Comprehensive Addiction Resources Emergency Act of 2021
This bill establishes programs, grants, and other activities to address substance use disorders.
Specifically, the Department of Health and Human Services (HHS) must establish a program for purchasing and distributing opioid overdose reversal drugs for states and Indian tribes.
HHS must also award grants for and otherwise support
In addition, HHS must issue model standards of care for treatment services and recovery residences and may award grants for training health care professionals. The bill also supports prevention and treatment services for workers, addiction and pain management research, and data collection on substance use disorders.
Further, dispensers, distributors, and manufacturers of schedule II controlled substances (e.g., oxycodone), with the exception of opioid treatment programs, must certify that they maintain effective drug diversion controls. Violators are subject to specified civil and criminal penalties. Collected penalties shall be used for the grant programs and other substance use disorder activities established under the bill.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6311 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 6311
To provide emergency assistance to States, territories, Tribal nations,
and local areas affected by substance use disorder, including the use
of opioids and stimulants, and to make financial assistance available
to States, territories, Tribal nations, local areas, public or private
nonprofit entities, and certain health providers, 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 HOUSE OF REPRESENTATIVES
December 16, 2021
Mrs. Carolyn B. Maloney of New York (for herself, Ms. Kuster, Mr.
Trone, Mr. Lynch, Ms. Dean, Ms. Lee of California, Ms. Jackson Lee, Ms.
Pingree, Ms. Ross, Mr. Moulton, Mr. McGovern, Mr. Keating, Ms. Norton,
Mr. Connolly, Ms. Tlaib, Mrs. McBath, Ms. Pressley, Mr. Pocan, Ms.
Garcia of Texas, Mr. Cicilline, Mr. Cleaver, Ms. Titus, Ms. Underwood,
Mrs. Trahan, Ms. Meng, Mr. Raskin, Mr. DeSaulnier, Mr. Cardenas, Ms.
Velazquez, Ms. Spanberger, Mr. Ryan, Ms. Manning, Ms. McCollum, Mr.
Schiff, Ms. Kelly of Illinois, Ms. Matsui, Ms. Brownley, Mr.
Perlmutter, Mr. Welch, Ms. Scanlon, Ms. Clark of Massachusetts, Ms.
Ocasio-Cortez, Mr. Takano, Mrs. Hayes, Mr. Cooper, Mr. Neguse, Mr.
Kilmer, Mr. Case, Mr. Blumenauer, Mr. Lieu, Mr. Grijalva, Mr.
O'Halleran, Ms. Wasserman Schultz, Mr. Gomez, Mr. Krishnamoorthi, Mr.
Suozzi, Mr. Nadler, Ms. Bush, Mr. Khanna, Ms. Sewell, Mr. Jones, Mr.
Gallego, Mr. Espaillat, Ms. Jayapal, Mr. Mfume, Ms. Barragan, Ms.
Schakowsky, Mr. Torres of New York, Ms. Moore of Wisconsin, Mr. Michael
F. Doyle of Pennsylvania, Mr. Huffman, Mr. Larson of Connecticut, Mr.
Thompson of California, Mr. Garcia of Illinois, Mr. Tonko, Mr. Carson,
Mr. Cartwright, Mr. Danny K. Davis of Illinois, Mr. Morelle, Ms. Bass,
Mrs. Watson Coleman, Mr. Meeks, Mrs. Dingell, Mr. Johnson of Georgia,
Ms. Brown of Ohio, Ms. Chu, Mr. Yarmuth, Ms. Bonamici, Mr. Sarbanes,
Mr. Cuellar, Ms. Escobar, Mr. Pappas, Mr. Bowman, Mr. Panetta, Ms.
Sanchez, Ms. DeGette, and Ms. Roybal-Allard) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committees on Natural Resources, the Judiciary, and
Oversight and Reform, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To provide emergency assistance to States, territories, Tribal nations,
and local areas affected by substance use disorder, including the use
of opioids and stimulants, and to make financial assistance available
to States, territories, Tribal nations, local areas, public or private
nonprofit entities, and certain health providers, 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 2021''.
(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 RESOURCES
``Subtitle A--Local Substance Use Emergency Relief Grant Program
``Sec. 3401. Establishment of program of grants.
``Sec. 3402. Planning council.
``Sec. 3403. Amount of grant, use of amounts, and funding
agreement.
``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, use of amounts, and funding
agreement.
``Sec. 3413. Application.
``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--Innovation, Training, and Health Systems Strengthening
``Sec. 3431. Special projects of national significance.
``Sec. 3432. Education and training centers.
``Sec. 3433. Substance use disorder treatment provider capacity
under the Medicaid program.
``Sec. 3434. Programs to support employees.
``Sec. 3435. Improving and expanding care.
``Sec. 3436. Naloxone distribution program.
``Sec. 3437. Additional funding for the National Institutes of
Health.
``Sec. 3438. Additional funding for the Centers for Disease
Control and Prevention.
``Sec. 3439. Definitions.
Sec. 4. Amendments to the Controlled Substances Act.
Sec. 5. General limitation on use of funds.
Sec. 6. Federal drug demand reduction activities.
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 substance use disorder, including the use
of opioids and stimulants, and to make financial assistance available
to States, territories, Tribal nations, local areas, public or private
nonprofit entities, and certain health providers, 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, including with co-
occurring mental health and substance use disorders, and their
families.
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 RESOURCES
``Subtitle A--Local Substance Use Emergency Relief Grant Program
``SEC. 3401. ESTABLISHMENT OF PROGRAM OF GRANTS.
``(a) In General.--The Secretary 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
population 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;
``(iii) a county that encompasses an
undeserved area, defined as a health
professional shortage area (as defined in
section 332(a)(1)(A)) and a medically
underserved area (according to a designation
under section 330(b)(3)(A)), that can
demonstrate a high burden of both fatal and
non-fatal drug overdoses in a manner determined
by the Secretary; or
``(iv) a city that is located within a
county described in clause (i), (ii), or (iii)
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 county
or 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) Data from tribal areas.--The Secretary, acting
through the Indian Health Service, shall consult with Indian
Tribes and confer with urban Indian organizations to establish
eligibility and allocation criteria that provide an equivalent
measure of need for Tribal and urban Indian areas for which the
data described in paragraph (1)(A) or (2)(D)(i) are not
available or do not apply.
``(8) 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) provide 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.
``(9) 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) cities or counties within multiple contiguous
counties 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, and facilities operated by the
Department of Veterans Affairs;
``(B) Native Hawaiian organizations as defined in
section 11 of the Native Hawaiian Health Care Act of
1988;
``(C) community-based health, harm reduction, or
addiction service organizations, including, where
applicable, representatives of Drug Free Communities
Coalition grantees;
``(D) social service providers, including providers
of housing and homelessness services and recovery
residence providers;
``(E) mental health care providers;
``(F) local public health agencies;
``(G) individuals with substance use disorder and
individuals who use drugs;
``(H) individuals in recovery from substance use
disorders;
``(I) State governments, including the State
Medicaid agency and the Single State Agency for
Substance Abuse Services;
``(J) local governments;
``(K) non-elected community leaders;
``(L) substance use disorder treatment providers,
including physician addiction specialists;
``(M) Indian tribes and tribal organizations as
defined in section 4 of the Indian Self-Determination
and Education Assistance Act;
``(N) Urban Indians as defined in section 4 of the
Indian Health Care Improvement Act;
``(O) historically underserved groups and
subpopulations;
``(P) individuals who were formerly incarcerated;
``(Q) organizations serving individuals who are
currently incarcerated or in pre-trial detention or
were formerly incarcerated;
``(R) Federal agencies;
``(S) organizations that provide drug prevention
programs and services to youth at risk of substance
use;
``(T) medical examiners or coroners;
``(U) labor unions and the workplace community;
``(V) local fire departments and emergency medical
services;
``(W) the lesbian, gay, bisexual, transgender,
queer (LGBTQ) community; and
``(X) certified or accredited addiction recovery
community organizations.
``(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
organizations.
``(3) Designation of existing entity.--If an existing
entity is designated to serve as the council under this
section, the membership of the entity shall comply with the
requirements of subsection (a)(1) before it performs any of the
duties set forth in subsection (e).
``(4) 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.
``(5) 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;
``(4) include at least 1 individual with a history of
substance use disorder;
``(5) include at least 1 representative from a nonprofit
substance use disorder service provider, at least 1
representative of an urban Indian organization, at least 1
physician addiction specialist, and at least 1 representative
from an organization providing harm reduction services;
``(6) include at least 1 representative of a Native
Hawaiian organization (as defined in section 11 of the Native
Hawaiian Health Care Act of 1988) when the Native Hawaiian
population exceeds 10 percent; and
``(7) serve not 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 use rates, overdose, substance use disorder, and health
conditions associated with drug use such as human
immunodeficiency virus, hepatitis B, and hepatitis C 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 prevention, intervention, treatment, and
recovery strategies that comply with best practices
identified by the Secretary;
``(B) the demonstrated or probable cost-
effectiveness of proposed substance use disorder
prevention, intervention, treatment, and recovery
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
non-governmental services;
``(2) ensure the use of grant funds will advance 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
prevention and treatment services;
``(4) regularly assess the efficiency of the administrative
mechanism in rapidly allocating funds to support evidence-based
substance use disorder prevention and 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 prevention, intervention, treatment, harm
reduction, and recovery 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 addictive substance-related
health disparities to gather data using culturally attuned data
collection methodologies;
``(9) coordinate with Federal grantees that provide
substance use disorder prevention and treatment services within
the eligible local area; and
``(10) annually assess the effectiveness of the substance
use disorder prevention and treatment services being supported
by the grant received by the eligible local area, including, to
the extent possible--
``(A) reductions in the rates of substance use,
overdose, and death from substance use;
``(B) rates of discontinuation from substance use
disorder treatment services and rates of sustained
recovery;
``(C) long-term outcomes among individuals
receiving treatment for substance use disorders; and
``(D) the availability and use 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.
