicine, shall establish an advisory 
commission to be known as the National Commission for 
Excellence on Post-Overdose Response (in this section re-
ferred to as the ‘‘Commission’’). 
(b) DUTIES.—The Commission shall— 
(1) improve the quality and safety of care for 
individuals who experience substance use disorder 
and have experienced drug overdose by providing 
evidence, practical tools, and other resources for 
healthcare experts, including— 
(A) researchers and evaluators; 
(B) clinicians and clinical teams; 
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(C) quality improvement experts; and 
(D) healthcare decision makers; 
(2) advise the healthcare experts described in 
paragraph (1) on— 
(A) achieving equitable outcomes with re-
spect to race and socioeconomic status; and 
(B) effectively and appropriately reducing 
the rate of— 
(i) 
inpatient 
hospital 
admissions 
where equivalent services are available to 
treat patients in a similar condition 
through outpatient hospital visits or non- 
hospital treatment facilities; 
(ii) emergency department admissions; 
and 
(iii) other adverse events related to 
care for individuals described in such para-
graph; and 
(3) develop best practices and clinical practice 
guidelines for improving the quality and safety of 
care for individuals who experience substance use 
disorder and have experienced drug overdose, that 
are culturally competent (as defined in section 102 
of the Developmental Disabilities Assistance and Bill 
of Rights Act of 2000 (42 U.S.C. 15002)). 
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(c) MEMBERSHIP.—The members of the Commission 
shall include— 
(1) a representative of the Substance Abuse 
and Mental Health Services Administration; 
(2) a representative of the Office of National 
Drug Control Policy; 
(3) a representative of the National Academy of 
Medicine; 
(4) a representative of the National Institute on 
Drug Abuse; 
(5) a substance use disorder specialist ap-
pointed by the Assistant Secretary; 
(6) a peer recovery specialist appointed by the 
Assistant Secretary; 
(7) an individual with experience in harm re-
duction; and 
(8) any other individual that the Assistant Sec-
retary determines appropriate. 
(d) SUNSET.—The Commission shall terminate on 
the date that is 10 years after the date of the enactment 
of this Act. 
SEC. 105. WORKFORCE FOR PREVENTION, TREATMENT, 
AND RECOVERY SUPPORT SERVICES. 
(a) EMPLOYMENT AND TRAINING SERVICES.—Sub-
part 2 of part B of title V of the Public Health Service 
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Act (42 U.S.C. 290bb–21 et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 519E. EMPLOYMENT AND TRAINING SERVICES. 
‘‘(a) IN GENERAL.—The Director of the Prevention 
Center shall— 
‘‘(1) beginning not later than 30 days after the 
date of enactment of this Act, award grants or enter 
into contracts with eligible entities to support em-
ployment and training services for substance use 
treatment professionals, including peer recovery spe-
cialists; and 
‘‘(2) subject to the availability of funds appro-
priated pursuant to subsection (d), not later than 45 
days after the date on which an entity submits an 
application that meets the requirements of the Sec-
retary under this section, award funds under this 
section to such entity. 
‘‘(b) APPLICATION.—An eligible entity desiring a 
grant under this section shall submit to the Director of 
the Prevention Center an application at such time, in such 
manner, and containing such information as the Director 
may require. 
‘‘(c) MINIMUM.—A recipient shall use not less than 
15 percent of funds awarded under subsection (a) for ac-
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tivities related to retention of substance use treatment 
professionals. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2022 through 2026.’’. 
(b) FUNDING
FOR
MENTAL
AND
BEHAVIORAL 
HEALTH EDUCATION AND TRAINING GRANTS.—Section 
756(f) of the Public Health Service Act (42 U.S.C. 294e– 
1(f)) is amended— 
(1) in the matter preceding paragraph (1), by 
striking 
‘‘$50,000,000’’ 
and 
inserting 
‘‘$55,000,000’’; and 
(2) by adding at the end the following: 
‘‘(5) For continuing education and other activi-
ties to increase retention and to strengthen the sub-
stance use disorder workforce, $5,000,000.’’. 
SEC. 106. REAUTHORIZATION OF COMMUNITY-BASED COA-
LITION ENHANCEMENT GRANTS TO ADDRESS 
LOCAL DRUG CRISES. 
Section 103(i) of the Comprehensive Addiction and 
Recovery Act of 2016 (21 U.S.C. 1536(i)) is amended by 
striking the period at the end and inserting ‘‘, and 
$10,000,000 for each of fiscal years 2022 through 2026.’’. 
