Title: CREATE Opportunities Act
Policy area: Health

Summary:
Community Re-Entry through Addiction Treatment to Enhance Opportunities Act or the CREATE Opportunities Act
This bill establishes the Medication-Assisted Treatment Corrections and Community Reentry Program in the Department of Justice. Under the program, the National Institute of Corrections may award grants to support local programs that provide medication-assisted treatment for incarcerated individuals who have opioid-use disorders; such treatment must be provided in accordance with specified requirements, including drug, screening, and personnel criteria.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1983 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 1983

  To authorize the Attorney General to make grants to, and enter into 
 cooperative agreements with, States and units of local government to 
develop, implement, or expand 1 or more programs to provide medication-
assisted treatment to individuals who have opioid use disorder and are 
 incarcerated within the jurisdictions of the States or units of local 
                              government.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 26, 2019

  Mr. Markey (for himself, Ms. Murkowski, Mr. Booker, and Ms. Warren) 
introduced the following bill; which was read twice and referred to the 
                       Committee on the Judiciary

_______________________________________________________________________

                                 A BILL


 
  To authorize the Attorney General to make grants to, and enter into 
 cooperative agreements with, States and units of local government to 
develop, implement, or expand 1 or more programs to provide medication-
assisted treatment to individuals who have opioid use disorder and are 
 incarcerated within the jurisdictions of the States or units of local 
                              government.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Community Re-Entry through Addiction 
Treatment to Enhance Opportunities Act'' or as the ``CREATE 
Opportunities Act''.

SEC. 2. MEDICATION-ASSISTED TREATMENT CORRECTIONS AND COMMUNITY REENTRY 
              PROGRAM.

