,i  #aaeth ,,congress  #b;d ,session    
,h4 ,r4 #eede  ,,in ,,the ,,house ,,of  
,,representatives  ,april #ah1 #bjah,mr4
 ,cummings introduced the following     
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committees on the  
,judiciary1 and ,natural ,resources1 for
 a period to be subsequently determined 
by the ,speaker1 in each case for       
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to     
provide emergency assistance to ,states1
 territories1 ,tribal nations1 and local
 areas affected by the opioid epidemic  
and to make financial assistance        
available to ,states1 territories1      
,tribal nations1 local areas1 and public
 or private nonprofit entities to       
provide for the development1            
organization1 coordination1 and         
operation of more effective and cost    
efficient systems for the delivery of   
essential services to individuals with  

substance use disorder and their        
families4  #a4 ,short title2 table of   
contents  7a7 ,short title ,this ,act   
may be cited as the ,comprehensive      
,addiction ,resources ,emergency ,act of
 #bjah4  7b7 ,table of contents ,the    
table of contents of this ,act is as    
follows3  ,sec4 #a4 ,short title2 table 
of contents4 ,sec4 #b4 ,purpose4 ,sec4  
#c4 ,amendment to the ,public ,health   
,service ,act4  ,,title                 
,,xxxiv--,substance use and opioid      
health resources  ,subtitle             
,a--,substance use and opioid emergency 
relief grant program  ,sec4 #cdja4      
,establishment of program of grants4    
,sec4 #cdjb4 ,planning council4  ,sec4  
#cdjc4 ,amount of grant and use of      
amounts4  ,sec4 #cdjd4 ,application4    
,sec4 #cdje4 ,technical assistance4     
,sec4 #cdjf4 ,authorization of          
appropriations4  ,subtitle ,b--,state   
and ,tribal substance use disorder      
prevention and intervention grant       
program  ,sec4 #cdaa4 ,establishment of 

program of grants4  ,sec4 #cdab4 ,amount
 of grant and use of amounts4  ,sec4    
#cdac4 ,application and limitation4     
,sec4 #cdad4 ,technical assistance4     
,sec4 #cdae4 ,authorization of          
appropriations4  ,subtitle ,c--,other   
grant program  ,sec4 #cdba4             
,establishment of grant program4  ,sec4 
#cdbb4 ,use of amounts4  ,sec4 #cdbc4   
,technical assistance4  ,sec4 #cdbd4    
,planning and development grants4  ,sec4
 #cdbe4 ,authorization of               
appropriations4  ,subtitle              
,d--,miscellaneous provisions  ,sec4    
#cdca4 ,special projects of national    
significance4  ,sec4 #cdcb4 ,education  
and training centers4  ,sec4 #cdcc4     
,other provisions4  ,sec4 #cdcd4        
,standards for substance use disorder   
treatment and recovery facilities4      
,sec4 #cdce4 ,naloxone distribution     
program4  ,sec4 #cdcf4 ,additional      
funding for the ,national ,institutes of
 ,health4  ,sec4 #cdcg4 ,additional     
funding for improved data collection and

 prevention of infectious disease       
transmission4  ,sec4 #cdch4             
,definitions4 ,sec4 #d4 ,amendments to  
the ,controlled ,substances ,act4  #b4  
,purpose ,it is the purpose of this ,act
 to provide emergency assistance to     
,states1 territories1 ,tribal nations1  
and local areas that are                
disproportionately affected by the      
opioid epidemic and to make financial   
assistance available to ,states1        
territories1 ,tribal nations1 local     
areas1 and other public or private      
nonprofit entities to provide for the   
development1 organization1 coordination1
 and operation of more effective and    
cost efficient systems for the delivery 
of essential services to individuals and
 families with substance use disorder4  
#c4 ,amendment to the ,public ,health   
,service ,act ,the ,public ,health      
,service ,act 7#db ,u4,s4,c4 #bja et    
seq47 is amended by adding at the end   
the following3  ,,xxxiv ,substance use  
and opioid health resources  ,a         

,substance use and opioid emergency     
relief grant program  #cdja4            
,establishment of program of grants  7a7
 ,in general ,the ,secretary1 in        
coordination with the ,director of the  
,office of ,national ,drug ,control     
,policy1 shall award grants to eligible 
localities for the purpose of addressing
 substance use within such localities4  
7b7 ,eligibility  7#a7 ,in general ,to  
be eligible to receive a grant under    
subsection 7a7 a locality shall-- 7,a7  
be--  7i7 a county that can demonstrate 
that the rate of drug overdose deaths   
per #ajj1jjj individuals residing in the
 county during the most recent #c-year  
period for which such data are available
 was not less than the rate of such     
deaths for the county that ranked at the
 #fgth percentile of all counties1 as   
determined by the ,secretary2  7ii7 a   
county that can demonstrate that the    
number of drug overdose deaths during   
the most recent #c-year period for which
 such data are available was not less   

than the number of such deaths for the  
county that ranked at the #ijth         
percentile of all counties1 as          
determined by the ,secretary2 or  7iii7 
a city that is located within a county  
described in clause 7i7 or 7ii71 that   
meets the requirements of paragraph     
7#c72 and  7,b7 submit to the ,secretary
 an application in accordance with      
section #cdjd4  7#b7 ,multiple          
contiguous counties ,in the case of an  
eligible county that is contiguous to   
one or more other eligible counties     
within the same ,state1 the group of    
counties shall--  7,a7 be considered as 
a single eligible county for purposes of
 a grant under this section2  7,b7      
submit a single application under       
section #cdjd2  7,c7 form a joint       
planning council 7for the purposes of   
section #cdjb72 and  7,d7 establish1    
through intergovernmental agreements1 an
 administrative mechanism to allocate   
funds and substance use disorder        
treatment services under the grant based

 on--  7i7 the number and rate of drug  
overdose deaths and nonfatal drug       
overdoses in each of the counties that  
compose the eligible county2  7ii7 the  
severity of need for services in each   
such county2 and  7iii7 the health and  
support personnel needs of each such    
county4  7#c7 ,cities and counties      
within multiple contiguous counties     
7,a7 ,in general ,a city that is within 
an eligible county described in         
paragraph 7#a71 or a group of counties  
that is within a group of counties      
determined to be an eligible county     
under paragraph 7#b71 shall be eligible 
to receive a grant under section #cdja  
if such city or county or group of      
counties meets the requirements of      
subparagraph 7,b74  7,b7 ,requirements  
,a city or county meets the requirements
 of this subparagraph if such city or   
county-- 7i7 except as provided in      
subparagraph 7,c71 has a population of  
not less than #ej1jjj residents2  7ii7  
meets the requirements of paragraph     

7#a77;,a72  7iii7 submits an application
 under section #cdjd2  7iv7 establishes 
a planning council 7for purposes of     
section #cdjb72 and  7v7 establishes an 
administrative mechanism to allocate    
funds and services under the grant based
 on--  7,i7 the number and rate of drug 
overdose deaths and nonfatal drug       
overdoses in the city or county2  7,,ii7
 the severity of need for substance use 
disorder treatment services in the city 
or county2 and  7,,iii7 the health and  
support personnel needs of the city or  
county4  7,c7 ,population exception ,a  
city or county or group of counties that
 does not meet the requirements of      
subparagraph 7,b77i7 may apply to the   
,secretary for a waiver of such         
requirement4 ,such application shall    
demonstrate--  7i7 that the needs of the
 population to be served are distinct or
 that addressing substance use in the   
service area would be best served by the
 formation of an independent council2   
and  7ii7 that the city or county or    

group of counties has the capacity to   
administer the funding received under   
this subtitle4  7,d7 ,minimum funding ,a
 city or county that meets the          
requirement of this paragraph and       
receives a grant under section #cdja    
shall be entitled to an amount of       
funding under the grant in an amount    
that is not less than the amount        
determined under section #cdjc7;a7 with 
respect to such city or county4  7#d7   
,independent city ,independent cities   
that are not located within the         
territory of a county shall be treated  
as eligible counties for purposes of    
this subtitle4  7#e7 ,political         
subdivisions ,with respect to ,states   
that do not have a local county system  
of governance1 the ,secretary shall     
determine the local political           
subdivisions within such ,states that   
are eligible to receive a grant under   
section #cdja and such subdivisions     
shall be treated as eligible counties   
for purposes of this subtitle4  7#f7    

,determinations where there is a lack of
 data ,the ,secretary shall establish   
eligibility and allocation criteria     
related to the prevalence of drug       
overdose deaths1 the mortality rate from
 drug overdoses1 and that provides an   
equivalent measure of need for funding  
for cities and counties for which the   
data described in paragraph 7#a77;,a7 or
 7#b77;,d77i7 is not available4  7#g7   
,study ,not later than #c years after   
the date of enactment of this title1 the
 ,comptroller ,general shall conduct a  
study to determine whether the data     
utilized for purposes of paragraph      
7#a77;,a7 provides the most precise     
measure of local area need related to   
substance use and addiction prevalence  
and whether additional data would       
provide more precise measures of        
substance use and addiction prevalence  
in local areas4 ,such study shall       
identify barriers to collecting or      
analyzing such data1 and make           
recommendations for revising the        

indicators used under such paragraph to 
determine eligibility in order to direct
 funds to the local areas in most need  
of funding to provide assistance related
 to substance use and addiction4  7#h7  
,reference ,for purposes of this        
subtitle1 the term eligible local area  
includes-- 7,a7 a city or county        
described in paragraph 7#a72  7,b7      
multiple contiguous counties described  
in paragraph 7#b72  7,c7 an independent 
locality described in paragraph 7#c72   
7,d7 an independent city described in   
paragraph 7#d72 and  7,e7 a political   
subdivision described in paragraph 7#e74
  7c7 ,administration  7#a7 ,in general 
,assistance made available under a grant
 awarded under this section shall be    
directed to the chief elected official  
of the eligible local area who shall    
administer the grant funds4  7#b7       
,multiple contiguous counties  7,a7 ,in 
general ,except as provided in          
subparagraph 7,b71 in the case of an    
eligible county described in subsection 

7b77#b71 assistance made available under
 a grant awarded under this section     
shall be directed to the chief elected  
official of the particular county       
designated in the application submitted 
for the grant under section #cdjd4 ,such
 chief elected official shall be the    
administrator of the grant4  7,b7 ,state
 administration ,notwithstanding        
subparagraph 7,a71 the eligible county  
described in subsection 7b77#b7 may     
elect to designate the chief elected    
,state official of the ,state in which  
the eligible county is located as the   
administrator of the grant funds4       
#cdjb4 ,planning council  7a7           
,establishment ,to be eligible to       
receive a grant under section #cdja1 the
 chief elected official of the eligible 
local area shall establish or designate 
a substance use disorder treatment and  
services planning council that shall1 to
 the maximum extent practicable--  7#a7 
be representative of the demographics of
 the population of individuals with     

substance use disorder in the area2 and 
7#b7 include representatives of-- 7,a7  
health care providers1 including        
federally qualified health centers1     
rural health clinics1 ,indian health    
programs as defined in section #d of the
 ,indian ,health ,care ,improvement     
,act1 urban ,indian organizations as    
defined in section #d of the ,indian    
,health ,care ,improvement ,act1 ,native
 ,hawaiian organizations as defined in  
section #ab of the ,native ,hawaiian    
,health ,care ,act of #aihh1 and        
facilities operated by the ,department  
of ,veterans ,affairs2  7,b7            
community-based health1 harm reduction1 
or addiction service organizations1     
including1 where applicable1            
representatives of ,drug ,free          
,communities ,coalition grantees2  7,c7 
social service providers1 including     
providers of housing and homelessness   
services and recovery residence         
providers2  7,d7 mental health care     
providers2  7,e7 local public health    

agencies2  7,f7 law enforcement         
officials1 including officials from     
,high ,intensity ,drug ,trafficking     
,area program1 where applicable2  7,g7  
affected communities1 including         
individuals with substance use disorder 
or a history of substance use disorder1 
including individuals in recovery from  
substance use disorders2  7,h7 ,state   
governments1 including the ,state       
,medicaid agency and the ,single ,state 
,agency for ,substance ,abuse ,services2
  7,i7 local governments2  7,j7         
non-elected community leaders2  7,k7    
substance use disorder treatment        
providers2  7,l7 ,indian tribes and     
tribal organizations as defined in      
section #d of the ,indian               
,self-,determination and ,education     
,assistance ,act2  7,m7 urban ,indians  
as defined in section #d of the ,indian 
,health ,care ,improvement ,act2  7,n7  
historically underserved groups and     
subpopulations2  7,o7 individuals who   
were formerly incarcerated2  7,p7       

organizations serving individuals who   
are currently or were formerly          
incarcerated2  7,q7 representatives of  
,federal agencies2  7,r7 representatives
 of organizations that provide services 
to youth at risk of substance use2  7,s7
 representatives of medical examiners or
 coroners2  7,t7 representatives of     
labor unions and the workplace          
community2 and  7,u7 representatives of 
local fire departments and emergency    
medical services4  7b7 ,method of       
providing for council  7#a7 ,in general 
,in providing for a council for purposes
 of subsection 7a71 the chief elected   
official of the eligible local area may 
establish the council directly or       
designate an existing entity to serve as
 the council1 subject to paragraph 7#b74
  7#b7 ,consideration regarding         
designation of council ,in making a     
determination of whether to establish or
 designate a council under paragraph    
7#a71 the chief elected official shall  
give priority to the designation of an  

existing entity that has demonstrated   
experience in the provision of health   
and support services to individuals with
 substance use disorder within the      
eligible local area1 that has a         
structure that recognizes the ,federal  
trust responsibility when spending      
,federal health care dollars1 and that  
has demonstrated a commitment to        
respecting the obligation of government 
agencies using ,federal dollars to      
consult with ,indian tribes and confer  
with ,urban ,indian health programs4    
7#c7 ,joint council ,the ,secretary     
shall establish a process to permit an  
eligible local area that is not         
contiguous with any other eligible local
 area to form a joint planning council  
with such other eligible local area or  
areas1 as long as such areas are located
 in geographical proximity to each      
other1 as determined by the ,secretary1 
and submit a joint application under    
section #cdjd4  7#d7 ,joint council     
across ,state lines ,eligible local     

areas may form a joint planning council 
with other eligible local areas across  
,state lines if such areas are located  
in geographical proximity to each other1
 as determined by the ,secretary1 submit
 a joint application under section      
#cdjd1 and establish intergovernmental  
agreements to allow the administration  
of the grant across ,state lines4  7c7  
,membership ,members of the planning    
council established or designated under 
subsection 7a7 shall-- 7#a7 be nominated
 and selected through an open process2  
7#b7 elect from among their membership a
 chair and vice chair2  7#c7 include at 
least one representative from ,indian   
tribes located within any eligible local
 area that receives funding under the   
grant program established in section    
#cdja2 and  7#d7 serve no more than #c  
consecutive years on the planning       
council4  7d7 ,membership terms ,members
 of the planning council established or 
designated under subsection 7a7 may     
serve additional terms if nominated and 