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SEC. 107. ACCESS TO NON-OPIOID TREATMENTS FOR PAIN. 
(a) IN GENERAL.—Section 1833(t) of the Social Se-
curity Act (42 U.S.C. 1395l(t)) is amended— 
(1) in paragraph (2)(E), by inserting ‘‘, sepa-
rate payments for non-opioid treatments under para-
graph (16)(G), and’’ after ‘‘payments under para-
graph (6) and’’; and 
(2) in paragraph (16), by adding at the end the 
following new subparagraph: 
‘‘(G) ACCESS TO NON-OPIOID TREATMENTS 
FOR PAIN.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
any other provision of this subsection, with 
respect to a covered OPD service (or group 
of services) furnished on or after January 
1, 2022, and before January 1, 2027, the 
Secretary shall not package, and shall 
make a separate payment as specified in 
clause (ii) for, a non-opioid treatment (as 
defined in clause (iii)) furnished as part of 
such service (or group of services). 
‘‘(ii) AMOUNT
OF
PAYMENT.—The 
amount of the payment specified in this 
clause is, with respect to a non-opioid 
treatment that is— 
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‘‘(I) a drug or biological product, 
the amount of payment for such drug 
or biological determined under section 
1847A; or 
‘‘(II) 
a 
medical 
device, 
the 
amount of the hospital’s charges for 
the device, adjusted to cost. 
‘‘(iii) DEFINITION
OF
NON-OPIOID 
TREATMENT.—A 
‘non-opioid 
treatment’ 
means— 
‘‘(I) a drug or biological product 
that is indicated to produce analgesia 
without acting upon the body’s opioid 
receptors; or 
‘‘(II) an implantable, reusable, or 
disposable medical device cleared or 
approved by the Administrator for 
Food and Drugs for the intended use 
of managing or treating pain; 
that has demonstrated the ability to re-
place, reduce, or avoid opioid use or the 
quantity of opioids prescribed in a clinical 
trial or through data published in a peer- 
reviewed journal.’’. 
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(b) AMBULATORY SURGICAL CENTER PAYMENT SYS-
TEM.—Section 1833(i)(2)(D) of the Social Security Act 
(42 U.S.C. 1395l(i)(2)(D)) is amended— 
(1) by aligning the margins of clause (v) with 
the margins of clause (iv); 
(2) by redesignating clause (vi) as clause (vii); 
and 
(3) by inserting after clause (v) the following 
new clause: 
‘‘(vi) In the case of surgical services 
furnished on or after January 1, 2022, and 
before January 1, 2027, the payment sys-
tem described in clause (i) shall provide, in 
a budget-neutral manner, for a separate 
payment for a non-opioid treatment (as de-
fined 
in 
clause 
(iii) 
of 
subsection 
(t)(16)(G)) furnished as part of such serv-
ices in the amount specified in clause (ii) 
of such subsection.’’. 
(c) EVALUATION OF THERAPEUTIC SERVICES FOR 
PAIN MANAGEMENT.— 
(1) REPORT TO CONGRESS.—Not later than 1 
year after the date of the enactment of this Act, the 
Secretary of Health and Human Services, acting 
through the Administrator of the Centers for Medi-
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care & Medicaid Services, shall submit to Congress 
a report on— 
(A) limitations, gaps, barriers to access, or 
deficits in coverage under the Medicare pro-
gram under title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.) or reimbursement 
for restorative therapies, behavioral approaches, 
and complementary and integrative health serv-
ices that— 
(i) are identified by the Pain Manage-
ment Best Practices Inter-Agency Task 
Force under section 101 of the Com-
prehensive Addiction and Recovery Act of 
2016 (42 U.S.C. 201 note); and 
(ii) have demonstrated the ability to 
replace or reduce opioid consumption; and 
(B) recommendations to address the limi-
tations, gaps, barriers to access, or deficits 
identified under subparagraph (A) to improve 
such coverage and reimbursement for such 
therapies, approaches, and services. 
(2) PUBLIC CONSULTATION.—In developing the 
report described in paragraph (1), the Secretary of 
Health and Human Services shall consult with ap-
propriate entities as determined by the Secretary. 
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(3) EXCLUSIVE TREATMENT.—Any drug, bio-
logical product, or medical device that is a non- 
opioid 
treatment 
(as 
defined 
in 
section 
1833(t)(16)(G)(iii) of the Social Security Act, as 
added by subsection (a)) shall not be considered a 
therapeutic service for the purpose of the report de-
scribed in paragraph (1). 
