Turn the Tide Act
Bill: S.1010 | Sponsor: Sen. Shaheen, Jeanne (D-NH)
Policy area: Health

Summary:
Turn the Tide Act
This bill provides funding for various programs and activities to prevent, treat, and otherwise address substance use disorders. It also makes changes to insurance coverage for substance use disorders.
Specifically, the bill provides funding for
In addition, the bill modifies insurance coverage for substance use disorder drugs and treatments by
Furthermore, the bill increases Medicaid payment rates for mental and behavioral health services and requires the federal government to cover the costs of this increase. Additionally, the bill requires that non-opioid treatment options associated with surgery be reimbursed separately, instead of on a packaged basis, under Medicare.
The bill also extends certain Medicaid waivers for delivery reform incentive payments for states that have high rates of drug overdose deaths.

To provide funding for programs and activities under the SUPPORT for 
                     Patients and Communities Act.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Turn the Tide Act''.

SEC. 2. CONTROLLED SUBSTANCE PROVISIONS OF THE SUPPORT FOR PATIENTS AND 
              COMMUNITIES ACT.

    (a) Grants To Enhance Access to Substance Use Disorder Treatment.--
Section 3203(b) of the Substance Use-Disorder Prevention that Promotes 
Opioid Recovery and Treatment for Patients and Communities Act (Public 
Law 115-271) is amended to read as follows:
    ``(b) Appropriations.--For grants under subsection (a), there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $4,000,000 for each 
of fiscal years 2021 through 2024.''.
    (b) Access to Increased Drug Disposal.--Section 3260 of the 
Substance Use-Disorder Prevention that Promotes Opioid Recovery and 
Treatment for Patients and Communities Act (Public Law 115-271) is 
amended to read as follows:

``SEC. 3260. APPROPRIATIONS.

    ``To carry out this chapter, there is authorized to be 
appropriated, and there is appropriated, out of any monies in the 
Treasury not otherwise appropriated, $10,000,000 for each of fiscal 
years 2021 through 2024.''.

SEC. 3. PUBLIC HEALTH PROVISIONS OF THE SUPPORT FOR PATIENTS AND 
              COMMUNITIES ACT.

    (a) First Responder Training.--Section 546(h) of the Public Health 
Service Act (42 U.S.C. 290ee-1(h)) is amended to read as follows:
    ``(h) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $36,000,000 for each 
of fiscal years 2021 through 2024.''.
    (b) Public Health Laboratories Pilot Program.--Section 7011(d) of 
the Substance Use-Disorder Prevention that Promotes Opioid Recovery and 
Treatment for Patients and Communities Act (Public Law 115-271) is 
amended to read as follows:
    ``(d) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $15,000,000 for each 
of fiscal years 2021 through 2024.''.
    (c) National Recovery Housing Best Practices.--Section 550(g) of 
the Public Health Service Act (42 U.S.C. 290ee-5(g)) is amended to read 
as follows:
    ``(g) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $3,000,000 for the 
period of fiscal years 2021 through 2022.''.
    (d) Model Training Programs for Substance Use Disorder Patient 
Records.--Section 7053(e) of the Substance Use-Disorder Prevention that 
Promotes Opioid Recovery and Treatment for Patients and Communities Act 
(Public Law 115-271) is amended to read as follows:
    ``(e) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated--
            ``(1) $4,000,000 for fiscal years 2021;
            ``(2) $2,000,000 for each of fiscal year 2022; and
            ``(3) $1,000,000 for each of fiscal years 2023 and 2024.''.
    (e) 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 the first sentence and inserting the 
following: ``To carry out this section, there is authorized to be 
appropriated, and there is appropriated, out of any monies in the 
Treasury not otherwise appropriated, $29,931,000 for each of fiscal 
years 2021 through 2024.''.
    (f) 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 to read as follows:
    ``(f) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $50,000,000 for each 
of fiscal years 2021 through 2024.''.
    (g) Coordination and Continuation of Care for Drug Overdose 
Patients.--Section 7081(f) of the Substance Use-Disorder Prevention 
that Promotes Opioid Recovery and Treatment for Patients and 
Communities Act (Public Law 115-271) is amended to read as follows:
    ``(f) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $10,000,000 for each 
of fiscal years 2021 through 2024.''.
    (h) Emergency Department Alternatives to Opioids Demonstration 
Program.--Section 7091(g) of the Substance Use-Disorder Prevention that 
Promotes Opioid Recovery and Treatment for Patients and Communities Act 
(Public Law 115-271) is amended to read as follows:
    ``(g) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $10,000,000 for each 
of fiscal years 2021 through 2024.''.
    (i) Regional Centers of Excellence in Substance Use Disorder 
Education.--Section 551(f) of the Public Health Service Act (42 U.S.C. 
290ee-6(f)) is amended to read as follows:
    ``(f) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $4,000,000 for each 
of fiscal years 2021 through 2024.''.
    (j) Youth Prevention and Recovery.--Section 7102(c)(9) of the 
Substance Use-Disorder Prevention that Promotes Opioid Recovery and 
Treatment for Patients and Communities Act (Public Law 115-271) is 
amended to read as follows:
            ``(9) Appropriations.--To carry out this subsection, there 
        is authorized to be appropriated, and there is appropriated, 
        out of any monies in the Treasury not otherwise appropriated, 
        $10,000,000 for each of fiscal years 2021 through 2024.''.
    (k) Comprehensive Opioid Recovery Centers.--Section 552(j) of the 
Public Health Service Act (42 U.S.C. 290ee-7(j)) is amended to read as 
follows:
    ``(j) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $10,000,000 for each 
of fiscal years 2021 through 2024.''.
    (l) CDC Surveillance and Data Collection.--Section 7131(e) of the 
Substance Use-Disorder Prevention that Promotes Opioid Recovery and 
Treatment for Patients and Communities Act (Public Law 115-271) is 
amended to read as follows:
    ``(e) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $2,000,000 for each 
of fiscal years 2021 through 2024.''.
    (m) National Child Traumatic Stress Initiative.--Section 582(j) of 
the Public Health Service Act (42 U.S.C. 290hh-1(j)) is amended to read 
as follows:
    ``(j) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $63,887,000 for each 
of fiscal years 2021 through 2024.''.
    (n) Trauma Support Services and Mental Health Care.--Section 
7134(l) of the Substance Use-Disorder Prevention that Promotes Opioid 
Recovery and Treatment for Patients and Communities Act (Public Law 
115-271) is amended to read as follows:
    ``(l) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $50,000,000 for each 
of fiscal years 2021 through 2024.''.
    (o) Surveillance and Education Regarding Infections Associated With 
Illicit Drug Use and Other Risk Factors.--Section 317N(d) of the Public 
Health Service Act (42 U.S.C. 247b-15(d)) is amended to read as 
follows:
    ``(d) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $40,000,000 for each 
of fiscal years 2021 through 2024.''.
    (p) Building Communities of Recovery.--Section 547(f) of the Public 
Health Service Act (42 U.S.C. 290ee-2(f)) is amended to read as 
follows:
    ``(f) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $5,000,000 for each 
of fiscal years 2021 through 2024.''.
    (q) Peer Support Technical Assistance Center.--Section 547A(e) of 
the Public Health Service Act (42 U.S.C. 290ee-2a(e)) is amended to 
read as follows:
    ``(e) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $1,000,000 for each 
of fiscal years 2021 through 2024.''.
    (r) Preventing Overdoses of Controlled Substances.--Section 392A(d) 
of the Public Health Service Act (42 U.S.C. 280b-1(d)) is amended to 
read as follows:
    ``(d) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $496,000,000 for 
each of fiscal years 2021 through 2024.''.
    (s) Career Act.--Section 7183(k) of the Substance Use-Disorder 
Prevention that Promotes Opioid Recovery and Treatment for Patients and 
Communities Act (Public Law 115-271) is amended to read as follows:
    ``(k) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $5,000,000 for each 
of fiscal years 2021 through 2024.''.

