Substance Use Disorder and Family Engagement in Recovery Act or the SAFE in Recovery Act
This bill expands services available to families affected by substance use disorders (SUD) and implements protections for parents seeking SUD treatment.
Specifically, the bill requires health centers funded through the Community Health Center Fund (CHC Fund) to provide mental health and SUD treatment services, and provides funds to the Department of Health and Human Services (HHS) to implement this change in FY2025. The bill also reauthorizes the CHC Fund through FY2028. Moreover, under the Opioid Use Disorder Treatment Demonstration Program, the bill permits HHS to provide increased per-beneficiary payments for beneficiaries receiving pregnancy or postpartum services.
As a condition of Maternal and Child Health Services Block Grant funding, the bill restricts states from investigating and reporting pregnant and postpartum patients affected by SUD in specified instances. For example, the results of toxicology testing on patients taking prescription drugs (including drugs that treat SUD) in accordance with the recommendations of the prescribing doctor may not be the sole factor in a family separation determination. Further, states may not investigate a patient for child neglect or abuse, nor report them to a child protective services system, solely on account of their use of a prescription drug.
Finally, the bill establishes new federal efforts to study and fund care for families affected by SUD, including a consortium led by the National Institutes of Health to set research priorities related to SUD.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5866 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 5866
To ensure comprehensive wraparound services for families impacted by
substance use disorders, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 2, 2023
Ms. Lee of California (for herself, Mr. Trone, Mr. Mullin, and Mr.
Schiff) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, and Education and the Workforce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To ensure comprehensive wraparound services for families impacted by
substance use disorders, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Substance Use Disorder and Family
Engagement in Recovery Act'' or the ``SAFE in Recovery Act''.
SEC. 2. ENSURING CARE AND NO UNDUE FAMILY SEPARATION OF FAMILIES
IMPACTED BY SUBSTANCE USE DISORDER.
(a) In General.--Section 503 of the Social Security Act (42 U.S.C.
703) is amended by adding at the end the following new subsection:
``(d) Limitations on Toxicology Testing To Detect Substance Use.--
``(1) In general.--As a condition of receiving payments
under this section, each State--
``(A) shall not require the birthing parent of an
infant who is identified as being affected by substance
abuse or withdrawal symptoms resulting from prenatal
drug exposure or a Fetal Alcohol Spectrum Disorder to
undergo toxicology testing to detect substance use
unless the parent--
``(i) gives clear and informed consent
prior to such testing; and
``(ii) is able to access, if necessary for
purposes of giving such consent, interpretation
services and reasonable accommodations for
disabilities;
``(B) shall ensure that a pregnant or postpartum
individual taking a prescription drug, including a
prescription drug for the treatment of a substance use
disorder, in accordance with the recommendations of the
prescribing practitioner, shall not be subject to
investigations of child abuse and neglect on the basis
that such individual is taking such prescription drug;
``(C) shall ensure that--
``(i) any toxicology testing to detect
substance use that is provided to a pregnant or
postpartum individual taking a prescription
drug, including a prescription drug for the
treatment of a substance use disorder, in
accordance with the recommendations of the
prescribing practitioner is consented to by the
pregnant or postpartum individual in accordance
with subparagraph (A); and
``(ii) such testing (and the results of
such testing) shall not affect the individual's
access to care or public assistance and shall
not be the sole factor in a family separation
determination involving the individual; and
``(D) shall ensure that any health care provider
involved in the delivery or care of an infant
identified as being affected by substance abuse or
withdrawal symptoms resulting from prenatal drug
exposure, or a Fetal Alcohol Spectrum Disorder, is not
required to notify the child protective services system
of the State or any unit of local government of the
State of the occurrence of such condition in such
infant if such condition is the result of the birthing
parent of the infant taking a prescription drug,
including a prescription drug for the treatment of a
substance use disorder, in accordance with the
recommendations of the prescribing practitioner, and
such provider has no other reason to suspect that the
infant is in imminent danger of abuse or neglect.
``(2) Definition of prescription drug.--In this subsection,
the term `prescription drug' means a drug approved under
section 505 of the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 355) or licensed under section 351 of the Public Health
Service Act (42 U.S.C. 262) that is subject to section
503(b)(1) of the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 353(b)(1)).''.
(b) Effective Date.--The amendment made by this section shall take
effect on the date that is 2 years after the date of enactment of this
Act.