    (a) Definitions.--In this section--
            (1) the term ``Attorney General'' means the Attorney 
        General, acting through the Director of the National Institute 
        of Corrections;
            (2) the term ``certified recovery coach'' means an 
        individual--
                    (A) with knowledge of, or experience with, recovery 
                from a substance use disorder; and
                    (B) who--
                            (i) has completed training through, and is 
                        determined to be in good standing by--
                                    (I) a single State agency; or
                                    (II) a recovery community 
                                organization that is capable of 
                                conducting that training and making 
                                that determination; and
                            (ii) meets the criteria specified by the 
                        Attorney General, in consultation with the 
                        Secretary of Health and Human Services, for 
                        qualifying as a certified recovery coach for 
                        the purposes of this Act;
            (3) the term ``correctional facility'' has the meaning 
        given the term in section 901 of title I of the Omnibus Crime 
        Control and Safe Streets Act of 1968 (34 U.S.C. 10251);
            (4) the term ``covered grant or cooperative agreement'' 
        means a grant received, or cooperative agreement entered into, 
        under the Program;
            (5) the term ``covered program'' means a program--
                    (A) to provide medication-assisted treatment to 
                individuals who have opioid use disorder and are 
                incarcerated within the jurisdiction of the State or 
                unit of local government carrying out the program; and
                    (B) that is developed, implemented, or expanded 
                through a covered grant or cooperative agreement;
            (6) the term ``medication-assisted treatment'' means the 
        use of 1 or more drugs, or 1 or more combinations of drugs, 
        that have been approved under the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 301 et seq.) or section 351 of the 
        Public Health Service Act (42 U.S.C. 262) for the treatment of 
        an opioid use disorder, in combination with evidence-based 
        counseling and behavioral therapies, such as psychosocial 
        counseling, overseen by 1 or more social work professionals and 
        1 or more qualified clinicians, to provide a comprehensive 
        approach to the treatment of substance use disorders;
            (7) the term ``nonprofit organization'' means an 
        organization that is described in section 501(c)(3) of the 
        Internal Revenue Code of 1986 and is exempt from taxation under 
        section 501(a) of such Code;
            (8) the term ``Panel'' means the Medication-assisted 
        Treatment Corrections and Community Reentry Application Review 
        Panel established under subsection (e)(2);
            (9) the term ``participant'' means an individual who 
        participates in a covered program;
            (10) the term ``political appointee'' has the meaning given 
        the term in section 714(h) of title 38, United States Code;
            (11) the term ``Program'' means the Medication-assisted 
        Treatment Corrections and Community Reentry Program established 
        under subsection (b);
            (12) the term ``psychosocial'' means the interrelation of 
        social factors and individual thought and behavior;
            (13) the term ``recovery community organization'' has the 
        meaning given the term in section 547 of the Public Health 
        Service Act (42 U.S.C. 290ee-2);
            (14) the term ``single State agency'' means, with respect 
        to a State or unit of local government, the single State agency 
        identified by the State, or the State in which the unit of 
        local government is located, in the plan submitted by that 
        State under section 1932(b)(1)(A)(i) of the Public Health 
        Service Act (42 U.S.C. 300x-32(b)(1)(A)(i));
            (15) the term ``State'' means--
                    (A) each State of the United States;
                    (B) the District of Columbia; and
                    (C) each commonwealth, territory, or possession of 
                the United States; and
            (16) the term ``unit of local government'' has the meaning 
        given the term in section 901 of title I of the Omnibus Crime 
        Control and Safe Streets Act of 1968 (34 U.S.C. 10251), except 
        that such term also includes a tribal organization, as defined 
        in section 4 of the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 5304).
    (b)  Authorization.--Not later than 90 days after the date of 
enactment of this Act, the Attorney General, in consultation with the 
Secretary of Health and Human Services, shall establish a program--
            (1) that shall be known as the ``Medication-assisted 
        Treatment Corrections and Community Reentry Program''; and
            (2) under which the Attorney General--
                    (A) may make grants to, and enter into cooperative 
                agreements with, States or units of local government to 
                develop, implement, or expand 1 or more programs to 
                provide medication-assisted treatment that meets the 
                standard of care generally accepted for the treatment 
                of opioid use disorder to individuals who have opioid 
                use disorder and are incarcerated within the 
                jurisdictions of the States or units of local 
                government; and
                    (B) shall establish a working relationship with 1 
                or more knowledgeable corrections organizations with 
                expertise in security, medical health, mental health, 
                and addiction care to oversee and support 
                implementation of the program, including through the 
                use of evidence-based clinical practices.
    (c) Purposes.--The purposes of the Program are to--
            (1) develop medication-assisted treatment programs in 
        consultation with nonprofit organizations and community 
        organizations that are qualified to provide technical support 
        for the programs;
            (2) reduce the risk of overdose to participants after the 
        participants are released from incarceration; and
            (3) reduce the rate of reincarceration.
    (d) Program Requirements.--In carrying out a covered program, a 
State or unit of local government shall--
            (1) in providing medication-assisted treatment under the 
        covered program, offer to participants 2 or more drugs that--
                    (A) have been approved under the Federal Food, 
                Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) or 
                section 351 of the Public Health Service Act (42 U.S.C. 
                262) for the treatment of an opioid use disorder; and
                    (B) do not contain the same active moiety; and
            (2) use--
                    (A) screening tools with psychometric reliability 
                and validity that provide useful clinical data to guide 
                the long-term treatment of participants who have--
                            (i) opioid use disorder; or
                            (ii) co-occurring opioid use disorder and 
                        mental disorders;
                    (B) at each correctional facility at which the 
                covered program is carried out, a sufficient number of 
                personnel, as determined by the Attorney General in 
                light of the number of individuals incarcerated at the 
                correctional facility and the number of those 
                individuals who the correctional facility has screened 
                and identified as having opioid use disorder, to--
                            (i) monitor participants with active opioid 
                        use disorder who begin participation in the 
                        covered program while demonstrating, or 
                        develop, signs and symptoms of opioid 
                        withdrawal;
                            (ii) provide evidence-based medically 
                        managed withdrawal care or assistance to the 
                        participants described in clause (i);
                            (iii) prescribe or otherwise dispense--
                                    (I) the drugs that are offered 
                                under the covered program, as required 
                                under paragraph (1); and
                                    (II) naloxone or any other 
                                emergency opioid antagonist approved by 
                                the Commissioner of Food and Drugs to 
                                treat opioid overdose; and
                            (iv) discuss with participants the risks 
                        and benefits of, and differences among, the 
                        opioid antagonist, opioid agonist, and partial 
                        agonist drugs used to treat opioid use 
                        disorder; and
                    (C) a certified recovery coach, social work 
                professional, or other qualified clinician who, in 
                order to support the sustained recovery of 
                participants, shall work with participants who are 
                recovering from opioid use disorder.
    (e) Application.--
            (1) In general.--A State or unit of local government 
        desiring a covered grant or cooperative agreement shall submit 
        to the Attorney General an application that--
                    (A) shall include--
                            (i) a description of--
                                    (I) the objectives of the 
                                medication-assisted treatment program 
                                that the applicant will develop, 
                                implement, or expand under the covered 
                                grant or cooperative agreement;
                                    (II) the activities that the 
                                applicant will carry out under the 
                                covered program;
                                    (III) how the activities described 
                                under subclause (II) will achieve the 
                                objectives described in subclause (I); 
                                and
                                    (IV) the outreach and education 
                                component of the covered program that 
                                the applicant will carry out in order 
                                to encourage maximum participation in 
                                the covered program;
                            (ii) if, under the covered program that the 
                        applicant will carry out, the applicant will 
                        not, in providing medication-assisted 
                        treatment, offer to participants not less than 
                        1 drug that uses an opioid antagonist, not less 
                        than 1 drug that uses an opioid agonist, and 
                        not less than 1 drug that uses an opioid 
                        partial agonist, an explanation of why the 
                        applicant is unable to or chooses not to offer 
                        a drug that uses an opioid antagonist, a drug 
                        that uses an opioid agonist, or a drug that 
                        uses an opioid partial agonist, as applicable;
                            (iii) a plan for--
                                    (I) measuring progress in achieving 
                                the objectives described in clause 
                                (i)(I), including a strategy to collect 
                                data that can be used to measure that 
                                progress;
                                    (II) collaborating with the single 
                                State agency for the applicant or 1 or 
                                more nonprofit organizations in the 
                                community of the applicant to help 
                                ensure that--
                                            (aa) if participants so 
                                        desire, participants have 
                                        continuity of care after 
                                        release from incarceration with 
                                        respect to the form of 
                                        medication-assisted treatment 
                                        the participants received 
                                        during incarceration, 
                                        including--

