CARA 3.0 Act of 2021
This bill addresses substance use disorders by expanding access to treatment and recovery services, providing for housing protections, and requiring other activities.
Specifically, the bill reauthorizes, establishes, and expands support for treatment and recovery services. This includes increasing access to treatment in the criminal justice system and other settings and for particular populations, such as pregnant and postpartum individuals and youth and young adults.
Additionally, the bill expands Medicare and Medicaid coverage for treatment, including by expanding telehealth access to medication to treat substance use disorders. The bill also temporarily requires that non-opioid pain treatment options be reimbursed separately, instead of on a packaged basis, under Medicare.
As a condition of receiving certain federal funding, states must mandate the use of prescription drug monitoring programs (PDMPs) by prescribers and dispensers and impose additional PDMP requirements. Moreover, prescribers of potentially addictive drugs must complete continuing education requirements. The bill also revises the registration process for providers who prescribe certain medications to treat substance use disorders, including by eliminating the provider's patient limit for such medications.
In addition, the Substance Abuse and Mental Health Services Administration must carry out activities to promote access to high-quality recovery housing. The bill also sets out protections for individuals with substance use disorders who live in, or apply to live in, federally assisted housing.
Furthermore, the bill requires other activities to address substance use, such as support for workforce education and training; public awareness campaigns and similar outreach; and research on prevention strategies, insurance coverage, and treatment modalities.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 987 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 987
To provide support with respect to the prevention of, treatment for,
and recovery from, substance use disorder.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 25, 2021
Mr. Portman (for himself, Mr. Whitehouse, Ms. Klobuchar, Mrs. Shaheen,
Ms. Cantwell, and Mrs. Capito) introduced the following bill; which was
read twice and referred to the Committee on Health, Education, Labor,
and Pensions
_______________________________________________________________________
A BILL
To provide support with respect to the prevention of, treatment for,
and recovery from, substance use disorder.
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 ``CARA 3.0 Act of
2021''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I--EDUCATION, PREVENTION, AND RESEARCH
Sec. 101. National Education Campaign.
Sec. 102. Research into non-opioid pain management.
Sec. 103. Long-term treatment and recovery support services outcomes
research.
Sec. 104. National Commission for Excellence on Post-Overdose Response.
Sec. 105. Workforce for prevention, treatment, and recovery support
services.
Sec. 106. Reauthorization of community-based coalition enhancement
grants to address local drug crises.
Sec. 107. Access to non-opioid treatments for pain.
TITLE II--TREATMENT
Sec. 201. Evidence-based substance use disorder treatment and
intervention demonstrations.
Sec. 202. Improving treatment for pregnant, postpartum, and parenting
women.
Sec. 203. Require the use of prescription drug monitoring programs.
Sec. 204. Prescriber education.
Sec. 205. Prohibition of utilization control policies or procedures for
medication-assisted treatment under
Medicaid.
Sec. 206. Medication-assisted treatment for recovery from substance use
disorder.
Sec. 207. Telehealth response for e-prescribing addiction therapy
services.
Sec. 208. Pilot program on expanding access to treatment.
Sec. 209. Reauthorization of PRAC Ed grant program.
Sec. 210. GAO study on parity.
Sec. 211. Improving substance use disorder prevention workforce act.
TITLE III--RECOVERY
Subtitle A--General Provisions
Sec. 301. Building communities of recovery.
Sec. 302. Recovery in the workplace.
Sec. 303. National youth and young adult recovery initiative.
Subtitle B--Recovery Housing
Sec. 311. Clarifying the role of SAMHSA in promoting the availability
of high-quality recovery housing.
Sec. 312. Developing guidelines for States to promote the availability
of high-quality recovery housing.
Sec. 313. Coordination of Federal activities to promote the
availability of high-quality recovery
housing.
Sec. 314. NAS study.
Sec. 315. Grants for States to promote the availability of high quality
recovery housing.
Sec. 316. Authorization of appropriations.
Sec. 317. Reputable providers and analysts of recovery housing services
definition.
Sec. 318. Technical correction.
TITLE IV--CRIMINAL JUSTICE
Sec. 401. Medication-Assisted Treatment Corrections and Community
Reentry Program.
Sec. 402. Deflection and pre-arrest diversion.
Sec. 403. Housing.
Sec. 404. Veterans treatment courts.
Sec. 405. Infrastructure for reentry.
SEC. 2. FINDINGS.
Congress finds as follows:
(1) In the 1980s and 1990s, pharmaceutical companies began
developing new drugs for pain treatment, including extended
release oxycodone. These companies aggressively marketed these
drugs to the medical community as a way to address ``under-
treatment'' of physical pain. Drug companies distributed
76,000,000,000 oxycodone and hydrocodone pain pills nationwide
from 2006 to 2012.
(2) The combination of a rising number of prescriptions,
misinformation about the addictive properties of prescription
opioids, and the perception that prescription drugs are less
harmful than illicit drugs has caused an increase in drug
misuse.
(3) As legitimate production and illegal diversion of
opioids skyrocketed, so did the number of opioid overdose
deaths. From 1999 to 2017, almost 218,000 people died in the
United States from overdoses related to prescription opioids.
More recently, fentanyl, a powerful synthetic opioid, surpassed
prescription opioids as the most lethal overdose substance and
now is linked to nearly 3 times as many deaths.
(4) The scale of the opioid crisis is staggering:
(A) In 2018, approximately 10,300,000 people in the
United States age 12 and older misused opioids.
(B) On average, 130 people in the United States die
every day from an opioid overdose.
(C) The opioid crisis has cost the United States
economy at least $631,000,000,000.
(D) From 2013 to 2017, the number of children in
foster care nationwide increased 10 percent to nearly
442,995. Parental drug use was cited as a factor in 36
percent of cases.
(5) The opioid crisis has also led to a cascade of other
negative health impacts. For example, syringe sharing among
people who inject drugs has led to increases in hepatitis C
virus infections and infective endocarditis, as well as
localized HIV outbreaks.
(6) The United States health care system has struggled to
catch up to the crisis:
(A) The majority of people in the United States
with an opioid use disorder do not receive substance
use treatment, and many who do receive such treatment
do not receive evidence-based treatment. Although
medication-assisted treatment has been endorsed by the
National Institutes of Health and the World Health
Organization, only one-third of treatment programs
offer any of the 3 drugs approved by the Food and Drug
Administration for the treatment of opioid use
disorder, and just 6 percent of medication-offering
facilities provide all 3.
(B) Facilities that provide medications for the
treatment of opioid disorder are concentrated in the
Northeast and Southwest, leaving many of the areas hit
hardest by the opioid crisis without access to
evidence-based treatment. The need is particularly
acute in rural areas, which often do not have enough
providers to meet the demand.
(C) Unlike other health care needs, substance use
treatment is largely funded by State and local revenues
and Federal block grants, rather than the Medicare
program, the Medicaid program, and private insurance.
(D) While new substances, particularly synthetic
drugs, continue to make inroads into communities in the
United States, funding streams are often dedicated to
particular substances, limiting providers' ability to
adapt to changing needs.
(E) The stigma associated with substance use
disorder prevents people from seeking treatment. Too
often, people enter substance use treatment only after
committing a criminal offense, whether through a court
mandate, as a condition of parole or probation
supervision, or as a condition of regaining employment
after conviction. In 2003, 36 percent of all substance
use treatment admissions, 40 percent of all alcohol
abuse treatment admissions, and 57 percent of all
marijuana use treatment admissions were referrals from
the criminal justice system.
(F) The stigma of substance use disorder also
limits people's ability to find jobs and housing. These
obstacles are exacerbated by the criminalization of
substance use disorder--even convictions for drug
possession for personal use can create lifelong
collateral consequences. The absence of stable housing
and employment make it even more difficult for people
to live drug free.
(7) Not all people in the United States have equal access
to substance use treatment in the community. Current research
has found that Black and Latinx Americans are less likely to
receive substance use treatment when controlling for other
relevant factors, like socioeconomic status.
(8) Inadequate access to substance use treatment can
exacerbate other health disparities. Individuals with substance
use disorders have higher rates of suicide attempts than
individuals in the general population, high health care
expenses, and significant disability.
(9) A comprehensive public health approach that tackles
both the causes and the consequences of substance use disorder
is necessary to stem the tide.
TITLE I--EDUCATION, PREVENTION, AND RESEARCH
SEC. 101. NATIONAL EDUCATION CAMPAIGN.
Section 102 of the Comprehensive Addiction and Recovery Act of 2016
(42 U.S.C. 290bb-25g) is amended--
(1) in subsection (a), by inserting ``or other controlled
substances (as defined in section 102 of the Controlled
Substances Act (21 U.S.C. 802))'' after ``opioids'' each place
such term appears;
(2) in subsection (b), by striking ``opioid'' each place it
appears and inserting ``substance'';
(3) in subsection (c)--
(A) in paragraph (2), by striking ``and'' at the
end;
(B) in paragraph (3), by striking the period and
inserting a semicolon; and
(C) by adding at the end the following:
``(4) use destigmatizing language promoting humane and
culturally competent (as defined in section 102 of the
Developmental Disabilities Assistance and Bill of Rights Act of
2000 (42 U.S.C. 15002)) treatment of all individuals who face
substance use disorder, including such individuals who use
medication-assisted treatment for recovery purposes;
``(5) educate stakeholders on the evidence base and
validation of harm reduction and where to obtain harm reduction
services;
``(6) include information about polysubstance use; and
``(7) include information about prevention and treatment
using medication-assisted treatment and recovery support.'';
and
(4) by adding at the end the following:
``(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2021 through 2026.''.
SEC. 102. RESEARCH INTO NON-OPIOID PAIN MANAGEMENT.
(a) In General.--The Secretary of Health and Human Services, acting
through the Director of the National Institutes of Health and the
Director of the Centers for Disease Control and Prevention, shall carry
out research with respect to non-opioid methods of pain management,
including non-pharmaceutical remedies for pain and integrative medicine
solutions.
(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2021 through 2026.
SEC. 103. LONG-TERM TREATMENT AND RECOVERY SUPPORT SERVICES OUTCOMES
RESEARCH.
(a) In General.--The Secretary of Health and Human Services shall
award grants to eligible entities to carry out evidence-based, long-
term outcomes research, over 5-year periods, for different modalities
of treatment and recovery support for substance use disorder, including
culturally competent (as defined in section 102 of the Developmental
Disabilities Assistance and Bill of Rights Act of 2001 (42 U.S.C.
15002)) treatment. Such research shall measure mortality, morbidity,
physical and emotional health, employment, stable housing, criminal
justice involvement, family relationships, and other quality-of-life
measures. Such research shall distinguish outcomes based on race,
gender, and socioeconomic status, as well as any other relevant
characteristics.
(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary.
SEC. 104. NATIONAL COMMISSION FOR EXCELLENCE ON POST-OVERDOSE RESPONSE.
(a) In General.--The Assistant Secretary of Health and Human
Services for Mental Health and Substance Use (referred to in this
section as the ``Assistant Secretary''), in consultation with the
Director of the Office of National Drug Control Policy, and the
President of the National Academy of Medicine, shall establish an
advisory commission, to be known as the ``National Commission for
Excellence on Post-Overdose Response'', that--
(1) provides evidence, practical tools, and other resources
for researchers and evaluators, clinicians and clinical teams,
quality improvement experts, and healthcare decision makers to
improve the quality and safety of care for drug overdoses and
substance use disorder;
(2) advises the individuals described in paragraph (1) on--
(A) how to achieve equitable outcomes across race
and socioeconomic status; and
(B) how to effectively and appropriately control
avoidable hospital admissions, emergency department
admissions, and other adverse events related to
substance use disorder care; and
(3) develops culturally competent (as defined in section
102 of the Developmental Disabilities Assistance and Bill of
Rights Act of 2000 (42 U.S.C. 15002)) best practices and
clinical practice guidelines.