TITLE II—TREATMENT 
SEC. 201. EVIDENCE-BASED SUBSTANCE USE DISORDER 
TREATMENT 
AND 
INTERVENTION 
DEM-
ONSTRATIONS. 
Section 514B of the Public Health Service Act (42 
U.S.C. 290bb–10) is amended— 
(1) in subsection (a), by adding at the end the 
following: 
‘‘(3) USE OF FUNDS FOR TRAINING.—Funds 
awarded under paragraph (1) may be used by a re-
cipient for training emergency room technicians, 
physicians, nurses, or other health care professionals 
on identifying the presence of substance use dis-
orders; how effectively to engage with, intervene with 
respect to, and refer patients for assessment and 
specialized substance use disorder care, including 
medication-assisted treatment and care for co-occur-
ring disorders; and offering peer-based interventions 
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in the emergency room and other health care envi-
ronments to connect people to clinical and commu-
nity-based supports for substance use disorder.’’; 
(2) in subsection (d), by inserting ‘‘, and Indian 
tribes and tribal organizations (as defined in section 
4 of the Indian Self-Determination and Education 
Assistance Act)’’ before the period of the first sen-
tence; and 
(3) in subsection (f), by striking ‘‘$25,000,000 
for each of fiscal years 2017 through 2021’’ and in-
serting ‘‘$300,000,000 for each of fiscal years 2022 
through 2026’’. 
SEC. 
202. 
IMPROVING 
TREATMENT 
FOR 
PREGNANT, 
POSTPARTUM, AND PARENTING WOMEN. 
Section 508 of the Public Health Service Act (42 
U.S.C. 290bb–1) is amended— 
(1) in subsection (m)— 
(A) by striking ‘‘that agrees to use’’ and 
inserting ‘‘that agrees— 
‘‘(1) to use’’; 
(B) by striking the period at the end and 
inserting ‘‘; or’’; and 
(C) by adding at the end the following: 
‘‘(2) to— 
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‘‘(A) allow participation in the program 
supported by the award by individuals taking a 
drug or combination of drugs approved by the 
Food and Drug Administration as a medication 
for addiction treatment, including such individ-
uals taking an opioid agonist; 
‘‘(B) provide culturally competent services 
(as defined in section 102 of the Developmental 
Disabilities Assistance and Bill of Rights Act of 
2000); 
‘‘(C) ensure flexible lengths of stay in the 
treatment program; and 
‘‘(D) use peer recovery advocates in the 
program supported by the award.’’; 
(2) in subsection (p), by inserting ‘‘, and demo-
graphic data on the individuals served by programs 
funded under this section and case outcomes, as re-
ported to the Director by award recipients’’ before 
the period at the end of the third sentence; and 
(3) in subsection (s), by striking ‘‘$29,931,000 
for each of fiscal years 2019 through 2023’’ and in-
serting ‘‘100,000,000 for each of fiscal years 2022 
through 2026’’. 
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SEC. 203. REQUIRE THE USE OF PRESCRIPTION DRUG MON-
ITORING PROGRAMS. 
(a) DEFINITIONS.—In this section: 
(1) 
CONTROLLED
SUBSTANCE.—The 
term 
‘‘controlled substance’’ has the meaning given the 
term in section 102 of the Controlled Substances 
Act (21 U.S.C. 802). 
(2) COVERED
STATE.—The term ‘‘covered 
State’’ means a State that receives funding under 
the Harold Rogers Prescription Drug Monitoring 
Program established under the Departments of 
Commerce, Justice, and State, the Judiciary, and 
Related Agencies Appropriations Act, 2002 (Public 
Law 107–77; 115 Stat. 748), under this Act (or an 
amendment made by this Act), or under the con-
trolled substance monitoring program under section 
399O of the Public Health Service Act (42 U.S.C. 
280g–3). 
(3) DISPENSER.—The term ‘‘dispenser’’— 
(A) means a person licensed or otherwise 
authorized by a State to deliver a prescription 
drug product to a patient or an agent of the pa-
tient; and 
(B) does not include a person involved in 
oversight or payment for prescription drugs. 
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(4) PDMP.—The term ‘‘PDMP’’ means a pre-
scription drug monitoring program. 
(5) PRACTITIONER.—The term ‘‘practitioner’’ 
means a practitioner registered under section 303(f) 
of the Controlled Substances Act (21 U.S.C. 823(f)) 
to prescribe, administer, or dispense controlled sub-
stances. 
(6) STATE.—The term ‘‘State’’ means each of 
the several States and the District of Columbia. 
