Title: Comprehensive Addiction Resources Emergency Act of 2018
Policy area: Health

Summary:
Comprehensive Addiction Resources Emergency Act of 2018
This bill establishes a series of grant programs to assist localities with addressing the opioid epidemic, such as through prevention and treatment services, training centers, and research activities.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2700 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  2d Session
                                S. 2700

To provide emergency assistance to States, territories, Tribal nations, 
 and local areas affected by the opioid epidemic and to make financial 
  assistance available to States, territories, Tribal nations, local 
  areas, and public or private nonprofit entities to provide for the 
    development, organization, coordination, and operation of more 
  effective and cost efficient systems for the delivery of essential 
services to individuals with substance use disorder and their families.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 18, 2018

  Ms. Warren introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To provide emergency assistance to States, territories, Tribal nations, 
 and local areas affected by the opioid epidemic and to make financial 
  assistance available to States, territories, Tribal nations, local 
  areas, and public or private nonprofit entities to provide for the 
    development, organization, coordination, and operation of more 
  effective and cost efficient systems for the delivery of essential 
services to individuals with substance use disorder and their families.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Comprehensive 
Addiction Resources Emergency Act of 2018''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Purpose.
Sec. 3. Amendment to the Public Health Service Act.
        ``TITLE XXXIV--SUBSTANCE USE AND OPIOID HEALTH RESOURCES

 ``Subtitle A--Substance Use and Opioid Emergency Relief Grant Program

        ``Sec. 3401. Establishment of program of grants.
        ``Sec. 3402. Planning council.
        ``Sec. 3403. Amount of grant and use of amounts.
        ``Sec. 3404. Application.
        ``Sec. 3405. Technical assistance.
        ``Sec. 3406. Authorization of appropriations.
 ``Subtitle B--State and Tribal Substance Use Disorder Prevention and 
                       Intervention Grant Program

        ``Sec. 3411. Establishment of program of grants.
        ``Sec. 3412. Amount of grant and use of amounts.
        ``Sec. 3413. Application and limitation.
        ``Sec. 3414. Technical assistance.
        ``Sec. 3415. Authorization of appropriations.
                   ``Subtitle C--Other Grant Program

        ``Sec. 3421. Establishment of grant program.
        ``Sec. 3422. Use of amounts.
        ``Sec. 3423. Technical assistance.
        ``Sec. 3424. Planning and development grants.
        ``Sec. 3425. Authorization of appropriations.
                 ``Subtitle D--Miscellaneous Provisions

        ``Sec. 3431. Special projects of national significance.
        ``Sec. 3432. Education and training centers.
        ``Sec. 3433. Other provisions.
        ``Sec. 3434. Standards for substance use disorder treatment and 
                            recovery facilities.
        ``Sec. 3435. Naloxone distribution program.
        ``Sec. 3436. Additional funding for the National Institutes of 
                            Health.
        ``Sec. 3437. Additional funding for improved data collection 
                            and prevention of infectious disease 
                            transmission.
        ``Sec. 3438. Definitions.
Sec. 4. Amendments to the Controlled Substances Act.

SEC. 2. PURPOSE.

    It is the purpose of this Act to provide emergency assistance to 
States, territories, Tribal nations, and local areas that are 
disproportionately affected by the opioid epidemic and to make 
financial assistance available to States, territories, Tribal nations, 
local areas, and other public or private nonprofit entities to provide 
for the development, organization, coordination, and operation of more 
effective and cost efficient systems for the delivery of essential 
services to individuals and families with substance use disorder.

SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

        ``TITLE XXXIV--SUBSTANCE USE AND OPIOID HEALTH RESOURCES

 ``Subtitle A--Substance Use and Opioid Emergency Relief Grant Program

``SEC. 3401. ESTABLISHMENT OF PROGRAM OF GRANTS.

    ``(a) In General.--The Secretary, in coordination with the Director 
of the Office of National Drug Control Policy, shall award grants to 
eligible localities for the purpose of addressing substance use within 
such localities.
    ``(b) Eligibility.--
            ``(1) In general.--To be eligible to receive a grant under 
        subsection (a) a locality shall--
                    ``(A) be--
                            ``(i) a county that can demonstrate that 
                        the rate of drug overdose deaths per 100,000 
                        individuals residing in the county during the 
                        most recent 3-year period for which such data 
                        are available was not less than the rate of 
                        such deaths for the county that ranked at the 
                        67th percentile of all counties, as determined 
                        by the Secretary;
                            ``(ii) a county that can demonstrate that 
                        the number of drug overdose deaths during the 
                        most recent 3-year period for which such data 
                        are available was not less than the number of 
                        such deaths for the county that ranked at the 
                        90th percentile of all counties, as determined 
                        by the Secretary; or
                            ``(iii) a city that is located within a 
                        county described in clause (i) or (ii), that 
                        meets the requirements of paragraph (3); and
                    ``(B) submit to the Secretary an application in 
                accordance with section 3404.
            ``(2) Multiple contiguous counties.--In the case of an 
        eligible county that is contiguous to one or more other 
        eligible counties within the same State, the group of counties 
        shall--
                    ``(A) be considered as a single eligible county for 
                purposes of a grant under this section;
                    ``(B) submit a single application under section 
                3404;
                    ``(C) form a joint planning council (for the 
                purposes of section 3402); and
                    ``(D) establish, through intergovernmental 
                agreements, an administrative mechanism to allocate 
                funds and substance use disorder treatment services 
                under the grant based on--
                            ``(i) the number and rate of drug overdose 
                        deaths and nonfatal drug overdoses in each of 
                        the counties that compose the eligible county;
                            ``(ii) the severity of need for services in 
                        each such county; and
                            ``(iii) the health and support personnel 
                        needs of each such county.
            ``(3) Cities and counties within multiple contiguous 
        counties.--
                    ``(A) In general.--A city that is within an 
                eligible county described in paragraph (1), or a group 
                of counties that is within a group of counties 
                determined to be an eligible county under paragraph 
                (2), shall be eligible to receive a grant under section 
                3401 if such city or county or group of counties meets 
                the requirements of subparagraph (B).
                    ``(B) Requirements.--A city or county meets the 
                requirements of this subparagraph if such city or 
                county--
                            ``(i) except as provided in subparagraph 
                        (C), has a population of not less than 50,000 
                        residents;
                            ``(ii) meets the requirements of paragraph 
                        (1)(A);
                            ``(iii) submits an application under 
                        section 3404;
                            ``(iv) establishes a planning council (for 
                        purposes of section 3402); and
                            ``(v) establishes an administrative 
                        mechanism to allocate funds and services under 
                        the grant based on--
                                    ``(I) the number and rate of drug 
                                overdose deaths and nonfatal drug 
                                overdoses in the city or county;
                                    ``(II) the severity of need for 
                                substance use disorder treatment 
                                services in the city or county; and
                                    ``(III) the health and support 
                                personnel needs of the city or county.
                    ``(C) Population exception.--A city or county or 
                group of counties that does not meet the requirements 
                of subparagraph (B)(i) may apply to the Secretary for a 
                waiver of such requirement. Such application shall 
                demonstrate--
                            ``(i) that the needs of the population to 
                        be served are distinct or that addressing 
                        substance use in the service area would be best 
                        served by the formation of an independent 
                        council; and
                            ``(ii) that the city or county or group of 
                        counties has the capacity to administer the 
                        funding received under this subtitle.
                    ``(D) Minimum funding.--A city or county that meets 
                the requirement of this paragraph and receives a grant 
                under section 3401 shall be entitled to an amount of 
                funding under the grant in an amount that is not less 
                than the amount determined under section 3403(a) with 
                respect to such city or county.
            ``(4) Independent city.--Independent cities that are not 
        located within the territory of a county shall be treated as 
        eligible counties for purposes of this subtitle.
            ``(5) Political subdivisions.--With respect to States that 
        do not have a local county system of governance, the Secretary 
        shall determine the local political subdivisions within such 
        States that are eligible to receive a grant under section 3401 
        and such subdivisions shall be treated as eligible counties for 
        purposes of this subtitle.
            ``(6) Determinations where there is a lack of data.--The 
        Secretary shall establish eligibility and allocation criteria 
        related to the prevalence of drug overdose deaths, the 
        mortality rate from drug overdoses, and that provides an 
        equivalent measure of need for funding for cities and counties 
        for which the data described in paragraph (1)(A) or (2)(D)(i) 
        is not available.
            ``(7) Study.--Not later than 3 years after the date of 
        enactment of this title, the Comptroller General shall conduct 
        a study to determine whether the data utilized for purposes of 
        paragraph (1)(A) provides the most precise measure of local 
        area need related to substance use and addiction prevalence and 
        whether additional data would provide more precise measures of 
        substance use and addiction prevalence in local areas. Such 
        study shall identify barriers to collecting or analyzing such 
        data, and make recommendations for revising the indicators used 
        under such paragraph to determine eligibility in order to 
        direct funds to the local areas in most need of funding to 
        provide assistance related to substance use and addiction.
            ``(8) Reference.--For purposes of this subtitle, the term 
        `eligible local area' includes--
                    ``(A) a city or county described in paragraph (1);
                    ``(B) multiple contiguous counties described in 
                paragraph (2);
                    ``(C) an independent locality described in 
                paragraph (3);
                    ``(D) an independent city described in paragraph 
                (4); and
                    ``(E) a political subdivision described in 
                paragraph (5).
    ``(c) Administration.--
            ``(1) In general.--Assistance made available under a grant 
        awarded under this section shall be directed to the chief 
        elected official of the eligible local area who shall 
        administer the grant funds.
            ``(2) Multiple contiguous counties.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), in the case of an eligible county 
                described in subsection (b)(2), assistance made 
                available under a grant awarded under this section 
                shall be directed to the chief elected official of the 
                particular county designated in the application 
                submitted for the grant under section 3404. Such chief 
                elected official shall be the administrator of the 
                grant.
                    ``(B) State administration.--Notwithstanding 
                subparagraph (A), the eligible county described in 
                subsection (b)(2) may elect to designate the chief 
                elected State official of the State in which the 
                eligible county is located as the administrator of the 
                grant funds.

``SEC. 3402. PLANNING COUNCIL.

