#aaeth ,,congress #b;d ,session ,in the ,house of ,representatives1 ,u4 ,s41 ,september #bh1 #bjah ,,house ,,amendment ,,to ,,senate ,,amendment3 ,that the ,house agree to the amendment of the ,senate to the bill 7,h4,r4 #f7 entitled ,an ,act to provide for opioid use disorder prevention1 recovery1 and treatment1 and for other purposes41 with the following ,in lieu of the matter proposed to be inserted by the ,senate amendment1 insert the following #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,substance ,use-,disorder ,prevention that ,promotes ,opioid ,recovery and ,treatment for ,patients and ,communities ,act or the ,,support for ,patients and ,communities ,act4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,title ,i--,medicaid ,provisions to ,address the ,opioid ,crisis ,sec4 #ajja4 ,at-risk youth ,medicaid protection4 ,sec4 #ajjb4 ,health insurance for former foster youth4 ,sec4 #ajjc4 ,demonstration project to increase substance use provider capacity under the ,medicaid program4 ,sec4 #ajjd4 ,medicaid drug review and utilization4 ,sec4 #ajje4 ,guidance to improve care for infants with neonatal abstinence syndrome and their mothers2 ,,gao study on gaps in ,medicaid coverage for pregnant and postpartum women with substance use disorder4 ,sec4 #ajjf4 ,medicaid health homes for substance-use-disorder ,medicaid enrollees4 ,sec4 #ajjg4 ,caring recovery for infants and babies4 ,sec4 #ajjh4 ,peer support enhancement and evaluation review4 ,sec4 #ajji4 ,medicaid substance use disorder treatment via telehealth4 ,sec4 #ajaj4 ,enhancing patient access to non-opioid treatment options4 ,sec4 #ajaa4 ,assessing barriers to opioid use disorder treatment4 ,sec4 #ajab4 ,help for moms and babies4 ,sec4 #ajac4 ,securing flexibility to treat substance use disorders4 ,sec4 #ajad4 ,,macpac study and report on ,,mat utilization controls under ,state ,medicaid programs4 ,sec4 #ajae4 ,opioid addiction treatment programs enhancement4 ,sec4 #ajaf4 ,better data sharing to combat the opioid crisis4 ,sec4 #ajag4 ,report on innovative ,state initiatives and strategies to provide housing-related services and supports to individuals struggling with substance use disorders under ,medicaid4 ,sec4 #ajah4 ,technical assistance and support for innovative ,state strategies to provide housing-related supports under ,medicaid4 ,title ,,ii--,medicare ,provisions to ,address the ,opioid ,crisis ,sec4 #bjja4 ,expanding the use of telehealth services for the treatment of opioid use disorder and other substance use disorders4 ,sec4 #bjjb4 ,comprehensive screenings for seniors4 ,sec4 #bjjc4 ,every prescription conveyed securely4 ,sec4 #bjjd4 ,requiring prescription drug plan sponsors under ,medicare to establish drug management programs for at-risk beneficiaries4 ,sec4 #bjje4 ,medicare coverage of certain services furnished by opioid treatment programs4 ,sec4 #bjjf4 ,encouraging appropriate prescribing under ,medicare for victims of opioid overdose4 ,sec4 #bjjg4 ,automatic escalation to external review under a ,medicare part ,d drug management program for at-risk beneficiaries4 ,sec4 #bjjh4 ,suspension of payments by ,medicare prescription drug plans and ,,ma-,,pd plans pending investigations of credible allegations of fraud by pharmacies4 ,title ,,iii--,,fda and ,controlled ,substance ,provisions ,subtitle ,a--,,fda provisions ,chapter #a--;,in general ,sec4 #cjja4 ,clarifying ,,fda regulation of non-addictive pain products4 ,sec4 #cjjb4 ,evidence-based opioid analgesic prescribing guidelines and report4 ,chapter #b--,stop ,counterfeit ,drugs by ,regulating and ,enhancing ,enforcement ,now ,sec4 #cjaa4 ,short title4 ,sec4 #cjab4 ,notification1 nondistribution1 and recall of controlled substances4 ,sec4 #cjac4 ,single source pattern of imported illegal drugs4 ,sec4 #cjad4 ,strengthening ,,fda and ,,cbp coordination and capacity4 ,chapter #c--,stop ,illicit ,drug ,importation ,sec4 #cjba4 ,short title4 ,sec4 #cjbb4 ,restricting entrance of illicit drugs4 ,chapter #d--,securing ,opioids and ,unused ,narcotics with ,deliberate ,disposal and ,packaging ,sec4 #cjca4 ,short title4 ,sec4 #cjcb4 ,safety-enhancing packaging and disposal features4 ,chapter #e--,postapproval study requirements ,sec4 #cjda4 ,clarifying ,,fda postmarket authorities4 ,subtitle ,b--,controlled substance provisions ,chapter #a--,more flexibility with respect to medication-,assisted treatment for opioid use disorders ,sec4 #cbja4 ,allowing for more flexibility with respect to medication-assisted treatment for opioid use disorders4 ,sec4 #cbjb4 ,medication-assisted treatment for recovery from substance use disorder4 ,sec4 #cbjc4 ,grants to enhance access to substance use disorder treatment4 ,sec4 #cbjd4 ,delivery of a controlled substance by a pharmacy to be administered by injection or implantation4 ,chapter #b--;,empowering ,pharmacists in the ,fight ,against ,opioid ,abuse ,sec4 #cbaa4 ,short title4 ,sec4 #cbab4 ,programs and materials for training on certain circumstances under which a pharmacist may decline to fill a prescription4 ,chapter #c--,safe ,disposal of ,unused ,medication ,sec4 #cbba4 ,short title4 ,sec4 #cbbb4 ,disposal of controlled substances of a hospice patient by employees of a qualified hospice program4 ,sec4 #cbbc4 ,,gao study and report on hospice safe drug management4 ,chapter #d--,special ,registration for ,telemedicine ,clarification ,sec4 #cbca4 ,short title4 ,sec4 #cbcb4 ,regulations relating to a special registration for telemedicine4 ,chapter #e--,synthetic ,abuse and ,labeling of ,toxic ,substances ,sec4 #cbda4 ,controlled substance analogues4 ,chapter #f--;,access to ,increased ,drug ,disposal ,sec4 #cbea4 ,short title4 ,sec4 #cbeb4 ,definitions4 ,sec4 #cbec4 ,authority to make grants4 ,sec4 #cbed4 ,application4 ,sec4 #cbee4 ,use of grant funds4 ,sec4 #cbef4 ,eligibility for grant4 ,sec4 #cbeg4 ,duration of grants4 ,sec4 #cbeh4 ,accountability and oversight4 ,sec4 #cbei4 ,duration of program4 ,sec4 #cbfj4 ,authorization of appropriations4 ,chapter #g--,using ,data ,to ,prevent ,opioid ,diversion ,sec4 #cbga4 ,short title4 ,sec4 #cbgb4 ,purpose4 ,sec4 #cbgc4 ,amendments4 ,sec4 #cbgd4 ,report4 ,chapter #h--,opioid ,quota ,reform ,sec4 #cbha4 ,short title4 ,sec4 #cbhb4 ,strengthening considerations for ,,dea opioid quotas4 ,chapter #i--,preventing ,drug ,diversion ,sec4 #cbia4 ,short title4 ,sec4 #cbib4 ,improvements to prevent drug diversion4 ,title ,,iv--,offsets ,sec4 #djja4 ,promoting value in ,medicaid managed care4 ,sec4 #djjb4 ,requiring reporting by group health plans of prescription drug coverage information for purposes of identifying primary payer situations under the ,medicare program4 ,sec4 #djjc4 ,additional religious exemption from health coverage responsibility requirement4 ,sec4 #djjd4 ,modernizing the reporting of biological and biosimilar products4 ,title ,v--,other ,medicaid ,provisions ,subtitle ,a--,mandatory reporting with respect to adult behavioral health measures ,sec4 #ejja4 ,mandatory reporting with respect to adult behavioral health measures4 ,subtitle ,b--,medicaid ,,imd ,additional ,info ,sec4 #ejaa4 ,short title4 ,sec4 #ejab4 ,,macpac exploratory study and report on institutions for mental diseases requirements and practices under ,medicaid4 ,subtitle ,c--,,chip ,mental ,health and ,substance ,use ,disorder ,parity ,sec4 #ejba4 ,short title4 ,sec4 #ejbb4 ,ensuring access to mental health and substance use disorder services for children and pregnant women under the ,children's ,health ,insurance ,program4 ,subtitle ,d--,medicaid ,reentry ,sec4 #ejca4 ,short title4 ,sec4 #ejcb4 ,promoting ,state innovations to ease transitions integration to the community for certain individuals4 ,subtitle ,e--,medicaid ,partnership ,sec4 #ejda4 ,short title4 ,sec4 #ejdb4 ,medicaid providers are required to note experiences in record systems to help in-need patients4 ,subtitle ,f--,,imd ,,care ,act ,sec4 #ejea4 ,short title4 ,sec4 #ejeb4 ,state option to provide ,medicaid coverage for certain individuals with substance use disorders who are patients in certain institutions for mental diseases4 ,subtitle ,g--,medicaid ,improvement ,fund ,sec4 #ejfa4 ,medicaid ,improvement ,fund4 ,title ,,vi--,other ,medicare ,provisions ,subtitle ,a--,testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology ,sec4 #fjja4 ,testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology4 ,subtitle ,b--,abuse ,deterrent ,access ,sec4 #fjaa4 ,short title4 ,sec4 #fjab4 ,study on abuse-deterrent opioid formulations access barriers under ,medicare4 ,subtitle ,c--,medicare ,opioid ,safety ,education ,sec4 #fjba4 ,medicare opioid safety education4 ,subtitle ,d--,opioid ,addiction ,action ,plan ,sec4 #fjca4 ,short title4 ,sec4 #fjcb4 ,action plan on recommendations for changes under ,medicare and ,medicaid to prevent opioids addictions and enhance access to medication-assisted treatment4 ,subtitle ,e--,advancing ,high ,quality ,treatment for ,opioid ,use ,disorders in ,medicare ,sec4 #fjda4 ,short title4 ,sec4 #fjdb4 ,opioid use disorder treatment demonstration program4 ,subtitle ,f--,responsible ,education ,achieves ,care and ,healthy ,outcomes for ,users' ,treatment ,sec4 #fjea4 ,short title4 ,sec4 #fjeb4 ,grants to provide technical assistance to outlier prescribers of opioids4 ,subtitle ,g--,preventing ,addiction for ,susceptible ,seniors ,sec4 #fjfa4 ,short title4 ,sec4 #fjfb4 ,electronic prior authorization for covered part ,d drugs4 ,sec4 #fjfc4 ,program integrity transparency measures under ,medicare parts ,c and ,d4 ,sec4 #fjfd4 ,expanding eligibility for medication therapy management programs under part ,d4 ,sec4 #fjfe4 ,commit to opioid medical prescriber accountability and safety for seniors4 ,sec4 #fjff4 ,no additional funds authorized4 ,subtitle ,h--,expanding ,oversight of ,opioid ,prescribing and ,payment ,sec4 #fjga4 ,short title4 ,sec4 #fjgb4 ,medicare ,payment ,advisory ,commission report on opioid payment1 adverse incentives1 and data under the ,medicare program4 ,sec4 #fjgc4 ,no additional funds authorized4 ,subtitle ,i--,dr4 ,todd ,graham ,pain ,management1 ,treatment1 and ,recovery ,sec4 #fjha4 ,short title4 ,sec4 #fjhb4 ,review and adjustment of payments under the ,medicare outpatient prospective payment system to avoid financial incentives to use opioids instead of non-opioid alternative treatments4 ,sec4 #fjhc4 ,expanding access under the ,medicare program to addiction treatment in ,federally qualified health centers and rural health clinics4 ,sec4 #fjhd4 ,studying the availability of supplemental benefits designed to treat or prevent substance use disorders under ,medicare ,advantage plans4 ,sec4 #fjhe4 ,clinical psychologist services models under the ,center for ,medicare and ,medicaid ,innovation2 ,,gao study and report4 ,sec4 #fjhf4 ,dr4 ,todd ,graham pain management study4 ,subtitle ,j--,combating ,opioid ,abuse for ,care in ,hospitals ,sec4 #fjia4 ,short title4 ,sec4 #fjib4 ,developing guidance on pain management and opioid use disorder prevention for hospitals receiving payment under part ,a of the ,medicare program4 ,sec4 #fjic4 ,requiring the review of quality measures relating to opioids and opioid use disorder treatments furnished under the medicare program and other federal health care programs4 ,sec4 #fjid4 ,technical expert panel on reducing surgical setting opioid use2 ,data collection on perioperative opioid use4 ,sec4 #fjie4 ,requiring the posting and periodic update of opioid prescribing guidance for ,medicare beneficiaries4 ,subtitle ,k--,providing ,reliable ,options for ,patients and ,educational ,resources ,sec4 #faja4 ,short title4 ,sec4 #fajb4 ,requiring ,medicare ,advantage plans and part ,d prescription drug plans to include information on risks associated with opioids and coverage of nonpharmacological therapies and nonopioid medications or devices used to treat pain4 ,sec4 #fajc4 ,requiring ,medicare ,advantage plans and prescription drug plans to provide information on the safe disposal of prescription drugs4 ,sec4 #fajd4 ,revising measures used under the ,hospital ,consumer ,assessment of ,healthcare ,providers and ,systems survey relating to pain management4 ,subtitle ,l--,fighting the ,opioid ,epidemic ,with ,sunshine ,sec4 #faaa4 ,fighting the opioid epidemic with sunshine4 ,title ,,vii--,public ,health ,provisions ,subtitle ,a--,awareness and training ,sec4 #gjja4 ,report on effects on public health of synthetic drug use4 ,sec4 #gjjb4 ,first responder training4 ,subtitle ,b--,pilot program for public health laboratories ,to detect fentanyl and other synthetic opioids ,sec4 #gjaa4 ,pilot program for public health laboratories to detect fentanyl and other synthetic opioids4 ,subtitle ,c--,indexing ,narcotics1 ,fentanyl1 and ,opioids ,sec4 #gjba4 ,establishment of substance use disorder information dashboard4 ,sec4 #gjbb4 ,interdepartmental ,substance ,use ,disorders ,coordinating ,committee4 ,sec4 #gjbc4 ,national milestones to measure success in curtailing the opioid crisis4 ,sec4 #gjbd4 ,study on prescribing limits4 ,subtitle ,d--,ensuring ,access to ,quality ,sober ,living ,sec4 #gjca4 ,national recovery housing best practices4 ,subtitle ,e--,advancing ,cutting ,edge ,research ,sec4 #gjda4 ,unique research initiatives4 ,sec4 #gjdb4 ,pain research4 ,subtitle ,f--,jessie's ,law ,sec4 #gjea4 ,inclusion of opioid addiction history in patient records4 ,sec4 #gjeb4 ,communication with families during emergencies4 ,sec4 #gjec4 ,development and dissemination of model training programs for substance use disorder patient records4 ,subtitle ,g--,protecting ,pregnant ,women and ,infants ,sec4 #gjfa4 ,report on addressing maternal and infant health in the opioid crisis4 ,sec4 #gjfb4 ,protecting moms and infants4 ,sec4 #gjfc4 ,early interventions for pregnant women and infants4 ,sec4 #gjfd4 ,prenatal and postnatal health4 ,sec4 #gjfe4 ,plans of safe care4 ,subtitle ,h--,substance ,use ,disorder ,treatment ,workforce ,sec4 #gjga4 ,loan repayment program for substance use disorder treatment workforce4 ,sec4 #gjgb4 ,clarification regarding service in schools and other community-based settings4 ,sec4 #gjgc4 ,programs for health care workforce4 ,subtitle ,i--,preventing ,overdoses ,while in ,emergency ,rooms ,sec4 #gjha4 ,program to support coordination and continuation of care for drug overdose patients4 ,subtitle ,j--,alternatives to ,opioids in the ,emergency ,department ,sec4 #gjia4 ,emergency department alternatives to opioids demonstration program4 ,subtitle ,k--,treatment1 ,education1 and ,community ,help ,to ,combat ,addiction ,sec4 #gaja4 ,establishment of regional centers of excellence in substance use disorder education4 ,sec4 #gajb4 ,youth prevention and recovery4 ,subtitle ,l--,information from ,national ,mental ,health and ,substance ,use ,policy ,laboratory ,sec4 #gaaa4 ,information from ,national ,mental ,health and ,substance ,use ,policy ,laboratory4 ,subtitle ,m--,comprehensive ,opioid ,recovery ,centers ,sec4 #gaba4 ,comprehensive opioid recovery centers4 ,subtitle ,n--,trauma-,informed ,care ,sec4 #gaca4 ,,cdc surveillance and data collection for child1 youth1 and adult trauma4 ,sec4 #gacb4 ,task force to develop best practices for trauma-informed identification1 referral1 and support4 ,sec4 #gacc4 ,national ,child ,traumatic ,stress ,initiative4 ,sec4 #gacd4 ,grants to improve trauma support services and mental health care for children and youth in educational settings4 ,sec4 #gace4 ,recognizing early childhood trauma related to substance abuse4 ,subtitle ,o--,eliminating ,opioid ,related ,infectious ,diseases ,sec4 #gada4 ,reauthorization and expansion of program of surveillance and education regarding infections associated with illicit drug use and other risk factors4 ,subtitle ,p--,peer ,support ,communities of ,recovery ,sec4 #gaea4 ,building communities of recovery4 ,sec4 #gaeb4 ,peer support technical assistance center4 ,subtitle ,q--,creating ,opportunities that ,necessitate ,new and ,enhanced ,connections ,that ,improve ,opioid ,navigation ,strategies ,sec4 #gafa4 ,preventing overdoses of controlled substances4 ,sec4 #gafb4 ,prescription drug monitoring program4 ,subtitle ,r--,review of substance use disorder treatment providers receiving ,federal funding ,sec4 #gaga4 ,review of substance use disorder treatment providers receiving ,federal funding4 ,subtitle ,s--,other health provisions ,sec4 #gaha4 ,state response to the opioid abuse crisis4 ,sec4 #gahb4 ,report on investigations regarding parity in mental health and substance use disorder benefits4 ,sec4 #gahc4 ,,career ,act4 ,title ,,viii--,miscellaneous ,subtitle ,a--,synthetics ,trafficking and ,overdose ,prevention ,sec4 #hjja4 ,short title4 ,sec4 #hjjb4 ,customs fees4 ,sec4 #hjjc4 ,mandatory advance electronic information for postal shipments4 ,sec4 #hjjd4 ,international postal agreements4 ,sec4 #hjje4 ,cost recoupment4 ,sec4 #hjjf4 ,development of technology to detect illicit narcotics4 ,sec4 #hjjg4 ,civil penalties for postal shipments4 ,sec4 #hjjh4 ,report on violations of arrival1 reporting1 entry1 and clearance requirements and falsity or lack of manifest4 ,sec4 #hjji4 ,effective date2 regulations4 ,subtitle ,b--,opioid ,addiction ,recovery ,fraud ,prevention ,sec4 #hjba4 ,short title4 ,sec4 #hjbb4 ,definitions4 ,sec4 #hjbc4 ,unfair or deceptive acts or practices with respect to substance use disorder treatment service and products4 ,subtitle ,c--,addressing economic and workforce impacts of the opioid crisis ,sec4 #hjda4 ,addressing economic and workforce impacts of the opioid crisis4 ,subtitle ,d--,peer support counseling program for women veterans ,sec4 #hjea4 ,peer support counseling program for women veterans4 ,subtitle ,e--,treating ,barriers to ,prosperity ,sec4 #hjfa4 ,short title4 ,sec4 #hjfb4 ,drug abuse mitigation initiative4 ,subtitle ,f--,pilot program to help individuals in recovery from a substance use disorder become stably housed ,sec4 #hjga4 ,pilot program to help individuals in recovery from a substance use disorder become stably housed4 ,subtitle ,g--,human ,services ,sec4 #hjha4 ,supporting family-focused residential treatment4 ,sec4 #hjhb4 ,improving recovery and reunifying families4 ,sec4 #hjhc4 ,building capacity for family-focused residential treatment4 ,subtitle ,h--,reauthorizing and ,extending ,grants for ,recovery from ,opioid ,use ,programs ,sec4 #hjia4 ,short title4 ,sec4 #hjib4 ,reauthorization of the comprehensive opioid abuse grant program4 ,subtitle ,i--,fighting ,opioid ,abuse in ,transportation ,sec4 #haja4 ,short title4 ,sec4 #hajb4 ,alcohol and controlled substance testing of mechanical employees4 ,sec4 #hajc4 ,department of ,transportation public drug and alcohol testing database4 ,sec4 #hajd4 ,,gao report on ,department of ,transportation's collection and use of drug and alcohol testing data4 ,sec4 #haje4 ,transportation ,workplace ,drug and ,alcohol ,testing ,program2 addition of fentanyl and other substances4 ,sec4 #hajf4 ,status reports on hair testing guidelines4 ,sec4 #hajg4 ,mandatory ,guidelines for ,federal ,workplace ,drug ,testing ,programs using ,oral ,fluid4 ,sec4 #hajh4 ,electronic recordkeeping4 ,sec4 #haji4 ,status reports on ,commercial ,driver's ,license ,drug and ,alcohol ,clearinghouse4 ,subtitle ,j--,eliminating ,kickbacks in ,recovery ,sec4 #haba4 ,short title4 ,sec4 #habb4 ,criminal penalties4 ,subtitle ,k--,substance ,abuse ,prevention ,sec4 #hbja4 ,short title4 ,sec4 #hbjb4 ,reauthorization of the ,office of ,national ,drug ,control ,policy4 ,sec4 #hbjc4 ,reauthorization of the ,drug-,free ,communities ,program4 ,sec4 #hbjd4 ,reauthorization of the ,national ,community ,anti-,drug ,coalition ,institute4 ,sec4 #hbje4 ,reauthorization of the ,high-,intensity ,drug ,trafficking ,area ,program4 ,sec4 #hbjf4 ,reauthorization of drug court program4 ,sec4 #hbjg4 ,drug court training and technical assistance4 ,sec4 #hbjh4 ,drug overdose response strategy4 ,sec4 #hbji4 ,protecting law enforcement officers from accidental exposure4 ,sec4 #hbaj4 ,,cops ,anti-,meth ,program4 ,sec4 #hbaa4 ,,cops anti-heroin task force program4 ,sec4 #hbab4 ,comprehensive ,addiction and ,recovery ,act education and awareness4 ,sec4 #hbac4 ,reimbursement of substance use disorder treatment professionals4 ,sec4 #hbad4 ,sobriety ,treatment and ,recovery ,teams 7,,start74 ,sec4 #hbae4 ,provider education4 ,sec4 #hbaf4 ,definitions4 ,sec4 #hbag4 ,amendments to administration of the ,office4 ,sec4 #hbah4 ,emerging threats committee1 plan1 and media campaign4 ,sec4 #hbai4 ,drug interdiction4 ,sec4 #hbbj4 ,,gao ,audit4 ,sec4 #hbba4 ,national ,drug ,control ,strategy4 ,sec4 #hbbb4 ,technical and conforming amendments to the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih4 ,subtitle ,l--,budgetary effects ,sec4 #hbca4 ,budgetary effect4 ,i ,medicaid ,provisions to ,address the ,opioid ,crisis #ajja4 ,at-risk youth ,medicaid protection 7a7 ,in general ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking and at the end of paragraph 7#hb72 7,b7 by striking the period at the end of paragraph 7#hc7 and inserting 2 and2 and 7,c7 by inserting after paragraph 7#hc7 the following new paragraph3 7#hd7 provide that-- 7,a7 the ,state shall not terminate eligibility for medical assistance under the ,state plan for an individual who is an eligible juvenile 7as defined in subsection 7nn77#b77 because the juvenile is an inmate of a public institution 7as defined in subsection 7nn77#c771 but may suspend coverage during the period the juvenile is such an inmate2 7,b7 in the case of an individual who is an eligible juvenile described in paragraph 7#b77;,a7 of subsection 7nn71 the ,state shall1 prior to the individual's release from such a public institution1 conduct a redetermination of eligibility for such individual with respect to such medical assistance 7without requiring a new application from the individual7 and1 if the ,state determines pursuant to such redetermination that the individual continues to meet the eligibility requirements for such medical assistance1 the ,state shall restore coverage for such medical assistance to such an individual upon the individual's release from such public institution2 and 7,c7 in the case of an individual who is an eligible juvenile described in paragraph 7#b77;,b7 of subsection 7nn71 the ,state shall process any application for medical assistance submitted by1 or on behalf of1 such individual such that the ,state makes a determination of eligibility for such individual with respect to such medical assistance upon release of such individual from such public institution4 2 and 7#b7 by adding at the end the following new subsection3 7nn7 ,juvenile2 eligible juvenile2 public institution ,for purposes of subsection 7a77#hd7 and this subsection3 7#a7 ,juvenile ,the term juvenile means an individual who is-- 7,a7 under #ba years of age2 or 7,b7 described in subsection 7a77#aj77;,a77i77,,ix74 7#b7 ,eligible juvenile ,the term eligible juvenile means a juvenile who is an inmate of a public institution and who-- 7,a7 was determined eligible for medical assistance under the ,state plan immediately before becoming an inmate of such a public institution2 or 7,b7 is determined eligible for such medical assistance while an inmate of a public institution4 7#c7 ,inmate of a public institution ,the term inmate of a public institution has the meaning given such term for purposes of applying the subdivision 7,a7 following paragraph 7#cj7 of section #aije7;a71 taking into account the exception in such subdivision for a patient of a medical institution4 4 7b7 ,no change in exclusion from medical assistance for inmates of public institutions ,nothing in this section shall be construed as changing the exclusion from medical assistance under the subdivision 7,a7 following paragraph 7#cj7 of section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a771 as redesignated by section #ajjf7;b77#b77;,b7 of this ,act1 including any applicable restrictions on a ,state submitting claims for ,federal financial participation under title ,,xix of such ,act for such assistance4 7c7 ,no change in continuity of eligibility before adjudication or sentencing ,nothing in this section shall be construed to mandate1 encourage1 or suggest that a ,state suspend or terminate coverage for individuals before they have been adjudicated or sentenced4 7d7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by subsection 7a7 shall apply to eligibility of juveniles who become inmates of public institutions on or after the date that is #a year after the date of the enactment of this ,act4 7#b7 ,rule for changes requiring state legislation ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendments made by subsection 7a71 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #ajjb4 ,health insurance for former foster youth 7a7 ,coverage continuity for former foster care children up to age #bf 7#a7 ,in general ,section #aijb7;a77#aj77;,a77i77,,ix7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,ix77 is amended-- 7,a7 in item 7bb71 by striking are not described in or enrolled under and inserting are not described in and are not enrolled under2 7,b7 in item 7cc71 by striking responsibility of the ,state and inserting responsibility of a ,state2 and 7,c7 in item 7dd71 by striking the ,state plan under this title or under a waiver of the and inserting a ,state plan under this title or under a waiver of such a4 7#b7 ,effective date ,the amendments made by this subsection shall take effect with respect to foster youth who attain #ah years of age on or after ,january #a1 #bjbc4 7b7 ,guidance ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue guidance to ,states1 with respect to the ,state ,medicaid programs of such ,states-- 7#a7 on best practices for-- 7,a7 removing barriers and ensuring streamlined1 timely access to ,medicaid coverage for former foster youth up to age #bf2 and 7,b7 conducting outreach and raising awareness among such youth regarding ,medicaid coverage options for such youth2 and 7#b7 which shall include examples of ,states that have successfully extended ,medicaid coverage to former foster youth up to age #bf4 #ajjc4 ,demonstration project to increase substance use provider capacity under the ,medicaid program ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by adding at the end the following new subsection3 7aa7 ,demonstration project ,to increase substance use provider capacity 7#a7 ,in general ,not later than the date that is #ahj days after the date of the enactment of this subsection1 the ,secretary shall1 in consultation1 as appropriate1 with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 conduct a #ed-month demonstration project for the purpose described in paragraph 7#b7 under which the ,secretary shall-- 7,a7 for the first #ah-month period of such project1 award planning grants described in paragraph 7#c72 and 7,b7 for the remaining #cf-month period of such project1 provide to each ,state selected under paragraph 7#d7 payments in accordance with paragraph 7#e74 7#b7 ,purpose ,the purpose described in this paragraph is for each ,state selected under paragraph 7#d7 to increase the treatment capacity of providers participating under the ,state plan 7or a waiver of such plan7 to provide substance use disorder treatment or recovery services under such plan 7or waiver7 through the following activities3 7,a7 ,for the purpose described in paragraph 7#c77;,c77i71 activities that support an ongoing assessment of the behavioral health treatment needs of the ,state1 taking into account the matters described in subclauses 7,i7 through 7,,iv7 of such paragraph4 7,b7 ,activities that1 taking into account the results of the assessment described in subparagraph 7,a71 support the recruitment1 training1 and provision of technical assistance for providers participating under the ,state plan 7or a waiver of such plan7 that offer substance use disorder treatment or recovery services4 7,c7 ,improved reimbursement for and expansion of1 through the provision of education1 training1 and technical assistance1 the number or treatment capacity of providers participating under the ,state plan 7or waiver7 that-- 7i7 are authorized to dispense drugs approved by the ,food and ,drug ,administration for individuals with a substance use disorder who need withdrawal management or maintenance treatment for such disorder2 7ii7 have in effect a registration or waiver under section #cjc7;g7 of the ,controlled ,substances ,act for purposes of dispensing narcotic drugs to individuals for maintenance treatment or detoxification treatment and are in compliance with any regulation promulgated by the ,assistant ,secretary for ,mental ,health and ,substance ,use for purposes of carrying out the requirements of such section #cjc7;g72 and 7iii7 are qualified under applicable ,state law to provide substance use disorder treatment or recovery services4 7,d7 ,improved reimbursement for and expansion of1 through the provision of education1 training1 and technical assistance1 the number or treatment capacity of providers participating under the ,state plan 7or waiver7 that have the qualifications to address the treatment or recovery needs of-- 7i7 individuals enrolled under the ,state plan 7or a waiver of such plan7 who have neonatal abstinence syndrome1 in accordance with guidelines issued by the ,american ,academy of ,pediatrics and ,american ,college of ,obstetricians and ,gynecologists relating to maternal care and infant care with respect to neonatal abstinence syndrome2 7ii7 pregnant women1 postpartum women1 and infants1 particularly the concurrent treatment1 as appropriate1 and comprehensive case management of pregnant women1 postpartum women and infants1 enrolled under the ,state plan 7or a waiver of such plan72 7iii7 adolescents and young adults between the ages of #ab and #ba enrolled under the ,state plan 7or a waiver of such plan72 or 7iv7 ,american ,indian and ,alaska ,native individuals enrolled under the ,state plan 7or a waiver of such plan74 7#c7 ,planning grants 7,a7 ,in general ,the ,secretary shall1 with respect to the first #ah-month period of the demonstration project conducted under paragraph 7#a71 award planning grants to at least #aj ,states selected in accordance with subparagraph 7,b7 for purposes of preparing an application described in paragraph 7#d77;,c7 and carrying out the activities described in subparagraph 7,c74 7,b7 ,selection ,in selecting ,states for purposes of this paragraph1 the ,secretary shall-- 7i7 select ,states that have a ,state plan 7or waiver of the ,state plan7 approved under this title2 7ii7 select ,states in a manner that ensures geographic diversity2 and 7iii7 give preference to ,states with a prevalence of substance use disorders 7in particular opioid use disorders7 that is comparable to or higher than the national average prevalence1 as measured by aggregate per capita drug overdoses1 or any other measure that the ,secretary deems appropriate4 7,c7 ,activities described ,activities described in this subparagraph are1 with respect to a ,state1 each of the following3 7i7 ,activities that support the development of an initial assessment of the behavioral health treatment needs of the ,state to determine the extent to which providers are needed 7including the types of such providers and geographic area of need7 to improve the network of providers that treat substance use disorders under the ,state plan 7or waiver71 including the following3 7,i7 ,an estimate of the number of individuals enrolled under the ,state plan 7or a waiver of such plan7 who have a substance use disorder4 7,,ii7 ,information on the capacity of providers to provide substance use disorder treatment or recovery services to individuals enrolled under the ,state plan 7or waiver71 including information on providers who provide such services and their participation under the ,state plan 7or waiver74 7,,iii7 ,information on the gap in substance use disorder treatment or recovery services under the ,state plan 7or waiver7 based on the information described in subclauses 7,i7 and 7,,ii74 7,,iv7 ,projections regarding the extent to which the ,state participating under the demonstration project would increase the number of providers offering substance use disorder treatment or recovery services under the ,state plan 7or waiver7 during the period of the demonstration project4 7ii7 ,activities that1 taking into account the results of the assessment described in clause 7i71 support the development of ,state infrastructure to1 with respect to the provision of substance use disorder treatment or recovery services under the ,state plan 7or a waiver of such plan71 recruit prospective providers and provide training and technical assistance to such providers4 7,d7 ,funding ,for purposes of subparagraph 7,a71 there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #ej1jjj1jjj1 to remain available until expended4 7#d7 ,post-planning ,states 7,a7 ,in general ,the ,secretary shall1 with respect to the remaining #cf-month period of the demonstration project conducted under paragraph 7#a71 select not more than #e ,states in accordance with subparagraph 7,b7 for purposes of carrying out the activities described in paragraph 7#b7 and receiving payments in accordance with paragraph 7#e74 7,b7 ,selection ,in selecting ,states for purposes of this paragraph1 the ,secretary shall-- 7i7 select ,states that received a planning grant under paragraph 7#c72 7ii7 select ,states that submit to the ,secretary an application in accordance with the requirements in subparagraph 7,c71 taking into consideration the quality of each such application2 7iii7 select ,states in a manner that ensures geographic diversity2 and 7iv7 give preference to ,states with a prevalence of substance use disorders 7in particular opioid use disorders7 that is comparable to or higher than the national average prevalence1 as measured by aggregate per capita drug overdoses1 or any other measure that the ,secretary deems appropriate4 7,c7 ,applications 7i7 ,in general ,a ,state seeking to be selected for purposes of this paragraph shall submit to the ,secretary1 at such time and in such form and manner as the ,secretary requires1 an application that includes such information1 provisions1 and assurances1 as the ,secretary may require1 in addition to the following3 7,i7 ,a proposed process for carrying out the ongoing assessment described in paragraph 7#b77;,a71 taking into account the results of the initial assessment described in paragraph 7#c77;,c77i74 7,,ii7 ,a review of reimbursement methodologies and other policies related to substance use disorder treatment or recovery services under the ,state plan 7or waiver7 that may create barriers to increasing the number of providers delivering such services4 7,,iii7 ,the development of a plan1 taking into account activities carried out under paragraph 7#c77;,c77ii71 that will result in long-term and sustainable provider networks under the ,state plan 7or waiver7 that will offer a continuum of care for substance use disorders4 ,such plan shall include the following3 7aa7 ,specific activities to increase the number of providers 7including providers that specialize in providing substance use disorder treatment or recovery services1 hospitals1 health care systems1 ,federally qualified health centers1 and1 as applicable1 certified community behavioral health clinics7 that offer substance use disorder treatment1 recovery1 or support services1 including short-term detoxification services1 outpatient substance use disorder services1 and evidence-based peer recovery services4 7bb7 ,strategies that will incentivize providers described in subparagraphs 7,c7 and 7,d7 of paragraph 7#b7 to obtain the necessary training1 education1 and support to deliver substance use disorder treatment or recovery services in the ,state4 7cc7 ,milestones and timeliness for implementing activities set forth in the plan4 7dd7 ,specific measurable targets for increasing the substance use disorder treatment and recovery provider network under the ,state plan 7or a waiver of such plan74 7,,iv7 ,a proposed process for reporting the information required under paragraph 7#f77;,a71 including information to assess the effectiveness of the efforts of the ,state to expand the capacity of providers to deliver substance use disorder treatment or recovery services during the period of the demonstration project under this subsection4 7,v7 ,the expected financial impact of the demonstration project under this subsection on the ,state4 7,,vi7 ,a description of all funding sources available to the ,state to provide substance use disorder treatment or recovery services in the ,state4 7,,vii7 ,a preliminary plan for how the ,state will sustain any increase in the capacity of providers to deliver substance use disorder treatment or recovery services resulting from the demonstration project under this subsection after the termination of such demonstration project4 7,,viii7 ,a description of how the ,state will coordinate the goals of the demonstration project with any waiver granted 7or submitted by the ,state and pending7 pursuant to section #aaae for the delivery of substance use services under the ,state plan1 as applicable4 7ii7 ,consultation ,in completing an application under clause 7i71 a ,state shall consult with relevant stakeholders1 including ,medicaid managed care plans1 health care providers1 and ,medicaid beneficiary advocates1 and include in such application a description of such consultation4 7#e7 ,payment 7,a7 ,in general ,for each quarter occurring during the period for which the demonstration project is conducted 7after the first #ah months of such period71 the ,secretary shall pay under this subsection1 subject to subparagraph 7,c71 to each ,state selected under paragraph 7#d7 an amount equal to #hj percent of so much of the qualified sums expended during such quarter4 7,b7 ,qualified sums defined ,for purposes of subparagraph 7,a71 the term qualified sums means1 with respect to a ,state and a quarter1 the amount equal to the amount 7if any7 by which the sums expended by the ,state during such quarter attributable to substance use disorder treatment or recovery services furnished by providers participating under the ,state plan 7or a waiver of such plan7 exceeds #a_/d of such sums expended by the ,state during fiscal year #bjah attributable to substance use disorder treatment or recovery services4 7,c7 ,non-duplication of payment ,in the case that payment is made under subparagraph 7,a7 with respect to expenditures for substance use disorder treatment or recovery services furnished by providers participating under the ,state plan 7or a waiver of such plan71 payment may not also be made under subsection 7a7 with respect to expenditures for the same services so furnished4 7#f7 ,reports 7,a7 ,state reports ,a ,state receiving payments under paragraph 7#e7 shall1 for the period of the demonstration project under this subsection1 submit to the ,secretary a quarterly report1 with respect to expenditures for substance use disorder treatment or recovery services for which payment is made to the ,state under this subsection1 on the following3 7i7 ,the specific activities with respect to which payment under this subsection was provided4 7ii7 ,the number of providers that delivered substance use disorder treatment or recovery services in the ,state under the demonstration project compared to the estimated number of providers that would have otherwise delivered such services in the absence of such demonstration project4 7iii7 ,the number of individuals enrolled under the ,state plan 7or a waiver of such plan7 who received substance use disorder treatment or recovery services under the demonstration project compared to the estimated number of such individuals who would have otherwise received such services in the absence of such demonstration project4 7iv7 ,other matters as determined by the ,secretary4 7,b7 ,,cms reports 7i7 ,initial report ,not later than ,october #a1 #bjbj1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 submit to ,congress an initial report on-- 7,i7 the ,states awarded planning grants under paragraph 7#c72 7,,ii7 the criteria used in such selection2 and 7,,iii7 the activities carried out by such ,states under such planning grants4 7ii7 ,interim report ,not later than ,october #a1 #bjbb1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 submit to ,congress an interim report-- 7,i7 on activities carried out under the demonstration project under this subsection2 7,,ii7 on the extent to which ,states selected under paragraph 7#d7 have achieved the stated goals submitted in their applications under subparagraph 7,c7 of such paragraph2 7,,iii7 with a description of the strengths and limitations of such demonstration project2 and 7,,iv7 with a plan for the sustainability of such project4 7iii7 ,final report ,not later than ,october #a1 #bjbd1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall1 in consultation with the ,director of the ,agency for ,healthcare ,research and ,quality and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 submit to ,congress a final report-- 7,i7 providing updates on the matters reported in the interim report under clause 7ii72 7,,ii7 including a description of any changes made with respect to the demonstration project under this subsection after the submission of such interim report2 and 7,,iii7 evaluating such demonstration project4 7,c7 ,,ahrq report ,not later than #c years after the date of the enactment of this subsection1 the ,director of the ,agency for ,healthcare ,research and ,quality1 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall submit to ,congress a summary on the experiences of ,states awarded planning grants under paragraph 7#c7 and ,states selected under paragraph 7#d74 7#g7 ,data sharing and best practices ,during the period of the demonstration project under this subsection1 the ,secretary shall1 in collaboration with ,states selected under paragraph 7#d71 facilitate data sharing and the development of best practices between such ,states and ,states that were not so selected4 7#h7 ,,cms funding ,there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #e1jjj1jjj to the ,centers for ,medicare ,medicaid ,services for purposes of