II 118th CONGRESS 1st Session S. 3006 IN THE SENATE OF THE UNITED STATES October 3, 2023 Mr. Markey introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To ensure comprehensive wraparound services for families impacted by substance use disorders, and for other purposes.

1. Short title This Act may be cited as the Substance Use Disorder and Family Engagement in Recovery Act or the SAFE in Recovery Act . 2. Ensuring care and no undue family separation of families impacted by substance use disorder (a) In general Section 503 of the Social Security Act ( 42 U.S.C. 703 ) is amended by adding at the end the following new subsection: (d) Limitations on toxicology testing to detect substance use (1) In general As a condition of receiving payments under this section, each State— (A) shall not require the birthing parent of an infant who is identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure or a Fetal Alcohol Spectrum Disorder to undergo toxicology testing to detect substance use unless the parent— (i) gives clear and informed consent prior to such testing; and (ii) is able to access, if necessary for purposes of giving such consent, interpretation services and reasonable accommodations for disabilities; (B) shall ensure that a pregnant or postpartum individual taking a prescription drug, including a prescription drug for the treatment of a substance use disorder, in accordance with the recommendations of the prescribing practitioner, shall not be subject to investigations of child abuse and neglect on the basis that such individual is taking such prescription drug; (C) shall ensure that— (i) any toxicology testing to detect substance use that is provided to a pregnant or postpartum individual taking a prescription drug, including a prescription drug for the treatment of a substance use disorder, in accordance with the recommendations of the prescribing practitioner is consented to by the pregnant or postpartum individual in accordance with subparagraph (A); and (ii) such testing (and the results of such testing) shall not affect the individual's access to care or public assistance and shall not be the sole factor in a family separation determination involving the individual; and (D) shall ensure that any health care provider involved in the delivery or care of an infant identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder, is not required to notify the child protective services system of the State or any unit of local government of the State of the occurrence of such condition in such infant if such condition is the result of the birthing parent of the infant taking a prescription drug, including a prescription drug for the treatment of a substance use disorder, in accordance with the recommendations of the prescribing practitioner, and such provider has no other reason to suspect that the infant is in imminent danger of abuse or neglect. (2) Definition of prescription drug In this subsection, the term prescription drug means a drug approved under section 505 of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355 ) or licensed under section 351 of the Public Health Service Act ( 42 U.S.C. 262 ) that is subject to section 503(b)(1) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 353(b)(1) ). . (b) Effective date The amendment made by this section shall take effect on the date that is 2 years after the date of enactment of this Act. 3. Ensuring a whole-of-government approach through a Federal interagency task force to support families impacted by substance use disorders (a) Establishment There is established within the Federal Government an interagency task force to improve— (1) efforts, resources, and services of the Federal Government to support families impacted by substance use disorders; (2) the utilization of such efforts, resources, and services; and (3) strategies to streamline the provision of comprehensive wraparound care for families impacted by substance use disorders. (b) Membership (1) Composition The task force shall be composed of the heads of the following Federal departments and agencies, or their designees: (A) The Centers for Medicare & Medicaid Services. (B) The Substance Abuse and Mental Health Services Administration. (C) The Agency for Healthcare Research and Quality. (D) The Centers for Disease Control and Prevention. (E) The Indian Health Service. (F) The Department of Veterans Affairs. (G) The National Institutes of Health. (H) The Food and Drug Administration. (I) The Health Resources and Services Administration. (J) The Department of Defense. (K) The Office of Minority Health of the Department of Health and Human Services. (L) The Administration for Children and Families. (M) The Office of the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services. (N) The Office for Civil Rights of the Department of Health and Human Services. (O) The Office of Juvenile Justice and Delinquency Prevention of the Department of Justice. (P) The Office of Community Oriented Policing Services of the Department of Justice. (Q) The National Center for Education Evaluation and Regional Assistance of the Department of Education. (R) The National Center for Special Education Research of the Institute of Education Science. (S) The Office of Elementary and Secondary Education of the Department of Education. (T) The Office for Civil Rights of the Department of Education. (U) The Office of Special Education and Rehabilitative Services of the Department of Education. (V) The Bureau of Indian Affairs of the Department of the Interior. (W) The Veterans Health Administration of the Department of Veterans Affairs. (X) The Office of Special Needs Assistance Programs of the Department of Housing and Urban Development. (Y) The Office of Head Start of the Administration for Children and Families. (Z) The