selected through the process established
 in subsection 7c77#a74  7e7 ,duties    
,the planning council established or    
designated under subsection 7a7 shall-- 
7#a7 establish priorities for the       
allocation of grant funds within the    
eligible local area that emphasize      
reducing drug overdose and substance use
 disorder through evidence-based        
interventions in both community and     
criminal justice settings and that are  
based on--  7,a7 the use by the grantee 
of substance use disorder treatment and 
intervention strategies that comply with
 best practices identified by the       
,secretary2  7,b7 the demonstrated or   
probable cost-effectiveness of proposed 
substance use disorder treatment        
services2  7,c7 the health priorities of
 the communities within the eligible    
local area that are affected by         
substance use2  7,d7 the priorities and 
needs of individuals with substance use 
disorder2 and  7,e7 the availability of 
other governmental and nongovernmental  

services2  7#b7 ensure the use of grant 
funds are consistent with any existing  
,state or local plan regarding the      
provision of substance use disorder     
treatment services to individuals with  
substance use disorder2  7#c7 in the    
absence of a ,state or local plan1 work 
with local public health agencies to    
develop a comprehensive plan for the    
organization and delivery of substance  
use disorder treatment services2  7#d7  
regularly assess the efficiency of the  
administrative mechanism in rapidly     
allocating funds to support             
evidence-based substance use disorder   
treatment services in the areas of      
greatest need within the eligible local 
area2  7#e7 work with local public      
health agencies to determine the size   
and demographics of the population of   
individuals with substance use disorders
 and the types of substance use that are
 most prevalent in the eligible local   
area2  7#f7 work with local public      
health agencies to determine the needs  

of such population1 including the need  
for substance use disorder treatment    
services2  7#g7 work with local public  
agencies to determine the disparities in
 access to services among affected      
subpopulations and historically         
underserved communities1 including      
infrastructure and capacity shortcomings
 of providers that contribute to these  
disparities2  7#h7 work with local      
public agencies to establish methods for
 obtaining input on community needs and 
priorities1 including by partnering with
 organizations that serve targeted      
communities experiencing high opioid    
related health disparities to gather    
data using culturally attuned data      
collection methodologies2  7#i7         
coordinate with ,federal grantees that  
provide substance use disorder treatment
 services within the eligible local     
area2 and  7#aj7 annually assess the    
effectiveness of the substance use      
disorder treatment services being       
supported by the grant received by the  

eligible local area1 including--  7,a7  
reductions in the rates of overdose and 
death from substance use disorders2     
7,b7 rates of discontinuation from      
substance use disorder treatment        
services2  7,c7 long-term outcomes among
 individuals receiving treatment for    
substance use disorders2 and  7,d7 the  
availability of substance use disorder  
treatment services needed by individuals
 with substance use disorders over their
 lifetimes4  7f7 ,conflicts of interest 
7#a7 ,in general ,the planning council  
under subsection 7a7 may not be directly
 involved in the administration of a    
grant under section #cdja4  7#b7        
,required agreements ,an individual may 
serve on the planning council under     
subsection 7a7 only if the individual   
agrees that if the individual has a     
financial interest in an entity1 if the 
individual is an employee of a public or
 private entity1 or if the individual is
 a member of a public or private        
organization1 and such entity or        

organization is seeking amounts from a  
grant under section #cdja1 the          
individual will not1 with respect to the
 purpose for which the entity seeks such
 amounts1 participate 7directly or in an
 advisory capacity7 in the process of   
selecting entities to receive such      
amounts for such purpose4  7g7          
,grievance procedures ,a planning       
council under subsection 7a7 shall      
develop procedures for addressing       
grievances with respect to funding under
 this subtitle1 including procedures for
 submitting grievances that cannot be   
resolved to binding arbitration4 ,such  
procedures shall be described in the    
by-laws of the planning council4  7h7   
,public deliberations ,with respect to a
 planning council under subsection 7a71 
in accordance with criteria established 
by the ,secretary1 the following        
applies3  7#a7 ,the meetings of the     
council shall be open to the public and 
shall be held only after adequate notice
 to the public4  7#b7 ,the records1     

reports1 transcripts1 minutes1 agenda1  
or other documents which were made      
available to or prepared for or by the  
council shall be available for public   
inspection and copying at a single      
location4  7#c7 ,detailed minutes of    
each meeting of the council shall be    
kept4 ,the accuracy of all minutes shall
 be certified to by the chair of the    
council4  7#d7 ,this subparagraph does  
not apply to any disclosure of          
information of a personal nature that   
would constitute a clearly unwarranted  
invasion of personal privacy1 including 
any disclosure of medical information or
 personnel matters4  #cdjc4 ,amount of  
grant and use of amounts  7a7 ,amount of
 grant  7#a7 ,grants based on relative  
need of area  7,a7 ,in general ,in      
carrying out this subtitle1 the         
,secretary shall make a grant for each  
eligible local area for which an        
application under section #cdjd has been
 approved4 ,each such grant shall be    
made in an amount determined in         

accordance with paragraph 7#c74  7,b7   
,expedited distribution ,not later than 
#ij days after an appropriation becomes 
available to carry out this subtitle for
 a fiscal year1 the ,secretary shall    
disburse #ec percent of the amount made 
available under section #cdjf for       
carrying out this subtitle for such     
fiscal year through grants to eligible  
local areas under section #cdja1 in     
accordance with subparagraphs 7,c7 and  
7,d74  7,c7 ,amount  7i7 ,in general    
,subject to the extent of amounts made  
available in appropriations ,acts1 a    
grant made for purposes of this         
subparagraph to an eligible local area  
shall be made in an amount equal to the 
product of--  7,i7 an amount equal to   
the amount available for distribution   
under subparagraph 7,b7 for the fiscal  
year involved2 and  7,,ii7 the          
percentage constituted by the ratio of  
the distribution factor for the eligible
 local area to the sum of the respective
 distribution factors for all eligible  

local areas2  which product shall then1 
as applicable1 be increased under       
subparagraph 7,d74  7ii7 ,distribution  
factor ,for purposes of clause          
7i77,,ii71 the term distribution factor 
means-- 7,i7 an amount equal to--  7aa7 
the estimated number of drug overdose   
deaths in the eligible local area1 as   
determined under clause 7iii72 or  7bb7 
the estimated number of non-fatal drug  
overdoses in the eligible local area1 as
 determined under clause 7iv72  as      
determined by the ,secretary based on   
which distribution factor 7item 7aa7 or 
7bb77 will result in the eligible local 
area receiving the greatest amount of   
funds2 or  7,,ii7 in the case of an     
eligible local area for which the data  
described in subclause 7,i7 is not      
available1 an amount determined by the  
,secretary--  7aa7 based on other data  
the ,secretary determines appropriate2  
and  7bb7 that is related to the        
prevalence of non-fatal drug overdoses1 
drug overdose deaths1 and the mortality 

rate from drug overdoses and provides an
 equivalent measure of need for funding4
  7iii7 ,number of drug overdose deaths 
,the number of drug overdose deaths     
determined under this clause for an     
eligible county for a fiscal year for   
purposes of clause 7ii7 is the number of
 drug overdose deaths during the most   
recent #c-year period for which such    
data are available4  7iv7 ,number of    
non-fatal drug overdoses ,the number of 
non-fatal drug overdose deaths          
determined under this clause for an     
eligible county for a fiscal year for   
purposes of clause 7ii7 may be          
determined by using data including      
emergency department syndromic data1    
visits1 or other emergency medical      
services for drug-related causes during 
the most recent #c-year period for which
 such data are available4  7v7 ,study   
,not later than #c years after the date 
of enactment of this title1 the         
,comptroller ,general shall conduct a   
study to determine whether the data     

utilized for purposes of clause 7ii7    
provide the most precise measure of     
local area need related to substance use
 and addiction prevalence in local areas
 and whether additional data would      
provide more precise measures of        
substance use and addiction prevalence  
in local areas4 ,such study shall       
identify barriers to collecting or      
analyzing such data1 and make           
recommendations for revising the        
distribution factors used under such    
clause to determine funding levels in   
order to direct funds to the local areas
 in most need of funding to provide     
substance use disorder treatment        
services4  7vi7 ,reductions in amounts  
,if a local area that is an eligible    
local area for a year loses such        
eligibility in a subsequent year based  
on the failure to meet the requirements 
of section #cdja7;b77#a77;,a71 such area
 will remain eligible to receive--  7,i7
 for such subsequent year1 an amount    
equal to #hj percent of the amount      

received under the grant in the previous
 year2 and  7,,ii7 for the second such  
subsequent year1 an amount equal to #ej 
percent of the amount received in the   
such previous year4  7#b7 ,supplemental 
grants  7,a7 ,in general ,the ,secretary
 shall disburse the remainder of amounts
 not disbursed under paragraph 7#a7 for 
such fiscal year for the purpose of     
making grants to cities and counties    
whose application under section #cdjd-- 
7i7 contains a report concerning the    
dissemination of emergency relief funds 
under paragraph 7#a7 and the plan for   
utilization of such funds1 if           
applicable2  7ii7 demonstrates the need 
in such local area1 on an objective and 
quantified basis1 for supplemental      
financial assistance to combat substance
 use disorder2  7iii7 demonstrates the  
existing commitment of local resources  
of the area1 both financial and in-kind1
 to combating substance use disorder2   
7iv7 demonstrates the ability of the    
area to utilize such supplemental       

financial resources in a manner that is 
immediately responsive and cost         
effective2  7v7 demonstrates that       
resources will be allocated in          
accordance with the local demographic   
incidence of substance use disorders and
 drug overdose mortality2  7vi7         
demonstrates the inclusiveness of       
affected communities and individuals    
with substance use disorders1 including 
those communities and individuals that  
are disproportionately affected or      
historically underserved2  7vii7        
demonstrates the manner in which the    
proposed services are consistent with   
the local needs assessment and the      
statewide coordinated statement of need 
required in section #cdac7;e72  7viii7  
demonstrates success in identifying     
individuals with substance use          
disorders2 and  7ix7 demonstrates that  
support for substance use disorder      
treatment services is organized to      
maximize the value to the population to 
be served with an appropriate mix of    

substance use disorder treatment        
services and attention to transition in 
care4  7,b7 ,amount  7i7 ,in general    
,the amount of each grant made for      
purposes of this paragraph shall be     
determined by the ,secretary4 ,in making
 such determination1 the ,secretary     
shall consider--  7,i7 the rate of drug 
overdose deaths per #ajj1jjj population 
in the eligible local area2 and  7,,ii7 
the increasing need for substance use   
disorder treatment services1 including  
relative rates of increase in the number
 of drug overdoses or drug overdose     
deaths1 recent increases in drug        
overdoses or drug overdose deaths since 
data was provided under section         
#cdja7;b71 if applicable4  7ii7         
,demonstrated need ,the factors         
considered by the ,secretary in         
determining whether a local area has a  
demonstrated need for purposes of clause
 7i77,,ii7 may include any or all of the
 following3  7,i7 ,the unmet need for   
substance use disorder treatment        

services1 including factors identified  
in subparagraph 7,b77i77,,ii74  7,,ii7  
,relative rates of increase in the      
number of drug overdoses or drug        
overdose deaths4  7,,iii7 ,the relative 
rates of increase in the number of drug 
overdoses or drug overdose deaths within
 new or emerging subpopulations4  7,,iv7
 ,the current prevalence of substance   
use disorders4  7,v7 ,relevant factors  
related to the cost and complexity of   
delivering substance use disorder       
treatment services to individuals in the
 eligible local area4  7,,vi7 ,the      
impact of co-morbid factors1 including  
co-occurring conditions1 determined     
relevant by the ,secretary4  7,,vii7    
,the prevalence of homelessness among   
individuals with substance use          
disorders4  7,,viii7 ,the relevant      
factors that limit access to health     
care1 including geographic variation1   
adequacy of health insurance coverage1  
and language barriers4  7,,ix7 ,the     
impact of a decline in the amount       

received pursuant to paragraph 7#a7 on  
substance use disorder treatment        
services available to all individuals   
with substance use disorders identified 
and eligible under this subtitle4  7,x7 
,the increasing incidence in conditions 
related to substance use1 including     
hepatitis ,c1 human immunodeficiency    
virus1 hepatitis ,b and other infections
 associated with injection drug use4    
7,c7 ,application of provisions ,a local
 area that receives a grant under this  
paragraph-- 7i7 shall use amounts       
received in accordance with subsection  
7b72  7ii7 shall not have to meet the   
eligible criteria in section #cdja7;b72 
and  7iii7 shall not have to establish a
 planning council under section #cdjb4  
7#c7 ,amount of grant to tribal         
governments  7,a7 ,indian tribes ,in    
this section1 the term ,indian tribe has
 the meaning given such term in section 
#d of the ,indian ,self-,determination  
and ,education ,assistance ,act4  7,b7  
,formula grants ,the ,secretary1 acting 

through the ,indian ,health ,service1   
shall use #aj percent of the amount     
available under section #cdjf for each  
fiscal year to provide formula grants to
 ,indian tribes disproportionately      
affected by substance use1 in an amount 
determined pursuant to a formula and    
eligibility criteria developed by the   
,secretary in consultation with ,indian 
tribes1 for the purposes of addressing  
substance use4  7,c7 ,use of amounts    
,notwithstanding any requirements in    
this section1 an ,indian tribe may use  
amounts provided under grants awarded   
under this paragraph for the uses       
identified in subsection 7b7 and any    
other activities determined appropriate 
by the ,secretary1 in consultation with 
,indian tribes4  7b7 ,use of amounts    
7#a7 ,requirements ,the ,secretary may  
not make a grant under section #cdja to 
an eligible local area unless the chief 
elected official of the area agrees     
that--  7,a7 the allocation of funds and
 services within the area under the     

grant will be made in accordance with   
the priorities established by the       
substance use disorder treatment        
services planning council2 and  7,b7    
funds provided under this grant will be 
expended for-- 7i7 prevention services  
described in paragraph 7#c72  7ii7 core 
medical services described in paragraph 
7#d72  7iii7 recovery and support       
services described in paragraph 7#e72   
7iv7 early intervention and engagement  
services described in paragraph 7#f72   
7v7 harm reduction services described in
 paragraph 7#g72  7vi7 financial        
assistance with health insurance        
described in paragraph 7#h72 and  7vii7 
administrative expenses described in    
paragraph 7#aj74  7#b7 ,direct financial
 assistance  7,a7 ,in general ,an       
eligible local area shall use amounts   
received under a grant under section    
#cdja to provide direct financial       
assistance to eligible entities for the 
purpose of providing prevention         
services1 core medical services1        