implementing this subsection4 ,such amount shall remain available until expended4 4 #ajjd4 ,medicaid drug review and utilization 7a7 ,medicaid drug utilization review 7#a7 ,state plan requirement ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a771 as amended by section #ajja1 is further amended-- 7,a7 in paragraph 7#hc71 at the end1 by striking and2 7,b7 in paragraph 7#hd71 at the end1 by striking the period and inserting 2 and2 and 7,c7 by inserting after paragraph 7#hd7 the following new paragraph3 7#he7 provide that the ,state is in compliance with the drug review and utilization requirements under subsection 7oo77#a74 4 7#b7 ,drug review and utilization requirements ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a71 as amended by section #ajja1 is further amended by adding at the end the following new subsection3 7oo7 ,drug review and utilization requirements 7#a7 ,in general ,for purposes of subsection 7a77#he71 the drug review and utilization requirements under this subsection are1 subject to paragraph 7#c7 and beginning ,october #a1 #bjai1 the following3 7,a7 ,claims review limitations 7i7 ,in general ,the ,state has in place-- 7,i7 safety edits 7as specified by the ,state7 for subsequent fills for opioids and a claims review automated process 7as designed and implemented by the ,state7 that indicates when an individual enrolled under the ,state plan 7or under a waiver of the ,state plan7 is prescribed a subsequent fill of opioids in excess of any limitation that may be identified by the ,state2 7,,ii7 safety edits 7as specified by the ,state7 on the maximum daily morphine equivalent that can be prescribed to an individual enrolled under the ,state plan 7or under a waiver of the ,state plan7 for treatment of chronic pain and a claims review automated process 7as designed and implemented by the ,state7 that indicates when an individual enrolled under the plan 7or waiver7 is prescribed the morphine equivalent for such treatment in excess of any limitation that may be identified by the ,state2 and 7,,iii7 a claims review automated process 7as designed and implemented by the ,state7 that monitors when an individual enrolled under the ,state plan 7or under a waiver of the ,state plan7 is concurrently prescribed opioids and-- 7aa7 benzodiazepines2 or 7bb7 antipsychotics4 7ii7 ,managed care entities ,the ,state requires each managed care entity 7as defined in section #aicb7;a77#a77;,b77 with respect to which the ,state has a contract under section #aijc7m7 or under section #aije7t77#c7 to have in place1 subject to paragraph 7#c71 with respect to individuals who are eligible for medical assistance under the ,state plan 7or under a waiver of the ,state plan7 and who are enrolled with the entity1 the limitations described in subclauses 7,i7 and 7,,ii7 of clause 7i7 and a claims review automated process described in subclause 7,,iii7 of such clause4 7iii7 ,rules of construction ,nothing in this subparagraph may be construed as prohibiting a ,state or managed care entity from designing and implementing a claims review automated process under this subparagraph that provides for prospective or retrospective reviews of claims4 ,nothing in this subparagraph shall be understood as prohibiting the exercise of clinical judgment from a provider enrolled as a participating provider in a ,state plan 7or waiver of the ,state plan7 or contracting with a managed care entity regarding the best items and services for an individual enrolled under such ,state plan 7or waiver74 7,b7 ,program to monitor antipsychotic medications by children ,the ,state has in place a program 7as designed and implemented by the ,state7 to monitor and manage the appropriate use of antipsychotic medications by children enrolled under the ,state plan 7or under a waiver of the ,state plan7 and submits annually to the ,secretary such information as the ,secretary may require on activities carried out under such program for individuals not more than the age of #ah years generally and children in foster care specifically4 7,c7 ,fraud and abuse identification ,the ,state has in place a process 7as designed and implemented by the ,state7 that identifies potential fraud or abuse of controlled substances by individuals enrolled under the ,state plan 7or under a waiver of the ,state plan71 health care providers prescribing drugs to individuals so enrolled1 and pharmacies dispensing drugs to individuals so enrolled4 7,d7 ,reports ,the ,state shall include in the annual report submitted to the ,secretary under section #aibg7;g77#c77;,d7 information on the limitations1 requirement1 program1 and processes applied by the ,state under subparagraphs 7,a7 through 7,c7 in accordance with such manner and time as specified by the ,secretary4 7,e7 ,clarification ,nothing shall prevent a ,state from satisfying the requirement-- 7i7 described in subparagraph 7,a7 by having safety edits or a claims review automated process described in such subparagraph that was in place before ,october #a1 #bjai2 7ii7 described in subparagraph 7,b7 by having a program described in such subparagraph that was in place before such date2 or 7iii7 described in subparagraph 7,c7 by having a process described in such subparagraph that was in place before such date4 7#b7 ,annual report by ,secretary ,for each fiscal year beginning with fiscal year #bjbj1 the ,secretary shall submit to ,congress a report on the most recent information submitted by ,states under paragraph 7#a77;,d74 7#c7 ,exceptions 7,a7 ,certain individuals exempted ,the drug review and utilization requirements under this subsection shall not apply with respect to an individual who-- 7i7 is receiving-- 7,i7 hospice or palliative care2 or 7,,ii7 treatment for cancer2 7ii7 is a resident of a long-term care facility1 of a facility described in section #aije7;d71 or of another facility for which frequently abused drugs are dispensed for residents through a contract with a single pharmacy2 or 7iii7 the ,state elects to treat as exempted from such requirements4 7,b7 ,exception relating to ensuring access ,in order to ensure reasonable access to health care1 the ,secretary shall waive the drug review and utilization requirements under this subsection1 with respect to a ,state1 in the case of natural disasters and similar situations1 and in the case of the provision of emergency services 7as defined for purposes of section #ahfj;,d-#d7;c77#e77;,d77ii77,,ii774 4 7#c7 ,managed care entities ,section #aicb of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7 is amended by adding at the end the following new subsection3 7i7 ,drug utilization review activities and requirements ,beginning not later than ,october #a1 #bjai1 each contract under a ,state plan with a managed care entity 7other than a primary care case manager7 under section #aijc7m7 shall provide that the entity is in compliance with the applicable provisions of section #dch4c7s77#b7 of title #db1 ,code of ,federal ,regulations1 section #dhc4c7s77#d77 of such title1 and section #dhc4c7s77#e7 of such title1 as such provisions were in effect on ,march #ca1 #bjah4 4 7b7 ,identifying and addressing inappropriate prescribing and billing practices under ,medicaid 7#a7 ,in general ,section #aibg7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;g77 is amended-- 7,a7 in paragraph 7#a77;,a7-- 7i7 by striking of section #aijc7;i77#aj77;,b7 and inserting of section #aijb7;a77#ed72 7ii7 by striking 1 by not later than ,january #a1 #aiic12 7iii7 by inserting after gross overuse1 the following3 excessive utilization12 and 7iv7 by striking or inappropriate or medically unnecessary care and inserting inappropriate or medically unnecessary care1 or prescribing or billing practices that indicate abuse or excessive utilization2 and 7,b7 in paragraph 7#b77;,b7-- 7i7 by inserting after gross overuse1 the following3 excessive utilization12 and 7ii7 by striking or inappropriate or medically unnecessary care and inserting inappropriate or medically unnecessary care1 or prescribing or billing practices that indicate abuse or excessive utilization4 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall take effect with respect to retrospective drug use reviews conducted on or after ,october #a1 #bjbj4 #ajje4 ,guidance to improve care for infants with neonatal abstinence syndrome and their mothers2 ,,gao study on gaps in ,medicaid coverage for pregnant and postpartum women with substance use disorder 7a7 ,guidance ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue guidance to improve care for infants with neonatal abstinence syndrome and their families4 ,such guidance shall include-- 7#a7 best practices from ,states with respect to innovative or evidenced-based payment models that focus on prevention1 screening1 treatment1 plans of safe care1 and postdischarge services for mothers and fathers with substance use disorders and babies with neonatal abstinence syndrome that improve care and clinical outcomes2 7#b7 recommendations for ,states on available financing options under the ,medicaid program under title ,,xix of such ,act and under the ,children's ,health ,insurance ,program under title ,,xxi of such ,act for ,children's ,health ,insurance ,program ,health ,services ,initiative funds for parents with substance use disorders1 infants with neonatal abstinence syndrome1 and home-visiting services2 7#c7 guidance and technical assistance to ,state ,medicaid agencies regarding additional flexibilities and incentives related to screening1 prevention1 and postdischarge services1 including parenting supports1 and infant-caregiver bonding1 including breastfeeding when it is appropriate2 and 7#d7 guidance regarding suggested terminology and ,,icd codes to identify infants with neonatal abstinence syndrome and neonatal opioid withdrawal syndrome1 which could include opioid-exposure1 opioid withdrawal not requiring pharmacotherapy1 and opioid withdrawal requiring pharmacotherapy4 7b7 ,,gao study ,not later than #a year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall conduct a study1 and submit to ,congress a report1 addressing gaps in coverage for pregnant women with substance use disorder under the ,medicaid program under title ,,xix of the ,social ,security ,act1 and gaps in coverage for postpartum women with substance use disorder who had coverage during their pregnancy under the ,medicaid program under such title4 #ajjf4 ,medicaid health homes for substance-use-disorder ,medicaid enrollees 7a7 ,extension of enhanced ,,fmap for certain health homes for individuals with substance use disorders ,section #aide7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifw-#d7;c77 is amended-- 7#a7 in paragraph 7#a71 by inserting subject to paragraph 7#d71 after except that12 and 7#b7 by adding at the end the following new paragraph3 7#d7 ,special rule relating to substance use disorder health homes 7,a7 ,in general ,in the case of a ,state with an ,,sud-focused ,state plan amendment approved by the ,secretary on or after ,october #a1 #bjah1 the ,secretary may1 at the request of the ,state1 extend the application of the ,federal medical assistance percentage described in paragraph 7#a7 to payments for the provision of health home services to ,,sud-eligible individuals under such ,state plan amendment1 in addition to the first #h fiscal year quarters the ,state plan amendment is in effect1 for the subsequent #b fiscal year quarters that the ,state plan amendment is in effect4 ,nothing in this section shall be construed as prohibiting a ,state with a ,state plan amendment that is approved under this section and that is not an ,,sud-focused ,state plan amendment from additionally having approved on or after such date an ,,sud-focused ,state plan amendment under this section1 including for purposes of application of this paragraph4 7,b7 ,report requirements ,in the case of a ,state with an ,,sud-focused ,state plan amendment for which the application of the ,federal medical assistance percentage has been extended under subparagraph 7,a71 such ,state shall1 at the end of the period of such ,state plan amendment1 submit to the ,secretary a report on the following1 with respect to ,,sud-eligible individuals provided health home services under such ,state plan amendment3 7i7 ,the quality of health care provided to such individuals1 with a focus on outcomes relevant to the recovery of each such individual4 7ii7 ,the access of such individuals to health care4 7iii7 ,the total expenditures of such individuals for health care4 ,for purposes of this subparagraph1 the ,secretary shall specify all applicable measures for determining quality1 access1 and expenditures4 7,c7 ,best practices ,not later than ,october #a1 #bjbj1 the ,secretary shall make publicly available on the internet website of the ,centers for ,medicare ,medicaid ,services best practices for designing and implementing an ,,sud-focused ,state plan amendment1 based on the experiences of ,states that have ,state plan amendments approved under this section that include ,,sud-eligible individuals4 7,d7 ,definitions ,for purposes of this paragraph3 7i7 ,,sud-eligible individuals ,the term ,,sud-eligible individual means1 with respect to a ,state1 an individual who satisfies all of the following3 7,i7 ,the individual is an eligible individual with chronic conditions4 7,,ii7 ,the individual is an individual with a substance use disorder4 7,,iii7 ,the individual has not previously received health home services under any other ,state plan amendment approved for the ,state under this section by the ,secretary4 7ii7 ,,sud-focused ,state plan amendment ,the term ,,sud-focused ,state plan amendment means a ,state plan amendment under this section that is designed to provide health home services primarily to ,,sud-eligible individuals4 4 7b7 ,requirement for ,state ,medicaid plans ,to provide coverage for medication-,assisted treatment 7#a7 ,requirement for ,state ,medicaid plans to provide coverage for medication-assisted treatment ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is amended1 in the matter preceding clause 7i71 by striking and 7#bh7 and inserting 7#bh71 and 7#bi74 7#b7 ,inclusion of medication-assisted treatment as medical assistance ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended-- 7,a7 in paragraph 7#bh71 by striking and at the end2 7,b7 by redesignating paragraph 7#bi7 as paragraph 7#cj72 and 7,c7 by inserting after paragraph 7#bh7 the following new paragraph3 7#bi7 subject to paragraph 7#b7 of subsection 7ee71 for the period beginning ,october #a1 #bjbj1 and ending ,september #cj1 #bjbe1 medication-assisted treatment 7as defined in paragraph 7#a7 of such subsection72 and 4 7#c7 ,medication-assisted treatment defined2 ,waivers ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended by adding at the end the following new subsection3 7ee7 ,medication-,assisted treatment 7#a7 ,definition ,for purposes of subsection 7a77#bi71 the term medication-assisted treatment-- 7,a7 means all drugs approved under section #eje of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee71 including methadone1 and all biological products licensed under section #cea of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfb7 to treat opioid use disorders2 and 7,b7 includes1 with respect to the provision of such drugs and biological products1 counseling services and behavioral therapy4 7#b7 ,exception ,the provisions of paragraph 7#bi7 of subsection 7a7 shall not apply with respect to a ,state for the period specified in such paragraph1 if before the beginning of such period the ,state certifies to the satisfaction of the ,secretary that implementing such provisions statewide for all individuals eligible to enroll in the ,state plan 7or waiver of the ,state plan7 would not be feasible by reason of a shortage of qualified providers of medication-assisted treatment1 or facilities providing such treatment1 that will contract with the ,state or a managed care entity with which the ,state has a contract under section #aijc7m7 or under section #aije7t77#c74 4 7#d7 ,effective date 7,a7 ,in general ,subject to subparagraph 7,b71 the amendments made by this subsection shall apply with respect to medical assistance provided on or after ,october #a1 #bjbj1 and before ,october #a1 #bjbe4 7,b7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 that the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the respective plan to meet any requirement imposed by the amendments made by this subsection1 the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be considered to be a separate regular session of the ,state legislature4 #ajjg4 ,caring recovery for infants and babies 7a7 ,state plan amendment ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a771 as amended by sections #ajja and #ajjd1 is further amended-- 7#a7 in paragraph 7#hd77;,c71 by striking and after the semicolon2 7#b7 in paragraph 7#he71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after paragraph 7#he71 the following new paragraph3 7#hf7 provide1 at the option of the ,state1 for making medical assistance available on an inpatient or outpatient basis at a residential pediatric recovery center 7as defined in subsection 7pp77 to infants with neonatal abstinence syndrome4 4 7b7 ,residential pediatric recovery center defined ,section #aijb of such ,act 7#db ,u4,s4,c4 #acif;a71 as amended by sections #ajja and #ajjd1 is further amended by adding at the end the following new subsection3 7pp7 ,residential pediatric recovery center defined 7#a7 ,in general ,for purposes of section #aijb7;a77#hf71 the term residential pediatric recovery center means a center or facility that furnishes items and services for which medical assistance is available under the ,state plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors4 7#b7 ,counseling and services ,a residential pediatric recovery center may offer counseling and other services to mothers 7and other appropriate family members and caretakers7 of infants receiving treatment at such centers if such services are otherwise covered under the ,state plan under this title or under a waiver of such plan4 ,such other services may include the following3 7,a7 ,counseling or referrals for services4 7,b7 ,activities to encourage caregiver-infant bonding4 7,c7 ,training on caring for such infants4 4 7c7 ,effective date ,the amendments made by this section take effect on the date of enactment of this ,act and shall apply to medical assistance furnished on or after that date1 without regard to final regulations to carry out such amendments being promulgated as of such date4 #ajjh4 ,peer support enhancement and evaluation review 7a7 ,in general ,not later than #b years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives1 the ,committee on ,finance of the ,senate1 and the ,committee on ,health1 ,education1 ,labor and ,pensions of the ,senate a report on the provision of peer support services under the ,medicaid program4 7b7 ,content of report 7#a7 ,in general ,the report required under subsection 7a7 shall include the following information3 7,a7 ,information on ,state coverage of peer support services under ,medicaid1 including-- 7i7 the mechanisms through which ,states may provide such coverage1 including through existing statutory authority or through waivers2 7ii7 the populations to which ,states have provided such coverage2 7iii7 the payment models1 including any alternative payment models1 used by ,states to pay providers of such services2 and 7iv7 where available1 information on ,federal and ,state spending under ,medicaid for peer support services4 7,b7 ,information on selected ,state experiences in providing medical assistance for peer support services under ,state ,medicaid plans and whether ,states measure the effects of providing such assistance with respect to-- 7i7 improving access to behavioral health services2 7ii7 improving early detection1 and preventing worsening1 of behavioral health disorders2 7iii7 reducing chronic and comorbid conditions2 and 7iv7 reducing overall health costs4 7#b7 ,recommendations ,the report required under subsection 7a7 shall include recommendations1 including recommendations for such legislative and administrative actions related to improving services1 including peer support services1 and access to peer support services under ,medicaid as the ,comptroller ,general of the ,united ,states determines appropriate4 #ajji4 ,medicaid substance use disorder treatment via telehealth 7a7 ,definitions ,in this section3 7#a7 ,comptroller ,general ,the term ,comptroller ,general means the ,comptroller ,general of the ,united ,states4 7#b7 ,school-based health center ,the term school-based health center has the meaning given that term in section #baaj7;c77#i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7c77#i774 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#d7 ,underserved area ,the term underserved area means a health professional shortage area 7as defined in section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a77#a77;,a777 and a medically underserved area 7according to a designation under section #ccj7;b77#c77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c77;,a7774 7b7 ,guidance to ,states regarding ,federal reimbursement for furnishing services and treatment for substance use disorders under ,medicaid using services delivered via telehealth1 including in school-,based health centers ,not later than #a year after the date of enactment of this ,act1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall issue guidance to ,states on the following3 7#a7 ,state options for ,federal reimbursement of expenditures under ,medicaid for furnishing services and treatment for substance use disorders1 including assessment1 medication-assisted treatment1 counseling1 medication management1 and medication adherence with prescribed medication regimes1 using services delivered via telehealth4 ,such guidance shall also include guidance on furnishing services and treatments that address the needs of high-risk individuals1 including at least the following groups3 7,a7 ,american ,indians and ,alaska ,natives4 7,b7 ,adults under the age of #dj4 7,c7 ,individuals with a history of non-fatal overdose4 7,d7 ,individuals with a co-occurring serious mental illness and substance use disorder4 7#b7 ,state options for ,federal reimbursement of expenditures under ,medicaid for education directed to providers serving ,medicaid beneficiaries with substance use disorders using the hub and spoke model1 through contracts with managed care entities1 through administrative claiming for disease management activities1 and under ,delivery ,system ,reform ,incentive ,payment 7,,dsrip7 programs4 7#c7 ,state options for ,federal reimbursement of expenditures under ,medicaid for furnishing services and treatment for substance use disorders for individuals enrolled in ,medicaid in a school-based health center using services delivered via telehealth4 7c7 ,,gao evaluation of children's access to services and treatment for substance use disorders under ,medicaid 7#a7 ,study ,the ,comptroller ,general shall evaluate children's access to services and treatment for substance use disorders under ,medicaid4 ,the evaluation shall include an analysis of ,state options for improving children's access to such services and treatment and for improving outcomes1 including by increasing the number of ,medicaid providers who offer services or treatment for substance use disorders in a school-based health center using services delivered via telehealth1 particularly in rural and underserved areas4 ,the evaluation shall include an analysis of ,medicaid provider reimbursement rates for services and treatment for substance use disorders4 7#b7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the evaluation conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7d7 ,report on reducing barriers to using services delivered via telehealth and remote patient monitoring for pediatric populations under ,medicaid 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall issue a report to the ,committee on ,finance of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives identifying best practices and potential solutions for reducing barriers to using services delivered via telehealth to furnish services and treatment for substance use disorders among pediatric populations under ,medicaid4 ,the report shall include-- 7,a7 analyses of the best practices1 barriers1 and potential solutions for using services delivered via telehealth to diagnose and provide services and treatment for children with substance use disorders1 including opioid use disorder2 and 7,b7 identification and analysis of the differences1 if any1 in furnishing services and treatment for children with substance use disorders using services delivered via telehealth and using services delivered in person1 such as1 and to the extent feasible1 with respect to-- 7i7 utilization rates2 7ii7 costs2 7iii7 avoidable inpatient admissions and readmissions2 7iv7 quality of care2 and 7v7 patient1 family1 and provider satisfaction4 7#b7 ,publication ,the ,secretary shall publish the report required under paragraph 7#a7 on a public internet website of the ,department of ,health and ,human ,services4 #ajaj4 ,enhancing patient access to non-opioid treatment options ,not later than ,january #a1 #bjai1 the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall issue #a or more final guidance documents1 or update existing guidance documents1 to ,states regarding mandatory and optional items and services that may be provided under a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or under a waiver of such a plan1 for non-opioid treatment and management of pain1 including1 but not limited to1 evidence-based1 non-opioid pharmacological therapies and non-pharmacological therapies4 #ajaa4 ,assessing barriers to opioid use disorder treatment 7a7 ,study 7#a7 ,in general ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study regarding the barriers to providing medication used in the treatment of substance use disorders under ,medicaid distribution models such as the buy-and-bill model1 and options for ,state ,medicaid programs to remove or reduce such barriers4 ,the study shall include analyses of each of the following models of distribution of substance use disorder treatment medications1 particularly buprenorphine1 naltrexone1 and buprenorphine-naloxone combinations3 7,a7 ,the purchasing1 storage1 and administration of substance use disorder treatment medications by providers4 7,b7 ,the dispensing of substance use disorder treatment medications by pharmacists4 7,c7 ,the ordering1 prescribing1 and obtaining substance use disorder treatment medications on demand from specialty pharmacies by providers4 7#b7 ,requirements ,for each model of distribution specified in paragraph 7#a71 the ,comptroller ,general shall evaluate how each model presents barriers or could be used by selected ,state ,medicaid programs to reduce the barriers related to the provision of substance use disorder treatment by examining what is known about the effects of the model of distribution on-- 7,a7 ,medicaid beneficiaries' access to substance use disorder treatment medications2 7,b7 the differential cost to the program between each distribution model for medication-assisted treatment2 and 7,c7 provider willingness to provide or prescribe substance use disorder treatment medications4 7b7 ,report ,not later than #ae months after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #ajab4 ,help for moms and babies 7a7 ,medicaid ,state plan ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a771 as amended by section #ajjf1 is further amended by adding at the end the following new sentence3 ,in the case of a woman who is eligible for medical assistance on the basis of being pregnant 7including through the end of the month in which the #fj-;day period beginning on the last day of her pregnancy ends71 who is a patient in an institution for mental diseases for purposes of receiving treatment for a substance use disorder1 and who was enrolled for medical assistance under the ,state plan immediately before becoming a patient in an institution for mental diseases or who becomes eligible to enroll for such medical assistance while such a patient1 the exclusion from the definition of medical assistance set forth in the subdivision 7,b7 following paragraph 7#cj7 of the first sentence of this subsection shall not be construed as prohibiting ,federal financial participation for medical assistance for items or services that are provided to the woman outside of the institution44 7b7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendment made by subsection 7a7 shall take effect on the date of enactment of this ,act4 7#b7 ,rule for changes requiring state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendment made by subsection 7a71 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #ajac4 ,securing flexibility to treat substance use disorders ,section #aijc7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77 is amended by adding at the end the following new paragraph3 7#g7 ,payment shall be made under this title to a ,state for expenditures for capitation payments described in section #dch4f7;e7 of title #db1 ,code of ,federal ,regulations 7or any successor regulation74 4 #ajad4 ,,macpac study and report on ,,mat utilization controls under ,state ,medicaid programs 7a7 ,study ,the ,medicaid and ,,chip ,payment and ,access ,commission shall conduct a study and analysis of utilization control policies applied to medication-assisted treatment for substance use disorders under ,state ,medicaid programs1 including policies and procedures applied both in fee-for-service ,medicaid and in risk-based managed care ,medicaid1 which shall-- 7#a7 include an inventory of such utilization control policies and related protocols for ensuring access to medically necessary treatment2 7#b7 determine whether managed care utilization control policies and procedures for medication-assisted treatment for substance use disorders are consistent with section #dch4baj7;a77#d77;ii7 of title #db1 ,code of ,federal ,regulations2 and 7#c7 identify policies that-- 7,a7 limit an individual's access to medication-assisted treatment for a substance use disorder by limiting the quantity of medication-assisted treatment prescriptions1 or the number of refills for such prescriptions1 available to the individual as part of a prior authorization process or similar utilization protocols2 and 7,b7 apply without evaluating individual instances of fraud1 waste1 or abuse4 7b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,medicaid and ,,chip ,payment and ,access ,commission shall make publicly available a report containing the results of the study conducted under subsection 7a74 #ajae4 ,opioid addiction treatment programs enhancement 7a7 ,t-,,msis substance use disorder data book 7#a7 ,in general ,not later than the date that is #ab months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall publish on the public website of the ,centers for ,medicare ,medicaid ,services a report with comprehensive data on the prevalence of substance use disorders in the ,medicaid beneficiary population and services provided for the treatment of substance use disorders under ,medicaid4 7#b7 ,content of report ,the report required under paragraph 7#a7 shall include1 at a minimum1 the following data for each ,state 7including1 to the extent available1 for the ,district of ,columbia1 ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa73 7,a7 ,the number and percentage of individuals enrolled in the ,state ,medicaid plan or waiver of such plan in each of the major enrollment categories 7as defined in a public letter from the ,medicaid and ,,chip ,payment and ,access ,commission to the ,secretary7 who have been diagnosed with a substance use disorder and whether such individuals are enrolled under the ,state ,medicaid plan or a waiver of such plan1 including the specific waiver authority under which they are enrolled1 to the extent available4 7,b7 ,a list of the substance use disorder treatment services by each major type of service1 such as counseling1 medication-assisted treatment1 peer support1 residential treatment1 and inpatient care1 for which beneficiaries in each ,state received at least #a service under the ,state ,medicaid plan or a waiver of such plan4 7,c7 ,the number and percentage of individuals with a substance use disorder diagnosis enrolled in the ,state ,medicaid plan or waiver of such plan who received substance use disorder treatment services under such plan or waiver by each major type of service under subparagraph 7,b7 within each major setting type1 such as outpatient1 inpatient1 residential1 and other home-based and community-based settings4 7,d7 ,the number of services provided under the ,state ,medicaid plan or waiver of such plan per individual with a substance use disorder diagnosis enrolled in such plan or waiver for each major type of service under subparagraph 7,b74 7,e7 ,the number and percentage of individuals enrolled in the ,state ,medicaid plan or waiver1 by major enrollment category1 who received substance use disorder treatment through-- 7i7 a medicaid managed care entity 7as defined in section #aicb7;a77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;a77#a77;,b7771 including the number of such individuals who received such assistance through a prepaid inpatient health plan or a prepaid ambulatory health plan2 7ii7 a fee-for-service payment model2 or 7iii7 an alternative payment model1 to the extent available4 7,f7 ,the number and percentage of individuals with a substance use disorder who receive substance use disorder treatment services in an outpatient or home-based and community-based setting after receiving treatment in an inpatient or residential setting1 and the number of services received by such individuals in the outpatient or home-based and community-based setting4 7#c7 ,annual updates ,the ,secretary shall issue an updated version of the report required under paragraph 7#a7 not later than ,january #a of each calendar year through #bjbd4 7#d7 ,use of ,t-,,msis data ,the report required under paragraph 7#a7 and updates required under paragraph 7#c7 shall-- 7,a7 use data and definitions from the ,transformed ,medicaid ,statistical ,information ,system 7,t-,,msis7 data set that is no more than #ab months old on the date that the report or update is published2 and 7,b7 as appropriate1 include a description with respect to each ,state of the quality and completeness of the data and caveats describing the limitations of the data reported to the ,secretary by the ,state that is sufficient to communicate the appropriate uses for the information4 7b7 ,making ,t-,,msis data on substance use disorders available to researchers 7#a7 ,in general ,the ,secretary shall publish in the ,federal ,register a system of records notice for the data specified in paragraph 7#b7 for the ,transformed ,medicaid ,statistical ,information ,system1 in accordance with section #eeb;a7e77#d7 of title #e1 ,united ,states ,code4 ,the notice shall outline policies that protect the security and privacy of the data that1 at a minimum1 meet the security and privacy policies of ,,sorn #ji-gj-jeda for the ,medicaid ,statistical ,information ,system4 7#b7 ,required data ,the data covered by the systems of records notice required under paragraph 7#a7 shall be sufficient for researchers and ,states to analyze the prevalence of substance use disorders in the ,medicaid beneficiary population and the treatment of substance use disorders under ,medicaid across all ,states 7including the ,district of ,columbia1 ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa71 forms of treatment1 and treatment settings4 7#c7 ,initiation of data-sharing activities ,not later than ,january #a1 #bjai1 the ,secretary shall initiate the data-sharing activities outlined in the notice required under paragraph 7#a74 #ajaf4 ,better data sharing to combat the opioid crisis 7a7 ,in general ,section #aijc7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m771 as amended by section #ajac1 is further amended by adding at the end the following new paragraph3 7#h7 7,a7 ,the ,state agency administering the ,state plan under this title may have reasonable access1 as determined by the ,state1 to #a or more prescription drug monitoring program databases administered or accessed by the ,state to the extent the ,state agency is permitted to access such databases under ,state law4 7,b7 ,such ,state agency may facilitate reasonable access1 as determined by the ,state1 to #a or more prescription drug monitoring program databases administered or accessed by the ,state1 to same extent that the ,state agency is permitted under ,state law to access such databases1 for-- 7i7 any provider enrolled under the ,state plan to provide services to ,medicaid beneficiaries2 and 7ii7 any managed care entity 7as defined under section #aicb7;a77#a77;,b77 that has a contract with the ,state under this subsection or under section #aije7t77#c74 7,c7 ,such ,state agency may share information in such databases1 to the same extent that the ,state agency is permitted under ,state law to share information in such databases1 with-- 7i7 any provider enrolled under the ,state plan to provide services to ,medicaid beneficiaries2 and 7ii7 any managed care entity 7as defined under section #aicb7;a77#a77;,b77 that has a contract with the ,state under this subsection or under section #aije7t77#c74 4 7b7 ,security and privacy ,all applicable ,state and ,federal security and privacy protections and laws shall apply to any ,state agency1 individual1 or entity accessing #a or more prescription drug monitoring program databases or obtaining information in such databases in accordance with section #aijc7m77#h7 of the ,social ,security ,act 7as added by subsection 7a774 7c7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date of enactment of this ,act4 #ajag4 ,report on innovative ,state initiatives and strategies to provide housing-related services and supports to individuals struggling with substance use disorders under ,medicaid 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue a report to ,congress describing innovative ,state initiatives and strategies for providing housing-related services and supports under a ,state ,medicaid program to individuals with substance use disorders who are experiencing or at risk of experiencing homelessness4 7b7 ,content of report ,the report required under subsection 7a7 shall describe the following3 7#a7 ,existing methods and innovative strategies developed and adopted by ,state ,medicaid programs that have achieved positive outcomes in increasing housing stability among ,medicaid beneficiaries with substance use disorders who are experiencing or at risk of experiencing homelessness1 including ,medicaid beneficiaries with substance use disorders who are-- 7,a7 receiving treatment for substance use disorders in inpatient1 residential1 outpatient1 or home-based and community-based settings2 7,b7 transitioning between substance use disorder treatment settings2 or 7,c7 living in supportive housing or another model of affordable housing4 7#b7 ,strategies employed by ,medicaid managed care organizations1 primary care case managers1 hospitals1 accountable care organizations1 and other care coordination providers to deliver housing-related services and supports and to coordinate services provided under ,state ,medicaid programs across different treatment settings4 7#c7 ,innovative strategies and lessons learned by ,states with ,medicaid waivers approved under section #aaae or #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae1 #acifn71 including-- 7,a7 challenges experienced by ,states in designing1 securing1 and implementing such waivers or plan amendments2 7,b7 how ,states developed partnerships with other organizations such as behavioral health agencies1 ,state housing agencies1 housing providers1 health care services agencies and providers1 community-based organizations1 and health insurance plans to implement waivers or ,state plan amendments2 and 7,c7 how and whether ,states plan to provide ,medicaid coverage for housing-related services and supports in the future1 including by covering such services and supports under ,state ,medicaid plans or waivers4 7#d7 ,existing opportunities for ,states to provide housing-related services and supports through a ,medicaid waiver under sections #aaae or #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae1 #acifn7 or through a ,state ,medicaid plan amendment1 such as the ,assistance in ,community ,integration ,service pilot program1 which promotes supportive housing and other housing-related supports under ,medicaid for individuals with substance use disorders and for which ,maryland has a waiver approved under such section #aaae to conduct the program4 7#e7 ,innovative strategies and partnerships developed and implemented by ,state ,medicaid programs or other entities to identify and enroll eligible individuals with substance use disorders who are experiencing or at risk of experiencing homelessness in ,state ,medicaid programs4 #ajah4 ,technical assistance and support for innovative ,state strategies to provide housing-related supports under ,medicaid 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall provide technical assistance and support to ,states regarding the development and expansion of innovative ,state strategies 7including through ,state ,medicaid demonstration projects7 to provide housing-related supports and services and care coordination services under ,medicaid to individuals with substance use disorders4 7b7 ,report ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary shall issue a report to ,congress detailing a plan of action to carry out the requirements of subsection 7a74 ,,ii ,medicare ,provisions to ,address the ,opioid ,crisis #bjja4 ,expanding the use of telehealth services for the treatment of opioid use disorder and other substance use disorders 7a7 ,in general ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7#a7 in paragraph 7#b77;,b7-- 7,a7 in clause 7i71 in the matter preceding