``(i) Neutrality Towards Organized Labor.--
``(1) In general.--In carrying out duties under subsection
(e), planning councils shall, to the extent practicable,
prioritize the distribution of grant funds to grantees that
have--
``(A)(i) a collective bargaining agreement; or
``(ii) an explicit policy not to deter employees
with respect to--
``(I) labor organizing for the employees
engaged in the covered activities; and
``(II) such employees' choice to form and
join labor organizations; and
``(B) policies that require--
``(i) the posting and maintenance of
notices in the workplace to such employees of
their rights under the National Labor Relations
Act (29 U.S.C. 151 et seq.);
``(ii) that such employees are, at the
beginning of their employment, provided notice
and information regarding the employees' rights
under such Act; and
``(iii) the employer to voluntarily
recognize a union in cases where a majority of
such workers of the employer have joined and
requested representation.
``(2) Limitation.--This subsection does not apply to Indian
tribes.
``SEC. 3403. AMOUNT OF GRANT, USE OF AMOUNTS, AND FUNDING AGREEMENT.
``(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) are 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, other emergency medical
services for drug-related causes, or Overdose
Detection Mapping Application Program (ODMAP)
data 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 paragraph (1)(A) or (6) of section 3401(b),
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
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 preventing, treating,
and managing substance use disorder and
supporting sustained recovery;
``(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 State plan
approved by the Secretary pursuant to section
1932(b);
``(viii) demonstrates success in
identifying individuals with substance use
disorders; and
``(ix) demonstrates that support for
substance use disorder prevention and treatment
services is organized to maximize the value to
the population to be served with an appropriate
mix of substance use disorder prevention and
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, or
recent increases in drug overdoses or
drug overdose deaths since data were
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 funds.--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 funds 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) Payment of funds.--At the option of an Indian
tribe the Secretary shall pay funds under this section
through a contract, cooperative agreement, or compact
under, as applicable, title I or V of the Indian Self-
Determination and Education Assistance Act.
``(D) Use of amounts.--Notwithstanding any
requirements in this section, an Indian tribe may use
amounts provided under funds 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. An
Indian tribe shall not be required to allocate funds
and services in accordance with the goals, priorities,
or objectives established by a planning council under
section 3402.
``(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 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 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 (9).
``(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 or providers for the purpose of providing
prevention services, core medical services, recovery
and support services, early intervention services, and
harm reduction services.
``(B) Appropriate entities.--Direct financial
assistance may be provided under subparagraph (A) to
public or nonprofit entities, other eligible Medicaid
providers if more than half of their patients are
diagnosed with a substance use disorder and covered by
Medicaid, or other private for-profit entities if such
entities are the only available provider of quality
substance use disorder treatment services in the area.
``(C) Limitation.--An eligible local area (not
including tribal areas) may not provide direct
financial assistance to any entity or provider that
provides medication for addiction treatment if that
entity or provider does not also offer mental health
services or psychotherapy by licensed clinicians
through a referral or onsite.
``(D) Neutrality towards organized labor.--
``(i) In general.--In carrying out duties
under this section, eligible local areas shall,
to the extent practicable, prioritize the
distribution of grant funds to grantees that
have--
``(I)(aa) a collective bargaining
agreement; or
``(bb) an explicit policy not to
deter employees with respect to--
``(AA) labor organizing for
the employees engaged in the
covered activities; and
``(BB) such employees'
choice to form and join labor
organizations; and
``(II) policies that require--
``(aa) the posting and
maintenance of notices in the
workplace to such employees of
their rights under the National
Labor Relations Act (29 U.S.C.
151 et seq.);
``(bb) that such employees
are, at the beginning of their
employment, provided notice and
information regarding the
employees' rights under such
Act; and
``(cc) the employer to
voluntarily recognize a union
in cases where a majority of
such workers of the employer
have joined and requested
representation.
``(ii) Limitation.--This subsection does
not apply to Indian tribes.
``(3) Prevention services.--
``(A) In general.--For purposes of this section,
the term `prevention services' means evidence-based
services, programs, or multi-sector strategies to
prevent substance use disorder (including education
campaigns, community-based prevention programs, risk
identification programs, opioid diversion, collection
and disposal of unused opioids, services to at-risk
populations, and trauma support services).
``(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 section,
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,
including through the use of telemedicine or a hub and spoke
model:
``(A) Substance use disorder treatments, as more
fully described in section 3439, including assessment
of disease presence, severity, and co-occurring
conditions, treatment planning, clinical stabilization
services, withdrawal management and detoxification,
intensive inpatient treatment, intensive outpatient
treatment, outpatient treatment, residential inpatient
services, treatment for co-occurring mental health and
substance use disorders, and all drugs approved by the
Food and Drug Administration for the treatment of
substance use disorder.
``(B) Outpatient and ambulatory health services,
including those administered by Federally-qualified
health centers, rural health clinics, tribal clinics
and hospitals, urban Indian organizations, certified
community behavioral health clinics (as described in
section 223 of the Protecting Access to Medicare Act),
Native Hawaiian organizations (as defined in section 11
of the Native Hawaiian Health Care Act of 1988), and
comprehensive opioid recovery centers (as described in
section 552 of this Act).
``(C) Hospice services.
``(D) Mental health services.
``(E) Opioid overdose reversal drug products
procurement, distribution, and training.
``(F) Pharmaceutical assistance and diagnostic
testing 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 substance use disorder
treatment adherence services.
``(I) Health insurance enrollment and cost-sharing
assistance in accordance with paragraph (8).
``(J) Programs that hire, employ, train, and
dispatch licensed health care professionals, mental
health professionals, harm reduction providers, or
community health workers to respond in lieu of law
enforcement officers in emergencies and that ensure a
licensed health care professional is a member of the
team that responds in lieu of law enforcement officers
in emergencies in which--
``(i) an individual calling 911, the
National Suicide Hotline, or another emergency
hotlines states that a person is experiencing a
drug overdose or is otherwise under the
influence of a legal or illegal substance; or
``(ii) a law enforcement officer, other
first responder, or other individual identifies
a person as being (or possibly being) under the
influence of a legal or illegal substance.
``(5) Recovery and support services.--For purposes of this
section, the term `recovery and support services' means
services that are provided to individuals with substance use
disorder, including residential recovery housing, mental health
services, 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.
The entities through which such services may be provided
include local and tribal authorities that provide child care,
housing, community development, and other recovery and support
services, so long as they do not exclude individuals on the
basis that such individuals receive medication for addiction
treatment.
``(6) Early intervention services.--For purposes of this
section, the term `early intervention services' means services
to provide screening and connection to the appropriate level of
substance use disorder and mental health treatment (including
same-day connection), counseling provided to individuals who
have misused substances, who have experienced an overdose, or
are at risk of developing substance use disorder, the provision
of referrals to facilitate the access of such individuals to
core medical services or recovery and support services for
substance use disorder, and rapid access to medication for
addiction treatment in the setting of recent overdose. The
entities through which such services may be provided include
emergency rooms, fire departments and emergency medical
services, detention facilities, prisons and jails, homeless
shelters, health care points of entry specified by eligible
local areas, Federally-qualified health centers, workforce
agencies and job centers, youth development centers, tribal
clinics and hospitals, urban Indian organizations, and rural
health clinics.
``(7) Harm reduction services.--For purposes of this
section, the term `harm reduction services' means services
provided to individuals engaging in substance use
scientifically accepted to reduce the risk of infectious
disease transmission, overdose, or death, including by
increasing access to health care, housing, and recovery and
support services, including syringe services programs. Such
term includes evidence-based services.
``(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) Administration and planning.--An eligible local area
(not including tribal areas) shall not use in excess of 15
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, in the first year of
receiving the grant, and shall not use in excess of 10 percent
of amounts received under a grant under section 3401 for such
activities in subsequent years.
``(10) Incarcerated individuals.--Amounts received under a
grant under section 3401 may be used to provide substance use
disorder treatment services, including medication for addiction
treatment, to individuals who are currently incarcerated or in
pre-trial detention.
``(c) Required Terms.--
``(1) Requirement of status as medicaid provider.--
``(A) Provision of service.--Subject to
subparagraph (B), 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--
``(I) will enter into agreements
with public or nonprofit entities, or
other Medicaid providers if more than
half of their patients are diagnosed
with a substance use disorder and
covered by Medicaid, under which such
entities and other providers will
provide the service, and such entities
and other providers have entered into
such a participation agreement and are
qualified to receive such payments; and
``(II) demonstrates that it will
ensure that such entities and other
providers providing the service will
seek payment for each such service
rendered in accordance with the usual
payment schedule under the State plan.
``(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. A waiver under this subparagraph shall
not be longer than 2 years in duration and
shall not be renewed.
``(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.
``(2) Required terms for expanding and improving care.--A
funding agreement for a grant under this section shall--
``(A) ensure that funds received under the grant
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); and
``(B) ensure that all entities providing substance
use disorder treatment services with assistance made
available under the grant offer all drugs approved by
the Food and Drug Administration for the treatment of
substance use disorder for which the applicant offers
treatment, in accordance with section 3435.