SEC. 4. HOUSING AND DEPARTMENT OF JUSTICE PROVISIONS OF THE SUPPORT FOR 
              PATIENTS AND COMMUNITIES ACT.

    (a) Assistance To Help Individuals in Recovery From Substance Use 
Disorder Become Stably Housed.--Section 8071(a) of the Substance Use-
Disorder Prevention that Promotes Opioid Recovery and Treatment for 
Patients and Communities Act (42 U.S.C. 5301 note; Public Law 115-271) 
is amended by striking ``such sums as may be necessary for each of 
fiscal years 2019 through 2023'' and inserting ``, and there are 
appropriated, out of any monies in the Treasury not otherwise 
appropriated, $25,000,000 for each of fiscal years 2021 through 2024''.
    (b) Building Capacity for Family-Focused Residential Treatment.--
Section 8083(c) of the Substance Use-Disorder Prevention that Promotes 
Opioid Recovery and Treatment for Patients and Communities Act (Public 
Law 115-271) is amended to read as follows:
    ``(c) Appropriations.--To carry out this section, there is 
authorized to be appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, $20,000,000 for 
fiscal years 2020, which shall remain available through fiscal year 
2023.''.
    (c) Comprehensive Opioid Abuse Grant Program.--Section 1001(a)(27) 
of title I of the Omnibus Crime Control and Safe Streets Act of 1968 
(34 U.S.C. 10261(a)(27)) is amended to read as follows:
    ``(27) To carry out part LL, there is authorized to be 
appropriated, and there is appropriated, out of any monies in the 
Treasury not otherwise appropriated, $500,000,000 for each of fiscal 
years 2021 through 2024.''.
    (d) Office of National Drug Control Policy.--Section 714 of the 
Office of National Drug Control Policy Reauthorization Act of 1998 (21 
U.S.C. 1711) is amended to read as follows:

``SEC. 714. AUTHORIZATION OF APPROPRIATIONS; APPROPRIATIONS.

