respectively, and adjusting the margins accord-
ingly; 
(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 the 
funds for providing transportation for individuals to 
participate in an activity 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 re-
ceiving vocational education or job training services 
or receiving services directly linked to treatment of 
or recovery from a substance use disorder.’’; 
(4) in subsection (j)— 
(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 
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(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 
(5) 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. 115. 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’’. 
SEC. 116. REFERENCES TO OPIOID OVERDOSE REVERSAL 
AGENTS IN HHS GRANT PROGRAMS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall ensure that, whenever the Depart-
ment of Health and Human Services issues a regulation, 
guidance, or other document for any grant program ad-
dressing opioid misuse and use disorders, any reference 
to an opioid overdose reversal agent (such as a reference 
to naloxone) is inclusive of any opioid overdose reversal 
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agent that has been approved or otherwise authorized for 
use by the Food and Drug Administration. 
(b) EXISTING REFERENCES.— 
(1) UPDATE.—Not later than the end of cal-
endar year 2023, the Secretary of Health and 
Human Services shall update all references described 
in paragraph (2) to be inclusive of any opioid over-
dose reversal agent that has been approved or other-
wise authorized for use by the Food and Drug Ad-
ministration. 
(2) REFERENCES.—A reference described in 
this paragraph is any reference to an opioid overdose 
reversal agent (such as naloxone) in any regulation, 
guidance, or other document of the Department of 
Health and Human Services that— 
(A) was issued before the date of enact-
ment of this Act; and 
(B) is for— 
(i) the grant program for State and 
Tribal response to opioid use disorders 
under section 1003 of the 21st Century 
Cures Act (42 U.S.C. 290ee–3 note; com-
monly referred to as ‘‘State Opioid Re-
sponse Grants’’ and ‘‘Tribal Opioid Re-
sponse Grants’’); or 
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(ii) the grant program for priority 
substance use disorder prevention needs of 
regional and national significance under 
section 516 of the Public Health Service 
Act (42 U.S.C. 290bb–22). 
SEC. 117. ADDRESSING OTHER CONCURRENT SUBSTANCE 
USE DISORDERS THROUGH GRANT PROGRAM 
FOR 
STATE 
AND 
TRIBAL 
RESPONSE 
TO 
OPIOID USE DISORDERS. 
(a) ADDITIONAL USE OF FUNDS.—Section 1003(b) 
of the 21st Century Cures Act (42 U.S.C. 290ee–3 note) 
is amended by adding at the end the following: 
‘‘(5) OTHER
CONCURRENT
SUBSTANCE
USE 
DISORDERS.—The Secretary may authorize the re-
cipient of a grant under this subsection, in addition 
to using the grant for activities described in para-
graph (4) with respect to opioid misuse and use dis-
orders and stimulant misuse and use disorders, to 
use the grant to for similar activities with respect to 
other concurrent substance use disorders.’’. 
(b) ANNUAL
REPORT
TO
CONGRESS.—Section 
1003(f) of the 21st Century Cures Act (42 U.S.C. 290ee– 
3 note) is amended— 
(1) in paragraph (2), strike ‘‘and’’ at the end; 
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(2) in paragraph (3), strike the period at the 
end and insert a semicolon; and 
(3) by adding at the end the following: 
‘‘(4) the amount of funds each State that re-
ceiving a grant under subsection (b) received for the 
12-month grant cycle covered by the report; 
‘‘(5) the amount of grant funds each such State 
spent for such grant cycle, disaggregated by the uses 
for which such funds were spent, including each al-
lowable use under paragraphs (4) and (5) of sub-
section (b); 
‘‘(6) how many such States for such grant cycle 
did not spend the all of the grant funds before such 
grant cycle expired; 
‘‘(7) how many such States for such grant cycle 
requested waivers to extend the grant cycle; and 
‘‘(8) challenges for such States to spend all of 
the funds allocated and the reason for such chal-
lenges, including to what extent reporting require-
ments or other requirements placed an increased 
burden on the ability of such States to spend all of 
the funds.’’. 