subclause 7,i71 by striking clause 7ii7 and inserting clause 7ii7 and paragraph 7#f77;,c72 and 7,b7 in clause 7ii71 in the heading1 by striking for home dialysis therapy2 7#b7 in paragraph 7#d77;,c7-- 7,a7 in clause 7i71 by striking paragraph 7#f7 and inserting paragraphs 7#e71 7#f71 and 7#g72 and 7,b7 in clause 7ii77,x71 by inserting or telehealth services described in paragraph 7#g7 before the period at the end2 and 7#c7 by adding at the end the following new paragraph3 7#g7 ,treatment of substance use disorder services furnished through telehealth ,the geographic requirements described in paragraph 7#d77;,c77i7 shall not apply with respect to telehealth services furnished on or after ,july #a1 #bjai1 to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder1 as determined by the ,secretary1 at an originating site described in paragraph 7#d77;,c77ii7 7other than an originating site described in subclause 7,,ix7 of such paragraph74 4 7b7 ,implementation ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 may implement the amendments made by this section by interim final rule4 7c7 ,report 7#a7 ,in general ,not later than #e years after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the impact of the implementation of the amendments made by this section with respect to telehealth services under section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 on-- 7,a7 the utilization of health care items and services under title ,,xviii of such ,act 7#db ,u4,s4,c4 #acie et seq47 related to substance use disorders1 including emergency department visits2 and 7,b7 health outcomes related to substance use disorders1 such as opioid overdose deaths4 7#b7 ,funding ,for purposes of carrying out paragraph 7#a71 in addition to funds otherwise available1 the ,secretary shall provide for the transfer1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 of #c1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account to remain available until expended4 #bjjb4 ,comprehensive screenings for seniors 7a7 ,initial preventive physical examination ,section #ahfa7ww7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ww77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 by striking paragraph 7#b7 and and inserting paragraph 7#b712 and 7,b7 by inserting and the furnishing of a review of any current opioid prescriptions 7as defined in paragraph 7#d771 after upon the agreement with the individual12 and 7#b7 in paragraph 7#b7-- 7,a7 by redesignating subparagraph 7,n7 as subparagraph 7,o72 and 7,b7 by inserting after subparagraph 7,m7 the following new subparagraph3 7,n7 ,screening for potential substance use disorders4 2 and 7#c7 by adding at the end the following new paragraph3 7#d7 ,for purposes of paragraph 7#a71 the term a review of any current opioid prescriptions means1 with respect to an individual determined to have a current prescription for opioids-- 7,a7 a review of the potential risk factors to the individual for opioid use disorder2 7,b7 an evaluation of the individual's severity of pain and current treatment plan2 7,c7 the provision of information on non-opioid treatment options2 and 7,d7 a referral to a specialist1 as appropriate4 4 7b7 ,annual wellness visit ,section #ahfa7;hhh77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7hhh77#b77 is amended-- 7#a7 by redesignating subparagraph 7,g7 as subparagraph 7,i72 and 7#b7 by inserting after subparagraph 7,f7 the following new subparagraphs3 7,g7 ,screening for potential substance use disorders and referral for treatment as appropriate4 7,h7 ,the furnishing of a review of any current opioid prescriptions 7as defined in subsection 7ww77#d774 4 7c7 ,rule of construction ,nothing in the amendments made by subsection 7a7 or 7b7 shall be construed to prohibit separate payment for structured assessment and intervention services for substance abuse furnished to an individual on the same day as an initial preventive physical examination or an annual wellness visit4 7d7 ,effective date ,the amendments made by this section shall apply to examinations and visits furnished on or after ,january #a1 #bjbj4 #bjjc4 ,every prescription conveyed securely 7a7 ,in general ,section #ahfj;,d-#d7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;e77 is amended by adding at the end the following3 7#g7 ,requirement of e-prescribing for controlled substances 7,a7 ,in general ,subject to subparagraph 7,b71 a prescription for a covered part ,d drug under a prescription drug plan 7or under an ,,ma-,,pd plan7 for a schedule ,,ii1 ,,iii1 ,,iv1 or ,v controlled substance shall be transmitted by a health care practitioner electronically in accordance with an electronic prescription drug program that meets the requirements of paragraph 7#b74 7,b7 ,exception for certain circumstances ,the ,secretary shall1 through rulemaking1 specify circumstances and processes by which the ,secretary may waive the requirement under subparagraph 7,a71 with respect to a covered part ,d drug1 including in the case of-- 7i7 a prescription issued when the practitioner and dispensing pharmacy are the same entity2 7ii7 a prescription issued that cannot be transmitted electronically under the most recently implemented version of the ,national ,council for ,prescription ,drug ,programs ,,script ,standard2 7iii7 a prescription issued by a practitioner who received a waiver or a renewal thereof for a period of time as determined by the ,secretary1 not to exceed one year1 from the requirement to use electronic prescribing due to demonstrated economic hardship1 technological limitations that are not reasonably within the control of the practitioner1 or other exceptional circumstance demonstrated by the practitioner2 7iv7 a prescription issued by a practitioner under circumstances in which1 notwithstanding the practitioner's ability to submit a prescription electronically as required by this subsection1 such practitioner reasonably determines that it would be impractical for the individual involved to obtain substances prescribed by electronic prescription in a timely manner1 and such delay would adversely impact the individual's medical condition involved2 7v7 a prescription issued by a practitioner prescribing a drug under a research protocol2 7vi7 a prescription issued by a practitioner for a drug for which the ,food and ,drug ,administration requires a prescription to contain elements that are not able to be included in electronic prescribing1 such as a drug with risk evaluation and mitigation strategies that include elements to assure safe use2 7vii7 a prescription issued by a practitioner-- 7,i7 for an individual who receives hospice care under this title2 and 7,,ii7 that is not covered under the hospice benefit under this title2 and 7viii7 a prescription issued by a practitioner for an individual who is-- 7,i7 a resident of a nursing facility 7as defined in section #aiai7;a772 and 7,,ii7 dually eligible for benefits under this title and title ,,xix4 7,c7 ,dispensing 7i7 ,nothing in this paragraph shall be construed as requiring a sponsor of a prescription drug plan under this part1 ,,ma organization offering an ,,ma-,,pd plan under part ,c1 or a pharmacist to verify that a practitioner1 with respect to a prescription for a covered part ,d drug1 has a waiver 7or is otherwise exempt7 under subparagraph 7,b7 from the requirement under subparagraph 7,a74 7ii7 ,nothing in this paragraph shall be construed as affecting the ability of the plan to cover or the pharmacists' ability to continue to dispense covered part ,d drugs from otherwise valid written1 oral1 or fax prescriptions that are consistent with laws and regulations4 7iii7 ,nothing in this paragraph shall be construed as affecting the ability of an individual who is being prescribed a covered part ,d drug to designate a particular pharmacy to dispense the covered part ,d drug to the extent consistent with the requirements under subsection 7b77#a7 and under this paragraph4 7,d7 ,enforcement ,the ,secretary shall1 through rulemaking1 have authority to enforce and specify appropriate penalties for non-compliance with the requirement under subparagraph 7,a74 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to coverage of drugs prescribed on or after ,january #a1 #bjba4 7c7 ,update of ,biometric ,component of ,multifactor ,authentication ,not later than #a year after the date of enactment of this ,act1 the ,attorney ,general shall update the requirements for the biometric component of multifactor authentication with respect to electronic prescriptions of controlled substances4 #bjjd4 ,requiring prescription drug plan sponsors under ,medicare to establish drug management programs for at-risk beneficiaries ,section #ahfj;,d-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77 is amended-- 7#a7 in paragraph 7#a71 by inserting after subparagraph 7,e7 the following new subparagraph3 7,f7 ,with respect to plan years beginning on or after ,january #a1 #bjbb1 a drug management program for at-risk beneficiaries described in paragraph 7#e74 2 and 7#b7 in paragraph 7#e77;,a71 by inserting 7and for plan years beginning on or after ,january #a1 #bjbb1 a ,,pdp sponsor shall7 after ,a ,,pdp sponsor may4 #bjje4 ,medicare coverage of certain services furnished by opioid treatment programs 7a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7#a7 in subparagraph 7,,ff71 by striking at the end and2 7#b7 in subparagraph 7,,gg71 by inserting at the end and2 and 7#c7 by adding at the end the following new subparagraph3 7,,hh7 opioid use disorder treatment services 7as defined in subsection 7jjj774 4 7b7 ,opioid use disorder treatment services and opioid treatment program defined ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsection3 7jjj7 ,opioid use disorder treatment services2 opioid treatment program 7#a7 ,opioid use disorder treatment services ,the term opioid use disorder treatment services means items and services that are furnished by an opioid treatment program for the treatment of opioid use disorder1 including-- 7,a7 opioid agonist and antagonist treatment medications 7including oral1 injected1 or implanted versions7 that are approved by the ,food and ,drug ,administration under section #eje of the ,federal ,food1 ,drug1 and ,cosmetic ,act for use in the treatment of opioid use disorder2 7,b7 dispensing and administration of such medications1 if applicable2 7,c7 substance use counseling by a professional to the extent authorized under ,state law to furnish such services2 7,d7 individual and group therapy with a physician or psychologist 7or other mental health professional to the extent authorized under ,state law72 7,e7 toxicology testing1 and 7,f7 other items and services that the ,secretary determines are appropriate 7but in no event to include meals or transportation74 7#b7 ,opioid treatment program ,the term opioid treatment program means an entity that is an opioid treatment program 7as defined in section #h4b of title #db of the ,code of ,federal ,regulations1 or any successor regulation7 that-- 7,a7 is enrolled under section #ahff7;j72 7,b7 has in effect a certification by the ,substance ,abuse and ,mental ,health ,services ,administration for such a program2 7,c7 is accredited by an accrediting body approved by the ,substance ,abuse and ,mental ,health ,services ,administration2 and 7,d7 meets such additional conditions as the ,secretary may find necessary to ensure-- 7i7 the health and safety of individuals being furnished services under such program2 and 7ii7 the effective and efficient furnishing of such services4 4 7c7 ,payment 7#a7 ,in general ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and 7,,bb7 and inserting 7,,bb72 and 7,b7 by inserting before the semicolon at the end the following 1 and 7,,cc7 with respect to opioid use disorder treatment services furnished during an episode of care1 the amount paid shall be equal to the amount payable under section #ahcd7w7 less any copayment required as specified by the ,secretary4 7#b7 ,payment determination ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7w7 ,opioid use disorder treatment services 7#a7 ,in general ,the ,secretary shall pay to an opioid treatment program 7as defined in paragraph 7#b7 of section #ahfa7;jjj77 an amount that is equal to #ajj percent of a bundled payment under this part for opioid use disorder treatment services 7as defined in paragraph 7#a7 of such section7 that are furnished by such program to an individual during an episode of care 7as defined by the ,secretary7 beginning on or after ,january #a1 #bjbj4 ,the ,secretary shall ensure1 as determined appropriate by the ,secretary1 that no duplicative payments are made under this part or part ,d for items and services furnished by an opioid treatment program4 7#b7 ,considerations ,the ,secretary may implement this subsection through one or more bundles based on the type of medication provided 7such as buprenorphine1 methadone1 naltrexone1 or a new innovative drug71 the frequency of services1 the scope of services furnished1 characteristics of the individuals furnished such services1 or other factors as the ,secretary determine appropriate4 ,in developing such bundles1 the ,secretary may consider payment rates paid to opioid treatment programs for comparable services under ,state plans under title ,,xix or under the ,,tricare program under chapter #ee of title #aj of the ,united ,states ,code4 7#c7 ,annual updates ,the ,secretary shall provide an update each year to the bundled payment amounts under this subsection4 4 7d7 ,including opioid treatment programs as ,medicare providers ,section #ahff7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7e77 is amended-- 7#a7 in paragraph 7#a71 by striking at the end and2 7#b7 in paragraph 7#b71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following new paragraph3 7#c7 opioid treatment programs 7as defined in paragraph 7#b7 of section #ahfa7;jjj771 but only with respect to the furnishing of opioid use disorder treatment services 7as defined in paragraph 7#a7 of such section74 4 #bjjf4 ,encouraging appropriate prescribing under ,medicare for victims of opioid overdose ,section #ahfj;,d-#d7;c77#e77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77#e77;,c77 is amended-- 7#a7 in clause 7i71 in the matter preceding subclause 7,i71 by striking ,for purposes and inserting ,except as provided in clause 7v71 for purposes2 and 7#b7 by adding at the end the following new clause3 7v7 ,treatment of enrollees with a history of opioid-related overdose 7,i7 ,in general ,for plan years beginning not later than ,january #a1 #bjba1 a part ,d eligible individual who is not an exempted individual described in clause 7ii7 and who is identified under this clause as a part ,d eligible individual with a history of opioid-related overdose 7as defined by the ,secretary7 shall be included as a potentially at-risk beneficiary for prescription drug abuse under the drug management program under this paragraph4 7,,ii7 ,identification and notice ,for purposes of this clause1 the ,secretary shall-- 7aa7 identify part ,d eligible individuals with a history of opioid-related overdose 7as so defined72 and 7bb7 notify the ,,pdp sponsor of the prescription drug plan in which such an individual is enrolled of such identification4 4 #bjjg4 ,automatic escalation to external review under a ,medicare part ,d drug management program for at-risk beneficiaries 7a7 ,in general ,section #ahfj;,d-#d7;c77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww-#aj7;c77#e77 is amended-- 7#a7 in subparagraph 7,b71 in each of clauses 7ii77,,iii7 and 7iii77,,iv71 by striking and the option of an automatic escalation to external review and inserting 1 including notice that if on reconsideration a ,,pdp sponsor affirms its denial1 in whole or in part1 the case shall be automatically forwarded to the independent1 outside entity contracted with the ,secretary for review and resolution2 and 7#b7 in subparagraph 7,e71 by striking and the option and all that follows and inserting the following3 and if on reconsideration a ,,pdp sponsor affirms its denial1 in whole or in part1 the case shall be automatically forwarded to the independent1 outside entity contracted with the ,secretary for review and resolution44 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply beginning not later ,january #a1 #bjba4 #bjjh4 ,suspension of payments by ,medicare prescription drug plans and ,,ma-,,pd plans pending investigations of credible allegations of fraud by pharmacies 7a7 ,in general ,section #ahfj;,d-#ab7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aab7;b77 is amended by adding at the end the following new paragraph3 7#g7 ,suspension of payments pending investigation of credible allegations of fraud by pharmacies 7,a7 ,in general ,section #ahfb7o77#a7 shall apply with respect to a ,,pdp sponsor with a contract under this part1 a pharmacy1 and payments to such pharmacy under this part in the same manner as such section applies with respect to the ,secretary1 a provider of services or supplier1 and payments to such provider of services or supplier under this title4 ,a ,,pdp sponsor shall notify the ,secretary regarding the imposition of any payment suspension pursuant to the previous sentence1 such as through the secure internet website portal 7or other successor technology7 established under section #ahei7;i74 7,b7 ,rule of construction ,nothing in this paragraph shall be construed as limiting the authority of a ,,pdp sponsor to conduct postpayment review4 4 7b7 ,application to ,,ma-,,pd plans ,section #aheg7;f77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;f77#c77 is amended by adding at the end the following new subparagraph3 7,d7 ,suspension of payments pending investigation of credible allegations of fraud by pharmacies ,section #ahfj;,d-#ab7;b77#g74 4 7c7 ,conforming amendment ,section #ahfb7o77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7o77#c77 is amended by inserting 1 section #ahfj;,d-#ab7;b77#g7 7including as applied pursuant to section #aheg7;f77#c77;,d771 after this subsection4 7d7 ,clarification relating to credible allegation of fraud ,section #ahfb7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7o77 is amended by adding at the end the following new paragraph3 7#d7 ,credible allegation of fraud ,in carrying out this subsection1 section #ahfj;,d-#ab7;b77#g7 7including as applied pursuant to section #aheg7;f77#c77;,d771 and section #aijc7;i77#b77;,c71 a fraud hotline tip 7as defined by the ,secretary7 without further evidence shall not be treated as sufficient evidence for a credible allegation of fraud4 4 7e7 ,effective date ,the amendments made by this section shall apply with respect to plan years beginning on or after ,january #a1 #bjbj4 ,,iii ,,fda and ,controlled ,substance ,provisions ,a ,,fda provisions #a ,in general #cjja4 ,clarifying ,,fda regulation of non-addictive pain products 7a7 ,public meetings ,not later than one year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,commissioner of ,food and ,drugs1 shall hold not less than one public meeting to address the challenges and barriers of developing non-addictive medical products intended to treat acute or chronic pain or addiction1 which may include-- 7#a7 the manner by which the ,secretary may incorporate the risks of misuse and abuse of a controlled substance 7as defined in section #ajb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb77 into the risk benefit assessments under subsections 7d7 and 7e7 of section #eje of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee71 section #eaj7k7 of such ,act 7#ba ,u4,s4,c4 #cfj7k771 or section #eae7;c7 of such ,act 7#ba ,u4,s4,c4 #cfj;e7c771 as applicable2 7#b7 the application of novel clinical trial designs 7consistent with section #cjba of the #bast ,century ,cures ,act 7,public ,law #aad-bee771 use of real world evidence 7consistent with section #eje;,f of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee;g771 and use of patient experience data 7consistent with section #efi;,c of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;bbb-#h;c77 for the development of non-addictive medical products intended to treat pain or addiction2 7#c7 the evidentiary standards and the development of opioid-sparing data for inclusion in the labeling of medical products intended to treat acute or chronic pain2 and 7#d7 the application of eligibility criteria under sections #ejf and #eae;,b of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cef1 #cfj;e-#c7 for non-addictive medical products intended to treat pain or addiction4 7b7 ,guidance ,not less than one year after the public meetings are conducted under subsection 7a7 the ,secretary shall issue one or more final guidance documents1 or update existing guidance documents1 to help address challenges to developing non-addictive medical products to treat pain or addiction4 ,such guidance documents shall include information regarding-- 7#a7 how the ,food and ,drug ,administration may apply sections #ejf and #eae;,b of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cef1 #cfj;e-#c7 to non-addictive medical products intended to treat pain or addiction1 including the circumstances under which the ,secretary-- 7,a7 may apply the eligibility criteria under such sections #ejf and #eae;,b to non-addictive medical products intended to treat pain or addiction2 7,b7 considers the risk of addiction of controlled substances approved to treat pain when establishing unmet medical need2 and 7,c7 considers pain1 pain control1 or pain management in assessing whether a disease or condition is a serious or life-threatening disease or condition2 7#b7 the methods by which sponsors may evaluate acute and chronic pain1 endpoints for non-addictive medical products intended to treat pain1 the manner in which endpoints and evaluations of efficacy will be applied across and within review divisions1 taking into consideration the etiology of the underlying disease1 and the manner in which sponsors may use surrogate endpoints1 intermediate endpoints1 and real world evidence2 7#c7 the manner in which the ,food and ,drug ,administration will assess evidence to support the inclusion of opioid-sparing data in the labeling of non-addictive medical products intended to treat acute or chronic pain1 including-- 7,a7 alternative data collection methodologies1 including the use of novel clinical trial designs 7consistent with section #cjba of the #bast ,century ,cures ,act 7,public ,law #aad-bee77 and real world evidence 7consistent with section #eje;,f of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee;g771 including patient registries and patient reported outcomes1 as appropriate1 to support product labeling2 7,b7 ethical considerations of exposing subjects to controlled substances in clinical trials to develop opioid-sparing data and considerations on data collection methods that reduce harm1 which may include the reduction of opioid use as a clinical benefit2 7,c7 endpoints1 including primary1 secondary1 and surrogate endpoints1 to evaluate the reduction of opioid use2 7,d7 best practices for communication between sponsors and the agency on the development of data collection methods1 including the initiation of data collection2 and 7,e7 the appropriate format in which to submit such data results to the ,secretary2 and 7#d7 the circumstances under which the ,food and ,drug ,administration considers misuse and abuse of a controlled substance 7as defined in section #ajb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb77 in making the risk benefit assessment under paragraphs 7#b7 and 7#d7 of subsection 7d7 of section #eje of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee7 and in finding that a drug is unsafe under paragraph 7#a7 or 7#b7 of subsection 7e7 of such section4 7c7 ,definitions ,in this section-- 7#a7 the term medical product means a drug 7as defined in section #bja7;g77#a7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cba7;g77#a7771 biological product 7as defined in section #cea7;i7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfb7;i7771 or device 7as defined in section #bja7;h7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cba7;h7772 and 7#b7 the term opioid-sparing means reducing1 replacing1 or avoiding the use of opioids or other controlled substances intended to treat acute or chronic pain4 #cjjb4 ,evidence-based opioid analgesic prescribing guidelines and report 7a7 ,guidelines ,the ,commissioner of ,food and ,drugs shall develop evidence-based opioid analgesic prescribing guidelines for the indication-specific treatment of acute pain only for the relevant therapeutic areas where such guidelines do not exist4 7b7 ,public input ,in developing the guidelines under subsection 7a71 the ,commissioner of ,food and ,drugs shall-- 7#a7 consult with stakeholders1 which may include conducting a public meeting of medical professional societies 7including any ,state-based societies71 health care providers1 ,state medical boards1 medical specialties including pain medicine specialty societies1 patient groups1 pharmacists1 academic or medical research entities1 and other entities with experience in health care1 as appropriate2 7#b7 collaborate with the ,director of the ,centers for ,disease ,control and ,prevention1 as applicable and appropriate1 and other ,federal agencies with relevant expertise as appropriate2 and 7#c7 provide for a notice and comment period consistent with section #gja7;h7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cga7;h77 for the submission of comments by the public4 7c7 ,report ,not later than #a year after the date of enactment of this ,act1 or1 if earlier1 at the time the guidelines under subsection 7a7 are finalized1 the ,commissioner of ,food and ,drugs shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 and post on the public website of the ,food and ,drug ,administration1 a report on how the ,food and ,drug ,administration will utilize the guidelines under subsection 7a7 to protect the public health and a description of the public health need with respect to each such indication-specific treatment guideline4 7d7 ,updates ,the ,commissioner of ,food and ,drugs shall periodically-- 7#a7 update the guidelines under subsection 7a71 informed by public input described in subsection 7b72 and 7#b7 submit to the committees specified in subsection 7c7 and post on the public website of the ,food and ,drug ,administration an updated report under such subsection4 7e7 ,statement ,to accompany guidelines and recommendations ,the ,commissioner of ,food and ,drugs shall ensure that opioid analgesic prescribing guidelines and other recommendations developed under this section are accompanied by a clear statement that such guidelines or recommendations1 as applicable-- 7#a7 are intended to help inform clinical decisionmaking by prescribers and patients2 and 7#b7 are not intended to be used for the purposes of restricting1 limiting1 delaying1 or denying coverage for1 or access to1 a prescription issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice4 #b ,stop ,counterfeit ,drugs by ,regulating and ,enhancing ,enforcement ,now #cjaa4 ,short title ,this chapter may be cited as the ,stop ,counterfeit ,drugs by ,regulating and ,enhancing ,enforcement ,now ,act or the ,,screen ,act4 #cjab4 ,notification1 nondistribution1 and recall of controlled substances 7a7 ,prohibited ,acts ,section #cja of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cca7 is amended by adding at the end the following3 7eee7 ,the failure to comply with any order issued under section #efi;,d4 4 7b7 ,notification1 nondistribution1 and recall of controlled substances ,subchapter ,e of chapter ,v of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;bbb et seq47 is amended by adding at the end the following3 #efi;,d4 ,notification1 nondistribution1 and recall of controlled substances 7a7 ,order ,to cease distribution and recall 7#a7 ,in general ,if the ,secretary determines there is a reasonable probability that a controlled substance would cause serious adverse health consequences or death1 the ,secretary may1 after providing the appropriate person with an opportunity to consult with the agency1 issue an order requiring manufacturers1 importers1 distributors1 or pharmacists1 who distribute such controlled substance to immediately cease distribution of such controlled substance4 7#b7 ,hearing ,an order under paragraph 7#a7 shall provide the person subject to the order with an opportunity for an informal hearing1 to be held not later than #aj days after the date of issuance of the order1 on whether adequate evidence exists to justify an amendment to the order1 and what actions are required by such amended order pursuant to subparagraph 7#c74 7#c7 ,order resolution ,after an order is issued according to the process under paragraphs 7#a7 and 7#b71 the ,secretary shall1 except as provided in paragraph 7#d7-- 7,a7 vacate the order1 if the ,secretary determines that inadequate grounds exist to support the actions required by the order2 7,b7 continue the order ceasing distribution of the controlled substance until a date specified in such order2 or 7,c7 amend the order to require a recall of the controlled substance1 including any requirements to notify appropriate persons1 a timetable for the recall to occur1 and a schedule for updates to be provided to the ,secretary regarding such recall4 7#d7 ,risk assessment ,if the ,secretary determines that the risk of recalling a controlled substance presents a greater health risk than the health risk of not recalling such controlled substance from use1 an amended order under subparagraph 7,b7 or 7,c7 of paragraph 7#c7 shall not include either a recall order for1 or an order to cease distribution of1 such controlled substance1 as applicable4 7#e7 ,action following order ,any person who is subject to an order pursuant to subparagraph 7,b7 or 7,c7 of paragraph 7#c7 shall immediately cease distribution of or recall1 as applicable1 the controlled substance and provide notification as required by such order4 7b7 ,notice to persons affected ,if the ,secretary determines necessary1 the ,secretary may require the person subject to an order pursuant to paragraph 7#a7 or an amended order pursuant to subparagraph 7,b7 or 7,c7 of paragraph 7#c7 to provide either a notice of a recall order for1 or an order to cease distribution of1 such controlled substance1 as applicable1 under this section to appropriate persons1 including persons who manufacture1 distribute1 import1 or offer for sale such product that is the subject of an order and to the public4 ,in providing such notice1 the ,secretary may use the assistance of health professionals who prescribed or dispensed such controlled substances4 7c7 ,nondelegation ,an order described in subsection 7a77#c7 shall be ordered by the ,secretary or an official designated by the ,secretary4 ,an official may not be so designated under this section unless the official is the ,director of the ,center for ,drug ,evaluation and ,research or an official senior to such ,director4 7d7 ,savings clause ,nothing contained in this section shall be construed as limiting-- 7#a7 the authority of the ,secretary to issue an order to cease distribution of1 or to recall1 any drug under any other provision of this ,act or the ,public ,health ,service ,act2 or 7#b7 the ability of the ,secretary to request any person to perform a voluntary activity related to any drug subject to this ,act or the ,public ,health ,service ,act4 4 7c7 ,controlled substances subject to refusal ,the third sentence of section #hja7;a7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cha7;a77 is amended by inserting 1 or is a controlled substance subject to an order under section #efi;,d before 1 or 7#d74 7d7 ,effective date ,sections #cja7;eee7 and #efi;,d of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 as added by subsections 7a7 and 7b71 shall be effective beginning on the date of enactment of this ,act4 #cjac4 ,single source pattern of imported illegal drugs ,section #hja of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cha71 as amended by section #cjab1 is further amended by adding at the end the following3 7t7 ,single source pattern of imported illegal drugs ,if the ,secretary determines that a person subject to debarment as a result of engaging in a pattern of importing or offering for import controlled substances or drugs as described in section #cjf7;b77#c77;,d71 and such pattern is identified by the ,secretary as being offered for import from the same manufacturer1 distributor1 or importer1 the ,secretary may by order determine all drugs being offered for import from such person as adulterated or misbranded1 unless such person can provide evidence otherwise4 4 #cjad4 ,strengthening ,,fda and ,,cbp coordination and capacity 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,commissioner of ,food and ,drugs1 shall coordinate with the ,secretary of ,homeland ,security to carry out activities related to customs and border protection and in response to illegal controlled substances and drug imports1 including at sites of import 7such as international mail facilities71 that will provide improvements to such facilities1 technologies1 and inspection capacity4 ,such ,secretaries may carry out such activities through a memorandum of understanding between the ,food and ,drug ,administration and the ,u4,s4 ,customs and ,border ,protection4 7b7 ,,fda import facilities and inspection capacity 7#a7 ,in general ,in carrying out this section1 the ,secretary shall1 in collaboration with the ,secretary of ,homeland ,security and the ,postmaster ,general of the ,united ,states ,postal ,service1 provide that import facilities in which the ,food and ,drug ,administration operates or carries out activities related to drug imports within the international mail facilities include-- 7,a7 facility upgrades and improved capacity in order to increase and improve inspection and detection capabilities1 which may include1 as the ,secretary determines appropriate-- 7i7 improvements to facilities1 such as upgrades or renovations1 and support for the maintenance of existing import facilities and sites to improve coordination between ,federal agencies2 7ii7 improvements in equipment and information technology enhancement to identify unapproved1 counterfeit1 or other unlawful controlled substances for destruction2 7iii7 the construction of1 or upgrades to1 laboratory capacity for purposes of detection and testing of imported goods2 7iv7 upgrades to the security of import facilities2 and 7v7 innovative technology and equipment to facilitate improved and near-real-time information sharing between the ,food and ,drug ,administration1 the ,department of ,homeland ,security1 and the ,united ,states ,postal ,service2 and 7,b7 innovative technology1 including controlled substance detection and testing equipment and other applicable technology1 in order to collaborate with the ,u4,s4 ,customs and ,border ,protection to share near-real-time information1 including information about test results1 as appropriate4 7#b7 ,innovative technology ,any technology used in accordance with paragraph 7#a77;,b7 shall be interoperable with technology used by other relevant ,federal agencies1 including the ,u4,s4 ,customs and ,border ,protection1 as the ,secretary determines appropriate and practicable4 7c7 ,report ,not later than #f months after the date of enactment of this ,act1 the ,secretary1 in consultation with the ,secretary of ,homeland ,security and the ,postmaster ,general of the ,united ,states ,postal ,service1 shall report to the ,committee on ,energy and ,commerce and the ,committee on ,homeland ,security of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions and the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate on the implementation of this section1 including a summary of progress made toward near-real-time information sharing and the interoperability of such technologies4 #c ,stop ,illicit ,drug ,importation #cjba4 ,short title ,this chapter may be cited as the ,stop ,illicit ,drug ,importation ,act of #bjah4 #cjbb4 ,restricting entrance of illicit drugs 7a7 ,food and ,drug ,administration and ,u4,s4 ,customs and ,border ,protection ,cooperation 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,commissioner of ,food and ,drugs and in consultation with the ,u4,s4 ,customs and ,border ,protection1 shall develop and periodically update a mutually agreed upon list of the controlled substances that the ,secretary will refer to ,u4,s4 ,customs and ,border ,protection1 unless the ,secretary and ,u4,s4 ,customs and ,border ,protection agree otherwise1 when such substances are offered for import via international mail and appear to violate the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hja et seq471 the ,controlled ,substances ,import and ,export ,act 7#ba ,u4,s4,c4 #iea et seq471 the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cja et seq471 or any other applicable law4 ,the ,secretary shall transfer controlled substances on such list to the ,u4,s4 ,customs and ,border ,protection4 ,if the ,secretary identifies additional packages that appear to be the same as such package containing a controlled substance1 such additional packages may also be transferred to ,u4,s4 ,customs and ,border ,protection4 ,the ,u4,s4 ,customs and ,border ,protection shall receive such packages consistent with the requirements of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hja et seq474 7#b7 ,report ,not later than #i months after the date of enactment of this ,act1 the ,secretary1 acting through the ,commissioner of ,food and ,drugs and in consultation with the ,secretary of ,homeland ,security1 shall report to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate on the implementation of this section4 7b7 ,debarment1 temporary denial of approval1 and suspension 7#a7 ,prohibited act ,section #cja7;cc7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cca7;cc77 is amended-- 7,a7 by inserting or a drug after food2 and 7,b7 by inserting from such activity after person debarred4 7#b7 ,debarment ,section #cjf7;b7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cce;a7b77 is amended-- 7,a7 in paragraph 7#a7-- 7i7 in the matter preceding subparagraph 7,a71 by inserting or 7#c7 after paragraph 7#b72 7ii7 in subparagraph 7,a71 by striking the comma at the end and inserting a semicolon2 7iii7 in subparagraph 7,b71 by striking 1 or and inserting a semicolon2 7iv7 in subparagraph 7,c71 by striking the period and inserting 2 or2 and 7v7 by adding at the end the following3 7,d7 a person from importing or offering for import into the ,united ,states a drug4 2 7,b7 in paragraph 7#c7-- 7i7 in the heading1 by inserting or drug after ,food2 7ii7 in subparagraph 7,a71 by striking 2 or and inserting a semicolon2 7iii7 in subparagraph 7,b71 by striking the period and inserting a semicolon2 and 7iv7 by adding at the end the following3 7,c7 the person has been convicted of a felony for conduct relating to the importation into the ,united ,states of any drug or controlled substance 7as defined in section #ajb of the ,controlled ,substances ,act72 7,d7 the person has engaged in a pattern of importing or offering for import-- 7i7 controlled substances that are prohibited from importation under section #dja7m7 of the ,tariff ,act of #aicj 7#ai ,u4,s4,c4 #adja7m772 or 7ii7 adulterated or misbranded drugs that are-- 7,i7 not designated in an authorized electronic data interchange system as a product that is regulated by the ,secretary2 or 7,,ii7 knowingly or intentionally falsely designated in an authorized electronic data interchange system as a product that is regulated by the ,secretary4 2 and 7,c7 by adding at the end the following3 7#e7 ,definition ,for purposes of paragraph 7#c77;,d71 the term pattern of importing or offering for import means importing or offering for import a drug described in clause 7i7 or 7ii7 of paragraph 7#c77;,d7 in an amount1 frequency1 or dosage that is inconsistent with personal or household use by the importer4 4 7c7 ,imports and exports ,section #hja7;a7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cha7;a771 as amended1 is further amended-- 7#a7 by striking 1 then such article shall be refused admission inserting or 7#e7 such article is being imported or offered for import in violation of section #cja7;cc71 then any such article described in any of clauses 7#a7 through 7#e7 shall be refused admission2 7#b7 by inserting ,if it appears from the examination of such samples or otherwise that the article is a counterfeit drug1 such article shall be refused admission4 before ,with respect to an article of food1 if importation2 and 7#c7 by striking ,clause 7#b7 of the third sentence and all that follows through the period at the end and inserting the following3 ,neither clause 7#b7 nor clause 7#e7 of the third sentence of this subsection shall be construed to prohibit the admission of narcotic drugs1 the importation of which is permitted under the ,controlled ,substances ,import and ,export ,act44 7d7 ,certain illicit articles ,section #hja of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cha71 as amended1 is amended by adding at the end the following-- 7u7 ,illicit articles containing active pharmaceutical ingredients 7#a7 ,in general ,for purposes of this section1 an article that is being imported or offered for import into the ,united ,states may be treated by the ,secretary as a drug if the article-- 7,a7 is not-- 7i7 accompanied by an electronic import entry for such article submitted using an authorized electronic data interchange system2 and 7ii7 designated in such a system as an article regulated by the ,secretary 7which may include regulation as a drug1 a device1 a dietary supplement1 or other product that is regulated under this ,act72 and 7,b7 is an ingredient that presents significant public health concern and is1 or contains-- 7i7 an active ingredient in a drug-- 7,i7 that is approved under section #eje or licensed under section #cea of the ,public ,health ,service ,act2 or 7,,ii7 for which-- 7aa7 an investigational use exemption has been authorized under section #eje7;i7 of this ,act or section #cea7;a7 of the ,public ,health ,service ,act2 and 7bb7 a substantial clinical investigation has been instituted1 and such investigation has been made public2 or 7ii7 a substance that has a chemical structure that is substantially similar to the chemical structure of an active ingredient in a drug or biological product described in subclause 7,i7 or 7,,ii7 of clause 7i74 7#b7 ,effect ,this subsection shall not be construed to bear upon any determination of whether an article is a drug within the meaning of section #bja7;g71 other than for the purposes described in paragraph 7#a74 4 #d ,securing ,opioids and ,unused ,narcotics with ,deliberate ,disposal and ,packaging #cjca4 ,short title ,this chapter may be cited as the ,securing ,opioids and ,unused ,narcotics with ,deliberate ,disposal and ,packaging ,act of #bjah or the ,,sound ,disposal and ,packaging ,act4 #cjcb4 ,safety-enhancing packaging and disposal features 7a7 ,deliberate disposal and packaging elements of strategy ,section #eje-a7;e7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee-a7;e77 is amended by adding at the end the following3 7#d7 ,packaging and disposal ,the ,secretary may require a risk evaluation mitigation strategy for a drug for which there is a serious risk of an adverse drug experience described in subparagraph 7,b7 or 7,c7 of subsection 7b77#a71 taking into consideration the factors described in subparagraphs 7,c7 and 7,d7 of subsection 7f77#b7 and in consultation with other relevant ,federal agencies with authorities over drug disposal packaging1 which may include requiring that-- 7,a7 the drug be made available for dispensing to certain patients in unit dose packaging1 packaging that provides a set duration1 or another packaging system that the ,secretary determines may mitigate such serious risk2 or 7,b7 the drug be dispensed to certain patients with a safe disposal packaging or safe disposal system for purposes of rendering drugs nonretrievable 7as defined in section #acjj4je of title #ba1 ,code of ,federal ,regulations 7or any successor regulation77 if the ,secretary determines that such safe disposal packaging or system may mitigate such serious risk and is sufficiently available4 4 7b7 ,assuring access and minimizing burden ,section #eje-a7;f77#b77;,c7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee-a7;f77#b77;,c77 is amended-- 7#a7 in clause 7i7 by striking and at the end2 and 7#b7 by adding at the end the following3 7iii7 patients with functional limitations2 and 4 7c7 ,application to abbreviated new drug applications ,section #eje-a7;i7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee-a7;i77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 by redesignating subparagraph 7,b7 as subparagraph 7,c72 and 7,b7 inserting after subparagraph 7,a7 the following3 7,b7 ,a packaging or disposal requirement1 if required under subsection 7e77#d7 for the applicable listed drug4 2 and 7#b7 in paragraph 7#b7-- 7,a7 in subparagraph 7,a71 by striking and at the end2 7,b7 by redesignating subparagraph 7,b7 as subparagraph 7,c72 and 7,c7 by inserting after subparagraph 7,a7 the following3 7,b7 shall permit packaging systems and safe disposal packaging or safe disposal systems that are different from those required for the applicable listed drug under subsection 7e77#d72 and 4 7d7 ,,gao report ,not later than #ab months after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall prepare and submit to ,congress a report containing-- 7#a7 a description of available evidence1 if any1 on the effectiveness of site-of-use1 in-home controlled substance disposal products and packaging technologies2 7#b7 an evaluation of existing reference standards with respect to controlled substance disposal products and packaging technologies1 including any such standards established by a standards development organization1 and how such standards should be considered in ensuring effectiveness of such products and technologies2 7#c7 identification of ways in which such disposal products intended for use by patients1 consumers1 and other end users that are not registrants under the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hja et seq471 are made available to the public and any barriers to the use of such disposal products2 7#d7 identification of ways in which packaging technologies are made available to the public and any barriers to the use of such technologies2 7#e7 a description of current ,federal oversight1 if any1 of site-of-use1 in-home controlled substance disposal products1 including-- 7,a7 identification of the ,federal agencies that oversee such products2 7,b7 identification of the methods of disposal of controlled substances recommended by such agencies for site-of-use1 in-home disposal2 and 7,c7 a description of the effectiveness of such recommendations at preventing the diversion of legally prescribed controlled substances2 7#f7 a description of current ,federal oversight1 if any1 of controlled substance packaging technologies1 including-- 7,a7 identification of the ,federal agencies that oversee such technologies2 7,b7 identification of the technologies recommended by such agencies1 including unit dose packaging1 packaging that provides a set duration1 and other packaging systems that may mitigate abuse or misuse2 and 7,c7 a description of the effectiveness of such recommendations at preventing the diversion of legally prescribed controlled substances2 and 7#g7 recommendations1 as appropriate1 on-- 7,a7 whether site-of-use1 in-home controlled substance disposal products and packaging technologies require ,federal oversight and1 if so1 which agency or agencies should be responsible for such oversight and1 as applicable1 review of such products or technologies2 and 7,b7 whether there are applicable standards that should be considered to ensure the effectiveness of such products4 #e ,postapproval study requirements #cjda4 ,clarifying ,,fda postmarket authorities 7a7 ,definition of adverse drug experience ,section #eje-a7;b77#a77;,e7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee-a7;b77#a77;,e77 is amended by striking of the drug and inserting of the drug1 which may include reduced effectiveness under the conditions of use prescribed in the labeling of such drug1 but which may not include reduced effectiveness that is in accordance with such labeling4 7b7 ,safety labeling changes ,section #eje7o77#d7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee7o77#d77 is amended-- 7#a7 in subparagraph 7,a7 by-- 7,a7 striking ,safety information and inserting ,safety or new effectiveness information2 and 7,b7 by striking ,if the ,secretary becomes and all that follows through in the labeling of the drug and inserting ,if the ,secretary becomes aware of new information1 including any new safety information or information related to reduced effectiveness1 that the ,secretary determines should be included in the labeling of the drug2 7#b7 in clause 7i7 of subparagraph 7,b71 by inserting before the semicolon 1 or new effectiveness information2 7#c7 in subparagraph 7,c7 by striking safety information and inserting safety or new effectiveness information2 and 7#d7 in subparagraph 7,e7 by striking safety information and inserting safety or new effectiveness information4 7c7 ,guidance ,not less than one year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue guidance regarding the circumstances under which the ,food and ,drug ,administration may require postmarket studies or clinical trials to assess the potential reduction in effectiveness of a drug and how such reduction in effectiveness could result in a change to the benefits of the drug and the risks to the patient4 ,such guidance shall also address how the ,food and ,drug ,administration may apply this section and the amendments made thereby with respect to circumstances under which the ,food and ,drug ,administration may require postmarket studies or clinical trials and safety labeling changes related to the use of controlled substances for acute or chronic pain4 ,b ,controlled substance provisions #a ,more flexibility with respect to medication-,assisted treatment for opioid use disorders #cbja4 ,allowing for more flexibility with respect to medication-assisted treatment for opioid use disorders 7a7 ,conforming applicable number ,subclause 7,,ii7 of section #cjc7;g77#b77;,b77iii7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,b77iii77 is amended to read as follows3 7,,ii7 ,the applicable number is-- 7aa7 #ajj if1 not sooner than #a year after the date on which the practitioner submitted the initial notification1 the practitioner submits a second notification to the ,secretary of the need and intent of the practitioner to treat up to #ajj patients2 7bb7 #ajj if the practitioner holds additional credentialing1 as defined in section #h4b of title #db1 ,code of ,federal ,regulations 7or successor regulations72 7cc7 #ajj if the practitioner provides medication-assisted treatment 7,,mat7 using covered medications 7as such terms are defined in section #h4b of title #db1 ,code of ,federal ,regulations 7or successor regulations77 in a qualified practice setting 7as described in section #h4fae of title #db1 ,code of ,federal ,regulations 7or successor regulations772 or 7dd7 #bge if the practitioner meets the requirements specified in sections #h4faj through #h4fee of title #db1 ,code of ,federal ,regulations 7or successor regulations74 4 7b7 ,eliminating any time limitation for nurse practitioners and physician assistants ,to become qualifying practitioners ,clause 7iii7 of section #cjc7;g77#b77;,g7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,g77 is amended-- 7#a7 in subclause 7,i71 by striking or at the end2 and 7#b7 by amending subclause 7,,ii7 to read as follows3 7,,ii7 a qualifying other practitioner1 as defined in clause 7iv71 who is a nurse practitioner or physician assistant2 or 4 7c7 ,imposing a time limitation for clinical nurse specialists1 certified registered nurse anesthetists1 and certified nurse midwifes ,to become qualifying practitioners ,clause 7iii7 of section #cjc7;g77#b77;,g7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,g771 as amended by subsection 7b71 is further amended by adding at the end the following3 7,,iii7 for the period beginning on ,october #a1 #bjah1 and ending on ,october #a1 #bjbc1 a qualifying other practitioner1 as defined in clause 7iv71 who is a clinical nurse specialist1 certified registered nurse anesthetist1 or certified nurse midwife4 4 7d7 ,definition of qualifying other practitioner ,section #cjc7;g77#b77;,g77iv7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,g77iv77 is amended by striking nurse practitioner or physician assistant each place it appears and inserting nurse practitioner1 clinical nurse specialist1 certified registered nurse anesthetist1 certified nurse midwife1 or physician assistant4 7e7 ,report by ,secretary ,not later than #b years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with the ,drug ,enforcement ,administration1 shall submit to ,congress a report that assesses the care provided by qualifying practitioners 7as defined in section #cjc7;g77#b77;,g77iii7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,g77iii777 who are treating1 in the case of physicians1 more than #ajj patients1 and in the case of qualifying practitioners who are not physicians1 more than #cj patients4 ,such report shall include recommendations on future applicable patient number levels and limits4 ,in preparing such report1 the ,secretary shall study1 with respect to opioid use disorder treatment-- 7#a7 the average frequency with which qualifying practitioners see their patients2 7#b7 the average frequency with which patients receive counseling1 including the rates by which such counseling is provided by such a qualifying practitioner directly1 or by referral2 7#c7 the frequency of toxicology testing1 including the average frequency with which random toxicology testing is administered2 7#d7 the average monthly patient caseload for each type of qualifying practitioner2 7#e7 the treatment retention rates for patients2 7#f7 overdose and mortality rates2 and 7#g7 any available information regarding the diversion of drugs by patients receiving such treatment from such a qualifying practitioner4 #cbjb4 ,medication-assisted treatment for recovery from substance use disorder 7a7 ,waivers for ,maintenance ,treatment or ,detoxification ,section #cjc7;g77#b77;,g77ii7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,g77ii77 is amended by adding at the end the following3 7,,viii7 ,the physician graduated in good standing from an accredited school of allopathic medicine or osteopathic medicine in the ,united ,states during the #e-year period immediately preceding the date on which the physician submits to the ,secretary a written notification under subparagraph 7,b7 and successfully completed a comprehensive allopathic or osteopathic medicine curriculum or accredited medical residency that-- 7aa7 included not less than #h hours of training on treating and managing opioid-dependent patients2 and 7bb7 included1 at a minimum-- 7,,aa7 the training described in items 7aa7 through 7gg7 of subclause 7,,iv72 and 7,,bb7 training with respect to any other best practice the ,secretary determines should be included in the curriculum1 which may include training on pain management1 including assessment and appropriate use of opioid and non-opioid alternatives4 4 7b7 ,treatment for children ,the ,secretary of ,health and ,human ,services shall consider ways to ensure that an adequate number of qualified practitioners1 as defined in subparagraph 7,g77ii7 of section #cjc7;g77#b7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b771 who have a specialty in pediatrics or the treatment of children or adolescents1 are granted a waiver under such section #cjc7;g77#b7 to treat children and adolescents with substance use disorders4 7c7 ,technical ,amendment ,section #ajb7bd7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb7bd77 is amended by striking ,health1 ,education1 and ,welfare and inserting ,health and ,human ,services4 #cbjc4 ,grants to enhance access to substance use disorder treatment 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall establish a grant program under which the ,secretary may make grants to accredited schools of allopathic medicine or osteopathic medicine and teaching hospitals located in the ,united ,states to support the development of curricula that meet the requirements under subclause 7,,viii7 of section #cjc7;g77#b77;,g77ii7 of the ,controlled ,substances ,act1 as added by section #cbjb7;a7 of this ,act4 7b7 ,authorization of appropriations ,there is authorized to be appropriated1 for grants under subsection 7a71 #d1jjj1jjj for each of fiscal years #bjai through #bjbc4 #cbjd4 ,delivery of a controlled substance by a pharmacy to be administered by injection or implantation 7a7 ,in general ,the ,controlled ,substances ,act is amended by inserting after section #cji 7#ba ,u4,s4,c4 #hbi7 the following3 #cji;,a4 ,delivery of a controlled substance by a pharmacy to an administering practitioner 7a7 ,in general ,notwithstanding section #ajb7aj71 a pharmacy may deliver a controlled substance to a practitioner in accordance with a prescription that meets the requirements of this title and the regulations issued by the ,attorney ,general under this title1 for the purpose of administering the controlled substance by the practitioner if-- 7#a7 the controlled substance is delivered by the pharmacy to the prescribing practitioner or the practitioner administering the controlled substance1 as applicable1 at the location listed on the practitioner's certificate of registration issued under this title2 7#b7 the controlled substance is to be administered for the purpose of maintenance or detoxification treatment under section #cjc7;g77#b7 and-- 7,a7 the practitioner who issued the prescription is a qualifying practitioner authorized under1 and acting within the scope of that section2 and 7,b7 the controlled substance is to be administered by injection or implantation2 7#c7 the pharmacy and the practitioner are authorized to conduct the activities specified in this section under the law of the ,state in which such activities take place2 7#d7 the prescription is not issued to supply any practitioner with a stock of controlled substances for the purpose of general dispensing to patients2 7#e7 except as provided in subsection 7b71 the controlled substance is to be administered only to the patient named on the prescription not later than #ad days after the date of receipt of the controlled substance by the practitioner2 and 7#f7 notwithstanding any exceptions under section #cjg1 the prescribing practitioner1 and the practitioner administering the controlled substance1 as applicable1 maintain complete and accurate records of all controlled substances delivered1 received1 administered1 or otherwise disposed of under this section1 including the persons to whom controlled substances were delivered and such other information as may be required by regulations of the ,attorney ,general4 7b7 ,modification of number of days before which controlled substance shall be administered 7#a7 ,initial #b-year period ,during the #b-year period beginning on the date of enactment of this section1 the ,attorney ,general1 in coordination with the ,secretary1 may reduce the number of days described in subsection 7a77#e7 if the ,attorney ,general determines that such reduction will-- 7,a7 reduce the risk of diversion2 or 7,b7 protect the public health4 7#b7 ,modifications after submission of report ,after the date on which the report described in section #cbjd7;b7 of the ,,support for ,patients and ,communities ,act is submitted1 the ,attorney ,general1 in coordination with the ,secretary1 may modify the number of days described in subsection 7a77#e74 7#c7 ,minimum number of days ,any modification under this subsection shall be for a period of not less than #g days4 4 7b7 ,study and report ,not later than #b years after the date of enactment of this section1 the ,comptroller ,general of the ,united ,states shall conduct a study and submit to ,congress a report on access to and potential diversion of controlled substances administered by injection or implantation4 7c7 ,technical and conforming amendment ,the table of contents for the ,comprehensive ,drug ,abuse ,prevention and ,control ,act of #aigj is amended by inserting after the item relating to section #cji the following3 ,sec4 #cji;,a4 ,delivery of a controlled substance by a pharmacy to an administering practitioner4 4 #b ,empowering ,pharmacists in the ,fight ,against ,opioid ,abuse #cbaa4 ,short title ,this chapter may be cited as the ,empowering ,pharmacists in the ,fight ,against ,opioid ,abuse ,act4 #cbab4 ,programs and materials for training on certain circumstances under which a pharmacist may decline to fill a prescription 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with the ,administrator of the ,drug ,enforcement ,administration1 ,commissioner of ,food and ,drugs1 ,director of the ,centers for ,disease ,control and ,prevention1 and ,assistant ,secretary for ,mental ,health and ,substance ,use1 shall develop and disseminate1 as appropriate1 materials for pharmacists1 health care providers1 and patients on-- 7#a7 circumstances under which a pharmacist may1 consistent with section #cji of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbi7 and regulations thereunder1 including section #acjf4jd of title #ba1 ,code of ,federal ,regulations1 decline to fill a prescription for a controlled substance because the pharmacist suspects the prescription is fraudulent1 forged1 or of doubtful1 questionable1 or suspicious origin2 and 7#b7 other ,federal requirements pertaining to declining to fill a prescription under such circumstances1 including the partial fill of prescriptions for certain controlled substances4 7b7 ,materials included ,in developing materials under subsection 7a71 the ,secretary of ,health and ,human ,services shall include information for-- 7#a7 pharmacists on how to decline to fill a prescription and actions to take after declining to fill a prescription2 and 7#b7 other health care practitioners and the public on a pharmacist's ability to decline to fill prescriptions in certain circumstances and a description of those circumstances 7as described in the materials developed under subsection 7a77#a774 7c7 ,stakeholder input ,in developing the programs and materials required under subsection 7a71 the ,secretary of ,health and ,human ,services shall seek input from relevant national1 ,state1 and local associations1 boards of pharmacy1 medical societies1 licensing boards1 health care practitioners1 and patients1 including individuals with chronic pain4 #c ,safe ,disposal of ,unused ,medication #cbba4 ,short title ,this chapter may be cited as the ,safe ,disposal of ,unused ,medication ,act4 #cbbb4 ,disposal of controlled substances of a hospice patient by employees of a qualified hospice program 7a7 ,in general ,subsection 7g7 of section #cjb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbb7 is amended by adding at the end the following3 7#e7 7,a7 ,in the case of a person receiving hospice care1 an employee of a qualified hospice program1 acting within the scope of employment1 may handle1 without being registered under this section1 any controlled substance that was lawfully dispensed to the person receiving hospice care1 for the purpose of disposal of the controlled substance so long as such disposal occurs onsite in accordance with all applicable ,federal1 ,state1 ,tribal1 and local law and-- 7i7 the disposal occurs after the death of a person receiving hospice care2 7ii7 the controlled substance is expired2 or 7iii7 7,i7 the employee is-- 7aa7 the physician of the person receiving hospice care2 and 7bb7 registered under section #cjc7;f72 and 7,,ii7 the hospice patient no longer requires the controlled substance because the plan of care of the hospice patient has been modified4 7,b7 ,for the purposes of this paragraph3 7i7 ,the terms hospice care and hospice program have the meanings given to those terms in section #ahfa7;dd7 of the ,social ,security ,act4 7ii7 ,the term employee of a qualified hospice program means a physician1 physician assistant1 nurse1 or other person who-- 7,i7 is employed by1 or pursuant to arrangements made by1 a qualified hospice program2 7,,ii7 7aa7 is licensed to perform medical or nursing services by the jurisdiction in which the person receiving hospice care was located2 and 7bb7 is acting within the scope of such employment in accordance with applicable ,state law2 and 7,,iii7 has completed training through the qualified hospice program regarding the disposal of controlled substances in a secure and responsible manner so as to discourage abuse1 misuse1 or diversion4 7iii7 ,the term qualified hospice program means a hospice program that-- 7,i7 has written policies and procedures for assisting in the disposal of the controlled substances of a person receiving hospice care after the person's death2 7,,ii7 at the time when the controlled substances are first ordered-- 7aa7 provides a copy of the written policies and procedures to the patient or patient representative and family2 7bb7 discusses the policies and procedures with the patient or representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe disposal of controlled substances2 and 7cc7 documents in the patient's clinical record that the written policies and procedures were provided and discussed2 and 7,,iii7 at the time following the disposal of the controlled substances-- 7aa7 documents in the patient's clinical record the type of controlled substance1 dosage1 route of administration1 and quantity so disposed2 and 7bb7 the time1 date1 and manner in which that disposal occurred4 4 7b7 ,guidance ,the ,attorney ,general may issue guidance to hospice programs 7as defined in paragraph 7#e7 of section #cjb7;g7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbb7;g771 as added by subsection 7a77 to assist the programs in satisfying the requirements under such paragraph 7#e74 7c7 ,rule of construction relating to ,state and local law ,nothing in this section or the amendments made by this section shall be construed to prevent a ,state or local government from imposing additional controls or restrictions relating to the regulation of the disposal of controlled substances in hospice care or hospice programs4 #cbbc4 ,,gao study and report on hospice safe drug management 7a7 ,study 7#a7 ,in general ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on the requirements applicable to1 and challenges of1 hospice programs with regard to the management and disposal of controlled substances in the home of an individual4 7#b7 ,contents ,in conducting the study under paragraph 7#a71 the ,comptroller ,general shall include-- 7,a7 an overview of any challenges encountered by selected hospice programs regarding the disposal of controlled substances1 such as opioids1 in a home setting1 including any key changes in policies1 procedures1 or best practices for the disposal of controlled substances over time2 and 7,b7 a description of ,federal requirements1 including requirements under the ,medicare program1 for hospice programs regarding the disposal of controlled substances in a home setting1 and oversight of compliance with those requirements4 7b7 ,report ,not later than #ah months after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under subsection 7a71 together with recommendations1 if any1 for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #d ,special ,registration for ,telemedicine ,clarification #cbca4 ,short title ,this chapter may be cited as the ,special ,registration for ,telemedicine ,clarification ,act of #bjah4 #cbcb4 ,regulations relating to a special registration for telemedicine ,section #caa7;h77#b7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hca7;h77#b77 is amended to read as follows3 7#b7 ,regulations ,not later than #a year after the date of enactment of the ,,support for ,patients and ,communities ,act1 in consultation with the ,secretary1 the ,attorney ,general shall promulgate final regulations specifying-- 7,a7 the limited circumstances in which a special registration under this subsection may be issued2 and 7,b7 the procedure for obtaining a special registration under this subsection4 4 #e ,synthetic ,abuse and ,labeling of ,toxic ,substances #cbda4 ,controlled substance analogues ,section #bjc of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hac7 is amended-- 7#a7 by striking ,a controlled and inserting 7a7 ,in general4--,a controlled2 and 7#b7 by adding at the end the following3 7b7 ,determination ,in determining whether a controlled substance analogue was intended for human consumption under subsection 7a71 the following factors may be considered1 along with any other relevant factors3 7#a7 ,the marketing1 advertising1 and labeling of the substance4 7#b7 ,the known efficacy or usefulness of the substance for the marketed1 advertised1 or labeled purpose4 7#c7 ,the difference between the price at which the substance is sold and the price at which the substance it is purported to be or advertised as is normally sold4 7#d7 ,the diversion of the substance from legitimate channels and the clandestine importation1 manufacture1 or distribution of the substance4 7#e7 ,whether the defendant knew or should have known the substance was intended to be consumed by injection1 inhalation1 ingestion1 or any other immediate means4 7#f7 ,any controlled substance analogue that is manufactured1 formulated1 sold1 distributed1 or marketed with the intent to avoid the provisions of existing drug laws4 7c7 ,limitation ,for purposes of this section1 evidence that a substance was not marketed1 advertised1 or labeled for human consumption1 by itself1 shall not be sufficient to establish that the substance was not intended for human consumption4 4 #f ,access to ,increased ,drug ,disposal #cbea4 ,short title ,this chapter may be cited as the ,access to ,increased ,drug ,disposal ,act of #bjah4 #cbeb4 ,definitions ,in this chapter-- 7#a7 the term ,attorney ,general means the ,attorney ,general1 acting through the ,assistant ,attorney ,general for the ,office of ,justice ,programs2 7#b7 the term authorized collector means a narcotic treatment program1 a hospital or clinic with an on-site pharmacy1 a retail pharmacy1 or a reverse distributor1 that is authorized as a collector under section #acag4dj of title #ba1 ,code of ,federal ,regulations 7or any successor regulation72 7#c7 the term covered grant means a grant awarded under section #cjjc2 and 7#d7 the term eligible collector means a person who is eligible to be an authorized collector4 #cbec4 ,authority to make grants ,the ,attorney ,general shall award grants to ,states to enable the ,states to increase the participation of eligible collectors as authorized collectors4 #cbed4 ,application ,a ,state desiring a covered grant shall submit to the ,attorney ,general an application that1 at a minimum-- 7#a7 identifies the single ,state agency that oversees pharmaceutical care and will be responsible for complying with the requirements of the grant2 7#b7 details a plan to increase participation rates of eligible collectors as authorized collectors2 and 7#c7 describes how the ,state will select eligible collectors to be served under the grant4 #cbee4 ,use of grant funds ,a ,state that receives a covered grant1 and any subrecipient of the grant1 may use the grant amounts only for the costs of installation1 maintenance1 training1 purchasing1 and disposal of controlled substances associated with the participation of eligible collectors as authorized collectors4 #cbef4 ,eligibility for grant ,the ,attorney ,general shall award a covered grant to #e ,states1 not less than #c of which shall be ,states in the lowest quartile of ,states based on the participation rate of eligible collectors as authorized collectors1 as determined by the ,attorney ,general4 #cbeg4 ,duration of grants ,the ,attorney ,general shall determine the period of years for which a covered grant is made to a ,state4 #cbeh4 ,accountability and oversight ,a ,state that receives a covered grant shall submit to the ,attorney ,general a report1 at such time and in such manner as the ,attorney ,general may reasonably require1 that-- 7#a7 lists the ultimate recipients of the grant amounts2 7#b7 describes the activities undertaken by the ,state using the grant amounts2 and 7#c7 contains performance measures relating to the effectiveness of the grant1 including changes in the participation rate of eligible collectors as authorized collectors4 #cbei4 ,duration of program ,the ,attorney ,general may award covered grants for each of the first #e fiscal years beginning after the date of enactment of this ,act4 #cbfj4 ,authorization of appropriations ,there is authorized to be appropriated to the ,attorney ,general such sums as may be necessary to carry out this chapter4 #g ,using ,data ,to ,prevent ,opioid ,diversion #cbga4 ,short title ,this chapter may be cited as the ,using ,data ,to ,prevent ,opioid ,diversion ,act of #bjah4 #cbgb4 ,purpose 7a7 ,in general ,the purpose of this chapter is to provide drug manufacturers and distributors with access to anonymized information through the ,automated ,reports and ,consolidated ,orders ,system to help drug manufacturers and distributors identify1 report1 and stop suspicious orders of opioids and reduce diversion rates4 7b7 ,rule of construction ,nothing in this chapter should be construed to absolve a drug manufacturer1 drug distributor1 or other ,drug ,enforcement ,administration registrant from the responsibility of the manufacturer1 distributor1 or other registrant to-- 7#a7 identify1 stop1 and report suspicious orders2 or 7#b7 maintain effective controls against diversion in accordance with section #cjc of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7 or any successor law or associated regulation4 #cbgc4 ,amendments 7a7 ,records and reports of registrants ,section #cjg of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbg7 is amended-- 7#a7 by redesignating subsections 7f71 7g71 and 7h7 as subsections 7g71 7h71 and 7i71 respectively2 7#b7 by inserting after subsection 7e7 the following3 7f7 7#a7 ,the ,attorney ,general shall1 not less frequently than quarterly1 make the following information available to manufacturer and distributor registrants through the ,automated ,reports and ,consolidated ,orders ,system1 or any subsequent automated system developed by the ,drug ,enforcement ,administration to monitor selected controlled substances3 7,a7 ,the total number of distributor registrants that distribute controlled substances to a pharmacy or practitioner registrant1 aggregated by the name and address of each pharmacy and practitioner registrant4 7,b7 ,the total quantity and type of opioids distributed1 listed by ,administration ,controlled ,substances ,code ,number1 to each pharmacy and practitioner registrant described in subparagraph 7,a74 7#b7 ,the information required to be made available under paragraph 7#a7 shall be made available not later than the #cjth day of the first month following the quarter to which the information relates4 7#c7 7,a7 ,all registered manufacturers and distributors shall be responsible for reviewing the information made available by the ,attorney ,general under this subsection4 7,b7 ,in determining whether to initiate proceedings under this title against a registered manufacturer or distributor based on the failure of the registrant to maintain effective controls against diversion or otherwise comply with the requirements of this title or the regulations issued thereunder1 the ,attorney ,general may take into account that the information made available under this subsection was available to the registrant4 2 and 7#c7 by inserting after subsection 7i71 as so redesignated1 the following3 7j7 ,all of the reports required under this section shall be provided in an electronic format4 4 7b7 ,cooperative arrangements ,section #ejc of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hgc7 is amended by striking subsection 7c7 and inserting the following3 7c7 7#a7 ,the ,attorney ,general shall1 once every #f months1 prepare and make available to regulatory1 licensing1 attorneys general1 and law enforcement agencies of ,states a standardized report containing descriptive and analytic information on the actual distribution patterns1 as gathered through the ,automated ,reports and ,consolidated ,orders ,system1 or any subsequent automated system1 pursuant to section #cjg and which includes detailed amounts1 outliers1 and trends of distributor and pharmacy registrants1 in such ,states for the controlled substances contained in schedule ,,ii1 which1 in the discretion of the ,attorney ,general1 are determined to have the highest abuse4 7#b7 ,if the ,attorney ,general publishes the report described in paragraph 7#a7 once every #f months as required under paragraph 7#a71 nothing in this subsection shall be construed to bring an action in any court to challenge the sufficiency of the information or to compel the ,attorney ,general to produce any documents or reports referred to in this subsection4 4 7c7 ,civil and criminal penalties ,section #djb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hdb7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#ae71 by striking or at the end2 7,b7 in paragraph 7#af71 by striking the period at the end and inserting 2 or2 and 7,c7 by inserting after paragraph 7#af7 the following3 7#ag7 in the case of a registered manufacturer or distributor of opioids1 to fail to review the most recent information1 directly related to the customers of the manufacturer or distributor1 made available by the ,attorney ,general in accordance with section #cjg7;f74 2 and 7#b7 in subsection 7c7-- 7,a7 in paragraph 7#a71 by striking subparagraph 7,b7 and inserting the following3 7,b7 7i7 ,except as provided in clause 7ii71 in the case of a violation of paragraph 7#e71 7#aj71 or 7#ag7 of subsection 7a71 the civil penalty shall not exceed #aj1jjj4 7ii7 ,in the case of a violation described in clause 7i7 committed by a registered manufacturer or distributor of opioids and related to the reporting of suspicious orders for opioids1 failing to maintain effective controls against diversion of opioids1 or failing to review the most recent information made available by the ,attorney ,general in accordance with section #cjg7;f71 the penalty shall not exceed #ajj1jjj4 2 and 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,a71 by inserting or 7,d7 after subparagraph 7,b72 and 7ii7 by adding at the end the following3 7,d7 ,in the case of a violation described in subparagraph 7,a7 that was a violation of paragraph 7#e71 7#aj71 or 7#ag7 of subsection 7a7 committed by a registered manufacturer or distributor of opioids that relates to the reporting of suspicious orders for opioids1 failing to maintain effective controls against diversion of opioids1 or failing to review the most recent information made available by the ,attorney ,general in accordance with section #cjg7;f71 the criminal fine under title #ah1 ,united ,states ,code1 shall not exceed #ejj1jjj4 4 #cbgd4 ,report ,not later than #a year after the date of enactment of this ,act1 the ,attorney ,general shall submit to ,congress a report that provides information about how the ,attorney ,general is using data in the ,automation of ,reports and ,consolidated ,orders ,system to identify and stop suspicious activity1 including whether the ,attorney ,general is looking at aggregate orders from individual pharmacies to multiple distributors that in total are suspicious1 even if no individual order rises to the level of a suspicious order to a given distributor4 #h ,opioid ,quota ,reform #cbha4 ,short title ,this chapter may be cited as the ,opioid ,quota ,reform ,act4 #cbhb4 ,strengthening considerations for ,,dea opioid quotas 7a7 ,in general ,section #cjf of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbf7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by inserting 7#a7 after 7a72 7,b7 in the second sentence1 by striking ,production and inserting ,except as provided in paragraph 7#b71 production2 and 7,c7 by adding at the end the following3 7#b7 ,the ,attorney ,general may1 if the ,attorney ,general determines it will assist in avoiding the overproduction1 shortages1 or diversion of a controlled substance1 establish an aggregate or individual production quota under this subsection1 or a procurement quota established by the ,attorney ,general by regulation1 in terms of pharmaceutical dosage forms prepared from or containing the controlled substance4 2 7#b7 in subsection 7b71 in the first sentence1 by striking production and inserting manufacturing2 7#c7 in subsection 7c71 by striking ,october and inserting ,december2 and 7#d7 by adding at the end the following3 7i7 7#a7 7,a7 ,in establishing any quota under this section1 or any procurement quota established by the ,attorney ,general by regulation1 for fentanyl1 oxycodone1 hydrocodone1 oxymorphone1 or hydromorphone 7in this subsection referred to as a covered controlled substance71 the ,attorney ,general shall estimate the amount of diversion of the covered controlled substance that occurs in the ,united ,states4 7,b7 ,in estimating diversion under this paragraph1 the ,attorney ,general-- 7i7 shall consider information the ,attorney ,general1 in consultation with the ,secretary of ,health and ,human ,services1 determines reliable on rates of overdose deaths and abuse and overall public health impact related to the covered controlled substance in the ,united ,states2 and 7ii7 may take into consideration whatever other sources of information the ,attorney ,general determines reliable4 7,c7 ,after estimating the amount of diversion of a covered controlled substance1 the ,attorney ,general shall make appropriate quota reductions1 as determined by the ,attorney ,general1 from the quota the ,attorney ,general would have otherwise established had such diversion not been considered4 7#b7 7,a7 ,for any year for which the approved aggregate production quota for a covered controlled substance is higher than the approved aggregate production quota for the covered controlled substance for the previous year1 the ,attorney ,general1 in consultation with the ,secretary of ,health and ,human ,services1 shall include in the final order an explanation of why the public health benefits of increasing the quota clearly outweigh the consequences of having an increased volume of the covered controlled substance available for sale1 and potential diversion1 in the ,united ,states4 7,b7 ,not later than #a year after the date of enactment of this subsection1 and every year thereafter1 the ,attorney ,general shall submit to the ,committee on the ,judiciary1 the ,committee on ,health1 ,education1 ,labor1 and ,pensions1 and the ,committee on ,appropriations of the ,senate and the ,committee on the ,judiciary1 the ,committee on ,energy and ,commerce1 and the ,committee on ,appropriations of the ,house of ,representatives the following information with regard to each covered controlled substance3 7i7 ,an anonymized count of the total number of manufacturers issued individual manufacturing quotas that year for the covered controlled substance4 7ii7 ,an anonymized count of how many such manufacturers were issued an approved manufacturing quota that was higher than the quota issued to that manufacturer for the covered controlled substance in the previous year4 7#c7 ,not later than #a year after the date of enactment of this subsection1 the ,attorney ,general shall submit to ,congress a report on how the ,attorney ,general1 when fixing and adjusting production and manufacturing quotas under this section for covered controlled substances1 will-- 7,a7 take into consideration changes in the accepted medical use of the covered controlled substances2 and 7,b7 work with the ,secretary of ,health and ,human ,services on methods to appropriately and anonymously estimate the type and amount of covered controlled substances that are submitted for collection from approved drug