``(3) Additional required terms.--A funding agreement for a
grant under this section is that--
``(A) funds received under the grant will be
utilized to supplement not supplant other Federal,
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, including funds for each of
prevention services, core medical services, recovery
and support services, early intervention services, harm
reduction services, mental health services, and
administrative expenses;
``(B) political subdivisions within the eligible
local area will maintain the level of expenditures by
such political subdivisions for substance use disorder
treatment services at a level that is at least equal to
the level of such expenditures by such political
subdivisions for the preceding fiscal year, including
expenditures for each of prevention services, core
medical services, recovery and support services, early
intervention services, harm reduction services, mental
health services, and administrative expenses;
``(C) 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 subparagraph (B);
``(D) substance use disorder treatment services
provided with assistance made available under the grant
will be provided without regard--
``(i) to the ability of the individual to
pay for such services; and
``(ii) to the current or past health
condition of the individual to be served;
``(E) 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;
``(F) 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;
``(G) Indian tribes are included in planning for
the use of grant funds and the Federal trust
responsibility is upheld at all levels of program
administration; and
``(H) the confidentiality of individuals receiving
substance use disorder treatment services will be
maintained in a manner not inconsistent with applicable
law.
``SEC. 3404. APPLICATION.
``(a) Application.--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 by these expenditures and a demonstration
that funds received from a grant under this subtitle in the
prior year were expended in accordance with local priorities
developed by the local 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);
``(2) establishment of goals and objectives to be achieved
with grant funds provided under this subtitle, including
targets and milestones that are intended to be met, the
activities that will be undertaken to achieve those targets,
the number of individuals likely to be served by the funds
sought, including demographic data on the populations to be
served, and an explanation of how these goals and objectives
advance the State plan approved by the Secretary pursuant to
section 1932(b);
``(3) a demonstration that the local area will use funds in
a manner that provides substance use disorder treatment
services in compliance with the evidence-based standards
developed in accordance with section 3435, including providing
all drugs approved by the Food and Drug Administration for the
treatment of substance use disorder;
``(4) 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;
``(5) an explanation of how income, asset, and medical
expense criteria will be established and applied to those who
qualify for assistance under the program;
``(6) where practical, an explanation of how an eligible
local area shall coordinate with local public health
departments in the distribution of funding; and
``(7) for any prior funding received under this section,
data provided in such form as the Secretary shall require
detailing, at a minimum, the extent to which the activities
supported by the funding met the goals and objectives specified
in the application for the funding, the number of individuals
who accessed medication for treatment by age, gender, sexual
orientation, race, disability status, and other demographic
criteria relevant to the program, and the effect of the program
on overdose rates and rates of death due to overdose in the
local area served by the program.
``(b) 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 150 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 150 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 150 percent of the official poverty level
but not exceeding 200 percent of such poverty level,
the provider will not, for any calendar year, impose
charges in an amount exceeding 2 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 250 percent of such poverty level,
the provider will not, for any calendar year, impose
charges in an amount exceeding 4 percent of the annual
gross income of the individual involved;
``(E) in the case of individuals with an income
greater than 250 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 6 percent of the annual
gross income of the individual involved;
``(F) in the case of individuals with an income
greater than 300 percent of the official poverty level
but not exceeding 400 percent of such poverty level,
the provider will not, for any calendar year, impose
charges in an amount exceeding 8.5 percent of the
annual gross income of the individual involved;
``(G) in the case of individuals with an income
greater than 400 percent of the official poverty level,
the provider will not, for any calendar year, impose
charges in an amount exceeding 8.5 percent of the
annual gross income of the individual involved; and
``(H) 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.
``(c) 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) $3,300,000,000 for fiscal year 2022;
``(2) $3,300,000,000 for fiscal year 2023;
``(3) $3,300,000,000 for fiscal year 2024;
``(4) $3,300,000,000 for fiscal year 2025;
``(5) $3,300,000,000 for fiscal year 2026;
``(6) $3,300,000,000 for fiscal year 2027;
``(7) $3,300,000,000 for fiscal year 2028;
``(8) $3,300,000,000 for fiscal year 2029;
``(9) $3,300,000,000 for fiscal year 2030; and
``(10) $3,300,000,000 for fiscal year 2031.
``Subtitle B--State and Tribal Substance Use Disorder Prevention and
Intervention Grant Program
``SEC. 3411. ESTABLISHMENT OF PROGRAM OF GRANTS.
``The Secretary shall award grants to States, territories, and
tribal governments for the purpose of addressing substance use within
such States.
``SEC. 3412. AMOUNT OF GRANT, USE OF AMOUNTS, AND FUNDING AGREEMENT.
``(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.--The number of non-fatal drug
overdose deaths determined under this clause
for a State for a fiscal year for purposes of
clause (ii) may be determined by using data
including emergency department syndromic data,
visits, other emergency medical services for
drug-related causes, or Overdose Detection
Mapping Application Program (ODMAP) data 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 overdose
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) provide 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, if applicable;
``(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 preventing,
treating, and managing substance use disorder
and supporting sustained recovery;
``(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 State plan
approved by the Secretary pursuant to section
1932(b);
``(viii) demonstrates success in
identifying individuals with substance use
disorders; and
``(ix) demonstrates that support for
substance use disorder prevention and 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
were reported under section 3413, if
applicable.
``(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
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 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 for each
substance use disorder treatment service and
recovery residence developed in accordance with
subsections (a) and (b) of section 3435.
``(ii) Requirement.--Effective beginning in
fiscal year 2024, the Secretary shall not award
a grant under this paragraph to a State unless
that State has adopted the model standards for
each of substance use disorder treatment
services and recovery residences developed in
accordance with subsections (a) and (b) of
section 3435.
``(D) Continuum of care.--
``(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 carried out the requirements to ensure a
continuum of services in accordance with
section 3435(d).
``(ii) Requirement.--Effective beginning in
fiscal year 2024, the Secretary shall not award
a grant under this paragraph to a State unless
that State has carried out the requirements to
ensure a continuum of services in accordance
with section 3435(d).
``(E) Utilization management for medication for
addiction treatment.--
``(i) Preference.--In determining whether a
State will receive funds under this paragraph,
the Secretary shall give preference to States
that have prohibited prior authorization and
step therapy requirements for at least 1 drug
in each class approved by the Food and Drug
Administration for the treatment of substance
use disorder.
``(ii) Additional preferences.--Additional
preference shall be given to States that have
prohibited prior authorization and step therapy
requirements for 2 or more drugs in each class
approved by the Food and Drug Administration
for the treatment of substance use disorder.
``(iii) Definitions.--In this subparagraph:
``(I) Prior authorization.--The
term `prior authorization' means the
process by which a health insurance
issuer or pharmacy benefit management
company determines the medical
necessity of otherwise covered health
care services prior to the rendering of
such health care services. Such term
includes any health insurance issuer's
or utilization review entity's
requirement that a subscriber or health
care provider notify the issuer or
entity prior to providing a health care
service.
``(II) Step therapy.--The term
`step therapy' means a protocol or
program that establishes the specific
sequence in which prescription drugs
for a medical condition that are
medically appropriate for a particular
patient are authorized by a health
insurance issuer or prescription drug
management company.
``(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 funds.--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 funds 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) Payment of funds.--At the option of an Indian
tribe the Secretary shall pay funds under this section
through a contract, cooperative agreement, or compact
under, as applicable, title I or V of the Indian Self-
Determination and Education Assistance Act.
``(D) Use of amounts.--Notwithstanding any
requirements in this section, an Indian tribe may use
amounts provided under funds 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 or tribe may use amounts
provided under grants awarded under section 3411 for--
``(A) prevention services described in paragraph
(3);
``(B) core medical services described in paragraph
(4);
``(C) recovery and support services described in
paragraph (5);
``(D) early intervention services described in
paragraph (6);
``(E) harm reduction services described in
paragraph (7);
``(F) financial assistance with health insurance as
described in paragraph (8); and
``(G) administrative expenses described in
paragraph (9).
``(2) Direct financial assistance.--
``(A) In general.--A State or tribe may use amounts
received under a grant under section 3411 to provide
direct financial assistance to eligible entities or
other eligible Medicaid providers for the purpose of
providing prevention services, core medical services,
recovery and support services, early intervention
services, and harm reduction services.
``(B) Appropriate entities.--Direct financial
assistance may be provided under subparagraph (A) to
public or nonprofit entities, other Medicaid providers
if more than half of their patients are diagnosed with
a substance use disorder and covered by Medicaid, or
other private for-profit entities if such entities are
the only available provider of quality substance use
disorder treatment services in the area.
``(C) Limitation.--A State may not provide direct
financial assistance to any entity or provider that
provides medication for addiction treatment if that
entity or provider does not also offer mental health
services or psychotherapy by licensed clinicians
through a referral or onsite.
``(D) Neutrality towards organized labor.--
``(i) In general.--In carrying out duties
under this section, States shall, to the extent
practicable, prioritize the distribution of
grant funds to grantees that have--
``(I)(aa) a collective bargaining
agreement; or
``(bb) an explicit policy not to
deter employees with respect to--
``(AA) labor organizing for
the employees engaged in the
covered activities; and
``(BB) such employees'
choice to form and join labor
organizations; and
``(II) policies that require--
``(aa) the posting and
maintenance of notices in the
workplace to such employees of
their rights under the National
Labor Relations Act (29 U.S.C.
151 et seq.);
``(bb) that such employees
are, at the beginning of their
employment, provided notice and
information regarding the
employees' rights under such
Act; and
``(cc) the employer to
voluntarily recognize a union
in cases where a majority of
such workers of the employer
have joined and requested
representation.
``(ii) Limitation.--This subsection does
not apply to Indian tribes.
``(3) Prevention services.--
``(A) In general.--For purposes of this section,
the term `prevention services' means evidence-based
services, programs, or multi-sector strategies to
prevent substance use disorder (including education
campaigns, community-based prevention programs, risk-
identification programs, opioid diversion, collection
and disposal of unused opioids, services to at-risk
populations, and trauma support services).