Children’s Bureau of the Administration for Children and Families. (AA) The Bureau of Indian Education of the Department of the Interior. (BB) Such other Federal agencies as the Secretaries determine to be appropriate. (2) Date of appointments The heads of Federal departments and agencies shall appoint the corresponding members of the task force not later than 60 days after the date of enactment of this Act. (3) Chairperson The task force shall be chaired by the Secretary of Health and Human Services. (c) Duties The interagency task force shall carry out each of the following activities: (1) Solicit input from stakeholders, including frontline service providers, educators, mental health professionals, researchers, experts in infant, child, and youth trauma, child welfare professionals, people in recovery, and the public, in order to inform the activities under this subsection. (2) Compile a comprehensive list of all Federal Government efforts, resources, and services to support families impacted by substance use disorders. (3) Assess the effectiveness of care, services, and resources available to families impacted by substance use disorders. (4) Analyze and make recommendations for means of eliminating barriers that prevent individuals with substance use disorders from entering and remaining in care for the disorder involved. (5) Analyze and make recommendations for means of eliminating barriers to social services for individuals with substance use disorders and their families. (6) Provide recommendations for effectively streamlining the provision of comprehensive wraparound care for families impacted by substance use disorders. (7) Recommend a plan for addressing the comprehensive wraparound care needs of families impacted by substance use disorders and specifically address in the plan the needs of populations most disproportionately affected. (8) Other activities as determined appropriate by the Secretary. (d) Operating plan Not later than 120 days after the date of enactment of this Act, the task force shall hold the first meeting. Not later than 2 years after such date of enactment, the task force shall submit to the Secretary of Education, the Secretary of Health and Human Services, the Secretary of Labor, the Secretary of the Interior, the Attorney General, and Congress an operating plan for carrying out the activities of the task force described in subsection (c). Such operating plan shall include— (1) a list of specific activities that the task force plans to carry out for purposes of carrying out duties described in subsection (c), which may include public engagement; (2) a plan for carrying out the activities under subsection (c); (3) a list of members of the task force and other individuals who are not members of the task force that may be consulted to carry out such activities; (4) an explanation of Federal agency involvement and coordination needed to carry out such activities, including any statutory or regulatory barriers to such coordination; (5) a budget for carrying out such activities; (6) a proposed timeline for implementing recommendations and efforts identified under subsection (c); and (7) other information that the task force determines appropriate as related to its duties. (e) Final report Not later than 3 years after the date of enactment of this Act, the Secretary shall submit to Congress and the general public a final report that contains the findings and recommendations (including the recommended plan described in subsection (c)(7)) of the task force. (f) Additional reports In addition to the final report under subsection (e), the task force shall submit— (1) a report to Congress identifying any recommendations identified under subsection (c) that require additional legislative authority to implement; and (2) a report to the Governors describing opportunities for local- and State-level partnerships, professional development, or best practices to support families impacted by substance use disorders. (g) Sunset The task force shall sunset on the date that is 60 days after the submission of the report under subsection (e), but not later than September 30, 2028. (h) Definition of comprehensive wraparound care In this section, the term comprehensive wraparound care includes clinical, ancillary health, mental health, substance use disorder, and social support services, to address a substance use disorder. 4. Increasing access to behavioral health care through community health centers (a) Required primary health services (1) In general Section 330(b) of the Public Health Service Act ( 42 U.S.C. 254b(b) ) is amended— (A) in paragraph (1)(A)(i)— (i) in subclause (IV), by striking ; and and inserting a semicolon; (ii) in subclause (V), by striking the semicolon and inserting ; and ; and (iii) by adding at the end the following: (VI) behavioral and mental health and substance use disorder services; ; (B) in paragraph (1)(A)(ii), by inserting , including such referrals to certified community behavioral health centers before the semicolon; and (C) in paragraph (2)— (i) by striking subparagraph (A); and (ii) by redesignating subparagraphs (B) through (D) as subparagraphs (A) through (C), respectively. (2) Funding For purposes of assisting health centers in incorporating behavioral and mental health and substance use disorder services into the required primary health services offered by such centers, there is appropriated to the Secretary of Health and Human Services, out of amounts in the Treasury not otherwise appropriated, $500,000,000 for fiscal year 2025, to remain available until expended. (3) Report Not later than 1 year after the date that is 3 years after the date of enactment of this Act, the Secretary of Health and Human Services shall submit a report to Congress on— (A) the impact that the amendments