    ``(a) Establishment.--To be eligible to receive a grant under 
section 3401, the chief elected official of the eligible local area 
shall establish or designate a substance use disorder treatment and 
services planning council that shall, to the maximum extent 
practicable--
            ``(1) be representative of the demographics of the 
        population of individuals with substance use disorder in the 
        area; and
            ``(2) include representatives of--
                    ``(A) health care providers, including federally 
                qualified health centers, rural health clinics, Indian 
                health programs as defined in section 4 of the Indian 
                Health Care Improvement Act, urban Indian organizations 
                as defined in section 4 of the Indian Health Care 
                Improvement Act, Native Hawaiian organizations as 
                defined in section 12 of the Native Hawaiian Health 
                Care Act of 1988, and facilities operated by the 
                Department of Veterans Affairs;
                    ``(B) community-based health, harm reduction, or 
                addiction service organizations, including, where 
                applicable, representatives of Drug Free Communities 
                Coalition grantees;
                    ``(C) social service providers, including providers 
                of housing and homelessness services and recovery 
                residence providers;
                    ``(D) mental health care providers;
                    ``(E) local public health agencies;
                    ``(F) law enforcement officials, including 
                officials from High Intensity Drug Trafficking Area 
                program, where applicable;
                    ``(G) affected communities, including individuals 
                with substance use disorder or a history of substance 
                use disorder, including individuals in recovery from 
                substance use disorders;
                    ``(H) State governments, including the State 
                Medicaid agency and the Single State Agency for 
                Substance Abuse Services;
                    ``(I) local governments;
                    ``(J) non-elected community leaders;
                    ``(K) substance use disorder treatment providers;
                    ``(L) Indian tribes and tribal organizations as 
                defined in section 4 of the Indian Self-Determination 
                and Education Assistance Act;
                    ``(M) urban Indians as defined in section 4 of the 
                Indian Health Care Improvement Act;
                    ``(N) historically underserved groups and 
                subpopulations;
                    ``(O) individuals who were formerly incarcerated;
                    ``(P) organizations serving individuals who are 
                currently or were formerly incarcerated;
                    ``(Q) representatives of Federal agencies;
                    ``(R) representatives of organizations that provide 
                services to youth at risk of substance use;
                    ``(S) representatives of medical examiners or 
                coroners;
                    ``(T) representatives of labor unions and the 
                workplace community; and
                    ``(U) representatives of local fire departments and 
                emergency medical services.
    ``(b) Method of Providing for Council.--
            ``(1) In general.--In providing for a council for purposes 
        of subsection (a), the chief elected official of the eligible 
        local area may establish the council directly or designate an 
        existing entity to serve as the council, subject to paragraph 
        (2).
            ``(2) Consideration regarding designation of council.--In 
        making a determination of whether to establish or designate a 
        council under paragraph (1), the chief elected official shall 
        give priority to the designation of an existing entity that has 
        demonstrated experience in the provision of health and support 
        services to individuals with substance use disorder within the 
        eligible local area, that has a structure that recognizes the 
        Federal trust responsibility when spending Federal health care 
        dollars, and that has demonstrated a commitment to respecting 
        the obligation of government agencies using Federal dollars to 
        consult with Indian tribes and confer with Urban Indian health 
        programs.
            ``(3) Joint council.--The Secretary shall establish a 
        process to permit an eligible local area that is not contiguous 
        with any other eligible local area to form a joint planning 
        council with such other eligible local area or areas, as long 
        as such areas are located in geographical proximity to each 
        other, as determined by the Secretary, and submit a joint 
        application under section 3404.
            ``(4) Joint council across state lines.--Eligible local 
        areas may form a joint planning council with other eligible 
        local areas across State lines if such areas are located in 
        geographical proximity to each other, as determined by the 
        Secretary, submit a joint application under section 3404, and 
        establish intergovernmental agreements to allow the 
        administration of the grant across State lines.
    ``(c) Membership.--Members of the planning council established or 
designated under subsection (a) shall--
            ``(1) be nominated and selected through an open process;
            ``(2) elect from among their membership a chair and vice 
        chair;
            ``(3) include at least one representative from Indian 
        tribes located within any eligible local area that receives 
        funding under the grant program established in section 3401; 
        and
            ``(4) serve no more than 3 consecutive years on the 
        planning council.
    ``(d) Membership Terms.--Members of the planning council 
established or designated under subsection (a) may serve additional 
terms if nominated and selected through the process established in 
subsection (c)(1).
    ``(e) Duties.--The planning council established or designated under 
subsection (a) shall--
            ``(1) establish priorities for the allocation of grant 
        funds within the eligible local area that emphasize reducing 
        drug overdose and substance use disorder through evidence-based 
        interventions in both community and criminal justice settings 
        and that are based on--
                    ``(A) the use by the grantee of substance use 
                disorder treatment and intervention strategies that 
                comply with best practices identified by the Secretary;
                    ``(B) the demonstrated or probable cost-
                effectiveness of proposed substance use disorder 
                treatment services;
                    ``(C) the health priorities of the communities 
                within the eligible local area that are affected by 
                substance use;
                    ``(D) the priorities and needs of individuals with 
                substance use disorder; and
                    ``(E) the availability of other governmental and 
                nongovernmental services;
            ``(2) ensure the use of grant funds are consistent with any 
        existing State or local plan regarding the provision of 
        substance use disorder treatment services to individuals with 
        substance use disorder;
            ``(3) in the absence of a State or local plan, work with 
        local public health agencies to develop a comprehensive plan 
        for the organization and delivery of substance use disorder 
        treatment services;
            ``(4) regularly assess the efficiency of the administrative 
        mechanism in rapidly allocating funds to support evidence-based 
        substance use disorder treatment services in the areas of 
        greatest need within the eligible local area;
            ``(5) work with local public health agencies to determine 
        the size and demographics of the population of individuals with 
        substance use disorders and the types of substance use that are 
        most prevalent in the eligible local area;
            ``(6) work with local public health agencies to determine 
        the needs of such population, including the need for substance 
        use disorder treatment services;
            ``(7) work with local public agencies to determine the 
        disparities in access to services among affected subpopulations 
        and historically underserved communities, including 
        infrastructure and capacity shortcomings of providers that 
        contribute to these disparities;
            ``(8) work with local public agencies to establish methods 
        for obtaining input on community needs and priorities, 
        including by partnering with organizations that serve targeted 
        communities experiencing high opioid related health disparities 
        to gather data using culturally attuned data collection 
        methodologies;
            ``(9) coordinate with Federal grantees that provide 
        substance use disorder treatment services within the eligible 
        local area; and
            ``(10) annually assess the effectiveness of the substance 
        use disorder treatment services being supported by the grant 
        received by the eligible local area, including--
                    ``(A) reductions in the rates of overdose and death 
                from substance use disorders;
                    ``(B) rates of discontinuation from substance use 
                disorder treatment services;
                    ``(C) long-term outcomes among individuals 
                receiving treatment for substance use disorders; and
                    ``(D) the availability of substance use disorder 
                treatment services needed by individuals with substance 
                use disorders over their lifetimes.
    ``(f) Conflicts of Interest.--
            ``(1) In general.--The planning council under subsection 
        (a) may not be directly involved in the administration of a 
        grant under section 3401.
            ``(2) Required agreements.--An individual may serve on the 
        planning council under subsection (a) only if the individual 
        agrees that if the individual has a financial interest in an 
        entity, if the individual is an employee of a public or private 
        entity, or if the individual is a member of a public or private 
        organization, and such entity or organization is seeking 
        amounts from a grant under section 3401, the individual will 
        not, with respect to the purpose for which the entity seeks 
        such amounts, participate (directly or in an advisory capacity) 
        in the process of selecting entities to receive such amounts 
        for such purpose.
    ``(g) Grievance Procedures.--A planning council under subsection 
(a) shall develop procedures for addressing grievances with respect to 
funding under this subtitle, including procedures for submitting 
grievances that cannot be resolved to binding arbitration. Such 
procedures shall be described in the by-laws of the planning council.
    ``(h) Public Deliberations.--With respect to a planning council 
under subsection (a), in accordance with criteria established by the 
Secretary, the following applies:
            ``(1) The meetings of the council shall be open to the 
        public and shall be held only after adequate notice to the 
        public.
            ``(2) The records, reports, transcripts, minutes, agenda, 
        or other documents which were made available to or prepared for 
        or by the council shall be available for public inspection and 
        copying at a single location.
            ``(3) Detailed minutes of each meeting of the council shall 
        be kept. The accuracy of all minutes shall be certified to by 
        the chair of the council.
            ``(4) This subparagraph does not apply to any disclosure of 
        information of a personal nature that would constitute a 
        clearly unwarranted invasion of personal privacy, including any 
        disclosure of medical information or personnel matters.

``SEC. 3403. AMOUNT OF GRANT AND USE OF AMOUNTS.

    ``(a) Amount of Grant.--
            ``(1) Grants based on relative need of area.--
                    ``(A) In general.--In carrying out this subtitle, 
                the Secretary shall make a grant for each eligible 
                local area for which an application under section 3404 
                has been approved. Each such grant shall be made in an 
                amount determined in accordance with paragraph (3).
                    ``(B) Expedited distribution.--Not later than 90 
                days after an appropriation becomes available to carry 
                out this subtitle for a fiscal year, the Secretary 
                shall disburse 53 percent of the amount made available 
                under section 3406 for carrying out this subtitle for 
                such fiscal year through grants to eligible local areas 
                under section 3401, in accordance with subparagraphs 
                (C) and (D).
                    ``(C) Amount.--
                            ``(i) In general.--Subject to the extent of 
                        amounts made available in appropriations Acts, 
                        a grant made for purposes of this subparagraph 
                        to an eligible local area shall be made in an 
                        amount equal to the product of--
                                    ``(I) an amount equal to the amount 
                                available for distribution under 
                                subparagraph (B) for the fiscal year 
                                involved; and
                                    ``(II) the percentage constituted 
                                by the ratio of the distribution factor 
                                for the eligible local area to the sum 
                                of the respective distribution factors 
                                for all eligible local areas;
                        which product shall then, as applicable, be 
                        increased under subparagraph (D).
                            ``(ii) Distribution factor.--For purposes 
                        of clause (i)(II), the term `distribution 
                        factor' means--
                                    ``(I) an amount equal to--
                                            ``(aa) the estimated number 
                                        of drug overdose deaths in the 
                                        eligible local area, as 
                                        determined under clause (iii); 
                                        or
                                            ``(bb) the estimated number 
                                        of non-fatal drug overdoses in 
                                        the eligible local area, as 
                                        determined under clause (iv);
                                as determined by the Secretary based on 
                                which distribution factor (item (aa) or 
                                (bb)) will result in the eligible local 
                                area receiving the greatest amount of 
                                funds; or
                                    ``(II) in the case of an eligible 
                                local area for which the data described 
                                in subclause (I) is not available, an 
                                amount determined by the Secretary--
                                            ``(aa) based on other data 
                                        the Secretary determines 
                                        appropriate; and
                                            ``(bb) that is related to 
                                        the prevalence of non-fatal 
                                        drug overdoses, drug overdose 
                                        deaths, and the mortality rate 
                                        from drug overdoses and 
                                        provides an equivalent measure 
                                        of need for funding.
                            ``(iii) Number of drug overdose deaths.--
                        The number of drug overdose deaths determined 
                        under this clause for an eligible county for a 
                        fiscal year for purposes of clause (ii) is the 
                        number of drug overdose deaths during the most 
                        recent 3-year period for which such data are 
                        available.
                            ``(iv) Number of non-fatal drug 
                        overdoses.--The number of non-fatal drug 
                        overdose deaths determined under this clause 
                        for an eligible county for a fiscal year for 
                        purposes of clause (ii) may be determined by 
                        using data including emergency department 
                        syndromic data, visits, or other emergency 
                        medical services for drug-related causes during 
                        the most recent 3-year period for which such 
                        data are available.
                            ``(v) Study.--Not later than 3 years after 
                        the date of enactment of this title, the 
                        Comptroller General shall conduct a study to 
                        determine whether the data utilized for 
                        purposes of clause (ii) provide the most 
                        precise measure of local area need related to 
                        substance use and addiction prevalence in local 
                        areas and whether additional data would provide 
                        more precise measures of substance use and 
                        addiction prevalence in local areas. Such study 
                        shall identify barriers to collecting or 
                        analyzing such data, and make recommendations 
                        for revising the distribution factors used 
                        under such clause to determine funding levels 
                        in order to direct funds to the local areas in 
                        most need of funding to provide substance use 
                        disorder treatment services.
                            ``(vi) Reductions in amounts.--If a local 
                        area that is an eligible local area for a year 
                        loses such eligibility in a subsequent year 
                        based on the failure to meet the requirements 
                        of section 3401(b)(1)(A), such area will remain 
                        eligible to receive--
                                    ``(I) for such subsequent year, an 
                                amount equal to 80 percent of the 
                                amount received under the grant in the 
                                previous year; and
                                    ``(II) for the second such 
                                subsequent year, an amount equal to 50 
                                percent of the amount received in the 
                                such previous year.
            ``(2) Supplemental grants.--
                    ``(A) In general.--The Secretary shall disburse the 
                remainder of amounts not disbursed under paragraph (1) 
                for such fiscal year for the purpose of making grants 
                to cities and counties whose application under section 
                3404--
                            ``(i) contains a report concerning the 
                        dissemination of emergency relief funds under 
                        paragraph (1) and the plan for utilization of 
                        such funds, if applicable;
                            ``(ii) demonstrates the need in such local 
                        area, on an objective and quantified basis, for 
                        supplemental financial assistance to combat 
                        substance use disorder;
                            ``(iii) demonstrates the existing 
                        commitment of local resources of the area, both 
                        financial and in-kind, to combating substance 
                        use disorder;
                            ``(iv) demonstrates the ability of the area 
                        to utilize such supplemental financial 
                        resources in a manner that is immediately 
                        responsive and cost effective;
                            ``(v) demonstrates that resources will be 
                        allocated in accordance with the local 
                        demographic incidence of substance use 
                        disorders and drug overdose mortality;
                            ``(vi) demonstrates the inclusiveness of 
                        affected communities and individuals with 
                        substance use disorders, including those 
                        communities and individuals that are 
                        disproportionately affected or historically 
                        underserved;
                            ``(vii) demonstrates the manner in which 
                        the proposed services are consistent with the 
                        local needs assessment and the statewide 
                        coordinated statement of need required in 
                        section 3413(e);
                            ``(viii) demonstrates success in 
                        identifying individuals with substance use 
                        disorders; and
                            ``(ix) demonstrates that support for 
                        substance use disorder treatment services is 
                        organized to maximize the value to the 
                        population to be served with an appropriate mix 
                        of substance use disorder treatment services 
                        and attention to transition in care.
                    ``(B) Amount.--
                            ``(i) In general.--The amount of each grant 
                        made for purposes of this paragraph shall be 
                        determined by the Secretary. In making such 
                        determination, the Secretary shall consider--
                                    ``(I) the rate of drug overdose 
                                deaths per 100,000 population in the 
                                eligible local area; and
                                    ``(II) the increasing need for 
                                substance use disorder treatment 
                                services, including relative rates of 
                                increase in the number of drug 
                                overdoses or drug overdose deaths, 
                                recent increases in drug overdoses or 
                                drug overdose deaths since data was 
                                provided under section 3401(b), if 
                                applicable.
                            ``(ii) Demonstrated need.--The factors 
                        considered by the Secretary in determining 
                        whether a local area has a demonstrated need 
                        for purposes of clause (i)(II) may include any 
                        or all of the following:
                                    ``(I) The unmet need for substance 
                                use disorder treatment services, 
                                including factors identified in 
                                subparagraph (B)(i)(II).
                                    ``(II) Relative rates of increase 
                                in the number of drug overdoses or drug 
                                overdose deaths.
                                    ``(III) The relative rates of 
                                increase in the number of drug 
                                overdoses or drug overdose deaths 
                                within new or emerging subpopulations.
                                    ``(IV) The current prevalence of 
                                substance use disorders.
                                    ``(V) Relevant factors related to 
                                the cost and complexity of delivering 
                                substance use disorder treatment 
                                services to individuals in the eligible 
                                local area.
                                    ``(VI) The impact of co-morbid 
                                factors, including co-occurring 
                                conditions, determined relevant by the 
                                Secretary.
                                    ``(VII) The prevalence of 
                                homelessness among individuals with 
                                substance use disorders.
                                    ``(VIII) The relevant factors that 
                                limit access to health care, including 
                                geographic variation, adequacy of 
                                health insurance coverage, and language 
                                barriers.
                                    ``(IX) The impact of a decline in 
                                the amount received pursuant to 
                                paragraph (1) on substance use disorder 
                                treatment services available to all 
                                individuals with substance use 
                                disorders identified and eligible under 
                                this subtitle.
                                    ``(X) The increasing incidence in 
                                conditions related to substance use, 
                                including hepatitis C, human 
                                immunodeficiency virus, hepatitis B and 
                                other infections associated with 
                                injection drug use.
                    ``(C) Application of provisions.--A local area that 
                receives a grant under this paragraph--
                            ``(i) shall use amounts received in 
                        accordance with subsection (b);
                            ``(ii) shall not have to meet the eligible 
                        criteria in section 3401(b); and
                            ``(iii) shall not have to establish a 
                        planning council under section 3402.
            ``(3) Amount of grant to tribal governments.--
                    ``(A) Indian tribes.--In this section, the term 
                `Indian tribe' has the meaning given such term in 
                section 4 of the Indian Self-Determination and 
                Education Assistance Act.
                    ``(B) Formula grants.--The Secretary, acting 
                through the Indian Health Service, shall use 10 percent 
                of the amount available under section 3406 for each 
                fiscal year to provide formula grants to Indian tribes 
                disproportionately affected by substance use, in an 
                amount determined pursuant to a formula and eligibility 
                criteria developed by the Secretary in consultation 
                with Indian tribes, for the purposes of addressing 
                substance use.
                    ``(C) Use of amounts.--Notwithstanding any 
                requirements in this section, an Indian tribe may use 
                amounts provided under grants awarded under this 
                paragraph for the uses identified in subsection (b) and 
                any other activities determined appropriate by the 
                Secretary, in consultation with Indian tribes.
    ``(b) Use of Amounts.--
            ``(1) Requirements.--The Secretary may not make a grant 
        under section 3401 to an eligible local area unless the chief 
        elected official of the area agrees that--
                    ``(A) the allocation of funds and services within 
                the area under the grant will be made in accordance 
                with the priorities established by the substance use 
                disorder treatment services planning council; and
                    ``(B) funds provided under this grant will be 
                expended for--
                            ``(i) prevention services described in 
                        paragraph (3);
                            ``(ii) core medical services described in 
                        paragraph (4);
                            ``(iii) recovery and support services 
                        described in paragraph (5);
                            ``(iv) early intervention and engagement 
                        services described in paragraph (6);
                            ``(v) harm reduction services described in 
                        paragraph (7);
                            ``(vi) financial assistance with health 
                        insurance described in paragraph (8); and
                            ``(vii) administrative expenses described 
                        in paragraph (10).
            ``(2) Direct financial assistance.--
                    ``(A) In general.--An eligible local area shall use 
                amounts received under a grant under section 3401 to 
                provide direct financial assistance to eligible 
                entities for the purpose of providing prevention 
                services, core medical services, recovery and support 
                services, harm reduction services, and early 
                intervention and engagement services.
                    ``(B) Appropriate entities.--Direct financial 
                assistance may be provided under subparagraph (A) to 
                public or nonprofit private entities, or private for-
                profit entities if such entities are the only available 
                provider of quality substance use disorder treatment 
                services in the area.
            ``(3) Prevention services.--
                    ``(A) In general.--For purposes of this subsection, 
                the term `prevention services' means services, 
                programs, or multi-sector strategies to prevent 
                substance use disorder (such as evidence-based 
                education campaigns, community-based prevention 
                programs, opioid diversion, collection and disposal or 
                unused opioids, and services to at-risk populations).
                    ``(B) Limit.--An eligible local area may use not to 
                exceed 20 percent of the amount of the grant under 
                section 3401 for prevention services. An eligible local 
                area may apply to the Secretary for a waiver of this 
                subparagraph.
            ``(4) Core medical services.--For purposes of this 
        subsection, the term `core medical services' means the 
        following evidence-based services provided to individuals with 
        substance use disorder or at risk for developing substance use 
        disorder:
                    ``(A) Substance use disorder treatments, including 
                clinical stabilization services, withdrawal management 
                and detoxification, intensive inpatient treatment, 
                intensive outpatient treatment, all forms of Federally-
                approved medication-assisted treatment, outpatient 
                treatment, and residential recovery treatment.
                    ``(B) Outpatient and ambulatory health services, 
                including those administered by Federally qualified 
                health centers and rural health clinics.
                    ``(C) Hospice services.
                    ``(D) Mental health services.
                    ``(E) Naloxone procurement, distribution, and 
                training.
                    ``(F) Pharmaceutical assistance and diagnostic 
                testing related to the management of substance-use 
                disorders a co-morbid conditions.
                    ``(G) Home and community based health services.
                    ``(H) Comprehensive Case Management, including 
                substance use disorder treatment adherence services.
                    ``(I) Health insurance enrollment and cost-sharing 
                assistance in accordance with paragraph (8).
            ``(5) Recovery and support services.--For purposes of 
        paragraph (1)(B)(ii), the term `recovery and support services' 
        means services, subject to the approval of the Secretary, that 
        are provided to individuals with substance use disorder, 
        including residential recovery treatment and housing, including 
        for individuals receiving medication-assisted treatment, long 
        term recovery services, 24/7 hotline crisis center support, 
        medical transportation services, respite care for persons 
        caring for individuals with substance use disorder, child care 
        and family services while an individual is receiving inpatient 
        treatment services or at the time of outpatient services, 
        outreach services, peer recovery services, nutrition services, 
        and referrals for job training and career services, housing, 
        legal services, and child care and family services.
            ``(6) Early intervention and engagement services.--For 
        purposes of this section, the term `early intervention and 
        engagement services' means services to provide rapid access to 
        substance use disorder treatment, counseling provided to 
        individuals who have misused substances, who have experienced 
        an overdose, or are at risk of developing substance use 
        disorder, and the provision of referrals to facilitate the 
        access of such individuals to core medical services or recovery 
        and support services. The entities through which such services 
        may be provided include emergency rooms, fire departments and 
        emergency medical services, detention facilities, homeless 
        shelters, law enforcement agencies, health care points of entry 
        specified by eligible local areas, Federally qualified health 
        centers, and rural health clinics.
            ``(7) Harm reduction services.--For purposes of this 
        section, the term `harm reduction services' means evidence-
        based services provided to individuals engaging in substance 
        use that reduce the risk of infectious disease transmission, 
        overdose, or death, including by increasing access to health 
        care.
            ``(8) Affordable health insurance coverage.--An eligible 
        local area may use amounts provided under a grant awarded under 
        section 3401 to establish a program of financial assistance to 
        assist eligible individuals with substance use disorder in--
                    ``(A) enrolling in health insurance coverage; or
                    ``(B) affording health care services, including 
                assistance paying cost-sharing amounts, including 
                premiums.
            ``(9) Requirement of status as medicaid provider.--
                    ``(A) Provision of service.--Subject to paragraph 
                (2), the Secretary may not make a grant under section 
                3401 for the provision of substance use disorder 
                treatment services under this section in an eligible 
                local area unless, in the case of any such service that 
                is available pursuant to the State plan approved under 
                title XIX of the Social Security Act for the State--
                            ``(i) the political subdivision involved 
                        will provide the service directly, and the 
                        political subdivision has entered into a 
                        participation agreement under the State plan 
                        and is qualified to receive payments under such 
                        plan; or
                            ``(ii) the eligible local area involved 
                        will enter into an agreement with a public or 
                        nonprofit private entity under which the entity 
                        will provide the service, and the entity has 
                        entered into such a participation agreement and 
                        is qualified to receive such payments.
                    ``(B) Waiver.--
                            ``(i) In general.--In the case of an entity 
                        making an agreement pursuant to subparagraph 
                        (A)(ii) regarding the provision of substance 
                        use disorder treatment services, the 
                        requirement established in such subparagraph 
                        shall be waived by the substance use planning 
                        council for the area involved if the entity 
                        does not, in providing health care services, 
                        impose a charge or accept reimbursement 
                        available from any third-party payor, including 
                        reimbursement under any insurance policy or 
                        under any Federal or State health benefits 
                        program.
                            ``(ii) Determination.--A determination by 
                        the substance use planning council of whether 
                        an entity referred to in clause (i) meets the 
                        criteria for a waiver under such clause shall 
                        be made without regard to whether the entity 
                        accepts voluntary donations for the purpose of 
                        providing services to the public.
            ``(10) Administration and planning.--An eligible local area 
        shall not use in excess of 10 percent of amounts received under 
        a grant under section 3401 for administration, accounting, 
        reporting, and program oversight functions, including the 
        development of systems to improve data collection and data 
        sharing.
            ``(11) Incarcerated individuals.--Amounts received under a 
        grant under section 3401 may be used to provide substance use 
        disorder treatment services to currently incarcerated 
        individuals.

