II 117th CONGRESS 2d Session S. 4839 IN THE SENATE OF THE UNITED STATES September 13, 2022 Ms. Baldwin (for herself and Mrs. Shaheen ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To reauthorize and expand a grant program for State and Tribal response to opioid and stimulant use and misuse, and for other purposes.

1. Short title This Act may be cited as the State Opioid Response Grant Authorization Act of 2022 . 2. Grant program for State and Tribal response to opioid and stimulant use and misuse Section 1003 of the 21st Century Cures Act ( 42 U.S.C. 290ee3 note) is amended to read as follows: 1003. Grant program for State and Tribal response to opioid and stimulant use and misuse (a) In general The Secretary of Health and Human Services (referred to in this section as the Secretary ) shall carry out the grant program described in subsection (b) for purposes of addressing opioid use disorder and stimulant misuse and use disorders, within States, Indian Tribes, and populations served by Tribal organizations and Urban Indian organizations. (b) Grants program (1) In general Subject to the availability of appropriations, the Secretary shall award grants to States, Indian Tribes, Tribal organizations, and Urban Indian organizations for the purpose of addressing opioid use disorder and stimulant use and misuse, within such States, such Indian Tribes, and populations served by such Tribal organizations and Urban Indian organizations, in accordance with paragraph (2). (2) Minimum allocations; preference In determining grant amounts for each recipient of a grant under paragraph (1), the Secretary shall— (A) ensure that each State receives not less than $12,000,000; and (B) give preference to States, Indian Tribes, Tribal organizations, and Urban Indian organizations— (i) whose populations have an incidence or prevalence of opioid use disorder that is substantially higher relative to the populations of other States, Indian Tribes, Tribal organizations, or Urban Indian organizations, as applicable; or (ii) whose areas are more rural relative to the populations of other States, Indian Tribes, Tribal organizations, or Urban Indian organizations, as applicable. (3) Formula methodology (A) In general At least 30 days before publishing a funding opportunity announcement with respect to grants under this section, the Secretary shall— (i) develop a formula methodology, consistent with paragraph (2), to be followed in allocating grant funds awarded under this section among grantees, which includes performance assessments for continuation awards; and (ii) not later than 30 days after developing the formula methodology under clause (i), submit the formula methodology to— (I) the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate; and (II) the Committee on Energy and Commerce and the Committee on Appropriations of the House of Representatives. (B) Transition period for new formula methodology The Secretary shall set a 2-year transition period for the implementation of any new formula methodology if such new formula methodology would reduce the allocation of any State by more than 10 percent. (C) Consideration The Secretary shall ensure that the formula developed under subparagraph (A) avoids a significant cliff between States with similar mortality rates related to opioid use disorders to prevent unusually large funding changes in States when compared to prior year allocations. (D) Report Not later than 2 years after the date of the enactment of the State Opioid Response Grant Authorization Act of 2022 , the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that assesses— (i) how grant funding is allocated to States under this section and how such allocations have changed over time; (ii) how any changes within the specified 2-year period after the date of enactment of the State Opioid Response Grant Authorization Act of 2022 have affected the efforts of States to address opioid use disorder or stimulant use and misuse; and (iii) the use of funding provided through the grant program under this section and other similar grant programs administered by the Substance Abuse and Mental Health Services Administration. (4) Use of funds Grants awarded under this subsection shall be used for carrying out activities that supplement activities pertaining to opioid use disorder and stimulant use and misuse, undertaken by the State agency responsible for administering the substance abuse prevention and treatment block grant under subpart II of part B of title XIX of the Public Health Service Act ( 42 U.S.C. 300x–21 et seq. ), which may include public health-related activities such as the following: (A) Implementing substance use disorder and overdose prevention activities and evaluating such activities to identify effective strategies to prevent substance use disorders and overdoses. (B) Establishing or improving prescription drug monitoring programs. (C) Training for health care practitioners, such as best practices for prescribing opioids and stimulants, pain management, recognizing potential cases of substance use disorders, referral of patients to treatment programs, preventing diversion of controlled substances, and overdose prevention. (D) Supporting access to health care services, including— (i) services provided by federally-certified opioid or stimulant treatment programs; (ii) outpatient and residential substance use disorder treatment services that utilize, or