made by paragraph (1) has had on access to behavioral and mental health and substance use disorder services; and (B) employee recruitment and retention for behavioral and mental health and substance use disorder providers, including for health centers, certified community behavioral health centers, and other community care settings. (b) Environmental justice communities Section 10503 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 254b–2 ) is amended— (1) in subsection (b)(1)— (A) in subparagraph (E), by striking and at the end; and (B) by adding at the end the following: (G) $130,000,000,000 for the period of fiscal years 2024 through 2028. (f) Environmental justice communities The Secretary shall ensure that not less than 50 percent of the amounts appropriated under subsection (b)(1) for fiscal year 2024 or any fiscal year thereafter are awarded to entities for use with respect to projects or sites located in or serving communities with significant representation of communities of color, low-income communities, or Tribal and Indigenous communities that experience, or are at risk of experiencing, higher or more adverse human health or environmental effects. (g) Prohibition No amounts made available under this section may be used for any activity that is subject to the reporting requirements set forth in section 203(a) of the Labor-Management Reporting and Disclosure Act of 1959 ( 29 U.S.C. 433(a) ). . 5. Improving outcomes for pregnant and postpartum patients with substance use disorder and payments to incentivize care for opioid use disorder (a) In general Section 1866F(b)(1) of the Social Security Act ( 42 U.S.C. 1395cc–6(b)(1) is amended by adding at the end the following new subparagraph: (G) Improves outcomes for pregnant and postpartum individuals with opioid use disorder. . (b) Payments Section 1866F(e)(1) of the Social Security Act ( 42 U.S.C. 1395cc–6(e)(1) is amended— (1) in subparagraph (A), by inserting pregnancy and postpartum services and after including ; and (2) in subparagraph (B)— (A) in clause (iii), by striking and ; (B) in clause (iv), by striking the period and inserting ; and ; and (C) by adding at the end the following new clause: (v) pay a higher per applicable beneficiary per month care management fee for an applicable beneficiary who receives pregnancy or postpartum services from a participant. . (c) Effective date The amendments made by this section shall take effect on January 1, 2024, and shall apply to services furnished on or after that date. 6. Increasing access to wraparound services for children from families impacted by substance use disorder (a) Grants The Head Start Act is amended by inserting after section 645A ( 42 U.S.C. 9840a ) the following: 645B. Children from families impacted by substance use disorder (a) Grants (1) In general The Secretary shall make grants, in accordance with paragraph (2), to Head Start and Early Head Start agencies to enable the agencies to provide comprehensive health, educational, nutritional, social, and other services to children in Head Start and Early Head Start programs, respectively, from families impacted by substance use disorder, or referring the children to such services, to assure best outcomes for the health, wellness, and school readiness of the children. (2) Formula The Secretary shall make those grants, to fund the activities described in paragraph (1) for a fiscal year, by— (A) using the amount appropriated under subsection (c) for that fiscal year; and (B) distributing that amount in accordance with clauses (i) (with respect to additional funding for the comprehensive services described in paragraph (1)) and (ii) of section 640(a)(4)(C). (b) Construction A reference in this subchapter (other than this section) to funds appropriated or provided under this subchapter shall not be considered to include funds appropriated or provided under this section. (c) Authorization of appropriations There is authorized to be appropriated to carry out this section $60,000,000 for fiscal year 2024 and each subsequent fiscal year. . (b) Conforming amendment Section 639 of the Head Start Act ( 42 U.S.C. 9834 ) is amended by striking section 657B and inserting sections 645B and 657B . 7. Coordinating research of the National Institutes of Health Part A of title IV of the Public Health Service Act ( 42 U.S.C. 281 et seq. ) is amended by adding at the end the following: 404P. Research with respect to co-occurring pregnancy and substance use disorder The Director of the National Institutes of Health shall establish a consortium on pregnancy, postpartum recovery, and substance use disorder research to establish research priorities and steward research activities across the national research institutes and national centers to understand and mitigate the harms of substance use disorder for pregnant and postpartum patients and their children. . 8. Ensuring the use of best available medical practices through a GAO report on clinical guidelines for treating pregnant and parenting patients with substance use disorder and their children The Comptroller General of the United States shall— (1) conduct a study assessing— (A) the extent to which clinical guidelines for treating pregnant and parenting patients with substance use disorder and their children are implemented; (B) any systemic and other barriers to ensuring that patients and children described in subparagraph (A) get access to up-to-date care that addresses the complexity of co-occurring substance use disorder and pregnancy; and (C) access to treatment for pregnant and postpartum individuals with substance use disorder and the impacts of interactions with child welfare systems; and (2) not later than 2 years after the date of enactment of this Act, submit a report to Congress on the results of such study.