Coordinating Substance Use and Homelessness Care Act of 2022
Bill: S.4482 | Sponsor: Sen. Padilla, Alex (D-CA)
Policy area: Housing and Community Development

Summary:
Coordinating Substance Use and Homelessness Care Act of 2022
This bill requires the Department of Housing and Urban Development to award competitive grants to improve coordination of health care and homelessness services for individuals who are homeless, have significant behavioral health issues (e.g., substance use disorders), and voluntarily seek assistance. Entities eligible for these grants include local and tribal governments, public housing agencies that administer housing choice vouchers, and certain nonprofits.

To help persons in the United States experiencing homelessness and 
     significant behavioral health issues, including substance use 
  disorders, by authorizing a grant program within the Department of 
 Housing and Urban Development to assist State and local governments, 
Continuums of Care, community-based organizations that administer both 
 health and homelessness services, and providers of services to people 
     experiencing homelessness, better coordinate health care and 
             homelessness services, and for other purposes.

    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 ``Coordinating Substance Use and 
Homelessness Care Act of 2022''.

SEC. 2. FINDINGS.

     Congress finds the following:
            (1) The United States has a homelessness crisis, with more 
        than 580,000 people experiencing homelessness on a single night 
        according to the Department of Housing and Urban Development's 
        2020 Annual Homeless Assessment Report to Congress.
            (2) While the lack of affordable housing is the primary 
        driver of homelessness, behavioral health conditions, including 
        substance use disorders, can exacerbate homelessness and can 
        also be a consequence of homelessness.
            (3) Research shows that people experiencing homelessness 
        have higher rates of substance use disorder than people with 
        housing stability. Some people who experience homelessness use 
        substances to cope with the trauma and deprivations of their 
        circumstances, but substance use disorders frequently make it 
        more difficult for people experiencing homelessness to secure 
        permanent housing.
            (4) Many individuals with substance use disorder who 
        experience homelessness have co-occurring illnesses. The 
        combined effect of physical illness, mental illness, and lack 
        of housing results in higher mortality rates for individuals 
        experiencing homelessness.
            (5) Safely and securely housing individuals who are 
        experiencing both homelessness and behavioral health issues, 
        including substance use disorders, often requires supportive 
        services and close coordination between housing and social 
        service providers, in addition to low-barrier, affordable 
        housing. Subsidized housing is critical, but not enough--access 
        to additional voluntary person-centered supportive services is 
        needed.
            (6) Nevertheless, it is imperative that when people 
        experiencing homelessness, including those with a behavioral 
        health condition such as substance use disorder, choose to seek 
        help that housing as well as health care and person-centered 
        supportive services be coordinated, particularly given their 
        acute needs and the significant costs incurred by communities 
        for law enforcement, correctional, and emergency department 
        care for failing to do so.
            (7) Providing access to health care and voluntary person-
        centered supportive services can be beneficial in securing and 
        successfully maintaining stable housing.
            (8) Integration of health and homelessness services to 
        achieve optimal outcomes for people experiencing homelessness, 
        significant behavioral health conditions such as substance use 
        disorder, and other health conditions can be challenging for 
        State and local governments, continuums of care, and community-
        based organizations that administer both health and 
        homelessness services and providers of homelessness services.
            (9) Capacity-building is needed to create systems-level 
        linkages between the 2 sets of services to allow for smoother 
        pathways and simpler navigation.
            (10) Black, Hispanic, and Indigenous people are 
        disproportionately underserved by person-centered supportive 
        services. In order to address critical services deficits and 
        affirmatively serve protected classes of people with 
        significant behavioral health conditions, including substance 
        use disorders, who are experiencing homelessness, the grant 
        program established under this Act can be used to build the 
        capacities of homelessness services providers that have 
        demonstrated cultural competencies in service provision and a 
        record of serving Black, Hispanic, and Indigenous people and 
        other underserved populations experiencing homelessness that 
        also suffer from substance use disorders.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Indian tribe; tribal organization.--The terms ``Indian 
        Tribe'' and ``Tribal organization''--
                    (A) have the meanings given those terms in section 
                4 of the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 5304); and
                    (B) include entities that serve Native Hawaiians, 
                as defined in section 338K(c) of the Public Health 
                Service Act (42 U.S.C. 254s(c)).
            (2) Person experiencing homelessness.--The term ``person 
        experiencing homelessness'' has the same meaning as the terms 
        ``homeless'', ``homeless individual'', and ``homeless person'', 
        as those terms are defined in the McKinney-Vento Homeless 
        Assistance Act (42 U.S.C. 11302).
            (3) Public housing agency.--The term ``public housing 
        agency'' has the meaning given the term in section 3(b) of the 
        United States Housing Act of 1937 (42 U.S.C. 1437a(b)).
            (4) Secretary.--The term ``Secretary'' means the Secretary 
        of Housing and Urban Development.
            (5) Substance use disorder.--The term ``substance use 
        disorder'' means the disorder that occurs when the recurrent 
        use of alcohol or drugs, or both, causes clinically significant 
        impairment, including health problems, disability, and failure 
        to meet major responsibilities at work, school, or home.
            (6) Tribally designated housing entity.--The term 
        ``tribally designated housing entity'' has the meaning given 
        the term in section 4 of the Native American Housing Assistance 
        and Self-Determination Act of 1996.

SEC. 4. ESTABLISHMENT OF GRANT PROGRAM.