collection receptacles1 mail-back programs1 and take-back events4 4 7b7 ,conforming change ,the ,law ,revision ,counsel is directed to amend the heading for subsection 7b7 of section #hbf of title #ba1 ,united ,states ,code1 by striking production and inserting manufacturing4 #i ,preventing ,drug ,diversion #cbia4 ,short title ,this chapter may be cited as the ,preventing ,drug ,diversion ,act of #bjah4 #cbib4 ,improvements to prevent drug diversion 7a7 ,definition ,section #ajb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb7 is amended by adding at the end the following3 7#eg7 ,the term suspicious order may include1 but is not limited to-- 7,a7 an order of a controlled substance of unusual size2 7,b7 an order of a controlled substance deviating substantially from a normal pattern2 and 7,c7 orders of controlled substances of unusual frequency4 4 7b7 ,suspicious orders ,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 ,suspicious orders 7a7 ,reporting ,each registrant shall-- 7#a7 design and operate a system to identify suspicious orders for the registrant2 7#b7 ensure that the system designed and operated under paragraph 7#a7 by the registrant complies with applicable ,federal and ,state privacy laws2 and 7#c7 upon discovering a suspicious order or series of orders1 notify the ,administrator of the ,drug ,enforcement ,administration and the ,special ,agent in ,charge of the ,division ,office of the ,drug ,enforcement ,administration for the area in which the registrant is located or conducts business4 7b7 ,suspicious order database 7#a7 ,in general ,not later than #a year after the date of enactment of this section1 the ,attorney ,general shall establish a centralized database for collecting reports of suspicious orders4 7#b7 ,satisfaction of reporting requirements ,if a registrant reports a suspicious order to the centralized database established under paragraph 7#a71 the registrant shall be considered to have complied with the requirement under subsection 7a77#c7 to notify the ,administrator of the ,drug ,enforcement ,administration and the ,special ,agent in ,charge of the ,division ,office of the ,drug ,enforcement ,administration for the area in which the registrant is located or conducts business4 7c7 ,sharing information with the ,states 7#a7 ,in general ,the ,attorney ,general shall prepare and make available information regarding suspicious orders in a ,state1 including information in the database established under subsection 7b77#a71 to the point of contact for purposes of administrative1 civil1 and criminal oversight relating to the diversion of controlled substances for the ,state1 as designated by the ,governor or chief executive officer of the ,state4 7#b7 ,timing ,the ,attorney ,general shall provide information in accordance with paragraph 7#a7 within a reasonable period of time after obtaining the information4 7#c7 ,coordination ,in establishing the process for the provision of information under this subsection1 the ,attorney ,general shall coordinate with ,states to ensure that the ,attorney ,general has access to information1 as permitted under ,state law1 possessed by the ,states relating to prescriptions for controlled substances that will assist in enforcing ,federal law4 4 7c7 ,reports to ,congress 7#a7 ,definition ,in this subsection1 the term suspicious order has the meaning given that term in section #ajb of the ,controlled ,substances ,act1 as amended by this chapter4 7#b7 ,one-time report ,not later than #a year after the date of enactment of this ,act1 the ,attorney ,general shall submit to ,congress a report on the reporting of suspicious orders1 which shall include-- 7,a7 a description of the centralized database established under section #cab of the ,controlled ,substances ,act1 as added by this section1 to collect reports of suspicious orders2 7,b7 a description of the system and reports established under section #cab of the ,controlled ,substances ,act1 as added by this section1 to share information with ,states2 7,c7 information regarding how the ,attorney ,general used reports of suspicious orders before the date of enactment of this ,act and after the date of enactment of this ,act1 including how the ,attorney ,general received the reports and what actions were taken in response to the reports2 and 7,d7 descriptions of the data analyses conducted on reports of suspicious orders to identify1 analyze1 and stop suspicious activity4 7#c7 ,additional reports ,not later than #a year after the date of enactment of this ,act1 and annually thereafter until the date that is #e years after the date of enactment of this ,act1 the ,attorney ,general shall submit to ,congress a report providing1 for the previous year-- 7,a7 the number of reports of suspicious orders2 7,b7 a summary of actions taken in response to reports1 in the aggregate1 of suspicious orders2 and 7,c7 a description of the information shared with ,states based on reports of suspicious orders4 7#d7 ,one-time ,,gao report ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states1 in consultation with the ,administrator of the ,drug ,enforcement ,administration1 shall submit to ,congress a report on the reporting of suspicious orders1 which shall include an evaluation of the utility of real-time reporting of potential suspicious orders of opioids on a national level using computerized algorithms1 including the extent to which such algorithms-- 7,a7 would help ensure that potentially suspicious orders are more accurately captured1 identified1 and reported in real time to suppliers before orders are filled2 7,b7 may produce false positives of suspicious order reports that could result in market disruptions for legitimate orders of opioids2 and 7,c7 would reduce the overall length of an investigation that prevents the diversion of suspicious orders of opioids4 ,,iv ,offsets #djja4 ,promoting value in ,medicaid managed care ,section #aijc7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m771 as amended by sections #ajac and #ajaf1 is further amended by adding at the end the following new paragraph3 7#i7 7,a7 ,with respect to expenditures described in subparagraph 7,b7 that are incurred by a ,state for any fiscal year after fiscal year #bjbj 7and before fiscal year #bjbd71 in determining the pro rata share to which the ,united ,states is equitably entitled under subsection 7d77#c71 the ,secretary shall substitute the ,federal medical assistance percentage that applies for such fiscal year to the ,state under section #aije7;b7 7without regard to any adjustments to such percentage applicable under such section or any other provision of law7 for the percentage that applies to such expenditures under section #aije7y74 7,b7 ,expenditures described in this subparagraph1 with respect to a fiscal year to which subparagraph 7,a7 applies1 are expenditures incurred by a ,state for payment for medical assistance provided to individuals described in subclause 7,,viii7 of section #aijb7;a77#aj77;,a77i7 by a managed care entity1 or other specified entity 7as defined in subparagraph 7,d77iii771 that are treated as remittances because the ,state-- 7i7 has satisfied the requirement of section #dch4h of title #db1 ,code of ,federal ,regulations 7or any successor regulation71 by electing-- 7,i7 in the case of a ,state described in subparagraph 7,c71 to apply a minimum medical loss ratio 7as defined in subparagraph 7,d77ii77 that is at least #he percent but not greater than the minimum medical loss ratio 7as so defined7 that such ,state applied as of ,may #ca1 #bjah2 or 7,,ii7 in the case of a ,state not described in subparagraph 7,c71 to apply a minimum medical loss ratio that is equal to #he percent2 and 7ii7 recovered all or a portion of the expenditures as a result of the entity's failure to meet such ratio4 7,c7 ,for purposes of subparagraph 7,b71 a ,state described in this subparagraph is a ,state that as of ,may #ca1 #bjah1 applied a minimum medical loss ratio 7as calculated under subsection 7d7 of section #dch4h of title #db1 ,code of ,federal ,regulations 7as in effect on ,june #a1 #bjah77 for payment for services provided by entities described in such subparagraph under the ,state plan under this title 7or a waiver of the plan7 that is equal to or greater than #he percent4 7,d7 ,for purposes of this paragraph3 7i7 ,the term managed care entity means a medicaid managed care organization described in section #aicb7;a77#a77;,b77i74 7ii7 ,the term minimum medical loss ratio means1 with respect to a ,state1 a minimum medical loss ratio 7as calculated under subsection 7d7 of section #dch4h of title #db1 ,code of ,federal ,regulations 7as in effect on ,june #a1 #bjah77 for payment for services provided by entities described in subparagraph 7,b7 under the ,state plan under this title 7or a waiver of the plan74 7iii7 ,the term other specified entity means-- 7,i7 a prepaid inpatient health plan1 as defined in section #dch4b of title #db1 ,code of ,federal ,regulations 7or any successor regulation72 and 7,,ii7 a prepaid ambulatory health plan1 as defined in such section 7or any successor regulation74 4 #djjb4 ,requiring reporting by group health plans of prescription drug coverage information for purposes of identifying primary payer situations under the ,medicare program ,clause 7i7 of section #ahfb7;b77#g77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#g77;,a77 is amended to read as follows3 7i7 secure from the plan sponsor and plan participants such information as the ,secretary shall specify for the purpose of identifying situations where the group health plan is or has been-- 7,i7 a primary plan to the program under this title2 or 7,,ii7 for calendar quarters beginning on or after ,january #a1 #bjbj1 a primary payer with respect to benefits relating to prescription drug coverage under part ,d2 and 4 #djjc4 ,additional religious exemption from health coverage responsibility requirement 7a7 ,in general ,section #ejjj;,a7d77#b77;,a7 of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7,a7 ,religious conscience exemptions 7i7 ,in general ,such term shall not include any individual for any month if such individual has in effect an exemption under section #acaa7;d77#d77;,h7 of the ,patient ,protection and ,affordable ,care ,act which certifies that-- 7,i7 such individual is a member of a recognized religious sect or division thereof which is described in section #adjb7;g77#a71 and is adherent of established tenets or teachings of such sect or division as described in such section2 or 7,,ii7 such individual is a member of a religious sect or division thereof which is not described in section #adjb7;g77#a71 who relies solely on a religious method of healing1 and for whom the acceptance of medical health services would be inconsistent with the religious beliefs of the individual4 7ii7 ,special rules 7,i7 ,medical health services defined ,for purposes of this subparagraph1 the term medical health services does not include routine dental1 vision and hearing services1 midwifery services1 vaccinations1 necessary medical services provided to children1 services required by law or by a third party1 and such other services as the ,secretary of ,health and ,human ,services may provide in implementing section #acaa7;d77#d77;,h7 of the ,patient ,protection and ,affordable ,care ,act4 7,,ii7 ,attestation required ,clause 7i77,,ii7 shall apply to an individual for months in a taxable year only if the information provided by the individual under section #adaa7;b77#e77;,a7 of such ,act includes an attestation that the individual has not received medical health services during the preceding taxable year4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to taxable years beginning after ,december #ca1 #bjah4 7c7 ,construction ,nothing in the amendment made by subsection 7a7 shall preempt any ,state law requiring the provision of medical treatment for children1 especially those who are seriously ill4 #djjd4 ,modernizing the reporting of biological and biosimilar products ,subtitle ,b of title ,,xi of the ,medicare ,prescription ,drug1 ,improvement1 and ,modernization ,act of #bjjc 7,public ,law #ajh-agc7 is amended-- 7#a7 in section #aaaa1 as amended by section #c7a7 of the ,patient ,right to ,know ,drug ,prices ,act-- 7,a7 in the paragraph 7#c7 inserted by such section #c7a71 by striking an application and inserting a biosimilar biological product application2 7,b7 in the paragraph 7#d7 inserted by such section #c7a71 by inserting application before under section #cea7k7 of the ,public ,health ,service ,act2 7,c7 in the paragraph 7#e7 inserted by such section #c7a71 by striking for licensure of a biological product under section #cea7k7 of the ,public ,health ,service ,act and inserting under section #cea7k7 of the ,public ,health ,service ,act for licensure of a biological product as biosimilar to1 or interchangeable with1 a reference product2 7,d7 in paragraph 7#g71 as redesignated and amended by such section #c7a71 by striking or under section #cea7;a7 of the ,public ,health ,service ,act and inserting or the owner1 or exclusive licensee1 of a patent included in a list provided under section #cea7l77#c7 of the ,public ,health ,service ,act2 and 7,e7 in the paragraph 7#ab7 added by such section #c7a71 by striking means a brand name drug for which a license is in effect under section #cea7;a7 and inserting has the meaning given such term in section #cea7;i72 and 7#b7 in section #aaab1 as amended by section #c7b7 of the ,patient ,right to ,know ,drug ,prices ,act-- 7,a7 in subsection 7a7-- 7i7 in paragraph 7#a71 by striking for which a statement under section #cea7l77#c77;,b77ii77,i7 of the ,public ,health ,service ,act has been provided2 7ii7 in paragraph 7#b7-- 7,i7 in subparagraph 7,c77i71 by striking brand name and inserting listed2 and 7,,ii7 by amending clause 7ii7 of subparagraph 7,c7 to read as follows3 7ii7 any of the time periods referred to in section #cea7k77#f7 of the ,public ,health ,service ,act as such period applies to such biosimilar biological product application or to any other biosimilar biological product application based on the same reference product4 2 7,b7 in subsection 7b7-- 7i7 in the subsection heading1 by inserting or ,biosimilar ,biological ,product ,applicant after ,applicant2 7ii7 in paragraph 7#a77;,b71 by striking the first sentence and inserting the following3 ,a biosimilar biological product applicant that has submitted a biosimilar biological product application that references a reference product and another biosimilar biological product applicant that has submitted a biosimilar biological product application that references the same reference product shall each file the agreement in accordance with subsection 7c742 and 7iii7 in paragraph 7#b7-- 7,i7 by striking #b generic drug applicants and inserting #b or more generic drug applicants2 and 7,,ii7 by striking or an agreement between #b biosimilar biological product applicants regarding the #a-year period referred to in section #cea7k77#f77;,a7 of the ,public ,health ,service ,act as it applies to the biosimilar biological product applications with which the agreement is concerned and inserting 1 an agreement between #b or more biosimilar biological product applicants regarding a time period referred to in section #cea7k77#f7 of the ,public ,health ,service ,act as it applies to the biosimilar biological product1 or an agreement between #b or more biosimilar biological product applicants regarding the manufacture1 marketing1 or sale of a biosimilar biological product2 and 7,c7 in subsection 7c77#b71 by inserting were entered into within #cj days of1 after condition for14 ,v ,other ,medicaid ,provisions ,a ,mandatory reporting with respect to adult behavioral health measures #ejja4 ,mandatory reporting with respect to adult behavioral health measures ,section #aaci;,b of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7 is amended-- 7#a7 in subsection 7b7-- 7,a7 in paragraph 7#c7-- 7i7 by striking ,not later than ,january #a1 #bjac and inserting the following3 7,a7 ,voluntary reporting ,not later than ,january #a1 #bjac 2 and 7ii7 by adding at the end the following3 7,b7 ,mandatory reporting with respect to behavioral health measures ,beginning with the ,state report required under subsection 7d77#a7 for #bjbd1 the ,secretary shall require ,states to use all behavioral health measures included in the core set of adult health quality measures and any updates or changes to such measures to report information1 using the standardized format for reporting information and procedures developed under subparagraph 7,a71 regarding the quality of behavioral health care for ,medicaid eligible adults4 2 and 7,b7 in paragraph 7#e71 by adding at the end the following new subparagraph3 7,c7 ,behavioral health measures ,beginning with respect to ,state reports required under subsection 7d77#a7 for #bjbd1 the core set of adult health quality measures maintained under this paragraph 7and any updates or changes to such measures7 shall include behavioral health measures4 2 and 7#b7 in subsection 7d77#a77;,a7-- 7,a7 by striking the such plan and inserting such plan2 and 7,b7 by striking subsection 7a77#e7 and inserting subsection 7b77#e7 and1 beginning with the report for #bjbd1 all behavioral health measures included in the core set of adult health quality measures maintained under such subsection 7b77#e7 and any updates or changes to such measures 7as required under subsection 7b77#c774 ,b ,medicaid ,,imd ,additional ,info #ejaa4 ,short title ,this subtitle may be cited as the ,medicaid ,institutes for ,mental ,disease ,are ,decisive in ,delivering ,inpatient ,treatment for ,individuals but ,opportunities for ,needed ,access are ,limited without ,information ,needed about ,facility ,obligations ,act or the ,medicaid ,,imd ,,additional ,,info ,act4 #ejab4 ,,macpac exploratory study and report on institutions for mental diseases requirements and practices under ,medicaid 7a7 ,in general ,not later than ,january #a1 #bjbj1 the ,medicaid and ,,chip ,payment and ,access ,commission established under section #aijj of the ,social ,security ,act 7#db ,u4,s4,c4 #acif7 shall conduct an exploratory study1 using data from a representative sample of ,states1 and submit to ,congress a report on at least the following information1 with respect to services furnished to individuals enrolled under ,state plans under the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 7or waivers of such plans7 who are patients in institutions for mental diseases and for which payment is made through fee-for-service or managed care arrangements under such ,state plans 7or waivers73 7#a7 ,a description of such institutions for mental diseases in each such ,state1 including at a minimum-- 7,a7 the number of such institutions in the ,state2 7,b7 the facility type of such institutions in the ,state2 and 7,c7 any coverage limitations under each such ,state plan 7or waiver7 on scope1 duration1 or frequency of such services4 7#b7 ,with respect to each such institution for mental diseases in each such ,state1 a description of-- 7,a7 such services provided at such institution2 7,b7 the process1 including any timeframe1 used by such institution to clinically assess and reassess such individuals2 and 7,c7 the discharge process used by such institution1 including any care continuum of relevant services or facilities provided or used in such process4 7#c7 ,a description of-- 7,a7 any ,federal waiver that each such ,state has for such institutions and the ,federal statutory authority for such waiver2 and 7,b7 any other ,medicaid funding sources used by each such ,state for funding such institutions1 such as supplemental payments4 7#d7 ,a summary of ,state requirements 7such as certification1 licensure1 and accreditation7 applied by each such ,state to such institutions in order for such institutions to receive payment under the ,state plan 7or waiver7 and how each such ,state determines if such requirements have been met4 7#e7 ,a summary of ,state standards 7such as quality standards1 clinical standards1 and facility standards7 that such institutions must meet to receive payment under such ,state plans 7or waivers7 and how each such ,state determines if such standards have been met4 7#f7 ,if determined appropriate by the ,commission1 recommendations for policies and actions by ,congress and the ,centers for ,medicare ,medicaid ,services1 such as on how ,state ,medicaid programs may improve care and improve standards and including a recommendation for how the ,centers for ,medicare ,medicaid ,services can improve data collection from such programs to address any gaps in information4 7b7 ,stakeholder input ,in carrying out subsection 7a71 the ,medicaid and ,,chip ,payment and ,access ,commission shall seek input from ,state ,medicaid directors and stakeholders1 including at a minimum the ,substance ,abuse and ,mental ,health ,services ,administration1 ,centers for ,medicare ,medicaid ,services1 ,state ,medicaid officials1 ,state mental health authorities1 ,medicaid beneficiary advocates1 health care providers1 and ,medicaid managed care organizations4 7c7 ,definitions ,in this section3 7#a7 ,representative sample of ,states ,the term representative sample of ,states means a non-probability sample in which at least two ,states are selected based on the knowledge and professional judgment of the selector4 7#b7 ,state ,the term ,state means each of the #ej ,states1 the ,district of ,columbia1 and any commonwealth or territory of the ,united ,states4 7#c7 ,institution for mental diseases ,the term institution for mental diseases has the meaning given such term in section #dce4ajaj of title #db1 ,code of ,federal ,regulations1 or any successor regulation4 ,c ,,chip ,mental ,health and ,substance ,use ,disorder ,parity #ejba4 ,short title ,this subtitle may be cited as the ,,chip ,mental ,health and ,substance ,use ,disorder ,parity ,act4 #ejbb4 ,ensuring access to mental health and substance use disorder services for children and pregnant women under the ,children's ,health ,insurance ,program 7a7 ,in general ,section #bajc7;c77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#a77 is amended by adding at the end the following new subparagraph3 7,e7 ,mental health and substance use disorder services 7as defined in paragraph 7#e774 4 7b7 ,mental health and substance use disorder services 7#a7 ,in general ,section #bajc7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77 is amended-- 7,a7 by redesignating paragraphs 7#e71 7#f71 7#g71 and 7#h7 as paragraphs 7#f71 7#g71 7#h71 and 7#i71 respectively2 and 7,b7 by inserting after paragraph 7#d7 the following new paragraph3 7#e7 ,mental health and substance use disorder services ,regardless of the type of coverage elected by a ,state under subsection 7a71 child health assistance provided under such coverage for targeted low-income children and1 in the case that the ,state elects to provide pregnancy-related assistance under such coverage pursuant to section #baab1 such pregnancy-related assistance for targeted low-income pregnant women 7as defined in section #baab7;d77 shall-- 7,a7 include coverage of mental health services 7including behavioral health treatment7 necessary to prevent1 diagnose1 and treat a broad range of mental health symptoms and disorders1 including substance use disorders2 and 7,b7 be delivered in a culturally and linguistically appropriate manner4 4 7#b7 ,conforming amendments 7,a7 ,section #bajc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7a77 is amended1 in the matter before paragraph 7#a71 by striking paragraphs 7#e71 7#f71 and 7#g7 and inserting paragraphs 7#e71 7#f71 7#g71 and 7#h74 7,b7 ,section #baaj7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7a77 is amended-- 7i7 in paragraph 7#ah71 by striking substance abuse each place it appears and inserting substance use2 and 7ii7 in paragraph 7#ai71 by striking substance abuse and inserting substance use4 7,c7 ,section #baaj7;b77#e77;,a77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7b77#e77;,a77i77 is amended by striking subsection 7c77#e7 and inserting subsection 7c77#f74 7c7 ,assuring access to care ,section #bajb7;a77#g77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7c77#b77 is amended by striking section #bajc7;c77#e7 and inserting paragraphs 7#e7 and 7#f7 of section #bajc7;c74 7d7 ,mental health services parity ,subparagraph 7,a7 of paragraph 7#g7 of section #bajc7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77 7as redesignated by subsection 7b77#a77 is amended to read as follows3 7,a7 ,in general ,a ,state child health plan shall ensure that the financial requirements and treatment limitations applicable to mental health and substance use disorder services 7as described in paragraph 7#e77 provided under such plan comply with the requirements of section #bgbf7;a7 of the ,public ,health ,service ,act in the same manner as such requirements or limitations apply to a group health plan under such section4 4 7e7 ,effective date 7#a7 ,in general ,subject to paragraph 7#b71 the amendments made by this section shall take effect with respect to child health assistance provided on or after the date that is #a year after the date of the enactment of this ,act4 7#b7 ,exception for ,state legislation ,in the case of a ,state child health plan under title ,,xxi of the ,social ,security ,act 7or a waiver of such plan71 which the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the respective plan 7or waiver7 to meet any requirement imposed by the amendments made by this section1 the respective plan 7or waiver7 shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of enactment of this section4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be considered to be a separate regular session of the ,state legislature4 ,d ,medicaid ,reentry #ejca4 ,short title ,this subtitle may be cited as the ,medicaid ,reentry ,act4 #ejcb4 ,promoting ,state innovations to ease transitions integration to the community for certain individuals 7a7 ,stakeholder group development of best practices2 ,state ,medicaid program innovation 7#a7 ,stakeholder group best practices ,not later than #f months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall convene a stakeholder group of representatives of managed care organizations1 ,medicaid beneficiaries1 health care providers1 the ,national ,association of ,medicaid ,directors1 and other relevant representatives from local1 ,state1 and ,federal jail and prison systems to develop best practices 7and submit to the ,secretary and ,congress a report on such best practices7 for ,states-- 7,a7 to ease the health care-related transition of an individual who is an inmate of a public institution from the public institution to the community1 including best practices for ensuring continuity of health insurance coverage or coverage under the ,state ,medicaid plan under title ,,xix of the ,social ,security ,act1 as applicable1 and relevant social services2 and 7,b7 to carry out1 with respect to such an individual1 such health care-related transition not later than #cj days after such individual is released from the public institution4 7#b7 ,state ,medicaid program innovation ,the ,secretary of ,health and ,human ,services shall work with ,states on innovative strategies to help individuals who are inmates of public institutions and otherwise eligible for medical assistance under the ,medicaid program under title ,,xix of the ,social ,security ,act transition1 with respect to enrollment for medical assistance under such program1 seamlessly to the community4 7b7 ,guidance on innovative service delivery systems demonstration project opportunities ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall issue a ,state ,medicaid ,director letter1 based on best practices developed under subsection 7a77#a71 regarding opportunities to design demonstration projects under section #aaae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae7 to improve care transitions for certain individuals who are soon-to-be former inmates of a public institution and who are otherwise eligible to receive medical assistance under title ,,xix of such ,act1 including systems for1 with respect to a period 7not to exceed #cj days7 immediately prior to the day on which such individuals are expected to be released from such institution-- 7#a7 providing assistance and education for enrollment under a ,state plan under the ,medicaid program under title ,,xix of such ,act for such individuals during such period2 and 7#b7 providing health care services for such individuals during such period4 7c7 ,rule of construction ,nothing under title ,,xix of the ,social ,security ,act or any other provision of law precludes a ,state from reclassifying or suspending 7rather than terminating7 eligibility of an individual for medical assistance under title ,,xix of the ,social ,security ,act while such individual is an inmate of a public institution4 ,e ,medicaid ,partnership #ejda4 ,short title ,this subtitle may be cited as the ,medicaid ,providers ,are ,required ,to ,note ,experiences in ,record ,systems to ,help ,in-need ,patients ,act or the ,medicaid ,,partnership ,act4 #ejdb4 ,medicaid providers are required to note experiences in record systems to help in-need patients 7a7 ,requirements under the ,medicaid program relating to qualified prescription drug monitoring programs and prescribing certain controlled substances ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended by inserting after section #aidc the following new section3 #aidd4 ,requirements relating to qualified prescription drug monitoring programs and prescribing certain controlled substances 7a7 ,in general ,subject to subsection 7d71 beginning ,october #a1 #bjba1 a ,state-- 7#a7 shall require each covered provider to check1 in accordance with such timing1 manner1 and form as specified by the ,state1 the prescription drug history of a covered individual being treated by the covered provider through a qualified prescription drug monitoring program described in subsection 7b7 before prescribing to such individual a controlled substance2 and 7#b7 in the case that such a provider is not able to conduct such a check despite a good faith effort by such provider-- 7,a7 shall require the provider to document such good faith effort1 including the reasons why the provider was not able to conduct the check2 and 7,b7 may require the provider to submit1 upon request1 such documentation to the ,state4 7b7 ,qualified prescription drug monitoring program described ,a qualified prescription drug monitoring program described in this subsection is1 with respect to a ,state1 a prescription drug monitoring program administered by the ,state that1 at a minimum1 satisfies each of the following criteria3 7#a7 ,the program facilitates access by a covered provider to1 at a minimum1 the following information with respect to a covered individual1 in as close to real-time as possible3 7,a7 ,information regarding the prescription drug history of a covered individual with respect to controlled substances4 7,b7 ,the number and type of controlled substances prescribed to and filled for the covered individual during at least the most recent #ab-month period4 7,c7 ,the name1 location1 and contact information 7or other identifying number selected by the ,state1 such as a national provider identifier issued by the ,national ,plan and ,provider ,enumeration ,system of the ,centers for ,medicare ,medicaid ,services7 of each covered provider who prescribed a controlled substance to the covered individual during at least the most recent #ab-month period4 7#b7 ,the program facilitates the integration of information described in paragraph 7#a7 into the workflow of a covered provider1 which may include the electronic system the covered provider uses to prescribe controlled substances4 ,a qualified prescription drug monitoring program described in this subsection1 with respect to a ,state1 may have in place1 in accordance with applicable ,state and ,federal law1 a data-sharing agreement with the ,state ,medicaid program that allows the medical director and pharmacy director of such program 7and any designee of such a director who reports directly to such director7 to access the information described in paragraph 7#a7 in an electronic format4 ,the ,state ,medicaid program under this title may facilitate reasonable and limited access1 as determined by the ,state and ensuring documented beneficiary protections regarding the use of such data1 to such qualified prescription drug monitoring program for the medical director or pharmacy director of any managed care entity 7as defined under section #aicb7;a77#a77;,b77 that has a contract with the ,state under section #aijc7m7 or under section #aije7t77#c71 or the medical director or pharmacy director of any entity that has a contract to manage the pharmaceutical benefit with respect to individuals enrolled in the ,state plan 7or under a waiver of the ,state plan74 ,all applicable ,state and ,federal security and privacy laws shall apply to the directors or designees of such directors of any ,state ,medicaid program or entity accessing a qualified prescription drug monitoring program under this section4 7c7 ,application of privacy rules clarification ,the ,secretary shall clarify privacy requirements1 including requirements under the regulations promulgated pursuant to section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note71 related to the sharing of data under subsection 7b7 in the same manner as the ,secretary is required under subparagraph 7,j7 of section #ahfj;,d-#d7;c77#e7 to clarify privacy requirements related to the sharing of data described in such subparagraph4 7d7 ,ensuring access ,in order to ensure reasonable access to health care1 the ,secretary shall waive the application of the requirement under subsection 7a71 with respect to a ,state1 in the case of natural disasters and similar situations1 and in the case of the provision of emergency services 7as defined for purposes of section #ahfj;,d-#d7;c77#e77;,d77ii77,,ii774 7e7 ,reports 7#a7 ,state reports ,each ,state shall include in the annual report submitted to the ,secretary under section #aibg7;g77#c77;,d71 beginning with such reports submitted for #bjbc1 information including1 at a minimum1 the following information for the most recent #ab-month period3 7,a7 ,the percentage of covered providers 7as determined pursuant to a process established by the ,state7 who checked the prescription drug history of a covered individual through a qualified prescription drug monitoring program described in subsection 7b7 before prescribing to such individual a controlled substance4 7,b7 ,aggregate trends with respect to prescribing controlled substances such as-- 7i7 the quantity of daily morphine milligram equivalents prescribed for controlled substances2 7ii7 the number and quantity of daily morphine milligram equivalents prescribed for controlled substances per covered individual2 and 7iii7 the types of controlled substances prescribed1 including the dates of such prescriptions1 the supplies authorized 7including the duration of such supplies71 and the period of validity of such prescriptions1 in different populations 7such as individuals who are elderly1 individuals with disabilities1 and individuals who are enrolled under both this title and title ,,xviii74 7,c7 ,whether or not the ,state requires 7and a detailed explanation as to why the ,state does or does not require7 pharmacists to check the prescription drug history of a covered individual through a qualified prescription drug monitoring program described in subsection 7b7 before dispensing a controlled substance to such individual4 7,d7 ,an accounting of any data or privacy breach of a qualified prescription drug monitoring program described in subsection 7b71 the number of covered individuals impacted by each such breach1 and a description of the steps the ,state has taken to address each such breach1 including1 to the extent required by ,state or ,federal law or otherwise determined appropriate by the ,state1 alerting any such impacted individual and law enforcement of the breach4 7#b7 ,report by ,,cms ,not later than ,october #a1 #bjbc1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall publish on the publicly available website of the ,centers for ,medicare ,medicaid ,services a report including the following information3 7,a7 ,guidance for ,states on how ,states can increase the percentage of covered providers who use qualified prescription drug monitoring programs described in subsection 7b74 7,b7 ,best practices for how ,states and covered providers should use such qualified prescription drug monitoring programs to reduce the occurrence of abuse of controlled substances4 7f7 ,increase to ,,fmap and ,federal matching rates for certain expenditures relating to qualified prescription drug monitoring programs 7#a7 ,in general ,with respect to a ,state that meets the condition described in paragraph 7#b7 and any quarter occurring during fiscal year #bjai or fiscal year #bjbj1 the ,federal medical assistance percentage or ,federal matching rate that would otherwise apply to such ,state under section #aijc7;a7 for such quarter1 with respect to expenditures by the ,state for activities under the ,state plan 7or a waiver of such plan7 to design1 develop1 or implement a prescription drug monitoring program 7and to make connections to such program7 that satisfies the criteria described in paragraphs 7#a7 and 7#b7 of subsection 7b71 shall be equal to #ajj percent4 7#b7 ,condition ,the condition described in this paragraph1 with respect to a ,state1 is that the ,state 7in this paragraph referred to as the administering ,state7 has in place agreements with all ,states that are contiguous to such administering ,state that1 when combined1 enable covered providers in all such contiguous ,states to access1 through the prescription drug monitoring program1 the information that is described in subsection 7b77#a7 of covered individuals of such administering ,state and that covered providers in such administering ,state are able to access through such program4 7g7 ,rule of construction ,nothing in this section prevents a ,state from requiring pharmacists to check the prescription drug history of covered individuals through a qualified prescription drug monitoring program before dispensing controlled substances to such individuals4 7h7 ,definitions ,in this section3 7#a7 ,controlled substance ,the term controlled substance means a drug that is included in schedule ,,ii of section #bjb7;c7 of the ,controlled ,substances ,act and1 at the option of the ,state involved1 a drug included in schedule ,,iii or ,,iv of such section4 7#b7 ,covered individual ,the term covered individual means1 with respect to a ,state1 an individual who is enrolled in the ,state plan 7or under a waiver of such plan74 ,such term does not include an individual who-- 7,a7 is receiving-- 7i7 hospice or palliative care2 or 7ii7 treatment for cancer2 7,b7 is a resident of a long-term care facility1 of a facility described in section #aije7;d71 or of another facility for which frequently abused drugs are dispensed for residents through a contract with a single pharmacy2 or 7,c7 the ,state elects to treat as exempted from such term4 7#c7 ,covered provider 7,a7 ,in general ,the term covered provider means1 subject to subparagraph 7,b71 with respect to a ,state1 a health care provider who is participating under the ,state plan 7or waiver of the ,state plan7 and licensed1 registered1 or otherwise permitted by the ,state to prescribe a controlled substance 7or the designee of such provider74 7,b7 ,exceptions 7i7 ,in general ,beginning ,october #a1 #bjba1 for purposes of this section1 such term does not include a health care provider included in any type of health care provider determined by the ,secretary to be exempt from application of this section under clause 7ii74 7ii7 ,exceptions process ,not later than ,october #a1 #bjbj1 the ,secretary1 after consultation with the ,national ,association of ,medicaid ,directors1 national health care provider associations1 ,medicaid beneficiary advocates1 and advocates for individuals with rare diseases1 shall determine1 based on such consultations1 the types of health care providers 7if any7 that should be exempted from the definition of the term covered provider for purposes of this section4 4 7b7 ,guidance ,not later than ,october #a1 #bjai1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 shall issue guidance on best practices on the uses of prescription drug monitoring programs required of prescribers and on protecting the privacy of ,medicaid beneficiary information maintained in and accessed through prescription drug monitoring programs4 7c7 ,development of model ,state practices 7#a7 ,in general ,not later than ,october #a1 #bjbj1 the ,secretary of ,health and ,human ,services shall develop and publish model practices to assist ,state ,medicaid program operations in identifying and implementing strategies to utilize data-sharing agreements described in the matter following paragraph 7#b7 of section #aidd7;b7 of the ,social ,security ,act1 as added by subsection 7a71 for the following purposes3 7,a7 ,monitoring and preventing fraud1 waste1 and abuse4 7,b7 ,improving health care for individuals enrolled in a ,state plan under title ,,xix of such ,act 7or under a waiver of such plan7 who-- 7i7 transition in and out of coverage under such title2 7ii7 may have sources of health care coverage in addition to coverage under such title2 or 7iii7 pay for prescription drugs with cash4 7,c7 ,any other purposes specified by the ,secretary4 7#b7 ,elements of model practices ,the model practices described in paragraph 7#a7-- 7,a7 shall include strategies for assisting ,states in allowing the medical director or pharmacy director 7or designees of such a director7 of managed care organizations or pharmaceutical benefit managers to access information with respect to all covered individuals served by such managed care organizations or pharmaceutical benefit managers to access as a single data set1 in an electronic format2 and 7,b7 shall include any appropriate beneficiary