II 118th CONGRESS 2d Session S. 4358 IN THE SENATE OF THE UNITED STATES May 16, 2024 Mr. Casey (for himself, Mr. Fetterman , Ms. Warren , Mr. Blumenthal , and Mrs. Gillibrand ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Public Health Service Act to require the Secretary to establish a grant program under the Substance Abuse and Mental Health Services Administration to address substance use disorders among older adults, and for other purposes.

1. Short title This Act may be cited as the Preventing and Treating Substance Use Disorders Among Older Adults Act . 2. Substance use disorder treatment and early intervention services for older adults Subpart 1 of part B of title V of the Public Health Service Act ( 42 U.S.C. 290bb et seq. ) is amended by adding at the end the following: 514C. Substance use disorder treatment and early intervention services for older adults (a) Definition of older adult In this section, the term older adult means an individual aged 60 or older. (b) Authority To award grants The Secretary shall award grants, contracts, or cooperative agreements to public and private nonprofit entities, Indian Tribes or Tribal organizations (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act), or other health facilities or programs operated by or in accordance with a contract or grant with the Indian Health Service, for the purposes of— (1) providing early identification and services to meet the needs of older adults who are at risk of substance use disorders; (2) providing substance use disorder treatment and prevention services for older adults, including older adults with co-occurring mental illness and substance use disorders; (3) linking older adults to resources, either in the community or within long-term care settings where they reside, to support independent lives; and (4) providing integrated care and comprehensive care coordination for substance use disorders and other health conditions. (c) Priority In awarding grants, contracts, or cooperative agreements under subsection (b), the Secretary shall give priority to applicants who propose to— (1) apply evidence-informed and cost-effective methods; (2) improve data collection on the scope of substance use among older adults, the scope of availability and utilization of treatment and prevention services, and the scope of integrated care; (3) coordinate and collect data on the provision of services with other social service agencies in the community, including congregate care, substance use, and mental health agencies; (4) provide a continuum of integrated treatment services, including case management and primary care services, for older adults with substance use disorders, including older adults with co-occurring mental illness and substance use disorders, and their families and caregivers; (5) provide treatment that is person-centered, culturally appropriate, and age-sensitive; (6) involve and work with peers and families and caregivers of older adults receiving services; and (7) provide continuing care services for older adults and their families following the completion of a treatment episode. (d) Duration of grants The Secretary shall award grants, contracts, or cooperative agreements under subsection (b) for periods not to exceed 5 fiscal years. (e) Application An entity desiring a grant, contract, or cooperative agreement under subsection (b) shall submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may reasonably require. (f) Evaluation An entity that receives a grant, contract, or cooperative agreement under subsection (b) shall submit, in the application for such grant, contract, or cooperative agreement, a plan for the evaluation of any project undertaken with funds provided under this section. Such entity shall provide the Secretary with periodic evaluations of the progress of such project and such evaluation at the completion of such project as the Secretary determines to be appropriate. (g) Authorization of appropriations There are authorized to be appropriated to carry out this section $25,000,000 for each of fiscal years 2025 through 2029. . 3. Evidence-based drugs and alcohol treatment and interventions demonstration Subpart 1 of part B of title V of the Public Health Service Act ( 42 U.S.C. 290bb et seq. ) (as amended by section 2) is amended by adding at the end the following: 514D. Evidence-based drugs and alcohol treatment and interventions demonstration (a) Grants To expand access (1) Authority to award grants The Secretary shall award grants, contracts, or cooperative agreements to State substance use disorder agencies, units of local government, United States territories, and Indian Tribes and Tribal organizations (as defined in section 4 of the Indian Self-Determination and Education Assistance Act) that have a high rate of, or have had a rapid increase in, the misuse of alcohol or prescription or illicit drugs, including opioids, in order to permit such entities to expand activities, including an expansion in the availability of evidence-based medications for substance use disorder treatment and other clinically appropriate services with respect to the treatment of substance use disorders in the specific geographical areas of such entities where there is a high rate of, or rapid increase in, the misuse of alcohol or prescription or illicit drugs, including opioids, or specific geographical areas where there is a high rate of unmet need for treatment, such as in rural areas and among communities of color. (2) Nature of activities Funds awarded under paragraph (1) shall be used for activities that are based on reliable scientific evidence of efficacy in the treatment of substance use disorders. (b) Application To be eligible for a grant, contract, or cooperative agreement under subsection (a), an entity shall submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may reasonably require. (c) Evaluation An entity that receives a grant, contract, or cooperative agreement under subsection (a) shall submit, in the application for such grant, contract, or agreement a plan for the evaluation of any project undertaken with funds provided under this section. Such entity shall provide the Secretary with periodic evaluations of the progress of such project and an evaluation at the completion of such project as the Secretary determines to be appropriate. (d) Geographic distribution In awarding grants, contracts, and cooperative agreements under this section, the Secretary shall ensure that not less than 15 percent of funds are awarded to eligible entities that are not located in metropolitan statistical areas (as defined by the Office of Management and Budget). The Secretary shall take into account the unique needs of rural communities, including communities with an incidence of individuals with substance use disorder that is above the national average and communities with a shortage of prevention and treatment services. (e) Additional activities In administering grants, contracts, and cooperative agreements under subsection (a), the Secretary shall— (1) evaluate the activities supported under such subsection; (2) disseminate information, as appropriate, derived from evaluations as the Secretary considers appropriate; (3) provide States, Indian Tribes and Tribal organizations, and providers with technical assistance in connection with the provision of treatment of substance use disorder; and (4) fund only those applications that specifically support recovery services as a critical component of the program involved. (f) Authorization of appropriations To carry out this section, there are authorized to be appropriated $25,000,000 for each of fiscal years 2025 through 2029. .