(b) Membership.--The members of the commission established under
subsection (a) shall include--
(1) a representative of the Substance Abuse and Mental
Health Services Administration;
(2) a representative of the Office of National Drug Control
Policy;
(3) a representative of the National Academy of Medicine;
(4) a representative of the National Institute on Drug
Abuse;
(5) a substance use disorder specialist appointed by the
Assistant Secretary;
(6) a peer recovery specialist appointed by the Assistant
Secretary;
(7) an individual with experience in harm reduction; and
(8) any other individual that the Assistant Secretary
determines appropriate.
(c) Sunset.--The commission established under subsection (a) shall
terminate on the date that is 10 years after the date of enactment of
this Act.
SEC. 105. WORKFORCE FOR PREVENTION, TREATMENT, AND RECOVERY SUPPORT
SERVICES.
(a) Employment and Training Services.--Subpart 2 of part B of title
V of the Public Health Service Act (42 U.S.C. 290bb-21 et seq.) is
amended by adding at the end the following:
``SEC. 519E. EMPLOYMENT AND TRAINING SERVICES.
``(a) In General.--The Director of the Prevention Center shall--
``(1) not later than 30 days after the date of enactment of
this Act, announce an opportunity to apply for grants or
contracts awarded to support the activities described in
subsection (b); and
``(2) from the funds appropriated under subsection (c), not
later than 45 days after the date on which an entity submits an
application that meets the requirements of the Secretary under
this section, award funds under this section to such entity.
``(b) Use of Funds.--An entity that receives funds under this
section shall use the funds to support employment and training services
for substance use treatment professionals, including peer recovery
specialists. Not less than 15 percent of the amount received by an
entity under this section shall be allocated to activities related to
retention of substance use disorder professionals.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2021 through 2026.''.
(b) Funding for Mental and Behavioral Health Education and Training
Grants.--Section 756(f) of the Public Health Service Act (42 U.S.C.
294e-1(f)) is amended--
(1) in the matter preceding paragraph (1), by striking
``$50,000,000'' and inserting ``$55,000,000''; and
(2) by adding at the end the following:
``(5) For continuing education and other activities to
increase retention and to strengthen the substance use disorder
workforce, $5,000,000.''.
SEC. 106. REAUTHORIZATION OF COMMUNITY-BASED COALITION ENHANCEMENT
GRANTS TO ADDRESS LOCAL DRUG CRISES.
Section 103(i) of the Comprehensive Addiction and Recovery Act of
2016 (21 U.S.C. 1536(i)) is amended by striking ``there are authorized
to be appropriated $5,000,000 for each of fiscal years 2017 through
2021.'' and inserting the following: ``there are authorized to be
appropriated--
``(1) $5,000,000 for each of fiscal years 2017 through
2020; and
``(2) $10,000,000 for each of fiscal years 2021 through
2026.''.
SEC. 107. ACCESS TO NON-OPIOID TREATMENTS FOR PAIN.
(a) In General.--Section 1833(t) of the Social Security Act (42
U.S.C. 1395l(t)) is amended--
(1) in paragraph (2)(E), by inserting ``and separate
payments for non-opioid treatments under paragraph (16)(G),''
after ``payments under paragraph (6)''; and
(2) in paragraph (16), by adding at the end the following
new subparagraph:
``(G) Access to non-opioid treatments for pain.--
``(i) In general.--Notwithstanding any
other provision of this subsection, with
respect to a covered OPD service (or group of
services) furnished on or after January 1,
2022, and before January 1, 2027, the Secretary
shall not package, and shall make a separate
payment as specified in clause (ii) for, a non-
opioid treatment (as defined in clause (iii))
furnished as part of such service (or group of
services).
``(ii) Amount of payment.--The amount of
the payment specified in this clause is, with
respect to a non-opioid treatment that is--
``(I) a drug or biological product,
the amount of payment for such drug or
biological determined under section
1847A; or
``(II) a medical device, the amount
of the hospital's charges for the
device, adjusted to cost.
``(iii) Definition of non-opioid
treatment.--A `non-opioid treatment' means--
``(I) a drug or biological product
that is indicated to produce analgesia
without acting upon the body's opioid
receptors; or
``(II) an implantable, reusable, or
disposable medical device cleared or
approved by the Administrator for Food
and Drugs for the intended use of
managing or treating pain;
that has demonstrated the ability to replace,
reduce, or avoid opioid use or the quantity of
opioids prescribed in a clinical trial or
through data published in a peer-reviewed
journal.''.
(b) Ambulatory Surgical Center Payment System.--Section
1833(i)(2)(D) of the Social Security Act (42 U.S.C. 1395l(i)(2)(D)) is
amended--
(1) by aligning the margins of clause (v) with the margins
of clause (iv);
(2) by redesignating clause (vi) as clause (vii); and
(3) by inserting after clause (v) the following new clause:
``(vi) In the case of surgical services
furnished on or after January 1, 2022, and
before January 1, 2027, the payment system
described in clause (i) shall provide, in a
budget-neutral manner, for a separate payment
for a non-opioid treatment (as defined in
clause (iii) of subsection (t)(16)(G))
furnished as part of such services in the
amount specified in clause (ii) of such
subsection.''.
(c) Evaluation of Therapeutic Services for Pain Management.--
(1) Report to congress.--Not later than 1 year after the
date of the enactment of this Act, the Secretary of Health and
Human Services (in this subsection referred to as the
``Secretary''), acting through the Administrator of the Centers
for Medicare & Medicaid Services, shall submit to Congress a
report identifying--
(A) limitations, gaps, barriers to access, or
deficits in Medicare coverage or reimbursement for
restorative therapies, behavioral approaches, and
complementary and integrative health services that are
identified in the Pain Management Best Practices Inter-
Agency Task Force Report and that have demonstrated the
ability to replace or reduce opioid consumption; and
(B) recommendations to address the limitations,
gaps, barriers to access, or deficits identified under
subparagraph (A) to improve Medicare coverage and
reimbursement for such therapies, approaches, and
services.
(2) Public consultation.--In developing the report
described in paragraph (1), the Secretary shall consult with
relevant stakeholders as determined appropriate by the
Secretary.
(3) Exclusive treatment.--Any drug, biological product, or
medical device that is a non-opioid treatment (as defined in
section 1833(t)(16)(G)(iii) of the Social Security Act, as
added by subsection (a)) shall not be considered a therapeutic
service for the purpose of the report described in paragraph
(1).
TITLE II--TREATMENT
SEC. 201. EVIDENCE-BASED SUBSTANCE USE DISORDER TREATMENT AND
INTERVENTION DEMONSTRATIONS.
Section 514B of the Public Health Service Act (42 U.S.C. 290bb-10)
is amended--
(1) in subsection (a), by adding at the end the following:
``(3) Use of funds for training.--Funds awarded under
paragraph (1) may be used by a recipient for training emergency
room technicians, physicians, nurses, or other health care
professionals on identifying the presence of substance use
disorders; how effectively to engage with, intervene with
respect to, and refer patients for assessment and specialized
substance use disorder care, including medication-assisted
treatment and care for co-occurring disorders; and offering
peer-based interventions in the emergency room and other health
care environments to connect people to clinical and community-
based supports for substance use disorder.'';
(2) in subsection (d), by inserting ``, and Indian tribes
and tribal organizations (as defined in section 4 of the Indian
Self-Determination and Education Assistance Act)'' before the
period of the first sentence; and
(3) in subsection (f), by inserting before the period the
following: ``, and $300,000,000 for each of fiscal years 2021
through 2026''.
SEC. 202. IMPROVING TREATMENT FOR PREGNANT, POSTPARTUM, AND PARENTING
WOMEN.
Section 508 of the Public Health Service Act (42 U.S.C. 290bb-1) is
amended--
(1) in subsection (m)--
(A) by striking ``that agrees to use'' and
inserting ``that agrees--
``(1) to use'';
(B) by striking the period at the end and inserting
``; or''; and
(C) by adding at the end the following:
``(2) to--
``(A) allow participation in the program supported
by the award by individuals taking a drug or
combination of drugs approved by the Food and Drug
Administration as a medication for addiction treatment,
including such individuals taking an opioid agonist;
``(B) provide culturally competent services (as
defined in section 102 of the Developmental
Disabilities Assistance and Bill of Rights Act of
2000);
``(C) ensure flexible lengths of stay in the
treatment program; and
``(D) use peer recovery advocates in the program
supported by the award.'';
(2) in subsection (p), by inserting ``, and demographic
data on the individuals served by programs funded under this
section and case outcomes, as reported to the Director by award
recipients'' before the period at the end of the third
sentence; and
(3) in subsection (s), by striking ``$29,931,000 for each
of fiscal years 2019 through 2023'' and inserting ``100,000,000
for each of fiscal years 2021 through 2026''.
SEC. 203. REQUIRE THE USE OF PRESCRIPTION DRUG MONITORING PROGRAMS.
(a) Definitions.--In this section:
(1) Controlled substance.--The term ``controlled
substance'' has the meaning given the term in section 102 of
the Controlled Substances Act (21 U.S.C. 802).
(2) Covered state.--The term ``covered State'' means a
State that receives funding under the Harold Rogers
Prescription Drug Monitoring Program established under the
Departments of Commerce, Justice, and State, the Judiciary, and
Related Agencies Appropriations Act, 2002 (Public Law 107-77;
115 Stat. 748), under this Act (or an amendment made by this
Act), or under the controlled substance monitoring program
under section 399O of the Public Health Service Act (42 U.S.C.
280g-3).
(3) Dispenser.--The term ``dispenser''--
(A) means a person licensed or otherwise authorized
by a State to deliver a prescription drug product to a
patient or an agent of the patient; and
(B) does not include a person involved in oversight
or payment for prescription drugs.
(4) PDMP.--The term ``PDMP'' means a prescription drug
monitoring program.
(5) Practitioner.--The term ``practitioner'' means a
practitioner registered under section 303(f) of the Controlled
Substances Act (21 U.S.C. 823(f)) to prescribe, administer, or
dispense controlled substances.
(6) State.--The term ``State'' means each of the several
States and the District of Columbia.
(b) In General.--Beginning 1 year after the date of enactment of
this Act, each covered State shall require--
(1) each prescribing practitioner within the covered State
or their designee, who shall be licensed or registered
healthcare professionals or other employees who report directly
to the practitioner, to consult the PDMP of the covered State
before initiating treatment with a prescription for a
controlled substance listed in schedule II, III, or IV of
section 202(c) of the Controlled Substances Act (21 U.S.C.
812(c)), and every 3 months thereafter as long as the treatment
continues;
(2) the PDMP of the covered State to provide proactive
notification to a practitioner when patterns indicative of
controlled substance misuse, including opioid misuse, are
detected;
(3) each dispenser within the covered State to report each
prescription for a controlled substance dispensed by the
dispenser to the PDMP not later than 24 hours after the
controlled substance is dispensed to the patient;
(4) that the PDMP make available a quarterly de-identified
data set and an annual report for public and private use,
including use by healthcare providers, health plans and health
benefits administrators, State agencies, and researchers, which
shall, at a minimum, meet requirements established by the
Attorney General, in coordination with the Secretary of Health
and Human Services;
(5) each State agency that administers the PDMP to--
(A) proactively analyze data available through the
PDMP; and
(B) provide reports to prescriber licensing boards
describing any prescribing practitioner that repeatedly
fall outside of expected norms or standard practices
for the prescribing practitioner's field; and
(6) that the data contained in the PDMP of the covered
State be made available to other States.
(c) Noncompliance.--If a covered State fails to comply with
subsection (a), the Attorney General or the Secretary of Health and
Human Services may withhold grant funds from being awarded to the
covered State under the Harold Rogers Prescription Drug Monitoring
Program established under the Departments of Commerce, Justice, and
State, the Judiciary, and Related Agencies Appropriations Act, 2002
(Public Law 107-77; 115 Stat. 748), under this Act (or an amendment
made by this Act), or under the controlled substance monitoring program
under section 399O of the Public Health Service Act (42 U.S.C. 280g-3).
SEC. 204. PRESCRIBER EDUCATION.