protections and privacy guidelines4 7#c7 ,consultation ,in developing model practices under this subsection1 the ,secretary shall consult with the ,national ,association of ,medicaid ,directors1 managed care entities 7as defined in section #aicb7;a77#a77;,b7 of the ,social ,security ,act7 with contracts with ,states pursuant to section #aijc7m7 of such ,act1 pharmaceutical benefit managers1 physicians and other health care providers1 beneficiary advocates1 and individuals with expertise in health care technology related to prescription drug monitoring programs and electronic health records4 7d7 ,report by ,comptroller ,general ,not later than ,october #a1 #bjbj1 the ,comptroller ,general of the ,united ,states shall issue a report examining the operation of prescription drug monitoring programs administered by ,states1 including data security and access standards used by such programs4 ,f ,,imd ,,care ,act #ejea4 ,short title ,this title may be cited as the ,individuals in ,medicaid ,deserve ,care that is ,appropriate and ,responsible in its ,execution ,act or the ,,imd ,,care ,act4 #ejeb4 ,state option to provide ,medicaid coverage for certain individuals with substance use disorders who are patients in certain institutions for mental diseases 7a7 ,in general ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 as amended by preceding sections of this ,act1 is further amended-- 7#a7 in section #aije7;a71 in the subdivision 7,b7 that follows paragraph 7#cj71 by inserting 7except in the case of services provided under a ,state plan amendment described in section #aiae7l77 before the period2 and 7#b7 in section #aiae1 by adding at the end the following new subsection3 7l7 ,state plan amendment option to provide medical assistance for certain individuals who are patients in certain institutions for mental diseases 7#a7 ,in general ,with respect to calendar quarters beginning during the period beginning ,october #a1 #bjai1 and ending ,september #cj1 #bjbc1 a ,state may elect1 through a ,state plan amendment1 to provide medical assistance for items and services furnished to an eligible individual who is a patient in an eligible institution for mental diseases in accordance with the requirements of this subsection4 7#b7 ,payments ,subject to paragraphs 7#c7 and 7#d71 amounts expended under a ,state plan amendment under paragraph 7#a7 for services described in such paragraph furnished1 with respect to a #ab-month period1 to an eligible individual who is a patient in an eligible institution for mental diseases shall be treated as medical assistance for which payment is made under section #aijc7;a7 but only to the extent that such services are furnished for not more than a period of #cj days 7whether or not consecutive7 during such #ab-month period4 7#c7 ,maintenance of effort 7,a7 ,in general ,as a condition for a ,state receiving payments under section #aijc7;a7 for medical assistance provided in accordance with this subsection1 the ,state shall 7during the period in which it so furnished such medical assistance through a ,state plan amendment under this subsection7 maintain on an annual basis a level of funding expended by the ,state 7and political subdivisions thereof7 other than under this title from non-,federal funds for-- 7i7 items and services furnished to eligible individuals who are patients in eligible institutions for mental diseases that is not less than the level of such funding for such items and services for the most recently ended fiscal year as of the date of enactment of this subsection or1 if higher1 for the most recently ended fiscal year as of the date the ,state submits a ,state plan amendment to the ,secretary to provide such medical assistance in accordance with this subsection2 and 7ii7 items and services 7including services described in subparagraph 7,b77 furnished to eligible individuals in outpatient and community-based settings that is not less than the level of such funding for such items and services for the most recently ended fiscal year as of the date of enactment of this subsection or1 if higher1 for the most recently ended fiscal year as of the date the ,state submits a ,state plan amendment to the ,secretary to provide such medical assistance in accordance with this subsection4 7,b7 ,services described ,for purposes of subparagraph 7,a77ii71 services described in this subparagraph are the following3 7i7 ,outpatient and community-based substance use disorder treatment4 7ii7 ,evidence-based recovery and support services4 7iii7 ,clinically-directed therapeutic treatment to facilitate recovery skills1 relapse prevention1 and emotional coping strategies4 7iv7 ,outpatient medication-assisted treatment1 related therapies1 and pharmacology4 7v7 ,counseling and clinical monitoring4 7vi7 ,outpatient withdrawal management and related treatment designed to alleviate acute emotional1 behavioral1 cognitive1 or biomedical distress resulting from1 or occurring with1 an individual's use of alcohol and other drugs4 7vii7 ,routine monitoring of medication adherence4 7viii7 ,other outpatient and community-based services for the treatment of substance use disorders1 as designated by the ,secretary4 7,c7 ,state reporting requirement 7i7 ,in general ,prior to approval of a ,state plan amendment under this subsection1 as a condition for a ,state receiving payments under section #aijc7;a7 for medical assistance provided in accordance with this subsection1 the ,state shall report to the ,secretary1 in accordance with the process established by the ,secretary under clause 7ii71 the information deemed necessary by the ,secretary under such clause4 7ii7 ,process ,not later than the date that is #h months after the date of enactment of this subsection1 the ,secretary shall establish a process for ,states to report to the ,secretary1 at such time and in such manner as the ,secretary deems appropriate1 such information as the ,secretary deems necessary to verify a ,state's compliance with subparagraph 7,a74 7#d7 ,ensuring a continuum of services 7,a7 ,in general ,as a condition for a ,state receiving payments under section #aijc7;a7 for medical assistance provided in accordance with this subsection1 the ,state shall carry out each of the requirements described in subparagraphs 7,b7 through 7,d74 7,b7 ,notification ,prior to approval of a ,state plan amendment under this subsection1 the ,state shall notify the ,secretary of how the ,state will ensure that eligible individuals receive appropriate evidence-based clinical screening prior to being furnished with items and services in an eligible institution for mental diseases1 including initial and periodic assessments to determine the appropriate level of care1 length of stay1 and setting for such care for each individual4 7,c7 ,outpatient services2 inpatient and residential services 7i7 ,outpatient services ,the ,state shall1 at a minimum1 provide medical assistance for services that could otherwise be covered under the ,state plan1 consistent with each of the following outpatient levels of care3 7,i7 ,early intervention for individuals who1 for a known reason1 are at risk of developing substance-related problems and for individuals for whom there is not yet sufficient information to document a diagnosable substance use disorder4 7,,ii7 ,outpatient services for less than #i hours per week for adults1 and for less than #f hours per week for adolescents1 for recovery or motivational enhancement therapies and strategies4 7,,iii7 ,intensive outpatient services for #i hours or more per week for adults1 and for #f hours or more per week for adolescents1 to treat multidimensional instability4 7,,iv7 ,partial hospitalization services for #bj hours or more per week for adults and adolescents to treat multidimensional instability that does not require #bd-;hour care4 7ii7 ,inpatient and residential services ,the ,state shall provide medical assistance for services that could otherwise be covered under the ,state plan1 consistent with at least #b of the following inpatient and residential levels of care3 7,i7 ,clinically managed1 low-intensity residential services that provide adults and adolescents with #bd-;hour living support and structure with trained personnel and at least #e hours of clinical service per week per individual4 7,,ii7 ,clinically managed1 population-specific1 high-intensity residential services that provide adults with #bd-;hour care with trained counselors to stabilize multidimensional imminent danger along with less intense milieu and group treatment for those with cognitive or other impairments unable to use full active milieu or therapeutic community4 7,,iii7 ,clinically managed1 medium-intensity residential services for adolescents1 and clinically managed1 high-intensity residential services for adults1 that provide #bd-;hour care with trained counselors to stabilize multidimensional imminent danger and preparation for outpatient treatment4 7,,iv7 ,medically monitored1 high-intensity inpatient services for adolescents1 and medically monitored1 intensive inpatient services withdrawal management for adults1 that provide #bd-;hour nursing care1 make physicians available for significant problems in ,dimensions #a1 #b1 or #c1 and provide counseling services #af hours per day4 7,v7 ,medically managed1 intensive inpatient services for adolescents and adults that provide #bd-;hour nursing care and daily physician care for severe1 unstable problems in ,dimensions #a1 #b or #c4 7,d7 ,transition of care ,in order to ensure an appropriate transition for an eligible individual from receiving care in an eligible institution for mental diseases to receiving care at a lower level of clinical intensity within the continuum of care 7including outpatient services71 the ,state shall ensure that-- 7i7 a placement in such eligible institution for mental diseases would allow for an eligible individual's successful transition to the community1 considering such factors as proximity to an individual's support network 7such as family members1 employment1 and counseling and other services near an individual's residence72 and 7ii7 all eligible institutions for mental diseases that furnish items and services to individuals for which medical assistance is provided under the ,state plan-- 7,i7 are able to provide care at such lower level of clinical intensity2 or 7,,ii7 have an established relationship with another facility or provider that is able to provide care at such lower level of clinical intensity and accepts patients receiving medical assistance under this title under which the eligible institution for mental diseases may arrange for individuals to receive such care from such other facility or provider4 7#e7 ,application to managed care ,payments for1 and limitations to1 medical assistance furnished in accordance with this subsection shall be in addition to and shall not be construed to limit or supersede the ability of ,states to make monthly capitation payments to managed care organizations for individuals receiving treatment in institutions for mental diseases in accordance with section #dch4f7;e7 of title #db1 ,code of ,federal ,regulations 7or any successor regulation74 7#f7 ,other medical assistance ,the provision of medical assistance for items and services furnished to an eligible individual who is a patient in an eligible institution for mental diseases in accordance with the requirements of this subsection shall not prohibit ,federal financial participation for medical assistance for items or services that are provided to such eligible individual in or away from the eligible institution for mental disease during any period in which the eligible individual is receiving items or services in accordance with this subsection4 7#g7 ,definitions ,in this subsection3 7,a7 ,dimensions #a1 #b1 or #c ,the term ,dimensions #a1 #b1 or #c has the meaning given that term for purposes of the publication of the ,american ,society of ,addiction ,medicine entitled ,the ,,asam ,criteria3 ,treatment ,criteria for ,addictive ,substance-,related1 and ,co-,occurring ,conditions1 #bjac4 7,b7 ,eligible individual ,the term eligible individual means an individual who-- 7i7 with respect to a ,state1 is enrolled for medical assistance under the ,state plan or a waiver of such plan2 7ii7 is at least #ba years of age2 7iii7 has not attained #fe years of age2 and 7iv7 has at least #a substance use disorder4 7,c7 ,eligible institution for mental diseases ,the term eligible institution for mental diseases means an institution for mental diseases that-- 7i7 follows reliable1 evidence-based practices2 and 7ii7 offers at least #b forms of medication-assisted treatment for substance use disorders on site1 including1 in the case of medication-assisted treatment for opioid use disorder1 at least #a antagonist and #a partial agonist4 7,d7 ,institution for mental diseases ,the term institution for mental diseases has the meaning given that term in section #aije7;i74 4 7b7 ,rule of construction ,nothing in the amendments made by subsection 7a7 shall be construed as encouraging a ,state to place an individual in an inpatient or a residential care setting where a home or community-based care setting would be more appropriate for the individual1 or as preventing a ,state from conducting or pursuing a demonstration project under section #aaae of the ,social ,security ,act to improve access to1 and the quality of1 substance use disorder treatment for eligible populations4 ,g ,medicaid ,improvement ,fund #ejfa4 ,medicaid ,improvement ,fund ,section #aida7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifw-#a7;b77#a77 is amended by striking #j and inserting #ca1jjj1jjj4 ,,vi ,other ,medicare ,provisions ,a ,testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology #fjja4 ,testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology ,section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is amended by adding at the end the following new clause3 7xxv7 ,providing1 for the adoption and use of certified ,,ehr technology 7as defined in section #ahdh7o77#d77 to improve the quality and coordination of care through the electronic documentation and exchange of health information1 incentive payments to behavioral health providers 7such as psychiatric hospitals 7as defined in section #ahfa7;f771 community mental health centers 7as defined in section #ahfa7;ff77#c77;,b771 hospitals that participate in a ,state plan under title ,,xix or a waiver of such plan1 treatment facilities that participate in such a ,state plan or such a waiver1 mental health or substance use disorder providers that participate in such a ,state plan or such a waiver1 clinical psychologists 7as defined in section #ahfa7;ii771 nurse practitioners 7as defined in section #ahfa7;aa77#e77 with respect to the provision of psychiatric services1 and clinical social workers 7as defined in section #ahfa7;hh77#a7774 4 ,b ,abuse ,deterrent ,access #fjaa4 ,short title ,this subtitle may be cited at the ,abuse ,deterrent ,access ,act of #bjah4 #fjab4 ,study on abuse-deterrent opioid formulations access barriers under ,medicare 7a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall conduct a study and submit to ,congress a report on-- 7#a7 the adequacy of access to abuse-deterrent opioid formulations for individuals with chronic pain enrolled in an ,,ma-,,pd plan under part ,c of title ,,xviii of the ,social ,security ,act or a prescription drug plan under part ,d of such title of such ,act1 taking into account any barriers preventing such individuals from accessing such formulations under such ,,ma-,,pd or part ,d plans1 such as cost-sharing tiers1 fail-first requirements1 the price of such formulations1 and prior authorization requirements2 and 7#b7 the effectiveness of abuse-deterrent opioid formulations in preventing opioid abuse or misuse2 the impact of the use of abuse-deterrent opioid formulations on the use or abuse of other prescription or illicit opioids 7including changes in deaths from such opioids72 and other public health consequences of the use of abuse-deterrent opioid formulations1 such as an increase in rates of human immunodeficiency virus4 7b7 ,definition of ,abuse-,deterrent opioid formulation ,in this section1 the term abuse-deterrent opioid formulation means an opioid that is a prodrug or that has certain abuse-deterrent properties1 such as physical or chemical barriers1 agonist or antagonist combinations1 aversion properties1 delivery system mechanisms1 or other features designed to prevent abuse of such opioid4 ,c ,medicare ,opioid ,safety ,education #fjba4 ,medicare opioid safety education 7a7 ,in general ,section #ahjd of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is amended by adding at the end the following new subsection3 7d7 ,the notice provided under subsection 7a7 shall include-- 7#a7 references to educational resources regarding opioid use and pain management2 7#b7 a description of categories of alternative1 non-opioid pain management treatments covered under this title2 and 7#c7 a suggestion for the beneficiary to talk to a physician regarding opioid use and pain management4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to notices distributed prior to each ,medicare open enrollment period beginning after ,january #a1 #bjai4 ,d ,opioid ,addiction ,action ,plan #fjca4 ,short title ,this subtitle may be cited as the ,opioid ,addiction ,action ,plan ,act4 #fjcb4 ,action plan on recommendations for changes under ,medicare and ,medicaid to prevent opioids addictions and enhance access to medication-assisted treatment 7a7 ,in general ,not later than ,january #a1 #bjbj1 the ,secretary of ,health and ,human ,services 7in this section referred to as the 8,secretary071 in collaboration with the ,pain ,management ,best ,practices ,inter-,agency ,task ,force convened under section #aja7;b7 of the ,comprehensive ,addiction and ,recovery ,act of #bjaf 7,public ,law #aad-aih71 shall develop an action plan as described in subsection 7b74 7b7 ,action plan components ,the action plan shall include a review by the ,secretary of ,medicare and ,medicaid payment and coverage policies that may be viewed as potential obstacles to an effective response to the opioid crisis1 and recommendations1 as determined appropriate by the ,secretary1 on the following3 7#a7 ,a review of payment and coverage policies under the ,medicare program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act1 including a review of coverage and payment under such programs of all medication-assisted treatment approved by the ,food and ,drug ,administration related to the treatment of opioid use disorder and other therapies that manage chronic and acute pain and treat and minimize risk of opioid misuse and abuse1 including in such review1 payment under the ,medicare prospective payment system for inpatient hospital services under section #ahhf7;d7 of such ,act 7#db ,u4,s4,c4 #acieww7d77 and the ,medicare prospective payment system for hospital outpatient department services under section #ahcc7t7 of such ,act 7#db ,u4,s4,c4 #acie;,i7t771 to determine whether those payment policies resulted in incentives or disincentives that have contributed to the opioid crisis4 7#b7 ,recommendations for payment and service delivery models to be tested as appropriate by the ,center for ,medicare and ,medicaid ,innovation and other federally authorized demonstration projects1 including value-based models1 that may encourage the use of appropriate medication-assisted treatment approved by the ,food and ,drug ,administration for the treatment of opioid use disorder and other therapies that manage chronic and acute pain and treat and minimize risk of opioid misuse and abuse4 7#c7 ,recommendations for data collection that could facilitate research and policy-making regarding prevention of opioid use disorder as well as data that would aid the ,secretary in making coverage and payment decisions under the ,medicare and ,medicaid programs related to the access to appropriate opioid dependence treatments4 7#d7 ,a review of ,medicare and ,medicaid beneficiaries' access to the full range of medication-assisted treatment approved by the ,food and ,drug ,administration for the treatment of opioid use disorder and other therapies that manage chronic and acute pain and treat and minimize risk of opioid misuse and abuse1 including access of beneficiaries residing in rural or medically underserved communities4 7#e7 ,a review of payment and coverage policies under the ,medicare program and the ,medicaid program related to medical devices that are non-opioid based treatments approved by the ,food and ,drug ,administration for the management of acute pain and chronic pain1 for monitoring substance use withdrawal and preventing overdoses of controlled substances1 and for treating substance use disorder1 including barriers to patient access4 7c7 ,stakeholder meetings 7#a7 ,in general ,beginning not later than #c months after the date of the enactment of this section1 the ,secretary shall convene a public stakeholder meeting to solicit public comment on the components of the action plan described in subsection 7b74 7#b7 ,participants ,participants of meetings described in paragraph 7#a7 shall include representatives from the ,food and ,drug ,administration and ,national ,institutes of ,health1 biopharmaceutical industry members1 medical researchers1 health care providers1 the medical device industry1 the ,medicare program1 the ,medicaid program1 and patient advocates4 7d7 ,request for information ,not later than #c months after the date of the enactment of this section1 the ,secretary shall issue a request for information seeking public feedback regarding ways in which the ,centers for ,medicare ,medicaid ,services can help address the opioid crisis through the development of and application of the action plan4 7e7 ,report to ,congress ,not later than ,june #a1 #bjbj1 the ,secretary shall submit to ,congress1 and make public1 a report that includes-- 7#a7 a summary of the results of the ,secretary's review and any recommendations under the action plan2 7#b7 the ,secretary's planned next steps with respect to the action plan2 and 7#c7 an evaluation of price trends for drugs used to reverse opioid overdoses 7such as naloxone71 including recommendations on ways to lower such prices for consumers4 7f7 ,definition of ,medication-,assisted treatment ,in this section1 the term medication-assisted treatment includes opioid treatment programs1 behavioral therapy1 and medications to treat substance abuse disorder4 ,e ,advancing ,high ,quality ,treatment for ,opioid ,use ,disorders in ,medicare #fjda4 ,short title ,this subtitle may be cited as the ,advancing ,high ,quality ,treatment for ,opioid ,use ,disorders in ,medicare ,act4 #fjdb4 ,opioid use disorder treatment demonstration program ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by inserting after section #ahff;,e 7#db ,u4,s4,c4 #acie;cc-#e7 the following new section3 #ahff;,f4 ,opioid use disorder treatment demonstration program 7a7 ,implementation of #d-,year demonstration program 7#a7 ,in general ,not later than ,january #a1 #bjba1 the ,secretary shall implement a #d-year demonstration program under this title 7in this section referred to as the ,program7 to increase access of applicable beneficiaries to opioid use disorder treatment services1 improve physical and mental health outcomes for such beneficiaries1 and to the extent possible1 reduce expenditures under this title4 ,under the ,program1 the ,secretary shall make payments under subsection 7e7 to participants 7as defined in subsection 7c77#a77;,a77 for furnishing opioid use disorder treatment services delivered through opioid use disorder care teams1 or arranging for such services to be furnished1 to applicable beneficiaries participating in the ,program4 7#b7 ,opioid use disorder treatment services ,for purposes of this section1 the term opioid use disorder treatment services-- 7,a7 means1 with respect to an applicable beneficiary1 services that are furnished for the treatment of opioid use disorders and that utilize drugs approved under section #eje of the ,federal ,food1 ,drug1 and ,cosmetic ,act for the treatment of opioid use disorders in an outpatient setting2 and 7,b7 includes-- 7i7 medication-assisted treatment2 7ii7 treatment planning2 7iii7 psychiatric1 psychological1 or counseling services 7or any combination of such services71 as appropriate2 7iv7 social support services1 as appropriate2 and 7v7 care management and care coordination services1 including coordination with other providers of services and suppliers not on an opioid use disorder care team4 7b7 ,program design 7#a7 ,in general ,the ,secretary shall design the ,program in such a manner to allow for the evaluation of the extent to which the ,program accomplishes the following purposes3 7,a7 ,reduces hospitalizations and emergency department visits4 7,b7 ,increases use of medication-assisted treatment for opioid use disorders4 7,c7 ,improves health outcomes of individuals with opioid use disorders1 including by reducing the incidence of infectious diseases 7such as hepatitis ,c and ,,hiv74 7,d7 ,does not increase the total spending on items and services under this title4 7,e7 ,reduces deaths from opioid overdose4 7,f7 ,reduces the utilization of inpatient residential treatment4 7#b7 ,consultation ,in designing the ,program1 including the criteria under subsection 7e77#b77;,a71 the ,secretary shall1 not later than #c months after the date of the enactment of this section1 consult with specialists in the field of addiction1 clinicians in the primary care community1 and beneficiary groups4 7c7 ,participants2 opioid use disorder care teams 7#a7 ,participants 7,a7 ,definition ,in this section1 the term participant means an entity or individual-- 7i7 that is otherwise enrolled under this title and that is-- 7,i7 a physician 7as defined in section #ahfa7r77#a772 7,,ii7 a group practice comprised of at least one physician described in subclause 7,i72 7,,iii7 a hospital outpatient department2 7,,iv7 a federally qualified health center 7as defined in section #ahfa7;aa77#d772 7,v7 a rural health clinic 7as defined in section #ahfa7;aa77#b772 7,,vi7 a community mental health center 7as defined in section #ahfa7;ff77#c77;,b772 7,,vii7 a clinic certified as a certified community behavioral health clinic pursuant to section #bbc of the ,protecting ,access to ,medicare ,act of #bjad2 or 7,,viii7 any other individual or entity specified by the ,secretary2 7ii7 that applied for and was selected to participate in the ,program pursuant to an application and selection process established by the ,secretary2 and 7iii7 that establishes an opioid use disorder care team 7as defined in paragraph 7#b77 through employing or contracting with health care practitioners described in paragraph 7#b77;,a71 and uses such team to furnish or arrange for opioid use disorder treatment services in the outpatient setting under the ,program4 7,b7 ,preference ,in selecting participants for the ,program1 the ,secretary shall give preference to individuals and entities that are located in areas with a prevalence of opioid use disorders that is higher than the national average prevalence4 7#b7 ,opioid use disorder care teams 7,a7 ,in general ,for purposes of this section1 the term opioid use disorder care team means a team of health care practitioners established by a participant described in paragraph 7#a77;,a7 that-- 7i7 shall include-- 7,i7 at least one physician 7as defined in section #ahfa7r77#a77 furnishing primary care services or addiction treatment services to an applicable beneficiary2 and 7,,ii7 at least one eligible practitioner 7as defined in paragraph 7#c771 who may be a physician who meets the criterion in subclause 7,i72 and 7ii7 may include other practitioners licensed under ,state law to furnish psychiatric1 psychological1 counseling1 and social services to applicable beneficiaries4 7,b7 ,requirements for receipt of payment under ,program ,in order to receive payments under subsection 7e71 each participant in the ,program shall-- 7i7 furnish opioid use disorder treatment services through opioid use disorder care teams to applicable beneficiaries who agree to receive the services2 7ii7 meet minimum criteria1 as established by the ,secretary2 and 7iii7 submit to the ,secretary1 in such form1 manner1 and frequency as specified by the ,secretary1 with respect to each applicable beneficiary for whom opioid use disorder treatment services are furnished by the opioid use disorder care team1 data and such other information as the ,secretary determines appropriate to-- 7,i7 monitor and evaluate the ,program2 7,,ii7 determine if minimum criteria are met under clause 7ii72 and 7,,iii7 determine the incentive payment under subsection 7e74 7#c7 ,eligible practitioner defined ,for purposes of this section1 the term eligible practitioner means a physician or other health care practitioner1 such as a nurse practitioner1 that-- 7,a7 is enrolled under section #ahff7;j77#a72 7,b7 is authorized to prescribe or dispense narcotic drugs to individuals for maintenance treatment or detoxification treatment2 and 7,c7 has in effect a waiver in accordance with section #cjc7;g7 of the ,controlled ,substances ,act for such purpose and is otherwise in compliance with regulations promulgated by the ,substance ,abuse and ,mental ,health ,services ,administration to carry out such section4 7d7 ,participation of applicable beneficiaries 7#a7 ,applicable beneficiary defined ,in this section1 the term applicable beneficiary means an individual who-- 7,a7 is entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under part ,b2 7,b7 is not enrolled in a ,medicare ,advantage plan under part ,c2 7,c7 has a current diagnosis for an opioid use disorder2 and 7,d7 meets such other criteria as the ,secretary determines appropriate4 ,such term shall include an individual who is dually eligible for benefits under this title and title ,,xix if such individual satisfies the criteria described in subparagraphs 7,a7 through 7,d74 7#b7 ,voluntary beneficiary participation2 limitation on number of beneficiaries ,an applicable beneficiary may participate in the ,program on a voluntary basis and may terminate participation in the ,program at any time4 ,not more than #bj1jjj applicable beneficiaries may participate in the ,program at any time4 7#c7 ,services ,in order to participate in the ,program1 an applicable beneficiary shall agree to receive opioid use disorder treatment services from a participant4 ,participation under the ,program shall not affect coverage of or payment for any other item or service under this title for the applicable beneficiary4 7#d7 ,beneficiary access to services ,nothing in this section shall be construed as encouraging providers to limit applicable beneficiary access to services covered under this title1 and applicable beneficiaries shall not be required to relinquish access to any benefit under this title as a condition of receiving services from a participant in the ,program4 7e7 ,payments 7#a7 ,per applicable beneficiary per month care management fee 7,a7 ,in general ,the ,secretary shall establish a schedule of per applicable beneficiary per month care management fees4 ,such a per applicable beneficiary per month care management fee shall be paid to a participant in addition to any other amount otherwise payable under this title to the health care practitioners in the participant's opioid use disorder care team or1 if applicable1 to the participant4 ,a participant may use such per applicable beneficiary per month care management fee to deliver additional services to applicable beneficiaries1 including services not otherwise eligible for payment under this title4 7,b7 ,payment amounts ,in carrying out subparagraph 7,a71 the ,secretary may-- 7i7 consider payments otherwise payable under this title for opioid use disorder treatment services and the needs of applicable beneficiaries2 7ii7 pay a higher per applicable beneficiary per month care management fee for an applicable beneficiary who receives more intensive treatment services from a participant and for whom those services are appropriate based on clinical guidelines for opioid use disorder care2 7iii7 pay a higher per applicable beneficiary per month care management fee for the month in which the applicable beneficiary begins treatment with a participant than in subsequent months1 to reflect the greater time and costs required for the planning and initiation of treatment1 as compared to maintenance of treatment2 and 7iv7 take into account whether a participant's opioid use disorder care team refers applicable beneficiaries to other suppliers or providers for any opioid use disorder treatment services4 7,c7 ,no duplicate payment ,the ,secretary shall make payments under this paragraph to only one participant for services furnished to an applicable beneficiary during a calendar month4 7#b7 ,incentive payments 7,a7 ,in general ,under the ,program1 the ,secretary shall establish a performance-based incentive payment1 which shall be paid 7using a methodology established and at a time determined appropriate by the ,secretary7 to participants based on the performance of participants with respect to criteria1 as determined appropriate by the ,secretary1 in accordance with subparagraph 7,b74 7,b7 ,criteria 7i7 ,in general ,criteria described in subparagraph 7,a7 may include consideration of the following3 7,i7 ,patient engagement and retention in treatment4 7,,ii7 ,evidence-based medication-assisted treatment4 7,,iii7 ,other criteria established by the ,secretary4 7ii7 ,required consultation and consideration ,in determining criteria described in subparagraph 7,a71 the ,secretary shall-- 7,i7 consult with stakeholders1 including clinicians in the primary care community and in the field of addiction medicine2 and 7,,ii7 consider existing clinical guidelines for the treatment of opioid use disorders4 7,c7 ,no duplicate payment ,the ,secretary shall ensure that no duplicate payments under this paragraph are made with respect to an applicable beneficiary4 7f7 ,multipayer strategy ,in carrying out the ,program1 the ,secretary shall encourage other payers to provide similar payments and to use similar criteria as applied under the ,program under subsection 7e77#b77;,c74 ,the ,secretary may enter into a memorandum of understanding with other payers to align the methodology for payment provided by such a payer related to opioid use disorder treatment services with such methodology for payment under the ,program4 7g7 ,evaluation 7#a7 ,in general ,the ,secretary shall conduct an intermediate and final evaluation of the program4 ,each such evaluation shall determine the extent to which each of the purposes described in subsection 7b7 have been accomplished under the ,program4 7#b7 ,reports ,the ,secretary shall submit to ,congress-- 7,a7 a report with respect to the intermediate evaluation under paragraph 7#a7 not later than #c years after the date of the implementation of the ,program2 and 7,b7 a report with respect to the final evaluation under paragraph 7#a7 not later than #f years after such date4 7h7 ,funding 7#a7 ,administrative funding ,for the purposes of implementing1 administering1 and carrying out the ,program 7other than for purposes described in paragraph 7#b771 #e1jjj1jjj shall be available from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda4 7#b7 ,care management fees and incentives ,for the purposes of making payments under subsection 7e71 #aj1jjj1jjj shall be available from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda for each of fiscal years #bjba through #bjbd4 7#c7 ,availability ,amounts transferred under this subsection for a fiscal year shall be available until expended4 7i7 ,waivers ,the ,secretary may waive any provision of this title as may be necessary to carry out the ,program under this section4 4 ,f ,responsible ,education ,achieves ,care and ,healthy ,outcomes for ,users' ,treatment #fjea4 ,short title ,this subtitle may be cited as the ,responsible ,education ,achieves ,care and ,healthy ,outcomes for ,users' ,treatment ,act of #bjah or the ,,reach ,,out ,act of #bjah4 #fjeb4 ,grants to provide technical assistance to outlier prescribers of opioids 7a7 ,grants authorized ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall1 through the ,centers for ,medicare ,medicaid ,services1 award grants1 contracts1 or cooperative agreements to eligible entities for the purposes described in subsection 7b74 7b7 ,use of funds ,grants1 contracts1 and cooperative agreements awarded under subsection 7a7 shall be used to support eligible entities through technical assistance-- 7#a7 to educate and provide outreach to outlier prescribers of opioids about best practices for prescribing opioids2 7#b7 to educate and provide outreach to outlier prescribers of opioids about non-opioid pain management therapies2 and 7#c7 to reduce the amount of opioid prescriptions prescribed by outlier prescribers of opioids4 7c7 ,application ,each eligible entity seeking to receive a grant1 contract1 or cooperative agreement under subsection 7a7 shall submit to the ,secretary an application1 at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,geographic distribution ,in awarding grants1 contracts1 and cooperative agreements under this section1 the ,secretary shall prioritize establishing technical assistance resources in each ,state4 7e7 ,definitions ,in this section3 7#a7 ,eligible entity ,the term eligible entity means-- 7,a7 an organization-- 7i7 that has demonstrated experience providing technical assistance to health care professionals on a ,state or regional basis2 and 7ii7 that has at least-- 7,i7 one individual who is a representative of consumers on its governing body2 and 7,,ii7 one individual who is a representative of health care providers on its governing body2 or 7,b7 an entity that is a quality improvement entity with a contract under part ,b of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;c et seq474 7#b7 ,outlier prescriber of opioids ,the term outlier prescriber of opioids means1 with respect to a period1 a prescriber identified by the ,secretary under subparagraph 7,d77ii7 of section #ahfj;,d-#d7;c77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77#d771 as added by section #fjfe of this ,act1 to be an outlier prescriber of opioids for such period4 7#c7 ,prescribers ,the term prescriber means any health care professional1 including a nurse practitioner or physician assistant1 who is licensed to prescribe opioids by the ,state or territory in which such professional practices4 7f7 ,funding ,for purposes of implementing this section1 #ge1jjj1jjj shall be available from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of the ,social ,security ,act 7#db ,u4,s4,c4 #aciet71 to remain available until expended4 ,g ,preventing ,addiction for ,susceptible ,seniors #fjfa4 ,short title ,this subtitle may be cited as the ,preventing ,addiction for ,susceptible ,seniors ,act of #bjah or the ,,pass ,act of #bjah4 #fjfb4 ,electronic prior authorization for covered part ,d drugs ,section #ahfj;,d-#d7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;e77#b77 is amended by adding at the end the following new subparagraph3 7,e7 ,electronic prior authorization 7i7 ,in general ,not later than ,january #a1 #bjba1 the program shall provide for the secure electronic transmission of-- 7,i7 a prior authorization request from the prescribing health care professional for coverage of a covered part ,d drug for a part ,d eligible individual enrolled in a part ,d plan 7as defined in section #ahfj;,d-#bc7;a77#e77 to the ,,pdp sponsor or ,medicare ,advantage organization offering such plan2 and 7,,ii7 a response1 in accordance with this subparagraph1 from such ,,pdp sponsor or ,medicare ,advantage organization1 respectively1 to such professional4 7ii7 ,electronic transmission 7,i7 ,exclusions ,for purposes of this subparagraph1 a facsimile1 a proprietary payer portal that does not meet standards specified by the ,secretary1 or an electronic form shall not be treated as an electronic transmission described in clause 7i74 7,,ii7 ,standards ,in order to be treated1 for purposes of this subparagraph1 as an electronic transmission described in clause 7i71 such transmission shall comply with technical standards adopted by the ,secretary in consultation with the ,national ,council for ,prescription ,drug ,programs1 other standard setting organizations determined appropriate by the ,secretary1 and stakeholders including ,,pdp sponsors1 ,medicare ,advantage organizations1 health care professionals1 and health information technology software vendors4 7,,iii7 ,application ,notwithstanding any other provision of law1 for purposes of this subparagraph1 the ,secretary may require the use of such standards adopted under subclause 7,,ii7 in lieu of any other applicable standards for an electronic transmission described in clause 7i7 for a covered part ,d drug for a part ,d eligible individual4 4 #fjfc4 ,program integrity transparency measures under ,medicare parts ,c and ,d 7a7 ,in general ,section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 is amended by adding at the end the following new subsection3 7i7 ,program integrity transparency measures 7#a7 ,program integrity portal 7,a7 ,in general ,not later than #b years after the date of the enactment of this subsection1 the ,secretary shall1 after consultation with stakeholders1 establish a secure internet website portal 7or other successor technology7 that would allow a secure path for communication between the ,secretary1 ,,ma plans under this part1 prescription drug plans under part ,d1 and an eligible entity with a contract under section #ahic 7such as a ,medicare drug integrity contractor or an entity responsible for carrying out program integrity activities under this part and part ,d7 for the purpose of enabling through such portal 7or other successor technology7-- 7i7 the referral by such plans of substantiated or suspicious activities1 as defined by the ,secretary1 of a provider of services 7including a prescriber7 or supplier related to fraud1 waste1 and abuse for initiating or assisting