                                                    (AA) by working 
                                                with community service 
                                                providers to assist 
                                                eligible participants, 
                                                before release from 
                                                incarceration in 
                                                registering for the 
                                                Medicaid program under 
                                                title XIX of the Social 
                                                Security Act (42 U.S.C. 
                                                1396 et seq.) or other 
                                                minimum essential 
                                                coverage, as defined in 
                                                section 5000A(f) of the 
                                                Internal Revenue Code 
                                                of 1986; and

                                                    (BB) if a 
                                                participant cannot 
                                                afford, or does not 
                                                qualify for, health 
                                                insurance that provides 
                                                coverage with respect 
                                                to enrollment in a 
                                                medication-assisted 
                                                treatment program, and 
                                                if the participant 
                                                cannot pay the cost of 
                                                enrolling in a 
                                                medication-assisted 
                                                treatment program, by 
                                                working with units of 
                                                local government, 
                                                nonprofit 
                                                organizations, opioid 
                                                use disorder treatment 
                                                providers, and entities 
                                                carrying out programs 
                                                under substance use 
                                                disorder grants to, 
                                                before the participant 
                                                is released from 
                                                incarceration, identify 
                                                a resource, other than 
                                                the applicant or the 
                                                covered program to be 
                                                carried out by the 
                                                applicant, that may be 
                                                used to pay the cost of 
                                                enrolling the 
                                                participant in a 
                                                medication-assisted 
                                                treatment program;