``SEC. 3404. APPLICATION.

    ``(a) In General.--To be eligible to receive a grant under section 
3401, an eligible local area shall prepare and submit to the Secretary 
an application in such form, and containing such information, as the 
Secretary shall require, including--
            ``(1) a complete accounting of the disbursement of any 
        prior grants received under this subtitle by the applicant and 
        the results achieved through such disbursements;
            ``(2) a demonstration of the extent of local need for the 
        funds under the grant and a plan for proposed substance use 
        disorder treatment services that is consistent with local 
        needs, including a comprehensive plan for the use of the grant 
        funds developed by the planning council established under 
        section 3402, except that the planning council requirement 
        shall not apply with respect to areas receiving supplemental 
        grant funds under section 3403(a)(2);
            ``(3) a demonstration that the area will use funds in a 
        manner that provides substance use disorder treatment services 
        compliant with the evidence-based standards developed in 
        accordance with section 3434, including all forms of Federally-
        approved medication-assisted treatments;
            ``(4) information on the number of individuals likely to be 
        served by the funds sought, including demographic data on the 
        populations to be served;
            ``(5) key outcomes that will be measured by all entities 
        that receive assistance, as well as an explanation of how the 
        outcomes will be measured;
            ``(6) a demonstration that resources provided under the 
        grant will be allocated in accordance with the local 
        demographic incidence of substance use, including allocations 
        for services for children, youths, and women;
            ``(7) a demonstration that funds received from a grant 
        under this subtitle in any prior year were expended in 
        accordance with the priorities established by the planning 
        council;
            ``(8) a demonstration that at least one representative from 
        Indian tribes located within any eligible local area are 
        included in the membership of a planning council;
            ``(9) a demonstration that the confidentiality of 
        individuals receiving substance use disorder treatment services 
        will be maintained in a manner not inconsistent with applicable 
        law; and
            ``(10) an explanation of how income, asset, and medical 
        expense criteria will be established and applied to those who 
        qualify for assistance under the program under this subtitle.
    ``(b) Assurances.--To be eligible to receive a grant under section 
3401, the application submitted by the eligible local area shall 
include assurances adequate to ensure--
            ``(1) that funds received under the grant will be utilized 
        to supplement not supplant other State or local funds made 
        available in the year for which the grant is awarded to provide 
        substance use disorder treatment services;
            ``(2) that the political subdivisions within the eligible 
        local area will maintain the level of expenditures by such 
        political subdivisions for substance use-related services at a 
        level that is equal to the level of such expenditures by such 
        political subdivisions for the preceding fiscal year;
            ``(3) that political subdivisions within the eligible local 
        area will not use funds received under a grant awarded under 
        section 3401 in maintaining the level of substance use disorder 
        treatment services as required in paragraph (2);
            ``(4) that substance use disorder treatment services 
        provided with assistance made available under the grant will be 
        provided without regard--
                    ``(A) to the ability of the individual to pay for 
                such services; and
                    ``(B) to the current or past health condition of 
                the individual to be served;
            ``(5) that substance use disorder treatment services will 
        be provided in a setting that is accessible to low-income 
        individuals with substance use disorder, and to individuals 
        with substance use disorder residing in rural areas;
            ``(6) that a program of outreach will be provided to low-
        income individuals with substance use disorder to inform such 
        individuals of substance use disorder treatment services, and 
        to individuals with substance use disorder residing in rural 
        areas; and
            ``(7) that funds received under a grant awarded under this 
        subtitle will not be utilized to make payments for any item or 
        service to the extent that payment has been made, or can 
        reasonably be expected to be made, with respect to that item or 
        service under any State compensation program, under an 
        insurance policy, or under any Federal or State health benefits 
        program (except for a program administered by, or providing the 
        services of, the Indian Health Service).
    ``(c) Requirements Regarding Imposition of Charges for Services.--
            ``(1) In general.--The Secretary may not make a grant under 
        section 3401 to an eligible local area unless the eligible 
        local area provides assurances that in the provision of 
        substance use disorder treatment services with assistance 
        provided under the grant--
                    ``(A) in the case of individuals with an income 
                less than or equal to 138 percent of the official 
                poverty level, the provider will not impose charges on 
                any such individual for the services provided under the 
                grant;
                    ``(B) in the case of individuals with an income 
                greater than 138 percent of the official poverty level, 
                the provider will impose a charge on each such 
                individual according to a schedule of charges made 
                available to the public;
                    ``(C) in the case of individuals with an income 
                greater than 138 percent of the official poverty level 
                but not exceeding 200 percent of such poverty level, 
                the provider will not, for an calendar year, impose 
                charges in an amount exceeding 5 percent of the annual 
                gross income of the individual;
                    ``(D) in the case of individuals with an income 
                greater than 200 percent of the official poverty level 
                but not exceeding 300 percent of such poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 7 percent of the annual 
                gross income of the individual involved;
                    ``(E) in the case of individuals with an income 
                greater than 300 percent of the official poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 15 percent of the annual 
                gross income of the individual involved; and
                    ``(F) in the case of eligible American Indian and 
                Alaska Native individuals as defined by section 447.50 
                of title 42, Code of Federal Regulations (as in effect 
                on July 1, 2010), the provider will not impose any 
                charges for substance use disorder treatment services, 
                including any charges or cost-sharing prohibited by 
                section 1402(d) of the Patient Protection and 
                Affordable Care Act.
            ``(2) Charges.--With respect to compliance with the 
        assurances made under paragraph (1), an eligible local area 
        may, in the case of individuals subject to a charge--
                    ``(A) assess the amount of the charge in the 
                discretion of the area, including imposing only a 
                nominal charge for the provision of substance use 
                disorder treatment services, subject to the provisions 
                of the paragraph regarding public schedules and 
                regarding limitations on the maximum amount of charges; 
                and
                    ``(B) take into consideration the total medical 
                expenses of individuals in assessing the amount of the 
                charge, subject to such provisions.
            ``(3) Aggregate charges.--The Secretary may not make a 
        grant under section 3401 to an eligible local area unless the 
        area agrees that the limitations on charges for substance use 
        disorder treatment services under this subsection applies to 
        the annual aggregate of charges imposed for such services, 
        however the charges are characterized, includes enrollment 
        fees, premiums, deductibles, cost sharing, co-payments, co-
        insurance costs, or any other charges.
    ``(d) Indian Tribes.--Any application requirements for grants 
distributed in accordance with section 3403(a)(3) shall be developed by 
the Secretary in consultation with Indian tribes.

``SEC. 3405. TECHNICAL ASSISTANCE.

    ``The Secretary shall, beginning on the date of enactment of this 
title, provide technical assistance, including assistance from other 
grantees, contractors or subcontractors under this title to assist 
newly eligible local areas in the establishment of planning councils 
and, to assist entities in complying with the requirements of this 
subtitle in order to make such areas eligible to receive a grant under 
this subtitle. The Secretary may make planning grants available to 
eligible local areas, in an amount not to exceed $75,000 for any area, 
that is projected to be eligible for funding under section 3401 in the 
following fiscal year. Such grant amounts shall be deducted from the 
first year formula award to eligible local areas accepting such grants.