(a) In General.--Section 303 of the Controlled Substances Act (21
U.S.C. 823), as amended by section 201, is amended--
(1) in subsection (f), in the matter preceding paragraph
(1), by striking ``The Attorney General shall register'' and
inserting ``Subject to subsection (m), the Attorney General
shall register''; and
(2) by adding at the end the following:
``(m) Prescriber Education.--
``(1) Definitions.--In this subsection--
``(A) the term `covered agent or employee' means an
agent or employee of a covered facility who--
``(i) prescribes controlled substances for
humans under the registration of the facility
under this part; and
``(ii) is a medical resident;
``(B) the term `covered facility' means a
practitioner--
``(i) that is a hospital or other
institution;
``(ii) that is licensed under State law to
prescribe controlled substances; and
``(iii) under whose registration under this
part agents or employees of the practitioner
prescribe controlled substances;
``(C) the term `covered individual practitioner'
means a practitioner who--
``(i) is an individual;
``(ii) is not a veterinarian; and
``(iii) is licensed under State law to
prescribe controlled substances; and
``(D) the term `specified continuing education
topics' means--
``(i) alternatives to opioids for pain
management;
``(ii) palliative care;
``(iii) substance use disorder;
``(iv) adverse events;
``(v) potential for dependence;
``(vi) tolerance;
``(vii) prescribing contraindicated
substances;
``(viii) medication-assisted treatment;
``(ix) overdose prevention and response,
including the administration of naloxone;
``(x) culturally competent (as defined in
section 102 of the Developmental Disabilities
Assistance and Bill of Rights Act of 2000 (42
U.S.C. 15002)) services;
``(xi) bias and stigma in prescribing
trends; and
``(xii) any other topic that the Attorney
General determines appropriate.
``(2) Certification of continuing education.--
``(A) Individual practitioners.--As a condition of
granting or renewing the registration of a covered
individual practitioner under this part to dispense
controlled substances in schedule II, III, IV, or V,
the Attorney General shall require the practitioner to
certify that, during the 3-year period preceding the
date of the grant or renewal of registration, the
practitioner completed course work or training from an
organization accredited by the Accreditation Council
for Continuing Medical Education (commonly known as the
`ACCME'), or by a State medical society accreditor
recognized by the ACCME, that included not fewer than 3
hours of content on the specified continuing education
topics.
``(B) Facilities.--As a condition of granting or
renewing the registration of a covered facility under
this part to dispense controlled substances in schedule
II, III, IV, or V, the Attorney General shall require
the covered facility to certify that the facility does
not allow a covered agent or employee to prescribe
controlled substances for humans under the registration
of the facility unless, during the preceding 3-year
period, the covered agent or employee completed course
work or training from an organization accredited by the
Accreditation Council for Continuing Medical Education
(commonly known as the `ACCME'), or a State medical
society accreditor recognized by the ACCME, that
included not fewer than 3 hours of content on the
specified continuing education topics.''.
(b) Effective Date.--Subsection (m) of section 303 of the
Controlled Substances Act (21 U.S.C. 823), as added by subsection (a),
shall apply to any grant or renewal of registration described in such
subsection (m) that occurs on or after the date that is 2 years after
the date of enactment of this Act.
SEC. 205. PROHIBITION OF UTILIZATION CONTROL POLICIES OR PROCEDURES FOR
MEDICATION-ASSISTED TREATMENT UNDER MEDICAID.
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended--
(1) in subsection (a)--
(A) in the matter preceding paragraph (1), by
moving the margin of clause (xvi) 4 ems to the left;
and
(B) in paragraph (29), by inserting ``and to the
extent allowed in paragraph (3) of such subsection''
after ``paragraph (1) of such subsection''; and
(2) in subsection (ee), by adding at the end the following
new paragraph:
``(3) Prohibition of utilization control policies or
procedures for medication-assisted treatment.--As a condition
for a State receiving payments under section 1903(a) for
medical assistance for medication-assisted treatment, a State
may not impose any utilization control policies or procedures
(as defined by the Secretary), including prior authorization
requirements, with respect to such treatment.''.
SEC. 206. MEDICATION-ASSISTED TREATMENT FOR RECOVERY FROM SUBSTANCE USE
DISORDER.
(a) In General.--Section 303(g) of the Controlled Substances Act
(21 U.S.C. 823(g)) is amended--
(1) by striking paragraph (2);
(2) by striking ``(g)(1) Except as provided in paragraph
(2), practitioners who dispense narcotic drugs to individuals
for maintenance treatment or detoxification treatment'' and
inserting ``(g) Practitioners who dispense narcotic drugs
(other than narcotic drugs in schedule III, IV, or V) to
individuals for maintenance treatment or detoxification
treatment'';
(3) by redesignating subparagraphs (A), (B), and (C) as
paragraphs (1), (2), and (3), respectively; and
(4) in paragraph (2), as redesignated, by redesignating
clauses (i) and (ii) as subparagraphs (A) and (B),
respectively.
(b) Technical and Conforming Edits.--
(1) In general.--
(A) Section 304 of the Controlled Substances Act
(21 U.S.C. 824) is amended--
(i) in subsection (a), by striking
``303(g)(1)'' each place it appears and
inserting ``303(g)''; and
(ii) in subsection (d)(1), by striking
``303(g)(1)'' and inserting ``303(g)''.
(B) Section 309A(a) of the Controlled Substances
Act (21 U.S.C. 829a(a)) is amended by striking
paragraph (2) and inserting the following:
``(2) the controlled substance--
``(A) is a narcotic drug in schedule III, IV, or V
to be administered for the purpose of maintenance or
detoxification treatment; and
``(B) is to be administered by injection or
implantation;''.
(C) Section 520E-4(c) of the Public Health Service
Act (42 U.S.C. 290bb-36d(c)) is amended, in the matter
preceding paragraph (1), by striking ``information on
any qualified practitioner that is certified to
prescribe medication for opioid dependency under
section 303(g)(2)(B) of the Controlled Substances Act''
and inserting ``information on any practitioner who
prescribes narcotic drugs in schedule III, IV, or V of
section 202 of the Controlled Substances Act for the
purpose of maintenance or detoxification treatment''.
(D) Section 544(a)(3) of the Public Health Service
Act (42 U.S.C. 290dd-3) is amended by striking ``any
practitioner dispensing narcotic drugs pursuant to
section 303(g) of the Controlled Substances Act'' and
inserting ``any practitioner dispensing narcotic drugs
for the purpose of maintenance or detoxification
treatment''.
(E) Section 1833 of the Social Security Act (42
U.S.C. 1395l) is amended by striking subsection (bb).
(F) Section 1834(o) of the Social Security Act (42
U.S.C. 1395m(o)) is amended by striking paragraph (3).
(G) Section 1866F(c)(3) of the Social Security Act
(42 U.S.C. 1395cc-6(c)(3)) is amended--
(i) in subparagraph (A), by inserting
``and'' at the end;
(ii) in subparagraph (B), by striking ``;
and'' and inserting a period; and
(iii) by striking subparagraph (C).
(H) Section 1903(aa)(2)(C) of the Social Security
Act (42 U.S.C. 1396b(aa)(2)(C)) is amended--
(i) in clause (i), by inserting ``and'' at
the end;
(ii) by striking clause (ii); and
(iii) by redesignating clause (iii) as
clause (ii).
(2) Effective date of medicare amendments.--The amendments
made by subparagraphs (E) and (F) of paragraph (1) shall take
effect one year after the date of enactment of this Act.
SEC. 207. TELEHEALTH RESPONSE FOR E-PRESCRIBING ADDICTION THERAPY
SERVICES.
(a) Funding for the Testing of Incentive Payments for Behavioral
Health Providers for Adoption and Use of Certified Electronic Health
Record Technology.--In addition to amounts appropriated under
subsection (f) of section 1135A of the Social Security Act (42 U.S.C.
13951315a), there are authorized to be appropriated to the Center for
Medicare and Medicaid Innovation such sums as may be necessary for
fiscal year 2021 to design, implement, and evaluate the model under
subsection (b)(2)(B)(xxv) of such section. Amounts appropriated under
the preceding sentence shall remain available until expended.
(b) Telehealth for Substance Use Disorder Treatment.--
(1) Substance use disorder services furnished through
telehealth under medicare.--Section 1834(m)(7) of the Social
Security Act (42 U.S.C. 1395m(m)(7)) is amended by adding at
the end the following: ``With respect to telehealth services
described in the preceding sentence that are furnished on or
after January 1, 2020, nothing shall preclude the furnishing of
such services through audio or telephone only technologies in
the case where a physician or practitioner has already
conducted an in-person medical evaluation or a telehealth
evaluation that utilizes both audio and visual capabilities
with the eligible telehealth individual.''.
(2) Controlled substances dispensed by means of the
internet.--Section 309(e)(2) of the Controlled Substances Act
(21 U.S.C. 829(e)(2)) is amended--
(A) in subparagraph (A)(i)--
(i) by striking ``at least 1 in-person
medical evaluation'' and inserting the
following: ``at least--
``(I) 1 in-person medical
evaluation''; and
(ii) by adding at the end the following:
``(II) for purposes of prescribing
a controlled substance in schedule III
or IV, 1 telehealth evaluation; or'';
and
(B) by adding at the end the following:
``(D)(i) The term `telehealth evaluation' means a
medical evaluation that is conducted in accordance with
applicable Federal and State laws by a practitioner
(other than a pharmacist) who is at a location remote
from the patient and is communicating with the patient
using a telecommunications system referred to in
section 1834(m) of the Social Security Act (42 U.S.C.
1395m(m)) that includes, at a minimum, audio and video
equipment permitting two-way, real-time interactive
communication between the patient and distant site
practitioner.
``(ii) Nothing in clause (i) shall be construed to
imply that 1 telehealth evaluation demonstrates that a
prescription has been issued for a legitimate medical
purpose within the usual course of professional
practice.
``(iii) A practitioner who prescribes the drugs or
combination of drugs that are covered under section
303(g)(2)(C) using the authority under subparagraph
(A)(i)(II) of this paragraph shall adhere to nationally
recognized evidence-based guidelines for the treatment
of patients with opioid use disorders and a diversion
control plan, as those terms are defined in section 8.2
of title 42, Code of Federal Regulations, as in effect
on the date of enactment of this subparagraph.''.
SEC. 208. PILOT PROGRAM ON EXPANDING ACCESS TO TREATMENT.
The Secretary of Health and Human Services (referred to in this
section as the ``Secretary'') shall establish a 5-year pilot program in
not less than 5 diverse regions to study the use of mobile methadone
clinics in rural and underserved environments. At the end of the pilot
program, the Secretary shall report to Congress on the program
outcomes, including the number of people served and the demographics of
people served, including race and income.
SEC. 209. REAUTHORIZATION OF PRAC ED GRANT PROGRAM.
To carry out the Practitioner Education grant program established
by the Substance Abuse and Mental Health Services Administration, there
is authorized to be appropriated such sums as may be necessary for each
of fiscal years 2021 through 2026.
SEC. 210. GAO STUDY ON PARITY.
The Comptroller General of the United States shall conduct a study
examining the reimbursement parity between substance use disorder
services and other health care services, and the effect of any inequity
in reimbursement with respect to substance use disorder services on the
substance use disorder workforce, and not later than December 31, 2023,
submit a report to Congress on the findings of such study.
SEC. 211. IMPROVING SUBSTANCE USE DISORDER PREVENTION WORKFORCE ACT.
Subpart 2 of part B of title V of the Public Health Service Act (42
U.S.C. 290bb-21 et seq), as amended by section 105, is further amended
by adding at the end the following:
``SEC. 519F. PILOT PROGRAM TO HELP ENHANCE SUBSTANCE USE DISORDER
PREVENTION WORKFORCE.
``(a) In General.--The Director of the Prevention Center (referred
to in this section as the `Director') shall develop a pilot program to
assist State alcohol and drug agencies in addressing the substance use
disorder prevention workforce needs in the States.
``(b) Definitions.--In this section, the term `State alcohol and
drug agency' means the State agency responsible for administering the
substance abuse prevention and treatment block grant under subpart II
of part B of title XIX.