(b) IN GENERAL.—Beginning 1 year after the date 
of enactment of this Act, each covered State shall re-
quire— 
(1) each prescribing practitioner within the cov-
ered State or their designee, who shall be licensed or 
registered healthcare professionals or other employ-
ees who report directly to the practitioner, to consult 
the PDMP of the covered State before initiating 
treatment with a prescription for a controlled sub-
stance listed in schedule II, III, or IV of section 
202(c) of the Controlled Substances Act (21 U.S.C. 
812(c)), and every 3 months thereafter as long as 
the treatment continues; 
(2) the PDMP of the covered State to provide 
proactive notification to a practitioner when patterns 
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indicative of controlled substance misuse, including 
opioid misuse, are detected; 
(3) each dispenser within the covered State to 
report each prescription for a controlled substance 
dispensed by the dispenser to the PDMP not later 
than 24 hours after the controlled substance is dis-
pensed to the patient; 
(4) that the PDMP make available a quarterly 
de-identified data set and an annual report for pub-
lic and private use, including use by healthcare pro-
viders, health plans and health benefits administra-
tors, State agencies, and researchers, which shall, at 
a minimum, meet requirements established by the 
Attorney General, in coordination with the Secretary 
of Health and Human Services; 
(5) each State agency that administers the 
PDMP to— 
(A) proactively analyze data available 
through the PDMP; and 
(B) provide reports to prescriber licensing 
boards describing any prescribing practitioner 
that repeatedly fall outside of expected norms 
or standard practices for the prescribing practi-
tioner’s field; and 
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(6) that the data contained in the PDMP of the 
covered State be made available to other States. 
(c) NONCOMPLIANCE.—If a covered State fails to 
comply with subsection (a), the Attorney General or the 
Secretary of Health and Human Services may withhold 
grant funds from being awarded to the covered State 
under the Harold Rogers Prescription Drug Monitoring 
Program established under the Departments of Com-
merce, Justice, and State, the Judiciary, and Related 
Agencies Appropriations Act, 2002 (Public Law 107–77; 
115 Stat. 748), under this Act (or an amendment made 
by this Act), or under the controlled substance monitoring 
program under section 399O of the Public Health Service 
Act (42 U.S.C. 280g–3). 
SEC. 204. PRESCRIBER EDUCATION. 
(a) IN GENERAL.—Section 303 of the Controlled 
Substances Act (21 U.S.C. 823) is amended— 
(1) in subsection (f), in the matter preceding 
paragraph (1), by striking ‘‘The Attorney General 
shall register’’ and inserting ‘‘Subject to subsection 
(m), the Attorney General shall register’’; and 
(2) by adding at the end the following: 
‘‘(l) PRESCRIBER EDUCATION.— 
‘‘(1) DEFINITIONS.—In this subsection— 
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‘‘(A) the term ‘covered agent or employee’ 
means an agent or employee of a covered facil-
ity who— 
‘‘(i) prescribes controlled substances 
for humans under the registration of the 
facility under this part; and 
‘‘(ii) is a medical resident; 
‘‘(B) the term ‘covered facility’ means a 
practitioner— 
‘‘(i) that is a hospital or other institu-
tion; 
‘‘(ii) that is licensed under State law 
to prescribe controlled substances; and 
‘‘(iii) under whose registration under 
this part agents or employees of the practi-
tioner prescribe controlled substances; 
‘‘(C) the term ‘covered individual practi-
tioner’ means a practitioner who— 
‘‘(i) is an individual; 
‘‘(ii) is not a veterinarian; and 
‘‘(iii) is licensed under State law to 
prescribe controlled substances; and 
‘‘(D) the term ‘specified continuing edu-
cation topics’ means— 
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‘‘(i) alternatives to opioids for pain 
management; 
‘‘(ii) palliative care; 
‘‘(iii) substance use disorder; 
‘‘(iv) adverse events; 
‘‘(v) potential for dependence; 
‘‘(vi) tolerance; 
‘‘(vii) prescribing contraindicated sub-
stances; 
‘‘(viii) medication-assisted treatment; 
‘‘(ix) overdose prevention and re-
sponse, including the administration of 
naloxone; 
‘‘(x) culturally competent (as defined 
in section 102 of the Developmental Dis-
abilities Assistance and Bill of Rights Act 
of 2000 (42 U.S.C. 15002)) services; 
‘‘(xi) bias and stigma in prescribing 
trends; and 
‘‘(xii) any other topic that the Attor-
ney General determines appropriate. 