``SEC. 3406. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this 
subtitle--
            ``(1) $2,700,000,000 for fiscal year 2019;
            ``(2) $2,700,000,000 for fiscal year 2020;
            ``(3) $2,700,000,000 for fiscal year 2021;
            ``(4) $2,700,000,000 for fiscal year 2022;
            ``(5) $2,700,000,000 for fiscal year 2023;
            ``(6) $2,700,000,000 for fiscal year 2024;
            ``(7) $2,700,000,000 for fiscal year 2025;
            ``(8) $2,700,000,000 for fiscal year 2026;
            ``(9) $2,700,000,000 for fiscal year 2027; and
            ``(10) $2,700,000,000 for fiscal year 2028.

 ``Subtitle B--State and Tribal Substance Use Disorder Prevention and 
                       Intervention Grant Program

``SEC. 3411. ESTABLISHMENT OF PROGRAM OF GRANTS.

    ``The Secretary, acting in coordination with the Director of the 
Office of National Drug Control Policy, shall award grants to States, 
territories, and tribal governments for the purpose of addressing 
substance use within such States.

``SEC. 3412. AMOUNT OF GRANT AND USE OF AMOUNTS.

    ``(a) Amount of Grant to States and Territories.--
            ``(1) In general.--
                    ``(A) Expedited distribution.--Not later than 90 
                days after an appropriation becomes available, the 
                Secretary shall disburse 50 percent of the amount made 
                available under section 3415 for carrying out this 
                subtitle for such fiscal year through grants to States 
                under section 3411, in accordance with subparagraphs 
                (B) and (C).
                    ``(B) Minimum allotment.--Subject to the amount 
                made available under section 3415, the amount of a 
                grant under section 3411 for--
                            ``(i) each of the 50 States, the District 
                        of Columbia, and Puerto Rico for a fiscal year 
                        shall be the greater of--
                                    ``(I) $2,000,000; or
                                    ``(II) an amount determined under 
                                the subparagraph (C); and
                            ``(ii) each territory other than Puerto 
                        Rico for a fiscal year shall be the greater 
                        of--
                                    ``(I) $500,000; or
                                    ``(II) an amount determined under 
                                the subparagraph (C).
                    ``(C) Determination.--
                            ``(i) Formula.--For purposes of 
                        subparagraph (B), the amount referred to in 
                        this subparagraph for a State (including a 
                        territory) for a fiscal year is--
                                    ``(I) an amount equal to the amount 
                                made available under section 3415 for 
                                the fiscal year involved for grants 
                                pursuant to subparagraph (B); and
                                    ``(II) the percentage constituted 
                                by the sum of--
                                            ``(aa) the product of 0.85 
                                        and the ratio of the State 
                                        distribution factor for the 
                                        State or territory to the sum 
                                        of the respective distribution 
                                        factors for all States; and
                                            ``(bb) the product of 0.15 
                                        and the ratio of the non-local 
                                        distribution factor for the 
                                        State or territory (as 
                                        determined under clause (iv)) 
                                        to the sum of the respective 
                                        non-local distribution factors 
                                        for all States or territories.
                            ``(ii) State distribution factor.--For 
                        purposes of clause (i)(II)(aa), the term `State 
                        distribution factor' means an amount equal to--
                                    ``(I) the estimated number of drug 
                                overdose deaths in the State, as 
                                determined under clause (iii); or
                                    ``(II) the number of non-fatal drug 
                                overdoses in the State, as determined 
                                under clause (iv);
                        as determined by the Secretary based on which 
                        distribution factor (subclause (I) or (II)) 
                        will result in the State receiving the greatest 
                        amount of funds.
                            ``(iii) Number of drug overdoses.--For 
                        purposes of clause (ii), the number of drug 
                        overdose deaths determined under this clause 
                        for a State for a fiscal year is the number of 
                        drug overdose deaths during the most recent 3-
                        year period for which such data are available.
                            ``(iv) Number of non-fatal drug 
                        overdoses.--For purposes of clause (ii), the 
                        number of non-fatal drug overdose deaths 
                        determined under this clause for State for a 
                        fiscal year for purposes of clause (ii) may be 
                        determined by using data including emergency 
                        department syndromic data, visits, or other 
                        emergency medical services for drug-related 
                        causes during the most recent 3-year period for 
                        which such data are available.
                            ``(v) Non-local distribution factors.--For 
                        purposes of clause (i)(II)(bb), the term `non-
                        local distribution factor' means an amount 
                        equal to the sum of--
                                    ``(I) the number of drug overdoses 
                                deaths in the State involved, as 
                                determined under clause (iii), or the 
                                number of non-fatal drug overdoses in 
                                the State, based on the criteria used 
                                by the State under clause (ii); less
                                    ``(II) the total number of drug 
                                overdose deaths or non-fatal drug 
                                overdoses that are within areas in such 
                                State or territory that are eligible 
                                counties under section 3401.
                            ``(vi) Study.--Not later than 3 years after 
                        the date of enactment of this title, the 
                        Comptroller General shall conduct a study to 
                        determine whether the data utilized for 
                        purposes of clause (ii) provides the most 
                        precise measure of State need related to 
                        substance use and addiction prevalence and 
                        whether additional data would provide more 
                        precise measures the levels of substance use 
                        and addiction prevalent in States. Such study 
                        shall identify barriers to collecting or 
                        analyzing such data, and make recommendations 
                        for revising the distribution factors used 
                        under such clause to determine funding levels 
                        in order to direct funds to the States in most 
                        need of funding to provide substance use 
                        disorder treatment services.
            ``(2) Supplemental grants.--
                    ``(A) In general.--Subject to subparagraph (C), the 
                Secretary shall disburse the remainder of amounts not 
                disbursed under paragraph (1) for such fiscal year for 
                the purpose of making grants to States whose 
                application--
                            ``(i) contains a report concerning the 
                        dissemination of emergency relief funds under 
                        paragraph (1) and the plan for utilization of 
                        such funds;
                            ``(ii) demonstrates the need in such State, 
                        on an objective and quantified basis, for 
                        supplemental financial assistance to combat 
                        substance use disorder;
                            ``(iii) demonstrates the existing 
                        commitment of local resources of the State, 
                        both financial and in-kind, to combating 
                        substance use disorder;
                            ``(iv) demonstrates the ability of the 
                        State to utilize such supplemental financial 
                        resources in a manner that is immediately 
                        responsive and cost effective;
                            ``(v) demonstrates that resources will be 
                        allocated in accordance with the local 
                        demographic incidence of substances use 
                        disorders and drug overdose mortality;
                            ``(vi) demonstrates the inclusiveness of 
                        affected communities and individuals with 
                        substance use disorders, including those 
                        communities and individuals that are 
                        disproportionately affected or historically 
                        underserved;
                            ``(vii) demonstrates the manner in which 
                        the proposed services are consistent with the 
                        local needs assessment and the statewide 
                        coordinated statement of need required under 
                        section 3413(e);
                            ``(viii) demonstrates success in 
                        identifying individuals with substance use 
                        disorders; and
                            ``(ix) demonstrates that support for 
                        substance use disorder treatment services is 
                        organized to maximize the value to the 
                        population to be served with an appropriate mix 
                        of substance use disorder treatment services 
                        and attention to transition in care.
                    ``(B) Amount.--
                            ``(i) In general.--The amount of each grant 
                        made for purposes of this paragraph shall be 
                        determined by the Secretary. In making such 
                        determination, the Secretary shall consider:
                                    ``(I) the rate of drug overdose 
                                deaths per 100,000 population in the 
                                State; and
                                    ``(II) the increasing need for 
                                substance use disorder treatment 
                                services, including relative rates of 
                                increase in the number of drug 
                                overdoses or drug overdose deaths, or 
                                recent increases in drug overdoses or 
                                drug overdose deaths since the data was 
                                reported under section 3413.
                            ``(ii) Demonstrated need.--The factors 
                        considered by the Secretary in determining 
                        whether a State has a demonstrated need for 
                        purposes of subparagraph (A)(ii) may include 
                        any or all of the following:
                                    ``(I) The unmet need for such 
                                services, including the factors 
                                identified in clause (i)(II).
                                    ``(II) Relative rates of increase 
                                in the number of drug overdoses or drug 
                                overdose deaths.
                                    ``(III) The relative rates of 
                                increase in the number of drug deaths 
                                within new or emerging subpopulations.
                                    ``(IV) The current prevalence of 
                                substance use disorders.
                                    ``(V) Relevant factors related to 
                                the cost and complexity of delivering 
                                substance use disorder treatment 
                                services to individuals in the State.
                                    ``(VI) The impact of co-morbid 
                                factors, including co-occurring 
                                conditions, determined relevant by the 
                                Secretary.
                                    ``(VII) The prevalence of 
                                homelessness among individuals with 
                                substance use disorder.
                                    ``(VIII) The relevant factors that 
                                limit access to health care, including 
                                geographic variation, adequacy of 
                                health insurance coverage, and language 
                                barriers.
                                    ``(IX) The impact of a decline in 
                                the amount received pursuant to 
                                paragraph (1) on substance use disorder 
                                treatment services available to all 
                                individuals with substance use 
                                disorders identified and eligible under 
                                this subtitle.
                                    ``(X) The increasing incidence in 
                                conditions related to substance use, 
                                including hepatitis C, human 
                                immunodeficiency virus, hepatitis B and 
                                other infections associated with 
                                injection drug use.
                    ``(C) Model standards.--
                            ``(i) Preference.--In determining whether a 
                        State will receive funds under this paragraph, 
                        except as provided in clause (ii), the 
                        Secretary shall give preference to States that 
                        have adopted the model standards developed in 
                        accordance with section 3434.
                            ``(ii) Requirement.--Effective beginning in 
                        fiscal year 2025, the Secretary shall not award 
                        a grant under this paragraph to a State unless 
                        that State has adopted the model standards 
                        developed in accordance with section 3434.
            ``(3) Amount of grant to tribal governments.--
                    ``(A) Indian tribes.--In this section, the term 
                `Indian tribe' has the meaning given such term in 
                section 4 of the Indian Self-Determination and 
                Education Assistance Act.
                    ``(B) Formula grants.--The Secretary, acting 
                through the Indian Health Service, shall use 10 percent 
                of the amount available under section 3415 for each 
                fiscal year to provide formula grants to Indian tribes 
                in an amount determined pursuant to a formula and 
                eligibility criteria developed by the Secretary in 
                consultation with Indian tribes, for the purposes of 
                addressing substance use.
                    ``(C) Use of amounts.--Notwithstanding any 
                requirements in this section, an Indian tribe may use 
                amounts provided under grants awarded under this 
                paragraph for the uses identified in subsection (b) and 
                any other activities determined appropriate by the 
                Secretary, in consultation with Indian tribes.
    ``(b) Use of Amounts.--
            ``(1) In general.--A State may use amounts provided under 
        grants awarded under section 3411 for--
                    ``(A) prevention services described in paragraph 
                (2);
                    ``(B) core medical services described in paragraph 
                (3);
                    ``(C) recovery and support services described in 
                paragraph (4);
                    ``(D) early intervention and engagement services 
                described in paragraph (5);
                    ``(E) harm reduction services described in 
                paragraph (6); and
                    ``(F) administrative expenses described in 
                paragraph (8).
            ``(2) Prevention services.--
                    ``(A) In general.--For purposes of this subsection, 
                the term `prevention services' means services, 
                programs, or multi-sector strategies to prevent 
                substance use disorder (including evidence-based 
                education campaigns, community-based prevention 
                programs, opioid diversion, collection and disposal of 
                unused opioids, and services to at-risk populations).
                    ``(B) Limit.--A State may use not to exceed 20 
                percent of the amount of the grant under section 3411 
                for prevention services. A State may apply to the 
                Secretary for a waiver of this subparagraph.
            ``(3) Core medical services.--For purposes of this 
        subsection, the term `core medical services' means the 
        following evidence-based services when provided to individuals 
        with substance use disorder or at risk for developing substance 
        use disorder:
                    ``(A) Substance use disorder treatments, including 
                clinical stabilization services, withdrawal management 
                and detoxification, intensive inpatient treatment, 
                intensive outpatient treatment, all forms of Federally-
                approved medication-assisted treatment, outpatient 
                treatment, and residential recovery treatment.
                    ``(B) Outpatient and ambulatory health services, 
                including those administered by Federally qualified 
                health centers and rural health clinics.
                    ``(C) Hospice services.
                    ``(D) Mental health services.
                    ``(E) Naloxone procurement, distribution, and 
                training.
                    ``(F) Pharmaceutical assistance related to the 
                management of substance-use disorders and co-morbid 
                conditions.
                    ``(G) Home and community based health services.
                    ``(H) Comprehensive Case Management and care 
                coordination, including treatment adherence services.
                    ``(I) Health insurance enrollment and cost-sharing 
                assistance in accordance with subsection (e).
            ``(4) Recovery and support services.--For purposes of 
        paragraph (1)(C), the term `recovery and support services' 
        means services, subject to the approval of the Secretary, that 
        are provided to individuals with substance use disorder, 
        including residential recovery treatment and housing, including 
        for individuals receiving medication-assisted treatment, long 
        term recovery services, 24/7 hotline crisis center services, 
        medical transportation services, respite care for persons 
        caring for individuals with substance use disorder, child care 
        and family services while an individual is receiving inpatient 
        treatment services or at the time of outpatient services, 
        outreach services, peer recovery services, nutrition services, 
        and referrals for job training and career services, housing, 
        legal services, and child care and family services.
            ``(5) Early intervention and engagement services.--For 
        purposes of this subsection, the term `early intervention and 
        engagement services' means services to provide rapid access to 
        substance use disorder treatment services, counseling provided 
        to individuals who have misused substances, who have 
        experienced an overdose, or are at risk of developing substance 
        use disorder, and the provision of referrals to facilitate the 
        access of such individuals to core medical services or recovery 
        and support services. The entities through which such services 
        may be provided include emergency rooms, fire departments and 
        emergency medical services, detention facilities, homeless 
        shelters, law enforcement agencies, health care points of entry 
        specified by eligible areas, Federally qualified health 
        centers, and rural health clinics.
            ``(6) Harm reduction services.--For purposes of this 
        subsection, the term `harm reduction services' means evidence-
        based services provided to individuals engaging in substance 
        use disorder that reduce the risk of infectious disease 
        transmission, overdose, or death, including by increasing 
        access to health care.
            ``(7) Affordable health insurance coverage.--A State may 
        use amounts provided under a grant awarded under section 3411 
        to establish a program of financial assistance to assist 
        eligible individuals with substance use disorder in--
                    ``(A) enrolling in health insurance coverage; or
                    ``(B) affording health care services, including 
                assistance paying cost-sharing amounts, including 
                premiums.
            ``(8) Administration and planning.--A State shall not use 
        in excess of 10 percent of amounts received under a grant under 
        section 3411 for administration, accounting, reporting, and 
        program oversight functions, including the development of 
        systems to improve data collection and data sharing.
            ``(9) Incarcerated individuals.--Amounts received under a 
        grant under section 3411 may be used to provide substance use 
        disorder treatment services to currently incarcerated 
        individuals.