``(c) Application.--A State alcohol and drug agency may apply to
the Director for approval of a grant authorized in this section. Such
application shall include a description of the proposed workforce
activities that will be carried out using grant funds, which may
include, with respect to substance use disorder prevention--
``(1) enhancing or developing training curricula;
``(2) supporting or coordinating with institutes of higher
education regarding curricula development;
``(3) partnering with elementary schools, middle schools,
high schools or institutions of higher education to generate
early student interest in avoiding misuse of substances;
``(4) enhancing or establishing initiatives related to
credentialing or other certification processes recognized by
the State alcohol and drug agency, including scholarships or
support for certification costs and testing;
``(5) establishing or enhancing initiatives that promote
recruitment, professional development, and access to education
and training that increase the State's ability to address
diversity, equity, and inclusion in the workforce, including
communication initiatives or campaigns designed to draw
interest in a career in substance use disorder prevention;
``(6) supporting loan repayment programs for individuals in
the substance use disorder prevention workforce;
``(7) establishing or enhancing internships, fellowships
and other career opportunities; and
``(8) retention initiatives that may include training,
leadership development or other educational opportunities.
``(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary.
``SEC. 519G. NATIONAL STUDY ON SUBSTANCE USE DISORDER WORKFORCE.
``(a) In General.--The Director shall conduct a comprehensive
national study regarding the substance use disorder prevention
workforce. Such study shall include--
``(1) an environmental assessment regarding the existing
workforce, including demographics, salaries, settings, current
or anticipated workforce shortages and other relevant
information;
``(2) challenges in maintaining support for an adequate
substance use disorder prevention workforce and a plan to
address such challenges; and
``(3) potential programming to help implement the plan.
``(b) Consultation.--The Director shall ensure the study under this
section is developed in consultation with key substance use disorder
prevention workforce stakeholders, including organizations representing
State alcohol and drug agencies, community anti-drug coalitions,
workforce credentialing bodies, researchers, and others.
``(c) Authorization of Appropriation.--To carry out this section,
there are authorized to be appropriated such sums as may be
necessary.''.
TITLE III--RECOVERY
Subtitle A--General Provisions
SEC. 301. BUILDING COMMUNITIES OF RECOVERY.
(a) In General.--Section 547 of the Public Health Service Act (42
U.S.C. 290ee-2) is amended--
(1) by striking subsection (c);
(2) by redesignating subsection (d) as subsection (c);
(3) in subsection (c) (as so redesignated)--
(A) in paragraph (1), by striking ``and'' at the
end;
(B) in paragraph (2)(C)(iv), by striking the period
and inserting ``; and''; and
(C) by adding at the and the following:
``(3) may be used as provided for in subsection (d).'';
(4) by inserting after subsection (c) (as so redesignated),
the following:
``(d) Establishment of Regional Technical Assistance Centers.--
``(1) In general.--Grants awarded under subsection (b) may
be used to provide for the establishment of regional technical
assistance centers to provide regional technical assistance for
the following:
``(A) Implementation of regionally driven peer
delivered substance use disorder recovery support
services before, during, after, or in lieu of substance
use disorder treatment.
``(B) Establishment of recovery community
organizations.
``(C) Establishment of recovery community centers.
``(D) Naloxone training and dissemination.
``(E) Development of connections between recovery
support services, community organizations, and
community centers and the broader medical community.
``(F) Establishment of online recovery support
services, with parity to physical health services.
``(G) Development of recovery wellness plans to
address perceived barriers to recovery, including
social determinants of health.
``(H) Collect and maintain accurate and reliable
data to inform service delivery and monitor and
evaluate the impact of culturally competent (as defined
in section 102 of the Developmental Disabilities
Assistance and Bill of Rights Act of 2000) services on
health equity outcomes.
``(I) Building capacity for recovery community
organizations to meet national accreditation standards
for the delivery of peer recover support services.
``(J) Expanding or enhancing recovery support
service programs.
``(2) Eligible entities.--To be eligible to receive a grant
under paragraph (1), an entity shall be--
``(A) a national nonprofit entity with a network of
local affiliates and partners that are geographically
and organizationally diverse; or
``(B) a national nonprofit organization led by
individuals in personal and family recovery with
established networks of recovery community
organizations providing peer recovery support services.
``(3) Preference.--In awarding grants under subsection (b),
the Secretary shall give preference to organizations that--
``(A) provide culturally competent (as defined in
section 102 of the Developmental Disabilities
Assistance and Bill of Rights Act of 2000) services,
promote racial equity, and are responsive to diverse
cultural health beliefs and practices, preferred
languages, health literacy, and other communication
needs;
``(B) allow participation by individuals receiving
medication-assisted treatment that involves
prescription drugs approved by the Food and Drug
Administration (at least one of which is an opioid
agonist);
``(C) use peer recovery advocates; and
``(D) meet national best practice and accreditation
standards.''; and
(5) in subsection (f), by striking `` 2023'' and inserting
``2020, and $200,000,000 for each of fiscal years 2021 through
2026''.
(b) Continuing Care and Community Support To Maintain Recovery.--
(1) In general.--The Secretary shall award grants to peer
recovery support services, for the purposes of providing
continuing care and ongoing community support for individuals
to maintain recovery from substance use disorders.
(2) Definition.--For purposes of this subsection, the term
``peer recovery support services'' means an independent
nonprofit organization that provides peer recovery support
services, through credentialed peer support professionals.
(3) Authorization of appropriations.--There are authorized
to be appropriated, for each of fiscal years 2021 through 2026,
$50,000,000 for purposes of awarding grants under paragraph
(1).
SEC. 302. RECOVERY IN THE WORKPLACE.
It is the sense of Congress that an employee who is taking opioid
antagonist, opioid agonist, or partial agonist drugs as part of a
medication-assisted treatment program shall not be in violation of a
drug-free workplace requirement.
SEC. 303. NATIONAL YOUTH AND YOUNG ADULT RECOVERY INITIATIVE.
(a) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means--
(A) a high school that has been accredited as a
substance use recovery high school or that is seeking
to establish or expand substance use recovery support
services;
(B) an institution of higher education;
(C) a recovery program at an institution of higher
education;
(D) a nonprofit organization; or
(E) a technical assistance center that can help
grantees install recovery support service programs
aimed at youth and young adults which include recovery
coaching, job training, transportation, linkages to
community-based services and supports, regularly
scheduled alternative peer group activities, life-
skills education, mentoring, and leadership
development.
(2) High school.--The term ``high school'' has the meaning
given the term in section 8101 of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 7801).
(3) Institution of higher education.--The term
``institution of higher education'' has the meaning given the
term in section 101 of the Higher Education Act of 1965 (20
U.S.C. 1001).
(4) Recovery program.--The term ``recovery program'' means
a program--
(A) to help youth or young adults who are
recovering from substance use disorders to initiate,
stabilize, and maintain healthy and productive lives in
the community; and
(B) that includes peer-to-peer support delivered by
individuals with lived experience in recovery, and
communal activities to build recovery skills and
supportive social networks.
(b) Grants Authorized.--The Assistant Secretary for Mental Health
and Substance Use, in consultation with the Secretary of Education,
shall award grants, on a competitive basis, to eligible entities to
enable the eligible entities to--
(1) provide culturally competent (as defined in section 102
of the Developmental Disabilities Assistance and Bill of Rights
Act of 2000 (42 U.S.C. 15002)) substance use recovery support
services to youth and young adults enrolled in high school or
an institution of higher education;
(2) help build communities of support for youth and young
adults in substance use recovery through a spectrum of
activities such as counseling, job training, recovery coaching,
alternative peer groups, life-skills workshops, family support
groups, and health and wellness-oriented social activities; and
(3) encourage initiatives designed to help youth and young
adults achieve and sustain recovery from substance use
disorders.
(c) Application.--An eligible entity desiring a grant under this
section shall submit to the Assistant Secretary for Mental Health and
Substance Use an application at such time, in such manner, and
containing such information as the Assistant Secretary may require.
(d) Preference.--In awarding grants under subsection (b), the
Assistant Secretary for Mental Health and Substance Use shall give
preference to eligible entities that propose to serve students from
areas with schools serving a high percentage of children who are
counted under section 1124(c) of the Elementary and Secondary Education
Act of 1965 (20 U.S.C. 6333(c)).
(e) Use of Funds.--Grants awarded under subsection (b) may be used
for activities to develop, support, or maintain substance use recovery
support services for youth or young adults, including--
(1) the development and maintenance of a dedicated physical
space for recovery programs;
(2) hiring dedicated staff for the provision of recovery
programs;
(3) providing health and wellness-oriented social
activities and community engagement;
(4) the establishment of a substance use recovery high
school;
(5) the coordination of a peer delivered substance use
recovery program with--
(A) substance use disorder treatment programs and
systems that utilize culturally competent (as defined
in section 102 of the Developmental Disabilities
Assistance and Bill of Rights Act of 2000 (42 U.S.C.
15002)) services that reflect the communities they
serve;
(B) providers of mental health services;
(C) primary care providers;
(D) the criminal justice system, including the
juvenile justice system;
(E) employers;
(F) recovery housing services;
(G) child welfare services;
(H) high schools; and
(I) institutions of higher education;
(6) the development of peer-to-peer support programs or
services delivered by individuals with lived experience in
substance use disorder recovery; and
(7) any additional activity that helps youth or young
adults achieve recovery from substance use disorders.
(f) Resource Center.--The Assistant Secretary for Mental Health and
Substance Use shall establish a resource center to provide technical
support to recipients of grants under this section.
(g) Authorization of Appropriations.--There are authorized to be
appropriated $10,000,000 for each of fiscal years 2021 through 2026.
Subtitle B--Recovery Housing
SEC. 311. CLARIFYING THE ROLE OF SAMHSA IN PROMOTING THE AVAILABILITY
OF HIGH-QUALITY RECOVERY HOUSING.
Section 501(d) of the Public Health Service Act (42 U.S.C. 290aa)
is amended--
(1) in paragraph (24)(E), by striking ``and'' at the end;
(2) in paragraph (25), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following:
``(26) collaborate with national accrediting entities and
reputable providers and analysts of recovery housing services
and all relevant Federal agencies, including the Centers for
Medicare & Medicaid Services, the Health Resources and Services
Administration, other offices and agencies within the
Department of Health and Human Services, the Office of National
Drug Control Policy, the Department of Justice, the Department
of Housing and Urban Development, and the Department of
Agriculture, to promote the availability of high-quality
recovery housing for individuals with a substance use
disorder.''.
SEC. 312. DEVELOPING GUIDELINES FOR STATES TO PROMOTE THE AVAILABILITY
OF HIGH-QUALITY RECOVERY HOUSING.
(a) In General.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Health and Human Services,
acting through the Assistant Secretary for Mental Health and Substance
Use, shall develop, and publish on the internet website of the
Substance Abuse and Mental Health Services Administration, consensus-
based guidelines and nationally recognized standards for States to
promote the availability of high-quality recovery housing for
individuals with a substance use disorder. Such guidelines shall--
(1) be developed in consultation with national accrediting
entities and reputable providers and analysts of recovery
housing services and be consistent with the best practices
developed under section 550 of the Public Health Service Act
(42 U.S.C. 290ee-5); and
(2) to the extent practicable, build on existing best
practices and suggested guidelines developed previously by the
Substance Abuse and Mental Health Services Administration.
(b) Public Comment Period.--Before finalizing guidelines under
subsection (a), the Secretary of Health and Human Services shall
provide for a public comment period.
(c) Exclusion of Guideline on Treatment Services.--In developing
the guidelines under subsection (a), the Secretary may not include any
guideline or standard with respect to substance use disorder treatment
services.
(d) Substance Use Disorder Treatment Services.--In this section,
the term ``substance use disorder treatment services'' means items or
services furnished for the treatment of a substance use disorder,
including--
(1) medications approved by the Food and Drug
Administration for use in such treatment, excluding each such
medication used to prevent or treat a drug overdose;
(2) the administering of such medications;
(3) recommendations for such treatment;
(4) clinical assessments and referrals;
(5) counseling with a physician, psychologist, or mental
health professional (including individual and group therapy);
and
(6) toxicology testing.