‘‘(2) CERTIFICATION
OF
CONTINUING
EDU-
CATION.— 
‘‘(A) INDIVIDUAL PRACTITIONERS.—As a 
condition of granting or renewing the registra-
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tion of a covered individual practitioner under 
this part to dispense controlled substances in 
schedule II, III, IV, or V, the Attorney General 
shall require the practitioner to certify that, 
during the 3-year period preceding the date of 
the grant or renewal of registration, the practi-
tioner completed course work or training from 
an organization accredited by the Accreditation 
Council for Continuing Medical Education 
(commonly known as the ‘ACCME’), or by a 
State medical society accreditor recognized by 
the ACCME, that included not fewer than 3 
hours of content on the specified continuing 
education topics. 
‘‘(B) FACILITIES.—As a condition of 
granting or renewing the registration of a cov-
ered facility under this part to dispense con-
trolled substances in schedule II, III, IV, or V, 
the Attorney General shall require the covered 
facility to certify that the facility does not allow 
a covered agent or employee to prescribe con-
trolled substances for humans under the reg-
istration of the facility unless, during the pre-
ceding 3-year period, the covered agent or em-
ployee completed course work or training from 
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an organization accredited by the Accreditation 
Council for Continuing Medical Education 
(commonly known as the ‘ACCME’), or a State 
medical society accreditor recognized by the 
ACCME, that included not fewer than 3 hours 
of content on the specified continuing education 
topics.’’. 
(b) EFFECTIVE DATE.—Subsection (l) of section 303 
of the Controlled Substances Act (21 U.S.C. 823), as 
added by subsection (a), shall apply to any grant or re-
newal of registration described in such subsection (l) that 
occurs on or after the date that is 2 years after the date 
of enactment of this Act. 
SEC. 205. PROHIBITION OF UTILIZATION CONTROL POLI-
CIES OR PROCEDURES FOR MEDICATION-AS-
SISTED TREATMENT UNDER MEDICAID. 
Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended— 
(1) in subsection (a)— 
(A) in the matter preceding paragraph (1), 
by moving the margin of clause (xvi) 4 ems to 
the left; and 
(B) in paragraph (29), by inserting ‘‘and 
to the extent allowed in paragraph (4) of such 
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subsection’’ after ‘‘paragraph (1) of such sub-
section’’; and 
(2) in subsection (ee), by adding at the end the 
following new paragraph: 
‘‘(4) PROHIBITION
OF
UTILIZATION
CONTROL 
POLICIES
OR
PROCEDURES
FOR
MEDICATION-AS-
SISTED TREATMENT.—As a condition for a State re-
ceiving payments under section 1903(a) for medical 
assistance for medication-assisted treatment, a State 
may not impose any utilization control policies or 
procedures (as defined by the Secretary), including 
prior authorization requirements, with respect to 
such treatment.’’. 
SEC. 206. MEDICATION-ASSISTED TREATMENT FOR RECOV-
ERY FROM SUBSTANCE USE DISORDER. 
(a) IN GENERAL.—Section 303(g) of the Controlled 
Substances Act (21 U.S.C. 823(g)) is amended— 
(1) by striking paragraph (2); 
(2) by striking ‘‘(g)(1) Except as provided in 
paragraph (2), practitioners who dispense narcotic 
drugs to individuals for maintenance treatment or 
detoxification treatment’’ and inserting ‘‘(g) Practi-
tioners who dispense narcotic drugs (other than nar-
cotic drugs in schedule III, IV, or V) to individuals 
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for maintenance treatment or detoxification treat-
ment’’; 
(3) by redesignating subparagraphs (A), (B), 
and (C) as paragraphs (1), (2), and (3), respectively; 
and 
(4) in paragraph (2), as redesignated, by redes-
ignating clauses (i) and (ii) as subparagraphs (A) 
and (B), respectively. 
(b) TECHNICAL AND CONFORMING EDITS.— 
(1) IN GENERAL.— 
(A) Section 304 of the Controlled Sub-
stances Act (21 U.S.C. 824) is amended— 
(i) in subsection (a), by striking 
‘‘303(g)(1)’’ each place it appears and in-
serting ‘‘303(g)’’; and 
(ii) in subsection (d)(1), by striking 
‘‘303(g)(1)’’ and inserting ‘‘303(g)’’. 
(B) Section 309A(a) of the Controlled 
Substances Act (21 U.S.C. 829a(a)) is amended 
by striking paragraph (2) and inserting the fol-
lowing: 
‘‘(2) the controlled substance— 
‘‘(A) is a narcotic drug in schedule III, IV, 
or V to be administered for the purpose of 
maintenance or detoxification treatment; and 
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‘‘(B) is to be administered by injection or 
implantation;’’. 
