IIB 
118TH CONGRESS 
1ST SESSION H. R. 4531 
IN THE SENATE OF THE UNITED STATES 
DECEMBER 13, 2023 
Received; read twice and referred to the Committee on Health, Education, 
Labor, and Pensions 
AN ACT 
To reauthorize certain programs that provide for opioid use 
disorder prevention, recovery, and treatment, and for 
other purposes. 
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. 
This Act may be cited as the ‘‘Support for Patients 
and Communities Reauthorization Act’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents for this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
TITLE I—PUBLIC HEALTH 
Sec. 101. Prenatal and postnatal health. 
Sec. 102. Monitoring and education regarding infections associated with illicit 
drug use and other risk factors. 
Sec. 103. Preventing overdoses of controlled substances. 
Sec. 104. Residential treatment programs for pregnant and postpartum women. 
Sec. 105. Youth prevention and recovery. 
Sec. 106. First responder training. 
Sec. 107. Building communities of recovery. 
Sec. 108. National Peer-Run Training and Technical Assistance Center for Ad-
diction Recovery Support. 
Sec. 109. Comprehensive opioid recovery centers. 
Sec. 110. Grants to address the problems of persons who experience violence re-
lated stress. 
Sec. 111. Mental and behavioral health education and training grants. 
Sec. 112. Loan repayment program for the substance use disorder treatment 
workforce. 
Sec. 113. Pilot program for public health laboratories to detect fentanyl and 
other synthetic opioids. 
Sec. 114. Monitoring and reporting of child, youth, and adult trauma. 
Sec. 115. Task force to develop best practices for trauma-informed identifica-
tion, referral, and support. 
Sec. 116. Treatment, recovery, and workforce support grants. 
Sec. 117. Grant program for State and Tribal response to opioid use disorders. 
Sec. 118. References to opioid overdose reversal agents in HHS grant pro-
grams. 
Sec. 119. Addressing other concurrent substance use disorders through grant 
program for State and Tribal response to opioid use disorders. 
Sec. 120. Providing for a study on the effects of remote monitoring on individ-
uals who are prescribed opioids. 
TITLE II—CONTROLLED SUBSTANCES 
Sec. 201. Delivery of certain substances by a pharmacy to an administering 
practitioner. 
Sec. 202. Reviewing the scheduling of approved products containing a combina-
tion of buprenorphine and naloxone. 
Sec. 203. Combating illicit xylazine. 
Sec. 204. Technical corrections. 
Sec. 205. Required training for prescribers of controlled substances. 
TITLE III—MEDICAID 
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Sec. 301. Extending requirement for State Medicaid plans to provide coverage 
for medication-assisted treatment. 
Sec. 302. Expanding required reports on T-MSIS substance use disorder data 
to include mental health condition data. 
Sec. 303. Monitoring prescribing of antipsychotic medications. 
Sec. 304. Lifting the IMD exclusion for substance use disorder. 
Sec. 305. Prohibition on termination of enrollment due to incarceration. 
Sec. 306. State option relating to inmates who are pregnant women pending 
disposition of charges. 
Sec. 307. Permitting access to medical assistance under the Medicaid program 
for foster youth. 
TITLE IV—OFFSETS 
Sec. 401. Promoting value in Medicaid managed care. 
TITLE I—PUBLIC HEALTH 
SEC. 101. PRENATAL AND POSTNATAL HEALTH. 
Section 317L(d) of the Public Health Service Act (42 
U.S.C. 247b–13(d)) is amended by striking ‘‘such sums 
as may be necessary for each of the fiscal years 2019 
through 2023’’ and inserting ‘‘$4,250,000 for each of fis-
cal years 2024 through 2028’’. 
SEC. 102. MONITORING AND EDUCATION REGARDING IN-
FECTIONS ASSOCIATED WITH ILLICIT DRUG 
USE AND OTHER RISK FACTORS. 
Section 317N of the Public Health Service Act (42 
U.S.C. 247b–15) is amended— 
(1) in the section heading, by striking ‘‘SUR-
VEILLANCE
AND’’ and inserting ‘‘MONITORING 
AND’’ ; and 
(2) in subsection (d), by striking ‘‘fiscal years 
2019 through 2023’’ and inserting ‘‘fiscal years 
2024 through 2028’’. 
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SEC. 103. PREVENTING OVERDOSES OF CONTROLLED SUB-
STANCES. 