``SEC. 3413. APPLICATION AND LIMITATION.

    ``(a) Application.--To be eligible to receive a grant under section 
3411, a State shall prepare and submit to the Secretary an application 
in such form, and containing such information, as the Secretary shall 
require, including--
            ``(1) a complete accounting of the disbursement of any 
        prior grants received under this subtitle by the applicant and 
        the results achieved by these expenditures;
            ``(2) a comprehensive plan for the use of the grant, 
        including a demonstration of the extent of local need for the 
        funds sought and a plan for proposed substance use disorder 
        treatment services that is consistent with local needs;
            ``(3) a demonstration that the State will use funds in a 
        manner that provides substance use disorder treatment services 
        compliant with the evidence-based standards developed in 
        accordance with section 3434, including all Federally-approved 
        medication-assisted treatments;
            ``(4) information on the number of individuals likely to be 
        served by the funds sought, including demographic data on the 
        populations to be served;
            ``(5) an identification of key outcomes that will be 
        measured by all entities that receive assistance, as well as an 
        explanation of how the outcomes will be measured;
            ``(6) a demonstration that resources provided under the 
        grant will be allocated in accordance with the local 
        demographic incidence of substance use, including allocations 
        for services for children, youths, and women;
            ``(7) a demonstration that funds received from a grant 
        under this subtitle in any prior year were expended in 
        accordance with State priorities;
            ``(8) a demonstration that the confidentiality of 
        individuals receiving substance use disorder treatment services 
        will be maintained in a manner not inconsistent with applicable 
        law; and
            ``(9) an explanation of how income, asset, and medical 
        expense criteria will be established and applied to those who 
        qualify for assistance under the program.
    ``(b) Assurances.--To be eligible to receive a grant under section 
3401, the application submitted by an eligible State shall include 
assurances adequate to ensure--
            ``(1) that funds received under the grant will be utilized 
        to supplement not supplant other State or local funds made 
        available in the year for which the grant is awarded to provide 
        substance use disorder treatment services to individuals with 
        substance use disorder;
            ``(2) that the political subdivisions within the State will 
        maintain the level of expenditures by such political 
        subdivisions for substance use disorder treatment services at a 
        level that is equal to the level of such expenditures by such 
        political subdivisions for the preceding fiscal year;
            ``(3) that political subdivisions within the State will not 
        use funds received under a grant awarded under section 3411 in 
        maintaining the level of substance use disorder treatment 
        services as required in paragraph (2);
            ``(4) that substance use disorder treatment services 
        provided with assistance made available under the grant will be 
        provided without regard--
                    ``(A) to the ability of the individual to pay for 
                such services; and
                    ``(B) to the current or past health condition of 
                the individual to be served;
            ``(5) that substance use disorder treatment services will 
        be provided in a setting that is accessible to low-income 
        individuals with substance use disorders and to individuals 
        with substance use disorders residing in rural areas;
            ``(6) that a program of outreach will be provided to low-
        income individuals with substance use disorders to inform such 
        individuals of substance use disorder treatment services and to 
        individuals with substance use disorders residing in rural 
        areas;
            ``(7) that Indian tribes are included in planning for the 
        use of grant funds and that the Federal trust responsibility is 
        upheld at all levels of program administration; and
            ``(8) that funds received under a grant awarded under this 
        section will not be utilized to make payments for any item or 
        service to the extent that payment has been made, or can 
        reasonably be expected to be made, with respect to that item or 
        service under a State compensation program, under an insurance 
        policy, or under any Federal or State health benefits program 
        (except for a program administered by or providing the services 
        of the Indian Health Service).
    ``(c) Medicaid IMD Waiver Application Requirement.--A State shall 
not be eligible to receive a grant under this subtitle for a fiscal 
year unless the State--
            ``(1) has in effect for the year a waiver under section 
        1115 of the Social Security Act (42 U.S.C. 1315) to provide 
        medical assistance under the State plan under title XIX of such 
        Act to individuals who--
                    ``(A) have not attained age 65 (or, if the State 
                provides the medical assistance described in section 
                1905(a)(16) of such Act, have attained age 21 but have 
                not attained age 65);
                    ``(B) are patients in an institution for mental 
                diseases; and
                    ``(C) are eligible for medical assistance under the 
                State plan; or
            ``(2) has submitted an application for the year for such a 
        waiver.
    ``(d) Requirements Regarding Imposition of Charges for Services.--
            ``(1) In general.--The Secretary may not make a grant under 
        section 3411 to a State unless the State provides assurances 
        that in the provision of services with assistance provided 
        under the grant--
                    ``(A) in the case of individuals with an income 
                less than or equal to 138 percent of the official 
                poverty level, the provider will not impose charges on 
                any such individual for the services provided under the 
                grant;
                    ``(B) in the case of individuals with an income 
                greater than 138 percent of the official poverty level, 
                the provider will impose a charge on each such 
                individual according to a schedule of charges made 
                available to the public;
                    ``(C) in the case of individuals with an income 
                greater than 138 percent of the official poverty level 
                but not exceeding 200 percent of such poverty level, 
                the provider will not, for an calendar year, impose 
                charges in an amount exceeding 5 percent of the annual 
                gross income of the individual;
                    ``(D) in the case of individuals with an income 
                greater than 200 percent of the official poverty level 
                but not exceeding 300 percent of such poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 7 percent of the annual 
                gross income of the individual involved;
                    ``(E) in the case of individuals with an income 
                greater than 300 percent of the official poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 15 percent of the annual 
                gross income of the individual involved; and
                    ``(F) in the case of eligible American Indian and 
                Alaska Native individuals as defined by section 447.50 
                of title 42, Code of Federal Regulations (as in effect 
                on July 1, 2010), the provider will not impose any 
                charges for substance use disorder treatment services, 
                including any charges or cost-sharing prohibited by 
                section 1402(d) of the Patient Protection and 
                Affordable Care Act.
            ``(2) Charges.--With respect to compliance with the 
        assurances made under paragraph (1), a State may, in the case 
        of individuals subject to a charge--
                    ``(A) assess the amount of the charge in the 
                discretion of the State, including imposing only a 
                nominal charge for the provision of services, subject 
                to the provisions of the paragraph regarding public 
                schedules and regarding limitations on the maximum 
                amount of charges; and
                    ``(B) take into consideration the total medical 
                expenses of individuals in assessing the amount of the 
                charge, subject to such provisions.
            ``(3) Aggregate charges.--The Secretary may not make a 
        grant under section 3411 to a State unless the State agrees 
        that the limitations on charges for substance use disorder 
        treatment services under this subsection applies to the annual 
        aggregate of charges imposed for such services, however the 
        charges are characterized, includes enrollment fees, premiums, 
        deductibles, cost sharing, co-payments, co-insurance costs, or 
        any other charges.
    ``(e) Statewide Coordinated Statement of Need.--A State shall not 
be eligible to receive a grant under this subtitle for a fiscal year 
unless the State develops and publishes a statewide coordinated 
statement of need, including a demonstration of the extent of State 
need for assistance in addressing addiction and substance use disorder 
in the State and identifying priorities for the delivery of essential 
services to individuals with substance use disorder and their families.
    ``(f) Indian Tribes.--Any application requirements applying to 
grants distributed in accordance with section 3412(c) shall be 
developed by the Secretary in consultation with Indian tribes.

``SEC. 3414. TECHNICAL ASSISTANCE.

    ``The Secretary shall provide technical assistance in administering 
and coordinating the activities authorized under section 3412, 
including technical assistance for the development of State 
applications for supplementary grants authorized in section 3212(a)(2).

``SEC. 3415. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this 
subtitle--
            ``(1) $4,000,000,000 for fiscal year 2019;
            ``(2) $4,000,000,000 for fiscal year 2020;
            ``(3) $4,000,000,000 for fiscal year 2021;
            ``(4) $4,000,000,000 for fiscal year 2022;
            ``(5) $4,000,000,000 for fiscal year 2023;
            ``(6) $4,000,000,000 for fiscal year 2024;
            ``(7) $4,000,000,000 for fiscal year 2025;
            ``(8) $4,000,000,000 for fiscal year 2026;
            ``(9) $4,000,000,000 for fiscal year 2027; and
            ``(10) $4,000,000,000 for fiscal year 2028.

                   ``Subtitle C--Other Grant Program

``SEC. 3421. ESTABLISHMENT OF GRANT PROGRAM.

    ``(a) In General.--The Secretary shall award grants to public, 
nonprofit, and Native entities for the purpose of funding core medical 
services, recovery and support services, harm reduction services, 
administrative expenses, and early intervention and engagement services 
in accordance with this section.
    ``(b) Eligibility.--
            ``(1) Entities.--Public, nonprofit, or Native entities 
        eligible to receive a grant under subsection (a) may include--
                    ``(A) federally qualified health centers under 
                section 1905(l)(2)(B) of the Social Security Act;
                    ``(B) family planning clinics;
                    ``(C) rural health clinics;
                    ``(D) Native entities, including Indian health 
                programs as defined in section 4 of the Indian Health 
                Care Improvement Act, urban Indian organizations as 
                defined in section 4 of the Indian Health Care 
                Improvement Act, and Native Hawaiian organizations as 
                defined in section 12 of the Native Hawaiian Health 
                Care Act of 1988;
                    ``(E) community-based organizations, clinics, 
                hospitals, and other health facilities that provide 
                substance use disorder treatment services;
                    ``(F) other nonprofit entities that provide 
                substance use disorder treatment services; and
                    ``(G) faith based organizations that provide 
                substance use disorder treatment services.
            ``(2) Underserved populations.--Entities described in 
        paragraph (1) shall serve underserved populations which may 
        include minority populations and Indian populations, ex-
        offenders, individuals with comorbidities including HIV/AIDS, 
        hepatitis B or C, mental illness, or other behavioral health 
        disorders, low-income populations, inner city populations, and 
        rural populations.
            ``(3) Application.--To be eligible to receive a grant under 
        this section, a public or nonprofit entity described in this 
        subsection shall prepare and submit to the Secretary an 
        application in such form, and containing such information, as 
        the Secretary shall require, including--
                    ``(A) a complete accounting of the disbursement of 
                any prior grants received under this subtitle by the 
                applicant and the results achieved by these 
                expenditures;
                    ``(B) a comprehensive plan for the use of the 
                grant, including a demonstration of the extent of local 
                need for the funds sought and a plan for proposed 
                substance use disorder treatment services that is 
                consistent with local needs;
                    ``(C) a demonstration that the grantee will use 
                funds in a manner that provides substance use disorder 
                treatment services compliant with the evidence-based 
                standards developed in accordance with section 3434, 
                including all Federally-approved medication-assisted 
                treatments;
                    ``(D) information on the number of individuals 
                likely to be served by the funds sought, including 
                demographic data on the populations to be served;
                    ``(E) an identification of key outcomes that will 
                be measured by all entities that receive assistance, as 
                well as an explanation of how the outcomes will be 
                measured;
                    ``(F) a demonstration that resources provided under 
                the grant will be allocated in accordance with the 
                local demographic incidence of substance use, including 
                allocations for services for children, youths, and 
                women;
                    ``(G) a demonstration that the confidentiality of 
                individuals receiving substance use disorder treatment 
                services will be maintained in a manner not 
                inconsistent with applicable law; and
                    ``(H) an explanation of how income, asset, and 
                medical expense criteria will be established and 
                applied to those who qualify for assistance under the 
                program.
    ``(c) Requirement of Status as Medicaid Provider.--
            ``(1) Provision of service.--Subject to paragraph (2), the 
        Secretary may not make a grant under this section for the 
        provision of substance use disorder treatment services under 
        this section in a State unless, in the case of any such service 
        that is available pursuant to the State plan approved under 
        title XIX of the Social Security Act for the State--
                    ``(A) the political subdivision involved will 
                provide the substance use disorder treatment service 
                directly, and the political subdivision has entered 
                into a participation agreement under the State plan and 
                is qualified to receive payments under such plan; or
                    ``(B) the political subdivision involved will enter 
                into an agreement with a public or nonprofit private 
                entity under which the entity will provide the 
                substance use disorder treatment service, and the 
                entity has entered into such a participation agreement 
                and is qualified to receive such payments.
            ``(2) Waiver.--
                    ``(A) In general.--In the case of an entity making 
                an agreement pursuant to paragraph (1)(B) regarding the 
                provision of substance use disorder treatment services, 
                the requirement established in such paragraph shall be 
                waived by the State if the entity does not, in 
                providing such services, impose a charge or accept 
                reimbursement available from any third-party payor, 
                including reimbursement under any insurance policy or 
                under any Federal or State health benefits program.
                    ``(B) Determination.--A determination by the State 
                of whether an entity referred to in subparagraph (A) 
                meets the criteria for a waiver under such subparagraph 
                shall be made without regard to whether the entity 
                accepts voluntary donations for the purpose of 
                providing services to the public.
    ``(d) Amount of Grant to Native Entities.--
            ``(1) Indian tribes.--In this section, the term `Indian 
        tribe' has the meaning given such term in section 4 of the 
        Indian Self-Determination and Education Assistance Act.
            ``(2) Formula grants.--The Secretary, acting through the 
        Indian Health Service, shall use 10 percent of the amount 
        available under section 3425 for each fiscal year to provide 
        grants to Native entities in an amount determined pursuant to 
        criteria developed by the Secretary in consultation with Indian 
        tribes, for the purposes of addressing substance use.
            ``(3) Use of amounts.--Notwithstanding any requirements in 
        this section, Native entities may use amounts provided under 
        grants awarded under this section for the uses identified in 
        section 3422 and any other activities determined appropriate by 
        the Secretary, in consultation with Indian tribes.