    ``To carry out this title, except activities otherwise specified, 
there is authorized to be appropriated, and there is appropriated, out 
of any monies in the Treasury not otherwise appropriated, $50,000,000 
for each of fiscal years 2021 through 2024, to remain available until 
expended.''.
    (e) Drug-Free Communities Program.--Section 1024 of the Anti-Drug 
Abuse Act of 1988 (21 U.S.C. 1524) is amended--
            (1) in the heading, by inserting ``; appropriations'' after 
        ``authorization of appropriations''; and
            (2) by striking subsection (a) and inserting the following:
    ``(a) In General.--To carry out this chapter, there is authorized 
to be appropriated to the Office of National Drug Control Policy, and 
there is appropriated, out of any monies in the Treasury not otherwise 
appropriated, $150,000,000 for each of fiscal years 2021 through 
2024.''.
    (f) High-Intensity Drug Trafficking Area Program.--Section 707(p) 
of the Office of National Drug Control Policy Reauthorization Act of 
1988 (21 U.S.C. 1706(p)) is amended--
            (1) by redesignating paragraphs (1) through (6) as 
        subparagraphs (A) through (F), respectively, and adjusting the 
        margins accordingly;
            (2) by striking ``There is authorized'' and inserting the 
        following:
            ``(1) In general.--There is authorized'';
            (3) in paragraph (1), as so designated--
                    (A) in subparagraph (E), as so redesignated, by 
                striking ``each of''; and
                    (B) in subparagraph (F), as so redesignated, by 
                striking ``2018 through 2023'' and inserting ``2018, 
                2019, and 2020''; and
            (4) by adding at the end the following:
            ``(2) Appropriations.--To carry out this section, there is 
        authorized to be appropriated to the Office of National Drug 
        Control Policy, and there is appropriated, out of any monies in 
        the Treasury not otherwise appropriated, $290,000,000 for each 
        of fiscal years 2021 through 2024.''.
    (g) Drug Court Program.--Section 1001(a)(25)(A) of title I of the 
Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 
10261(a)(25)(A)) is amended to read as follows:
    ``(25)(A) Except as provided in subparagraph (C), to carry out part 
EE, there is authorized to be appropriated, and there is appropriated, 
out of any monies in the Treasury not otherwise appropriated, 
$75,000,000 for each of fiscal years 2021 through 2024.''.
    (h) Drug Court Training and Technical Assistance.--Section 
705(e)(2) of the Office of National Drug Control Policy Reauthorization 
Act of 1988 (21 U.S.C. 1704(e)(2)) is amended to read as follows:
            ``(2) Authorization of appropriations; appropriations.--To 
        carry out this subsection, there is authorized to be 
        appropriated, and there is appropriated, out of any monies in 
        the Treasury not otherwise appropriated, $2,000,000 for each of 
        fiscal years 2021 through 2024.''.
    (i) Administration of the Office of National Drug Control Policy.--
Section 704(i)(2) of the Office of National Drug Control Policy 
Reauthorization Act of 1998 (21 U.S.C. 1703(i)(2)) is amended to read 
as follows:
            ``(2) Authorization of appropriations; appropriations.--To 
        carry out this subsection, there is authorized to be 
        appropriated, and there is appropriated, out of any monies in 
        the Treasury not otherwise appropriated, $1,250,000 for each of 
        fiscal years 2021 through 2024.''.
    (j) Emerging Threats Committee, Plan, and Media Campaign.--Section 
709(g) of the Office of National Drug Control Policy Reauthorization 
Act of 1998 (21 U.S.C. 1708(g)) is amended to read as follows:
    ``(g) Authorization of Appropriations; Appropriations.--To carry 
out this section, there is authorized to be appropriated to the Office, 
and there is appropriated, out of any monies in the Treasury not 
otherwise appropriated, $25,000,000 for each of fiscal years 2021 
through 2024.''.

SEC. 5. BOLSTERING COMMITMENTS TO STATE GRANTS FOR SUBSTANCE USE 
              DISORDER TREATMENT AND PREVENTION.

    (a) State Opioid Response Grants.--
            (1) In general.--To carry out activities under section 1003 
        of the 21st Century Cures Act (42 U.S.C. 290ee-3 note) relating 
        to opioids by the State agency responsible for administering 
        the substance abuse prevention and treatment block grant under 
        subpart II of part B of title XIX of the Public Health Service 
        Act (42 U.S.C. 300x-21 et seq.), there is authorized to be 
        appropriated, and there is appropriated, $5,500,000,000 for 
        each of fiscal years 2021 through 2025.
            (2) Flexibility in 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:
            ``(3) Flexibility.--States and Indian tribes may use 
        amounts provided under grants under this subsection to support 
        substance use disorder treatment care and related services 
        regardless of whether the patient involved has a primary 
        diagnosis of opioid use disorder, so long as the individual has 
        a substance use disorder diagnosis.
            ``(4) Rule of construction.--Nothing in this subsection 
        shall be construed to prohibit States from using grant funds 
        under this subsection to allocate amounts to local governments 
        to establish subgrantee awards in such localities.''.
            (3) Substance abuse prevention and treatment block 
        grants.--Section 1935(a) of the Public Health Service Act (42 
        U.S.C. 300x-35(a)) is amended to read as follows:
    ``(a) Appropriations.--To carry out this subpart, subpart III, and 
section 505(d), there is authorized to be appropriated, and there is 
appropriated, out of any monies in the Treasury not otherwise 
appropriated, $3,000,000,000 for each of fiscal years 2021 through 
2025, and $2,500,000,000 for each of fiscal years 2026 through 2030.''.
    (b) Requirements.--For the purposes of carrying out activities with 
amounts appropriated under this section (and the amendment made by this 
section), the Secretary of Health and Human Services shall ensure that 
the following requirements are complied with:
            (1) Of the amount appropriated for each fiscal year under 
        subsection (a) (and the amendment made by such subsection), 
        $50,000,000 shall be made available to Indian Tribes or tribal 
        organizations.
            (2) Of such remaining amounts for each such fiscal year, 15 
        percent shall be made available to the States with the highest 
        mortality rate related to opioid use disorders.
            (3) Of the amount made available for each fiscal year under 
        subsections (a)(1) for State Opioid Response Grants, not more 
        than 2 percent of such amount shall be available for Federal 
        administrative expenses, training, technical assistance, and 
        evaluation.
            (4) Of the amounts not reserved under paragraphs (1) 
        through (3), the Secretary shall make allocations to States, 
        territories, and the District of Columbia according to a 
        formula using national survey results that the Secretary 
        determines are the most objective and reliable measure of drug 
        use and drug-related deaths.
            (5) The formula methodology under paragraph (4) shall be 
        submitted to the Committees on Appropriations of the House of 
        Representatives and the Committee on Appropriations of the 
        Senate not less than 15 days prior to publishing a Funding 
        Opportunity Announcement.
            (6) The prevention and treatment activities funded through 
        grants under this section may include education, treatment 
        (including the provision of medication), behavioral health 
        services for individuals in treatment programs, referral to 
        treatment services, recovery support, and medical screening 
        associated with such treatment.
            (7) Each State, including the District of Columbia, shall 
        receive not less than $4,000,000 under grants under this 
        section.
            (8) In addition to amounts appropriated under this section 
        (and the amendment made by this section), the following amounts 
        shall be available under section 241 of the Public Health 
        Service Act (42 U.S.C. 238j):
                    (A) $79,200,000 to carry out subpart II of part B 
                of title XIX of the Public Health Service Act to fund 
                section 1935(b) (42 U.S.C. 300x-35) (relating to 
                technical assistance, national data, data collection 
                and evaluation activities) and the total available 
                under this Act for activities under such section 
                1935(b) shall not exceed 5 percent of the amounts 
                appropriated for such subpart II of part B of title 
                XIX.
                    (B) $2,000,000 to evaluate substance abuse 
                treatment programs.
            (9) None of the funds provided for under section 1921 of 
        the Public Health Service Act (42 U.S.C. 300x-21) or State 
        Opioid Response Grants under section 1003 of the 21st Century 
        Cures Act (42 U.S.C. 290ee-3 note) shall be subject to section 
        241 of such Act (42 U.S.C. 238j).