SEC. 313. COORDINATION OF FEDERAL ACTIVITIES TO PROMOTE THE
AVAILABILITY OF HIGH-QUALITY RECOVERY HOUSING.
Section 550 of the Public Health Service Act (42 U.S.C. 290ee-5) is
amended--
(1) by redesignating subsections (e), (f), and (g) as
subsections (h), (i), and (j), respectively; and
(2) by inserting after subsection (d) the following:
``(e) Coordination of Federal Activities To Promote the
Availability of High-Quality Recovery Housing for Individuals With a
Substance Use Disorder.--
``(1) In general.--The Secretary, acting through the
Assistant Secretary, and the Secretary of the Department of
Housing and Urban Development, shall convene and serve as the
co-chairs of an interagency working group composed of
representatives of each of the Federal agencies described in
paragraph (2) (referred to in this section as the `working
group') for the following purposes:
``(A) To increase collaboration, cooperation, and
consultation among such Federal agencies, with respect
to promoting the availability of high-quality recovery
housing.
``(B) To align the efforts of such agencies and
avoid duplication of such efforts by such agencies.
``(C) To develop objectives, priorities, and a
long-term plan for supporting State, Tribal, and local
efforts with respect to the operation of high-quality
recovery housing that is consistent with the best
practices developed under this section.
``(D) To coordinate inspection and enforcement
among Federal and State agencies.
``(E) To coordinate data collection on the quality
of recovery housing.
``(2) Federal agencies described.--The Federal agencies
described in this paragraph are the following:
``(A) The Department of Health and Human Services.
``(B) The Centers for Medicare & Medicaid Services.
``(C) The Substance Abuse and Mental Health
Services Administration.
``(D) The Health Resources and Services
Administration.
``(E) The Indian Health Service.
``(F) The Department of Housing and Urban
Development.
``(G) The Department of Agriculture.
``(H) The Department of Justice.
``(I) The Office of National Drug Control Policy.
``(J) The Bureau of Indian Affairs.
``(K) Any other such agency or subagency as the
chair determines necessary and appropriate.
``(3) Meetings.--The working group shall meet on a
quarterly basis.
``(4) Reports to congress.--Beginning not later than 1 year
after the date of the enactment of this section and annually
thereafter, the working group shall submit to the Committee on
Health, Education, Labor, and Pensions, the Committee on
Agriculture, Nutrition, and Forestry, and the Committee on
Finance of the Senate and the Committee on Energy and Commerce,
the Committee on Ways and Means, the Committee on Agriculture,
and the Committee on Financial Services of the House of
Representatives a report describing the work of the working
group and any recommendations of the working group to improve
Federal, State, or local policy with respect to recovery
housing operations.''.
SEC. 314. NAS STUDY.
Section 550 of the Public Health Service Act (42 U.S.C. 290ee-5),
as amended by section 313, is further amended by inserting after
subsection (e) (as inserted by such section 313) the following:
``(f) NAS Study and Report.--
``(1) In general.--The Secretary, acting through the
Assistant Secretary, shall enter into an arrangement with the
National Academy of Sciences under which the National Academy
agrees to conduct a study on--
``(A) the availability in the United States of
high-quality recovery housing and whether that
availability meets the demand for such housing in the
United States; and
``(B) State, Tribal, and local regulation and
oversight of recovery housing.
``(2) Report.--The arrangement under paragraph (1) shall
provide for the National Academy of Sciences to submit, not
later than 1 year after the date of the enactment of this
subsection, a report that contains--
``(A) the results of the study under such
paragraph;
``(B) the National Academy's recommendations for
Federal, State, and local policies to promote the
availability of high-quality recovery housing in the
United States;
``(C) recommendations for Federal, State, and local
policies to improve data collection on the quality of
recovery housing;
``(D) recommendations for recovery housing quality
metrics;
``(E) recommendations to eliminate restrictions by
recovery residences that exclude individuals who take
prescribed medications for opioid use disorder; and
``(F) a summary of allegations, assertions, or
formal legal actions on the State and local levels by
governments and non-governmental organizations with
respect to the opening and operation of recovery
residences.
``(3) Consultation.--In conducting the study under this
subsection, the National Academy of Sciences shall consult with
national accrediting entities and reputable providers and
analysts of recovery housing services.''.
SEC. 315. GRANTS FOR STATES TO PROMOTE THE AVAILABILITY OF HIGH QUALITY
RECOVERY HOUSING.
Section 550 of the Public Health Service Act (42 U.S.C. 290ee-5),
as amended by sections 313 and 314 is further amended by inserting
after subsection (f) (as added by such section 314) the following:
``(g) Grants for Implementing National Recovery Housing Best
Practices.--
``(1) In general.--The Secretary shall award grants to
States (and political subdivisions thereof), Tribes, and
territories--
``(A) for the provision of technical assistance by
national accrediting entities and reputable providers
and analysts of recovery housing services to implement
the guidelines, nationally recognized standards, and
recommendations developed under section 312 of the CARA
3.0 Act of 2021 and this section; and
``(B) to promote the availability of high-quality
recovery housing for individuals with a substance use
disorder and practices to maintain housing quality long
term.
``(2) Accrediting, standards, and technical assistance
grants.--
``(A) In general.--The Secretary shall award grants
to one or more national accrediting, standards, and
technical assistance organizations with specific
recovery housing expertise--
``(i) for development of technical
assistance and educational programs that are
national or multi-State in scope, targeted to
the needs of grantees under paragraph (1), and
to statewide recovery housing accreditation,
standards and support organizations;
``(ii) for the development and maintenance
of a summary information resource describing
State-level regulation, funding, recognition,
support, and system expansion programs for
recovery housing;
``(iii) for the development and maintenance
of a consultant workforce dedicated to serving
the needs of the Department of Health and Human
Services and the Department of Housing and
Urban Development, with respect to the programs
under subtitle B of title III of the CARA 3.0
Act of 2021 (including the amendments made by
such subtitle); and
``(iv) for development of training and
educational resources for recovery housing
providers and staff focusing on best practices
for operating recovery housing in a manner
consistent with best practices developed or
identified through the programs under subtitle
B of title III of the CARA 3.0 Act of 2021
(including the amendments made by such
subtitle).
``(B) Eligible entities.--To be eligible for a
grant under this paragraph, an entity shall--
``(i) be a nonprofit entity, or a
consortium of nonprofit entities; and
``(ii) demonstrate--
``(I) expertise in developing
recovery housing standards, including
widespread adoption of its standards;
``(II) an existing network of
national affiliate organizations
responsible for implementation of
standards and accreditation of
providers; and
``(III) the ability to manage
relationships with Federal agencies,
agencies receiving grants under
paragraph (1), statewide recovery
housing accrediting organizations, and
national behavioral health and housing
organizations.
``(3) State enforcement plans.--Beginning not later than 90
days after the date of the enactment of this paragraph and
every 2 years thereafter, as a condition on the receipt of a
grant under paragraph (1), each State (or political
subdivisions thereof), Tribe, or territory receiving such a
grant shall submit to the Secretary, and make publicly
available on a publicly accessible internet website of the
State (or political subdivisions thereof), Tribe, or territory,
the plan of the State (or political subdivisions thereof),
Tribe, or territory, with respect to the promotion of high-
quality recovery housing for individuals with a substance use
disorder located within the jurisdiction of such State (or
political subdivisions thereof), Tribe, or territory, and how
such plan is consistent with the best practices developed under
this section and guidelines developed under section 312 of the
CARA 3.0 Act of 2021.
``(4) Review of accrediting entities.--The Secretary shall
periodically review the accrediting entities providing
technical assistance pursuant to paragraph (1)(A).''.
SEC. 316. AUTHORIZATION OF APPROPRIATIONS.
Section 550 of the Public Health Service Act (42 U.S.C. 290ee-5),
as amended by sections 313, 314, and 315, is further amended by
amending subsection (j) (as redesignated by such section 313) to read
as follows:
``(j) Authorization of Appropriations.--
``(1) In general.--To carry out this section, there is
authorized to be appropriated--
``(A) $2,000,000 for fiscal year 2021; and
``(B) $11,000,000 for each of fiscal years 2022
through 2026.
``(2) Reservations of funds.--For each of fiscal years 2021
through 2026, of the amounts appropriated under paragraph (1)
for such fiscal year, the Secretary shall reserve--
``(A) not less than $1,000,000 to carry out
subsection (e);
``(B) not less than $1,000,000 to carry out
subsection (f); and
``(C) not less than $10,000,000 to award grants
under paragraphs (1) and (2) of subsection (g).''.
SEC. 317. REPUTABLE PROVIDERS AND ANALYSTS OF RECOVERY HOUSING SERVICES
DEFINITION.
Section 550(i) of the Public Health Service Act (42 U.S.C. 290ee-
5(i)), as redesignated by section 313, is amended by adding at the end
the following:
``(4) The term `reputable providers and analysts of
recovery housing services' means recovery housing service
providers and analysts that--
``(A) use evidence-based approaches;
``(B) act in accordance with guidelines issued by
the Assistant Secretary for Mental Health and Substance
Use;
``(C) have not been found guilty of health care
fraud by the Department of Justice; and
``(D) have not been found to have violated Federal,
State, or local codes of conduct with respect to
recovery housing for individuals with a substance use
disorder.''.
SEC. 318. TECHNICAL CORRECTION.
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.)
is amended--
(1) by redesignating section 550 (relating to Sobriety
Treatment and Recovery Teams) (42 U.S.C. 290ee-10), as added by
section 8214 of Public Law 115-271, as section 550A; and
(2) moving such section so it appears after section 550
(relating to National Recovery Housing Best Practices).
TITLE IV--CRIMINAL JUSTICE
SEC. 401. MEDICATION-ASSISTED TREATMENT CORRECTIONS AND COMMUNITY
REENTRY PROGRAM.
(a) Definitions.--In this section--
(1) the term ``Attorney General'' means the Attorney
General, acting through the Director of the National Institute
of Corrections;
(2) the term ``certified recovery coach'' means an
individual--
(A) with knowledge of, or experience with, recovery
from a substance use disorder; and
(B) who--
(i) has completed training through, and is
determined to be in good standing by--
(I) a single State agency; or
(II) a recovery community
organization that is capable of
conducting that training and making
that determination; and
(ii) meets the criteria specified by the
Attorney General, in consultation with the
Secretary of Health and Human Services, for
qualifying as a certified recovery coach for
the purposes of this Act;
(3) the term ``correctional facility'' has the meaning
given the term in section 901 of title I of the Omnibus Crime
Control and Safe Streets Act of 1968 (34 U.S.C. 10251);
(4) the term ``covered grant or cooperative agreement''
means a grant received, or cooperative agreement entered into,
under the Program;
(5) the term ``covered program'' means a program--
(A) to provide medication-assisted treatment to
individuals who have opioid use disorder and are
incarcerated within the jurisdiction of the State or
unit of local government carrying out the program; and
(B) that is developed, implemented, or expanded
through a covered grant or cooperative agreement;
(6) the term ``medication-assisted treatment'' means the
use of any drug or combination of drugs that have been approved
under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301
et seq.) or section 351 of the Public Health Service Act (42
U.S.C. 262) for the treatment of an opioid use disorder, in
combination with evidence-based counseling and behavioral
therapies, such as psychosocial counseling, overseen by 1 or
more social work professionals and 1 or more qualified
clinicians, to provide a comprehensive approach to the
treatment of substance use disorders;
(7) the term ``nonprofit organization'' means an
organization that is described in section 501(c)(3) of the
Internal Revenue Code of 1986 and is exempt from taxation under
section 501(a) of such Code;
(8) the term ``Panel'' means the medication-assisted
treatment Corrections and Community Reentry Application Review
Panel established under subsection (f)(2);
(9) the term ``participant'' means an individual who
participates in a covered program;
(10) the term ``political appointee'' has the meaning given
the term in section 714(h) of title 38, United States Code;
(11) the term ``Program'' means the medication-assisted
treatment Corrections and Community Reentry Program established
under subsection (b);
(12) the term ``psychosocial'' means the interrelation of
social factors and individual thought and behavior;
(13) the term ``recovery community organization'' has the
meaning given the term in section 547 of the Public Health
Service Act (42 U.S.C. 290ee-2);
(14) the term ``single State agency'' means, with respect
to a State or unit of local government, the single State agency
identified by the State, or the State in which the unit of
local government is located, in the plan submitted by that
State under section 1932(b)(1)(A)(i) of the Public Health
Service Act (42 U.S.C. 300x-32(b)(1)(A)(i));
(15) the term ``State'' means--
(A) each State of the United States;
(B) the District of Columbia; and
(C) each commonwealth, territory, or possession of
the United States; and
(16) the term ``unit of local government'' has the meaning
given the term in section 901 of title I of the Omnibus Crime
Control and Safe Streets Act of 1968 (34 U.S.C. 10251), except
that such term also includes a Tribal organization, as defined
in section 4 of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 5304).