    (a) In General.--The Secretary, in consultation with the working 
group established pursuant to subsection (b), shall establish a grant 
program to award competitive grants to eligible entities described in 
subsection (c)(4) to build or increase their capacities for the better 
coordination of health care and homelessness services for people who 
are experiencing homelessness and significant behavioral health issues, 
including substance use disorders, and are voluntarily seeking 
assistance.
    (b) Working Group.--
            (1) Establishment.--The Secretary shall establish an 
        interagency working group to provide advice to the Secretary in 
        carrying out the program under subsection (a).
            (2) Composition.--The working group established under 
        paragraph (1) shall include representatives from the Department 
        of Housing and Urban Development, the United States Interagency 
        Council on Homelessness, the Department of Health and Human 
        Services, the Department of Agriculture, and the Bureau of 
        Indian Affairs, to be appointed by the heads of those agencies.
            (3) Development of assistance tools.--Not later than 1 year 
        after the date of enactment of this Act, the working group 
        established under paragraph (1) shall--
                    (A) develop training, tools, and other technical 
                assistance materials that simplify homelessness 
                services for providers of health care and simplify 
                health care services for providers of homelessness 
                services by identifying the basic elements the health 
                and homelessness sectors need to understand about the 
                other; and
                    (B) circulate the materials described in 
                subparagraph (A) to interested entities, particularly 
                those that apply for grants awarded under this section.
    (c) Capacity-Building Grants.--
            (1) In general.--The Secretary shall award 5-year grants to 
        eligible entities described in paragraph (4), which shall be 
        used only to build or increase their capacities to coordinate 
        health care and homelessness services.
            (2) Prohibition.--None of the proceeds from the grants 
        awarded pursuant to this Act may be used to pay for--
                    (A) health care, with the exception of efforts to 
                increase the availability of Naloxone and provide 
                training for its administration; or
                    (B) rent.
            (3) Amount.--The amount awarded to an entity under a grant 
        under this section shall not exceed $500,000.
            (4) Eligibility.--To be eligible to receive a grant under 
        this subsection an entity shall--
                    (A) be--
                            (i) a governmental entity at the county, 
                        city, regional, or locality level;
                            (ii) an Indian Tribe, a tribally designated 
                        housing entity, or a Tribal organization;
                            (iii) a public housing agency administering 
                        housing choice vouchers; or
                            (iv) a continuum of care or nonprofit 
                        organization designated by the continuum of 
                        care;
                    (B) be responsible for homelessness services;
                    (C) provide such assurances as the Secretary shall 
                require that, in carrying out activities with amounts 
                from the grant, the entity will ensure that services 
                are culturally competent, meet the needs of the people 
                being served, and follow trauma-informed best practices 
                to address those needs using a harm reduction approach; 
                and
                    (D) demonstrate how the capacity of the entity to 
                coordinate health care and homelessness services to 
                better serve people experiencing homelessness and 
                significant behavioral health issues, including 
                substance use disorders, can be increased through--
                            (i) the designation of a governmental 
                        official as a coordinator for making 
                        connections between health and homelessness 
                        services and developing a strategy for using 
                        those services in a holistic way to help people 
                        experiencing homelessness and behavioral health 
                        conditions such as substance use disorders, 
                        including those with cooccurring conditions;
                            (ii) improvements in infrastructure at the 
                        systems level;
                            (iii) improvements in technology for 
                        voluntary remote monitoring capabilities, 
                        including internet and video, which can allow 
                        for more home- and community-based behavioral 
                        health care services and ensure those 
                        improvements maintain effective communication 
                        requirements for persons with disabilities and 
                        program access for persons with limited English 
                        proficiency;
                            (iv) improvements in connections to health 
                        care services delivered by providers 
                        experienced in behavioral health care and 
                        people experiencing homelessness;
                            (v) efforts to increase the availability of 
                        Naloxone and provide training for its 
                        administration; and
                            (vi) any additional activities identified 
                        by the Secretary that will advance the 
                        coordination of homelessness assistance, 
                        housing, and substance use services and other 
                        health care services.
            (5) Eligible activities.--An eligible entity receiving a 
        grant under this section may use the grant to cover costs 
        related to--
                    (A) hiring system coordinators; and
                    (B) administrative costs, including staffing costs, 
                technology costs, and other such costs identified by 
                the Secretary.
            (6) Distribution of funds.--An eligible entity receiving a 
        grant under this section may distribute all or a portion of the 
        grant amounts to private nonprofit organizations, other 
        government entities, public housing agencies, tribally 
        designated housing entities, or other entities as determined by 
        the Secretary to carry out programs and activities in 
        accordance with this section.
            (7) Oversight requirements.--
                    (A) Annual reports.--Not later than 6 years after 
                the date on which grant amounts are first received by 
                an eligible entity under this section, the entity shall 
                submit to the Secretary a report on the activities 
                carried out under the grant, which shall include, with 
                respect to activities carried out with grant amounts in 
                the community served--
                            (i) measures of outcomes relating to 
                        whether people experiencing homelessness and 
                        significant behavioral health issues, including 
                        substance use disorders, who sought help from 
                        the entity--
                                    (I) were housed and did not 
                                experience intermittent periods of 
                                homelessness;
                                    (II) were voluntarily enrolled in 
                                treatment and recovery programs;
                                    (III) experienced improvements in 
                                their health;
                                    (IV) obtained access to specific 
                                primary care providers; and
                                    (V) have health care plans that 
                                meet their individual needs, including 
                                access to mental health and substance 
                                use disorder treatment and recovery 
                                services;
                            (ii) how grant funds were used; and
                            (iii) any other matters determined 
                        appropriate by the Secretary.
                    (B) Rule of construction.--Nothing in this 
                subsection may be construed to condition the receipt of 
                future housing and other services by individuals 
                assisted with activities and services provided with 
                grant amounts on the outcomes detailed in the reports 
                submitted under this paragraph.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $20,000,000 for each of fiscal 
years 2022 through 2027, of which not less than 5 percent of such funds 
shall be awarded to Indian Tribes, tribally designated housing 
entities, and Tribal organizations.
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