recovery and support services1 harm     
reduction services1 and early           
intervention and engagement services4   
7,b7 ,appropriate entities ,direct      
financial assistance may be provided    
under subparagraph 7,a7 to public or    
nonprofit private entities1 or private  
for-profit entities if such entities are
 the only available provider of quality 
substance use disorder treatment        
services in the area4  7#c7 ,prevention 
services  7,a7 ,in general ,for purposes
 of this subsection1 the term prevention
 services means services1 programs1 or  
multi-sector strategies to prevent      
substance use disorder 7such as         
evidence-based education campaigns1     
community-based prevention programs1    
opioid diversion1 collection and        
disposal or unused opioids1 and services
 to at-risk populations74  7,b7 ,limit  
,an eligible local area may use not to  
exceed #bj percent of the amount of the 
grant under section #cdja for prevention
 services4 ,an eligible local area may  

apply to the ,secretary for a waiver of 
this subparagraph4  7#d7 ,core medical  
services ,for purposes of this          
subsection1 the term core medical       
services means the following            
evidence-based services provided to     
individuals with substance use disorder 
or at risk for developing substance use 
disorder3  7,a7 ,substance use disorder 
treatments1 including clinical          
stabilization services1 withdrawal      
management and detoxification1 intensive
 inpatient treatment1 intensive         
outpatient treatment1 all forms of      
,federally-approved medication-assisted 
treatment1 outpatient treatment1 and    
residential recovery treatment4  7,b7   
,outpatient and ambulatory health       
services1 including those administered  
by ,federally qualified health centers  
and rural health clinics4  7,c7 ,hospice
 services4  7,d7 ,mental health         
services4  7,e7 ,naloxone procurement1  
distribution1 and training4  7,f7       
,pharmaceutical assistance and          

diagnostic testing related to the       
management of substance-use disorders a 
co-morbid conditions4  7,g7 ,home and   
community based health services4  7,h7  
,comprehensive ,case ,management1       
including substance use disorder        
treatment adherence services4  7,i7     
,health insurance enrollment and        
cost-sharing assistance in accordance   
with paragraph 7#h74  7#e7 ,recovery and
 support services ,for purposes of      
paragraph 7#a77;,b77ii71 the term       
recovery and support services means     
services1 subject to the approval of the
 ,secretary1 that are provided to       
individuals with substance use disorder1
 including residential recovery         
treatment and housing1 including for    
individuals receiving                   
medication-assisted treatment1 long term
 recovery services1 #bd_/g hotline      
crisis center support1 medical          
transportation services1 respite care   
for persons caring for individuals with 
substance use disorder1 child care and  

family services while an individual is  
receiving inpatient treatment services  
or at the time of outpatient services1  
outreach services1 peer recovery        
services1 nutrition services1 and       
referrals for job training and career   
services1 housing1 legal services1 and  
child care and family services4  7#f7   
,early intervention and engagement      
services ,for purposes of this section1 
the term early intervention and         
engagement services means services to   
provide rapid access to substance use   
disorder treatment1 counseling provided 
to individuals who have misused         
substances1 who have experienced an     
overdose1 or are at risk of developing  
substance use disorder1 and the         
provision of referrals to facilitate the
 access of such individuals to core     
medical services or recovery and support
 services4 ,the entities through which  
such services may be provided include   
emergency rooms1 fire departments and   
emergency medical services1 detention   

facilities1 homeless shelters1 law      
enforcement agencies1 health care points
 of entry specified by eligible local   
areas1 ,federally qualified health      
centers1 and rural health clinics4  7#g7
 ,harm reduction services ,for purposes 
of this section1 the term harm reduction
 services means evidence-based services 
provided to individuals engaging in     
substance use that reduce the risk of   
infectious disease transmission1        
overdose1 or death1 including by        
increasing access to health care4  7#h7 
,affordable health insurance coverage   
,an eligible local area may use amounts 
provided under a grant awarded under    
section #cdja to establish a program of 
financial assistance to assist eligible 
individuals with substance use disorder 
in--  7,a7 enrolling in health insurance
 coverage2 or  7,b7 affording health    
care services1 including assistance     
paying cost-sharing amounts1 including  
premiums4  7#i7 ,requirement of status  
as ,medicaid provider  7,a7 ,provision  

of service ,subject to paragraph 7#b71  
the ,secretary may not make a grant     
under section #cdja for the provision of
 substance use disorder treatment       
services under this section in an       
eligible local area unless1 in the case 
of any such service that is available   
pursuant to the ,state plan approved    
under title ,,xix of the ,social        
,security ,act for the ,state--  7i7 the
 political subdivision involved will    
provide the service directly1 and the   
political subdivision has entered into a
 participation agreement under the      
,state plan and is qualified to receive 
payments under such plan2 or  7ii7 the  
eligible local area involved will enter 
into an agreement with a public or      
nonprofit private entity under which the
 entity will provide the service1 and   
the entity has entered into such a      
participation agreement and is qualified
 to receive such payments4  7,b7 ,waiver
  7i7 ,in general ,in the case of an    
entity making an agreement pursuant to  

subparagraph 7,a77ii7 regarding the     
provision of substance use disorder     
treatment services1 the requirement     
established in such subparagraph shall  
be waived by the substance use planning 
council for the area involved if the    
entity does not1 in providing health    
care services1 impose a charge or accept
 reimbursement available from any       
third-party payor1 including            
reimbursement under any insurance policy
 or under any ,federal or ,state health 
benefits program4  7ii7 ,determination  
,a determination by the substance use   
planning council of whether an entity   
referred to in clause 7i7 meets the     
criteria for a waiver under such clause 
shall be made without regard to whether 
the entity accepts voluntary donations  
for the purpose of providing services to
 the public4  7#aj7 ,administration and 
planning ,an eligible local area shall  
not use in excess of #aj percent of     
amounts received under a grant under    
section #cdja for administration1       

accounting1 reporting1 and program      
oversight functions1 including the      
development of systems to improve data  
collection and data sharing4  7#aa7     
,incarcerated individuals ,amounts      
received under a grant under section    
#cdja may be used to provide substance  
use disorder treatment services to      
currently incarcerated individuals4     
#cdjd4 ,application  7a7 ,in general ,to
 be eligible to receive a grant under   
section #cdja1 an eligible local area   
shall prepare and submit to the         
,secretary an application in such form1 
and containing such information1 as the 
,secretary shall require1 including--   
7#a7 a complete accounting of the       
disbursement of any prior grants        
received under this subtitle by the     
applicant and the results achieved      
through such disbursements2  7#b7 a     
demonstration of the extent of local    
need for the funds under the grant and a
 plan for proposed substance use        
disorder treatment services that is     

consistent with local needs1 including a
 comprehensive plan for the use of the  
grant funds developed by the planning   
council established under section #cdjb1
 except that the planning council       
requirement shall not apply with respect
 to areas receiving supplemental grant  
funds under section #cdjc7;a77#b72  7#c7
 a demonstration that the area will use 
funds in a manner that provides         
substance use disorder treatment        
services compliant with the             
evidence-based standards developed in   
accordance with section #cdcd1 including
 all forms of ,federally-approved       
medication-assisted treatments2  7#d7   
information on the number of individuals
 likely to be served by the funds       
sought1 including demographic data on   
the populations to be served2  7#e7 key 
outcomes that will be measured by all   
entities that receive assistance1 as    
well as an explanation of how the       
outcomes will be measured2  7#f7 a      
demonstration that resources provided   

under the grant will be allocated in    
accordance with the local demographic   
incidence of substance use1 including   
allocations for services for children1  
youths1 and women2  7#g7 a demonstration
 that funds received from a grant under 
this subtitle in any prior year were    
expended in accordance with the         
priorities established by the planning  
council2  7#h7 a demonstration that at  
least one representative from ,indian   
tribes located within any eligible local
 area are included in the membership of 
a planning council2  7#i7 a             
demonstration that the confidentiality  
of individuals receiving substance use  
disorder treatment services will be     
maintained in a manner not inconsistent 
with applicable law2 and  7#aj7 an      
explanation of how income1 asset1 and   
medical expense criteria will be        
established and applied to those who    
qualify for assistance under the program
 under this subtitle4  7b7 ,assurances  
,to be eligible to receive a grant under

 section #cdja1 the application         
submitted by the eligible local area    
shall include assurances adequate to    
ensure--  7#a7 that funds received under
 the grant will be utilized to          
supplement not supplant other ,state or 
local funds made available in the year  
for which the grant is awarded to       
provide substance use disorder treatment
 services2  7#b7 that the political     
subdivisions within the eligible local  
area will maintain the level of         
expenditures by such political          
subdivisions for substance use-related  
services at a level that is equal to the
 level of such expenditures by such     
political subdivisions for the preceding
 fiscal year2  7#c7 that political      
subdivisions within the eligible local  
area will not use funds received under a
 grant awarded under section #cdja in   
maintaining the level of substance use  
disorder treatment services as required 
in paragraph 7#b72  7#d7 that substance 
use disorder treatment services provided

 with assistance made available under   
the grant will be provided without      
regard--  7,a7 to the ability of the    
individual to pay for such services2 and
  7,b7 to the current or past health    
condition of the individual to be       
served2  7#e7 that substance use        
disorder treatment services will be     
provided in a setting that is accessible
 to low-income individuals with         
substance use disorder1 and to          
individuals with substance use disorder 
residing in rural areas2  7#f7 that a   
program of outreach will be provided to 
low-income individuals with substance   
use disorder to inform such individuals 
of substance use disorder treatment     
services1 and to individuals with       
substance use disorder residing in rural
 areas2 and  7#g7 that funds received   
under a grant awarded under this        
subtitle will not be utilized to make   
payments for any item or service to the 
extent that payment has been made1 or   
can reasonably be expected to be made1  

with respect to that item or service    
under any ,state compensation program1  
under an insurance policy1 or under any 
,federal or ,state health benefits      
program 7except for a program           
administered by1 or providing the       
services of1 the ,indian ,health        
,service74  7c7 ,requirements regarding 
imposition of charges for services  7#a7
 ,in general ,the ,secretary may not    
make a grant under section #cdja to an  
eligible local area unless the eligible 
local area provides assurances that in  
the provision of substance use disorder 
treatment services with assistance      
provided under the grant--  7,a7 in the 
case of individuals with an income less 
than or equal to #ach percent of the    
official poverty level1 the provider    
will not impose charges on any such     
individual for the services provided    
under the grant2  7,b7 in the case of   
individuals with an income greater than 
#ach percent of the official poverty    
level1 the provider will impose a charge

 on each such individual according to a 
schedule of charges made available to   
the public2  7,c7 in the case of        
individuals with an income greater than 
#ach percent of the official poverty    
level but not exceeding #bjj percent of 
such poverty level1 the provider will   
not1 for an calendar year1 impose       
charges in an amount exceeding #e       
percent of the annual gross income of   
the individual2  7,d7 in the case of    
individuals with an income greater than 
#bjj percent of the official poverty    
level but not exceeding #cjj percent of 
such poverty level1 the provider will   
not1 for any calendar year1 impose      
charges in an amount exceeding #g       
percent of the annual gross income of   
the individual involved2  7,e7 in the   
case of individuals with an income      
greater than #cjj percent of the        
official poverty level1 the provider    
will not1 for any calendar year1 impose 
charges in an amount exceeding #ae      
percent of the annual gross income of   

the individual involved2 and  7,f7 in   
the case of eligible ,american ,indian  
and ,alaska ,native individuals as      
defined by section #ddg4ej of title #db1
 ,code of ,federal ,regulations 7as in  
effect on ,july #a1 #bjaj71 the provider
 will not impose any charges for        
substance use disorder treatment        
services1 including any charges or      
cost-sharing prohibited by section      
#adjb7;d7 of the ,patient ,protection   
and ,affordable ,care ,act4  7#b7       
,charges ,with respect to compliance    
with the assurances made under paragraph
 7#a71 an eligible local area may1 in   
the case of individuals subject to a    
charge--  7,a7 assess the amount of the 
charge in the discretion of the area1   
including imposing only a nominal charge
 for the provision of substance use     
disorder treatment services1 subject to 
the provisions of the paragraph         
regarding public schedules and regarding
 limitations on the maximum amount of   
charges2 and  7,b7 take into            

consideration the total medical expenses
 of individuals in assessing the amount 
of the charge1 subject to such          
provisions4  7#c7 ,aggregate charges    
,the ,secretary may not make a grant    
under section #cdja to an eligible local
 area unless the area agrees that the   
limitations on charges for substance use
 disorder treatment services under this 
subsection applies to the annual        
aggregate of charges imposed for such   
services1 however the charges are       
characterized1 includes enrollment fees1
 premiums1 deductibles1 cost sharing1   
co-payments1 co-insurance costs1 or any 
other charges4  7d7 ,indian tribes ,any 
application requirements for grants     
distributed in accordance with section  
#cdjc7;a77#c7 shall be developed by the 
,secretary in consultation with ,indian 
tribes4  #cdje4 ,technical assistance   
,the ,secretary shall1 beginning on the 
date of enactment of this title1 provide
 technical assistance1 including        
assistance from other grantees1         

contractors or subcontractors under this
 title to assist newly eligible local   
areas in the establishment of planning  
councils and1 to assist entities in     
complying with the requirements of this 
subtitle in order to make such areas    
eligible to receive a grant under this  
subtitle4 ,the ,secretary may make      
planning grants available to eligible   
local areas1 in an amount not to exceed 
#ge1jjj for any area1 that is projected 
to be eligible for funding under section
 #cdja in the following fiscal year4    
,such grant amounts shall be deducted   
from the first year formula award to    
eligible local areas accepting such     
grants4  #cdjf4 ,authorization of       
appropriations ,there is authorized to  
be appropriated to carry out this       
subtitle-- 7#a7 #b1gjj1jjj1jjj for      
fiscal year #bjai2  7#b7 #b1gjj1jjj1jjj 
for fiscal year #bjbj2  7#c7            
#b1gjj1jjj1jjj for fiscal year #bjba2   
7#d7 #b1gjj1jjj1jjj for fiscal year     
#bjbb2  7#e7 #b1gjj1jjj1jjj for fiscal  

year #bjbc2  7#f7 #b1gjj1jjj1jjj for    
fiscal year #bjbd2  7#g7 #b1gjj1jjj1jjj 
for fiscal year #bjbe2  7#h7            
#b1gjj1jjj1jjj for fiscal year #bjbf2   
7#i7 #b1gjj1jjj1jjj for fiscal year     
#bjbg2 and  7#aj7 #b1gjj1jjj1jjj for    
fiscal year #bjbh4  ,b ,state and       
,tribal substance use disorder          
prevention and intervention grant       
program  #cdaa4 ,establishment of       
program of grants ,the ,secretary1      
acting in coordination with the         
,director of the ,office of ,national   
,drug ,control ,policy1 shall award     
grants to ,states1 territories1 and     
tribal governments for the purpose of   
addressing substance use within such    
,states4  #cdab4 ,amount of grant and   
use of amounts  7a7 ,amount of grant to 
,states and territories  7#a7 ,in       
general  7,a7 ,expedited distribution   
,not later than #ij days after an       
appropriation becomes available1 the    
,secretary shall disburse #ej percent of
 the amount made available under section