``(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.
``(4) Core medical services.--For purposes of this section,
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,
including through the use of telemedicine or a hub and spoke
model:
``(A) Substance use disorder treatment, as
described in section 3439(4), including assessment of
disease presence, severity, and co-occurring
conditions, treatment planning, clinical stabilization
services, withdrawal management and detoxification,
intensive inpatient treatment, intensive outpatient
treatment, outpatient treatment, residential inpatient
services, treatment for co-occurring mental health and
substance use disorders, and all drugs approved by the
Food and Drug Administration for the treatment of
substance use disorder.
``(B) Outpatient and ambulatory health services,
including those administered by Federally-qualified
health centers, rural health clinics, tribal clinics
and hospitals, urban Indian organizations, certified
community behavioral health clinics (as described in
section 223 of the Protecting Access to Medicare Act),
and comprehensive opioid recovery centers (as described
in section 552 of this Act).
``(C) Hospice services.
``(D) Mental health services.
``(E) Opioid overdose reversal drug products
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 substance use disorder
treatment adherence services.
``(I) Health insurance enrollment and cost-sharing
assistance in accordance with paragraph (8).
``(J) Programs that hire, employ, train, and
dispatch licensed health care professionals, mental
health professionals, harm reduction providers, or
community health workers to respond in lieu of law
enforcement officers in emergencies and that ensure a
licensed health care professional is a member of the
team that responds in lieu of law enforcement officers
in emergencies in which--
``(i) an individual calling 911, the
National Suicide Hotline, or another emergency
hotlines states that a person is experiencing a
drug overdose or is otherwise under the
influence of a legal or illegal substance; or
``(ii) a law enforcement officer, other
first responder, or other individual identifies
a person as being (or possibly being) under the
influence of a legal or illegal substance.
``(5) Recovery and support services.--For purposes of this
section, the term `recovery and support services' means
services including residential recovery housing, mental health
services, 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.
The entities through which such services may be provided
include State, local, and tribal authorities that provide child
care, housing, community development, and other recovery and
support services, so long as they do not exclude individuals on
the basis that such individuals receive medication for
addiction treatment.
``(6) Early intervention services.--For purposes of this
section, the term `early intervention services' means services
to provide screening and connection to the appropriate level of
substance use disorder and mental health treatment (including
same-day connection), counseling provided to individuals who
have misused substances, who have experienced an overdose, or
are at risk of developing substance use disorder, the provision
of referrals to facilitate the access of such individuals to
core medical services or recovery and support services for
substance use disorder, and rapid access to medication for
addiction treatment in the setting of recent overdose. The
entities through which such services may be provided include
emergency rooms, fire departments and emergency medical
services, detention facilities, prisons and jails, homeless
shelters, health care points of entry specified by eligible
local areas, Federally-qualified health centers, workforce
agencies and job centers, youth development centers, tribal
clinics and hospitals, urban Indian organizations, and rural
health clinics.
``(7) Harm reduction services.--For purposes of this
section, the term `harm reduction services' means services
provided to individuals engaging in substance use
scientifically accepted to reduce the risk of infectious
disease transmission, overdose, or death, including by
increasing access to health care, housing, recovery, and
support services, including syringe services programs. Such
term includes evidence-based services.
``(8) 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.
``(9) 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.
``(10) Incarcerated individuals.--Amounts received under a
grant under section 3411 may be used to provide substance use
disorder treatment services, including medication for addiction
treatment, to individuals who are currently incarcerated or in
pre-trial detention.
``(c) Required Terms.--
``(1) Requirement of status as medicaid provider.--
``(A) Provision of service.--Subject to
subparagraph (B), the Secretary may not make a grant
under section 3411 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--
``(i)(I) the State will enter into an
agreement with a political subdivision, under
which the political subdivision 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 State will enter into agreements
with public or nonprofit entities, or other
Medicaid providers if more than half of their
patients are diagnosed with a substance use
disorder and covered by Medicaid, under which
such entities and other providers will provide
the service, and such entities and other
providers have entered into such a
participation agreement and are qualified to
receive such payments; and
``(III) the State ensures the political
subdivision under clause (i)(I) or the public
or nonprofit private entities and other
providers under clause (i)(II) will seek
payment for each such service rendered in
accordance with the usual payment schedule
under the State plan.
``(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 State 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. A waiver
under this subparagraph shall not be longer
than 2 years in duration and shall not be
renewed.
``(ii) Determination.--A determination by
the State 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.
``(2) Required terms for expanding and improving care.--A
funding agreement for a grant under this section shall--
``(A) ensure that funds received under the grant
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); and
``(B) ensure that all entities providing substance
use disorder treatment services with assistance made
available under the grant shall offer all drugs
approved by the Food and Drug Administration for the
treatment of substance use disorder for which the
applicant offers treatment, in accordance with section
3435.
``(3) Additional required terms.--A funding agreement for a
grant under this section is that--
``(A) funds received under the grant will be
utilized to supplement not supplant other Federal,
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, including funds for each of
prevention services, core medical services, recovery
and support services, early intervention services, harm
reduction services, mental health services, and
administrative expenses;
``(B) 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 at least equal to the level
of such expenditures by such political subdivisions for
the preceding fiscal year including expenditures for
each of prevention services, core medical services,
recovery and support services, early intervention
services, harm reduction services, mental health
services, and administrative expenses;
``(C) 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 subparagraph
(B);
``(D) substance use disorder treatment services
provided with assistance made available under the grant
will be provided without regard--
``(i) to the ability of the individual to
pay for such services; and
``(ii) to the current or past health
condition of the individual to be served;
``(E) 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;
``(F) 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;
``(G) Indian tribes are included in planning for
the use of grant funds and the Federal trust
responsibility is upheld at all levels of program
administration; and
``(H) the confidentiality of individuals receiving
substance use disorder treatment services will be
maintained in a manner not inconsistent with applicable
law.
``SEC. 3413. APPLICATION.
``(a) Application.--To be eligible to receive a grant under section
3411, a State shall have in effect a State plan approved by the
Secretary pursuant to section 1932(b), and 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 and a demonstration
that funds received from a grant under this subtitle in the
prior year were expended in accordance with State priorities;
``(2) establishment of goals and objectives to be achieved
with grant funds provided under this subtitle, including
targets and milestones that are intended to be met, the
activities that will be undertaken to achieve those targets,
and the number of individuals likely to be served by the funds
sought, including demographic data on the populations to be
served;
``(3) a demonstration that the State will use funds in a
manner that provides substance use disorder treatment services
in compliance with the evidence-based standards developed in
accordance with section 3435, including all drugs approved by
the Food and Drug Administration for the treatment of substance
use disorder;
``(4) 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;
``(5) an explanation of how income, asset, and medical
expense criteria will be established and applied to those who
qualify for assistance under the program; and
``(6) for any prior funding received under this section,
data provided in such form as the Secretary shall require
detailing, at a minimum, the extent to which the activities
supported by the funding met the goals and objectives specified
in the application for the funding, the number of individuals
who accessed medication for addiction treatment by age, gender,
sexual orientation, race, disability status, and other
demographic criteria relevant to the program, and the effect of
the program on overdose rates and rates of death due to
overdose in the region served by the program.
``(b) 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 150 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 150 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 150 percent of the official poverty level
but not exceeding 200 percent of such poverty level,
the provider will not, for any calendar year, impose
charges in an amount exceeding 2 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 250 percent of such poverty level,
the provider will not, for any calendar year, impose
charges in an amount exceeding 4 percent of the annual
gross income of the individual involved;
``(E) in the case of individuals with an income
greater than 250 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 6 percent of the annual
gross income of the individual involved;
``(F) in the case of individuals with an income
greater than 300 percent of the official poverty level
but not exceeding 400 percent of such poverty level,
the provider will not, for any calendar year, impose
charges in an amount exceeding 8.5 percent of the
annual gross income of the individual involved;
``(G) in the case of individuals with an income
greater than 400 percent of the official poverty level,
the provider will not, for any calendar year, impose
charges in an amount exceeding 8.5 percent of the
annual gross income of the individual involved; and
``(H) in the case of eligible American Indian and
Alaska Native and urban Indian 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.
``(c) Indian Tribes.--Any application requirements applying to
grants distributed in accordance with section 3412(b) shall be
developed by the Secretary in consultation with Indian tribes.
``SEC. 3414. TECHNICAL ASSISTANCE.
``The Secretary shall, directly or through grants or contracts,
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 3412(a)(2).
``SEC. 3415. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated to carry out this
subtitle--
``(1) $4,600,000,000 for fiscal year 2022;
``(2) $4,600,000,000 for fiscal year 2023;
``(3) $4,600,000,000 for fiscal year 2024;
``(4) $4,600,000,000 for fiscal year 2025;
``(5) $4,600,000,000 for fiscal year 2026;
``(6) $4,600,000,000 for fiscal year 2027;
``(7) $4,600,000,000 for fiscal year 2028;
``(8) $4,600,000,000 for fiscal year 2029;
``(9) $4,600,000,000 for fiscal year 2030; and
``(10) $4,600,000,000 for fiscal year 2031.
``Subtitle C--Other Grant Program
``SEC. 3421. ESTABLISHMENT OF GRANT PROGRAM.
``(a) Grants.--
``(1) In general.--The Secretary shall award grants to
public entities, nonprofit entities, Indian entities, and other
eligible Medicaid providers for the purpose of funding
prevention services, core medical services, recovery and
support services, early intervention services, harm reduction
services, and administrative expenses in accordance with this
section.