(C) Section 520E–4(c) of the Public 
Health Service Act (42 U.S.C. 290bb–36d(c)) is 
amended, in the matter preceding paragraph 
(1), by striking ‘‘information on any qualified 
practitioner that is certified to prescribe medi-
cation for opioid dependency under section 
303(g)(2)(B) of the Controlled Substances Act’’ 
and inserting ‘‘information on any practitioner 
who prescribes narcotic drugs in schedule III, 
IV, or V of section 202 of the Controlled Sub-
stances Act for the purpose of maintenance or 
detoxification treatment’’. 
(D) Section 544(a)(3) of the Public Health 
Service Act (42 U.S.C. 290dd–3) is amended by 
striking ‘‘any practitioner dispensing narcotic 
drugs pursuant to section 303(g) of the Con-
trolled Substances Act’’ and inserting ‘‘any 
practitioner dispensing narcotic drugs for the 
purpose of maintenance or detoxification treat-
ment’’. 
(E) Section 1833 of the Social Security 
Act (42 U.S.C. 1395l) is amended by striking 
subsection (bb). 
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(F) Section 1834(o) of the Social Security 
Act (42 U.S.C. 1395m(o)) is amended by strik-
ing paragraph (3). 
(G) Section 1866F(c)(3) of the Social Se-
curity Act (42 U.S.C. 1395cc–6(c)(3)) is 
amended— 
(i) in subparagraph (A), by inserting 
‘‘and’’ at the end; 
(ii) in subparagraph (B), by striking 
‘‘; and’’ and inserting a period; and 
(iii) by striking subparagraph (C). 
(H) Section 1903(aa)(2)(C) of the Social 
Security Act (42 U.S.C. 1396b(aa)(2)(C)) is 
amended— 
(i) in clause (i), by inserting ‘‘and’’ at 
the end; 
(ii) by striking clause (ii); and 
(iii) by redesignating clause (iii) as 
clause (ii). 
(2) EFFECTIVE
DATE
OF
MEDICARE
AMEND-
MENTS.—The amendments made by subparagraphs 
(E) and (F) of paragraph (1) shall take effect one 
year after the date of enactment of this Act. 
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SEC. 207. TELEHEALTH RESPONSE FOR E-PRESCRIBING AD-
DICTION THERAPY SERVICES. 
(a) FUNDING FOR THE TESTING OF INCENTIVE PAY-
MENTS
FOR
BEHAVIORAL
HEALTH
PROVIDERS
FOR 
ADOPTION
AND
USE
OF
CERTIFIED
ELECTRONIC 
HEALTH RECORD TECHNOLOGY.—In addition to amounts 
appropriated under subsection (f) of section 1115A of the 
Social Security Act (42 U.S.C. 1315a), there are author-
ized to be appropriated to the Center for Medicare and 
Medicaid Innovation such sums as may be necessary for 
fiscal year 2022 to design, implement, and evaluate the 
model under subsection (b)(2)(B)(xxv) of such section. 
Amounts appropriated under the preceding sentence shall 
remain available until expended. 
(b) TELEHEALTH FOR SUBSTANCE USE DISORDER 
TREATMENT.— 
(1) SUBSTANCE USE DISORDER SERVICES FUR-
NISHED
THROUGH
TELEHEALTH
UNDER
MEDI-
CARE.—Section 1834(m)(7) of the Social Security 
Act (42 U.S.C. 1395m(m)(7)) is amended by adding 
at the end the following: ‘‘With respect to telehealth 
services described in the preceding sentence that are 
furnished on or after January 1, 2020, nothing shall 
preclude the furnishing of such services through 
audio or telephone only technologies in the case 
where a physician or practitioner has already con-
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ducted an in-person medical evaluation or a tele-
health evaluation that utilizes both audio and visual 
capabilities with the eligible telehealth individual.’’. 