(b) Authorization.--Not later than 90 days after the date of
enactment of this Act, the Attorney General, in consultation with the
Secretary of Health and Human Services, shall establish a program--
(1) that shall be known as the ``medication-assisted
treatment Corrections and Community Reentry Program''; and
(2) under which the Attorney General--
(A) may make grants to, and enter into cooperative
agreements with, States or units of local government to
develop, implement, or expand 1 or more programs to
provide medication-assisted treatment that meets the
standard of care generally accepted for the treatment
of opioid use disorder to individuals who have opioid
use disorder and are incarcerated within the
jurisdictions of the States or units of local
government; and
(B) shall establish a working relationship with 1
or more knowledgeable corrections organizations with
expertise in security, medical health, mental health,
and substance use disorder care to oversee and support
implementation of the program, including through the
use of evidence-based clinical practices.
(c) Use of Funds for Infrastructure.--In developing, implementing,
or expanding a medication-assisted treatment program under subsection
(b)(2)(A), a State or unit of local government may use funds from a
grant or cooperative agreement under that subsection to develop the
infrastructure necessary to provide the medication-assisted treatment,
such as--
(1) establishing safe storage facilities for the drugs used
in the treatment; and
(2) obtaining appropriate licenses for the individuals who
will administer the treatment.
(d) Purposes.--The purposes of the Program are to--
(1) develop culturally competent (as defined in section 102
of the Developmental Disabilities Assistance and Bill of Rights
Act of 2000 (42 U.S.C. 15002)) medication-assisted treatment
programs in consultation with nonprofit organizations and
community organizations that are qualified to provide technical
support for the programs;
(2) reduce the risk of overdose to participants after the
participants are released from incarceration; and
(3) reduce the rate of reincarceration.
(e) Program Requirements.--In carrying out a covered program, a
State or unit of local government--
(1) shall ensure that each individual who is newly
incarcerated at a correctional facility at which the covered
program is carried out, and who was receiving medication-
assisted treatment before being incarcerated, continues to
receive medication-assisted treatment while incarcerated;
(2) in providing medication-assisted treatment under the
covered program, shall offer to participants each type of drug
that has been approved under the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 301 et seq.) or section 351 of the
Public Health Service Act (42 U.S.C. 262) for the treatment of
an opioid use disorder; and
(3) shall use--
(A) screening tools with psychometric reliability
and validity that provide useful clinical data to guide
the long-term treatment of participants who have--
(i) opioid use disorder; or
(ii) co-occurring opioid use disorder and
mental disorders;
(B) at each correctional facility at which the
covered program is carried out, a sufficient number of
personnel, as determined by the Attorney General in
light of the number of individuals incarcerated at the
correctional facility and the number of those
individuals whom the correctional facility has screened
and identified as having opioid use disorder, to--
(i) monitor participants with active opioid
use disorder who begin participation in the
covered program while demonstrating, or
develop, signs and symptoms of opioid
withdrawal;
(ii) provide evidence-based medically
managed withdrawal care or assistance to the
participants described in clause (i);
(iii) prescribe or otherwise dispense--
(I) the drugs that are offered
under the covered program, as required
under paragraph (1); and
(II) naloxone or any other
emergency opioid antagonist approved by
the Commissioner of Food and Drugs to
treat opioid overdose;
(iv) discuss with participants the risks
and benefits of, and differences among, the
opioid antagonist, opioid agonist, and partial
agonist drugs used to treat opioid use
disorder; and
(v) prepare a plan for release, including
connecting participants with mental health and
substance use treatment programs, medical care,
public benefits, and housing; and
(C) a certified recovery coach, social work
professional, or other qualified clinician who, in
order to support the sustained recovery of
participants, shall work with participants who are
recovering from opioid use disorder.
(f) Application.--
(1) In general.--A State or unit of local government
desiring a covered grant or cooperative agreement shall submit
to the Attorney General an application that--
(A) shall include--
(i) a description of--
(I) the objectives of the
medication-assisted treatment program
that the applicant will develop,
implement, or expand under the covered
grant or cooperative agreement;
(II) the activities that the
applicant will carry out under the
covered program;
(III) how the activities described
under subclause (II) will achieve the
objectives described in subclause (I);
(IV) the outreach and education
component of the covered program that
the applicant will carry out in order
to encourage maximum participation in
the covered program; and
(V) how the applicant will develop
connections to culturally competent (as
defined in section 102 of the
Developmental Disabilities Assistance
and Bill of Rights Act of 2000 (42
U.S.C. 15002)) substance use and mental
health treatment providers, medical
professionals, nonprofit organizations,
and other State agencies in order to
plan for participants to receive a
continuum of care and appropriate wrap-
around services after release from
incarceration;
(ii) if, under the covered program that the
applicant will carry out, the applicant will
not, in providing medication-assisted
treatment, offer to participants not less than
1 drug that uses an opioid antagonist, not less
than 1 drug that uses an opioid agonist, and
not less than 1 drug that uses an opioid
partial agonist, an explanation of why the
applicant is unable to or chooses not to offer
a drug that uses an opioid antagonist, a drug
that uses an opioid agonist, or a drug that
uses an opioid partial agonist, as applicable;
(iii) a plan for--
(I) measuring progress in achieving
the objectives described in clause
(i)(I), including a strategy to collect
data that can be used to measure that
progress;
(II) collaborating with the single
State agency for the applicant or 1 or
more nonprofit organizations in the
community of the applicant to help
ensure that--
(aa) if participants so
desire, participants have
continuity of care after
release from incarceration with
respect to the form of
medication-assisted treatment
the participants received
during incarceration,
including--
(AA) by working
with community service
providers to assist
eligible participants,
before release from
incarceration in
registering for the
Medicaid program under
title XIX of the Social
Security Act (42 U.S.C.
1396 et seq.) or other
minimum essential
coverage, as defined in
section 5000A(f) of the
Internal Revenue Code
of 1986; and
(BB) if a
participant cannot
afford, or does not
qualify for, health
insurance that provides
coverage with respect
to enrollment in a
medication-assisted
treatment program, and
if the participant
cannot pay the cost of
enrolling in a
medication-assisted
treatment program, by
working with units of
local government,
nonprofit
organizations, opioid
use disorder treatment
providers, and entities
carrying out programs
under substance use
disorder grants to,
before the participant
is released from
incarceration, identify
a resource, other than
the applicant or the
covered program to be
carried out by the
applicant, that may be
used to pay the cost of
enrolling the
participant in a
medication-assisted
treatment program;
(bb) medications are
securely stored; and
(cc) protocols relating to
diversion are maintained; and
(III) with respect to each
community in which a correctional
facility at which a covered program
will be carried out is located,
collaborating with State agencies
responsible for overseeing programs
relating to substance use disorder and
local public health officials and
nonprofit organizations in the
community to help ensure that
medication-assisted treatment provided
at each correctional facility at which
the covered program will be carried out
is also available at locations that are
not correctional facilities in those
communities, to the greatest extent
practicable; and
(iv) a certification that--
(I) each correctional facility at
which the covered program will be
carried out has access to a sufficient
number of clinicians who are licensed
to prescribe or otherwise dispense to
participants the drugs for the
treatment of opioid use disorder
required to be offered under subsection
(e)(1), which may include clinicians
who use telemedicine, in accordance
with regulations issued by the
Administrator of the Drug Enforcement
Administration, to provide services
under the covered program; and
(II) the covered program will
provide culturally competent (as
defined in section 102 of the
Developmental Disabilities Assistance
and Bill of Rights Act of 2000 (42
U.S.C. 15002)) evidence-based
counseling and behavioral therapies,
which may include counseling and
therapy administered through the use of
telemedicine, as appropriate, to
participants as part of the medication-
assisted treatment provided under the
covered program; and
(B) may include a statement indicating the number
of participants that the applicant expects to serve
through the covered program.
(2) Medication-assisted treatment corrections and community
reentry application review panel.--
(A) In general.--Not later than 60 days after the
date of enactment of this Act, the Attorney General
shall establish a Medication-Assisted Treatment
Corrections and Community Reentry Application Review
Panel that shall--
(i) be composed of not fewer than 10
individuals and not more than 15 individuals;
and
(ii) include--
(I) 1 or more employees, who are
not political appointees, of--
(aa) the Department of
Justice;
(bb) the Substance Abuse
and Mental Health Service
Administration;
(cc) the National Center
for Injury Prevention and
Control at the Centers for
Disease Control and Prevention;
and
(dd) the Office of National
Drug Control Policy; and
(II) other stakeholders who--
(aa) have expert knowledge
relating to the opioid
epidemic, drug treatment,
health equity, culturally
competent (as defined in
section 102 of the
Developmental Disabilities
Assistance and Bill of Rights
Act of 2000 (42 U.S.C. 15002))
care, or community substance
use disorder services; and
(bb) represent law
enforcement organizations and
public health entities.
(B) Duties.--
(i) In general.--The Panel shall--
(I) review and evaluate
applications for covered grants and
cooperative agreements; and
(II) make recommendations to the
Attorney General relating to the
awarding of covered grants and
cooperative agreements.
(ii) Rural communities.--In reviewing and
evaluating applications under clause (i), the
Panel shall take into consideration the unique
circumstances, including the lack of resources
relating to the treatment of opioid use
disorder, faced by rural States and units of
local government.
(C) Termination.--The Panel shall terminate on the
last day of fiscal year 2023.
(3) Publication of criteria in federal register.--Not later
than 90 days after the date of enactment of this Act, the
Attorney General, in consultation with the Panel, shall publish
in the Federal Register--
(A) the process through which applications
submitted under paragraph (1) shall be submitted and
evaluated; and
(B) the criteria used in awarding covered grants
and cooperative agreements.
(g) Duration.--A covered grant or cooperative agreement shall be
for a period of not more than 4 years, except that the Attorney General
may extend the term of a covered grant or cooperative agreement based
on outcome data or extenuating circumstances relating to the covered
program carried out under the covered grant or cooperative agreement.
(h) Report.--
(1) In general.--Not later than 2 years after the date on
which a State or unit of local government is awarded a covered
grant or cooperative agreement, and each year thereafter until
the date that is 1 year after the date on which the period of
the covered grant or cooperative agreement ends, the State or
unit of local government shall submit a report to the Attorney
General that includes information relating to the covered
program carried out by the State or unit of local government,
including information relating to--
(A) the goals of the covered program;
(B) any evidence-based interventions carried out
under the covered program;
(C) outcomes of the covered program, which shall--
(i) be reported in a manner that
distinguishes the outcomes based on the
categories of, with respect to the participants
in the covered program--
(I) the race of the participants;
and
(II) the gender of the
participants; and
(ii) include information relating to the
rate of reincarceration among participants in
the covered program, if available; and
(D) expenditures under the covered program.
(2) Publication.--
(A) Awardee.--A State or unit of local government
that submits a report under paragraph (1) shall make
the report publicly available on--
(i) the website of each correctional
facility at which the State or unit of local
government carried out the covered grant
program; and
(ii) if a correctional facility at which
the State or unit of local government carried
out the covered grant program does not operate
a website, the website of the State or unit of
local government.