 #cdae for carrying out this subtitle   
for such fiscal year through grants to  
,states under section #cdaa1 in         
accordance with subparagraphs 7,b7 and  
7,c74  7,b7 ,minimum allotment ,subject 
to the amount made available under      
section #cdae1 the amount of a grant    
under section #cdaa for--  7i7 each of  
the #ej ,states1 the ,district of       
,columbia1 and ,puerto ,rico for a      
fiscal year shall be the greater of--   
7,i7 #b1jjj1jjj2 or  7,,ii7 an amount   
determined under the subparagraph 7,c72 
and  7ii7 each territory other than     
,puerto ,rico for a fiscal year shall be
 the greater of-- 7,i7 #ejj1jjj2 or     
7,,ii7 an amount determined under the   
subparagraph 7,c74  7,c7 ,determination 
7i7 ,formula ,for purposes of           
subparagraph 7,b71 the amount referred  
to in this subparagraph for a ,state    
7including a territory7 for a fiscal    
year is--  7,i7 an amount equal to the  
amount made available under section     
#cdae for the fiscal year involved for  

grants pursuant to subparagraph 7,b72   
and  7,,ii7 the percentage constituted  
by the sum of-- 7aa7 the product of     
#j4he and the ratio of the ,state       
distribution factor for the ,state or   
territory to the sum of the respective  
distribution factors for all ,states2   
and  7bb7 the product of #j4ae and the  
ratio of the non-local distribution     
factor for the ,state or territory 7as  
determined under clause 7iv77 to the sum
 of the respective non-local            
distribution factors for all ,states or 
territories4  7ii7 ,state distribution  
factor ,for purposes of clause          
7i77,,ii77aa71 the term ,state          
distribution factor means an amount     
equal to-- 7,i7 the estimated number of 
drug overdose deaths in the ,state1 as  
determined under clause 7iii72 or       
7,,ii7 the number of non-fatal drug     
overdoses in the ,state1 as determined  
under clause 7iv72  as determined by the
 ,secretary based on which distribution 
factor 7subclause 7,i7 or 7,,ii77 will  

result in the ,state receiving the      
greatest amount of funds4  7iii7 ,number
 of drug overdoses ,for purposes of     
clause 7ii71 the number of drug overdose
 deaths determined under this clause for
 a ,state for a fiscal year is the      
number of drug overdose deaths during   
the most recent #c-year period for which
 such data are available4  7iv7 ,number 
of non-fatal drug overdoses ,for        
purposes of clause 7ii71 the number of  
non-fatal drug overdose deaths          
determined under this clause for ,state 
for a fiscal year for purposes of clause
 7ii7 may be determined by using data   
including emergency department syndromic
 data1 visits1 or other emergency       
medical services for drug-related causes
 during the most recent #c-year period  
for which such data are available4  7v7 
,non-local distribution factors ,for    
purposes of clause 7i77,,ii77bb71 the   
term non-local distribution factor means
 an amount equal to the sum of-- 7,i7   
the number of drug overdoses deaths in  

the ,state involved1 as determined under
 clause 7iii71 or the number of         
non-fatal drug overdoses in the ,state1 
based on the criteria used by the ,state
 under clause 7ii72 less  7,,ii7 the    
total number of drug overdose deaths or 
non-fatal drug overdoses that are within
 areas in such ,state or territory that 
are eligible counties under section     
#cdja4  7vi7 ,study ,not later than #c  
years after the date of enactment of    
this title1 the ,comptroller ,general   
shall conduct a study to determine      
whether the data utilized for purposes  
of clause 7ii7 provides the most precise
 measure of ,state need related to      
substance use and addiction prevalence  
and whether additional data would       
provide more precise measures the levels
 of substance use and addiction         
prevalent in ,states4 ,such study shall 
identify barriers to collecting or      
analyzing such data1 and make           
recommendations for revising the        
distribution factors used under such    

clause to determine funding levels in   
order to direct funds to the ,states in 
most need of funding to provide         
substance use disorder treatment        
services4  7#b7 ,supplemental grants    
7,a7 ,in general ,subject to            
subparagraph 7,c71 the ,secretary shall 
disburse the remainder of amounts not   
disbursed under paragraph 7#a7 for such 
fiscal year for the purpose of making   
grants to ,states whose application--   
7i7 contains a report concerning the    
dissemination of emergency relief funds 
under paragraph 7#a7 and the plan for   
utilization of such funds2  7ii7        
demonstrates the need in such ,state1 on
 an objective and quantified basis1 for 
supplemental financial assistance to    
combat substance use disorder2  7iii7   
demonstrates the existing commitment of 
local resources of the ,state1 both     
financial and in-kind1 to combating     
substance use disorder2  7iv7           
demonstrates the ability of the ,state  
to utilize such supplemental financial  

resources in a manner that is           
immediately responsive and cost         
effective2  7v7 demonstrates that       
resources will be allocated in          
accordance with the local demographic   
incidence of substances use disorders   
and drug overdose mortality2  7vi7      
demonstrates the inclusiveness of       
affected communities and individuals    
with substance use disorders1 including 
those communities and individuals that  
are disproportionately affected or      
historically underserved2  7vii7        
demonstrates the manner in which the    
proposed services are consistent with   
the local needs assessment and the      
statewide coordinated statement of need 
required under section #cdac7;e72       
7viii7 demonstrates success in          
identifying individuals with substance  
use disorders2 and  7ix7 demonstrates   
that support for substance use disorder 
treatment services is organized to      
maximize the value to the population to 
be served with an appropriate mix of    

substance use disorder treatment        
services and attention to transition in 
care4  7,b7 ,amount  7i7 ,in general    
,the amount of each grant made for      
purposes of this paragraph shall be     
determined by the ,secretary4 ,in making
 such determination1 the ,secretary     
shall consider3  7,i7 the rate of drug  
overdose deaths per #ajj1jjj population 
in the ,state2 and  7,,ii7 the          
increasing need for substance use       
disorder treatment services1 including  
relative rates of increase in the number
 of drug overdoses or drug overdose     
deaths1 or recent increases in drug     
overdoses or drug overdose deaths since 
the data was reported under section     
#cdac4  7ii7 ,demonstrated need ,the    
factors considered by the ,secretary in 
determining whether a ,state has a      
demonstrated need for purposes of       
subparagraph 7,a77ii7 may include any or
 all of the following3  7,i7 ,the unmet 
need for such services1 including the   
factors identified in clause 7i77,,ii74 

7,,ii7 ,relative rates of increase in   
the number of drug overdoses or drug    
overdose deaths4  7,,iii7 ,the relative 
rates of increase in the number of drug 
deaths within new or emerging           
subpopulations4  7,,iv7 ,the current    
prevalence of substance use disorders4  
7,v7 ,relevant factors related to the   
cost and complexity of delivering       
substance use disorder treatment        
services to individuals in the ,state4  
7,,vi7 ,the impact of co-morbid factors1
 including co-occurring conditions1     
determined relevant by the ,secretary4  
7,,vii7 ,the prevalence of homelessness 
among individuals with substance use    
disorder4  7,,viii7 ,the relevant       
factors that limit access to health     
care1 including geographic variation1   
adequacy of health insurance coverage1  
and language barriers4  7,,ix7 ,the     
impact of a decline in the amount       
received pursuant to paragraph 7#a7 on  
substance use disorder treatment        
services available to all individuals   

with substance use disorders identified 
and eligible under this subtitle4  7,x7 
,the increasing incidence in conditions 
related to substance use1 including     
hepatitis ,c1 human immunodeficiency    
virus1 hepatitis ,b and other infections
 associated with injection drug use4    
7,c7 ,model standards  7i7 ,preference  
,in determining whether a ,state will   
receive funds under this paragraph1     
except as provided in clause 7ii71 the  
,secretary shall give preference to     
,states that have adopted the model     
standards developed in accordance with  
section #cdcd4  7ii7 ,requirement       
,effective beginning in fiscal year     
#bjbe1 the ,secretary shall not award a 
grant under this paragraph to a ,state  
unless that ,state has adopted the model
 standards developed in accordance with 
section #cdcd4  7#c7 ,amount of grant to
 tribal governments  7,a7 ,indian tribes
 ,in this section1 the term ,indian     
tribe has the meaning given such term in
 section #d of the ,indian              

,self-,determination and ,education     
,assistance ,act4  7,b7 ,formula grants 
,the ,secretary1 acting through the     
,indian ,health ,service1 shall use #aj 
percent of the amount available under   
section #cdae for each fiscal year to   
provide formula grants to ,indian tribes
 in an amount determined pursuant to a  
formula and eligibility criteria        
developed by the ,secretary in          
consultation with ,indian tribes1 for   
the purposes of addressing substance    
use4  7,c7 ,use of amounts              
,notwithstanding any requirements in    
this section1 an ,indian tribe may use  
amounts provided under grants awarded   
under this paragraph for the uses       
identified in subsection 7b7 and any    
other activities determined appropriate 
by the ,secretary1 in consultation with 
,indian tribes4  7b7 ,use of amounts    
7#a7 ,in general ,a ,state may use      
amounts provided under grants awarded   
under section #cdaa for-- 7,a7          
prevention services described in        

paragraph 7#b72  7,b7 core medical      
services described in paragraph 7#c72   
7,c7 recovery and support services      
described in paragraph 7#d72  7,d7 early
 intervention and engagement services   
described in paragraph 7#e72  7,e7 harm 
reduction services described in         
paragraph 7#f72 and  7,f7 administrative
 expenses described in paragraph 7#h74  
7#b7 ,prevention services  7,a7 ,in     
general ,for purposes of this           
subsection1 the term prevention services
 means services1 programs1 or           
multi-sector strategies to prevent      
substance use disorder 7including       
evidence-based education campaigns1     
community-based prevention programs1    
opioid diversion1 collection and        
disposal of unused opioids1 and services
 to at-risk populations74  7,b7 ,limit  
,a ,state may use not to exceed #bj     
percent of the amount of the grant under
 section #cdaa for prevention services4 
,a ,state may apply to the ,secretary   
for a waiver of this subparagraph4  7#c7

 ,core medical services ,for purposes of
 this subsection1 the term core medical 
services means the following            
evidence-based services when provided to
 individuals with substance use disorder
 or at risk for developing substance use
 disorder3  7,a7 ,substance use disorder
 treatments1 including clinical         
stabilization services1 withdrawal      
management and detoxification1 intensive
 inpatient treatment1 intensive         
outpatient treatment1 all forms of      
,federally-approved medication-assisted 
treatment1 outpatient treatment1 and    
residential recovery treatment4  7,b7   
,outpatient and ambulatory health       
services1 including those administered  
by ,federally qualified health centers  
and rural health clinics4  7,c7 ,hospice
 services4  7,d7 ,mental health         
services4  7,e7 ,naloxone procurement1  
distribution1 and training4  7,f7       
,pharmaceutical assistance related to   
the management of substance-use         
disorders and co-morbid conditions4     

7,g7 ,home and community based health   
services4  7,h7 ,comprehensive ,case    
,management and care coordination1      
including treatment adherence services4 
7,i7 ,health insurance enrollment and   
cost-sharing assistance in accordance   
with subsection 7e74  7#d7 ,recovery and
 support services ,for purposes of      
paragraph 7#a77;,c71 the term recovery  
and support services means services1    
subject to the approval of the          
,secretary1 that are provided to        
individuals with substance use disorder1
 including residential recovery         
treatment and housing1 including for    
individuals receiving                   
medication-assisted treatment1 long term
 recovery services1 #bd_/g hotline      
crisis center services1 medical         
transportation services1 respite care   
for persons caring for individuals with 
substance use disorder1 child care and  
family services while an individual is  
receiving inpatient treatment services  
or at the time of outpatient services1  

outreach services1 peer recovery        
services1 nutrition services1 and       
referrals for job training and career   
services1 housing1 legal services1 and  
child care and family services4  7#e7   
,early intervention and engagement      
services ,for purposes of this          
subsection1 the term early intervention 
and engagement services means services  
to provide rapid access to substance use
 disorder treatment services1 counseling
 provided to individuals who have       
misused substances1 who have experienced
 an overdose1 or are at risk of         
developing substance use disorder1 and  
the provision of referrals to facilitate
 the access of such individuals to core 
medical services or recovery and support
 services4 ,the entities through which  
such services may be provided include   
emergency rooms1 fire departments and   
emergency medical services1 detention   
facilities1 homeless shelters1 law      
enforcement agencies1 health care points
 of entry specified by eligible areas1  