(a) EVIDENCE-BASED PREVENTION GRANTS.—Sec-
tion 392A(a)(2)(D) of the Public Health Service Act (42 
U.S.C. 280b–1(a)(2)(D)) is amended by inserting after 
‘‘new and emerging public health crises’’ the following: ‘‘, 
such as the fentanyl crisis,’’. 
(b) USE OF GRANTS BY STATES, LOCALITIES, AND 
INDIAN TRIBES TO CONDUCT WASTEWATER SURVEIL-
LANCE.—Section 392A(a)(3)(A) of the Public Health 
Service Act (42 U.S.C. 280b–1(a)(3)(A)) is amended by 
inserting ‘‘, including through the use of wastewater sur-
veillance to identify trends associated with controlled sub-
stance use if it is determined by appropriate evidence that 
wastewater surveillance is an effective way to survey con-
trolled substance use within a community’’ before the 
semicolon. 
(c) AUTHORIZATION OF APPROPRIATIONS.—Section 
392A(e) of the Public Health Service Act (42 U.S.C. 
280b–1(e)) is amended by striking ‘‘$496,000,000 for 
each of fiscal years 2019 through 2023’’ and inserting 
‘‘$505,579,000 for each of fiscal years 2024 through 
2028’’. 
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SEC. 
104. 
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 ‘‘$29,931,000 
for each of fiscal years 2019 through 2023’’ and inserting 
‘‘$38,931,000 for each of fiscal years 2024 through 
2028’’. 
SEC. 105. YOUTH PREVENTION AND RECOVERY. 
Section 7102(c)(9) of the SUPPORT for Patients 
and Communities Act (42 U.S.C. 290bb–7a(c)(9)) is 
amended by striking ‘‘fiscal years 2019 through 2023’’ 
and inserting ‘‘fiscal years 2024 through 2028’’. 
SEC. 106. FIRST RESPONDER TRAINING. 
Section 546(h) of the Public Health Service Act (42 
U.S.C. 290ee–1(h)) is amending by striking ‘‘$36,000,000 
for each of fiscal years 2019 through 2023’’ and inserting 
‘‘$56,000,000 for each of fiscal years 2024 through 
2028’’. 
SEC. 107. BUILDING COMMUNITIES OF RECOVERY. 
Section 547(f) of the Public Health Service Act (42 
U.S.C. 290ee–2(f)) is amended by striking ‘‘$5,000,000 
for each of fiscal years 2019 through 2023’’ and inserting 
‘‘$16,000,000 for each of fiscal years 2024 through 
2028’’. 
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SEC. 108. NATIONAL PEER-RUN TRAINING AND TECHNICAL 
ASSISTANCE CENTER FOR ADDICTION RE-
COVERY SUPPORT. 
Section 547A(e) of the Public Health Service Act (42 
U.S.C. 290ee–2a(e)) is amended by striking ‘‘$1,000,000 
for each of fiscal years 2019 through 2023’’ and inserting 
‘‘$2,000,000 for each of fiscal years 2024 through 2028’’. 
SEC. 109. COMPREHENSIVE OPIOID RECOVERY CENTERS. 
(a) REAUTHORIZATION.—Section 552(j) of the Public 
Health Service Act (42 U.S.C. 290ee–7(j)) is amended by 
striking ‘‘2019 through 2023’’ and inserting ‘‘2024 
through 2028’’. 
(b) DOCUMENTATION FOR EVIDENCE OF CAPACITY 
TO CARRY OUT REQUIRED ACTIVITIES.—Section 552(d) 
of the Public Health Service Act (42 U.S.C. 290ee–7(d)) 
is amended by adding at the end the following: 
‘‘(3) DOCUMENTATION.— 
‘‘(A) IN GENERAL.—Evidence required to 
be provided under paragraph (1) may be pro-
vided through a letter of intent from partner 
agencies or other relevant documentation (as 
defined by the Secretary). 
‘‘(B) PARTNER AGENCY DEFINED.—In this 
paragraph, the term ‘partner agency’ means a 
non-governmental organization or other public 
or private entity— 
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‘‘(i) the primary purpose of which is 
the delivery of mental health or substance 
use disorder treatment services; and 
‘‘(ii) with which the applicant coordi-
nates to provide the full continuum of 
treatment services (as specified in sub-
section (g)(1)(B)) that the applicant is un-
able to offer on site.’’. 