``SEC. 3422. USE OF AMOUNTS.

    ``(a) Use of Funds.--An entity shall use amounts received under a 
grant under section 3421 to provide direct financial assistance to 
eligible entities for the purpose of delivering or enhancing--
            ``(1) prevention services described in subsection (b);
            ``(2) core medical services described in subsection (c);
            ``(3) recovery and support services described in subsection 
        (d);
            ``(4) early intervention and engagement services described 
        in subsection (e);
            ``(5) harm reduction services described in subsection (f); 
        and
            ``(6) administrative expenses described in subsection (g).
    ``(b) Prevention Services.--For purposes of this subsection, the 
term `prevention services' means services, programs, or multi-sector 
strategies to prevent substance use disorder, including evidence-based 
education campaigns, community-based prevention programs, opioid 
diversion, collection and disposal of unused opioids, and services to 
at-risk populations.
    ``(c) Core Medical Services.--For purposes of this section, the 
term `core medical services' means the following services when provided 
to individuals with substance use disorder or at risk for developing 
substance use disorder:
            ``(1) Substance use disorder treatments, including clinical 
        stabilization services, withdrawal management and 
        detoxification, intensive inpatient treatment, intensive 
        outpatient treatment, all forms of Federally-approved 
        medication-assisted treatment, and residential recovery 
        treatment.
            ``(2) Outpatient and ambulatory health services, including 
        those administered by federally qualified health centers and 
        rural health clinics.
            ``(3) Hospice services.
            ``(4) Mental health services.
            ``(5) Naloxone procurement, distribution, and training.
            ``(6) Pharmaceutical assistance and diagnostic testing 
        related to the management of substance-use disorder and co-
        morbid conditions.
            ``(7) Home and community based health services.
            ``(8) Comprehensive Case Management and care coordination, 
        including treatment adherence services.
            ``(9) Health insurance enrollment and cost-sharing 
        assistance in accordance with section 3412.
    ``(d) Recovery and Support Services.--For purposes of subsection 
(a)(3), the term `recovery and support services' means services, 
subject to the approval of the Secretary, that are provided to 
individuals with substance use disorder, including residential recovery 
treatment and housing, including for individuals receiving medication-
assisted treatment, long term recovery services, 24/7 hotline services, 
medical transportation services, respite care for persons caring for 
individuals with substance use disorder, child care and family services 
while an individual is receiving inpatient treatment services or at the 
time of outpatient services, outreach services, peer recovery services, 
nutrition services, and referrals for job training and career services, 
housing, legal services, and child care and family services.
    ``(e) Early Intervention and Engagement Services.--For purposes of 
this section, the term `early intervention and engagement services' 
means services to provide rapid access to substance use disorder 
treatment services, counseling provided to individuals who have misused 
substances, who have experienced an overdose, or are at risk of 
developing substance use disorder and the provision of referrals to 
facilitate the access of such individuals to core medical services or 
recovery and support services. The entities through which such services 
may be provided include emergency rooms, fire departments and emergency 
medical services, detention facilities, homeless shelters, law 
enforcement agencies, health care points of entry specified by eligible 
areas, Federally qualified health centers, and rural health clinics.
    ``(f) Harm Reduction Services.--For purposes of this subsection, 
the term `harm reduction services' means evidence-based services 
provided to individuals engaging in substance use that reduce the risk 
of infectious disease transmission, overdose, or death, including by 
increasing access to health care.
    ``(g) Administration and Planning.--An entity shall not use in 
excess of 10 percent of amounts received under a grant under section 
3421 for administration, accounting, reporting, and program oversight 
functions, including for the purposes of developing systems to improve 
data collection and data sharing.

``SEC. 3423. TECHNICAL ASSISTANCE.

    ``The Secretary may, directly or through grants or contracts, 
provide technical assistance to nonprofit private entities and Native 
entities regarding the process of submitting to the Secretary 
applications for grants under section 3421, and may provide technical 
assistance with respect to the planning, development, and operation of 
any program or service carried out pursuant to such section.

``SEC. 3424. PLANNING AND DEVELOPMENT GRANTS.

    ``(a) In General.--The Secretary may provide planning grants to 
public, nonprofit private, and Native entities for purposes of 
assisting such entities in expanding their capacity to provide 
substance use disorder treatment services in low-income communities and 
affected subpopulations that are underserviced with respect to such 
services.
    ``(b) Amount.--A grant under this section may be made in an amount 
not to exceed $150,000.

``SEC. 3425. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this 
subtitle--
            ``(1) $500,000,000 for fiscal year 2019;
            ``(2) $500,000,000 for fiscal year 2020;
            ``(3) $500,000,000 for fiscal year 2021;
            ``(4) $500,000,000 for fiscal year 2022;
            ``(5) $500,000,000 for fiscal year 2023;
            ``(6) $500,000,000 for fiscal year 2024;
            ``(7) $500,000,000 for fiscal year 2025;
            ``(8) $500,000,000 for fiscal year 2026;
            ``(9) $500,000,000 for fiscal year 2027; and
            ``(10) $500,000,000 for fiscal year 2028.

                 ``Subtitle D--Miscellaneous Provisions

``SEC. 3431. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

    ``(a) In General.--The Secretary, acting in consultation with the 
Director of the Office of National Drug Control Policy, shall award 
grants to entities to administer special projects of national 
significance to support the development of innovative and original 
models for the delivery of substance use disorder treatment services.
    ``(b) Grants.--The Secretary shall award grants under a project 
under subsection (a) to entities eligible for grants under subtitles A, 
B, and C based on newly emerging needs of individuals receiving 
assistance under this title.
    ``(c) Replication.--The Secretary shall make information concerning 
successful models or programs developed under this section available to 
grantees under this title for the purpose of coordination, replication, 
and integration. To facilitate efforts under this subsection, the 
Secretary may provide for peer-based technical assistance for grantees 
funded under this section.
    ``(d) Grants to Tribal Governments.--
            ``(1) Indian tribes.--In this section, the term `Indian 
        tribe' has the meaning given such term in section 4 of the 
        Indian Self-Determination and Education Assistance Act.
            ``(2) Use of funds.--The Secretary, acting through the 
        Indian Health Service, shall use 10 percent of the amount 
        available under this section for each fiscal year to provide 
        grants to Indian tribes for the purposes of supporting the 
        development of innovative and original models for the delivery 
        of substance use disorder treatment and services, including the 
        development of culturally-informed care models.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            ``(1) $500,000,000 for fiscal year 2019;
            ``(2) $500,000,000 for fiscal year 2020;
            ``(3) $500,000,000 for fiscal year 2021;
            ``(4) $500,000,000 for fiscal year 2022;
            ``(5) $500,000,000 for fiscal year 2023;
            ``(6) $500,000,000 for fiscal year 2024;
            ``(7) $500,000,000 for fiscal year 2025;
            ``(8) $500,000,000 for fiscal year 2026;
            ``(9) $500,000,000 for fiscal year 2027; and
            ``(10) $500,000,000 for fiscal year 2028.

``SEC. 3432. EDUCATION AND TRAINING CENTERS.

    ``(a) In General.--The Secretary may make grants and enter into 
contracts to assist public and nonprofit private entities, and schools, 
and academic health centers in meeting the cost of projects--
            ``(1) to train health personnel, including practitioners in 
        programs under this title and other community providers, 
        including counselors, case managers, social workers, peer 
        recovery coaches, and harm reduction workers, in the diagnosis, 
        treatment, and prevention of substance use disorders, including 
        measures for the prevention and treatment of co-occurring 
        infectious diseases and other conditions, and including (as 
        applicable to the type of health professional involved), care 
        for women, pregnant women, and children;
            ``(2) to train the faculty of schools of medicine, nursing, 
        public health, osteopathic medicine, dentistry, allied health, 
        and mental health practice to teach health professions students 
        to screen for and provide for the needs of individuals with 
        substance use disorders or at risk of substance use; and
            ``(3) to develop and disseminate curricula and resource 
        materials relating to evidence-based practices for the 
        screening, prevention, and treatment of substance use 
        disorders, including information about prescribing best 
        practices, alternative pain therapies, and Federally-approved 
        medication-assisted treatment options.
    ``(b) Preference in Making Grants.--In making grants under 
subsection (a), the Secretary shall give preference to qualified 
projects that will--
            ``(1) train, or result in the training of, health 
        professionals, including counselors, case managers, social 
        workers, peer recovery coaches, and harm reduction workers, who 
        will provide substance use disorder treatments for underserved 
        groups, including minority individuals and Indians with 
        substance use disorder and other individuals who are at a high 
        risk of substance use;
            ``(2) train, or result in the training of, minority health 
        professionals and minority allied health professionals, 
        including counselors, case managers, social workers, peer 
        recovery coaches, and harm reduction workers, to provide 
        substance use disorder treatment for individuals with such 
        disease;
            ``(3) train or result in the training of individuals, 
        including counselors, case managers, social workers, peer 
        recovery coaches, and harm reduction workers, who will provide 
        substance use disorder treatment in rural or other areas that 
        are underserved by current treatment structures; and
            ``(4) train or result in the training of health 
        professionals and allied health professionals, including 
        counselors, case managers, social workers, peer recovery 
        coaches, and harm reduction workers, to provide treatment for 
        infectious diseases and mental health conditions co-occurring 
        with substance use disorder.
    ``(c) Native Education and Training Centers.--The Secretary shall 
use 10 percent of the amount available under subsection (d) for each 
fiscal year to provide grants authorized under this subtitle to--
            ``(1) tribal colleges and universities;
            ``(2) Indian Health Service grant funded institutions; and
            ``(3) Native partner institutions, including institutions 
        of higher education with medical training programs that partner 
        with one or more Indian tribes, tribal organizations, Native 
        Hawaiian organizations, or tribal colleges and universities to 
        train Native health professionals that will provide substance 
        use disorder treatment services in Native communities.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            ``(1) $400,000,000 for fiscal year 2019;
            ``(2) $400,000,000 for fiscal year 2020;
            ``(3) $400,000,000 for fiscal year 2021;
            ``(4) $400,000,000 for fiscal year 2022;
            ``(5) $400,000,000 for fiscal year 2023;
            ``(6) $400,000,000 for fiscal year 2024;
            ``(7) $400,000,000 for fiscal year 2025;
            ``(8) $400,000,000 for fiscal year 2026;
            ``(9) $400,000,000 for fiscal year 2027; and
            ``(10) $400,000,000 for fiscal year 2028.

``SEC. 3433. OTHER PROVISIONS.

    ``(a) Medication-Assisted Treatment.--The Secretary may not make a 
grant under this title unless the applicant for the grant agrees to 
require all entities offering substance use disorder treatment services 
under the grant to offer all Federally-approved forms of medication-
assisted substance use treatment for the substance use disorders for 
which the applicant offers treatment.
    ``(b) Waiver.--The Secretary may grant a waiver with respect to any 
requirement of this title if the grant applicant involved--
            ``(1) submits to the Secretary a justification containing 
        such information as the Secretary shall require; and
            ``(2) agrees to require all entities offering substance use 
        disorder treatment services under the grant--
                    ``(A) to offer at least two Federally-approved 
                forms of medication-assisted treatment on site;
                    ``(B) provide counseling to patients on the 
                benefits and risks of all forms of Federally-approved 
                medication-assisted treatments; and
                    ``(C) maintain an affiliation with a provider that 
                can prescribe or otherwise dispense all other forms of 
                Federally-approved medication-assisted treatment.
    ``(c) GAO Study.--Not later than 1 year after the date of enactment 
of this title, the Comptroller General of the United States shall 
submit to Congress a comprehensive report describing any relationship 
between substance use rates, pain management practices of the Indian 
Health Service, and patient request denials through the purchased/
referred care program of the Indian Health Service.

``SEC. 3434. STANDARDS FOR SUBSTANCE USE DISORDER TREATMENT AND 
              RECOVERY FACILITIES.