``(2) Prioritization.--
``(A) In general.--In awarding grants under this
section, the Secretary shall, to the extent
practicable, prioritize the distribution of grant funds
to grantees that have--
``(i) an explicit policy not to deter
employees with respect to--
``(I) labor organizing for the
employees engaged in the covered
activities; and
``(II) such employees' choice to
form and join labor organizations; or
``(ii) policies that require--
``(I) the posting and maintenance
of notices in the workplace to such
employees of their rights under the
National Labor Relations Act (29 U.S.C.
151 et seq.);
``(II) that such employees are, at
the beginning of their employment,
provided notice and information
regarding the employees' rights under
such Act; and
``(III) the employer to voluntarily
recognize a union in cases where such
workers of the employer have joined and
requested representation.
``(B) Exception.--This paragraph shall not apply to
Indian tribes.
``(b) Eligibility.--
``(1) Entities.--Public entities, nonprofit entities, urban
Indian organizations, and other Medicaid providers 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) Indian 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 11 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;
``(G) certified community behavioral health clinics
and certified community behavioral health clinic
expansion grant recipients, under section 223 of the
Protecting Access to Medicare Act (42 U.S.C. 1396a
note); and
``(H) other Medicaid providers if more than half of
their patients are diagnosed with a substance use
disorder and covered by Medicaid.
``(2) Underserved populations.--Entities described in
paragraph (1) shall serve underserved populations which may
include--
``(A) minority populations and Indian populations;
``(B) formerly incarcerated individuals;
``(C) individuals with comorbidities including
human immunodeficiency virus, hepatitis B, hepatitis C,
mental health disorder or other behavioral health
disorders;
``(D) low-income populations;
``(E) people with disabilities;
``(F) urban populations;
``(G) rural populations;
``(H) the lesbian, gay, bisexual, transgender,
queer (LGBTQ) community; and
``(I) pregnant individuals with, or at risk of
developing, substance use disorder and infants with
neonatal abstinence syndrome.
``(3) Application.--To be eligible to receive a grant under
this section, public entities, nonprofit entities, and other
Medicaid providers 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--
``(i) a demonstration of the extent of
local need for the funds sought;
``(ii) a plan for providing substance use
disorder treatment services that is consistent
with local needs; and
``(iii) goals and objectives to be achieved
with grant funds provided under this section,
including targets and milestones that are
intended to be met and a description of the
activities that will be undertaken to achieve
those targets;
``(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 3435,
including all drugs approved by the Food and Drug
Administration for the treatment of substance use
disorder for which the applicant offers treatment, in
accordance with section 3435(c);
``(D) information on the number of individuals to
be served by the funds sought, including demographic
data on the populations to be served;
``(E) 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;
``(F) an explanation of how income, asset, and
medical expense criteria will be established and
applied to those who qualify for assistance under the
program; and
``(G) for any prior funding received under this
section, data provided in such form as the Secretary
shall require detailing, at a minimum, the extent to
which the activities supported by the funding met the
goals and objectives specified in the application for
the funding, the number of individuals who accessed
medication for addiction treatment by age, gender,
race, sexual orientation, disability status, and other
demographic criteria relevant to the program, and the
effect of the program on overdose rates and rates of
death due to overdose in the region served by the
program.
``(4) Requirement of status as medicaid provider.--
``(A) Provision of service.--Subject to
subparagraph (B), 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--
``(i)(I) the applicant for the grant will
provide the service directly, and the applicant
has entered into a participation agreement
under the State plan and is qualified to
receive payments under such plan; or
``(II) the applicant for the grant will
enter into an agreement with public or
nonprofit entities, Indian entities, or other
Medicaid providers if more than half of their
patients are diagnosed with a substance use
disorder and covered by Medicaid, under which
such entities and other providers will provide
the substance use disorder treatment service,
and such entities and other providers have
entered into such a participation agreement and
are qualified to receive such payments; and
``(ii) the applicant ensures that payment
will be sought for each such service rendered
in accordance with the usual payment schedule
under the State plan.
``(B) Waiver.--In the case of an entity making an
agreement pursuant to subparagraph (A) 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. A
waiver under this subparagraph shall not be longer than
2 years in duration and shall not be renewed.
``(C) 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.
``(5) Required terms for expanding and improving care.--A
funding agreement for a grant under this section is that--
``(A) funds received under the grant 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);
``(B) entities providing substance use disorder
treatment services with assistance made available under
the grant shall offer all drugs approved by the Food
and Drug Administration for the treatment of substance
use disorder for which the applicant offers treatment,
in accordance with section 3435(c);
``(C) substance use disorder treatment services
provided with assistance made available under the grant
will be provided without regard--
``(i) to the ability of the individual to
pay for such services; and
``(ii) to the current or past health
condition of the individual to be served;
``(D) 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; and
``(E) the confidentiality of individuals receiving
substance use disorder treatment services will be
maintained in a manner not inconsistent with applicable
law.
``(c) Amount of Grant to Indian 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 Indian entities in an amount determined pursuant to
criteria developed by the Secretary in consultation with Indian
Tribes and after conferring with urban Indian organizations,
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 section, the term
`prevention services' means evidence-based services, programs, or
multi-sector strategies to prevent substance use disorder (including
education campaigns, community-based prevention programs, risk
identification programs, opioid diversion, collection and disposal of
unused opioids, services to at-risk populations, and trauma support
services).
``(c) Core Medical Services.--For purposes of this section, 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, including through the use of
telemedicine or a hub and spoke model:
``(1) Substance use disorder treatment, as more fully
described in section 3439(4), including assessment of disease
presence, severity, and co-occurring conditions, treatment
planning, clinical stabilization services, withdrawal
management and detoxification, intensive inpatient treatment,
intensive outpatient treatment, outpatient treatment,
residential inpatient services, treatment for co-occurring
mental health and substance use disorders, and all drugs
approved by the Food and Drug Administration for the treatment
of substance use disorder.
``(2) Outpatient and ambulatory health services, including
those administered by Federally-qualified health centers, rural
health clinics, tribal clinics and hospitals, urban Indian
organizations, certified community behavioral health clinics
(as described in section 223 of the Protecting Access to
Medicare Act), and comprehensive opioid recovery centers (as
described in section 552 of this Act).
``(3) Hospice services.
``(4) Mental health services.
``(5) Opioid overdose reversal drug products procurement,
distribution, and training.
``(6) Pharmaceutical assistance 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 substance use disorder treatment adherence services.
``(9) Health insurance enrollment and cost-sharing
assistance in accordance with section 3412.
``(10) Programs that hire, employ, train, and dispatch
mental health professionals, harm reduction providers, or
community health workers to respond in lieu of law enforcement
officers in emergencies in which--
``(A) an individual calling 911, the National
Suicide Hotline, or another emergency hotlines states
that a person is experiencing a drug overdose or is
otherwise under the influence of a legal or illegal
substance; and
``(B) a law enforcement officer, other first
responder, or other individual identifies a person as
being (or possibly being) under the influence of a
legal or illegal substance.
``(d) Recovery and Support Services.--For purposes of this section,
the term `recovery and support services' means services that are
provided to individuals with substance use disorder, including
residential recovery housing, mental health services, 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. The
entities through which such services may be provided include local and
tribal authorities that provide child care, housing, community
development, and other recovery and support services, so long as they
do not exclude individuals on the basis that such individuals receive
medication for addiction treatment.
``(e) Early Intervention Services.--For purposes of this section,
the term `early intervention services' means services to provide
screening and connection to the appropriate level of substance use
disorder and mental health treatment (including same-day connection),
counseling provided to individuals who have misused substances, who
have experienced an overdose, or are at risk of developing substance
use disorder, the provision of referrals to facilitate the access of
such individuals to core medical services or recovery and support
services for substance use disorder, and rapid access to medication for
addiction treatment in the setting of recent overdose. The entities
through which such services may be provided include emergency rooms,
fire departments and emergency medical services, detention facilities,
prisons and jails homeless shelters, health care points of entry
specified by eligible local areas, Federally-qualified health centers,
workforce agencies and job centers, youth development centers, tribal
clinics and hospitals, urban Indian organizations, and rural health
clinics.
``(f) Harm Reduction Services.--For purposes of this section, the
term `harm reduction services' means services provided to individuals
engaging in substance use that are scientifically accepted to reduce
the risk of infectious disease transmission, overdose, or death,
including by increasing access to health care, housing, and recovery
and support services, including syringe services programs. Such term
includes evidence-based services.
``(g) Administration and Planning.--An entity (not including tribal
entities) 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.
``(h) Relation to Existing Emergency Medical Services.--Nothing in
this section shall be construed to diminish or alter the rights,
privileges, remedies, or obligations of any provider or any Federal,
State, or local government to provide emergency medical services.
``SEC. 3423. TECHNICAL ASSISTANCE.
``The Secretary may, directly or through grants or contracts,
provide technical assistance to public or nonprofit entities, Indian
entities, and other eligible Medicaid providers 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 or nonprofit entities, Indian entities, and other eligible
Medicaid providers for purposes of assisting such entities and
providers 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) $1,000,000,000 for fiscal year 2022;
``(2) $1,000,000,000 for fiscal year 2023;
``(3) $1,000,000,000 for fiscal year 2024;
``(4) $1,000,000,000 for fiscal year 2025;
``(5) $1,000,000,000 for fiscal year 2026;
``(6) $1,000,000,000 for fiscal year 2027;
``(7) $1,000,000,000 for fiscal year 2028;
``(8) $1,000,000,000 for fiscal year 2029;
``(9) $1,000,000,000 for fiscal year 2030; and
``(10) $1,000,000,000 for fiscal year 2031.
``Subtitle D--Innovation, Training, and Health Systems Strengthening
``SEC. 3431. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.