(c) CENTER ACTIVITIES CARRIED OUT THROUGH 
THIRD PARTIES.—Section 552(g) of the Public Health 
Service Act (42 U.S.C. 290ee–7(g)) is amended in the 
matter preceding paragraph (1) by striking ‘‘Each Center 
shall’’ and all that follows through ‘‘subsection (f):’’ and 
inserting the following: ‘‘Each Center shall, at a minimum, 
carry out the activities specified in this subsection directly, 
through referral, or through contractual arrangements. If 
a Center elects to carry out such activities through con-
tractual arrangements, the Secretary may issue guidance 
on best practices to ensure that the Center is capable of 
carrying out such activities, including carrying out such 
activities through technology-enabled collaborative learn-
ing and capacity building models described in subsection 
(f) and coordinating the full continuum of treatment serv-
ices specified in subparagraph (B). Such activities include 
the following:’’. 
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SEC. 110. GRANTS TO ADDRESS THE PROBLEMS OF PER-
SONS WHO EXPERIENCE VIOLENCE RELATED 
STRESS. 
Section 582(j) of the Public Health Service Act (42 
U.S.C. 290hh–1(j)) is amended by striking ‘‘$63,887,000 
for each of fiscal years 2019 through 2023’’ and inserting 
‘‘$93,887,000 for each of fiscal years 2024 through 
2028’’. 
SEC. 111. 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 by striking ‘‘fiscal years 
2023 through 2027’’ and inserting ‘‘fiscal years 2024 
through 2028’’. 
SEC. 112. LOAN REPAYMENT PROGRAM FOR THE SUB-
STANCE USE DISORDER TREATMENT WORK-
FORCE. 
Section 781(j) of the Public Health Service Act (42 
U.S.C. 295h(j)) is amended by striking ‘‘$25,000,000 for 
each of fiscal years 2019 through 2023’’ and inserting 
‘‘$40,000,000 for each of fiscal years 2024 through 
2028’’. 
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SEC. 113. PILOT PROGRAM FOR PUBLIC HEALTH LABORA-
TORIES TO DETECT FENTANYL AND OTHER 
SYNTHETIC OPIOIDS. 
(a) DETECTION ACTIVITIES.—Section 7011(b) of the 
SUPPORT for Patients and Communities Act (42 U.S.C. 
247d–10 note) is amended— 
(1) in paragraph (2), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (3), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(4) public, private, and academic entities with 
expertise in detection and testing activities, such as 
wastewater surveillance, with respect to synthetic 
opioids, including fentanyl and its analogues.’’. 
(b) AUTHORIZATION OF APPROPRIATIONS.—Section 
7011(d) of the SUPPORT for Patients and Communities 
Act (42 U.S.C. 247d–10(d)) is amended by striking ‘‘fiscal 
years 2019 through 2023’’ and inserting ‘‘fiscal years 
2024 through 2028’’. 
SEC. 114. MONITORING AND REPORTING OF CHILD, YOUTH, 
AND ADULT TRAUMA. 
Section 7131(e) of the SUPPORT for Patients and 
Communities Act (42 U.S.C. 242t(e)) is amended by strik-
ing ‘‘$2,000,000 for each of fiscal years 2019 through 
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2023’’ and inserting ‘‘$9,000,000 for each of fiscal years 
2024 through 2028’’. 
SEC. 115. TASK FORCE TO DEVELOP BEST PRACTICES FOR 
TRAUMA-INFORMED 
IDENTIFICATION, 
RE-
FERRAL, AND SUPPORT. 
Section 7132 of the SUPPORT for Patients and 
Communities Act (Public Law 115–271) is amended— 
(1) in subsection (g)— 
(A) in paragraph (1), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (2), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(3) additional reports and updates to existing 
reports, as necessary.’’; and 
(2) by amending subsection (i) to read as fol-
lows: 
‘‘(i) SUNSET.—The task force shall sunset on Sep-
tember 30, 2026.’’. 
SEC. 116. TREATMENT, RECOVERY, AND WORKFORCE SUP-
PORT GRANTS. 