SEC. 3. ENSURING A WHOLE-OF-GOVERNMENT APPROACH THROUGH A FEDERAL
INTERAGENCY TASK FORCE TO SUPPORT FAMILIES IMPACTED BY
SUBSTANCE USE DISORDERS.
(a) Establishment.--There is established within the Federal
Government an interagency task force to improve--
(1) efforts, resources, and services of the Federal
Government to support families impacted by substance use
disorders;
(2) the utilization of such efforts, resources, and
services; and
(3) strategies to streamline the provision of comprehensive
wraparound care for families impacted by substance use
disorders.
(b) Membership.--
(1) Composition.--The task force shall be composed of the
heads of the following Federal departments and agencies, or
their designees:
(A) The Centers for Medicare & Medicaid Services.
(B) The Substance Abuse and Mental Health Services
Administration.
(C) The Agency for Healthcare Research and Quality.
(D) The Centers for Disease Control and Prevention.
(E) The Indian Health Service.
(F) The Department of Veterans Affairs.
(G) The National Institutes of Health.
(H) The Food and Drug Administration.
(I) The Health Resources and Services
Administration.
(J) The Department of Defense.
(K) The Office of Minority Health of the Department
of Health and Human Services.
(L) The Administration for Children and Families.
(M) The Office of the Assistant Secretary for
Planning and Evaluation of the Department of Health and
Human Services.
(N) The Office for Civil Rights of the Department
of Health and Human Services.
(O) The Office of Juvenile Justice and Delinquency
Prevention of the Department of Justice.
(P) The Office of Community Oriented Policing
Services of the Department of Justice.
(Q) The National Center for Education Evaluation
and Regional Assistance of the Department of Education.
(R) The National Center for Special Education
Research of the Institute of Education Science.
(S) The Office of Elementary and Secondary
Education of the Department of Education.
(T) The Office for Civil Rights of the Department
of Education.
(U) The Office of Special Education and
Rehabilitative Services of the Department of Education.
(V) The Bureau of Indian Affairs of the Department
of the Interior.
(W) The Veterans Health Administration of the
Department of Veterans Affairs.
(X) The Office of Special Needs Assistance Programs
of the Department of Housing and Urban Development.
(Y) The Office of Head Start of the Administration
for Children and Families.
(Z) The Children's Bureau of the Administration for
Children and Families.
(AA) The Bureau of Indian Education of the
Department of the Interior.
(BB) Such other Federal agencies as the Secretaries
determine to be appropriate.
(2) Date of appointments.--The heads of Federal departments
and agencies shall appoint the corresponding members of the
task force not later than 60 days after the date of enactment
of this Act.
(3) Chairperson.--The task force shall be chaired by the
Secretary of Health and Human Services.
(c) Duties.--The interagency task force shall carry out each of the
following activities:
(1) Solicit input from stakeholders, including frontline
service providers, educators, mental health professionals,
researchers, experts in infant, child, and youth trauma, child
welfare professionals, people in recovery, and the public, in
order to inform the activities under this subsection.
(2) Compile a comprehensive list of all Federal Government
efforts, resources, and services to support families impacted
by substance use disorders.
(3) Assess the effectiveness of care, services, and
resources available to families impacted by substance use
disorders.
(4) Analyze and make recommendations for means of
eliminating barriers that prevent individuals with substance
use disorders from entering and remaining in care for the
disorder involved.
(5) Analyze and make recommendations for means of
eliminating barriers to social services for individuals with
substance use disorders and their families.
(6) Provide recommendations for effectively streamlining
the provision of comprehensive wraparound care for families
impacted by substance use disorders.
(7) Recommend a plan for addressing the comprehensive
wraparound care needs of families impacted by substance use
disorders and specifically address in the plan the needs of
populations most disproportionately affected.
(8) Other activities as determined appropriate by the
Secretary.