``(a) In General.--The Secretary 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 and harm reduction 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 section, 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 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 2022;
``(2) $500,000,000 for fiscal year 2023;
``(3) $500,000,000 for fiscal year 2024;
``(4) $500,000,000 for fiscal year 2025;
``(5) $500,000,000 for fiscal year 2026;
``(6) $500,000,000 for fiscal year 2027;
``(7) $500,000,000 for fiscal year 2028;
``(8) $500,000,000 for fiscal year 2029;
``(9) $500,000,000 for fiscal year 2030; and
``(10) $500,000,000 for fiscal year 2031.
``SEC. 3432. EDUCATION AND TRAINING CENTERS.
``(a) In General.--The Secretary may make grants and enter into
contracts to assist public or nonprofit entities, public or nonprofit
schools, and academic health centers in meeting the cost of projects--
``(1) to train health professionals, including
practitioners in programs under this title and other community
providers, including physician addiction specialists,
psychologists, counselors, case managers, social workers, peer
recovery coaches, harm reduction workers, public health
workers, and community health workers, and paraprofessionals,
such as peer support specialists and recovery coaches, in the
diagnosis, treatment, and prevention of substance use disorders
and drug use-related health issues, including measures for the
prevention and treatment of co-occurring infectious diseases,
mental health disorders, 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,
social work, 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
and drug use-related health issues, including information about
combating stigma, prescribing best practices, overdose
reversal, alternative pain therapies, and all drugs approved by
the Food and Drug Administration for the treatment of substance
use disorders, including for the purposes authorized under the
amendments made by section 3203 of the SUPPORT for Patients and
Communities Act.
``(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 and other community providers described in
subsection (a)(1), to 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, to
provide substance use disorder treatment for individuals with
such disease;
``(3) train or result in the training of individuals who
will provide substance use disorder treatment in rural or other
areas that are underserved by current treatment structures;
``(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, public health workers, and
community health workers, to provide treatment for infectious
diseases and mental health disorders co-occurring with
substance use disorder; and
``(5) train or result in the training of health
professionals and other community providers to provide
substance use disorder treatments for pregnant women, children,
and adolescents.
``(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) $500,000,000 for fiscal year 2022;
``(2) $500,000,000 for fiscal year 2023;
``(3) $500,000,000 for fiscal year 2024;
``(4) $500,000,000 for fiscal year 2025;
``(5) $500,000,000 for fiscal year 2026;
``(6) $500,000,000 for fiscal year 2027;
``(7) $500,000,000 for fiscal year 2028;
``(8) $500,000,000 for fiscal year 2029;
``(9) $500,000,000 for fiscal year 2030; and
``(10) $500,000,000 for fiscal year 2031.
``SEC. 3433. SUBSTANCE USE DISORDER TREATMENT PROVIDER CAPACITY UNDER
THE MEDICAID PROGRAM.
``(a) Projects.--
``(1) In general.--The Secretary shall use amounts
appropriated under this section to provide funding for projects
in any State or territory to increase substance use provider
capacity, as provided for in section 1903(aa) of the Social
Security Act.
``(2) Prioritizations.--
``(A) In general.--In awarding grants under this
section, the Secretary shall, to the extent
practicable, prioritize the distribution of grant funds
to grantees that have--
``(i) an explicit policy not to deter
employees with respect to--
``(I) labor organizing for the
employees engaged in the covered
activities; and
``(II) such employees' choice to
form and join labor organizations; and
``(ii) policies that require--
``(I) the posting and maintenance
of notices in the workplace to such
employees of their rights under the
National Labor Relations Act (29 U.S.C.
151 et seq.);
``(II) that such employees are, at
the beginning of their employment,
provided notice and information
regarding the employees' rights under
such Act; and
``(III) the employer to voluntarily
recognize a union in cases where such
workers of the employer have joined and
requested representation.
``(B) Exception.--This paragraph shall not apply to
Indian tribes.
``(b) Amount of Grant to Indian 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) Urban indian organization.--In this section, the term
`urban Indian organization' has the meaning given such in
section 4 of the Indian Health Care Improvement Act.
``(3) Grants.--The Secretary, acting through the Indian
Health Service, shall use 10 percent of the amount appropriated
under this section for each fiscal year to award grants to
Indian tribes and urban Indian organizations in an amount
determined pursuant to criteria developed by the Secretary in
consultation with Indian tribes and in conference with urban
Indian organizations.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section--
``(1) $50,000,000 for fiscal year 2022;
``(2) $50,000,000 for fiscal year 2023;
``(3) $50,000,000 for fiscal year 2024;
``(4) $50,000,000 for fiscal year 2025;
``(5) $50,000,000 for fiscal year 2026;
``(6) $50,000,000 for fiscal year 2027;
``(7) $50,000,000 for fiscal year 2028;
``(8) $50,000,000 for fiscal year 2029;
``(9) $50,000,000 for fiscal year 2030; and
``(10) $50,000,000 for fiscal year 2031.
``SEC. 3434. PROGRAMS TO SUPPORT EMPLOYEES.
``(a) Grant Program for Workers.--
``(1) In general.--The Secretary, acting through the
Director of the National Institute for Occupational Safety and
Health, shall award grants to non-profit entities that meet the
requirements of this section to fund programs and projects to
assist workers who are at risk of substance use disorder, who
have substance use disorder, or who are recovering from
substance use disorder to maintain or gain employment.
``(2) Grants for workers.--
``(A) In general.--The Secretary shall, on a
competitive basis, award grants for a period of not
more than 3 years to non-profit entities that submit an
application under paragraph (3) to enable such entities
to implement, conduct, continue, and expand evidence-
based programs and projects to assist individuals
described in subparagraph (G).
``(B) Use of amounts.--An entity may use amounts
provided under this subsection for--
``(i) prevention services described in
subparagraph (C), including providing education
and information to workers regarding the
dangers of illicit and licit drug use, non-
opioid pain management and non-drug pain
management, or occupational injury and illness
prevention;
``(ii) early intervention services
described in subparagraph (D) to enable
individuals to maintain or gain employment;
``(iii) recovery and support services
described in subparagraph (E) to enable
individuals to maintain or gain employment;
``(iv) harm reduction services described in
subparagraph (F) to enable individuals to
maintain or gain employment;
``(v) hiring case managers, care
coordinators, and peer support specialists to
assist employed individuals who are
experiencing substance use disorder, or who are
recovering from substance use disorder, in
accessing substance use disorder treatment
services; or
``(vi) providing vocational, life skills,
and other forms of job training to workers who
are receiving substance use disorder treatment
services to enable such workers to maintain or
gain employment.
``(C) Prevention services.--For purposes of this
section, the term `prevention services' means evidence-
based services, programs, or multi-sector strategies to
prevent substance use disorder (including education
campaigns, community-based prevention programs, risk
identification programs, opioid diversion, collection
and disposal of unused opioids, services to at-risk
populations, and trauma support services).
``(D) Recovery and support services.--For purposes
of this section, the term `recovery and support
services' means services including residential recovery
housing, mental health services, 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 so long as
they do not exclude individuals on the basis that such
individuals receive medication for addiction treatment.
``(E) Early intervention services.--For purposes of
this section, the term `early intervention services'
means services to provide screening and connection to
the appropriate level of substance use disorder and
mental health treatment (including same-day
connection), counseling provided to individuals who
have misused substances, who have experienced an
overdose, or are at risk of developing substance use
disorder, the provision of referrals to facilitate the
access of such individuals to core medical services or
recovery and support services for substance use
disorder, and rapid access to medication for addiction
treatment in the setting of recent overdose.
``(F) Harm reduction services.--For purposes of
this section, the term `harm reduction services' means
services provided to individuals engaging in substance
use scientifically accepted to reduce the risk of
infectious disease transmission, overdose, or death,
including by increasing access to health care, housing,
and recovery and support services, including syringe
services programs. Such term includes evidence-based
services.
``(G) Individuals described.--Individuals described
in this subparagraph are individuals who--
``(i)(I) have been employed in the 12-month
period immediately preceding the date on which
the determination is being made, or who are
participating in an employee training or
apprenticeship program; and
``(II) are at high risk of developing
substance use disorder, including as a result
of employment in industries that experience
high rates of occupational injuries and
illness; or
``(ii) are experiencing a substance use
disorder or are in recovery from a substance
use disorder.
``(3) Applications.--To be eligible for a grant under this
subsection, an entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require, including--
``(A) a complete accounting of the disbursement of
any prior grants received under this title by the
applicant and the results achieved by such
expenditures;
``(B) a description of the population to be served
with grant funds provided under this section, including
a description of the unique risks the population faces
for experiencing occupational injuries or exposure to
illicit substances;
``(C) the goals and objectives to be achieved with
grant funds provided under this section, including
targets and milestones that are intended to be met, the
activities that will be undertaken to achieve those
targets, and the number of individuals likely to be
served by the grant funds, including demographic data
on the populations to be served;
``(D) a demonstration of the ability of the
applicant to reach the individuals described in
paragraph (2)(G) and to provide services described in
paragraph (2)(B) included in the applicant's grant
application, including by partnering with local
stakeholders;
``(E) for any prior funding received under this
subsection, data provided in such form as the Secretary
shall require detailing, at a minimum, the extent to
which the activities supported by the funding met the
goals, objectives, targets, and milestones specified in
the application for the funding, and the number of
individuals with and without substance use disorder who
received services supported by the funding, including
the services provided to these individuals, the
industries in which the individuals were employed when
they received services, and whether the individuals
were still employed in that same industry or in any
industry when the individuals ceased receiving services
supported by the funding; and
``(F) any other information the Secretary shall
require.