    ``(a) In General.--Not later than 3 years after the date of 
enactment of this title, the Secretary, in consultation with the 
American Society of Addiction Medicine, shall promulgate model 
standards for the regulation of substance use disorder treatment 
services.
    ``(b) Contents.--The model standards promulgated under subsection 
(a) shall--
            ``(1) identify the types of providers intended to be 
        covered without regard to whether such providers participate in 
        any Federal health care program (as defined in section 1128B(f) 
        of the Social Security Act (42 U.S.C. 1320a-7b(f))) and shall 
        not include a private practitioner who is already licensed by a 
        State medical licensing board and whose practice is limited to 
        outpatient care;
            ``(2) require that all substance use disorder treatment 
        services be licensed by the respective States for the levels of 
        care which they provide;
            ``(3) identify the professional credentials needed by each 
        type of substance use disorder treatment professional;
            ``(4) require that patients have access to licensed 
        substance use disorder treatment services, including health 
        care providers and physicians, for inpatient and outpatient 
        care;
            ``(5) identify and develop strategies for States to ensure 
        that all substance use disorder patients receive a medical 
        assessment, including for co-occurring mental health issues and 
        infectious diseases;
            ``(6) require States to implement a process to ensure that 
        residential treatment provider qualifications are verified by 
        the single State agency serving as the primary regulator in the 
        State for substance use disorder treatment services (as 
        required in paragraph (13)) or by an independent third party 
        with the necessary competencies to use evidence-based patient 
        placement assessment tools and nationally-recognized program 
        standards, as applicable;
            ``(7) ensure that patients receiving substance use disorder 
        treatment have access directly, by referral, or in such other 
        manner as determined by the Secretary, to all Federally-
        approved medication-assisted treatments for substance use 
        disorder;
            ``(8) develop standards for data reporting and require 
        compilation of Statewide reports;
            ``(9) develop standards for licensed providers to ensure 
        all patients receive an outpatient treatment and discharge 
        plan;
            ``(10) develop standards for the certification of recovery 
        residences that have an ongoing economic relationship with any 
        commercial substance use disorder treatment service, including 
        any relationship with any such service that includes receiving 
        or making referrals for substance use disorder treatment, 
        including--
                    ``(A) application, inspection, and renewal 
                procedures for recovery residences;
                    ``(B) fire, safety, and health standards;
                    ``(C) standards for equipping residences with 
                naloxone and training residence owners, operators, and 
                employees in the administration of naloxone;
                    ``(D) standards for recovery residence owners and 
                operators; and
                    ``(E) standards to identify, disqualify from grant 
                funding, and refer to the appropriate regulatory 
                authority any entity engaged in the soliciting or 
                receiving of a commission, benefit, bonus, rebate, 
                kickback, or bribe, directly or indirectly, in cash or 
                in kind, or engaging in any split-fee arrangement, 
                aimed at inducing the referral of a patient to or from 
                a substance use disorder treatment service;
            ``(11) establish a toll-free telephone number to handle 
        complaints about recovery residences;
            ``(12) establish and maintain on a publicly accessible 
        internet website a list of all recovery residences in the State 
        that have a certification in effect in accordance with this 
        section;
            ``(13) require the designation of a single State agency to 
        serve as the primary regulator in the State for substance use 
        disorder treatment services;
            ``(14) require a single State agency to implement a process 
        to ensure that treatment provider assessments for all substance 
        use disorder treatment services, including levels of care and 
        length-of-stay recommendations, are verified by an independent 
        third party that has the necessary competencies to use 
        evidence-based patient placement assessment tools and 
        nationally-recognized program standards, as applicable; and
            ``(15) consider existing barriers to substance use disorder 
        treatment and service access, including capacity and 
        infrastructure needs, as well as access to culturally attuned 
        services.
    ``(c) Annual Assessment.--Beginning with respect to fiscal year 
2021, the Secretary shall make a determination with respect to each 
State on whether the State has adopted the model standards promulgated 
in accordance with this section.
    ``(d) Quality Measures.--The Secretary shall engage a nonprofit, 
non-partisan standards development and quality measurement organization 
to convene government regulators, State representatives, consumer 
representatives, substance use disorder treatment providers, recovery 
residence owners and operators, and purchasers of substance use 
disorder treatments exercising leadership in quality-based purchasing 
to develop and annually revise a set of health care quality measures 
for substance use disorder treatment providers and owners and operators 
of recovery residences.

``SEC. 3435. NALOXONE DISTRIBUTION PROGRAM.

    ``(a) Establishment of Program.--
            ``(1) In general.--The Secretary shall provide for the 
        purchase and delivery of Federally-approved opioid overdose 
        reversal drug products on behalf of each State (or Indian tribe 
        as defined in section 4 of the Indian Health Care Improvement 
        Act) that receives a grant under subtitle B. This paragraph 
        constitutes budget authority in advance of appropriations Acts, 
        and represents the obligation of the Federal Government to 
        provide for the purchase and delivery to States of the opioid 
        overdose reversal drug products in accordance with this 
        paragraph.
            ``(2) Special rules where opioid overdose reversal drug 
        products are unavailable.--To the extent that a sufficient 
        quantity of opioid overdose reversal drug products are not 
        available for purchase or delivery under paragraph (1), the 
        Secretary shall provide for the purchase and delivery of the 
        available opioid overdose reversal drug products in accordance 
        with priorities established by the Secretary, with priority 
        given to States with at least one local area eligible for 
        funding under section 3401(a).
    ``(b) Negotiation of Contracts With Manufacturers.--
            ``(1) In general.--For the purpose of carrying out this 
        section, the Secretary shall negotiate and enter into contracts 
        with manufacturers of opioid overdose reversal drug products 
        consistent with the requirements of this subsection and, to the 
        maximum extent practicable, consolidate such contracting with 
        any other contracting activities conducted by the Secretary to 
        purchase opioid overdose reversal drug products. The Secretary 
        may enter into such contracts under which the Federal 
        Government is obligated to make outlays, the budget authority 
        for which is not provided for in advance in appropriations 
        Acts, for the purchase and delivery of opioid overdose reversal 
        drug products under subsection (a).
            ``(2) Authority to decline contracts.--The Secretary may 
        decline to enter into contracts under this subsection and may 
        modify or extend such contracts.
            ``(3) Contract price.--
                    ``(A) In general.--The Secretary, in negotiating 
                the prices at which opioid overdose reversal drug 
                products will be purchased and delivered from a 
                manufacturer under this subsection, shall take into 
                account quantities of opioid overdose reversal drug 
                products to be purchased by States under the option 
                under paragraph (4)(B).
                    ``(B) Negotiation of discounted price for opioid 
                overdose reversal drug products.--With respect to 
                contracts entered into for the purchase of opioid 
                overdose reversal drug products on behalf of States 
                under this subsection, the price for the purchase of 
                such drug product shall be a discounted price 
                negotiated by the Secretary.
            ``(4) Product dosage.--All opioid overdose reversal 
        products purchased under this section shall contain--
                    ``(A) for each dose, the maximum amount of active 
                pharmaceutical ingredient that acts as an opioid 
                receptor antagonist as recommended by the Food and Drug 
                Administration as an initial dose when administered by 
                one of the approved, labeled routes of administration 
                in adults; and
                    ``(B) a minimum of two doses packaged together.
            ``(5) Quantities and terms of delivery.--Under contracts 
        under this subsection--
                    ``(A) the Secretary shall provide, consistent with 
                paragraph (6), for the purchase and delivery on behalf 
                of States and Indian tribes of quantities of opioid 
                overdose reversal drug products; and
                    ``(B) each State and Indian tribe, at the option of 
                the State or tribe, shall be permitted to obtain 
                additional quantities of opioid overdose reversal drug 
                products (subject to amounts specified to the Secretary 
                by the State or tribe in advance of negotiations) 
                through purchasing the opioid overdose reversal drug 
                products from the manufacturers at the applicable price 
                negotiated by the Secretary consistent with paragraph 
                (3), if the State or tribe provides to the Secretary 
                such information (at a time and manner specified by the 
                Secretary, including in advance of negotiations under 
                paragraph (1)) as the Secretary determines to be 
                necessary, to provide for quantities of opioid overdose 
                reversal drug products for the State or tribe to 
                purchase pursuant to this subsection and to determine 
                annually the percentage of the opioid overdose reversal 
                drug market that is purchased pursuant to this section 
                and this subparagraph.
        The Secretary shall enter into the initial negotiations not 
        later than 180 days after the date of the enactment of this 
        title.
            ``(6) Charges for shipping and handling.--The Secretary may 
        enter into a contract referred to in paragraph (1) only if the 
        manufacturer involved agrees to submit to the Secretary such 
        reports as the Secretary determines to be appropriate to assure 
        compliance with the contract and if, with respect to a State 
        program under this section that does not provide for the direct 
        delivery of qualified opioid overdose reversal drug products, 
        the manufacturer involved agrees that the manufacturer will 
        provide for the delivery of the opioid overdose reversal drug 
        products on behalf of the State in accordance with such program 
        and will not impose any charges for the costs of such delivery 
        (except to the extent such costs are provided for in the price 
        established under paragraph (3)).
            ``(7) Multiple suppliers.--In the case of the opioid 
        overdose reversal drug product involved, the Secretary may, as 
        appropriate, enter into a contract referred to in paragraph (1) 
        with each manufacturer of the opioid overdose reversal drug 
        product that meets the terms and conditions of the Secretary 
        for an award of such a contract (including terms and conditions 
        regarding safety and quality). With respect to multiple 
        contracts entered into pursuant to this paragraph, the 
        Secretary may have in effect different prices under each of 
        such contracts and, with respect to a purchase by States 
        pursuant to paragraph (4)(B), each eligible State may choose 
        which of such contracts will be applicable to the purchase.
    ``(c) Use of Opioid Overdose Reversal Drug Product List.--Beginning 
not later than one year after the first contract has been entered into 
under this section, the Secretary shall use, for the purpose of the 
purchase, delivery, and administration of opioid overdose reversal drug 
products under this section, the list established (and periodically 
reviewed and, as appropriate, revised) by an advisory committee, 
established by the Secretary and located within the Centers for Disease 
Control and Prevention, which considers the cost effectiveness of each 
opioid overdose reversal drug product.
    ``(d) State Distribution of Opioid Overdose Reversal Drug 
Products.--States shall distribute opioid overdose reversal drug 
products received under this section to the following:
            ``(1) First Responders, including--
                    ``(A) all State, county, and local law enforcement 
                departments;
                    ``(B) all Tribal police departments;
                    ``(C) all local fire departments, including career 
                fire departments, combination fire departments, and 
                volunteer fire departments; and
                    ``(D) all local emergency medical services 
                organizations, including volunteer emergency medical 
                services organizations.
            ``(2) Public entities with authority to administer local 
        public health services, including all local health departments, 
        for the purposes of making opioid overdose reversal drug 
        products available to--
                    ``(A) public and nonprofit entities, including--
                            ``(i) community-based organizations that 
                        provide substance use disorder treatments or 
                        harm reduction services;
                            ``(ii) nonprofit entities that provide 
                        substance use disorder treatments or harm 
                        reduction services; and
                            ``(iii) faith based organizations that 
                        provide substance use disorder treatments or 
                        harm reduction services; and
                    ``(B) the general public.
    ``(e) State Requirements.--To be eligible to receive opioid 
overdose reversal drugs under this section, each State shall--
            ``(1) establish a program for distributing opioid overdose 
        reversal drug products to first responders and entities with 
        authority to administer local public health services, including 
        local health departments;
            ``(2) beginning in the second year of the program, 
        demonstrate a distribution rate of a minimum of 90 percent of 
        the opioid overdose reversal drug products received under this 
        program; and
            ``(3) certify to the Secretary that the State has in place 
        measures that enhance access to opioid overdose reversal drug 
        products, such as laws that provide civil or disciplinary 
        immunity for medical personnel who prescribe an opioid overdose 
        reversal drug product, Good Samaritan Laws, Third Party 
        Prescription Laws, Collaborative Practice Agreements, and 
        Standing Orders.
    ``(f) Indian Tribe Requirements.--The Indian Health Service, in 
consultation with Indian tribes, shall determine any requirements that 
shall apply to Indian tribes receiving opioid overdose reversal drug 
products made available under this section.
    ``(g) Definitions.--For purposes of this section:
            ``(1) Career fire department.--The term `career fire 
        department' means a fire department that has an all-paid force 
        of firefighting personnel other than paid-on-call firefighters.
            ``(2) Collaborative practice agreement.--The term 
        `Collaborative Practice Agreement' means an agreement under 
        which a pharmacist operates under authority delegated by 
        another licensed practitioner with prescribing authority.
            ``(3) Combination fire department.--The term `combination 
        fire department' means a fire department that has paid 
        firefighting personnel and volunteer firefighting personnel.
            ``(4) Emergency medical service.--The term `emergency 
        medical service' means resources used by a public or private 
        nonprofit licensed entity to deliver medical care outside of a 
        medical facility under emergency conditions that occur as a 
        result of the condition of the patient and includes services 
        delivered (either on a compensated or volunteer basis) by an 
        emergency medical services provider or other provider that is 
        licensed or certified by the State involved as an emergency 
        medical technician, a paramedic, or an equivalent professional 
        (as determined by the State).
            ``(5) Good samaritan law.--The term `Good Samaritan Law' 
        means a law that provides criminal immunity for a person who 
        administers an opioid overdose reversal drug product, a person 
        who, in good faith, seeks medical assistance for someone 
        experiencing a drug-related overdose, or a person who 
        experiences a drug-related overdose and is in need of medical 
        assistance and, in good faith, seeks such medical assistance, 
        or is the subject of such a good faith request for medical 
        assistance.
            ``(6) Indians.--The terms `Indian', `Indian tribe', `tribal 
        organization', and `Urban Indian Health Program' have the 
        meanings given such terms in section 4 of the Indian Health 
        Care Improvement Act.
            ``(7) Manufacturer.--The term `manufacturer' means any 
        corporation, organization, or institution, whether public or 
        private (including Federal, State, and local departments, 
        agencies, and instrumentalities), which manufactures, imports, 
        processes, or distributes under its label any opioid overdose 
        reversal drug product. The term `manufacture' means to 
        manufacture, import, process, or distribute an opioid overdose 
        reversal drug.
            ``(8) Opioid overdose reversal drug product.--The term 
        `opioid overdose reversal drug product' means a finished dosage 
        form that has been approved by the Food and Drug Administration 
        and that contains an active pharmaceutical ingredient that acts 
        as an opioid receptor antagonist. The term `opioid overdose 
        reversal drug product' includes a combination product, as 
        defined in section 3.2(e) of title 21, Code of Federal 
        Regulations.
            ``(9) Standing order.--The term `standing order' means a 
        non-patient-specific order covering administration of 
        medication by others to a patient who may be unknown to the 
        prescriber at the time of the order.
            ``(10) Third party prescription.--The term `third party 
        prescription' means an order written for medication dispensed 
        to one person with the intention that it will be administered 
        to another person.
            ``(11) Volunteer fire department.--The term `volunteer fire 
        department' means a fire department that has an all-volunteer 
        force of firefighting personnel.
    ``(h) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this suction--
            ``(1) $500,000,000 for fiscal year 2019;
            ``(2) $500,000,000 for fiscal year 2020;
            ``(3) $500,000,000 for fiscal year 2021;
            ``(4) $500,000,000 for fiscal year 2022;
            ``(5) $500,000,000 for fiscal year 2023;
            ``(6) $500,000,000 for fiscal year 2024;
            ``(7) $500,000,000 for fiscal year 2025;
            ``(8) $500,000,000 for fiscal year 2026;
            ``(9) $500,000,000 for fiscal year 2027; and
            ``(10) $500,000,000 for fiscal year 2028.

``SEC. 3436. ADDITIONAL FUNDING FOR THE NATIONAL INSTITUTES OF HEALTH.