SEC. 6. ELIMINATING INSURANCE BARRIERS TO MEDICATION-ASSISTED 
              TREATMENT.

    (a) Limitation on Use of Utilization Control Policies or Procedures 
for Medication-Assisted Treatments.--Subpart II of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is 
amended by adding at the end the following:

``SEC. 2729A. ELIMINATING BARRIERS TO MEDICATION-ASSISTED TREATMENT.

    ``A group health plan (other than a self-insured plan) or a health 
insurance issuer offering group or individual health insurance coverage 
shall not impose any utilization control policies or procedures (as 
defined by the Secretary), including prior authorization requirements, 
with respect to medication-assisted treatment covered under the plan or 
coverage.''.
    (b) No Prior Authorization or Other Utilization Restrictions Under 
Medicaid.--
            (1) Prohibition.--Section 1903(i) of the Social Security 
        Act (42 U.S.C. 1396b(i)) is amended--
                    (A) in paragraph (26), by striking ``; or'' and 
                inserting a semicolon;
                    (B) in paragraph (27), by striking the period at 
                the end and inserting ``; or''; and
                    (C) by inserting after paragraph (27) the following 
                new paragraph:
            ``(28) with respect to any amount expended for medical 
        assistance for medication-assisted treatment (as defined in 
        section 1905(ee)) if the State imposes any utilization control 
        policies or procedures (as defined by the Secretary), including 
        any prior authorization requirements, with respect to the 
        provision of such assistance; or''.
            (2) Conforming amendment.--Section 1905(a)(29) of the 
        Social Security Act (42 U.S.C. 1396d(a)(29)) is amended by 
        inserting ``and section 1903(i)(28)'' after ``subsection 
        (ee)''.
            (3) Effective date.--The amendments made by this subsection 
        take effect on October 1, 2021.

SEC. 7. LIMITATIONS ON COST-SHARING FOR OPIOID OVERDOSE REVERSAL 
              MEDICATIONS.

    (a) Limitations on Cost-Sharing.--Subpart II of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 300gg-11 et seq.), as 
amended by section 6, is further amended by adding at the end the 
following:

``SEC. 2729B. LIMITATIONS ON COST-SHARING FOR OPIOID OVERDOSE REVERSAL 
              MEDICATIONS.

    ``(a) In General.--A group health plan (other than a self-insured 
plan) or a health insurance issuer offering group or individual health 
insurance coverage shall not impose any cost-sharing requirement under 
the plan or coverage with respect to at least one brand or generic 
version of opioid overdose reversal drug.
    ``(b) Definition.--In this section, the term `opioid overdose 
reversal drug' means a drug or biological product approved by the Food 
and Drug Administration for--
            ``(1) complete or partial reversal of opioid depression, 
        including respiratory depression, induced by opioids; or
            ``(2) emergency treatment of a known or suspected opioid 
        overdose, as manifested by respiratory or central nervous 
        system depression.''.
    (b) Limitations on Cost-Sharing Under Medicare Part D.--
            (1) In general.--Section 1860D-2(b) of the Social Security 
        Act (42 U.S.C. 1395w-102(b)) is amended--
                    (A) in paragraph (1)(A), by striking ``The 
                coverage'' and inserting ``Subject to paragraph (8), 
                the coverage'';
                    (B) in paragraph (2)(A), by striking ``and (D)'' 
                and inserting ``and (D) and paragraph (8)'';
                    (C) in paragraph (3)(A), by striking ``and (4)'' 
                and inserting ``(4), and (8)'';
                    (D) in paragraph (4)(A)(i), by striking ``The 
                coverage'' and inserting ``Subject to paragraph (8), 
                the coverage''; and
                    (E) by adding at the end the following new 
                paragraph:
            ``(8) Limitations on cost-sharing for opioid overdose 
        reversal drugs.--
                    ``(A) In general.--For plan year 2023 and each 
                subsequent plan year, each prescription drug plan and 
                MA-PD plan shall not impose any cost-sharing 
                requirement under the plan with respect to at least one 
                brand or generic version of an opioid overdose reversal 
                drug (as defined in section 2729B of the Public Health 
                Service Act). The requirement under the preceding 
                sentence shall also apply to cost-sharing applicable to 
                subsidy eligible individuals under section 1814D-14.
                    ``(B) Cost-sharing.--For purposes of subparagraph 
                (A), the elimination of cost-sharing shall include the 
                following:
                            ``(i) No application of deductible.--The 
                        waiver of the deductible under paragraph (1).
                            ``(ii) No application of coinsurance.--The 
                        waiver of coinsurance under paragraph (2).
                            ``(iii) No application of initial coverage 
                        limit.--The initial coverage limit under 
                        paragraph (3) shall not apply.
                            ``(iv) No cost-sharing above annual out-of-
                        pocket threshold.--The waiver of cost-sharing 
                        under paragraph (4).''.
            (2) Conforming amendments to cost-sharing for low-income 
        individuals.--Section 1860D-14(a) of the Social Security Act 
        (42 U.S.C. 1395w-114(a)) is amended--
                    (A) in paragraph (1), in the matter preceding 
                subparagraph (A), by striking ``In the case'' and 
                inserting ``Subject to section 1860D-2(b)(8), in the 
                case''; and
                    (B) in paragraph (2), in the matter preceding 
                subparagraph (A), by striking ``In the case'' and 
                inserting ``Subject to section 1860D-2(b)(8), in the 
                case''.