investigations conducted by the eligible entity2 and 7ii7 data sharing among such ,,ma plans1 prescription drug plans1 and the ,secretary4 7,b7 ,required uses of portal ,the ,secretary shall disseminate the following information to ,,ma plans under this part and prescription drug plans under part ,d through the secure internet website portal 7or other successor technology7 established under subparagraph 7,a73 7i7 ,providers of services and suppliers that have been referred pursuant to subparagraph 7,a77i7 during the previous #ab-month period4 7ii7 ,providers of services and suppliers who are the subject of an active exclusion under section #aabh or who are subject to a suspension of payment under this title pursuant to section #ahfb7o7 or otherwise4 7iii7 ,providers of services and suppliers who are the subject of an active revocation of participation under this title1 including for not satisfying conditions of participation4 7iv7 ,in the case of such a plan that makes a referral under subparagraph 7,a77i7 through the portal 7or other successor technology7 with respect to activities of substantiated or suspicious activities of fraud1 waste1 or abuse of a provider of services 7including a prescriber7 or supplier1 if such provider 7including a prescriber7 or supplier has been the subject of an administrative action under this title or title ,,xi with respect to similar activities1 a notification to such plan of such action so taken4 7,c7 ,rulemaking ,for purposes of this paragraph1 the ,secretary shall1 through rulemaking1 specify what constitutes substantiated or suspicious activities of fraud1 waste1 and abuse1 using guidance such as what is provided in the ,medicare ,program ,integrity ,manual #d4h4 ,in carrying out this subsection1 a fraud hotline tip 7as defined by the ,secretary7 without further evidence shall not be treated as sufficient evidence for substantiated fraud1 waste1 or abuse4 7,d7 ,,hipaa compliant information only ,for purposes of this subsection1 communications may only occur if the communications are permitted under the ,federal regulations 7concerning the privacy of individually identifiable health information7 promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif4 7#b7 ,quarterly reports ,beginning not later than #b years after the date of the enactment of this subsection1 the ,secretary shall make available to ,,ma plans under this part and prescription drug plans under part ,d in a timely manner 7but no less frequently than quarterly7 and using information submitted to an entity described in paragraph 7#a7 through the portal 7or other successor technology7 described in such paragraph or pursuant to section #ahic1 information on fraud1 waste1 and abuse schemes and trends in identifying suspicious activity4 ,information included in each such report shall-- 7,a7 include administrative actions1 pertinent information related to opioid overprescribing1 and other data determined appropriate by the ,secretary in consultation with stakeholders2 and 7,b7 be anonymized information submitted by plans without identifying the source of such information4 7#c7 ,clarification ,nothing in this subsection shall preclude or otherwise affect referrals to the ,inspector ,general of the ,department of ,health and ,human ,services or other law enforcement entities4 4 7b7 ,contract requirement to communicate plan corrective actions against opioids over-prescribers ,section #aheg7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;e77 is amended by adding at the end the following new paragraph3 7#e7 ,communicating plan corrective actions against opioids over-prescribers 7,a7 ,in general ,beginning with plan years beginning on or after ,january #a1 #bjba1 a contract under this section with an ,,ma organization shall require the organization to submit to the ,secretary1 through the process established under subparagraph 7,b71 information on the investigations1 credible evidence of suspicious activities of a provider of services 7including a prescriber7 or supplier related to fraud1 and other actions taken by such plans related to inappropriate prescribing of opioids4 7,b7 ,process ,not later than ,january #a1 #bjba1 the ,secretary shall1 in consultation with stakeholders1 establish a process under which ,,ma plans and prescription drug plans shall submit to the ,secretary information described in subparagraph 7,a74 7,c7 ,regulations ,for purposes of this paragraph1 including as applied under section #ahfj;,d-#ab7;b77#c77;,d71 the ,secretary shall1 pursuant to rulemaking-- 7i7 specify a definition for the term inappropriate prescribing and a method for determining if a provider of services prescribes inappropriate prescribing2 and 7ii7 establish the process described in subparagraph 7,b7 and the types of information that shall be submitted through such process4 4 7c7 ,reference under part ,d to program integrity transparency measures ,section #ahfj;,d-#d of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7 is amended by adding at the end the following new subsection3 7m7 ,program integrity transparency measures ,for program integrity transparency measures applied with respect to prescription drug plan and ,,ma plans1 see section #ahei7;i74 4 #fjfd4 ,expanding eligibility for medication therapy management programs under part ,d ,section #ahfj;,d-#d7;c77#b77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77#b77;,a77ii77 is amended-- 7#a7 by redesignating subclauses 7,i7 through 7,,iii7 as items 7aa7 through 7cc71 respectively1 and adjusting the margins accordingly2 7#b7 by striking are part ,d eligible individuals who-- and inserting are the following3 7,i7 ,part ,d eligible individuals who-- 2 and 7#c7 by adding at the end the following new subclause3 7,,ii7 ,beginning ,january #a1 #bjba1 at-risk beneficiaries for prescription drug abuse 7as defined in paragraph 7#e77;,c774 4 #fjfe4 ,commit to opioid medical prescriber accountability and safety for seniors ,section #ahfj;,d-#d7;c77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77#d77 is amended by adding at the end the following new subparagraph3 7,d7 ,notification and additional requirements with respect to outlier prescribers of opioids 7i7 ,notification ,not later than ,january #a1 #bjba1 the ,secretary shall1 in the case of a prescriber identified by the ,secretary under clause 7ii7 to be an outlier prescriber of opioids1 provide1 subject to clause 7iv71 an annual notification to such prescriber that such prescriber has been so identified and that includes resources on proper prescribing methods and other information as specified in accordance with clause 7iii74 7ii7 ,identification of outlier prescribers of opioids 7,i7 ,in general ,the ,secretary shall1 subject to subclause 7,,iii71 using the valid prescriber ,national ,provider ,identifiers included pursuant to subparagraph 7,a7 on claims for covered part ,d drugs for part ,d eligible individuals enrolled in prescription drug plans under this part or ,,ma-,,pd plans under part ,c and based on the thresholds established under subclause 7,,ii71 identify prescribers that are outlier opioids prescribers for a period of time specified by the ,secretary4 7,,ii7 ,establishment of thresholds ,for purposes of subclause 7,i7 and subject to subclause 7,,iii71 the ,secretary shall1 after consultation with stakeholders1 establish thresholds1 based on prescriber specialty and geographic area1 for identifying whether a prescriber in a specialty and geographic area is an outlier prescriber of opioids as compared to other prescribers of opioids within such specialty and area4 7,,iii7 ,exclusions ,the following shall not be included in the analysis for identifying outlier prescribers of opioids under this clause3 7aa7 ,claims for covered part ,d drugs for part ,d eligible individuals who are receiving hospice care under this title4 7bb7 ,claims for covered part ,d drugs for part ,d eligible individuals who are receiving oncology services under this title4 7cc7 ,prescribers who are the subject of an investigation by the ,centers for ,medicare ,medicaid ,services or the ,inspector ,general of the ,department of ,health and ,human ,services4 7iii7 ,contents of notification ,the ,secretary shall include the following information in the notifications provided under clause 7i73 7,i7 ,information on how such prescriber compares to other prescribers within the same specialty and geographic area4 7,,ii7 ,information on opioid prescribing guidelines1 based on input from stakeholders1 that may include the ,centers for ,disease ,control and ,prevention guidelines for prescribing opioids for chronic pain and guidelines developed by physician organizations4 7,,iii7 ,other information determined appropriate by the ,secretary4 7iv7 ,modifications and expansions 7,i7 ,frequency ,beginning #e years after the date of the enactment of this subparagraph1 the ,secretary may change the frequency of the notifications described in clause 7i7 based on stakeholder input and changes in opioid prescribing utilization and trends4 7,,ii7 ,expansion to other prescriptions ,the ,secretary may expand notifications under this subparagraph to include identifications and notifications with respect to concurrent prescriptions of covered ,part ,d drugs used in combination with opioids that are considered to have adverse side effects when so used in such combination1 as determined by the ,secretary4 7v7 ,additional requirements for persistent outlier prescribers ,in the case of a prescriber who the ,secretary determines is persistently identified under clause 7ii7 as an outlier prescriber of opioids1 the following shall apply3 7,i7 ,such prescriber may be required to enroll in the program under this title under section #ahff7;j7 if such prescriber is not otherwise required to enroll1 but only after other appropriate remedies have been provided1 such as the provision of education funded through section #fjeb of the ,,support for ,patients and ,communities ,act1 for a period determined by the ,secretary as sufficient to correct the prescribing patterns that lead to identification of such prescriber as a persistent outlier prescriber of opioids4 ,the ,secretary shall determine the length of the period for which such prescriber is required to maintain such enrollment1 which shall be the minimum period necessary to correct such prescribing patterns4 7,,ii7 ,not less frequently than annually 7and in a form and manner determined appropriate by the ,secretary71 the ,secretary1 consistent with clause7iv77,i71 shall communicate information on such prescribers to sponsors of a prescription drug plan and ,medicare ,advantage organizations offering an ,,ma-,,pd plan4 7vi7 ,public availability of information ,the ,secretary shall make aggregate information under this subparagraph available on the internet website of the ,centers for ,medicare ,medicaid ,services4 ,such information shall be in a form and manner determined appropriate by the ,secretary and shall not identify any specific prescriber4 ,in carrying out this clause1 the ,secretary shall consult with interested stakeholders4 7vii7 ,opioids defined ,for purposes of this subparagraph1 the term opioids has such meaning as specified by the ,secretary4 7viii7 ,other activities ,nothing in this subparagraph shall preclude the ,secretary from conducting activities that provide prescribers with information as to how they compare to other prescribers that are in addition to the activities under this subparagraph1 including activities that were being conducted as of the date of the enactment of this subparagraph4 4 #fjff4 ,no additional funds authorized ,no additional funds are authorized to be appropriated to carry out the requirements of this subtitle and the amendments made by this subtitle4 ,such requirements shall be carried out using amounts otherwise authorized to be appropriated4 ,h ,expanding ,oversight of ,opioid ,prescribing and ,payment #fjga4 ,short title ,this subtitle may be cited as the ,expanding ,oversight of ,opioid ,prescribing and ,payment ,act of #bjah4 #fjgb4 ,medicare ,payment ,advisory ,commission report on opioid payment1 adverse incentives1 and data under the ,medicare program ,not later than ,march #ae1 #bjai1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress a report on1 with respect to the ,medicare program under title ,,xviii of the ,social ,security ,act1 the following3 7#a7 ,a description of how the ,medicare program pays for pain management treatments 7both opioid and non-opioid pain management alternatives7 in both inpatient and outpatient hospital settings4 7#b7 ,the identification of incentives under the hospital inpatient prospective payment system under section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 and incentives under the hospital outpatient prospective payment system under section #ahcc7t7 of such ,act 7#db ,u4,s4,c4 #aciel7t77 for prescribing opioids and incentives under each such system for prescribing non-opioid treatments1 and recommendations as the ,commission deems appropriate for addressing any of such incentives that are adverse incentives4 7#c7 ,a description of how opioid use is tracked and monitored through ,medicare claims data and other mechanisms and the identification of any areas in which further data and methods are needed for improving data and understanding of opioid use4 #fjgc4 ,no additional funds authorized ,no additional funds are authorized to be appropriated to carry out the requirements of this subtitle4 ,such requirements shall be carried out using amounts otherwise authorized to be appropriated4 ,i ,dr4 ,todd ,graham ,pain ,management1 ,treatment1 and ,recovery #fjha4 ,short title ,this subtitle may be cited as the ,dr4 ,todd ,graham ,pain ,management1 ,treatment1 and ,recovery ,act of #bjah4 #fjhb4 ,review and adjustment of payments under the ,medicare outpatient prospective payment system to avoid financial incentives to use opioids instead of non-opioid alternative treatments 7a7 ,outpatient prospective payment system ,section #ahcc7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77 is amended by adding at the end the following new paragraph3 7#bb7 ,review and revisions of payments for non-opioid alternative treatments 7,a7 ,in general ,with respect to payments made under this subsection for covered ,,opd services 7or groups of services71 including covered ,,opd services assigned to a comprehensive ambulatory payment classification1 the ,secretary-- 7i7 shall1 as soon as practicable1 conduct a review 7part of which may include a request for information7 of payments for opioids and evidence-based non-opioid alternatives for pain management 7including drugs and devices1 nerve blocks1 surgical injections1 and neuromodulation7 with a goal of ensuring that there are not financial incentives to use opioids instead of non-opioid alternatives2 7ii7 may1 as the ,secretary determines appropriate1 conduct subsequent reviews of such payments2 and 7iii7 shall consider the extent to which revisions under this subsection to such payments 7such as the creation of additional groups of covered ,,opd services to classify separately those procedures that utilize opioids and non-opioid alternatives for pain management7 would reduce payment incentives to use opioids instead of non-opioid alternatives for pain management4 7,b7 ,priority ,in conducting the review under clause 7i7 of subparagraph 7,a7 and considering revisions under clause 7iii7 of such subparagraph1 the ,secretary shall focus on covered ,,opd services 7or groups of services7 assigned to a comprehensive ambulatory payment classification1 ambulatory payment classifications that primarily include surgical services1 and other services determined by the ,secretary which generally involve treatment for pain management4 7,c7 ,revisions ,if the ,secretary identifies revisions to payments pursuant to subparagraph 7,a77iii71 the ,secretary shall1 as determined appropriate1 begin making such revisions for services furnished on or after ,january #a1 #bjbj4 ,revisions under the previous sentence shall be treated as adjustments for purposes of application of paragraph 7#i77;,b74 7,d7 ,rules of construction ,nothing in this paragraph shall be construed to preclude the ,secretary-- 7i7 from conducting a demonstration before making the revisions described in subparagraph 7,c72 or 7ii7 prior to implementation of this paragraph1 from changing payments under this subsection for covered ,,opd services 7or groups of services7 which include opioids or non-opioid alternatives for pain management4 4 7b7 ,ambulatory surgical centers ,section #ahcc7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7i77 is amended by adding at the end the following new paragraph3 7#h7 ,the ,secretary shall conduct a similar type of review as required under paragraph 7#bb7 of section #ahcc7t771 including the second sentence of subparagraph 7,c7 of such paragraph1 to payment for services under this subsection1 and make such revisions under this paragraph1 in an appropriate manner 7as determined by the ,secretary74 4 #fjhc4 ,expanding access under the ,medicare program to addiction treatment in ,federally qualified health centers and rural health clinics 7a7 ,federally qualified health centers ,section #ahcd7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7o77 is amended by adding at the end the following new paragraph3 7#c7 ,additional payments for certain ,f,q,h,cs with physicians or other practitioners receiving ,,data #bjjj waivers 7,a7 ,in general ,in the case of a ,federally qualified health center with respect to which1 beginning on or after ,january #a1 #bjai1 ,federally qualified health center services 7as defined in section #ahfa7;aa77#c77 are furnished for the treatment of opioid use disorder by a physician or practitioner who meets the requirements described in subparagraph 7,c71 the ,secretary shall1 subject to availability of funds under subparagraph 7,d71 make a payment 7at such time and in such manner as specified by the ,secretary7 to such ,federally qualified health center after receiving and approving an application submitted by such ,federally qualified health center under subparagraph 7,b74 ,such a payment shall be in an amount determined by the ,secretary1 based on an estimate of the average costs of training for purposes of receiving a waiver described in subparagraph 7,c77ii74 ,such a payment may be made only one time with respect to each such physician or practitioner4 7,b7 ,application ,in order to receive a payment described in subparagraph 7,a71 a ,federally qualified health center shall submit to the ,secretary an application for such a payment at such time1 in such manner1 and containing such information as specified by the ,secretary4 ,a ,federally qualified health center may apply for such a payment for each physician or practitioner described in subparagraph 7,a7 furnishing services described in such subparagraph at such center4 7,c7 ,requirements ,for purposes of subparagraph 7,a71 the requirements described in this subparagraph1 with respect to a physician or practitioner1 are the following3 7i7 ,the physician or practitioner is employed by or working under contract with a ,federally qualified health center described in subparagraph 7,a7 that submits an application under subparagraph 7,b74 7ii7 ,the physician or practitioner first receives a waiver under section #cjc7;g7 of the ,controlled ,substances ,act on or after ,january #a1 #bjai4 7,d7 ,funding ,for purposes of making payments under this paragraph1 there are appropriated1 out of amounts in the ,treasury not otherwise appropriated1 #f1jjj1jjj1 which shall remain available until expended4 4 7b7 ,rural health clinic ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is amended-- 7#a7 by redesignating the subsection 7z7 relating to medical review of spinal subluxation services as subsection 7aa72 and 7#b7 by adding at the end the following new subsection3 7bb7 ,additional payments for certain rural health clinics with physicians or practitioners receiving ,,data #bjjj waivers 7#a7 ,in general ,in the case of a rural health clinic with respect to which1 beginning on or after ,january #a1 #bjai1 rural health clinic services 7as defined in section #ahfa7;aa77#a77 are furnished for the treatment of opioid use disorder by a physician or practitioner who meets the requirements described in paragraph 7#c71 the ,secretary shall1 subject to availability of funds under paragraph 7#d71 make a payment 7at such time and in such manner as specified by the ,secretary7 to such rural health clinic after receiving and approving an application described in paragraph 7#b74 ,such payment shall be in an amount determined by the ,secretary1 based on an estimate of the average costs of training for purposes of receiving a waiver described in paragraph 7#c77;,b74 ,such payment may be made only one time with respect to each such physician or practitioner4 7#b7 ,application ,in order to receive a payment described in paragraph 7#a71 a rural health clinic shall submit to the ,secretary an application for such a payment at such time1 in such manner1 and containing such information as specified by the ,secretary4 ,a rural health clinic may apply for such a payment for each physician or practitioner described in paragraph 7#a7 furnishing services described in such paragraph at such clinic4 7#c7 ,requirements ,for purposes of paragraph 7#a71 the requirements described in this paragraph1 with respect to a physician or practitioner1 are the following3 7,a7 ,the physician or practitioner is employed by or working under contract with a rural health clinic described in paragraph 7#a7 that submits an application under paragraph 7#b74 7,b7 ,the physician or practitioner first receives a waiver under section #cjc7;g7 of the ,controlled ,substances ,act on or after ,january #a1 #bjai4 7#d7 ,funding ,for purposes of making payments under this subsection1 there are appropriated1 out of amounts in the ,treasury not otherwise appropriated1 #b1jjj1jjj1 which shall remain available until expended4 4 #fjhd4 ,studying the availability of supplemental benefits designed to treat or prevent substance use disorders under ,medicare ,advantage plans 7a7 ,in general ,not later than #b years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall submit to ,congress a report on the availability of supplemental health care benefits 7as described in section #aheb7;a77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#c77;,a777 designed to treat or prevent substance use disorders under ,medicare ,advantage plans offered under part ,c of title ,,xviii of such ,act4 ,such report shall include the analysis described in subsection 7c7 and any differences in the availability of such benefits under specialized ,,ma plans for special needs individuals 7as defined in section #ahei7;b77#f7 of such ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f777 offered to individuals entitled to medical assistance under title ,,xix of such ,act and other such ,medicare ,advantage plans4 7b7 ,consultation ,the ,secretary shall develop the report described in subsection 7a7 in consultation with relevant stakeholders1 including-- 7#a7 individuals entitled to benefits under part ,a or enrolled under part ,b of title ,,xviii of the ,social ,security ,act2 7#b7 entities who advocate on behalf of such individuals2 7#c7 ,medicare ,advantage organizations2 7#d7 pharmacy benefit managers2 and 7#e7 providers of services and suppliers 7as such terms are defined in section #ahfa of such ,act 7#db ,u4,s4,c4 #aciex774 7c7 ,contents ,the report described in subsection 7a7 shall include an analysis on the following3 7#a7 ,the extent to which plans described in such subsection offer supplemental health care benefits relating to coverage of-- 7,a7 medication-assisted treatments for opioid use1 substance use disorder counseling1 peer recovery support services1 or other forms of substance use disorder treatments 7whether furnished in an inpatient or outpatient setting72 and 7,b7 non-opioid alternatives for the treatment of pain4 7#b7 ,challenges associated with such plans offering supplemental health care benefits relating to coverage of items and services described in subparagraph 7,a7 or 7,b7 of paragraph 7#a74 7#c7 ,the impact1 if any1 of increasing the applicable rebate percentage determined under section #ahed7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bd7;b77#a77;,c77 for plans offering such benefits relating to such coverage would have on the availability of such benefits relating to such coverage offered under ,medicare ,advantage plans4 7#d7 ,potential ways to improve upon such coverage or to incentivize such plans to offer additional supplemental health care benefits relating to such coverage4 #fjhe4 ,clinical psychologist services models under the ,center for ,medicare and ,medicaid ,innovation2 ,,gao study and report 7a7 ,,cmi models ,section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b771 as amended by section #fjja1 is further amended by adding at the end the following new clauses3 7xxvi7 ,supporting ways to familiarize individuals with the availability of coverage under part ,b of title ,,xviii for qualified psychologist services 7as defined in section #ahfa7;ii774 7xxvii7 ,exploring ways to avoid unnecessary hospitalizations or emergency department visits for mental and behavioral health services 7such as for treating depression7 through use of a #bd-;hour1 #g-;day a week help line that may inform individuals about the availability of treatment options1 including the availability of qualified psychologist services 7as defined in section #ahfa7;ii774 4 7b7 ,,gao study and report ,not later than #ah months after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall conduct a study1 and submit to ,congress a report1 on mental and behavioral health services under the ,medicare program under title ,,xviii of the ,social ,security ,act1 including an examination of the following3 7#a7 ,information about services furnished by psychiatrists1 clinical psychologists1 and other professionals4 7#b7 ,information about ways that ,medicare beneficiaries familiarize themselves about the availability of ,medicare payment for qualified psychologist services 7as defined in section #ahfa7;ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ii77 and ways that the provision of such information could be improved4 #fjhf4 ,dr4 ,todd ,graham pain management study 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the 8,secretary07 shall conduct a study analyzing best practices as well as payment and coverage for pain management services under title ,,xviii of the ,social ,security ,act and submit to the ,committee on ,ways and ,means and the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report containing options for revising payment to providers and suppliers of services and coverage related to the use of multi-disciplinary1 evidence-based1 non-opioid treatments for acute and chronic pain management for individuals entitled to benefits under part ,a or enrolled under part ,b of title ,,xviii of the ,social ,security ,act4 ,the ,secretary shall make such report available on the public website of the ,centers for ,medicare ,medicaid ,services4 7b7 ,consultation ,in developing the report described in subsection 7a71 the ,secretary shall consult with-- 7#a7 relevant agencies within the ,department of ,health and ,human ,services2 7#b7 licensed and practicing osteopathic and allopathic physicians1 behavioral health practitioners1 physician assistants1 nurse practitioners1 dentists1 pharmacists1 and other providers of health services2 7#c7 providers and suppliers of services 7as such terms are defined in section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex772 7#d7 substance abuse and mental health professional organizations2 7#e7 pain management professional organizations and advocacy entities1 including individuals who personally suffer chronic pain2 7#f7 medical professional organizations and medical specialty organizations2 7#g7 licensed health care providers who furnish alternative pain management services2 7#h7 organizations with expertise in the development of innovative medical technologies for pain management2 7#i7 beneficiary advocacy organizations2 and 7#aj7 other organizations with expertise in the assessment1 diagnosis1 treatment1 and management of pain1 as determined appropriate by the ,secretary4 7c7 ,contents ,the report described in subsection 7a7 shall include the following3 7#a7 ,an analysis of payment and coverage under title ,,xviii of the ,social ,security ,act with respect to the following3 7,a7 ,evidence-based treatments and technologies for chronic or acute pain1 including such treatments that are covered1 not covered1 or have limited coverage under such title4 7,b7 ,evidence-based treatments and technologies that monitor substance use withdrawal and prevent overdoses of opioids4 7,c7 ,evidence-based treatments and technologies that treat substance use disorders4 7,d7 ,items and services furnished by practitioners through a multi-disciplinary treatment model for pain management1 including the patient-centered medical home4 7,e7 ,items and services furnished to beneficiaries with psychiatric disorders1 substance use disorders1 or who are at risk of suicide1 or have comorbidities and require consultation or management of pain with one or more specialists in pain management1 mental health1 or addiction treatment4 7#b7 ,an evaluation of the following3 7,a7 ,barriers inhibiting individuals entitled to benefits under part ,a or enrolled under part ,b of such title from accessing treatments and technologies described in subparagraphs 7,a7 through 7,e7 of paragraph 7#a74 7,b7 ,costs and benefits associated with potential expansion of coverage under such title to include items and services not covered under such title that may be used for the treatment of pain1 such as acupuncture1 therapeutic massage1 and items and services furnished by integrated pain management programs4 7,c7 ,pain management guidance published by the ,federal ,government that may be relevant to coverage determinations or other coverage requirements under title ,,xviii of the ,social ,security ,act4 7#c7 ,an assessment of all guidance published by the ,department of ,health and ,human ,services on or after ,january #a1 #bjaf1 relating to the prescribing of opioids4 ,such assessment shall consider incorporating into such guidance relevant elements of the ,va_/,do,d ,clinical ,practice ,guideline for ,opioid ,therapy for ,chronic ,pain published in ,february #bjag by the ,department of ,veterans ,affairs and ,department of ,defense1 including adoption of elements of the ,department of ,defense and ,department of ,veterans ,affairs pain rating scale4 7#d7 ,the options described in subsection 7d74 7#e7 ,the impact analysis described in subsection 7e74 7d7 ,options ,the options described in this subsection are1 with respect to individuals entitled to benefits under part ,a or enrolled under part ,b of title ,,xviii of the ,social ,security ,act1 legislative and administrative options for accomplishing the following3 7#a7 ,improving coverage of and payment for pain management therapies without the use of opioids1 including interventional pain therapies1 and options to augment opioid therapy with other clinical and complementary1 integrative health services to minimize the risk of substance use disorder1 including in a hospital setting4 7#b7 ,improving coverage of and payment for medical devices and non-opioid based pharmacological and non-pharmacological therapies approved or cleared by the ,food and ,drug ,administration for the treatment of pain as an alternative or augment to opioid therapy4 7#c7 ,improving and disseminating treatment strategies for beneficiaries with psychiatric disorders1 substance use disorders1 or who are at risk of suicide1 and treatment strategies to address health disparities related to opioid use and opioid abuse treatment4 7#d7 ,improving and disseminating treatment strategies for beneficiaries with comorbidities who require a consultation or comanagement of pain with one or more specialists in pain management1 mental health1 or addiction treatment1 including in a hospital setting4 7#e7 ,educating providers on risks of coadministration of opioids and other drugs1 particularly benzodiazepines4 7#f7 ,ensuring appropriate case management for beneficiaries who transition between inpatient and outpatient hospital settings1 or between opioid therapy to non-opioid therapy1 which may include the use of care transition plans4 7#g7 ,expanding outreach activities designed to educate providers of services and suppliers under the ,medicare program and individuals entitled to benefits under part ,a or under part ,b of such title on alternative1 non-opioid therapies to manage and treat acute and chronic pain4 7#h7 ,creating a beneficiary education tool on alternatives to opioids for chronic pain management4 7e7 ,impact analysis ,the impact analysis described in this subsection consists of an analysis of any potential effects implementing the options described in subsection 7d7 would have-- 7#a7 on expenditures under the ,medicare program2 and 7#b7 on preventing or reducing opioid addiction for individuals receiving benefits under the ,medicare program4 ,j ,combating ,opioid ,abuse for ,care in ,hospitals #fjia4 ,short title ,this subtitle may be cited as the ,combating ,opioid ,abuse for ,care in ,hospitals ,act of #bjah or the ,,coach ,act of #bjah4 #fjib4 ,developing guidance on pain management and opioid use disorder prevention for hospitals receiving payment under part ,a of the ,medicare program 7a7 ,in general ,not later than ,july #a1 #bjai1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall develop and publish on the public website of the ,centers for ,medicare ,medicaid ,services guidance for hospitals receiving payment under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 on pain management strategies and opioid use disorder prevention strategies with respect to individuals entitled to benefits under such part4 7b7 ,consultation ,in developing the guidance described in subsection 7a71 the ,secretary shall consult with relevant stakeholders1 including-- 7#a7 medical professional organizations2 7#b7 providers and suppliers of services 7as such terms are defined in section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex772 7#c7 health care consumers or groups representing such consumers2 and 7#d7 other entities determined appropriate by the ,secretary4 7c7 ,contents ,the guidance described in subsection 7a7 shall include1 with respect to hospitals and individuals described in such subsection1 the following3 7#a7 ,best practices regarding evidence-based screening and practitioner education initiatives relating to screening and treatment protocols for opioid use disorder1 including-- 7,a7 methods to identify such individuals at-risk of opioid use disorder1 including risk stratification2 7,b7 ways to prevent1 recognize1 and treat opioid overdoses2 and 7,c7 resources available to such individuals1 such as opioid treatment programs1 peer support groups1 and other recovery programs4 7#b7 ,best practices for such hospitals to educate practitioners furnishing items and services at such hospital with respect to pain management and substance use disorders1 including education on-- 7,a7 the adverse effects of prolonged opioid use2 7,b7 non-opioid1 evidence-based1 non-pharmacological pain management treatments2 7,c7 monitoring programs for individuals who have been prescribed opioids2 and 7,d7 the prescribing of naloxone along with an initial opioid prescription4 7#c7 ,best practices for such hospitals to make such individuals aware of the risks associated with opioid use 7which may include use of the notification template described in paragraph 7#d774 7#d7 ,a notification template developed by the ,secretary1 for use as appropriate1 for such individuals who are prescribed an opioid that-- 7,a7 explains the risks and side effects associated with opioid use 7including the risks of addiction and overdose7 and the importance of adhering to the prescribed treatment regimen1 avoiding medications that may have an adverse interaction with such opioid1 and storing such opioid safely and securely2 7,b7 highlights multimodal and evidence-based non-opioid alternatives for pain management2 7,c7 encourages such individuals to talk to their health care providers about such alternatives2 7,d7 provides for a method 7through signature or otherwise7 for such an individual1 or person acting on such individual's behalf1 to acknowledge receipt of such notification template2 7,e7 is worded in an easily understandable manner and made available in multiple languages determined appropriate by the ,secretary2 and 7,f7 includes any other information determined appropriate by the ,secretary4 7#e7 ,best practices for such hospital to track opioid prescribing trends by practitioners furnishing items and services at such hospital1 including-- 7,a7 ways for such hospital to establish target levels1 taking into account the specialties of such practitioners and the geographic area in which such hospital is located1 with respect to opioids prescribed by such practitioners2 7,b7 guidance on checking the medical records of such individuals against information included in prescription drug monitoring programs2 7,c7 strategies to reduce long-term opioid prescriptions2 and 7,d7 methods to identify such practitioners who may be over-prescribing opioids4 7#f7 ,other information the ,secretary determines appropriate1 including any such information from the ,opioid ,safety ,initiative established by the ,department of ,veterans ,affairs or the ,opioid ,overdose ,prevention ,toolkit published by the ,substance ,abuse and ,mental ,health ,services ,administration4 #fjic4 ,requiring the review of quality measures relating to opioids and opioid use disorder treatments furnished under the medicare program and other federal health care programs ,section #ahij;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa-#a7 is amended by adding at the end the following new subsection3 7g7 ,technical expert panel review of opioid and opioid use disorder quality measures 7#a7 ,in general ,not later than #ahj days after the date of the enactment of this subsection1 the ,secretary shall establish a technical expert panel for purposes of reviewing quality measures relating to opioids and opioid use disorders1 including care1 prevention1 diagnosis1 health outcomes1 and treatment furnished to individuals with opioid use disorders4 ,the ,secretary may use the entity with a contract under section #ahij7;a7 and amend such contract as necessary to provide for the establishment of such technical expert panel4 7#b7 ,review and assessment ,not later than #a year after the date the technical expert panel described in paragraph 7#a7 is established 7and periodically thereafter as the ,secretary determines appropriate71 the technical expert panel shall-- 7,a7 review quality measures that relate to opioids and opioid use disorders1 including existing measures and those under development2 7,b7 identify gaps in areas of quality measurement that relate to opioids and opioid use disorders1 and identify measure development priorities for such measure gaps2 and 7,c7 make recommendations to the ,secretary on quality measures with respect to opioids and opioid use disorders for purposes of improving care1 prevention1 diagnosis1 health outcomes1 and treatment1 including recommendations for revisions of such measures1 need for development of new measures1 and recommendations for including such measures in the ,merit-,based ,incentive ,payment ,system under section #ahdh7q71 the alternative payment models under section #ahcc7z77#c77;,c71 the shared savings program under section #ahii1 the quality reporting requirements for inpatient hospitals under section #ahhf7;b77#c77;,b77viii71 and the hospital value-based purchasing program under section #ahhf7o74 7#c7 ,consideration of measures by secretary ,the ,secretary shall consider-- 7,a7 using opioid and opioid use disorder measures 7including measures used under the ,merit-,based ,incentive ,payment ,system under section #ahdh7q71 measures recommended under paragraph 7#b77;,c71 and other such measures identified by the ,secretary7 in alternative payment models under section #ahcc7z77#c77;,c7 and in the shared savings program under section #ahii2 and 7,b7 using opioid measures described in subparagraph 7,a71 as applicable1 in the quality reporting requirements for inpatient hospitals under section #ahhf7;b77#c77;,b77viii71 and in the hospital value-based purchasing program under section #ahhf7o74 7#d7 ,prioritization of measure development ,the ,secretary shall prioritize for measure development the gaps in quality measures identified under paragraph 7#b77;,b74 7#e7 ,prioritization of measure endorsement ,the ,secretary-- 7,a7 during the period beginning on the date of the enactment of this subsection and ending on ,december #ca1 #bjbc1 shall prioritize the endorsement of measures relating to opioids and opioid use disorders by the entity with a contract under subsection 7a7 of section #ahij in connection with endorsement of measures described in subsection 7b77#b7 of such section2 and 7,b7 on and after ,january #a1 #bjbd1 may prioritize the endorsement of such measures by such entity4 4 #fjid4 ,technical expert panel on reducing surgical setting opioid use2 ,data collection on perioperative opioid use 7a7 ,technical expert panel on reducing surgical setting opioid use 7#a7 ,in general ,not later than #f months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall convene a technical expert panel1 including medical and surgical specialty societies and hospital organizations1 to provide recommendations on reducing opioid use in the inpatient and outpatient surgical settings and on best practices for pain management1 including with respect to the following3 7,a7 ,approaches that limit patient exposure to opioids during the perioperative period1 including pre-surgical and post-surgical injections1 and that identify such patients at risk of opioid use disorder pre-operation4 