(B) Attorney general.--The Attorney General shall
make each report received under paragraph (1) publicly
available on the website of the National Institute of
Corrections.
(3) Submission to congress.--Not later than 2 years after
the date on which the Attorney General awards the first covered
grant or cooperative agreement, and each year thereafter, the
Attorney General shall submit to the Committee on the Judiciary
of the Senate and the Committee on the Judiciary of the House
of Representatives a summary and compilation of the reports
that the Attorney General has received under paragraph (1)
during the year preceding the date on which the Attorney
General submits the summary and compilation.
(i) Authorization of Appropriations.--There are authorized to be
appropriated $50,000,000 to carry out this section for each of fiscal
years 2021 through 2026.
SEC. 402. DEFLECTION AND PRE-ARREST DIVERSION.
(a) Findings.--Congress finds the following:
(1) Law enforcement officers and other first responders are
at the front line of the opioid epidemic. However, a
traditional law enforcement response to substance use often
fails to disrupt the cycle of addiction and arrest, or reduce
the risk of overdose.
(2) Law enforcement-assisted deflection and diversion
programs have the potential to improve public health, decrease
the number of people entering the criminal justice system for
low-level offenses, and address racial disparities.
(3) According to the Bureau of Justice Assistance of the
Department of Justice, ``Five pathways have been most commonly
associated with opioid overdose prevention and diversion to
treatment.'' The 5 pathways are--
(A) ``self-referral'', in which--
(i) an individual voluntarily initiates
contact with a first responder, such as a law
enforcement officer, firefighter, or emergency
medical services professional, for a treatment
referral (without fear of arrest); and
(ii) the first responder personally
introduces the individual to a treatment
provider (commonly known as a ``warm
handoff'');
(B) ``active outreach'', in which a law enforcement
officer or other first responder--
(i) identifies or seeks out individuals in
need of substance use disorder treatment; and
(ii) makes a warm handoff of such an
individual to a treatment provider, who engages
the individual in treatment;
(C) ``naloxone plus'', in which a law enforcement
officer or other first responder engages an individual
in treatment as a follow-up to an overdose response;
(D) ``officer prevention referral'', in which a law
enforcement officer or other first responder initiates
treatment engagement with an individual, but no
criminal charges are filed against the individual; and
(E) ``officer intervention referral'', in which--
(i) a law enforcement officer or other
first responder initiates treatment engagement
with an individual; and
(ii)(I) criminal charges are filed against
the individual and held in abeyance; or
(II) a citation is issued to the
individual.
(4) As of the date of enactment of this Act, there are no
national best practices or guidelines for law enforcement-
assisted deflection and diversion programs.
(b) Use of Byrne JAG Funds for Deflection and Diversion Programs.--
Section 501 of title I of the Omnibus Crime Control and Safe Streets
Act of 1968 (34 U.S.C. 10152) is amended--
(1) in subsection (a)(1)(E), by inserting before the period
at the end the following: ``, including law enforcement-
assisted deflection programs and law enforcement-assisted pre-
arrest and pre-booking diversion programs (as those terms are
defined in subsection (h))''; and
(2) by adding at the end the following:
``(h) Law Enforcement-Assisted Deflection Programs and Law
Enforcement-Assisted Pre-Arrest and Pre-Booking Diversion Programs.--
``(1) Definitions.--In this subsection:
``(A) Covered grant.--The term `covered grant'
means a grant for a deflection or diversion program
awarded under subsection (a)(1)(E).
``(B) Deflection or diversion program.--The term
`deflection or diversion program' means a law
enforcement-assisted deflection program or a law
enforcement-assisted pre-arrest or pre-booking
diversion, including a program under which--
``(i) an individual voluntarily initiates
contact with a first responder for a substance
use disorder or mental health treatment
referral without fear of arrest and receives a
warm handoff to such treatment;
``(ii) a law enforcement officer or other
first responder identifies or seeks out
individuals in need of substance use disorder
or mental health treatment and a warm handoff
is made to a treatment provider, who engages
the individuals in treatment;
``(iii) a law enforcement officer or other
first responder engages an individual in
substance use disorder treatment as part of an
overdose response;
``(iv) a law enforcement officer or other
first responder initiates substance use
disorder or mental health treatment engagement,
but no criminal charges are filed;
``(v) a law enforcement officer or other
first responder initiates substance use
disorder or mental health treatment engagement
with an individual; or
``(vi) charges are filed against an
individual who has committed an offense that is
not a crime against a person, and the primary
cause of which appears to be based on a
substance use disorder or mental health
disorder and held in abeyance or a citation is
issued to such an individual.
``(C) Law enforcement-assisted deflection
program.--The term `law enforcement-assisted deflection
program' means a program under which a law enforcement
officer, when encountering an individual who is not
engaged in criminal activity but appears to have a
substance use disorder or mental health disorder,
instead of taking no action at the time of contact or
taking action at a later time, attempts to connect the
individual to substance use disorder treatment
providers or mental health treatment providers--
``(i) without the use of coercion or fear
of arrest; and
``(ii) using established pathways for
connections to local, community-based
treatment.
``(D) Law enforcement-assisted pre-arrest or pre-
booking diversion program.--The term `law enforcement-
assisted pre-arrest or pre-booking diversion program'
means a program--
``(i) under which a law enforcement
officer, when encountering an individual who
has committed an offense that is not a crime
against a person, and the primary cause of
which appears to be based on a substance use
disorder or the mental health disorder of the
individual, instead of arresting the
individual, or instead of booking the
individual after having arrested the
individual, attempts to connect the individual
to substance use disorder treatment providers
or mental health treatment providers--
``(I) without the use of coercion;
and
``(II) using established pathways
for connections to local, community-
based treatment;
``(ii) under which, in the case of pre-
arrest diversion, a law enforcement officer
described in clause (i) may decide to--
``(I) issue a civil citation; or
``(II) take no action with respect
to the offense for which the officer
would otherwise have arrested the
individual described in clause (i); and
``(iii) that may authorize a law
enforcement officer to refer an individual to
substance use disorder treatment providers or
mental health treatment providers if the
individual appears to have a substance use
disorder or mental health disorder and the
officer suspects the individual of chronic
violations of law but lacks probable cause to
arrest the individual (commonly known as a
`social contact referral').
``(2) Sense of congress regarding deflection or diversion
programs.--It is the sense of Congress that a deflection or
diversion program funded under this subpart should not exclude
individuals who are chronically exposed to the criminal justice
system.
``(3) Reports to attorney general.--Not later than 2 years
after the date on which a State or unit of local government is
awarded a covered grant, and each year thereafter until the
date that is 1 year after the date on which the period of the
covered grant ends, the State or unit of local government shall
submit a report to the Attorney General that includes
information relating to the deflection or diversion program
carried out by the State or unit of local government, including
information relating to--
``(A) the goals of the deflection or diversion
program;
``(B) any evidence-based interventions carried out
under the deflection or diversion program;
``(C) outcomes of the deflection or diversion
program, which shall--
``(i) be reported in a manner that
distinguishes the outcomes based on the
categories of, with respect to the participants
in the deflection or diversion program--
``(I) the race of the participants;
and
``(II) the gender of the
participants; and
``(ii) include information relating to the
rate of reincarceration among participants in
the deflection or diversion program, if
available; and
``(D) expenditures under the deflection or
diversion program.''.
(c) Technical Assistance Grant Program.--
(1) Definitions.--In this subsection--
(A) the term ``deflection or diversion program''
has the meaning given the term in subsection (h) of
section 501 of title I of the Omnibus Crime Control and
Safe Streets Act of 1968 (34 U.S.C. 10152), as added by
subsection (b); and
(B) the terms ``State'' and ``unit of local
government'' have the meanings given those terms in
section 901 of title I of the Omnibus Crime Control and
Safe Streets Act of 1968 (34 U.S.C. 10251).
(2) Grant authorized.--The Attorney General shall award a
single grant to an entity with significant experience in
working with law enforcement agencies, community-based
treatment providers, and other community-based human service
providers to develop or administer both deflection and
diversion programs that use each of the 5 pathways described in
subsection (a)(3), to promote and maximize the effectiveness
and racial equity of deflection or diversion programs, in order
to--
(A) help State and units of local government launch
and expand deflection or diversion programs;
(B) develop best practices for deflection or
diversion teams, which shall include--
(i) recommendations on community input and
engagement in order to implement deflection or
diversion programs as rapidly as possible and
with regard to the particular needs of a
community, including regular community meetings
and other mechanisms for engagement with--
(I) law enforcement agencies;
(II) community-based treatment
providers and other community-based
human service providers;
(III) the recovery community; and
(IV) the community at-large; and
(ii) the implementation of metrics to
measure community satisfaction concerning the
meaningful participation and interaction of the
community with the deflection or diversion
program and program stakeholders;
(C) develop and publish a training and technical
assistance tool kit for deflection or diversion for
public education purposes;
(D) disseminate uniform criteria and standards for
the delivery of deflection or diversion program
services; and
(E) develop outcome measures that can be used to
continuously inform and improve social, clinical,
financial and racial equity outcomes.
(3) Term.--The term of the grant awarded under paragraph
(2) shall be 5 years.
(4) Authorization of appropriations.--There are authorized
to be appropriated to the Attorney General $30,000,000 for the
grant under paragraph (2).
SEC. 403. HOUSING.
(a) In General.--Section 576 of the Quality Housing and Work
Responsibility Act of 1998 (42 U.S.C. 13661) is amended by striking
subsections (a), (b), and (c) and inserting the following:
``(a) Ineligibility of Illegal Drug Users and Alcohol Abusers.--
Notwithstanding any other provision of law, a public housing agency or
an owner of federally assisted housing, as determined by the Secretary,
may only prohibit admission to the program or admission to federally
assisted housing for an individual whom the public housing agency or
owner determines is illegally using a controlled substance or abusing
alcohol if--
``(1) the agency or owner determines that the individual is
using the controlled substance or abusing alcohol in a manner
that interferes with the health or safety of other residents;
and
``(2) the individual is not participating in a substance
use disorder assessment and treatment.
``(b) Authority To Deny Admission to Criminal Offenders.--
``(1) In general.--Except as provided in subsection (a), in
addition to any other authority to screen applicants, and
subject to paragraphs (2) and (3) of this subsection, a public
housing agency or an owner of federally assisted housing may
only prohibit admission to the program or to federally assisted
housing for an individual based on criminal activity of the
individual if the public housing agency or owner determines
that the individual, during a reasonable time preceding the
date on which the individual would otherwise be selected for
admission, was convicted of a crime involving conduct that
threatens the health or safety of other residents.
``(2) Exceptions and limitations.--A conviction that has
been vacated, a conviction the record of which has been sealed
or expunged, or a conviction for a crime committed by an
individual when the individual was less than 18 years of age,
shall not be grounds for denial of admission under paragraph
(1).
``(3) Admission policy.--
``(A) Factors to consider.--In evaluating the
criminal history of an individual under paragraph (1),
a public housing agency or an owner of federally
assisted housing shall consider--
``(i) whether an offense of which the
individual was convicted bears a relationship
to the safety and security of other residents;
``(ii) the level of violence, if any, of an
offense of which the individual was convicted;
``(iii) the length of time since a
conviction;
``(iv) the number of convictions;
``(v) if the individual is in recovery for
a substance use disorder, whether the
individual was under the influence of alcohol
or illegal drugs at the time of an offense; and
``(vi) any rehabilitation efforts that the
individual has undertaken since the time of a
conviction, including completion of a substance
use treatment program.
``(B) Written policy.--A public housing agency or
an owner of federally assisted housing shall establish
and make available to applicants a written admission
policy that enumerates the specific factors, including
the factors described in subparagraph (A), that will be
considered when the public housing agency or owner
evaluates the criminal history of an individual under
paragraph (1).''.
(b) Updating Regulations.--The Secretary of Housing and Urban
Development shall amend subpart I of part 5 of title 24, Code of
Federal Regulations, as necessary to implement the amendment made by
subsection (a) of this section.