``(4) Data reporting and oversight.--An entity awarded a
grant under this subsection shall submit to the Secretary an
annual report at such time and in such manner as the Secretary
shall require. Such report shall include, at a minimum, a
description of--
``(A) the activities funded by the grant;
``(B) the number of individuals with and without
substance use disorder served through activities funded
by the grant, including the services provided to those
individuals and the industries in which those
individuals were employed at the time they received
services supported by the grant;
``(C) for workers experiencing substance use
disorder or recovering from substance use disorder
served by activities funded by the grant, the number of
individuals who maintained employment, the number of
individuals who gained employment, and the number of
individuals who failed to maintain employment over the
course of the reporting period; and
``(D) any other information required by the
Secretary.
``(5) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection--
``(A) $40,000,000 for fiscal year 2022;
``(B) $40,000,000 for fiscal year 2023;
``(C) $40,000,000 for fiscal year 2024;
``(D) $40,000,000 for fiscal year 2025;
``(E) $40,000,000 for fiscal year 2026;
``(F) $40,000,000 for fiscal year 2027;
``(G) $40,000,000 for fiscal year 2028;
``(H) $40,000,000 for fiscal year 2029;
``(I) $40,000,000 for fiscal year 2030; and
``(J) $40,000,000 for fiscal year 2031.
``(b) Research on the Impact of Substance Use Disorder in the
Workplace and on Direct Service Providers.--
``(1) Risks of substance use disorder.--The Secretary, in
consultation with the Director of the National Institute for
Occupational Safety and Health, shall conduct (directly or
through grants or contracts) research, experiments, and
demonstrations, and publish studies relating to--
``(A) the risks faced by employees in various
occupations of developing substance use disorder and of
drug overdose deaths and non-fatal drug overdoses, and
the formulation of prevention activities tailored to
the risks identified in these occupations, including
occupational injury and illness prevention;
``(B) the prevalence of substance use disorder
among employees in various occupations;
``(C) efforts that employers may undertake to
assist employees who are undergoing substance use
disorder treatment services in maintaining employment
while ensuring workplaces are safe and healthful;
``(D) risks of occupational exposure to opioids and
other illicit substances and the formulation of
prevention activities tailored to the risks identified;
and
``(E) other subjects related to substance use
disorder in the workplace as the Secretary determines.
``(2) Direct service providers.--The Secretary shall
conduct (directly or through grants or contracts) research,
experiments, and demonstrations, and publish studies relating
to the occupational health and safety, recruitment, and
retention of behavioral health providers who, as part of their
job responsibilities, provide direct services to individuals
who are at risk of experiencing substance use disorder or who
are experiencing or recovering from substance use disorder,
including--
``(A) identifying factors that the Secretary
believes may endanger the health or safety of such
workers, including factors that affect the risks such
workers face of developing substance use disorder;
``(B) motivational and behavioral factors relating
to the field of behavioral health providers;
``(C) strategies to support the recruitment and
retention of behavioral health providers; and
``(D) other subjects related to behavioral health
providers engaged in direct provision of substance use
disorder prevention and treatment services as the
Secretary determines appropriate.
``(3) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection--
``(A) $10,000,000 for fiscal year 2022;
``(B) $10,000,000 for fiscal year 2023;
``(C) $10,000,000 for fiscal year 2024;
``(D) $10,000,000 for fiscal year 2025;
``(E) $10,000,000 for fiscal year 2026;
``(F) $10,000,000 for fiscal year 2027;
``(G) $10,000,000 for fiscal year 2028;
``(H) $10,000,000 for fiscal year 2029;
``(I) $10,000,000 for fiscal year 2030; and
``(J) $10,000,000 for fiscal year 2031.
``SEC. 3435. IMPROVING AND EXPANDING CARE.
``(a) Level of Care Standards for Substance Use Disorder Treatment
Services.--
``(1) In general.--Not later than 1 year after the date of
enactment of this title, the Secretary, in consultation with
the American Society of Addiction Medicine, State and tribal
officials selected by the Secretary, and other stakeholders as
the Secretary determines necessary, and after seeking public
input, shall promulgate model standards for the regulation of
substance use disorder treatment services.
``(2) Substance use disorder treatment services.--The model
standards promulgated under paragraph (1) shall, at a minimum--
``(A) identify the types of substance use disorder
treatment services intended to be covered without
regard to whether they participate in any Federal
health care program (as defined in section 1128B(f) of
the Social Security Act) and shall not include--
``(i) a private practitioner who is already
licensed by a State licensing board and whose
practice is limited to non-intensive outpatient
care; or
``(ii) any substance use disorder treatment
service provided on a non-intensive outpatient
basis in the office of a private practitioner
who is licensed by a State licensing board;
``(B) require the designation of a single State
agency to serve as the primary regulator in the State
for substance use disorder treatment services;
``(C) subject to paragraph (3), require that
substance use disorder treatment services identified in
accordance with subparagraph (A), be licensed by the
respective States according to the standards for levels
of care set forth by the American Society of Addiction
Medicine in 2013 or an equivalent set of standards;
``(D) require implementation of a process to ensure
that substance use disorder treatment program
qualifications are verified by means of an onsite
inspection not less frequently than every 3 years by
the State agency serving as the primary regulator in
the State for substance use disorder treatment services
or by an independent third party that is approved by
the State's primary regulator; and
``(E) require that all patients leaving a
residential treatment program receive a written
transition plan prior to discharge from that level of
care.
``(3) Annual assessment.--Beginning with respect to fiscal
year 2022, the Secretary shall make a determination with
respect to each State on whether the State has adopted, for
each of the substance use disorder treatment services
identified in accordance with paragraph (2)(A), licensure
standards that are in compliance in all material respects with
the model standards promulgated in accordance with this
subsection. In the event the American Society of Addiction
Medicine revises its criteria, the Secretary shall revise the
national model level of care standards accordingly and
disseminate any such update to the States, and the States may
adopt any such updates to be in compliance with this
subsection.
``(b) Standards for Other Specified Matters Related to Substance
Use Disorder Treatment Services and Recovery Residences.--
``(1) In general.--Not later than 2 years after the date of
enactment of this title, the Secretary, in consultation with
representatives of nonprofit service providers and State and
tribal officials as the Secretary determines necessary, shall
promulgate model standards for the regulation of--
``(A) other specified matters related to substance
use disorder treatment services; and
``(B) recovery residences.
``(2) Other specified matters related to substance use
disorder treatment services.--The model standards promulgated
under paragraph (1)(A) shall, at a minimum--
``(A) identify the professional credentials needed
by each type of substance use disorder treatment
professional;
``(B) include standards for data reporting and
require compilation of statewide reports;
``(C) require the establishment and maintenance
within each State of a toll-free telephone number to
receive complaints from the public regarding substance
use disorder treatment service providers; and
``(D) require the establishment and maintenance on
a publicly accessible internet website of a list of all
substance use disorder treatment services in the State
that have a certification in effect in accordance with
this section.
``(3) Recovery residences.--
``(A) Economic relationship.--The model standards
promulgated under paragraph (1)(B) shall, at a minimum,
be applied to recovery residences that have an ongoing
economic relationship with any commercial substance use
disorder treatment service.
``(B) Minimum requirements.--The model standards
promulgated under paragraph (1)(B), which may include
any model laws developed under section 550(a) shall, at
a minimum, identify requirements for--
``(i) the designation of a single State
agency to certify recovery residences;
``(ii) the implementation of a process to
ensure that the qualifications of recovery
residences in which not fewer than 10
individuals may lawfully reside are verified by
means of an onsite inspection not less
frequently than every 3 years by the State
agency serving as the primary regulator in the
State or by an independent third party that is
approved by the State's primary regulator;
``(iii) fire, safety, and health standards;
``(iv) equipping residences with opioid
overdose reversal drug products, such as
naloxone and training residence owners,
operators, and employees in the administration
of naloxone;
``(v) recovery residence owners and
operators;
``(vi) a written policy that prohibits the
exclusion of individuals on the basis that such
individuals receive drugs approved by the Food
and Drug Administration for the treatment of
substance use disorder;
``(vii) the establishment and maintenance
within each State of a toll-free telephone
number to receive complaints from the public
regarding recovery residences; and
``(viii) the establishment and maintenance
on a publicly accessible internet website of a
list of all recovery residences in the State
that have a certification in effect in
accordance with this section.
``(4) Annual assessment.--Beginning with respect to fiscal
year 2023, the Secretary shall make a determination with
respect to each State on whether the State has adopted, for
each of the other specified substance use disorder treatment
services identified in this section and for recovery
residences, standards that are in compliance in all material
respects with the model standards promulgated in accordance
with this subsection.
``(c) Ensuring Access to Medication for Addiction Treatment.--
``(1) Medication for addiction treatment.--The Secretary
may not make a grant under this section unless the applicant
for the grant agrees to require all entities offering substance
use disorder treatment services under the grant to offer all
drugs approved by the Food and Drug Administration for the
treatment of substance use disorder for which the applicant
offers treatment.
``(2) Waiver.--The Secretary may grant a waiver with
respect to any requirement of this section if the grant
applicant involved--
``(A) submits to the Secretary a justification for
such waiver containing such information as the
Secretary shall require; and
``(B) agrees to require all entities offering
substance use disorder treatment services under the
grant to--
``(i) offer, on site, at least 2 drugs
approved by the Food and Drug Administration
for the treatment of substance use disorder;
``(ii) provide counseling to patients on
the benefits and risks of all drugs approved by
the Food and Drug Administration for the
treatment of substance use disorder; and
``(iii) maintain an affiliation agreement
with a provider that can prescribe or otherwise
dispense all other forms of drugs approved by
the Food and Drug Administration for the
treatment of substance use disorder.
``(3) 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.