                                            (bb) medications are 
                                        securely stored; and
                                            (cc) protocols relating to 
                                        diversion are maintained; and
                                    (III) with respect to each 
                                community in which a correctional 
                                facility at which a covered program 
                                will be carried out is located, 
                                collaborating with State agencies 
                                responsible for overseeing programs 
                                relating to substance use disorder and 
                                local public health officials and 
                                nonprofit organizations in the 
                                community to help ensure that 
                                medication-assisted treatment provided 
                                at each correctional facility at which 
                                the covered program will be carried out 
                                is also available at locations that are 
                                not correctional facilities in those 
                                communities, to the greatest extent 
                                practicable; and
                            (iv) a certification that--
                                    (I) each correctional facility at 
                                which the covered program will be 
                                carried out has access to a sufficient 
                                number of clinicians who are licensed 
                                to prescribe or otherwise dispense to 
                                participants the drugs for the 
                                treatment of opioid use disorder 
                                required to be offered under subsection 
                                (d)(1), which may include clinicians 
                                who use telemedicine, in accordance 
                                with regulations issued by the 
                                Administrator of the Drug Enforcement 
                                Administration, to provide services 
                                under the covered program; and
                                    (II) the covered program will 
                                provide evidence-based counseling and 
                                behavioral therapies, which may include 
                                counseling and therapy administered 
                                through the use of telemedicine, as 
                                appropriate, to participants as part of 
                                the medication-assisted treatment 
                                provided under the covered program; and
                    (B) may include a statement indicating the number 
                of participants that the applicant expects to serve 
                through the covered program.
            (2) Medication-assisted treatment corrections and community 
        reentry application review panel.--
                    (A) In general.--Not later than 60 days after the 
                date of enactment of this Act, the Attorney General 
                shall establish a Medication-assisted Treatment 
                Corrections and Community Reentry Application Review 
                Panel that shall--
                            (i) be composed of not fewer than 10 
                        individuals and not more than 15 individuals; 
                        and
                            (ii) include--
                                    (I) 1 or more employees, who are 
                                not political appointees, of--
                                            (aa) the Department of 
                                        Justice;
                                            (bb) the Drug Enforcement 
                                        Administration;
                                            (cc) the Substance Abuse 
                                        and Mental Health Service 
                                        Administration;
                                            (dd) the National Center 
                                        for Injury Prevention and 
                                        Control at the Centers for 
                                        Disease Control and Prevention; 
                                        and
                                            (ee) the Office of National 
                                        Drug Control Policy; and
                                    (II) other stakeholders who--
                                            (aa) have expert knowledge 
                                        relating to the opioid 
                                        epidemic, drug treatment, or 
                                        community addiction services; 
                                        and
                                            (bb) represent law 
                                        enforcement organizations and 
                                        public health entities.
                    (B) Duties.--
                            (i) In general.--The Panel shall--
                                    (I) review and evaluate 
                                applications for covered grants and 
                                cooperative agreements; and
                                    (II) make recommendations to the 
                                Attorney General relating to the 
                                awarding of covered grants and 
                                cooperative agreements.
                            (ii) Rural communities.--In reviewing and 
                        evaluating applications under clause (i), the 
                        Panel shall take into consideration the unique 
                        circumstances, including the lack of resources 
                        relating to the treatment of opioid use 
                        disorder, faced by rural States and units of 
                        local government.
                    (C) Termination.--The Panel shall terminate on the 
                last day of fiscal year 2023.
            (3) Publication of criteria in federal register.--Not later 
        than 90 days after the date of enactment of this Act, the 
        Attorney General, in consultation with the Panel, shall publish 
        in the Federal Register--
                    (A) the process through which applications 
                submitted under paragraph (1) shall be submitted and 
                evaluated; and
                    (B) the criteria used in awarding covered grants 
                and cooperative agreements.
    (f) Duration.--A covered grant or cooperative agreement shall be 
for a period of not more than 4 years, except that the Attorney General 
may extend the term of a covered grant or cooperative agreement based 
on outcome data or extenuating circumstances relating to the covered 
program carried out under the covered grant or cooperative agreement.
    (g) Report.--
            (1) In general.--Not later than 2 years after the date on 
        which a State or unit of local government is awarded a covered 
        grant or cooperative agreement, and each year thereafter until 
        the date that is 1 year after the date on which the period of 
        the covered grant or cooperative agreement ends, the State or 
        unit of local government shall submit a report to the Attorney 
        General that includes information relating to the covered 
        program carried out by the State or unit of local government, 
        including information relating to--
                    (A) the goals of the covered program;
                    (B) any evidence-based interventions carried out 
                under the covered program;
                    (C) outcomes of the covered program, which shall--
                            (i) be reported in a manner that 
                        distinguishes the outcomes based on the 
                        categories of, with respect to the participants 
                        in the covered program--
                                    (I) the race of the participants; 
                                and
                                    (II) the gender of the 
                                participants; and
                            (ii) include information relating to the 
                        rate of reincarceration among participants in 
                        the covered program; and
                    (D) expenditures under the covered program.
            (2) Publication.--
                    (A) Awardee.--A State or unit of local government 
                that submits a report under paragraph (1) shall make 
                the report publicly available on--
                            (i) the website of each correctional 
                        facility at which the State or unit of local 
                        government carried out the covered grant 
                        program; and
                            (ii) if a correctional facility at which 
                        the State or unit of local government carried 
                        out the covered grant program does not operate 
                        a website, the website of the State or unit of 
                        local government.
                    (B) Attorney general.--The Attorney General shall 
                make each report received under paragraph (1) publicly 
                available on the website of the National Institute of 
                Corrections.
            (3) Submission to congress.--Not later than 2 years after 
        the date on which the Attorney General awards the first covered 
        grant or cooperative agreement, and each year thereafter, the 
        Attorney General shall submit to the Committee on the Judiciary 
        of the Senate and the Committee on the Judiciary of the House 
        of Representatives a summary and compilation of the reports 
        that the Attorney General has received under paragraph (1) 
        during the year preceding the date on which the Attorney 
        General submits the summary and compilation.
    (h) Authorization of Appropriations.--There is authorized to be 
appropriated $50,000,000 to carry out this section for each of fiscal 
years 2020 through 2023.
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