,federally qualified health centers1 and
 rural health clinics4  7#f7 ,harm      
reduction services ,for purposes of this
 subsection1 the term harm reduction    
services means evidence-based services  
provided to individuals engaging in     
substance use disorder that reduce the  
risk of infectious disease transmission1
 overdose1 or death1 including by       
increasing access to health care4  7#g7 
,affordable health insurance coverage ,a
 ,state may use amounts provided under a
 grant awarded under section #cdaa to   
establish a program of financial        
assistance to assist eligible           
individuals with substance use disorder 
in--  7,a7 enrolling in health insurance
 coverage2 or  7,b7 affording health    
care services1 including assistance     
paying cost-sharing amounts1 including  
premiums4  7#h7 ,administration and     
planning ,a ,state shall not use in     
excess of #aj percent of amounts        
received under a grant under section    
#cdaa for administration1 accounting1   

reporting1 and program oversight        
functions1 including the development of 
systems to improve data collection and  
data sharing4  7#i7 ,incarcerated       
individuals ,amounts received under a   
grant under section #cdaa may be used to
 provide substance use disorder         
treatment services to currently         
incarcerated individuals4  #cdac4       
,application and limitation  7a7        
,application ,to be eligible to receive 
a grant under section #cdaa1 a ,state   
shall prepare and submit to the         
,secretary an application in such form1 
and containing such information1 as the 
,secretary shall require1 including--   
7#a7 a complete accounting of the       
disbursement of any prior grants        
received under this subtitle by the     
applicant and the results achieved by   
these expenditures2  7#b7 a             
comprehensive plan for the use of the   
grant1 including a demonstration of the 
extent of local need for the funds      
sought and a plan for proposed substance

 use disorder treatment services that is
 consistent with local needs2  7#c7 a   
demonstration that the ,state will use  
funds in a manner that provides         
substance use disorder treatment        
services compliant with the             
evidence-based standards developed in   
accordance with section #cdcd1 including
 all ,federally-approved                
medication-assisted treatments2  7#d7   
information on the number of individuals
 likely to be served by the funds       
sought1 including demographic data on   
the populations to be served2  7#e7 an  
identification of key outcomes that will
 be measured by all entities that       
receive assistance1 as well as an       
explanation of how the outcomes will be 
measured2  7#f7 a demonstration that    
resources provided under the grant will 
be allocated in accordance with the     
local demographic incidence of substance
 use1 including allocations for services
 for children1 youths1 and women2  7#g7 
a demonstration that funds received from

 a grant under this subtitle in any     
prior year were expended in accordance  
with ,state priorities2  7#h7 a         
demonstration that the confidentiality  
of individuals receiving substance use  
disorder treatment services will be     
maintained in a manner not inconsistent 
with applicable law2 and  7#i7 an       
explanation of how income1 asset1 and   
medical expense criteria will be        
established and applied to those who    
qualify for assistance under the        
program4  7b7 ,assurances ,to be        
eligible to receive a grant under       
section #cdja1 the application submitted
 by an eligible ,state shall include    
assurances adequate to ensure--  7#a7   
that funds received under the grant will
 be utilized to supplement not supplant 
other ,state or local funds made        
available in the year for which the     
grant is awarded to provide substance   
use disorder treatment services to      
individuals with substance use disorder2
  7#b7 that the political subdivisions  

within the ,state will maintain the     
level of expenditures by such political 
subdivisions for substance use disorder 
treatment services at a level that is   
equal to the level of such expenditures 
by such political subdivisions for the  
preceding fiscal year2  7#c7 that       
political subdivisions within the ,state
 will not use funds received under a    
grant awarded under section #cdaa in    
maintaining the level of substance use  
disorder treatment services as required 
in paragraph 7#b72  7#d7 that substance 
use disorder treatment services provided
 with assistance made available under   
the grant will be provided without      
regard--  7,a7 to the ability of the    
individual to pay for such services2 and
  7,b7 to the current or past health    
condition of the individual to be       
served2  7#e7 that substance use        
disorder treatment services will be     
provided in a setting that is accessible
 to low-income individuals with         
substance use disorders and to          

individuals with substance use disorders
 residing in rural areas2  7#f7 that a  
program of outreach will be provided to 
low-income individuals with substance   
use disorders to inform such individuals
 of substance use disorder treatment    
services and to individuals with        
substance use disorders residing in     
rural areas2  7#g7 that ,indian tribes  
are included in planning for the use of 
grant funds and that the ,federal trust 
responsibility is upheld at all levels  
of program administration2 and  7#h7    
that funds received under a grant       
awarded under this section will not be  
utilized to make payments for any item  
or service to the extent that payment   
has been made1 or can reasonably be     
expected to be made1 with respect to    
that item or service under a ,state     
compensation program1 under an insurance
 policy1 or under any ,federal or ,state
 health benefits program 7except for a  
program administered by or providing the
 services of the ,indian ,health        

,service74  7c7 ,medicaid ,,imd waiver  
application requirement ,a ,state shall 
not be eligible to receive a grant under
 this subtitle for a fiscal year unless 
the ,state--  7#a7 has in effect for the
 year a waiver under section #aaae of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #acae7 to provide medical     
assistance under the ,state plan under  
title ,,xix of such ,act to individuals 
who--  7,a7 have not attained age #fe   
7or1 if the ,state provides the medical 
assistance described in section         
#aije7;a77#af7 of such ,act1 have       
attained age #ba but have not attained  
age #fe72  7,b7 are patients in an      
institution for mental diseases2 and    
7,c7 are eligible for medical assistance
 under the ,state plan2 or  7#b7 has    
submitted an application for the year   
for such a waiver4  7d7 ,requirements   
regarding imposition of charges for     
services  7#a7 ,in general ,the         
,secretary may not make a grant under   
section #cdaa to a ,state unless the    

,state provides assurances that in the  
provision of services with assistance   
provided under the grant--  7,a7 in the 
case of individuals with an income less 
than or equal to #ach percent of the    
official poverty level1 the provider    
will not impose charges on any such     
individual for the services provided    
under the grant2  7,b7 in the case of   
individuals with an income greater than 
#ach percent of the official poverty    
level1 the provider will impose a charge
 on each such individual according to a 
schedule of charges made available to   
the public2  7,c7 in the case of        
individuals with an income greater than 
#ach percent of the official poverty    
level but not exceeding #bjj percent of 
such poverty level1 the provider will   
not1 for an calendar year1 impose       
charges in an amount exceeding #e       
percent of the annual gross income of   
the individual2  7,d7 in the case of    
individuals with an income greater than 
#bjj percent of the official poverty    

level but not exceeding #cjj percent of 
such poverty level1 the provider will   
not1 for any calendar year1 impose      
charges in an amount exceeding #g       
percent of the annual gross income of   
the individual involved2  7,e7 in the   
case of individuals with an income      
greater than #cjj percent of the        
official poverty level1 the provider    
will not1 for any calendar year1 impose 
charges in an amount exceeding #ae      
percent of the annual gross income of   
the individual involved2 and  7,f7 in   
the case of eligible ,american ,indian  
and ,alaska ,native individuals as      
defined by section #ddg4ej of title #db1
 ,code of ,federal ,regulations 7as in  
effect on ,july #a1 #bjaj71 the provider
 will not impose any charges for        
substance use disorder treatment        
services1 including any charges or      
cost-sharing prohibited by section      
#adjb7;d7 of the ,patient ,protection   
and ,affordable ,care ,act4  7#b7       
,charges ,with respect to compliance    

with the assurances made under paragraph
 7#a71 a ,state may1 in the case of     
individuals subject to a charge--  7,a7 
assess the amount of the charge in the  
discretion of the ,state1 including     
imposing only a nominal charge for the  
provision of services1 subject to the   
provisions of the paragraph regarding   
public schedules and regarding          
limitations on the maximum amount of    
charges2 and  7,b7 take into            
consideration the total medical expenses
 of individuals in assessing the amount 
of the charge1 subject to such          
provisions4  7#c7 ,aggregate charges    
,the ,secretary may not make a grant    
under section #cdaa to a ,state unless  
the ,state agrees that the limitations  
on charges for substance use disorder   
treatment services under this subsection
 applies to the annual aggregate of     
charges imposed for such services1      
however the charges are characterized1  
includes enrollment fees1 premiums1     
deductibles1 cost sharing1 co-payments1 

co-insurance costs1 or any other        
charges4  7e7 ,statewide coordinated    
statement of need ,a ,state shall not be
 eligible to receive a grant under this 
subtitle for a fiscal year unless the   
,state develops and publishes a         
statewide coordinated statement of need1
 including a demonstration of the extent
 of ,state need for assistance in       
addressing addiction and substance use  
disorder in the ,state and identifying  
priorities for the delivery of essential
 services to individuals with substance 
use disorder and their families4  7f7   
,indian tribes ,any application         
requirements applying to grants         
distributed in accordance with section  
#cdab7;c7 shall be developed by the     
,secretary in consultation with ,indian 
tribes4  #cdad4 ,technical assistance   
,the ,secretary shall provide technical 
assistance in administering and         
coordinating the activities authorized  
under section #cdab1 including technical
 assistance for the development of      

,state applications for supplementary   
grants authorized in section            
#cbab7;a77#b74  #cdae4 ,authorization of
 appropriations ,there is authorized to 
be appropriated to carry out this       
subtitle-- 7#a7 #d1jjj1jjj1jjj for      
fiscal year #bjai2  7#b7 #d1jjj1jjj1jjj 
for fiscal year #bjbj2  7#c7            
#d1jjj1jjj1jjj for fiscal year #bjba2   
7#d7 #d1jjj1jjj1jjj for fiscal year     
#bjbb2  7#e7 #d1jjj1jjj1jjj for fiscal  
year #bjbc2  7#f7 #d1jjj1jjj1jjj for    
fiscal year #bjbd2  7#g7 #d1jjj1jjj1jjj 
for fiscal year #bjbe2  7#h7            
#d1jjj1jjj1jjj for fiscal year #bjbf2   
7#i7 #d1jjj1jjj1jjj for fiscal year     
#bjbg2 and  7#aj7 #d1jjj1jjj1jjj for    
fiscal year #bjbh4  ,c ,other grant     
program  #cdba4 ,establishment of grant 
program  7a7 ,in general ,the ,secretary
 shall award grants to public1          
nonprofit1 and ,native entities for the 
purpose of funding core medical         
services1 recovery and support services1
 harm reduction services1 administrative

 expenses1 and early intervention and   
engagement services in accordance with  
this section4  7b7 ,eligibility  7#a7   
,entities ,public1 nonprofit1 or ,native
 entities eligible to receive a grant   
under subsection 7a7 may include-- 7,a7 
federally qualified health centers under
 section #aije7l77#b77;,b7 of the       
,social ,security ,act2  7,b7 family    
planning clinics2  7,c7 rural health    
clinics2  7,d7 ,native entities1        
including ,indian health programs as    
defined in section #d of the ,indian    
,health ,care ,improvement ,act1 urban  
,indian organizations as defined in     
section #d of the ,indian ,health ,care 
,improvement ,act1 and ,native ,hawaiian
 organizations as defined in section #ab
 of the ,native ,hawaiian ,health ,care 
,act of #aihh2  7,e7 community-based    
organizations1 clinics1 hospitals1 and  
other health facilities that provide    
substance use disorder treatment        
services2  7,f7 other nonprofit entities
 that provide substance use disorder    

treatment services2 and  7,g7 faith     
based organizations that provide        
substance use disorder treatment        
services4  7#b7 ,underserved populations
 ,entities described in paragraph 7#a7  
shall serve underserved populations     
which may include minority populations  
and ,indian populations1 ex-offenders1  
individuals with comorbidities including
 ,,hiv_/,,aids1 hepatitis ,b or ,c1     
mental illness1 or other behavioral     
health disorders1 low-income            
populations1 inner city populations1 and
 rural populations4  7#c7 ,application  
,to be eligible to receive a grant under
 this section1 a public or nonprofit    
entity described in this subsection     
shall prepare and submit to the         
,secretary an application in such form1 
and containing such information1 as the 
,secretary shall require1 including--   
7,a7 a complete accounting of the       
disbursement of any prior grants        
received under this subtitle by the     
applicant and the results achieved by   

these expenditures2  7,b7 a             
comprehensive plan for the use of the   
grant1 including a demonstration of the 
extent of local need for the funds      
sought and a plan for proposed substance
 use disorder treatment services that is
 consistent with local needs2  7,c7 a   
demonstration that the grantee will use 
funds in a manner that provides         
substance use disorder treatment        
services compliant with the             
evidence-based standards developed in   
accordance with section #cdcd1 including
 all ,federally-approved                
medication-assisted treatments2  7,d7   
information on the number of individuals
 likely to be served by the funds       
sought1 including demographic data on   
the populations to be served2  7,e7 an  
identification of key outcomes that will
 be measured by all entities that       
receive assistance1 as well as an       
explanation of how the outcomes will be 
measured2  7,f7 a demonstration that    
resources provided under the grant will 

be allocated in accordance with the     
local demographic incidence of substance
 use1 including allocations for services
 for children1 youths1 and women2  7,g7 
a demonstration that the confidentiality
 of individuals receiving substance use 
disorder treatment services will be     
maintained in a manner not inconsistent 
with applicable law2 and  7,h7 an       
explanation of how income1 asset1 and   
medical expense criteria will be        
established and applied to those who    
qualify for assistance under the        
program4  7c7 ,requirement of status as 
,medicaid provider  7#a7 ,provision of  
service ,subject to paragraph 7#b71 the 
,secretary may not make a grant under   
this section for the provision of       
substance use disorder treatment        
services under this section in a ,state 
unless1 in the case of any such service 
that is available pursuant to the ,state
 plan approved under title ,,xix of the 
,social ,security ,act for the ,state-- 
7,a7 the political subdivision involved 

will provide the substance use disorder 
treatment service directly1 and the     
political subdivision has entered into a
 participation agreement under the      
,state plan and is qualified to receive 
payments under such plan2 or  7,b7 the  
political subdivision involved will     
enter into an agreement with a public or
 nonprofit private entity under which   
the entity will provide the substance   
use disorder treatment service1 and the 
entity has entered into such a          
participation agreement and is qualified
 to receive such payments4  7#b7 ,waiver
  7,a7 ,in general ,in the case of an   
entity making an agreement pursuant to  
paragraph 7#a77;,b7 regarding the       
provision of substance use disorder     
treatment services1 the requirement     
established in such paragraph shall be  
waived by the ,state if the entity does 
not1 in providing such services1 impose 
a charge or accept reimbursement        
available from any third-party payor1   
including reimbursement under any       

insurance policy or under any ,federal  
or ,state health benefits program4  7,b7
 ,determination ,a determination by the 
,state of whether an entity referred to 
in subparagraph 7,a7 meets the criteria 
for a waiver under such subparagraph    
shall be made without regard to whether 
the entity accepts voluntary donations  
for the purpose of providing services to
 the public4  7d7 ,amount of grant to   
,native entities  7#a7 ,indian tribes   
,in this section1 the term ,indian tribe
 has the meaning given such term in     
section #d of the ,indian               
,self-,determination and ,education     
,assistance ,act4  7#b7 ,formula grants 
,the ,secretary1 acting through the     
,indian ,health ,service1 shall use #aj 
percent of the amount available under   
section #cdbe for each fiscal year to   
provide grants to ,native entities in an
 amount determined pursuant to criteria 
developed by the ,secretary in          
consultation with ,indian tribes1 for   
the purposes of addressing substance    

use4  7#c7 ,use of amounts              
,notwithstanding any requirements in    
this section1 ,native entities may use  
amounts provided under grants awarded   
under this section for the uses         
identified in section #cdbb and any     
other activities determined appropriate 
by the ,secretary1 in consultation with 
,indian tribes4  #cdbb4 ,use of amounts 
7a7 ,use of funds ,an entity shall use  
amounts received under a grant under    
section #cdba to provide direct         
financial assistance to eligible        
entities for the purpose of delivering  
or enhancing--  7#a7 prevention services
 described in subsection 7b72  7#b7 core
 medical services described in          
subsection 7c72  7#c7 recovery and      
support services described in subsection
 7d72  7#d7 early intervention and      
engagement services described in        
subsection 7e72  7#e7 harm reduction    
services described in subsection 7f72   
and  7#f7 administrative expenses       
described in subsection 7g74  7b7       