SEC. 8. TARGETING HEALTH WORKFORCE LOAN REPAYMENT ASSISTANCE TO 
              HARDEST-HIT STATES.

    (a) Loan Repayment Program for Substance Use Disorder Treatment 
Workforce.--Section 781(j) of the Public Health Service Act (42 U.S.C. 
295h(j)) is amended to read as follows:
    ``(j) Appropriations.--
            ``(1) In general.--To carry out this section (other than 
        paragraph (2)), there is authorized to be appropriated, and 
        there is appropriated, out of any monies in the Treasury not 
        otherwise appropriated, $25,000,000 for each of fiscal years 
        2021 through 2024.
            ``(2) States with highest drug overdose death rates.--
                    ``(A) In general.--To carry out the program under 
                this section with respect to individuals who agree to 
                provide obligated service in States described in 
                subparagraph (B), there is authorized to be 
                appropriated, and there is appropriated, out of any 
                monies in the Treasury not otherwise appropriated, 
                $25,000,000 for each of fiscal years 2021 through 2025.
                    ``(B) States described.--A State described in this 
                subparagraph is a State that is in the top quintile of 
                all States in terms of the highest mean drug overdose 
                death rate per 100,000 residents for the 3-year period 
                immediately preceding the year for which the 
                determination is being made, as determined by the 
                Secretary.
                    ``(C) Application of section.--Except as provided 
                in this paragraph, the requirements of this section 
                otherwise applicable to individuals under this section 
                shall apply to individuals receiving assistance under 
                this paragraph.''.
    (b) Training Demonstration Program.--Section 760(g) of the Public 
Health Service Act (42 U.S.C. 294k(g)) is amended to read as follows:
    ``(g) Appropriations.--
            ``(1) In general.--To carry out this section (other than 
        paragraph (2)), there is authorized to be appropriated, and 
        there is appropriated, out of any monies in the Treasury not 
        otherwise appropriated, $10,000,000 for each of fiscal years 
        2021 through 2024.
            ``(2) States with highest drug overdose death rates.--
                    ``(A) In general.--To carry out the program under 
                this section with respect to grantees located in States 
                described in subparagraph (B), there is authorized to 
                be appropriated, and there is appropriated, out of any 
                monies in the Treasury not otherwise appropriated, 
                $20,000,000 for each of fiscal years 2021 through 2025.
                    ``(B) States described.--A State described in this 
                subparagraph is a State that is in the top quintile of 
                all States in terms of the highest mean drug overdose 
                death rate per 100,000 residents for the 3-year period 
                immediately preceding the year for which the 
                determination is being made, as determined by the 
                Secretary.
                    ``(C) Application of section.--Except as provided 
                in this paragraph, the requirements of this section 
                otherwise applicable to grantees under this section 
                shall apply to grantees receiving assistance under this 
                paragraph.''.

SEC. 9. MEDICAID PAYMENTS FOR BEHAVIORAL HEALTH AND MENTAL HEALTH 
              PROVIDERS.