(2) CONTROLLED SUBSTANCES DISPENSED BY 
MEANS
OF
THE
INTERNET.—Section 309(e)(2) of 
the Controlled Substances Act (21 U.S.C. 829(e)(2)) 
is amended— 
(A) in subparagraph (A)(i)— 
(i) by striking ‘‘at least 1 in-person 
medical evaluation’’ and inserting the fol-
lowing: ‘‘at least— 
‘‘(I) 1 in-person medical evalua-
tion’’; and 
(ii) by adding at the end the fol-
lowing: 
‘‘(II) for purposes of prescribing 
a controlled substance in schedule III 
or IV, 1 telehealth evaluation; or’’; 
and 
(B) by adding at the end the following: 
‘‘(D)(i) In this subsection, the term ‘tele-
health evaluation’ means a medical evaluation 
that is conducted in accordance with applicable 
Federal and State laws by a practitioner (other 
than a pharmacist) who is at a location remote 
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from the patient and is communicating with the 
patient using a telecommunications system re-
ferred to in section 1834(m) of the Social Secu-
rity Act (42 U.S.C. 1395m(m)) that includes, 
at a minimum, audio and video equipment per-
mitting two-way, real-time interactive commu-
nication between the patient and distant site 
practitioner. 
‘‘(ii) Nothing in clause (i) shall be con-
strued to imply that 1 telehealth evaluation 
demonstrates that a prescription has been 
issued for a legitimate medical purpose within 
the usual course of professional practice. 
‘‘(iii) A practitioner who prescribes the 
drugs or combination of drugs that are covered 
under section 303(g)(2)(C) using the authority 
under subparagraph (A)(i)(II) of this para-
graph shall adhere to nationally recognized evi-
dence-based guidelines for the treatment of pa-
tients with opioid use disorders and a diversion 
control plan, as those terms are defined in sec-
tion 8.2 of title 42, Code of Federal Regula-
tions, as in effect on the date of enactment of 
this subparagraph.’’. 
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SEC. 208. PILOT PROGRAM ON EXPANDING ACCESS TO 
TREATMENT. 
The Secretary of Health and Human Services (re-
ferred to in this section as the ‘‘Secretary’’) shall establish 
a 5-year pilot program in not less than 5 diverse regions 
to study the use of mobile methadone clinics in rural and 
underserved environments. At the end of the pilot pro-
gram, the Secretary shall report to Congress on the pro-
gram outcomes, including the number of people served and 
the demographics of people served, including race and in-
come. 
SEC. 209. REAUTHORIZATION OF PRAC ED GRANT PRO-
GRAM. 
To carry out the Practitioner Education grant pro-
gram established by the Substance Abuse and Mental 
Health Services Administration, there are authorized to 
be appropriated such sums as may be necessary for each 
of fiscal years 2022 through 2026. 
SEC. 210. GAO STUDY ON PARITY. 
The Comptroller General of the United States shall 
conduct a study examining the reimbursement parity be-
tween substance use disorder services and other health 
care services, and the effect of any inequity in reimburse-
ment with respect to substance use disorder services on 
the substance use disorder workforce, and not later than 
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December 31, 2023, submit a report to Congress on the 
findings of such study. 
SEC. 211. IMPROVING SUBSTANCE USE DISORDER PREVEN-
TION WORKFORCE ACT. 
Subpart 2 of part B of title V of the Public Health 
Service Act (42 U.S.C. 290bb–21 et seq), as amended by 
section 105, is further amended by adding at the end the 
following: 
‘‘SEC. 519F. PILOT PROGRAM TO HELP ENHANCE SUB-
STANCE USE DISORDER PREVENTION WORK-
FORCE. 
‘‘(a) IN GENERAL.—The Director of the Prevention 
Center (referred to in this section as the ‘Director’) shall 
develop a pilot program to assist State alcohol and drug 
agencies in addressing the substance use disorder preven-
tion workforce needs in the States. 
‘‘(b) DEFINITIONS.—In this section, the term ‘State 
alcohol and drug agency’ means the State agency respon-
sible for administering the substance abuse prevention and 
treatment block grant under subpart II of part B of title 
XIX. 
‘‘(c) APPLICATION.—A State alcohol and drug agency 
may apply to the Director for approval of a grant author-
ized in this section. Such application shall include a de-
scription of the proposed workforce activities that will be 
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carried out using grant funds, which may include, with 
respect to substance use disorder prevention— 
‘‘(1) enhancing or developing training curricula; 
‘‘(2) supporting or coordinating with institutes 
of higher education regarding curricula development; 
‘‘(3) partnering with elementary schools, middle 
schools, high schools or institutions of higher edu-
cation to generate early student interest in avoiding 
misuse of substances; 
‘‘(4) enhancing or establishing initiatives re-
lated to credentialing or other certification processes 
recognized by the State alcohol and drug agency, in-
cluding scholarships or support for certification costs 
and testing; 
‘‘(5) establishing or enhancing initiatives that 
promote recruitment, professional development, and 
access to education and training that increase the 
State’s ability to address diversity, equity, and inclu-
sion in the workforce, including communication ini-
tiatives or campaigns designed to draw interest in a 
career in substance use disorder prevention; 
‘‘(6) supporting loan repayment programs for 
individuals in the substance use disorder prevention 
workforce; 
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‘‘(7) establishing or enhancing internships, fel-
lowships and other career opportunities; and 
‘‘(8) retention initiatives that may include 
training, leadership development or other edu-
cational opportunities. 