(d) Operating Plan.--Not later than 120 days after the date of
enactment of this Act, the task force shall hold the first meeting. Not
later than 2 years after such date of enactment, the task force shall
submit to the Secretary of Education, the Secretary of Health and Human
Services, the Secretary of Labor, the Secretary of the Interior, the
Attorney General, and Congress an operating plan for carrying out the
activities of the task force described in subsection (c). Such
operating plan shall include--
(1) a list of specific activities that the task force plans
to carry out for purposes of carrying out duties described in
subsection (c), which may include public engagement;
(2) a plan for carrying out the activities under subsection
(c);
(3) a list of members of the task force and other
individuals who are not members of the task force that may be
consulted to carry out such activities;
(4) an explanation of Federal agency involvement and
coordination needed to carry out such activities, including any
statutory or regulatory barriers to such coordination;
(5) a budget for carrying out such activities;
(6) a proposed timeline for implementing recommendations
and efforts identified under subsection (c); and
(7) other information that the task force determines
appropriate as related to its duties.
(e) Final Report.--Not later than 3 years after the date of
enactment of this Act, the Secretary shall submit to Congress and the
general public a final report that contains the findings and
recommendations (including the recommended plan described in subsection
(c)(7)) of the task force.
(f) Additional Reports.--In addition to the final report under
subsection (e), the task force shall submit--
(1) a report to Congress identifying any recommendations
identified under subsection (c) that require additional
legislative authority to implement; and
(2) a report to the Governors describing opportunities for
local- and State-level partnerships, professional development,
or best practices to support families impacted by substance use
disorders.
(g) Sunset.--The task force shall sunset on the date that is 60
days after the submission of the report under subsection (e), but not
later than September 30, 2028.
(h) Definition of Comprehensive Wraparound Care.--In this section,
the term ``comprehensive wraparound care'' includes clinical, ancillary
health, mental health, substance use disorder, and social support
services, to address a substance use disorder.
SEC. 4. INCREASING ACCESS TO BEHAVIORAL HEALTH CARE THROUGH COMMUNITY
HEALTH CENTERS.
(a) Required Primary Health Services.--
(1) In general.--Section 330(b) of the Public Health
Service Act (42 U.S.C. 254b(b)) is amended--
(A) in paragraph (1)(A)(i)--
(i) in subclause (IV), by striking ``;
and'' and inserting a semicolon;
(ii) in subclause (V), by striking the
semicolon and inserting ``; and''; and
(iii) by adding at the end the following:
``(VI) behavioral and mental health
and substance use disorder services;'';
(B) in paragraph (1)(A)(ii), by inserting ``,
including such referrals to certified community
behavioral health centers'' before the semicolon; and
(C) in paragraph (2)--
(i) by striking subparagraph (A); and
(ii) by redesignating subparagraphs (B)
through (D) as subparagraphs (A) through (C),
respectively.
(2) Funding.--For purposes of assisting health centers in
incorporating behavioral and mental health and substance use
disorder services into the required primary health services
offered by such centers, there is appropriated to the Secretary
of Health and Human Services, out of amounts in the Treasury
not otherwise appropriated, $500,000,000 for fiscal year 2025,
to remain available until expended.
(3) Report.--Not later than 1 year after the date that is 3
years after the date of enactment of this Act, the Secretary of
Health and Human Services shall submit a report to Congress
on--
(A) the impact that the amendments made by
paragraph (1) has had on access to behavioral and
mental health and substance use disorder services; and
(B) employee recruitment and retention for
behavioral and mental health and substance use disorder
providers, including for health centers, certified
community behavioral health centers, and other
community care settings.
(b) Environmental Justice Communities.--Section 10503 of the
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2) is
amended--
(1) in subsection (b)(1)--
(A) in subparagraph (E), by striking ``and'' at the
end; and
(B) by adding at the end the following:
``(G) $130,000,000,000 for the period of fiscal
years 2024 through 2028.
``(f) Environmental Justice Communities.--The Secretary shall
ensure that not less than 50 percent of the amounts appropriated under
subsection (b)(1) for fiscal year 2024 or any fiscal year thereafter
are awarded to entities for use with respect to projects or sites
located in or serving communities with significant representation of
communities of color, low-income communities, or Tribal and Indigenous
communities that experience, or are at risk of experiencing, higher or
more adverse human health or environmental effects.
``(g) Prohibition.--No amounts made available under this section
may be used for any activity that is subject to the reporting
requirements set forth in section 203(a) of the Labor-Management
Reporting and Disclosure Act of 1959 (29 U.S.C. 433(a)).''.
SEC. 5. IMPROVING OUTCOMES FOR PREGNANT AND POSTPARTUM PATIENTS WITH
SUBSTANCE USE DISORDER AND PAYMENTS TO INCENTIVIZE CARE
FOR OPIOID USE DISORDER.