,prevention services ,for purposes of   
this subsection1 the term prevention    
services means services1 programs1 or   
multi-sector strategies to prevent      
substance use disorder1 including       
evidence-based education campaigns1     
community-based prevention programs1    
opioid diversion1 collection and        
disposal of unused opioids1 and services
 to at-risk populations4  7c7 ,core     
medical services ,for purposes of this  
section1 the term core medical services 
means the following services when       
provided to individuals with substance  
use disorder or at risk for developing  
substance use disorder3  7#a7 ,substance
 use disorder treatments1 including     
clinical stabilization services1        
withdrawal management and               
detoxification1 intensive inpatient     
treatment1 intensive outpatient         
treatment1 all forms of                 
,federally-approved medication-assisted 
treatment1 and residential recovery     
treatment4  7#b7 ,outpatient and        

ambulatory health services1 including   
those administered by federally         
qualified health centers and rural      
health clinics4  7#c7 ,hospice services4
  7#d7 ,mental health services4  7#e7   
,naloxone procurement1 distribution1 and
 training4  7#f7 ,pharmaceutical        
assistance and diagnostic testing       
related to the management of            
substance-use disorder and co-morbid    
conditions4  7#g7 ,home and community   
based health services4  7#h7            
,comprehensive ,case ,management and    
care coordination1 including treatment  
adherence services4  7#i7 ,health       
insurance enrollment and cost-sharing   
assistance in accordance with section   
#cdab4  7d7 ,recovery and support       
services ,for purposes of subsection    
7a77#c71 the term recovery and support  
services means services1 subject to the 
approval of the ,secretary1 that are    
provided to individuals with substance  
use disorder1 including residential     
recovery treatment and housing1         

including for individuals receiving     
medication-assisted treatment1 long term
 recovery services1 #bd_/g hotline      
services1 medical transportation        
services1 respite care for persons      
caring for individuals with substance   
use disorder1 child care and family     
services while an individual is         
receiving inpatient treatment services  
or at the time of outpatient services1  
outreach services1 peer recovery        
services1 nutrition services1 and       
referrals for job training and career   
services1 housing1 legal services1 and  
child care and family services4  7e7    
,early intervention and engagement      
services ,for purposes of this section1 
the term early intervention and         
engagement services means services to   
provide rapid access to substance use   
disorder treatment services1 counseling 
provided to individuals who have misused
 substances1 who have experienced an    
overdose1 or are at risk of developing  
substance use disorder and the provision

 of referrals to facilitate the access  
of such individuals to core medical     
services or recovery and support        
services4 ,the entities through which   
such services may be provided include   
emergency rooms1 fire departments and   
emergency medical services1 detention   
facilities1 homeless shelters1 law      
enforcement agencies1 health care points
 of entry specified by eligible areas1  
,federally qualified health centers1 and
 rural health clinics4  7f7 ,harm       
reduction services ,for purposes of this
 subsection1 the term harm reduction    
services means evidence-based services  
provided to individuals engaging in     
substance use that reduce the risk of   
infectious disease transmission1        
overdose1 or death1 including by        
increasing access to health care4  7g7  
,administration and planning ,an entity 
shall not use in excess of #aj percent  
of amounts received under a grant under 
section #cdba for administration1       
accounting1 reporting1 and program      

oversight functions1 including for the  
purposes of developing systems to       
improve data collection and data        
sharing4  #cdbc4 ,technical assistance  
,the ,secretary may1 directly or through
 grants or contracts1 provide technical 
assistance to nonprofit private entities
 and ,native entities regarding the     
process of submitting to the ,secretary 
applications for grants under section   
#cdba1 and may provide technical        
assistance with respect to the planning1
 development1 and operation of any      
program or service carried out pursuant 
to such section4  #cdbd4 ,planning and  
development grants  7a7 ,in general ,the
 ,secretary may provide planning grants 
to public1 nonprofit private1 and       
,native entities for purposes of        
assisting such entities in expanding    
their capacity to provide substance use 
disorder treatment services in          
low-income communities and affected     
subpopulations that are underserviced   
with respect to such services4  7b7     

,amount ,a grant under this section may 
be made in an amount not to exceed      
#aej1jjj4  #cdbe4 ,authorization of     
appropriations ,there is authorized to  
be appropriated to carry out this       
subtitle--  7#a7 #ejj1jjj1jjj for fiscal
 year #bjai2  7#b7 #ejj1jjj1jjj for     
fiscal year #bjbj2  7#c7 #ejj1jjj1jjj   
for fiscal year #bjba2  7#d7            
#ejj1jjj1jjj for fiscal year #bjbb2     
7#e7 #ejj1jjj1jjj for fiscal year #bjbc2
  7#f7 #ejj1jjj1jjj for fiscal year     
#bjbd2  7#g7 #ejj1jjj1jjj for fiscal    
year #bjbe2  7#h7 #ejj1jjj1jjj for      
fiscal year #bjbf2  7#i7 #ejj1jjj1jjj   
for fiscal year #bjbg2 and  7#aj7       
#ejj1jjj1jjj for fiscal year #bjbh4  ,d 
,miscellaneous provisions  #cdca4       
,special projects of national           
significance  7a7 ,in general ,the      
,secretary1 acting in consultation with 
the ,director of the ,office of         
,national ,drug ,control ,policy1 shall 
award grants to entities to administer  
special projects of national            

significance to support the development 
of innovative and original models for   
the delivery of substance use disorder  
treatment services4  7b7 ,grants ,the   
,secretary shall award grants under a   
project under subsection 7a7 to entities
 eligible for grants under subtitles ,a1
 ,b1 and ,c based on newly emerging     
needs of individuals receiving          
assistance under this title4  7c7       
,replication ,the ,secretary shall make 
information concerning successful models
 or programs developed under this       
section available to grantees under this
 title for the purpose of coordination1 
replication1 and integration4 ,to       
facilitate efforts under this           
subsection1 the ,secretary may provide  
for peer-based technical assistance for 
grantees funded under this section4  7d7
 ,grants to tribal governments  7#a7    
,indian tribes ,in this section1 the    
term ,indian tribe has the meaning given
 such term in section #d of the ,indian 
,self-,determination and ,education     

,assistance ,act4  7#b7 ,use of funds   
,the ,secretary1 acting through the     
,indian ,health ,service1 shall use #aj 
percent of the amount available under   
this section for each fiscal year to    
provide grants to ,indian tribes for the
 purposes of supporting the development 
of innovative and original models for   
the delivery of substance use disorder  
treatment and services1 including the   
development of culturally-informed care 
models4  7e7 ,authorization of          
appropriations ,there is authorized to  
be appropriated to carry out this       
section-- 7#a7 #ejj1jjj1jjj for fiscal  
year #bjai2  7#b7 #ejj1jjj1jjj for      
fiscal year #bjbj2  7#c7 #ejj1jjj1jjj   
for fiscal year #bjba2  7#d7            
#ejj1jjj1jjj for fiscal year #bjbb2     
7#e7 #ejj1jjj1jjj for fiscal year #bjbc2
  7#f7 #ejj1jjj1jjj for fiscal year     
#bjbd2  7#g7 #ejj1jjj1jjj for fiscal    
year #bjbe2  7#h7 #ejj1jjj1jjj for      
fiscal year #bjbf2  7#i7 #ejj1jjj1jjj   
for fiscal year #bjbg2 and  7#aj7       

#ejj1jjj1jjj for fiscal year #bjbh4     
#cdcb4 ,education and training centers  
7a7 ,in general ,the ,secretary may make
 grants and enter into contracts to     
assist public and nonprofit private     
entities1 and schools1 and academic     
health centers in meeting the cost of   
projects--  7#a7 to train health        
personnel1 including practitioners in   
programs under this title and other     
community providers1 including          
counselors1 case managers1 social       
workers1 peer recovery coaches1 and harm
 reduction workers1 in the diagnosis1   
treatment1 and prevention of substance  
use disorders1 including measures for   
the prevention and treatment of         
co-occurring infectious diseases and    
other conditions1 and including 7as     
applicable to the type of health        
professional involved71 care for women1 
pregnant women1 and children2  7#b7 to  
train the faculty of schools of         
medicine1 nursing1 public health1       
osteopathic medicine1 dentistry1 allied 

health1 and mental health practice to   
teach health professions students to    
screen for and provide for the needs of 
individuals with substance use disorders
 or at risk of substance use2 and  7#c7 
to develop and disseminate curricula and
 resource materials relating to         
evidence-based practices for the        
screening1 prevention1 and treatment of 
substance use disorders1 including      
information about prescribing best      
practices1 alternative pain therapies1  
and ,federally-approved                 
medication-assisted treatment options4  
7b7 ,preference in making grants ,in    
making grants under subsection 7a71 the 
,secretary shall give preference to     
qualified projects that will--  7#a7    
train1 or result in the training of1    
health professionals1 including         
counselors1 case managers1 social       
workers1 peer recovery coaches1 and harm
 reduction workers1 who will provide    
substance use disorder treatments for   
underserved groups1 including minority  

individuals and ,indians with substance 
use disorder and other individuals who  
are at a high risk of substance use2    
7#b7 train1 or result in the training   
of1 minority health professionals and   
minority allied health professionals1   
including counselors1 case managers1    
social workers1 peer recovery coaches1  
and harm reduction workers1 to provide  
substance use disorder treatment for    
individuals with such disease2  7#c7    
train or result in the training of      
individuals1 including counselors1 case 
managers1 social workers1 peer recovery 
coaches1 and harm reduction workers1 who
 will provide substance use disorder    
treatment in rural or other areas that  
are underserved by current treatment    
structures2 and  7#d7 train or result in
 the training of health professionals   
and allied health professionals1        
including counselors1 case managers1    
social workers1 peer recovery coaches1  
and harm reduction workers1 to provide  
treatment for infectious diseases and   

mental health conditions co-occurring   
with substance use disorder4  7c7       
,native education and training centers  
,the ,secretary shall use #aj percent of
 the amount available under subsection  
7d7 for each fiscal year to provide     
grants authorized under this subtitle   
to--  7#a7 tribal colleges and          
universities2  7#b7 ,indian ,health     
,service grant funded institutions2 and 
7#c7 ,native partner institutions1      
including institutions of higher        
education with medical training programs
 that partner with one or more ,indian  
tribes1 tribal organizations1 ,native   
,hawaiian organizations1 or tribal      
colleges and universities to train      
,native health professionals that will  
provide substance use disorder treatment
 services in ,native communities4  7d7  
,authorization of appropriations ,there 
is authorized to be appropriated to     
carry out this section-- 7#a7           
#djj1jjj1jjj for fiscal year #bjai2     
7#b7 #djj1jjj1jjj for fiscal year #bjbj2

  7#c7 #djj1jjj1jjj for fiscal year     
#bjba2  7#d7 #djj1jjj1jjj for fiscal    
year #bjbb2  7#e7 #djj1jjj1jjj for      
fiscal year #bjbc2  7#f7 #djj1jjj1jjj   
for fiscal year #bjbd2  7#g7            
#djj1jjj1jjj for fiscal year #bjbe2     
7#h7 #djj1jjj1jjj for fiscal year #bjbf2
  7#i7 #djj1jjj1jjj for fiscal year     
#bjbg2 and  7#aj7 #djj1jjj1jjj for      
fiscal year #bjbh4  #cdcc4 ,other       
provisions  7a7 ,medication-,assisted   
treatment ,the ,secretary may not make a
 grant under this title unless the      
applicant for the grant agrees to       
require all entities offering substance 
use disorder treatment services under   
the grant to offer all                  
,federally-approved forms of            
medication-assisted substance use       
treatment for the substance use         
disorders for which the applicant offers
 treatment4  7b7 ,waiver ,the ,secretary
 may grant a waiver with respect to any 
requirement of this title if the grant  
applicant involved--  7#a7 submits to   

the ,secretary a justification          
containing such information as the      
,secretary shall require2 and  7#b7     
agrees to require all entities offering 
substance use disorder treatment        
services under the grant-- 7,a7 to offer
 at least two ,federally-approved forms 
of medication-assisted treatment on     
site2  7,b7 provide counseling to       
patients on the benefits and risks of   
all forms of ,federally-approved        
medication-assisted treatments2 and     
7,c7 maintain an affiliation with a     
provider that can prescribe or otherwise
 dispense all other forms of            
,federally-approved medication-assisted 
treatment4  7c7 ,,gao study ,not later  
than #a year after the date of enactment
 of this title1 the ,comptroller        
,general of the ,united ,states shall   
submit to ,congress a comprehensive     
report describing any relationship      
between substance use rates1 pain       
management practices of the ,indian     
,health ,service1 and patient request   

denials through the purchased_/referred 
care program of the ,indian ,health     
,service4  #cdcd4 ,standards for        
substance use disorder treatment and    
recovery facilities  7a7 ,in general    
,not later than #c years after the date 
of enactment of this title1 the         
,secretary1 in consultation with the    
,american ,society of ,addiction        
,medicine1 shall promulgate model       
standards for the regulation of         
substance use disorder treatment        
services4  7b7 ,contents ,the model     
standards promulgated under subsection  
7a7 shall-- 7#a7 identify the types of  
providers intended to be covered without
 regard to whether such providers       
participate in any ,federal health care 
program 7as defined in section          
#aabh;,b7f7 of the ,social ,security    
,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f777   
and shall not include a private         
practitioner who is already licensed by 
a ,state medical licensing board and    
whose practice is limited to outpatient 

care2  7#b7 require that all substance  
use disorder treatment services be      
licensed by the respective ,states for  
the levels of care which they provide2  
7#c7 identify the professional          
credentials needed by each type of      
substance use disorder treatment        
professional2  7#d7 require that        
patients have access to licensed        
substance use disorder treatment        
services1 including health care         
providers and physicians1 for inpatient 
and outpatient care2  7#e7 identify and 
develop strategies for ,states to ensure
 that all substance use disorder        
patients receive a medical assessment1  
including for co-occurring mental health
 issues and infectious diseases2  7#f7  
require ,states to implement a process  
to ensure that residential treatment    
provider qualifications are verified by 
the single ,state agency serving as the 
primary regulator in the ,state for     
substance use disorder treatment        
services 7as required in paragraph      