    ``There is authorized to be appropriated to the National Institute 
of Health for the purpose of conducting research on addiction and pain 
related to substance misuse, including research to develop overdose 
reversal drug products, non-addictive drug products for treating pain, 
and drug products used to treat substance use disorder--
            ``(1) $1,000,000,000 for fiscal year 2019;
            ``(2) $1,000,000,000 for fiscal year 2020;
            ``(3) $1,000,000,000 for fiscal year 2021;
            ``(4) $1,000,000,000 for fiscal year 2022;
            ``(5) $1,000,000,000 for fiscal year 2023;
            ``(6) $1,000,000,000 for fiscal year 2024;
            ``(7) $1,000,000,000 for fiscal year 2025;
            ``(8) $1,000,000,000 for fiscal year 2026;
            ``(9) $1,000,000,000 for fiscal year 2027; and
            ``(10) $1,000,000,000 for fiscal year 2028.

``SEC. 3437. ADDITIONAL FUNDING FOR IMPROVED DATA COLLECTION AND 
              PREVENTION OF INFECTIOUS DISEASE TRANSMISSION.

    ``(a) Data Collection.--The Centers for Disease Control and 
Prevention shall use a portion of the funding appropriated under this 
section to ensure that all States participate in the Enhanced State 
Opioid Overdose Surveillance program and to provide technical 
assistance to medical examiners and coroners to facilitate improved 
data collection on fatal overdoses through such program.
    ``(b) Centers for Disease Control and Prevention.--The Centers for 
Disease Control and Prevention shall use amounts appropriated under 
this section for the purpose of improving data on drug overdose deaths 
and non-fatal drug overdoses, surveillance related to addiction and 
substance use disorder, and the prevention of transmission of 
infectious diseases related to substance use.
    ``(c) Tribal Epidemiology Centers.--There shall be made available 
to the Indian Health Service for the purpose of funding efforts by 
tribal epidemiology centers to improve data on drug overdose deaths and 
non-fatal drug overdoses and surveillance related to addiction and 
substance use disorder, not less than 1.5 percent of the total amount 
appropriated under this section for each fiscal year.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            ``(1) $400,000,000 for fiscal year 2019;
            ``(2) $400,000,000 for fiscal year 2020;
            ``(3) $400,000,000 for fiscal year 2021;
            ``(4) $400,000,000 for fiscal year 2022;
            ``(5) $400,000,000 for fiscal year 2023;
            ``(6) $400,000,000 for fiscal year 2024;
            ``(7) $400,000,000 for fiscal year 2025;
            ``(8) $400,000,000 for fiscal year 2026;
            ``(9) $400,000,000 for fiscal year 2027; and
            ``(10) $400,000,000 for fiscal year 2028.

``SEC. 3438. DEFINITIONS.

    ``In this title:
            ``(1) Planning council.--The term `planning council' means 
        the substance use planning council established under section 
        3402.
            ``(2) Recovery residence.--The term `recovery residence' 
        means a residential dwelling unit, or other form of group 
        housing, that is offered or advertised through any means, 
        including oral, written, electronic, or printed means, by any 
        individual or entity as a residence that provides an evidence-
        based, peer-supported living environment for individuals 
        undergoing any type of substance use disorder treatment or who 
        have received any type of substance use disorder treatment in 
        the past 3 years, including medication-assisted treatment.
            ``(3) State.--
                    ``(A) In general.--The term `State' means each of 
                the 50 States, the District of Columbia, and each of 
                the territories.
                    ``(B) Territories.--The term `territory' means each 
                of American Samoa, Guam, the Commonwealth of Puerto 
                Rico, the Commonwealth of the Northern Mariana Islands, 
                the Virgin Islands, the Republic of the Marshall 
                Islands, the Federated States of Micronesia, and Palau.
            ``(4) Substance use disorder treatment.--
                    ``(A) In general.--The term `substance use disorder 
                treatment' means an evidence-based, professionally 
                directed, deliberate, and planned regimen including 
                evaluation, observation, medical monitoring, and 
                rehabilitative services and interventions such as 
                pharmacotherapy, behavioral therapy, and individual and 
                group counseling, on an inpatient or outpatient basis, 
                to help patients with substance use disorder reach 
                recovery.
                    ``(B) Types of treatment.--Substance use disorder 
                treatments shall include the following:
                            ``(i) Clinical stabilization services, 
                        which are evidence-based services provided in 
                        secure, acute care facilities (which may be 
                        referred to as `addictions receiving 
                        facilities') that, at a minimum--
                                    ``(I) provide detoxification and 
                                stabilization services;
                                    ``(II) are operated 24 hours per 
                                day, 7 days per week; and
                                    ``(III) that serve individuals 
                                found to be substance use impaired. 
                                These can also be referred to as 
                                `Addictions receiving facilities'.
                            ``(ii) Withdrawal management and 
                        detoxification, which is a service that is 
                        provided on an inpatient or an outpatient basis 
                        to assist individuals manage the process of 
                        withdrawing from the physiological and 
                        psychological effects of substance use 
                        disorder.
                            ``(iii) Intensive inpatient treatment, 
                        which is a service that provides a planned 
                        regimen of evidence-based evaluation, 
                        observation, medical monitoring, and evidence-
                        based rehabilitative services and interventions 
                        such as pharmacotherapy, behavioral therapy, 
                        and counseling, 24 hours per day, 7 days per 
                        week, in a highly structured, residential 
                        environment.
                            ``(iv) Intensive outpatient treatment, 
                        which is a service that provides a planned 
                        regimen of evidence-based evaluation, 
                        observation, medical monitoring, and evidence-
                        based rehabilitative services and interventions 
                        such as pharmacotherapy, behavioral therapy, 
                        and counseling, in a structured, nonresidential 
                        environment at a higher level of intensity and 
                        duration than outpatient treatment.
                            ``(v) Medication-assisted treatment, which 
                        is a service that uses Federally-approved 
                        medication as authorized by Federal and State 
                        law, in combination with evidence-based 
                        medical, rehabilitative, and counseling 
                        services, in the treatment of individuals who 
                        suffer from substance use disorder.
                            ``(vi) Outpatient treatment, which is a 
                        service that provides a planned regimen of 
                        evidence-based evaluation, observation, medical 
                        monitoring, and evidence-based rehabilitative 
                        services and interventions such as 
                        pharmacotherapy, behavioral therapy, and 
                        counseling in a structured, nonresidential 
                        environment by appointment during scheduled 
                        operating hours.
                            ``(vii) Residential recovery treatment, 
                        which is a service that provides a planned 
                        regimen of evidence-based evaluation, 
                        observation, medical monitoring, and evidence-
                        based rehabilitative services and interventions 
                        such as pharmacotherapy, behavioral therapy, 
                        and counseling provided in a structured, live-
                        in environment within a nonhospital setting on 
                        a 24-hours-per-day, 7-days-per-week basis.
                    ``(C) Limitation.--Substance use disorder treatment 
                providers shall not include--
                            ``(i) prevention only providers; and
                            ``(ii) a private practitioner who is 
                        licensed by a State medical licensing board and 
                        whose practice is limited to outpatient care.
            ``(5) Substance use disorder treatment services.--The term 
        `substance use disorder treatment services' means any 
        prevention services, core medical services, recovery and 
        support services, early intervention and engagement services, 
        and harm reduction services authorized under this title.''.

SEC. 4. AMENDMENTS TO THE CONTROLLED SUBSTANCES ACT.

    (a) Certifications.--Part C of the Controlled Substances Act (21 
U.S.C. 821 et seq.) is amended by adding at the end the following:

    ``certifications relating to diversion controls and misbranding

    ``Sec. 312.  (a) Definitions.--In this section--
            ``(1) the term `covered dispenser'--
                    ``(A) means a dispenser--
                            ``(i) that is required to register under 
                        section 302(a)(2); and
                            ``(ii) dispenses a controlled substance in 
                        schedule II; and
                    ``(B) does not include a dispenser that is--
                            ``(i) registered to dispense opioid agonist 
                        treatment medication under section 303(g)(1); 
                        and
                            ``(ii) operating in that capacity;
            ``(2) the term `covered distributor' means a distributor--
                    ``(A) that is required to register under section 
                302(a)(1); and
                    ``(B) distributes a controlled substance in 
                schedule II;
            ``(3) the term `covered manufacturer' means a 
        manufacturer--
                    ``(A) that is required to register under section 
                302(a)(1); and
                    ``(B) manufactures a controlled substance in 
                schedule II;
            ``(4) the term `covered officer', with respect to a covered 
        person means--
                    ``(A) in the case of a covered person that is not 
                an individual--
                            ``(i) the chief executive officer of the 
                        covered person;
                            ``(ii) the president of the covered person;
                            ``(iii) the chief medical officer of the 
                        covered person; and
                            ``(iv) the chief counsel of the covered 
                        person; and
                    ``(B) in the case of a covered person that is an 
                individual, that individual; and
            ``(5) the term `covered person' means a covered dispenser, 
        a covered distributor, or a covered manufacturer.
    ``(b) Certifications Relating to Diversion Controls.--Not later 
than 180 days after the date of enactment of this section, and each 
year thereafter, each covered officer of a covered person shall submit 
to the Attorney General, for each controlled substance in schedule II 
dispensed, distributed, or manufactured by the covered person, a 
certification--
            ``(1) signed by the covered officer; and
            ``(2) certifying that--
                    ``(A) the covered person maintains effective 
                controls against diversion of the controlled substance 
                into channels other than legitimate medical, 
                scientific, research, or industrial channels;
                    ``(B) all information contained in any record, 
                inventory, or report required to be kept or submitted 
                to the Attorney General by the covered person under 
                section 307, or under any regulation issued under that 
                section, is accurate; and
                    ``(C) the covered person is in compliance with all 
                applicable requirements under Federal law relating to 
                reporting suspicious orders for controlled substances.
    ``(c) Certifications Relating to Misbranding.--Not later than 180 
days after the date of enactment of this section, and each year 
thereafter, each covered officer of a covered manufacturer shall submit 
to the Attorney General, for each controlled substance in schedule II 
manufactured by the covered manufacturer, a certification--
            ``(1) signed by the covered officer; and
            ``(2) certifying that the controlled substance is not 
        misbranded, as described in section 502 of the Federal Food, 
        Drug, and Cosmetic Act (21 U.S.C. 352).''.
    (b) Offenses.--Part D of title II of the Controlled Substances Act 
(21 U.S.C. 841 et seq.) is amended by adding at the end the following:

                  ``certifications by covered officers

    ``Sec. 424.  (a) Definitions.--In this section, the terms `covered 
dispenser', `covered distributor', `covered manufacturer', `covered 
officer', and `covered person' have the meanings given those terms in 
section 312.
    ``(b) Offenses.--
            ``(1) Failure to submit certifications.--
                    ``(A) Certifications relating to diversion 
                controls.--It shall be unlawful for a covered officer 
                of a covered person to fail to submit a certification 
                required under section 312(b), without regard to the 
                state of mind of the covered officer.
                    ``(B) Certifications relating to misbranding.--It 
                shall be unlawful for a covered officer of a covered 
                manufacturer to fail to submit a certification required 
                under section 312(c), without regard to the state of 
                mind of the covered officer.
            ``(2) Submission of false certifications.--
                    ``(A) False certifications relating to diversion 
                controls.--It shall be unlawful for a covered officer 
                of a covered person to submit a certification required 
                under section 312(b), without regard to the state of 
                mind of the covered officer, that contains a materially 
                false statement or representation relating to the 
                information required to be certified under that section 
                for the year for which the certification is submitted.
                    ``(B) False certifications relating to 
                misbranding.--It shall be unlawful for a covered 
                officer of a covered manufacturer to submit a 
                certification required under section 312(c), without 
                regard to the state of mind of the covered officer, 
                that contains a materially false statement or 
                representation relating to the misbranding of a 
                controlled substance with respect to the year for which 
                the certification is submitted.
    ``(c) Penalties.--
            ``(1) Civil penalties.--Except as provided in paragraph 
        (2), a covered officer who violates subsection (b) shall be 
        subject to a civil penalty of not more than $25,000.
            ``(2) Criminal penalties.--A covered officer who knowingly 
        violates subsection (b)(2) shall be subject to criminal 
        penalties under section 403(d).
    ``(d) Comprehensive Addiction Resources Fund.--
            ``(1) Establishment.--There is established in the Treasury 
        a fund to be known as the `Comprehensive Addiction Resources 
        Fund'.
            ``(2) Transfer of amounts.--There shall be transferred to 
        the Comprehensive Addiction Resources Fund 100 percent of--
                    ``(A) any civil penalty paid to the United States 
                under this section; and
                    ``(B) any fine paid to the United States under 
                section 403(d) for a knowing violation of subsection 
                (b)(2) of this section.
            ``(3) Availability and use of funds.--Amounts transferred 
        to the Comprehensive Addiction Fund under paragraph (2) shall--
                    ``(A) remain available until expended; and
                    ``(B) be made available to supplement amounts 
                appropriated to carry out title XXXIV of the Public 
                Health Service Act.''.
    (c) Criminal Penalties.--Section 403 of the Controlled Substances 
Act (21 U.S.C. 843) is amended--
            (1) in subsection (d)(1)--
                    (A) by inserting ``or knowingly violates section 
                424(b)(2)'' after ``any person who violates this 
                section''; and
                    (B) by striking ``violation of this section'' and 
                inserting ``such a violation''; and
            (2) in subsection (f)--
                    (A) in paragraph (1), by striking ``or 416'' and 
                inserting ``or section 416, or knowing violations of 
                section 424(b)(2)''; and
                    (B) in paragraph (3), by inserting ``or knowing 
                violations of section 424(b)(2)'' before the period at 
                the end.
    (d) Technical and Conforming Amendments.--The table of contents for 
the Comprehensive Drug Abuse Prevention and Control Act of 1970 (Public 
Law 91-513; 84 Stat. 1236) is amended--
            (1) by inserting after the item relating to section 311 the 
        following:

``Sec. 312. Certifications relating to diversion controls and 
                            misbranding.'';
        and
            (2) by inserting after the item relating to section 423 the 
        following:

``Sec. 424. Certifications by covered officers.''.
    (e) Effective Date.--The amendments made by subsections (b) and (c) 
of this section shall take effect on the date that is 180 days after 
the date of enactment of this Act.
                                 <all>