    (a) In General.--
            (1) Fee-for-service.--Section 1902 of the Social Security 
        Act (42 U.S.C. 1396a) is amended--
                    (A) in subsection (a)(13)--
                            (i) by striking ``and'' at the end of 
                        subparagraph (B);
                            (ii) by adding ``and'' at the end of 
                        subparagraph (C); and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(D) payment for mental health and behavioral 
                health services (as defined in subsection (tt)(1)) 
                furnished on or after October 1, 2021, and before 
                October 1, 2025, by a physician or applicable 
                professional (as defined in subsection (tt)(2)) at a 
                rate not less than 100 percent of the payment rate that 
                applies to such services and physician or applicable 
                professional under part B of title XVIII (or, if 
                greater, the payment rate that would be applicable 
                under such part if the conversion factor under section 
                1848(d) for the year involved were the conversion 
                factor under such section for 2021, and, if such 
                services are not covered under such part, the 
                reasonable and customary rate the Secretary determines 
                would apply to such services and physician or 
                applicable professional);''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(tt) Mental Health and Behavioral Health Services.--For purposes 
of subsection (a)(13)(D):
            ``(1) Mental health and behavioral health services.--
                    ``(A) In general.--The term `mental health and 
                behavioral health services' means the following 
                services, when provided to a patient with a diagnosis 
                of substance use disorder (as defined in subparagraph 
                (B)) as a part of the management or treatment of the 
                patient's substance use disorder (as determined in 
                accordance with regulations promulgated by the 
                Secretary under subparagraph (C)):
                            ``(i) Evaluation and management services 
                        that are procedure codes (for services covered 
                        under title XVIII) for services in the category 
                        designated Evaluation and Management in the 
                        Healthcare Common Procedure Coding System 
                        (established by the Secretary under section 
                        1848(c)(5) as of December 31, 2020, and as 
                        subsequently modified).
                            ``(ii) Counseling services, as defined by 
                        the Secretary.
                            ``(iii) Payment codes established by the 
                        Secretary for opioid use disorder treatment 
                        services under section 1866F.
                            ``(iv) Any other services the Secretary 
                        determines are necessary for the management or 
                        treatment of a patient with a diagnosis of 
                        substance use disorder.
                    ``(B) Patient with a diagnosis of substance use 
                disorder.--For purposes of subparagraph (A), the term 
                `patient with a diagnosis of substance use disorder' 
                means an individual who has been diagnosed with 1 or 
                more diagnosis codes within the code set entitled the 
                `Mental health and behavioral disorders due to 
                psychoactive substance use' under the 10th revision of 
                the International Statistical Classification of 
                Diseases and Related Health Problems.
                    ``(C) Regulations.--Not later than 90 days after 
                the enactment of this subsection, the Secretary shall 
                promulgate regulations regarding when services are 
                sufficiently related to part of the management or 
                treatment of a patient's substance use disorder.
            ``(2) Applicable professional.--The term `applicable 
        professional' means--
                    ``(A) a clinical psychologist (as defined for 
                purposes of section 1861(ii));
                    ``(B) a clinical social worker (as defined in 
                section 1861(hh)(1));
                    ``(C) a medical professional approved to furnish 
                medication-assisted treatment under section 303(g)(2) 
                of the Controlled Substances Act; or
                    ``(D) a medical professional that is authorized 
                under the State plan to furnish mental and behavioral 
                health services (as defined in paragraph (1)).''.
            (2) Managed care.--Section 1932(f) of such Act (42 U.S.C. 
        1396u-2(f)) is amended--
                    (A) in the subsection heading, by inserting ``and 
                Mental Health and Behavioral Health Services'' after 
                ``Care Services''; and
                    (B) by inserting before the period at the end the 
                following: ``, and, in the case of mental health and 
                behavioral health services described in section 
                1902(a)(13)(D), consistent with the minimum payment 
                rates specified in such section (regardless of the 
                manner in which such payments are made, including in 
                the form of capitation or partial capitation)''.
    (b) Increased FMAP for Additional Costs.--Section 1905 of the 
Social Security Act (42 U.S.C. 1396d) is amended--
            (1) in subsection (b), by striking ``and (ii)'' and 
        inserting ``(ii), and (jj)''; and
            (2) by adding at the end the following new subsection:
    ``(jj) Increased FMAP for Additional Expenditures for Mental Health 
and Behavioral Health Services.--
            ``(1) In general.--Notwithstanding subsection (b), with 
        respect to the portion of the amounts expended for medical 
        assistance for services described in section 1902(a)(13)(D) 
        furnished on or after October 1, 2021, and before October 1, 
        2025, that is attributable to the amount by which the minimum 
        payment rate required under such section (or, by application, 
        section 1932(f)) exceeds the payment rate applicable to such 
        services under the State plan or a waiver of such plan as of 
        July 1, 2021, the Federal medical assistance percentage for a 
        State shall be equal to 100 percent. The preceding sentence 
        shall not be construed as prohibiting the payment of Federal 
        financial participation based on the Federal medical assistance 
        percentage for the portion of the amounts expended for medical 
        assistance for such services that is attributable to the amount 
        (if any) by which the payment rate applicable to such services 
        under the State plan or waiver exceeds such minimum payment 
        rate.
            ``(2) Disregard of enhanced payments for purposes of 
        territorial limits.--The amount of any payment made for 
        expenditures on medical assistance that is attributable to the 
        application of the Federal medical assistance percentage 
        described in paragraph (1) shall not be taken into account for 
        purposes of applying payment limits under subsections (f) and 
        (g) of section 1108.''.

SEC. 10. CMI DEMONSTRATION TO TEST THE PROVISION OF RECOVERY HOUSING 
              FOR INDIVIDUALS WITH OPIOID USE DISORDER UNDER MEDICAID.