7#ac77 or by an independent third party 
with the necessary competencies to use  
evidence-based patient placement        
assessment tools and                    
nationally-recognized program standards1
 as applicable2  7#g7 ensure that       
patients receiving substance use        
disorder treatment have access directly1
 by referral1 or in such other manner as
 determined by the ,secretary1 to all   
,federally-approved medication-assisted 
treatments for substance use disorder2  
7#h7 develop standards for data         
reporting and require compilation of    
,statewide reports2  7#i7 develop       
standards for licensed providers to     
ensure all patients receive an          
outpatient treatment and discharge plan2
  7#aj7 develop standards for the       
certification of recovery residences    
that have an ongoing economic           
relationship with any commercial        
substance use disorder treatment        
service1 including any relationship with
 any such service that includes         

receiving or making referrals for       
substance use disorder treatment1       
including--  7,a7 application1          
inspection1 and renewal procedures for  
recovery residences2  7,b7 fire1 safety1
 and health standards2  7,c7 standards  
for equipping residences with naloxone  
and training residence owners1          
operators1 and employees in the         
administration of naloxone2  7,d7       
standards for recovery residence owners 
and operators2 and  7,e7 standards to   
identify1 disqualify from grant funding1
 and refer to the appropriate regulatory
 authority any entity engaged in the    
soliciting or receiving of a commission1
 benefit1 bonus1 rebate1 kickback1 or   
bribe1 directly or indirectly1 in cash  
or in kind1 or engaging in any split-fee
 arrangement1 aimed at inducing the     
referral of a patient to or from a      
substance use disorder treatment        
service2  7#aa7 establish a toll-free   
telephone number to handle complaints   
about recovery residences2  7#ab7       

establish and maintain on a publicly    
accessible internet website a list of   
all recovery residences in the ,state   
that have a certification in effect in  
accordance with this section2  7#ac7    
require the designation of a single     
,state agency to serve as the primary   
regulator in the ,state for substance   
use disorder treatment services2  7#ad7 
require a single ,state agency to       
implement a process to ensure that      
treatment provider assessments for all  
substance use disorder treatment        
services1 including levels of care and  
length-of-stay recommendations1 are     
verified by an independent third party  
that has the necessary competencies to  
use evidence-based patient placement    
assessment tools and                    
nationally-recognized program standards1
 as applicable2 and  7#ae7 consider     
existing barriers to substance use      
disorder treatment and service access1  
including capacity and infrastructure   
needs1 as well as access to culturally  

attuned services4  7c7 ,annual          
assessment ,beginning with respect to   
fiscal year #bjba1 the ,secretary shall 
make a determination with respect to    
each ,state on whether the ,state has   
adopted the model standards promulgated 
in accordance with this section4  7d7   
,quality measures ,the ,secretary shall 
engage a nonprofit1 non-partisan        
standards development and quality       
measurement organization to convene     
government regulators1 ,state           
representatives1 consumer               
representatives1 substance use disorder 
treatment providers1 recovery residence 
owners and operators1 and purchasers of 
substance use disorder treatments       
exercising leadership in quality-based  
purchasing to develop and annually      
revise a set of health care quality     
measures for substance use disorder     
treatment providers and owners and      
operators of recovery residences4       
#cdce4 ,naloxone distribution program   
7a7 ,establishment of program  7#a7 ,in 

general ,the ,secretary shall provide   
for the purchase and delivery of        
,federally-approved opioid overdose     
reversal drug products on behalf of each
 ,state 7or ,indian tribe as defined in 
section #d of the ,indian ,health ,care 
,improvement ,act7 that receives a grant
 under subtitle ,b4 ,this paragraph     
constitutes budget authority in advance 
of appropriations ,acts1 and represents 
the obligation of the ,federal          
,government to provide for the purchase 
and delivery to ,states of the opioid   
overdose reversal drug products in      
accordance with this paragraph4  7#b7   
,special rules where opioid overdose    
reversal drug products are unavailable  
,to the extent that a sufficient        
quantity of opioid overdose reversal    
drug products are not available for     
purchase or delivery under paragraph    
7#a71 the ,secretary shall provide for  
the purchase and delivery of the        
available opioid overdose reversal drug 
products in accordance with priorities  

established by the ,secretary1 with     
priority given to ,states with at least 
one local area eligible for funding     
under section #cdja7;a74  7b7           
,negotiation of contracts with          
manufacturers  7#a7 ,in general ,for the
 purpose of carrying out this section1  
the ,secretary shall negotiate and enter
 into contracts with manufacturers of   
opioid overdose reversal drug products  
consistent with the requirements of this
 subsection and1 to the maximum extent  
practicable1 consolidate such           
contracting with any other contracting  
activities conducted by the ,secretary  
to purchase opioid overdose reversal    
drug products4 ,the ,secretary may enter
 into such contracts under which the    
,federal ,government is obligated to    
make outlays1 the budget authority for  
which is not provided for in advance in 
appropriations ,acts1 for the purchase  
and delivery of opioid overdose reversal
 drug products under subsection 7a74    
7#b7 ,authority to decline contracts    

,the ,secretary may decline to enter    
into contracts under this subsection and
 may modify or extend such contracts4   
7#c7 ,contract price  7,a7 ,in general  
,the ,secretary1 in negotiating the     
prices at which opioid overdose reversal
 drug products will be purchased and    
delivered from a manufacturer under this
 subsection1 shall take into account    
quantities of opioid overdose reversal  
drug products to be purchased by ,states
 under the option under paragraph       
7#d77;,b74  7,b7 ,negotiation of        
discounted price for opioid overdose    
reversal drug products ,with respect to 
contracts entered into for the purchase 
of opioid overdose reversal drug        
products on behalf of ,states under this
 subsection1 the price for the purchase 
of such drug product shall be a         
discounted price negotiated by the      
,secretary4  7#d7 ,product dosage ,all  
opioid overdose reversal products       
purchased under this section shall      
contain-- 7,a7 for each dose1 the       

maximum amount of active pharmaceutical 
ingredient that acts as an opioid       
receptor antagonist as recommended by   
the ,food and ,drug ,administration as  
an initial dose when administered by one
 of the approved1 labeled routes of     
administration in adults2 and  7,b7 a   
minimum of two doses packaged together4 
7#e7 ,quantities and terms of delivery  
,under contracts under this subsection--
  7,a7 the ,secretary shall provide1    
consistent with paragraph 7#f71 for the 
purchase and delivery on behalf of      
,states and ,indian tribes of quantities
 of opioid overdose reversal drug       
products2 and  7,b7 each ,state and     
,indian tribe1 at the option of the     
,state or tribe1 shall be permitted to  
obtain additional quantities of opioid  
overdose reversal drug products 7subject
 to amounts specified to the ,secretary 
by the ,state or tribe in advance of    
negotiations7 through purchasing the    
opioid overdose reversal drug products  
from the manufacturers at the applicable

 price negotiated by the ,secretary     
consistent with paragraph 7#c71 if the  
,state or tribe provides to the         
,secretary such information 7at a time  
and manner specified by the ,secretary1 
including in advance of negotiations    
under paragraph 7#a77 as the ,secretary 
determines to be necessary1 to provide  
for quantities of opioid overdose       
reversal drug products for the ,state or
 tribe to purchase pursuant to this     
subsection and to determine annually the
 percentage of the opioid overdose      
reversal drug market that is purchased  
pursuant to this section and this       
subparagraph4  ,the ,secretary shall    
enter into the initial negotiations not 
later than #ahj days after the date of  
the enactment of this title4  7#f7      
,charges for shipping and handling ,the 
,secretary may enter into a contract    
referred to in paragraph 7#a7 only if   
the manufacturer involved agrees to     
submit to the ,secretary such reports as
 the ,secretary determines to be        

appropriate to assure compliance with   
the contract and if1 with respect to a  
,state program under this section that  
does not provide for the direct delivery
 of qualified opioid overdose reversal  
drug products1 the manufacturer involved
 agrees that the manufacturer will      
provide for the delivery of the opioid  
overdose reversal drug products on      
behalf of the ,state in accordance with 
such program and will not impose any    
charges for the costs of such delivery  
7except to the extent such costs are    
provided for in the price established   
under paragraph 7#c774  7#g7 ,multiple  
suppliers ,in the case of the opioid    
overdose reversal drug product involved1
 the ,secretary may1 as appropriate1    
enter into a contract referred to in    
paragraph 7#a7 with each manufacturer of
 the opioid overdose reversal drug      
product that meets the terms and        
conditions of the ,secretary for an     
award of such a contract 7including     
terms and conditions regarding safety   

and quality74 ,with respect to multiple 
contracts entered into pursuant to this 
paragraph1 the ,secretary may have in   
effect different prices under each of   
such contracts and1 with respect to a   
purchase by ,states pursuant to         
paragraph 7#d77;,b71 each eligible      
,state may choose which of such         
contracts will be applicable to the     
purchase4  7c7 ,use of opioid overdose  
reversal drug product list ,beginning   
not later than one year after the first 
contract has been entered into under    
this section1 the ,secretary shall use1 
for the purpose of the purchase1        
delivery1 and administration of opioid  
overdose reversal drug products under   
this section1 the list established 7and 
periodically reviewed and1 as           
appropriate1 revised7 by an advisory    
committee1 established by the ,secretary
 and located within the ,centers for    
,disease ,control and ,prevention1 which
 considers the cost effectiveness of    
each opioid overdose reversal drug      

product4  7d7 ,state distribution of    
opioid overdose reversal drug products  
,states shall distribute opioid overdose
 reversal drug products received under  
this section to the following3  7#a7    
,first ,responders1 including-- 7,a7 all
 ,state1 county1 and local law          
enforcement departments2  7,b7 all      
,tribal police departments2  7,c7 all   
local fire departments1 including career
 fire departments1 combination fire     
departments1 and volunteer fire         
departments2 and  7,d7 all local        
emergency medical services              
organizations1 including volunteer      
emergency medical services              
organizations4  7#b7 ,public entities   
with authority to administer local      
public health services1 including all   
local health departments1 for the       
purposes of making opioid overdose      
reversal drug products available to--   
7,a7 public and nonprofit entities1     
including-- 7i7 community-based         
organizations that provide substance use

 disorder treatments or harm reduction  
services2  7ii7 nonprofit entities that 
provide substance use disorder          
treatments or harm reduction services2  
and  7iii7 faith based organizations    
that provide substance use disorder     
treatments or harm reduction services2  
and  7,b7 the general public4  7e7      
,state requirements ,to be eligible to  
receive opioid overdose reversal drugs  
under this section1 each ,state shall-- 
7#a7 establish a program for            
distributing opioid overdose reversal   
drug products to first responders and   
entities with authority to administer   
local public health services1 including 
local health departments2  7#b7         
beginning in the second year of the     
program1 demonstrate a distribution rate
 of a minimum of #ij percent of the     
opioid overdose reversal drug products  
received under this program2 and  7#c7  
certify to the ,secretary that the      
,state has in place measures that       
enhance access to opioid overdose       

reversal drug products1 such as laws    
that provide civil or disciplinary      
immunity for medical personnel who      
prescribe an opioid overdose reversal   
drug product1 ,good ,samaritan ,laws1   
,third ,party ,prescription ,laws1      
,collaborative ,practice ,agreements1   
and ,standing ,orders4  7f7 ,indian     
tribe requirements ,the ,indian ,health 
,service1 in consultation with ,indian  
tribes1 shall determine any requirements
 that shall apply to ,indian tribes     
receiving opioid overdose reversal drug 
products made available under this      
section4  7g7 ,definitions ,for purposes
 of this section3 7#a7 ,career fire     
department ,the term career fire        
department means a fire department that 
has an all-paid force of firefighting   
personnel other than paid-on-call       
firefighters4  7#b7 ,collaborative      
practice agreement ,the term            
,collaborative ,practice ,agreement     
means an agreement under which a        
pharmacist operates under authority     

delegated by another licensed           
practitioner with prescribing authority4
  7#c7 ,combination fire department ,the
 term combination fire department means 
a fire department that has paid         
firefighting personnel and volunteer    
firefighting personnel4  7#d7 ,emergency
 medical service ,the term emergency    
medical service means resources used by 
a public or private nonprofit licensed  
entity to deliver medical care outside  
of a medical facility under emergency   
conditions that occur as a result of the
 condition of the patient and includes  
services delivered 7either on a         
compensated or volunteer basis7 by an   
emergency medical services provider or  
other provider that is licensed or      
certified by the ,state involved as an  
emergency medical technician1 a         
paramedic1 or an equivalent professional
 7as determined by the ,state74  7#e7   
,good ,samaritan ,law ,the term ,good   
,samaritan ,law means a law that        
provides criminal immunity for a person 

who administers an opioid overdose      
reversal drug product1 a person who1 in 
good faith1 seeks medical assistance for
 someone experiencing a drug-related    
overdose1 or a person who experiences a 
drug-related overdose and is in need of 
medical assistance and1 in good faith1  
seeks such medical assistance1 or is the
 subject of such a good faith request   
for medical assistance4  7#f7 ,indians  
,the terms ,indian1 ,indian tribe1      
tribal organization1 and ,urban ,indian 
,health ,program have the meanings given
 such terms in section #d of the ,indian
 ,health ,care ,improvement ,act4  7#g7 
,manufacturer ,the term manufacturer    
means any corporation1 organization1 or 
institution1 whether public or private  
7including ,federal1 ,state1 and local  
departments1 agencies1 and              
instrumentalities71 which manufactures1 
imports1 processes1 or distributes under
 its label any opioid overdose reversal 
drug product4 ,the term manufacture     
means to manufacture1 import1 process1  

or distribute an opioid overdose        
reversal drug4  7#h7 ,opioid overdose   
reversal drug product ,the term opioid  
overdose reversal drug product means a  
finished dosage form that has been      
approved by the ,food and ,drug         
,administration and that contains an    
active pharmaceutical ingredient that   
acts as an opioid receptor antagonist4  
,the term opioid overdose reversal drug 
product includes a combination product1 
as defined in section #c4b7;e7 of title 
#ba1 ,code of ,federal ,regulations4    
7#i7 ,standing order ,the term standing 
order means a non-patient-specific order
 covering administration of medication  
by others to a patient who may be       
unknown to the prescriber at the time of
 the order4  7#aj7 ,third party         
prescription ,the term third party      
prescription means an order written for 
medication dispensed to one person with 
the intention that it will be           
administered to another person4  7#aa7  
,volunteer fire department ,the term    

volunteer fire department means a fire  
department that has an all-volunteer    
force of firefighting personnel4  7h7   
,authorization of appropriations ,there 
is authorized to be appropriated to     
carry out this suction--  7#a7          
#ejj1jjj1jjj for fiscal year #bjai2     
7#b7 #ejj1jjj1jjj for fiscal year #bjbj2
  7#c7 #ejj1jjj1jjj for fiscal year     
#bjba2  7#d7 #ejj1jjj1jjj for fiscal    
year #bjbb2  7#e7 #ejj1jjj1jjj for      
fiscal year #bjbc2  7#f7 #ejj1jjj1jjj   
for fiscal year #bjbd2  7#g7            
#ejj1jjj1jjj for fiscal year #bjbe2     
7#h7 #ejj1jjj1jjj for fiscal year #bjbf2
  7#i7 #ejj1jjj1jjj for fiscal year     
#bjbg2 and  7#aj7 #ejj1jjj1jjj for      
fiscal year #bjbh4  #cdcf4 ,additional  
funding for the ,national ,institutes of
 ,health ,there is authorized to be     
appropriated to the ,national ,institute
 of ,health for the purpose of          
conducting research on addiction and    
pain related to substance misuse1       
including research to develop overdose  

reversal drug products1 non-addictive   
drug products for treating pain1 and    
drug products used to treat substance   
use disorder--  7#a7 #a1jjj1jjj1jjj for 
fiscal year #bjai2  7#b7 #a1jjj1jjj1jjj 
for fiscal year #bjbj2  7#c7            
#a1jjj1jjj1jjj for fiscal year #bjba2   
7#d7 #a1jjj1jjj1jjj for fiscal year     
#bjbb2  7#e7 #a1jjj1jjj1jjj for fiscal  
year #bjbc2  7#f7 #a1jjj1jjj1jjj for    
fiscal year #bjbd2  7#g7 #a1jjj1jjj1jjj 
for fiscal year #bjbe2  7#h7            
#a1jjj1jjj1jjj for fiscal year #bjbf2   
7#i7 #a1jjj1jjj1jjj for fiscal year     
#bjbg2 and  7#aj7 #a1jjj1jjj1jjj for    
fiscal year #bjbh4  #cdcg4 ,additional  
funding for improved data collection and
 prevention of infectious disease       
transmission  7a7 ,data collection ,the 
,centers for ,disease ,control and      
,prevention shall use a portion of the  
funding appropriated under this section 
to ensure that all ,states participate  
in the ,enhanced ,state ,opioid         
,overdose ,surveillance program and to  

provide technical assistance to medical 
examiners and coroners to facilitate    
improved data collection on fatal       
overdoses through such program4  7b7    
,centers for ,disease ,control and      
,prevention ,the ,centers for ,disease  
,control and ,prevention shall use      
amounts appropriated under this section 
for the purpose of improving data on    
drug overdose deaths and non-fatal drug 
overdoses1 surveillance related to      
addiction and substance use disorder1   
and the prevention of transmission of   
infectious diseases related to substance
 use4  7c7 ,tribal epidemiology centers 
,there shall be made available to the   
,indian ,health ,service for the purpose
 of funding efforts by tribal           
epidemiology centers to improve data on 
drug overdose deaths and non-fatal drug 
overdoses and surveillance related to   
addiction and substance use disorder1   
not less than #a4e percent of the total 
amount appropriated under this section  
for each fiscal year4  7d7              