refer patients to, medication-assisted treatment, where clinically appropriate; (iii) services to treat substance use disorders provided by other appropriate health care providers and at other locations; or (iv) overdose prevention programs and services, including drugs or devices approved, cleared, or otherwise legally marketed under the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or suspected overdose. (E) Recovery support services, including— (i) community-based services that include peer supports; (ii) mutual aid recovery programs that support medication-assisted treatment; (iii) services to address housing needs, transportation needs, food insecurity, and employment issues; or (iv) resources or programs that support families that include an individual with a substance use disorder, including education, training, outreach, and peer support services. (F) Other public health-related activities, as the grant recipient determines appropriate, related to addressing substance use disorders within the State, Indian Tribe, Tribal organization, or Urban Indian organization, including directing resources in accordance with local needs related to substance use disorders. (c) Accountability and oversight A State receiving a grant under subsection (b) shall include in reporting related to substance use disorders submitted to the Secretary pursuant to section 1942 of the Public Health Service Act ( 42 U.S.C. 300x–52 ), a description of— (1) the purposes for which the grant funds received by the State under such subsection for the preceding fiscal year were expended and a description of the activities of the State under the grant; (2) the ultimate recipients of amounts provided to the State; and (3) the number of individuals served through each of the activities of the State under the grant and the total number of individuals served through the grant. (d) Limitations Any funds made available pursuant to subsection (i)— (1) notwithstanding any transfer authority in any appropriations Act, shall not be used for any purpose other than the grant program under subsection (b); and (2) shall be subject to the same requirements as substance use disorders prevention and treatment programs under titles V and XIX of the Public Health Service Act ( 42 U.S.C. 290aa et seq. , 300w et seq.). (e) Indian Tribes, Tribal organizations, and Urban Indian organizations The Secretary, in consultation with Indian Tribes, Tribal organizations, and Urban Indian organizations, shall identify and establish appropriate mechanisms for Indian Tribes, Tribal organizations, and Urban Indian organizations to demonstrate or report information as required under subsections (b), (c), and (d). (f) Report to Congress Not later than September 30, 2024, and biennially thereafter, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate and the Committee on Energy and Commerce and the Committee on Appropriations of the House of Representatives a report that includes a summary of the information provided to the Secretary in reports made pursuant to subsections (c) and (e), including— (1) the purposes for which grant funds are awarded under this section; (2) the activities of the grant recipients; and (3) for each State, Indian Tribe, Tribal organization, and Urban Indian organization that receives a grant under this section, the funding level provided to such recipient. (g) Technical assistance The Secretary, acting, as appropriate, through the Tribal Training and Technical Assistance Center of the Substance Abuse and Mental Health Services Administration, shall provide States, Indian Tribes, Tribal organizations, and Urban Indian organizations, as applicable, with— (1) technical assistance concerning grant application and submission procedures under this section; (2) award management activities; and (3) enhancement of outreach and direct support to rural and underserved communities and providers in addressing substance use disorders. (h) Definitions In this section: (1) Indian Tribe; Tribal organization The terms Indian Tribe and Tribal organization have the meanings given such terms in section 4 of the Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 5304 ). (2) State The term State has the meaning given such term in section 1954(b) of the Public Health Service Act ( 42 U.S.C. 300x–64(b) ). (3) Urban indian organization The term Urban Indian organization has the meaning given such term in section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 ). (i) Authorization of appropriations (1) In general For purposes of carrying out the grant program under subsection (b), there is authorized to be appropriated $2,700,000,000 for each of fiscal years 2023 through 2027, to remain available until expended. (2) Federal administrative expenses Of the amounts made available for each fiscal year to award grants under subsection (b), the Secretary shall use not more than 2 percent for Federal administrative expenses, training, technical assistance, and evaluation. (3) Set aside Of the amounts made available for each fiscal year to award grants under subsection (b) for a fiscal year, the Secretary shall— (A) award 5 percent to Indian Tribes, Tribal organizations, and Urban Indian organizations; and (B) award up to 15 percent to States with the highest age-adjusted rates of drug overdose death over the most recent 2-year period, according to the Director of the Centers for Disease Control and Prevention. .