(c) OTHER CONCURRENT SUBSTANCE USE DIS-
ORDERS DEFINED.—Section 1003(h) of the 21st Century 
Cures Act (42 U.S.C. 290ee–3 note) is amended— 
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(1) by redesignating paragraphs (2) through 
(4) as paragraphs (3) through (5); and 
(2) by inserting before paragraph (3), as redes-
ignated, the following: 
‘‘(2) OTHER
CONCURRENT
SUBSTANCE
USE 
DISORDERS.—The term ‘other substance use dis-
orders’ includes alcohol use disorders co-occurring 
with opioid misuse and use disorders and alcohol use 
disorders co-occurring with stimulant misuse and 
use disorders, including polydrug use and alcohol use 
disorder.’’. 
(d) RULE OF CONSTRUCTION.—Nothing in this Act 
or the amendments made by this Act shall be construed 
to change the allocation of funds among grantees pursuant 
to the minimum allocations and formula methodology 
under section 1003 of the 21st Century Cures Act (42 
U.S.C. 290ee–3 note). 
SEC. 118. PROVIDING FOR A STUDY ON THE EFFECTS OF 
REMOTE MONITORING ON INDIVIDUALS WHO 
ARE PRESCRIBED OPIOIDS. 
(a) IN GENERAL.—Not later than 18 months after 
the date of enactment of this Act, the Comptroller General 
of the United States shall conduct a study and submit to 
the Committee on Energy and Commerce of the House 
of Representatives and the Committee on Health, Edu-
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cation, Labor, and Pensions and the Committee on Fi-
nance of the Senate a report on the use of remote moni-
toring with respect to individuals who are prescribed 
opioids. 
(b) REPORT.—The report described in subsection (a) 
shall include— 
(1) an assessment of scientific evidence related 
to the efficacy, individual outcomes, and potential 
cost savings associated with remote monitoring for 
individuals who are prescribed opioids compared to 
such individuals who are not so monitored; 
(2) an assessment of the current prevalence of 
remote monitoring for individuals who are prescribed 
opioids, including the use of such monitoring for 
such individuals in other countries; and 
(3) recommendations to improve availability, ac-
cess, and coverage for remote monitoring for individ-
uals who are prescribed opioids, including through 
changes to Federal health care programs (as defined 
in section 1128B of the Social Security Act (42 
U.S.C. 1320a–7b)) and, if determined appropriate 
by the Comptroller General, an identification of co-
horts of individuals who stand to benefit the most 
from remote monitoring when prescribed opioids. 
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TITLE II—CONTROLLED 
SUBSTANCES 
SEC. 201. DELIVERY OF CERTAIN SUBSTANCES BY A PHAR-
MACY 
TO 
AN 
ADMINISTERING 
PRACTI-
TIONER. 
Paragraph (2) of section 309A(a) of the Controlled 
Substances Act (21 U.S.C. 829a(a)) is amended to read 
as follows: 
‘‘(2) the controlled substance is a drug in 
schedule III, IV, or V that is, pursuant to the ap-
proval or licensure of such drug under the Federal 
Food, Drug, and Cosmetic Act or section 351 of the 
Public Health Service Act, to be administered by, or 
under the supervision of, the practitioner;’’. 
SEC. 202. REVIEWING THE SCHEDULING OF APPROVED 
PRODUCTS CONTAINING A COMBINATION OF 
BUPRENORPHINE AND NALOXONE. 
(a) SECRETARY OF HHS.—The Secretary of Health 
and Human Services shall, consistent with the require-
ments and procedures set forth in sections 201 and 202 
of the Controlled Substances Act (21 U.S.C. 811; 812)— 
(1) review the relevant data pertaining to the 
scheduling of products containing a combination of 
buprenorphine and naloxone that have been ap-
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proved under section 505 of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 355); and 
(2) if appropriate, request that the Attorney 
General initiate rulemaking proceedings to revise the 
schedules accordingly with respect to such products. 
(b) ATTORNEY GENERAL.—The Attorney General 
shall review any request made by the Secretary of Health 
and Human Services under subsection (a)(2) and deter-
mine whether to initiate proceedings to revise the sched-
ules in accordance with the criteria set forth in sections 
201 and 202 of the Controlled Substances Act (21 U.S.C. 
811; 812). 
SEC. 203. COMBATING ILLICIT XYLAZINE. 
(a) DEFINITIONS.— 
(1) IN
GENERAL.—In this section, the term 
‘‘xylazine’’ has the meaning given the term in para-
graph (60) of section 102 of the Controlled Sub-
stances Act, as added by paragraph (2). 