‘‘(d) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated such sums as may be necessary. 
‘‘SEC. 519G. NATIONAL STUDY ON SUBSTANCE USE DIS-
ORDER WORKFORCE. 
‘‘(a) IN GENERAL.—The Director shall conduct a 
comprehensive national study regarding the substance use 
disorder prevention workforce. Such study shall include— 
‘‘(1) an environmental assessment regarding the 
existing workforce, including demographics, salaries, 
settings, current or anticipated workforce shortages 
and other relevant information; 
‘‘(2) challenges in maintaining support for an 
adequate substance use disorder prevention work-
force and a plan to address such challenges; and 
‘‘(3) potential programming to help implement 
the plan. 
‘‘(b) CONSULTATION.—The Director shall ensure the 
study under this section is developed in consultation with 
key substance use disorder prevention workforce stake-
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(3) Covered recovery housing programs that 
provide services to— 
(A) residents on a voluntary basis; and 
(B) residents pursuant to a judicial order. 
(4) Number of clients served, disaggregated to 
the extent possible by covered recovery housing serv-
ing— 
(A) 6 or fewer recovering residents; 
(B) 10 to 13 recovering residents; and 
(C) 18 or more recovering residents. 
(5) 
Bedroom 
occupancy 
in 
a 
house, 
disaggregated to the extent possible by— 
(A) single room occupancy; 
(B) 2 residents occupying 1 room; and 
(C) more than 2 residents occupying 1 
room. 
(6) Duration of services received by clients, 
disaggregated to the extent possible according to 
whether the services were— 
(A) 30 days or fewer; 
(B) 31 to 90 days; 
(C) more than 90 days and fewer than 6 
months; or 
(D) 6 months or more. 
(7) Certification levels of staff. 
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pbinns on DSKJLVW7X2PROD with BILLS
incarceration in registering 
for the Medicaid program 
under title XIX of the Social 
Security Act (42 U.S.C. 
1396 et seq.) or other min-
imum essential coverage, as 
defined in section 5000A(f) 
of 
the 
Internal 
Revenue 
Code of 1986; and 
(BB) if a participant 
cannot afford, or does not 
qualify for, health insurance 
that provides coverage with 
respect to enrollment in a 
medication-assisted 
treat-
ment program, and if the 
participant cannot pay the 
cost of enrolling in a medi-
cation-assisted 
treatment 
program, by working with 
units of local government, 
nonprofit 
organizations, 
opioid use disorder treat-
ment providers, and entities 
carrying out programs under 
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pbinns on DSKJLVW7X2PROD with BILLS
substance 
use 
disorder 
grants to, before the partici-
pant is released from incar-
ceration, identify a resource, 
other than the applicant or 
the covered program to be 
carried out by the applicant, 
that may be used to pay the 
cost of enrolling the partici-
pant in a medication-as-
sisted treatment program; 
(bb) medications are se-
curely stored; and 
(cc) protocols relating to di-
version are maintained; and 
(III) with respect to each com-
munity in which a correctional facility 
at which a covered program will be 
carried out is located, collaborating 
with State agencies responsible for 
overseeing programs relating to sub-
stance use disorder and local public 
health officials and nonprofit organi-
zations in the community to help en-
sure that medication-assisted treat-
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pbinns on DSKJLVW7X2PROD with BILLS
health disorder of the individual, instead of 
arresting the individual, or instead of 
booking the individual after having ar-
rested the individual, attempts to connect 
the individual to substance use disorder 
treatment providers or mental health treat-
ment providers— 
‘‘(I) without the use of coercion; 
and 
‘‘(II) using established pathways 
for connections to local, community- 
based treatment; 
‘‘(ii) under which, in the case of pre- 
arrest diversion, a law enforcement officer 
described in clause (i) may decide to— 
‘‘(I) issue a civil citation; or 
‘‘(II) take no action with respect 
to the offense for which the officer 
would otherwise have arrested the in-
dividual described in clause (i); and 
‘‘(iii) that may authorize a law en-
forcement officer to refer an individual to 
substance use disorder treatment providers 
or mental health treatment providers if the 
individual appears to have a substance use 
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