    Section 1115A of the Social Security Act (42 U.S.C. 1315a) is 
amended--
            (1) in subsection (b)(2)(A), by adding at the end the 
        following new sentence: ``The models selected under this 
        subparagraph shall include the demonstration described in 
        subsection (h) (which shall be implemented not later than 18 
        months after the date of enactment of such subsection).''; and
            (2) by adding at the end the following new subsection:
    ``(h) Demonstration To Test the Provision of Recovery Housing for 
Individuals With Opioid Use Disorder Under Medicaid.--
            ``(1) In general.--The CMI, in consultation with the 
        Department of Housing and Urban Development and other agencies, 
        as the Secretary determines appropriate, shall conduct a 
        demonstration project (referred to in this subsection as the 
        `demonstration') to test whether providing Medicaid managed 
        care entities with an elevated global capitated budget for 
        eligible Medicaid beneficiaries, paired with flexibilities to 
        allow States to provide medical assistance for recovery housing 
        for such beneficiaries, would result in reduced emergency 
        department visits, hospitalizations and program expenditures 
        under per beneficiary, or improve quality of care for the such 
        beneficiaries without increasing expenditures under the 
        Medicaid program under title XIX.
            ``(2) Demonstration requirements.--
                    ``(A) In general.--Under the demonstration, each 
                eligible State that is selected by the CMI to 
                participate in the demonstration shall enter into an 
                agreement with a Medicaid managed care entity under 
                which the entity agrees to provide services (including 
                recovery housing) to eligible Medicaid beneficiaries 
                under a payment model that meets the requirements of 
                subparagraph (B).
                    ``(B) Capitated payments.--
                            ``(i) In general.--The CMI shall establish 
                        a capitated payments system for Medicaid 
                        managed care entities under the demonstration 
                        that is based on the demonstration budget 
                        determined under clause (ii).
                            ``(ii) Demonstration budget.--
                                    ``(I) In general.--For purposes of 
                                clause (i), the demonstration budget of 
                                a Medicaid managed care entity for each 
                                year of a demonstration period shall be 
                                determined by the CMI based on the 
                                number of eligible Medicaid 
                                beneficiaries enrolled with the entity 
                                and the average annual spending under 
                                title XIX in the State involved on 
                                individuals who are enrolled in the 
                                State plan under such title (or a 
                                waiver of such plan) and who--
                                            ``(aa) have a diagnosis of 
                                        opioid use disorder;
                                            ``(bb) are in the top 
                                        quartile of per beneficiary 
                                        spending for such plan or 
                                        waiver for the most recent 
                                        year; and
                                            ``(cc) have attained age 21 
                                        but have not attained age 65.
                                    ``(II) Risk adjustment.--The CMI 
                                may adjust the demonstration budget 
                                determined for a Medicaid managed care 
                                entity and a year under this clause 
                                using a risk adjustment model selected 
                                by the CMI to account for differences 
                                in age and clinical conditions of the 
                                eligible Medicaid beneficiaries 
                                enrolled with the entity compared to 
                                the overall population upon which the 
                                demonstration budget is based.
                    ``(C) Selection of eligible states.--Not later than 
                1 year after the date of enactment of this subsection, 
                the CMI shall select not less than 2 eligible States to 
                participate in the demonstration.
            ``(3) Additional waiver authority.--In addition to the 
        authority described in subsection (d)(1), the Secretary may 
        waive such requirements of title XIX as necessary to carry out 
        the demonstration.
            ``(4) Definitions.--In this subsection:
                    ``(A) Eligible medicaid beneficiary.--The term 
                `eligible Medicaid beneficiary' means an individual 
                who--
                            ``(i) is eligible for medical assistance 
                        under a State plan under title XIX or a waiver 
                        of such a plan;
                            ``(ii) has a diagnosis of opioid use 
                        disorder;
                            ``(iii) does not have a permanent residence 
                        (as certified by the individual);
                            ``(iv) is currently receiving medication-
                        assisted treatment or completed a course of 
                        medication-assisted treatment during the 3-
                        month period preceding the individual's 
                        participation in the demonstration; and
                            ``(v) has attained age 21 but has not 
                        attained age 65.
                    ``(B) Eligible state.--
                            ``(i) In general.--The term `eligible 
                        State' means a State that--
                                    ``(I) makes medical assistance 
                                available to all individuals described 
                                in section 1902(a)(10)(A)(i)(VIII); and
                                    ``(II) agrees to participate in the 
                                demonstration.
                            ``(ii) Selection of eligible states.--In 
                        selecting eligible States to participate in the 
                        demonstration, the CMI shall give priority to 
                        States that are--
                                    ``(I) among the top 10 States in 
                                terms of highest per capita drug 
                                poisoning deaths in each of calendar 
                                years 2017, 2018, and 2019, based on 
                                the most recent data available from the 
                                Centers for Disease Control and 
                                Prevention; and
                                    ``(II) among the 10 States with the 
                                lowest physician reimbursement rates 
                                for services furnished under title XIX 
                                (as determined by the Secretary) in 
                                each of calendar years 2017, 2018, and 
                                2019.
                    ``(C) Managed care entity.--The term `managed care 
                entity' means a medicaid managed care organization 
                described in section 1932(a)(1)(B)(i).
                    ``(D) Recovery housing.--The term `recovery 
                housing' means a shared living environment free from 
                alcohol and illicit drug use and centered on peer 
                support and connection to services that promote 
                sustained recovery from substance use disorders.
                    ``(E) State.--The term `State' includes the 50 
                States and the District of Columbia.''.

SEC. 11. EXTENSION OF MEDICAID DELIVERY SYSTEM REFORM AND INCENTIVE 
              PAYMENT WAIVERS.

    (a) Extension of Waivers.--In the case of a Medicaid section 1115 
waiver described in subsection (b), not later than 60 days after the 
date of enactment of this Act, the Secretary of Health and Human 
Services shall--
            (1) extend the termination date for the waiver to December 
        31, 2026 (or such earlier date as the State conducting the 
        waiver may elect);
            (2) apply the same annual dollar allotment for the period 
        for which the waiver is extended under paragraph (1) as the 
        annual dollar allotment that applied to the waiver period in 
        effect on the date of enactment of this Act; and
            (3) allow any State with such a waiver to use funds 
        provided during the period for which the waiver is extended 
        under paragraph (1) to support the training of direct service 
        workers that provide home and community-based services.
    (b) Medicaid Section 1115 Waiver Described.--The Medicaid section 
1115 waiver described in this subsection is a waiver approved under 
section 1115 of the Social Security Act (42 U.S.C. 1315) relating to 
delivery system reform incentive payments that--
            (1) as of the date of enactment of this Act, is to 
        terminate on or before December 31, 2021;
            (2) was in effect as of January 1, 2019; and
            (3) was approved for any State that ranks in the top 
        quintile of all States in terms of the highest mean drug 
        overdose death rate per 100,000 residents for the most recent 
        3-year period preceding the date of enactment of this Act for 
        which data is available.

SEC. 12. SEPARATE AMBULATORY PAYMENT CLASSIFICATIONS (APC) CODES UNDER 
              THE MEDICARE HOSPITAL OUTPATIENT DEPARTMENT PROSPECTIVE 
              PAYMENT SYSTEM AND THE MEDICARE AMBULATORY SURGICAL 
              CENTER PAYMENT SYSTEM FOR SURGERIES UTILIZING NON-OPIOID 
              PAIN MANAGEMENT DRUGS.