(2) CONTROLLED
SUBSTANCES
ACT.—Section 
102 of the Controlled Substances Act (21 U.S.C. 
802) is amended— 
(A) by redesignating the second paragraph 
(57) (relating to serious drug felony) and para-
graph (58) as paragraphs (58) and (59), re-
spectively; 
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(B) by moving the margin of paragraph 
(57) 2 ems to the left; 
(C) by moving the margins of paragraphs 
(58) and (59), as redesignated, 2 ems to the 
left; and 
(D) by adding at the end the following: 
‘‘(60)(A) The term ‘xylazine’ means the substance 
xylazine as well as its salts, isomers, and salts of isomers 
whenever the existence of such salts, isomers, and salts 
of isomers is possible. 
‘‘(B) Except as provided in subparagraph (E), such 
term does not include a substance described in subpara-
graph (A) to the extent— 
‘‘(i) such substance is used or intended for use 
in animals other than humans and is an animal drug 
that has been approved by the Secretary of Health 
and Human Services under section 512 of the Fed-
eral Food, Drug, and Cosmetic Act, conditionally ap-
proved under section 571 of such Act, index listed 
under section 573 of such Act, or subject to an ex-
emption for investigational use under section 512(j) 
of such Act, and such use or intended use conforms 
to the approved application or index listing, includ-
ing the manufacturing, importation, holding, or dis-
tribution for such use; 
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‘‘(ii) such substance is used or intended for use 
in animals other than humans as permitted under 
section 512(a)(4) of the Federal Food, Drug, and 
Cosmetic Act; 
‘‘(iii) such substance is manufactured, im-
ported, held, distributed, or used— 
‘‘(I) as an active pharmaceutical ingredient 
for manufacturing an animal drug approved 
under section 512 of the Federal Food, Drug, 
and Cosmetic Act, conditionally approved under 
section 571 of such Act, index listed under sec-
tion 573 of the such Act, or subject to an ex-
emption for investigational use under section 
512(j) of such Act; or 
‘‘(II) as a bulk chemical for pharma-
ceutical compounding of a new animal drug (as 
defined in section 201 of the Federal Food, 
Drug, and Cosmetic Act) by or under the direct 
supervision of a licensed pharmacist or by or on 
the lawful written or oral order of a licensed 
veterinarian within the context of a veteri-
narian-client-patient relationship, as defined by 
the Secretary of Health and Human Services; 
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‘‘(iv) such substance is held or used as a com-
pounded new animal drug described in clause 
(iii)(II); 
‘‘(v) such substance is otherwise used or in-
tended for use in animals other than humans, and 
such use is approved or otherwise authorized under 
the Federal Food, Drug, and Cosmetic Act provided 
any such use conforms to such approval or author-
ization; 
‘‘(vi) such substance is subject to an exemption 
for investigational use under section 505(i) or 
520(g) of the Federal Food, Drug, and Cosmetic 
Act; 
‘‘(vii) such substance is imported, held, distrib-
uted, or used for the development, manufacturing, or 
performance of tests for detection of xylazine (in-
cluding xylazine used as a control or calibration 
standard) by persons who are professionally, regu-
larly, and lawfully engaged in such activities; or 
‘‘(viii) such substance is held, distributed, or 
used in a commercially manufactured test for the de-
tection of xylazine, provided such test does not con-
tain xylazine in a form that can be extracted. 
‘‘(C) Notwithstanding subparagraph (B), the Attor-
ney General may place any substance listed in such sub-
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paragraph on a schedule under section 202 in accordance 
with subsections (a) through (c) of section 201. 
‘‘(D) Nothing in this paragraph shall be construed 
as a basis for inferring that a compounded animal drug 
is not a new animal drug subject to the requirements of 
section 512(a) of the Federal Food, Drug, and Cosmetic 
Act. 
‘‘(E) If any person prescribes, dispenses, distributes, 
manufactures, or imports xylazine for human use, such 
person shall be considered to have prescribed, dispensed, 
distributed, manufactured, or imported xylazine not sub-
ject to an exclusion under subparagraph (B).’’. 
(b) PLACEMENT OF XYLAZINE ON SCHEDULE III.— 
Schedule III in section 202(c) of the Controlled Sub-
stances Act (21 U.S.C. 812(c)) is amended by adding at 
the end the following: 
‘‘(f) Xylazine.’’. 