(a) In General.--Section 1866F(b)(1) of the Social Security Act (42
U.S.C. 1395cc-6(b)(1) is amended by adding at the end the following new
subparagraph:
``(G) Improves outcomes for pregnant and postpartum
individuals with opioid use disorder.''.
(b) Payments.--Section 1866F(e)(1) of the Social Security Act (42
U.S.C. 1395cc-6(e)(1)) is amended--
(1) in subparagraph (A), by inserting ``pregnancy and
postpartum services and'' after ``including''; and
(2) in subparagraph (B)--
(A) in clause (iii), by striking ``and'';
(B) in clause (iv), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(v) pay a higher per applicable
beneficiary per month care management fee for
an applicable beneficiary who receives
pregnancy or postpartum services from a
participant.''.
(c) Effective Date.--The amendments made by this section shall take
effect on January 1, 2024, and shall apply to services furnished on or
after that date.
SEC. 6. INCREASING ACCESS TO WRAPAROUND SERVICES FOR CHILDREN FROM
FAMILIES IMPACTED BY SUBSTANCE USE DISORDER.
(a) Grants.--The Head Start Act is amended by inserting after
section 645A (42 U.S.C. 9840a) the following:
``SEC. 645B. CHILDREN FROM FAMILIES IMPACTED BY SUBSTANCE USE DISORDER.
``(a) Grants.--
``(1) In general.--The Secretary shall make grants, in
accordance with paragraph (2), to Head Start and Early Head
Start agencies to enable the agencies to provide comprehensive
health, educational, nutritional, social, and other services to
children in Head Start and Early Head Start programs,
respectively, from families impacted by substance use disorder,
or referring the children to such services, to assure best
outcomes for the health, wellness, and school readiness of the
children.
``(2) Formula.--The Secretary shall make those grants, to
fund the activities described in paragraph (1) for a fiscal
year, by--
``(A) using the amount appropriated under
subsection (c) for that fiscal year; and
``(B) distributing that amount in accordance with
clauses (i) (with respect to additional funding for the
comprehensive services described in paragraph (1)) and
(ii) of section 640(a)(4)(C).
``(b) Construction.--A reference in this subchapter (other than
this section) to funds appropriated or provided under this subchapter
shall not be considered to include funds appropriated or provided under
this section.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $60,000,000 for fiscal year 2024
and each subsequent fiscal year.''.
(b) Conforming Amendment.--Section 639 of the Head Start Act (42
U.S.C. 9834) is amended by striking ``section 657B'' and inserting
``sections 645B and 657B''.
SEC. 7. COORDINATING RESEARCH OF THE NATIONAL INSTITUTES OF HEALTH.
Part A of title IV of the Public Health Service Act (42 U.S.C. 281
et seq.) is amended by adding at the end the following:
``SEC. 404P. RESEARCH WITH RESPECT TO CO-OCCURRING PREGNANCY AND
SUBSTANCE USE DISORDER.
``The Director of the National Institutes of Health shall establish
a consortium on pregnancy, postpartum recovery, and substance use
disorder research to establish research priorities and steward research
activities across the national research institutes and national centers
to understand and mitigate the harms of substance use disorder for
pregnant and postpartum patients and their children.''.
SEC. 8. ENSURING THE USE OF BEST AVAILABLE MEDICAL PRACTICES THROUGH A
GAO REPORT ON CLINICAL GUIDELINES FOR TREATING PREGNANT
AND PARENTING PATIENTS WITH SUBSTANCE USE DISORDER AND
THEIR CHILDREN.
The Comptroller General of the United States shall--
(1) conduct a study assessing--
(A) the extent to which clinical guidelines for
treating pregnant and parenting patients with substance
use disorder and their children are implemented;
(B) any systemic and other barriers to ensuring
that patients and children described in subparagraph
(A) get access to up-to-date care that addresses the
complexity of co-occurring substance use disorder and
pregnancy; and
(C) access to treatment for pregnant and postpartum
individuals with substance use disorder and the impacts
of interactions with child welfare systems; and
(2) not later than 2 years after the date of enactment of
this Act, submit a report to Congress on the results of such
study.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Work and Welfare.
Referred to the Subcommittee on Health.
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