,authorization of appropriations ,there 
is authorized to be appropriated to     
carry out this section-- 7#a7           
#djj1jjj1jjj for fiscal year #bjai2     
7#b7 #djj1jjj1jjj for fiscal year #bjbj2
  7#c7 #djj1jjj1jjj for fiscal year     
#bjba2  7#d7 #djj1jjj1jjj for fiscal    
year #bjbb2  7#e7 #djj1jjj1jjj for      
fiscal year #bjbc2  7#f7 #djj1jjj1jjj   
for fiscal year #bjbd2  7#g7            
#djj1jjj1jjj for fiscal year #bjbe2     
7#h7 #djj1jjj1jjj for fiscal year #bjbf2
  7#i7 #djj1jjj1jjj for fiscal year     
#bjbg2 and  7#aj7 #djj1jjj1jjj for      
fiscal year #bjbh4  #cdch4 ,definitions 
,in this title3  7#a7 ,planning council 
,the term planning council means the    
substance use planning council          
established under section #cdjb4  7#b7  
,recovery residence ,the term recovery  
residence means a residential dwelling  
unit1 or other form of group housing1   
that is offered or advertised through   
any means1 including oral1 written1     
electronic1 or printed means1 by any    

individual or entity as a residence that
 provides an evidence-based1            
peer-supported living environment for   
individuals undergoing any type of      
substance use disorder treatment or who 
have received any type of substance use 
disorder treatment in the past #c years1
 including medication-assisted          
treatment4  7#c7 ,state  7,a7 ,in       
general ,the term ,state means each of  
the #ej ,states1 the ,district of       
,columbia1 and each of the territories4 
7,b7 ,territories ,the term territory   
means each of ,american ,samoa1 ,guam1  
the ,commonwealth of ,puerto ,rico1 the 
,commonwealth of the ,northern ,mariana 
,islands1 the ,virgin ,islands1 the     
,republic of the ,marshall ,islands1 the
 ,federated ,states of ,micronesia1 and 
,palau4  7#d7 ,substance use disorder   
treatment  7,a7 ,in general ,the term   
substance use disorder treatment means  
an evidence-based1 professionally       
directed1 deliberate1 and planned       
regimen including evaluation1           

observation1 medical monitoring1 and    
rehabilitative services and             
interventions such as pharmacotherapy1  
behavioral therapy1 and individual and  
group counseling1 on an inpatient or    
outpatient basis1 to help patients with 
substance use disorder reach recovery4  
7,b7 ,types of treatment ,substance use 
disorder treatments shall include the   
following3 7i7 ,clinical stabilization  
services1 which are evidence-based      
services provided in secure1 acute care 
facilities 7which may be referred to as 
addictions receiving facilities7 that1  
at a minimum--  7,i7 provide            
detoxification and stabilization        
services2  7,,ii7 are operated #bd hours
 per day1 #g days per week2 and  7,,iii7
 that serve individuals found to be     
substance use impaired4 ,these can also 
be referred to as ,addictions receiving 
facilities4  7ii7 ,withdrawal management
 and detoxification1 which is a service 
that is provided on an inpatient or an  
outpatient basis to assist individuals  

manage the process of withdrawing from  
the physiological and psychological     
effects of substance use disorder4      
7iii7 ,intensive inpatient treatment1   
which is a service that provides a      
planned regimen of evidence-based       
evaluation1 observation1 medical        
monitoring1 and evidence-based          
rehabilitative services and             
interventions such as pharmacotherapy1  
behavioral therapy1 and counseling1 #bd 
hours per day1 #g days per week1 in a   
highly structured1 residential          
environment4  7iv7 ,intensive outpatient
 treatment1 which is a service that     
provides a planned regimen of           
evidence-based evaluation1 observation1 
medical monitoring1 and evidence-based  
rehabilitative services and             
interventions such as pharmacotherapy1  
behavioral therapy1 and counseling1 in a
 structured1 nonresidential environment 
at a higher level of intensity and      
duration than outpatient treatment4  7v7
 ,medication-assisted treatment1 which  

is a service that uses                  
,federally-approved medication as       
authorized by ,federal and ,state law1  
in combination with evidence-based      
medical1 rehabilitative1 and counseling 
services1 in the treatment of           
individuals who suffer from substance   
use disorder4  7vi7 ,outpatient         
treatment1 which is a service that      
provides a planned regimen of           
evidence-based evaluation1 observation1 
medical monitoring1 and evidence-based  
rehabilitative services and             
interventions such as pharmacotherapy1  
behavioral therapy1 and counseling in a 
structured1 nonresidential environment  
by appointment during scheduled         
operating hours4  7vii7 ,residential    
recovery treatment1 which is a service  
that provides a planned regimen of      
evidence-based evaluation1 observation1 
medical monitoring1 and evidence-based  
rehabilitative services and             
interventions such as pharmacotherapy1  
behavioral therapy1 and counseling      

provided in a structured1 live-in       
environment within a nonhospital setting
 on a #bd-;hours-per-day1               
#g-;days-per-week basis4  7,c7          
,limitation ,substance use disorder     
treatment providers shall not include-- 
7i7 prevention only providers2 and  7ii7
 a private practitioner who is licensed 
by a ,state medical licensing board and 
whose practice is limited to outpatient 
care4  7#e7 ,substance use disorder     
treatment services ,the term substance  
use disorder treatment services means   
any prevention services1 core medical   
services1 recovery and support services1
 early intervention and engagement      
services1 and harm reduction services   
authorized under this title4  4  #d4    
,amendments to the ,controlled          
,substances ,act  7a7 ,certifications   
,part ,c of the ,controlled ,substances 
,act 7#ba ,u4,s4,c4 #hba et seq47 is    
amended by adding at the end the        
following3  #cab4 ,certifications       
relating to diversion controls and      

misbranding  7a7 ,definitions ,in this  
section-- 7#a7 the term covered         
dispenser--  7,a7 means a dispenser--   
7i7 that is required to register under  
section #cjb7;a77#b72 and  7ii7         
dispenses a controlled substance in     
schedule ,,ii2 and  7,b7 does not       
include a dispenser that is--  7i7      
registered to dispense opioid agonist   
treatment medication under section      
#cjc7;g77#a72 and  7ii7 operating in    
that capacity2  7#b7 the term covered   
distributor means a distributor-- 7,a7  
that is required to register under      
section #cjb7;a77#a72 and  7,b7         
distributes a controlled substance in   
schedule ,,ii2  7#c7 the term covered   
manufacturer means a manufacturer--     
7,a7 that is required to register under 
section #cjb7;a77#a72 and  7,b7         
manufactures a controlled substance in  
schedule ,,ii2  7#d7 the term covered   
officer1 with respect to a covered      
person means-- 7,a7 in the case of a    
covered person that is not an           

individual--  7i7 the chief executive   
officer of the covered person2  7ii7 the
 president of the covered person2  7iii7
 the chief medical officer of the       
covered person2 and  7iv7 the chief     
counsel of the covered person2 and  7,b7
 in the case of a covered person that is
 an individual1 that individual2 and    
7#e7 the term covered person means a    
covered dispenser1 a covered            
distributor1 or a covered manufacturer4 
7b7 ,certifications relating to         
diversion controls ,not later than #ahj 
days after the date of enactment of this
 section1 and each year thereafter1 each
 covered officer of a covered person    
shall submit to the ,attorney ,general1 
for each controlled substance in        
schedule ,,ii dispensed1 distributed1 or
 manufactured by the covered person1 a  
certification--  7#a7 signed by the     
covered officer2 and  7#b7 certifying   
that--  7,a7 the covered person         
maintains effective controls against    
diversion of the controlled substance   

into channels other than legitimate     
medical1 scientific1 research1 or       
industrial channels2  7,b7 all          
information contained in any record1    
inventory1 or report required to be kept
 or submitted to the ,attorney ,general 
by the covered person under section     
#cjg1 or under any regulation issued    
under that section1 is accurate2 and    
7,c7 the covered person is in compliance
 with all applicable requirements under 
,federal law relating to reporting      
suspicious orders for controlled        
substances4  7c7 ,certifications        
relating to misbranding ,not later than 
#ahj days after the date of enactment of
 this section1 and each year thereafter1
 each covered officer of a covered      
manufacturer shall submit to the        
,attorney ,general1 for each controlled 
substance in schedule ,,ii manufactured 
by the covered manufacturer1 a          
certification--  7#a7 signed by the     
covered officer2 and  7#b7 certifying   
that the controlled substance is not    

misbranded1 as described in section #ejb
 of the ,federal ,food1 ,drug1 and      
,cosmetic ,act 7#ba ,u4,s4,c4 #ceb74  4 
7b7 ,offenses ,part ,d of title ,,ii of 
the ,controlled ,substances ,act 7#ba   
,u4,s4,c4 #hda et seq47 is amended by   
adding at the end the following3  #dbd4 
,certifications by covered officers  7a7
 ,definitions ,in this section1 the     
terms covered dispenser1 covered        
distributor1 covered manufacturer1      
covered officer1 and covered person have
 the meanings given those terms in      
section #cab4  7b7 ,offenses  7#a7      
,failure to submit certifications  7,a7 
,certifications relating to diversion   
controls ,it shall be unlawful for a    
covered officer of a covered person to  
fail to submit a certification required 
under section #cab7;b71 without regard  
to the state of mind of the covered     
officer4  7,b7 ,certifications relating 
to misbranding ,it shall be unlawful for
 a covered officer of a covered         
manufacturer to fail to submit a        

certification required under section    
#cab7;c71 without regard to the state of
 mind of the covered officer4  7#b7     
,submission of false certifications     
7,a7 ,false certifications relating to  
diversion controls ,it shall be unlawful
 for a covered officer of a covered     
person to submit a certification        
required under section #cab7;b71 without
 regard to the state of mind of the     
covered officer1 that contains a        
materially false statement or           
representation relating to the          
information required to be certified    
under that section for the year for     
which the certification is submitted4   
7,b7 ,false certifications relating to  
misbranding ,it shall be unlawful for a 
covered officer of a covered            
manufacturer to submit a certification  
required under section #cab7;c71 without
 regard to the state of mind of the     
covered officer1 that contains a        
materially false statement or           
representation relating to the          

misbranding of a controlled substance   
with respect to the year for which the  
certification is submitted4  7c7        
,penalties  7#a7 ,civil penalties       
,except as provided in paragraph 7#b71 a
 covered officer who violates subsection
 7b7 shall be subject to a civil penalty
 of not more than #be1jjj4  7#b7        
,criminal penalties ,a covered officer  
who knowingly violates subsection       
7b77#b7 shall be subject to criminal    
penalties under section #djc7;d74  7d7  
,comprehensive ,addiction ,resources    
,fund  7#a7 ,establishment ,there is    
established in the ,treasury a fund to  
be known as the ,comprehensive          
,addiction ,resources ,fund4  7#b7      
,transfer of amounts ,there shall be    
transferred to the ,comprehensive       
,addiction ,resources ,fund #ajj percent
 of--  7,a7 any civil penalty paid to   
the ,united ,states under this section2 
and  7,b7 any fine paid to the ,united  
,states under section #djc7;d7 for a    
knowing violation of subsection 7b77#b7 

of this section4  7#c7 ,availability and
 use of funds ,amounts transferred to   
the ,comprehensive ,addiction ,fund     
under paragraph 7#b7 shall-- 7,a7 remain
 available until expended2 and  7,b7 be 
made available to supplement amounts    
appropriated to carry out title ,,xxxiv 
of the ,public ,health ,service ,act4  4
  7c7 ,criminal penalties ,section #djc 
of the ,controlled ,substances ,act 7#ba
 ,u4,s4,c4 #hdc7 is amended-- 7#a7 in   
subsection 7d77#a7--  7,a7 by inserting 
or knowingly violates section           
#dbd7;b77#b7 after any person who       
violates this section2 and  7,b7 by     
striking violation of this section and  
inserting such a violation2 and  7#b7 in
 subsection 7f7-- 7,a7 in paragraph     
7#a71 by striking or #daf and inserting 
or section #daf1 or knowing violations  
of section #dbd7;b77#b72 and  7,b7 in   
paragraph 7#c71 by inserting or knowing 
violations of section #dbd7;b77#b7      
before the period at the end4  7d7      
,technical and conforming amendments    

,the table of contents for the          
,comprehensive ,drug ,abuse ,prevention 
and ,control ,act of #aigj 7,public ,law
 #ia-eac2 #hd ,stat4 #abcf7 is amended--
  7#a7 by inserting after the item      
relating to section #caa the following3 
,sec4 #cab4 ,certifications relating to 
diversion controls and misbranding4  2  
and  7#b7 by inserting after the item   
relating to section #dbc the following3 
,sec4 #dbd4 ,certifications by covered  
officers4  4  7e7 ,effective date ,the  
amendments made by subsections 7b7 and  
7c7 of this section shall take effect on
 the date that is #ahj days after the   
date of enactment of this ,act4