(c) REPORT TO CONGRESS ON XYLAZINE.— 
(1) INITIAL REPORT.—Not later than 1 year 
after the date of enactment of this Act, the Attorney 
General, acting through the Administrator of the 
Drug Enforcement Administration and in coordina-
tion with the Commissioner of Food and Drugs, 
shall submit to Congress a report on the prevalence 
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of illicit use of xylazine in the United States and the 
impacts of such use, including— 
(A) where the drug is being diverted; 
(B) where the drug is originating; 
(C) whether any analogues to such drug 
present a substantial risk of abuse; 
(D) whether and to what extent the illicit 
supply of xylazine derives from the licit supply 
chain; and 
(E) recommendations for Congress with re-
spect to whether xylazine should be transferred 
to another schedule under section 202 of the 
Controlled Substances Act (21 U.S.C. 812). 
(2) ADDITIONAL
REPORT.—Not later than 4 
years after the date of enactment of this Act, the 
Attorney General, acting through the Administrator 
of the Drug Enforcement Administration and in co-
ordination with the Commissioner of Food and 
Drugs, shall submit to Congress a report updating 
Congress on the prevalence of xylazine trafficking, 
misuse, and proliferation in the United States, in-
cluding recommendations for Congress with respect 
to whether xylazine should be transferred to another 
schedule under section 202 of the Controlled Sub-
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stances Act (21 U.S.C. 812) or removed from sched-
ule III of such part. 
SEC. 204. TECHNICAL CORRECTIONS. 
Effective as if included in the enactment of Public 
Law 117–328— 
(1) section 1252(a) of division FF of Public 
Law 117–328 is amended, in the matter being in-
serted into section 302(e) of the Controlled Sub-
stances Act, by striking ‘‘303(g)’’ and inserting 
‘‘303(h)’’; 
(2) section 1262 of division FF of Public Law 
117–328 is amended— 
(A) in subsection (a)— 
(i) in the matter preceding paragraph 
(1), by striking ‘‘303(g)’’ and inserting 
‘‘303(h)’’; 
(ii) in the matter being stricken by 
subsection (a)(2), by striking ‘‘(g)(1)’’ and 
inserting ‘‘(h)(1)’’; and 
(iii) in the matter being inserted by 
subsection (a)(2), by striking ‘‘(g) Practi-
tioners’’ and inserting ‘‘(h) Practitioners’’; 
and 
(B) in subsection (b)— 
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(i) in the matter being stricken by 
paragraph (1), by striking ‘‘303(g)(1)’’ 
and inserting ‘‘303(h)(1)’’; 
(ii) in the matter being inserted by 
paragraph (1), by striking ‘‘303(g)’’ and 
inserting ‘‘303(h)’’; 
(iii) in the matter being stricken by 
paragraph (2)(A), by striking ‘‘303(g)(2)’’ 
and inserting ‘‘303(h)(2)’’; 
(iv) in the matter being stricken by 
paragraph (3), by striking ‘‘303(g)(2)(B)’’ 
and inserting ‘‘303(h)(2)(B)’’; 
(v) in the matter being stricken by 
paragraph (5), by striking ‘‘303(g)’’ and 
inserting ‘‘303(h)’’; and 
(vi) in the matter being stricken by 
paragraph (6), by striking ‘‘303(g)’’ and 
inserting ‘‘303(h)’’; and 
(3) section 1263(b) of division FF of Public 
Law 117–328 is amended— 
(A) by striking ‘‘303(g)(2)’’ and inserting 
‘‘303(h)(2)’’; and 
(B) by striking ‘‘(21 U.S.C. 823(g)(2))’’ 
and inserting ‘‘(21 U.S.C. 823(h)(2))’’. 
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TITLE III—MEDICAID 
SEC. 301. EXTENDING REQUIREMENT FOR STATE MEDICAID 
PLANS TO PROVIDE COVERAGE FOR MEDICA-
TION-ASSISTED TREATMENT. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (a)(29), by striking ‘‘for the 
period beginning October 1, 2020, and ending Sep-
tember 30, 2025,’’ and inserting ‘‘beginning on Oc-
tober 1, 2020,’’; and 
(2) in subsection (ee)(2), by striking ‘‘for the 
period specified in such paragraph, if before the be-
ginning of such period the State certifies to the sat-
isfaction of the Secretary’’ and inserting ‘‘if such 
State certifies, not less than every 5 years and to the 
satisfaction of the Secretary,’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1006(b)(4)(A) of the Substance Use-Disorder Prevention 
that Promotes Opioid Recovery and Treatment for Pa-
tients and Communities Act (42 U.S.C. 1396a note) is 
amended by striking ‘‘, and before October 1, 2025’’. 