    (a) Hospital Outpatient Department Prospective Payment System.--
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is 
amended--
            (1) in paragraph (2)(A), by striking ``the Secretary'' and 
        inserting ``subject to paragraph (23), the Secretary''; and
            (2) by adding at the end the following new paragraph:
            ``(23) Separate apcs for surgeries using non-opioid pain 
        management drugs.--
                    ``(A) In general.--In the case of covered OPD 
                services furnished on or after January 1, 2023, the 
                classification system developed under paragraph (2)(A) 
                shall provide for separate ambulatory payment 
                classification codes for--
                            ``(i) surgeries that utilize non-opioid 
                        drugs, including such drugs delivered using an 
                        external infusion pump and the delivery 
                        mechanisms necessary for the delivery of such 
                        drugs, to treat pain after the surgery; and
                            ``(ii) surgeries that utilize opioid drugs 
                        to treat pain after the surgery.
                    ``(B) Application.--For purposes of this paragraph, 
                the Secretary shall--
                            ``(i) treat any drug with a Food and Drug 
                        Administration indication for pain management 
                        during and after surgery that is also non-
                        opioid as a `non-opioid drug'; and
                            ``(ii) establish a clear definition for 
                        non-opioid pain management drugs that do not 
                        have a Food and Drug Administration indication 
                        for pain management during or after the 
                        surgery.''.
    (b) Ambulatory Surgical Center Payment System.--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, 2023, the payment system described in clause (i) shall 
provide for separate ambulatory payment classification codes for--
            ``(I) consistent with subsection (t)(23), surgeries that 
        utilize non-opioid drugs, including such drugs delivered using 
        an external infusion pump and the delivery mechanisms necessary 
        for the delivery of such drugs, to treat pain after the 
        surgery; and
            ``(II) surgeries that utilize opioid drugs to treat pain 
        after the surgery.''.

SEC. 13. EXPANDING DRUG-FREE COMMUNITIES SUPPORT GRANTS.

    Section 1032 of the Anti-Drug Abuse Act of 1988 (21 U.S.C. 1532) is 
amended--
            (1) in subsection (b)--
                    (A) in paragraph (3)--
                            (i) in subparagraph (A), by striking 
                        ``subparagraph (F)'' and inserting 
                        ``subparagraph (H)'';
                            (ii) by redesignating subparagraphs (D), 
                        (E), and (F) as subparagraphs (F), (G), and 
                        (H), respectively;
                            (iii) by inserting after subparagraph (C) 
                        the following:
                    ``(D) Subsequent additional grants.--Subject to 
                subparagraph (H), the Administrator may award a 
                subsequent additional grant to a grant recipient under 
                subparagraph (A), for each fiscal year during the 4-
                fiscal-year period following the fiscal year for which 
                the initial additional grant under subparagraph (A) is 
                awarded, in an amount not to exceed the amount of non-
                Federal funds, including in-kind contributions, raised 
                by the grant recipient for the fiscal year for which 
                the subsequent additional grant is awarded.
                    ``(E) Renewal grants.--Subject to subparagraph (H), 
                the Administrator may award a renewal grant to a grant 
                recipient under subparagraph (D), for the first fiscal 
                year following the 4-fiscal-year period for which the 
                subsequent additional grant under subparagraph (D) is 
                awarded, in an amount not to exceed the amount of non-
                Federal funds, including in-kind contributions, raised 
                by the grant recipient for the fiscal year for which 
                the renewal grant is awarded.''; and
                            (iv) in subparagraph (F), as so 
                        redesignated--
                                    (I) in the subparagraph heading, by 
                                striking ``renewal'' and inserting 
                                ``subsequent renewal''; and
                                    (II) in the matter preceding clause 
                                (i)--
                                            (aa) by striking ``clause 
                                        (iv)'' and inserting 
                                        ``subparagraph (H)'';
                                            (bb) by striking ``renewal 
                                        grant to a grant recipient 
                                        under this subparagraph'' and 
                                        inserting ``subsequent renewal 
                                        grant to a grant recipient 
                                        under subparagraph (E)''; and
                                            (cc) by striking ``initial 
                                        additional grant under 
                                        subparagraph (A)'' and 
                                        inserting ``renewal grant under 
                                        subparagraph (E)''; and
                    (B) in paragraph (4), by striking ``(3)(E)'' and 
                inserting ``(3)(G)'';
            (2) in subsection (d)--
                    (A) by striking ``In awarding'' and inserting the 
                following:
            ``(1) Priority for economically disadvantaged areas.--In 
        awarding''; and
                    (B) by adding at the end the following:
            ``(2) Priority for states demonstrating high mortality 
        rates relating to opioid use disorder.--
                    ``(A) Grants to more than 1 eligible coalition 
                representing a community.--In awarding grants under 
                subsection (b)(1)(B)(ii), the Administrator shall give 
                priority to eligible coalitions that serve 1 or more 
                communities in a State that has a high mortality rate 
                relating to opioid use disorder.
                    ``(B) Subsequent additional grants.--In awarding 
                subsequent additional grants under subsection 
                (b)(3)(D), the Administrator shall give priority to an 
                eligible coalition that serves 1 or more communities in 
                a State that has a high mortality rate relating to 
                opioid use disorder.''; and
            (3) by adding at the end the following:
    ``(e) Limitation on Subsequent Renewal Grants.--A recipient of a 
subsequent renewal grant awarded under subsection (b)(3)(F) may not be 
awarded any further grant under this section.''.

SEC. 14. SUPPORT FOR LAW ENFORCEMENT MENTAL HEALTH AND WELLNESS.

    There is authorized to be appropriated, and there is appropriated, 
out of any monies in the Treasury not otherwise appropriated, 
$10,000,000 for each of fiscal years 2021 through 2024 for grants under 
section 1701(b)(23) of title I of the Omnibus Crime Control and Safe 
Streets Act of 1968 (34 U.S.C. 10381(b)(23)) to establish peer 
mentoring mental health and wellness pilot programs within State, 
tribal, and local law enforcement agencies.
                                 <all>