``(d) Ensuring a Full Continuum of Services.--
``(1) In general.--Not later than 6 months after the date
of the enactment of this title, the Administrator of the
Centers for Medicare & Medicaid Services shall issue a State
Medicaid Director letter and tribal leader letter explaining
how States and tribes can ensure access to a continuum of
services for adults with substance use disorders who are
receiving medical assistance under title XIX of the Social
Security Act. Such letter shall describe how States can cover
the continuum of community-based, residential, and inpatient
substance use disorder services and care coordination between
different levels of care as medical assistance, as defined in
section 1905(a) of such Act, including through section 1915 of
such Act and through demonstration projects under section 1115
of such Act.
``(2) MACPAC analysis.--Not later than 1 year after the
date of the enactment of this title, the Medicaid and CHIP
Payment and Access Commission shall conduct an analysis, and
make publicly available a report containing the results of such
analysis, of States' coverage of substance use services for
Medicaid beneficiaries. Such report shall include examples of
promising strategies States use to cover a continuum of
community-based substance use services.
``(3) Annual assessment.--Beginning with respect to fiscal
year 2022, the Secretary shall make a determination with
respect to each State on whether the State has carried out the
requirements to ensure a continuum of services as described in
section 1915(l)(4)(C) of the Social Security Act.
``SEC. 3436. 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 and Indian
tribes 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 and 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) 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;
``(B) other areas of high need; and
``(C) 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, the general public,
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;
``(3) certify to the Secretary that the State has in place
a Good Samaritan Law that ensures immunity from arrest and
prosecution, including from parole and probation violations,
except that the State may apply to the Secretary for a waiver
of the requirement of this paragraph, and such waiver if
granted shall not be longer than 3 years in duration and may
not be renewed unless the State can show progress being made
towards instituting a Good Samaritan Law; and
``(4) certify to the Secretary that the State has in place
additional 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, 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) 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.
``(2) Emergency medical service.--The term `emergency
medical service' means resources used by a public or private
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).
``(3) 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.
``(4) Indians.--The terms `Indian', `Indian tribe', `tribal
organization', and `urban Indian organization' have the
meanings given such terms in section 4 of the Indian Health
Care Improvement Act.
``(5) 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.
``(6) 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.
``(7) 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.
``(8) 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.
``(h) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this suction--
``(1) $1,000,000,000 for fiscal year 2022;
``(2) $1,000,000,000 for fiscal year 2023;
``(3) $1,000,000,000 for fiscal year 2024;
``(4) $1,000,000,000 for fiscal year 2025;
``(5) $1,000,000,000 for fiscal year 2026;
``(6) $1,000,000,000 for fiscal year 2027;
``(7) $1,000,000,000 for fiscal year 2028;
``(8) $1,000,000,000 for fiscal year 2029;
``(9) $1,000,000,000 for fiscal year 2030; and
``(10) $1,000,000,000 for fiscal year 2031.
``SEC. 3437. ADDITIONAL FUNDING FOR THE NATIONAL INSTITUTES OF HEALTH.
``There is authorized to be appropriated to the National Institutes
of Health for the purpose of conducting research on addiction and pain,
including research to develop overdose reversal drug products, non-
opioid drug products and non-pharmacological treatments for addressing
pain and substance use disorder, and drug products used to treat
substance use disorder--
``(1) $1,000,000,000 for fiscal year 2022;
``(2) $1,000,000,000 for fiscal year 2023;
``(3) $1,000,000,000 for fiscal year 2024;
``(4) $1,000,000,000 for fiscal year 2025;
``(5) $1,000,000,000 for fiscal year 2026;
``(6) $1,000,000,000 for fiscal year 2027;
``(7) $1,000,000,000 for fiscal year 2028;
``(8) $1,000,000,000 for fiscal year 2029;
``(9) $1,000,000,000 for fiscal year 2030; and
``(10) $1,000,000,000 for fiscal year 2031.
``SEC. 3438. ADDITIONAL FUNDING FOR THE CENTERS FOR DISEASE CONTROL AND
PREVENTION.
``(a) Improved Data Collection and Prevention of Infectious Disease
Transmission.--
``(1) 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.
``(2) 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.
``(3) Tribal data.--Not later than 6 months after the date
of enactment of this title, the Director of the Centers for
Disease Control and Prevention shall consult with Indian tribes
and confer with urban Indian organizations to develop and
implement strategies that improve surveillance and reporting of
fatal overdose deaths among American Indians and Alaska
Natives, including strategies that reduce the underestimation
of fatal overdose deaths among American Indians and Alaska
Natives due to undersampling or racial misclassification in
State and Federal public health surveillance systems.
``(b) Childhood Trauma.--The Centers for Disease Control and
Prevention shall use a portion of the funding appropriated under this
section to fund the surveillance and data collection activities
described in section 7131 of the SUPPORT for Patients and Communities
Act, including to encourage all States to participate in collecting and
reporting data on adverse childhood experiences through the Behavioral
Risk Factor Surveillance System, the Youth Risk Behavior Surveillance
System, and other relevant public health surveys or questionnaires.
``(c) Worker Health Risks.--The Centers for Disease Control and
Prevention shall use a portion of the funding appropriated under this
section for data collection and surveillance activities on substance
use, substance use disorders, drug overdose deaths, and non-fatal drug
overdoses among workers, and the factors and practices that contribute
to such use, disorders, and overdoses, including occupational injuries
and illness as well as occupational exposure to opioids and other
illicit and licit drugs.
``(d) Tribal Epidemiology Centers.--There shall be made available
to the Indian Health Service for the purpose of funding efforts by
Indian tribes and tribal epidemiology centers to improve data on drug
overdose deaths and non-fatal drug overdoses, surveillance related to
addiction and substance use disorder, and prevention of childhood
trauma, not less than 1.5 percent of the total amount appropriated
under this section for each fiscal year.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section--
``(1) $500,000,000 for fiscal year 2022;
``(2) $500,000,000 for fiscal year 2023;
``(3) $500,000,000 for fiscal year 2024;
``(4) $500,000,000 for fiscal year 2025;
``(5) $500,000,000 for fiscal year 2026;
``(6) $500,000,000 for fiscal year 2027;
``(7) $500,000,000 for fiscal year 2028;
``(8) $500,000,000 for fiscal year 2029;
``(9) $500,000,000 for fiscal year 2030; and
``(10) $500,000,000 for fiscal year 2031.
``SEC. 3439. 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 for addiction 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, mental health services, and individual
and group counseling, on an inpatient or outpatient
basis, to help patients with substance use disorder
reach remission and maintain 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 intoxication
management 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 medical service that
is provided on an inpatient or an outpatient
basis to assist an individual in managing the
process of withdrawal from the physiological
and psychological effects of substance use
disorder.
``(iii) All outpatient, residential, and
inpatient services described in section
1915(l)(4)(c) of the Social Security Act.
``(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 licensing board and whose
practice is limited to non-intensive 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 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. 313. (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; or
``(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) a covered dispenser;
``(B) a covered distributor; or
``(C) 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.--
``(1) In general.--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
Secretary, for each controlled substance in schedule II
manufactured by the covered manufacturer, a certification--
``(A) signed by the covered officer; and
``(B) 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).
``(2) Notification to the attorney general.--
``(A) Failure to submit certifications.--Not later
than 30 days after the date on which a covered officer
of a covered manufacturer is required to submit a
certification under paragraph (1) and fails to do so,
the Secretary shall notify the Attorney General of the
failure by the covered officer to submit the
certification.
``(B) False certifications relating to
misbranding.--Not later than 30 days after the date on
which the Secretary becomes aware that a certification
submitted under paragraph (1) 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, the
Secretary shall notify the Attorney General that the
certification contains the materially false statement
or representation.''.
(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 313.
``(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 313(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 313(c)(1), 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 313(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 313(c)(1), 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. Suspicious orders.
``Sec. 313. 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.
SEC. 5. GENERAL LIMITATION ON USE OF FUNDS.
Amounts appropriated or provided under this Act, or an amendment
made by this Act, shall be used only for the public health purposes
described in this Act (or amendments) and shall not be used to increase
the incarceration or institutionalization of individuals with substance
use disorder.
SEC. 6. FEDERAL DRUG DEMAND REDUCTION ACTIVITIES.
(a) Publication of List.--
(1) Amendment.--Section 705(f) of the Office of National
Drug Control Policy Reauthorization Act of 1998 (21 U.S.C.
1704(f)) is amended by inserting at the end the following new
paragraph:
``(5) Publication of list.--The Director shall publish
online a complete list of all drug control program grant
programs and any other relevant information included in the
system developed under paragraph (1).''.
(2) Deadline and frequency.--Not later than one year after
the date of the enactment of this Act, and annually thereafter,
the Director of National Drug Control Policy shall publish the
list required under section 705(f)(5) of the National Drug
Control Act of 1998, as added by paragraph (1).
(b) National Drug Control Strategy.--Section 706(c)(1) of the
National Drug Control Act of 1998 (21 U.S.C. 1705(c)(1)) is amended by
adding at the end the following new subparagraph:
``(O) A review of all federally funded demand
reduction activities, including an evaluation of--
``(i) the effectiveness of those
activities;
``(ii) the contribution of those activities
to demand reduction activities funded by State,
local, and Tribal governments; and
``(iii) whether any duplication or
inefficiency in federally funded demand
reduction activities needs to be addressed.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Natural Resources, the Judiciary, and Oversight and Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Natural Resources, the Judiciary, and Oversight and Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Natural Resources, the Judiciary, and Oversight and Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Natural Resources, the Judiciary, and Oversight and Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee for Indigenous Peoples of the United States.
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Referred to the Subcommittee on Crime, Terrorism, and Homeland Security.