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SEC. 302. EXPANDING REQUIRED REPORTS ON T–MSIS SUB-
STANCE USE DISORDER DATA TO INCLUDE 
MENTAL HEALTH CONDITION DATA. 
(a) IN GENERAL.—Section 1015(a) of the SUP-
PORT for Patients and Communities Act (42 U.S.C. 
1320d–2 note) is amended— 
(1) in the heading, by striking ‘‘SUBSTANCE 
USE DISORDER DATA BOOK’’ and inserting ‘‘BE-
HAVIORAL HEALTH DATA BOOK’’; 
(2) in paragraph (2)— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘, including as updated in ac-
cordance with paragraph (3),’’ after ‘‘paragraph 
(1)’’; 
(B) in subparagraph (A), by inserting ‘‘, 
mental health condition, or a mental health con-
dition co-occurring with substance use disorder’’ 
after ‘‘substance use disorder’’; 
(C) in subparagraph (B), by inserting 
‘‘and mental health treatment services’’ after 
‘‘substance use disorder treatment services’’; 
(D) in subparagraph (C)— 
(i) by inserting ‘‘, mental health con-
dition, or a mental health condition co-oc-
curring with a substance use disorder diag-
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nosis’’ after ‘‘substance use disorder diag-
nosis’’; and 
(ii) by inserting ‘‘or mental health 
treatment services, respectively,’’ after 
‘‘substance use disorder treatment serv-
ices’’; 
(E) in subparagraph (D), by inserting ‘‘, 
mental health condition, or a mental health con-
dition co-occurring with substance use disorder’’ 
after ‘‘substance use disorder diagnosis’’; 
(F) in subparagraph (E), by inserting ‘‘or 
mental health treatment’’ after ‘‘substance use 
disorder treatment’’; and 
(G) in subparagraph (F), by inserting ‘‘, 
individuals with a mental health condition who 
receive mental health treatment services, and 
individuals with a co-occurring mental health 
condition and substance use disorder who re-
ceive substance use disorder treatment services 
and mental health treatment services,’’ after 
‘‘substance use disorder treatment services’’; 
and 
(3) in paragraph (3), by striking ‘‘through 
2024’’. 
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(b) APPLICATION.—The amendments made by sub-
section (a)(1) shall apply beginning with respect to the 
first update made pursuant to section 1015(a)(3) of the 
SUPPORT for Patients and Communities Act (42 U.S.C. 
1320d–2 note) after the date that is 12 months after the 
date of enactment of this Act. 
SEC. 303. MONITORING PRESCRIBING OF ANTIPSYCHOTIC 
MEDICATIONS. 
Section 1902(oo) of the Social Security Act (42 
U.S.C. 1396a(oo)) is amended— 
(1) in paragraph (1)(B)— 
(A) in the subparagraph heading, by strik-
ing ‘‘BY CHILDREN’’; and 
(B) by inserting ‘‘, and beginning on the 
date that is 24 months after the date of enact-
ment of the Support for Patients and Commu-
nities Reauthorization Act, individuals over the 
age of 18, individuals receiving home and com-
munity-based services (as defined in section 
9817(a)(2)(B) of Public Law 117–2), and indi-
viduals residing in institutional care settings 
(including nursing facilities and intermediate 
care facilities for individuals with intellectual 
disabilities) enrolled,’’ after ‘‘children enrolled’’; 
and 
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(2) in paragraph (3)— 
(A) in subparagraph (A)(ii), by striking ‘‘is 
a resident’’ and inserting ‘‘subject to subpara-
graph (C), is a resident’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(C) APPLICATION IN CASE OF PROGRAM 
TO MONITOR ANTIPSYCHOTIC MEDICATIONS.— 
Subparagraph (A)(ii) shall not apply to the 
drug review and utilization requirement de-
scribed in paragraph (1)(B) with respect to an 
individual to whom such subparagraph applies 
by reason of the amendments made by section 
303(1) of the Support for Patients and Com-
munities Reauthorization Act.’’. 
Æ 
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