Section 7183 of the SUPPORT for Patients and 
Communities Act (42 U.S.C. 290ee–8) is amended— 
(1) in subsection (b), by inserting ‘‘each’’ before 
‘‘for a period’’; 
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(2) by amending subsection (c)(2) to read as 
follows: 
‘‘(2) RATES.—The rates described in this para-
graph are the following: 
‘‘(A) The amount by which the average 
rate of drug overdose deaths in the State, ad-
justed for age, for the period of 5 calendar 
years for which there is available data, includ-
ing if necessary provisional data, immediately 
preceding the grant cycle (which shall be the 
period of calendar years 2018 through 2022 for 
the first grant cycle following the enactment of 
the Support for Patients and Communities Re-
authorization Act) is above the average national 
overdose mortality rate, as determined by the 
Director of the Centers for Disease Control and 
Prevention, for the same period. 
‘‘(B) The amount by which the average 
rate of unemployment for the State, based on 
data provided by the Bureau of Labor Statis-
tics, for the period of 5 calendar years for 
which there is available data, including if nec-
essary provisional data, immediately preceding 
the grant cycle (which shall be the period of cal-
endar years 2018 through 2022 for the first 
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grant cycle following the enactment of the Sup-
port for Patients and Communities Reauthor-
ization Act) is above the national average for 
the same period. 
‘‘(C) The amount by which the average 
rate of labor force participation in the State, 
based on data provided by the Bureau of Labor 
Statistics, for the period of 5 calendar years for 
which there is available data, including if nec-
essary provisional data, immediately preceding 
the grant cycle (which shall be the period of cal-
endar years 2018 through 2022 for the first 
grant cycle following the enactment of the Sup-
port for Patients and Communities Reauthor-
ization Act) is below the national average for 
the same period.’’; 
(3) in subsection (g)— 
(A) in paragraphs (1) and (3), by redesig-
nating subparagraphs (A) and (B) as clauses 
(i) and (ii), respectively, and adjusting the mar-
gins accordingly; 
(B) 
by 
redesignating 
paragraphs 
(1) 
through (3) as subparagraphs (A) through (C), 
respectively, and adjusting the margins accord-
ingly; 
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(C) by striking ‘‘An entity’’ and inserting 
the following: 
‘‘(1) IN GENERAL.—An entity’’; and 
(D) by adding at the end the following: 
‘‘(2) TRANSPORTATION
SERVICES.—An entity 
receiving a grant under this section may use not 
more than 5 percent of the funds for providing 
transportation for individuals to participate in an ac-
tivity supported by a grant under this section, which 
transportation shall be to or from a place of work 
or a place where the individual is receiving voca-
tional education or job training services or receiving 
services directly linked to treatment of or recovery 
from a substance use disorder. 
‘‘(3) NO OTHER AUTHORIZED USES.—An entity 
receiving a grant under this section may not use the 
funds for any activity other than the activities listed 
in paragraphs (1) and (2).’’; 
(4) in subsection (i)(2), by inserting ‘‘, which 
shall include the employment and earnings outcomes 
as described in subclauses (I) and (III) of section 
116(b)(2)(A)(i) of the Workforce Innovation and 
Opportunity Act (29 U.S.C. 3141(b)(2)(A)(i))’’ after 
‘‘subsection (g)’’; 
(5) in subsection (j)— 
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(A) in paragraph (1), by inserting ‘‘for 
each grant cycle’’ after ‘‘grant period’’; and 
(B) in paragraph (2)— 
(i) in the matter preceding subpara-
graph (A)— 
(I) by striking ‘‘the preliminary 
report’’ and inserting ‘‘each prelimi-
nary report’’; and 
(II) by inserting ‘‘for the grant 
cycle’’ after ‘‘final report’’; and 
(ii) in subparagraph (A), by striking 
‘‘(g)(3)’’ and inserting ‘‘(g)(1)(C)’’; and 
(6) in subsection (k), by striking ‘‘$5,000,000 
for each of fiscal years 2019 through 2023’’ and in-
serting ‘‘$12,000,000 for each of fiscal years 2024 
through 2028’’. 
SEC. 117. GRANT PROGRAM FOR STATE AND TRIBAL RE-
SPONSE TO OPIOID USE DISORDERS. 
Section 1003(b)(4)(A) of the 21st Century Cures Act 
(42 U.S.C. 290ee–3a(b)(4)(A)) is amended after ‘‘which 
may include drugs or devices approved, cleared, or other-
wise legally marketed under the Federal Food, Drug, and 
Cosmetic Act’’ by inserting ‘‘or fentanyl or xylazine test 
strips’’. 
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