SEC. 404. VETERANS TREATMENT COURTS.
Section 2991 of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (34 U.S.C. 10651) is amended--
(1) in subsection (a)--
(A) in paragraph (2)--
(i) in the matter preceding subparagraph
(A)--
(I) by inserting ``, substance use
disorder,'' after ``mental health'';
and
(II) by inserting ``or adults or
juveniles with substance use
disorders'' after ``mentally ill adults
or juveniles'';
(ii) in subparagraph (A), by inserting ``or
substance use'' after ``mental health''; and
(iii) in subparagraph (B), by inserting
``or substance use'' after ``mental health'';
(B) in paragraph (4)--
(i) in subparagraph (A), by inserting ``or
substance use disorder'' after ``mental
health''; and
(ii) in subparagraph (C), by inserting ``or
offenders with substance use disorders'' after
``mentally ill offenders'';
(C) in paragraph (5)--
(i) in the heading, by inserting ``or
substance use disorder'' after ``Mental
health'';
(ii) by striking ``mental health agency''
and inserting ``mental health or substance use
agency''; and
(iii) by inserting ``, substance use
services,'' after ``mental health services'';
(D) in paragraph (9)--
(i) in subparagraph (A)--
(I) in clause (i)--
(aa) in subclause (I), by
inserting ``, a substance use
disorder,'' after ``a mental
illness''; and
(bb) in subclause (II), by
inserting ``, substance use
disorder,'' after ``mental
illness''; and
(II) in clause (ii)(II), by
inserting ``or substance use'' after
``mental health'';
(E) by redesignating paragraph (11) as paragraph
(12); and
(F) by inserting after paragraph (10) the
following:
``(11) Substance use court.--The term `substance use court'
means a judicial program that meets the requirements of part EE
of this title.'';
(2) in subsection (b)--
(A) in paragraph (2)--
(i) in subparagraph (A), by inserting ``,
substance use courts,'' after ``mental health
courts'';
(ii) in subparagraph (B)--
(I) by inserting ``mental health
disorders, substance use disorders,
or'' before ``co-occurring mental
illness and substance use problems'';
and
(II) by striking ``illnesses'' and
inserting ``disorders, illnesses, or
problems'';
(iii) in subparagraph (C)--
(I) in the matter preceding clause
(i)--
(aa) by striking ``mental
health agencies'' and inserting
``mental health or substance
use agencies''; and
(bb) by striking ``and,
where appropriate,'' and
inserting ``or''; and
(II) in clause (i), by inserting
``, substance use disorders,'' after
``mental illness''; and
(iv) in subparagraph (D), by inserting ``or
offender with a substance use disorder'' after
``mentally ill offender''; and
(B) in paragraph (5)--
(i) in subparagraph (B)--
(I) in clause (i)--
(aa) by inserting ``or
substance use court'' after
``mental health court''; and
(bb) by striking ``mental
health agency'' and inserting
``mental health or substance
use agency''; and
(II) in clause (ii), by striking
``and substance use services for
individuals with co-occurring mental
health and substance use disorders''
and inserting ``or substance use
services'';
(ii) in subparagraph (C)--
(I) in clause (i)(I), by inserting
``, substance use disorders,'' after
``mental illness'';
(II) in clause (ii)--
(aa) in subclause (II), by
inserting ``, substance use,''
after ``mental health,'';
(bb) in subclause (V), by
striking ``mental health
services'' and inserting
``mental health or substance
use services''; and
(cc) in subclause (VI), by
inserting ``or individuals with
substance use disorders'' after
``mentally ill individuals'';
(iii) in subparagraph (D), by inserting
``or offenders with substance use disorders''
after ``mentally ill offenders'';
(iv) in subparagraph (E), by inserting ``or
substance use disorders'' after ``mental
illness'';
(v) in subparagraph (H), by striking ``and
mental health'' and inserting ``, mental
health, and substance use''; and
(vi) in subparagraph (I)--
(I) in clause (i)--
(aa) in the heading, by
inserting ``, substance use
courts,'' after ``Mental health
courts'';
(bb) by inserting ``or
substance use courts'' after
``mental health courts''; and
(cc) by inserting ``or part
EE, as applicable,'' after
``part V''; and
(II) in clause (iv), by inserting
``or substance use'' after ``mental
health'';
(3) in subsection (c)--
(A) in paragraph (1), by inserting ``, offenders
with substance use disorders,'' after ``mentally ill
offenders'';
(B) in paragraph (2), by inserting `` and offenders
with substance use disorders'' after ``mentally ill
offenders''; and
(C) in paragraph (3), by inserting ``or substance
use courts'' after ``mental health courts'';
(4) in subsection (e)--
(A) in paragraph (1), by inserting ``or substance
use disorders'' after ``mental illness''; and
(B) in paragraph (4), by inserting ``or substance
use disorders'' after ``mental illness'';
(5) in subsection (h)--
(A) in the heading, by inserting ``and Offenders
With Substance Use Disorders'' after ``Mentally Ill
Offenders'';
(B) in paragraph (1)--
(i) in subparagraph (A), by inserting ``or
substance use disorders'' after ``mental
illnesses'';
(ii) in subparagraph (C), by inserting ``or
offenders with substance use disorders'' after
``mentally ill offenders'';
(iii) in subparagraph (D)--
(I) by inserting ``or substance
use'' after ``mental health''; and
(II) by inserting ``or offenders
with substance use disorders'' after
``mentally ill offenders'';
(iv) in subparagraph (E), by inserting ``or
substance use disorders'' after ``mental
illnesses''; and
(v) in subparagraph (F), by inserting ``,
substance use disorders,'' after ``mental
health disorders''; and
(C) in paragraph (2), by inserting ``or substance
use disorders'' after ``mental illnesses'';
(6) in subsection (i)(2)--
(A) in subparagraph (B)--
(i) by redesignating clauses (i), (ii), and
(iii) as subclauses (I), (II), and (III), and
adjusting the margins accordingly;
(ii) in the matter preceding subclause (I),
as so redesignated, by striking ``shall give
priority to applications that--'' and inserting
the following: ``shall give priority to--
``(i) applications that--''; and
(iii) by striking the period at the end and
inserting the following: ``; and
``(ii) applications to establish or expand
veterans treatment court programs that--
``(I) allow participation by a
veteran receiving any type of
medication-assisted treatment that
involves the use of any drug or
combination of drugs that have been
approved under the Federal Food, Drug,
and Cosmetic Act (21 U.S.C. 301 et
seq.) or section 351 of the Public
Health Service Act (42 U.S.C. 262) for
the treatment of an opioid use
disorder;
``(II) follow the Adult Drug Court
Best Practice Standards published by
the National Association of Drug Court
Professionals; and
``(III) provide culturally
competent (as defined in section 102 of
the Developmental Disabilities
Assistance and Bill of Rights Act of
2000 (42 U.S.C. 15002)) services.'';
and
(B) by adding at the end the following:
``(C) Disclosure and reporting requirements.--
``(i) Requirements for veterans treatment
court program grantees.--An applicant that
receives a grant under this subsection to
establish or expand a veterans treatment court
program shall--
``(I) disclose to the Attorney
General any contract or relationship
between the applicant and a local
treatment provider;
``(II) track and report to the
Attorney General the number of
referrals to local treatment providers
provided by the program; and
``(III) track and report to the
Attorney General, with respect to each
participant in the program--
``(aa) each charge brought
against the participant;
``(bb) the demographics of
the participant; and
``(cc) the outcome of the
participant's case.
``(ii) Attorney general report.--The
Attorney General shall periodically submit to
Congress a report containing the information
reported to the Attorney General under clause
(i).
``(D) Sense of congress regarding veterans
treatment court programs.--It is the sense of Congress
that a veterans treatment court program that receives
funding from a grant under this subsection should not
exclude individuals who are chronically exposed to the
criminal justice system.'';
(7) in subsection (j)--
(A) in paragraph (1), by inserting ``or substance
use disorders'' after ``mental illness''; and
(B) in paragraph (2)(A), by inserting ``or
substance use disorders'' after ``mental illnesses'';
(8) in subsection (k)(3)(A)(i)(I)(aa), by inserting `` or
substance use disorders'' after ``mental illnesses'';
(9) in subsection (l)--
(A) in paragraph (1)(B)(ii), by inserting ``or
substance use disorder'' after ``mental illness'' each
place that term appears; and
(B) in paragraph (2)--
(i) in subparagraph (C)(iii), by inserting
``or substance use'' after ``mental health'';
and
(ii) in subparagraph (D), by striking
``mental health or'' and inserting ``mental
health disorders, substance use disorders,
or''; and
(10) in subsection (o)(3)--
(A) by striking ``Limitation'' and inserting
``Veterans'';
(B) by striking ``Not more than'' and inserting the
following:
``(A) Limitation.--Not more than'';
(C) in subparagraph (A), as so designated, by
striking ``this section'' and inserting ``paragraph
(1)''; and
(D) by adding at the end the following:
``(B) Additional funding.--In addition to the
amounts authorized under paragraph (1), there are
authorized to be appropriated to the Department of
Justice to carry out subsection (i) $20,000,000 for
each of fiscal years 2021 through 2026.''.
SEC. 405. INFRASTRUCTURE FOR REENTRY.
(a) Community Economic Development Grants.--Section 680(a)(2) of
the Community Services Block Grant Act (42 U.S.C. 9921(a)(2)) is
amended--
(1) in subparagraph (A)--
(A) by striking ``to private, nonprofit
organizations that are community development
corporations'' and inserting the following: ``to--
``(i) private, nonprofit community
development corporations'';
(B) by striking the period at the end and inserting
``; or''; and
(C) by adding at the end the following:
``(ii) community development corporations
described in clause (i), or partnerships
between such a corporation and another private,
nonprofit entity, to fund and oversee the
construction of facilities for treatment of
mental and substance use disorders, supportive
housing, or of re-entry centers, that are not
jails, prisons, or other correctional
facilities.'';
(2) in subparagraph (C)--
(A) by inserting ``or partnership'' after
``corporation'' each place it appears;
(B) by striking ``principal purpose planning'' and
inserting ``principal purpose--
``(i) planning'';
(C) by striking the period at the end and inserting
``; or''; and
``(ii) planning or constructing facilities
for crisis intervention, treatment of mental
and substance use disorders, supportive
housing, or of re-entry centers.''; and
(3) by adding at the end the following:
``(F) Definition.--In this paragraph, the term
`crisis intervention' means the provision of immediate,
short-term assistance to individuals who are
experiencing acute emotional, mental, physical, and
behavioral distress or problems using a `one-stop'
model.''.
(b) CDBG Assistance for Construction of Substance Abuse and Mental
Health Treatment Facilities, Supportive Housing, and Reentry Centers.--
Section 105(a) of the Housing and Community Development Act of 1974 (42
U.S.C. 5305(a)) is amended--
(1) in paragraph (25), by striking ``and'' at the end;
(2) in paragraph (26), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following:
``(27) the construction of crisis intervention centers,
substance abuse and mental health treatment facilities,
supportive housing, and reentry centers.''.
(c) Communities Facilities Loan and Grant Programs.--Section 306(a)
of the Consolidated Farm and Rural Development Act (7 U.S.C. 1926(a))
is amended--
(1) by inserting after paragraph (6) the following:
``(7) Prohibition on use of loans for certain purposes.--No
loan made or insured under this subsection shall be used to
support the construction, renovation, equipment purchasing,
operation, staffing, or any other function of a jail, prison,
detention center, or other correctional facility.''; and
(2) in paragraph (19), by adding at the end the following:
``(C) Prohibition on use of grants for certain
purposes.--No grant made under this paragraph shall be
used to support the construction, renovation, equipment
purchasing, operation, staffing, or any other function
of a jail, prison, detention center, or other
correctional facility.
``(D) Inclusion of certain infrastructure for
reentry.--In this paragraph, the terms `essential
community facility' and `facility' include a crisis
intervention center, substance abuse or mental health
treatment facility, a supportive housing facility, and
a reentry center.''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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