7,b7 ,shared decision making with patients and families on pain management1 including a review of payment to ensure payment under the ,medicare program under title ,,xviii of the ,social ,security ,act accounts for time spent on shared decision making4 7,c7 ,education on the safe use1 storage1 and disposal of opioids4 7,d7 ,prevention of opioid misuse and abuse after discharge4 7,e7 ,development of a clinical algorithm to identify and treat at-risk1 opiate-tolerant patients and reduce reliance on opioids for acute pain during the perioperative period4 7#b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress and make public a report containing the recommendations developed under paragraph 7#a7 and an action plan for broader implementation of pain management protocols that limit the use of opioids in the perioperative setting and upon discharge from such setting4 7b7 ,data collection on perioperative opioid use ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit to ,congress a report that contains the following3 7#a7 ,the diagnosis-related group codes identified by the ,secretary as having the highest volume of surgeries4 7#b7 ,with respect to each of such diagnosis-related group codes so identified1 a determination by the ,secretary of the data that is both available and reported on opioid use following such surgeries1 such as with respect to-- 7,a7 surgical volumes1 practices1 and opioid prescribing patterns2 7,b7 opioid consumption1 including-- 7i7 perioperative days of therapy2 7ii7 average daily dose at the hospital1 including dosage greater than #ij milligram morphine equivalent2 7iii7 post-discharge prescriptions and other combination drugs that are used before intervention and after intervention2 7iv7 quantity and duration of opioid prescription at discharge2 and 7v7 quantity consumed and number of refills2 7,c7 regional anesthesia and analgesia practices1 including pre-surgical and post-surgical injections2 7,d7 naloxone reversal2 7,e7 post-operative respiratory failure2 7,f7 information about storage and disposal2 and 7,g7 such other information as the ,secretary may specify4 7#c7 ,recommendations for improving data collection on perioperative opioid use1 including an analysis to identify and reduce barriers to collecting1 reporting1 and analyzing the data described in paragraph 7#b71 including barriers related to technological availability4 #fjie4 ,requiring the posting and periodic update of opioid prescribing guidance for ,medicare beneficiaries 7a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall post on the public website of the ,centers for ,medicare ,medicaid ,services all guidance published by the ,department of ,health and ,human ,services on or after ,january #a1 #bjaf1 relating to the prescribing of opioids and applicable to opioid prescriptions for individuals entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 or enrolled under part ,b of such title of such ,act 7#db ,u4,s4,c4 #acie;j et seq474 7b7 ,update of guidance 7#a7 ,periodic update ,the ,secretary shall1 in consultation with the entities specified in paragraph 7#b71 periodically 7as determined appropriate by the ,secretary7 update guidance described in subsection 7a7 and revise the posting of such guidance on the website described in such subsection4 7#b7 ,consultation ,the entities specified in this paragraph are the following3 7,a7 ,medical professional organizations4 7,b7 ,providers and suppliers of services 7as such terms are defined in section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex774 7,c7 ,health care consumers or groups representing such consumers4 7,d7 ,other entities determined appropriate by the ,secretary4 ,k ,providing ,reliable ,options for ,patients and ,educational ,resources #faja4 ,short title ,this subtitle may be cited as the ,providing ,reliable ,options for ,patients and ,educational ,resources ,act of #bjah or the ,,proper ,act of #bjah4 #fajb4 ,requiring ,medicare ,advantage plans and part ,d prescription drug plans to include information on risks associated with opioids and coverage of nonpharmacological therapies and nonopioid medications or devices used to treat pain ,section #ahfj;,d-#d7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;a77#a77 is amended-- 7#a7 in subparagraph 7,a71 by inserting 1 subject to subparagraph 7,c71 before including2 7#b7 in subparagraph 7,b71 by adding at the end the following new clause3 7vi7 ,for plan year #bjba and each subsequent plan year1 subject to subparagraph 7,c71 with respect to the treatment of pain-- 7,i7 the risks associated with prolonged opioid use2 and 7,,ii7 coverage of nonpharmacological therapies1 devices1 and nonopioid medications-- 7aa7 in the case of an ,,ma-,,pd plan under part ,c1 under such plan2 and 7bb7 in the case of a prescription drug plan1 under such plan and under parts ,a and ,b4 2 and 7#c7 by adding at the end the following new subparagraph3 7,c7 ,targeted provision of information ,a ,,pdp sponsor of a prescription drug plan may1 in lieu of disclosing the information described in subparagraph 7,b77vi7 to each enrollee under the plan1 disclose such information through mail or electronic communications to a subset of enrollees under the plan1 such as enrollees who have been prescribed an opioid in the previous #b-year period4 4 #fajc4 ,requiring ,medicare ,advantage plans and prescription drug plans to provide information on the safe disposal of prescription drugs 7a7 ,medicare ,advantage ,section #aheb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7 is amended by adding at the end the following new subsection3 7n7 ,provision of information relating to the safe disposal of certain prescription drugs 7#a7 ,in general ,in the case of an individual enrolled under an ,,ma or ,,ma-,,pd plan who is furnished an in-home health risk assessment on or after ,january #a1 #bjba1 such plan shall ensure that such assessment includes information on the safe disposal of prescription drugs that are controlled substances that meets the criteria established under paragraph 7#b74 ,such information shall include information on drug takeback programs that meet such requirements determined appropriate by the ,secretary and information on in-home disposal4 7#b7 ,criteria ,the ,secretary shall1 through rulemaking1 establish criteria the ,secretary determines appropriate with respect to information provided to an individual to ensure that such information sufficiently educates such individual on the safe disposal of prescription drugs that are controlled substances4 4 7b7 ,prescription drug plans ,section #ahfj;,d-#d7;c77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77#b77;,b77 is amended-- 7#a7 by striking may include elements that promote2 7#b7 by redesignating clauses 7i7 through 7iii7 as subclauses 7,i7 through 7,,iii7 and adjusting the margins accordingly2 7#c7 by inserting before subclause 7,i71 as so redesignated1 the following new clause3 7i7 may include elements that promote-- 2 7#d7 in subclause 7,,iii71 as so redesignated1 by striking the period at the end and inserting 2 and2 and 7#e7 by adding at the end the following new clause3 7ii7 with respect to plan years beginning on or after ,january #a1 #bjba1 shall provide for-- 7,i7 the provision of information to the enrollee on the safe disposal of prescription drugs that are controlled substances that meets the criteria established under section #aheb7n77#b71 including information on drug takeback programs that meet such requirements determined appropriate by the ,secretary and information on in-home disposal2 and 7,,ii7 cost-effective means by which an enrollee may so safely dispose of such drugs4 4 #fajd4 ,revising measures used under the ,hospital ,consumer ,assessment of ,healthcare ,providers and ,systems survey relating to pain management 7a7 ,restriction on the use of pain questions in ,,hcahps ,section #ahhf7;b77#c77;,b77viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77viii77 is amended by adding at the end the following new subclause3 7,,xii7 7aa7 ,with respect to a ,hospital ,consumer ,assessment of ,healthcare ,providers and ,systems survey 7or a successor survey7 conducted on or after ,january #a1 #bjbj1 such survey may not include questions about communication by hospital staff with an individual about such individual's pain unless such questions take into account1 as applicable1 whether an individual experiencing pain was informed about risks associated with the use of opioids and about non-opioid alternatives for the treatment of pain4 7bb7 ,the ,secretary shall not include on the ,hospital ,compare internet website any measures based on the questions appearing on the ,hospital ,consumer ,assessment of ,healthcare ,providers and ,systems survey in #bjah or #bjai about communication by hospital staff with an individual about such individual's pain4 4 7b7 ,restriction on use of #bjah and #bjai pain questions in the hospital value-based purchasing program ,section #ahhf7o77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7o77#b77;,b77 is amended by adding at the end the following new clause3 7iii7 ,,hcahps pain questions ,the ,secretary may not include under subparagraph 7,a7 a measure that is based on the questions appearing on the ,hospital ,consumer ,assessment of ,healthcare ,providers and ,systems survey in #bjah or #bjai about communication by hospital staff with an individual about the individual's pain4 4 ,l ,fighting the ,opioid ,epidemic ,with ,sunshine #faaa4 ,fighting the opioid epidemic with sunshine 7a7 ,inclusion of information regarding payments to additional practitioners 7#a7 ,in general ,section #aabh;,g7e77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;h7e77#f77 is amended-- 7,a7 in subparagraph 7,a71 by adding at the end the following new clauses3 7iii7 ,a physician assistant1 nurse practitioner1 or clinical nurse specialist 7as such terms are defined in section #ahfa7;aa77#e774 7iv7 ,a certified registered nurse anesthetist 7as defined in section #ahfa7;bb77#b774 7v7 ,a certified nurse-midwife 7as defined in section #ahfa7;gg77#b774 2 and 7,b7 in subparagraph 7,b71 by inserting 1 physician assistant1 nurse practitioner1 clinical nurse specialist1 certified nurse anesthetist1 or certified nurse-midwife after physician4 7#b7 ,effective date ,the amendments made by this subsection shall apply with respect to information required to be submitted under section #aabh;,g of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;h7 on or after ,january #a1 #bjbb4 7b7 ,sunset of exclusion of ,national ,provider ,identifier of covered recipient in information made publicly available ,section #aabh;,g7c77#a77;,c77viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;h7c77#a77;,c77viii77 is amended by striking does not contain and inserting in the case of information made available under this subparagraph prior to ,january #a1 #bjbb1 does not contain4 7c7 ,administration ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply to this section or the amendments made by this section4 ,,vii ,public ,health ,provisions ,a ,awareness and training #gjja4 ,report on effects on public health of synthetic drug use 7a7 ,in general ,not later than #c years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in coordination with the ,surgeon ,general of the ,public ,health ,service1 shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate a report on the health effects of new psychoactive substances1 including synthetic drugs1 used by adolescents and young adults4 7b7 ,new psychoactive substance defined ,for purposes of subsection 7a71 the term new psychoactive substance means a controlled substance analogue 7as defined in section #ajb7cb7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb7cb774 #gjjb4 ,first responder training ,section #edf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;ee-#a7 is amended-- 7#a7 in subsection 7c7-- 7,a7 in paragraph 7#b71 by striking and at the end2 7,b7 in paragraph 7#c71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following3 7#d7 train and provide resources for first responders and members of other key community sectors on safety around fentanyl1 carfentanil1 and other dangerous licit and illicit drugs to protect themselves from exposure to such drugs and respond appropriately when exposure occurs4 2 7#b7 in subsection 7d71 by striking and mechanisms for referral to appropriate treatment for an entity receiving a grant under this section and inserting mechanisms for referral to appropriate treatment1 and safety around fentanyl1 carfentanil1 and other dangerous licit and illicit drugs2 7#c7 in subsection 7f7-- 7,a7 in paragraph 7#c71 by striking and at the end2 7,b7 in paragraph 7#d71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following3 7#e7 the number of first responders and members of other key community sectors trained on safety around fentanyl1 carfentanil1 and other dangerous licit and illicit drugs4 2 7#d7 by redesignating subsection 7g7 as subsection 7h72 7#e7 by inserting after subsection 7f7 the following3 7g7 ,other key community sectors ,in this section1 the term other key community sectors includes substance use disorder treatment providers1 emergency medical services agencies1 agencies and organizations working with prison and jail populations and offender reentry programs1 health care providers1 harm reduction groups1 pharmacies1 community health centers1 tribal health facilities1 and mental health providers4 2 and 7#f7 in subsection 7h71 as so redesignated1 by striking #ab1jjj1jjj for each of fiscal years #bjag through #bjba and inserting #cf1jjj1jjj for each of fiscal years #bjai through #bjbc4 ,b ,pilot program for public health laboratories ,to detect fentanyl and other synthetic opioids #gjaa4 ,pilot program for public health laboratories to detect fentanyl and other synthetic opioids 7a7 ,grants ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall award grants to1 or enter into cooperative agreements with1 ,federal1 ,state1 and local agencies to improve coordination between public health laboratories and laboratories operated by law enforcement agencies1 such as ,customs and ,border ,protection and the ,drug ,enforcement ,administration1 to improve detection of synthetic opioids1 including fentanyl and its analogues1 as described in subsection 7b74 7b7 ,detection activities ,the ,secretary1 in consultation with the ,director of the ,national ,institute of ,standards and ,technology1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,attorney ,general of the ,united ,states1 and the ,administrator of the ,drug ,enforcement ,administration1 shall1 for purposes of this section1 develop or identify-- 7#a7 best practices for safely handling and testing synthetic opioids1 including fentanyl and its analogues1 including with respect to reference materials1 instrument calibration1 and quality control protocols2 7#b7 reference materials and quality control standards related to synthetic opioids1 including fentanyl and its analogues1 to enhance-- 7,a7 clinical diagnostics2 7,b7 postmortem data collection2 and 7,c7 portable testing equipment utilized by law enforcement and public health officials2 and 7#c7 procedures for the identification of new and emerging synthetic opioid formulations and procedures for reporting those findings to appropriate law enforcement agencies and ,federal1 ,state1 and local public health laboratories and health departments1 as appropriate4 7c7 ,laboratories ,the ,secretary shall require recipients of grants or cooperative agreements under subsection 7a7 to-- 7#a7 follow the best practices established under subsection 7b7 and have the appropriate capabilities to provide laboratory testing of controlled substances1 such as synthetic fentanyl1 and biospecimens for the purposes of aggregating and reporting public health information to ,federal1 ,state1 and local public health officials1 laboratories1 and other entities the ,secretary deems appropriate2 7#b7 work with law enforcement agencies and public health authorities1 as practicable2 7#c7 provide early warning information to ,federal1 ,state1 and local law enforcement agencies and public health authorities regarding trends or other data related to the supply of synthetic opioids1 including fentanyl and its analogues2 7#d7 provide biosurveillance capabilities with respect to identifying trends in adverse health outcomes associated with non-fatal exposures2 and 7#e7 provide diagnostic testing1 as appropriate and practicable1 for non-fatal exposures of emergency personnel1 first responders1 and other individuals4 7d7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #ae1jjj1jjj for each of fiscal years #bjai through #bjbc4 ,c ,indexing ,narcotics1 ,fentanyl1 and ,opioids #gjba4 ,establishment of substance use disorder information dashboard ,title ,,xvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju et seq47 is amended by adding at the end the following new section3 #agaa4 ,establishment of substance use disorder information dashboard 7a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary of ,health and ,human ,services shall1 in consultation with the ,director of ,national ,drug ,control ,policy1 establish and periodically update1 on the ,internet website of the ,department of ,health and ,human ,services1 a public information dashboard that-- 7#a7 provides links to information on programs within the ,department of ,health and ,human ,services related to the reduction of opioid and other substance use disorders2 7#b7 provides access1 to the extent practicable and appropriate1 to publicly available data1 which may include data from agencies within the ,department of ,health and ,human ,services and-- 7,a7 other ,federal agencies2 7,b7 ,state1 local1 and ,tribal governments2 7,c7 nonprofit organizations2 7,d7 law enforcement2 7,e7 medical experts2 7,f7 public health educators2 and 7,g7 research institutions regarding prevention1 treatment1 recovery1 and other services for opioid and other substance use disorders2 7#c7 provides data on substance use disorder prevention and treatment strategies in different regions of and populations in the ,united ,states2 7#d7 identifies information on alternatives to controlled substances for pain management1 such as approaches studied by the ,national ,institutes of ,health ,pain ,consortium1 the ,national ,center for ,complimentary and ,integrative ,health1 and other institutes and centers at the ,national ,institutes of ,health1 as appropriate2 and 7#e7 identifies guidelines and best practices for health care providers regarding treatment of substance use disorders4 7b7 ,controlled substance defined ,in this section1 the term controlled substance has the meaning given that term in section #ajb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb74 4 #gjbb4 ,interdepartmental ,substance ,use ,disorders ,coordinating ,committee 7a7 ,establishment ,not later than #c months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall1 in coordination with the ,director of ,national ,drug ,control ,policy1 establish a committee1 to be known as the ,interdepartmental ,substance ,use ,disorders ,coordinating ,committee 7in this section referred to as the ,committee71 to coordinate ,federal activities related to substance use disorders4 7b7 ,membership 7#a7 ,federal members ,the ,committee shall be composed of the following ,federal representatives1 or the designees of such representatives3 7,a7 ,the ,secretary1 who shall serve as the ,chair of the ,committee4 7,b7 ,the ,attorney ,general of the ,united ,states4 7,c7 ,the ,secretary of ,labor4 7,d7 ,the ,secretary of ,housing and ,urban ,development4 7,e7 ,the ,secretary of ,education4 7,f7 ,the ,secretary of ,veterans ,affairs4 7,g7 ,the ,commissioner of ,social ,security4 7,h7 ,the ,assistant ,secretary for ,mental ,health and ,substance ,use4 7,i7 ,the ,director of ,national ,drug ,control ,policy4 7,j7 ,representatives of other ,federal agencies that support or conduct activities or programs related to substance use disorders1 as determined appropriate by the ,secretary4 7#b7 ,non-,federal members ,the ,committee shall include a minimum of #ae non-,federal members appointed by the ,secretary1 of which-- 7,a7 at least two such members shall be an individual who has received treatment for a diagnosis of a substance use disorder2 7,b7 at least two such members shall be a director of a ,state substance abuse agency2 7,c7 at least two such members shall be a representative of a leading research1 advocacy1 or service organization for adults with substance use disorder2 7,d7 at least two such members shall-- 7i7 be a physician1 licensed mental health professional1 advance practice registered nurse1 or physician assistant2 and 7ii7 have experience in treating individuals with substance use disorders2 7,e7 at least one such member shall be a substance use disorder treatment professional who provides treatment services at a certified opioid treatment program2 7,f7 at least one such member shall be a substance use disorder treatment professional who has research or clinical experience in working with racial and ethnic minority populations2 7,g7 at least one such member shall be a substance use disorder treatment professional who has research or clinical mental health experience in working with medically underserved populations2 7,h7 at least one such member shall be a ,state-certified substance use disorder peer support specialist2 7,i7 at least one such member shall be a drug court judge or a judge with experience in adjudicating cases related to substance use disorder2 7,j7 at least one such member shall be a public safety officer with extensive experience in interacting with adults with a substance use disorder2 and 7,k7 at least one such member shall be an individual with experience providing services for homeless individuals with a substance use disorder4 7c7 ,terms 7#a7 ,in general ,a member of the ,committee appointed under subsection 7b77#b7 shall be appointed for a term of #c years and may be reappointed for one or more #c-year terms4 7#b7 ,vacancies ,a vacancy on the ,committee shall be filled in the same manner in which the original appointment was made4 ,any individual appointed to fill a vacancy for an unexpired term shall be appointed for the remainder of such term and may serve after the expiration of such term until a successor has been appointed4 7d7 ,meetings ,the ,committee shall meet not fewer than two times each year4 7e7 ,duties ,the ,committee shall-- 7#a7 identify areas for improved coordination of activities1 if any1 related to substance use disorders1 including research1 services1 supports1 and prevention activities across all relevant ,federal agencies2 7#b7 identify and provide to the ,secretary recommendations for improving ,federal programs for the prevention and treatment of1 and recovery from1 substance use disorders1 including by expanding access to prevention1 treatment1 and recovery services2 7#c7 analyze substance use disorder prevention and treatment strategies in different regions of and populations in the ,united ,states and evaluate the extent to which ,federal substance use disorder prevention and treatment strategies are aligned with ,state and local substance use disorder prevention and treatment strategies2 7#d7 make recommendations to the ,secretary regarding any appropriate changes with respect to the activities and strategies described in paragraphs 7#a7 through 7#c72 7#e7 make recommendations to the ,secretary regarding public participation in decisions relating to substance use disorders and the process by which public feedback can be better integrated into such decisions2 and 7#f7 make recommendations to ensure that substance use disorder research1 services1 supports1 and prevention activities of the ,department of ,health and ,human ,services and other ,federal agencies are not unnecessarily duplicative4 7f7 ,annual report ,not later than #a year after the date of the enactment of this ,act1 and annually thereafter for the life of the ,committee1 the ,committee shall publish on the ,internet website of the ,department of ,health and ,human ,services1 which may include the public information dashboard established under section #agaa of the ,public ,health ,service ,act1 as added by section #gjba1 a report summarizing the activities carried out by the ,committee pursuant to subsection 7e71 including any findings resulting from such activities4 7g7 ,working groups ,the ,committee may establish working groups for purposes of carrying out the duties described in subsection 7e74 ,any such working group shall be composed of members of the ,committee 7or the designees of such members7 and may hold such meetings as are necessary to enable the working group to carry out the duties delegated to the working group4 7h7 ,federal ,advisory ,committee ,act ,the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall apply to the ,committee only to the extent that the provisions of such ,act do not conflict with the requirements of this section4 7i7 ,sunset ,the ,committee shall terminate on the date that is #f years after the date on which the ,committee is established under subsection 7a74 #gjbc4 ,national milestones to measure success in curtailing the opioid crisis 7a7 ,in general ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in coordination with the ,administrator of the ,drug ,enforcement ,administration and the ,director of the ,office of ,national ,drug ,control ,policy1 shall develop or identify existing national indicators 7referred to in this section as the national milestones7 to measure success in curtailing the opioid crisis1 with the goal of significantly reversing the incidence and prevalence of opioid misuse and abuse1 and opioid-related morbidity and mortality in the ,united ,states within #e years of such date of enactment4 7b7 ,national milestones to end the opioid crisis ,the national milestones under subsection 7a7 shall include the following3 7#a7 ,not fewer than #aj indicators or metrics to accurately and expediently measure progress in meeting the goal described in subsection 7a71 which shall1 as appropriate1 include1 indicators or metrics related to-- 7,a7 the number of fatal and non-fatal opioid overdoses2 7,b7 the number of emergency room visits related to opioid misuse and abuse2 7,c7 the number of individuals in sustained recovery from opioid use disorder2 7,d7 the number of infections associated with illicit drug use1 such as ,,hiv1 viral hepatitis1 and infective endocarditis1 and available capacity for treating such infections2 7,e7 the number of providers prescribing medication-assisted treatment for opioid use disorders1 including in primary care settings1 community health centers1 jails1 and prisons2 7,f7 the number of individuals receiving treatment for opioid use disorder2 and 7,g7 additional indicators or metrics1 as appropriate1 such as metrics pertaining to specific populations1 including women and children1 ,american ,indians and ,alaskan ,natives1 individuals living in rural and non-urban areas1 and justice-involved populations1 that would further clarify the progress made in addressing the opioid crisis4 7#b7 ,a reasonable goal1 such as a percentage decrease or other specified metric1 that signifies progress in meeting the goal described in subsection 7a71 and annual targets to help achieve that goal4 7c7 ,consideration of other substance use disorders ,in developing the national milestones under subsection 7b71 the ,secretary shall1 as appropriate1 consider other substance use disorders in addition to opioid use disorder4 7d7 ,extension of period ,if the ,secretary determines that the goal described in subsection 7a7 will not be achieved with respect to any indicator or metric established under subsection 7b77#b7 within #e years of the date of enactment of this ,act1 the ,secretary may extend the timeline for meeting such goal with respect to that indicator or metric4 ,the ,secretary shall include with any such extension a rationale for why additional time is needed and information on whether significant changes are needed in order to achieve such goal with respect to the indicator or metric4 7e7 ,annual status update ,not later than one year after the date of enactment of this ,act1 the ,secretary shall make available on the ,internet website of the ,department of ,health and ,human ,services1 and submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 an update on the progress1 including expected progress in the subsequent year1 in achieving the goals detailed in the national milestones4 ,each such update shall include the progress made in the first year or since the previous report1 as applicable1 in meeting each indicator or metric in the national milestones4 #gjbd4 ,study on prescribing limits ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in consultation with the ,attorney ,general of the ,united ,states1 shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report on the impact of ,federal and ,state laws and regulations that limit the length1 quantity1 or dosage of opioid prescriptions4 ,such report shall address-- 7#a7 the impact of such limits on-- 7,a7 the incidence and prevalence of overdose related to prescription opioids2 7,b7 the incidence and prevalence of overdose related to illicit opioids2 7,c7 the prevalence of opioid use disorders2 7,d7 medically appropriate use of1 and access to1 opioids1 including any impact on travel expenses and pain management outcomes for patients1 whether such limits are associated with significantly higher rates of negative health outcomes1 including suicide1 and whether the impact of such limits differs based on the clinical indication for which opioids are prescribed2 7#b7 whether such limits lead to a significant increase in burden for prescribers of opioids or prescribers of treatments for opioid use disorder1 including any impact on patient access to treatment1 and whether any such burden is mitigated by any factors such as electronic prescribing or telemedicine2 and 7#c7 the impact of such limits on diversion or misuse of any controlled substance in schedule ,,ii1 ,,iii1 or ,,iv of section #bjb7;c7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hab7;c774 ,d ,ensuring ,access to ,quality ,sober ,living #gjca4 ,national recovery housing best practices ,part ,d of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd et seq47 is amended by adding at the end the following new section3 #eej4 ,national recovery housing best practices 7a7 ,best practices for operating recovery housing 7#a7 ,in general ,the ,secretary1 in consultation with the individuals and entities specified in paragraph 7#b71 shall identify or facilitate the development of best practices1 which may include model laws for implementing suggested minimum standards1 for operating recovery housing4 7#b7 ,consultation ,in carrying out the activities described in paragraph 7#a71 the ,secretary shall consult with1 as appropriate-- 7,a7 relevant divisions of the ,department of ,health and ,human ,services1 including the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,office of ,inspector ,general1 the ,indian ,health ,service1 and the ,centers for ,medicare ,medicaid ,services2 7,b7 the ,secretary of ,housing and ,urban ,development2 7,c7 directors or commissioners1 as applicable1 of ,state health departments1 tribal health departments1 ,state ,medicaid programs1 and ,state insurance agencies2 7,d7 representatives of health insurance issuers2 7,e7 national accrediting entities and reputable providers of1 and analysts of1 recovery housing services1 including ,indian tribes1 tribal organizations1 and tribally designated housing entities that provide recovery housing services1 as applicable2 7,f7 individuals with a history of substance use disorder2 and 7,g7 other stakeholders identified by the ,secretary4 7b7 ,identification of fraudulent recovery housing operators 7#a7 ,in general ,the ,secretary1 in consultation with the individuals and entities described in paragraph 7#b71 shall identify or facilitate the development of common indicators that could be used to identify potentially fraudulent recovery housing operators4 7#b7 ,consultation ,in carrying out the activities described in paragraph 7#a71 the ,secretary shall consult with1 as appropriate1 the individuals and entities specified in subsection 7a77#b7 and the ,attorney ,general of the ,united ,states4 7#c7 ,requirements 7,a7 ,practices for identification and reporting ,in carrying out the activities described in paragraph 7#a71 the ,secretary shall consider how law enforcement1 public and private payers1 and the public can best identify and report fraudulent recovery housing operators4 7,b7 ,factors to be considered ,in carrying out the activities described in paragraph 7#a71 the ,secretary shall identify or develop indicators1 which may include indicators related to-- 7i7 unusual billing practices2 7ii7 average lengths of stays2 7iii7 excessive levels of drug testing 7in terms of cost or frequency72 and 7iv7 unusually high levels of recidivism4 7c7 ,dissemination ,the ,secretary shall1 as appropriate1 disseminate the best practices identified or developed under subsection 7a7 and the common indicators identified or developed under subsection 7b7 to-- 7#a7 ,state agencies1 which may include the provision of technical assistance to ,state agencies seeking to adopt or implement such best practices2 7#b7 ,indian tribes1 tribal organizations1 and tribally designated housing entities2 7#c7 the ,attorney ,general of the ,united ,states2 7#d7 the ,secretary of ,labor2 7#e7 the ,secretary of ,housing and ,urban ,development2 7#f7 ,state and local law enforcement agencies2 7#g7 health insurance issuers2 7#h7 recovery housing entities2 and 7#i7 the public4 7d7 ,requirements ,in carrying out the activities described in subsections 7a7 and 7b71 the ,secretary1 in consultation with appropriate individuals and entities described in subsections 7a77#b7 and 7b77#b71 shall consider how recovery housing is able to support recovery and prevent relapse1 recidivism1 or overdose 7including overdose death71 including by improving access and adherence to treatment1 including medication-assisted treatment4 7e7 ,rule of construction ,nothing in this section shall be construed to provide the ,secretary with the authority to require ,states to adhere to minimum standards in the ,state oversight of recovery housing4 7f7 ,definitions ,in this section3 7#a7 ,the term recovery housing means a shared living environment free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders4 7#b7 ,the terms ,indian tribe and tribal organization have the meanings given those terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#c7 ,the term tribally designated housing entity has the meaning given that term in section #d of the ,native ,american ,housing ,assistance and ,self-,determination ,act of #aiif 7#be ,u4,s4,c4 #dajc74 7g7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #c1jjj1jjj for the period of fiscal years #bjai through #bjba4 4 ,e ,advancing ,cutting ,edge ,research #gjda4 ,unique research initiatives ,section #djb7n77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhb7n77#a77 is amended-- 7#a7 in subparagraph 7,a71 by striking or2 7#b7 in subparagraph 7,b71 by striking the period and inserting 2 or2 and 7#c7 by adding at the end the following3 7,c7 high impact cutting-edge research that fosters scientific creativity and increases fundamental biological understanding leading to the prevention1 diagnosis1 or treatment of diseases and disorders1 or research urgently required to respond to a public health threat4 4 #gjdb4 ,pain research ,section #dji;,j7b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhdq7b77 is amended-- 7#a7 in paragraph 7#e7-- 7,a7 in subparagraph 7,a71 by striking and treatment of pain and diseases and disorders associated with pain and inserting treatment1 and management of pain and diseases and disorders associated with pain1 including information on best practices for the utilization of non-pharmacologic treatments1 non-addictive medical products1 and other drugs or devices approved or cleared by the ,food and ,drug ,administration2 7,b7 in subparagraph 7,b71 by striking on the symptoms and causes of pain2 and inserting the following3 8on-- 7i7 the symptoms and causes of pain1 including the identification of relevant biomarkers and screening models and the epidemiology of acute and chronic pain2 7ii7 the diagnosis1 prevention1 treatment1 and management of acute and chronic pain1 including with respect to non-pharmacologic treatments1 non-addictive medical products1 and other drugs or devices approved or cleared by the ,food and ,drug ,administration2 and 7iii7 risk factors for1 and early warning signs of1 substance use disorders in populations with acute and chronic pain2 and 2 and 7,c7 by striking subparagraphs 7,c7 through 7,e7 and inserting the following3 7,c7 make recommendations to the ,director of ,,nih-- 7i7 to ensure that the activities of the ,national ,institutes of ,health and other ,federal agencies are free of unnecessary duplication of effort2 7ii7 on how best to disseminate information on pain care and epidemiological data related to acute and chronic pain2 and 7iii7 on how to expand partnerships between public entities and private entities to expand collaborative1 cross-cutting research4 2 7#b7 by redesignating paragraph 7#f7 as paragraph 7#g72 and 7#c7 by inserting after paragraph 7#e7 the following3 7#f7 ,report ,the ,secretary shall ensure that recommendations and actions taken by the ,director with respect to the topics discussed at the meetings described in paragraph 7#d7 are included in appropriate reports to ,congress4 4 ,f ,jessie's ,law #gjea4 ,inclusion of opioid addiction history in patient records 7a7 ,best practices 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 in consultation with appropriate stakeholders1 including a patient with a history of opioid use disorder1 an expert in electronic health records1 an expert in the confidentiality of patient health information and records1 and a health care provider1 shall identify or facilitate the development of best practices regarding-- 7,a7 the circumstances under which information that a patient has provided to a health care provider regarding such patient's history of opioid use disorder should1 only at the patient's request1 be prominently displayed in the medical records 7including electronic health records7 of such patient2 7,b7 what constitutes the patient's request for the purpose described in subparagraph 7,a72 and 7,c7 the process and methods by which the information should be so displayed4 7#b7 ,dissemination ,the ,secretary shall disseminate the best practices developed under paragraph 7#a7 to health care providers and ,state agencies4 7b7 ,requirements ,in identifying or facilitating the development of best practices under subsection 7a71 as applicable1 the ,secretary1 in consultation with appropriate stakeholders1 shall consider the following3 7#a7 ,the potential for addiction relapse or overdose1 including overdose death1 when opioid medications are prescribed to a patient recovering from opioid use disorder4 7#b7 ,the benefits of displaying information about a patient's opioid use disorder history in a manner similar to other potentially lethal medical concerns1 including drug allergies and contraindications4 7#c7 ,the importance of prominently displaying information about a patient's opioid use disorder when a physician or medical professional is prescribing medication1 including methods for avoiding alert fatigue in providers4 7#d7 ,the importance of a variety of appropriate medical professionals1 including physicians1 nurses1 and pharmacists1 having access to information described in this section when prescribing or dispensing opioid medication1 consistent with ,federal and ,state laws and regulations4 7#e7 ,the importance of protecting patient privacy1 including the requirements related to consent for disclosure of substance use disorder information under all applicable laws and regulations4 7#f7 ,all applicable ,federal and ,state laws and regulations4 #gjeb4 ,communication with families during emergencies 7a7 ,promoting awareness of authorized disclosures during emergencies ,the ,secretary of ,health and ,human ,services shall annually notify health care providers regarding permitted disclosures under ,federal health care privacy law during emergencies1 including overdoses1 of certain health information to families1 caregivers1 and health care providers4 7b7 ,use of material ,for the purposes of carrying out subsection 7a71 the ,secretary of ,health and ,human ,services may use material produced under section #gjec of this ,act or section #aajjd of the #bast ,century ,cures ,act 7#db ,u4,s4,c4 #acbj;d-#b note74 #gjec4 ,development and dissemination of model training programs for substance use disorder patient records 7a7 ,initial programs and materials ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 in consultation with appropriate experts1 shall identify the following model programs and materials 7or if no such programs or materials exist1 recognize private or public entities to develop and disseminate such programs and materials73 7#a7 ,model programs and materials for training health care providers 7including physicians1 emergency medical personnel1 psychiatrists1 psychologists1 counselors1 therapists1 nurse practitioners1 physician assistants1 behavioral health facilities and clinics1 care managers1 and hospitals1 including individuals such as general counsels or regulatory compliance staff who are responsible for establishing provider privacy policies7 concerning the permitted uses and disclosures1 consistent with the standards and regulations governing the privacy and security of substance use disorder patient records promulgated by the ,secretary under section #edc of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd-#b7 for the confidentiality of patient records4 7#b7 ,model programs and materials for training patients and their families regarding their rights to protect and obtain information under the standards and regulations described in paragraph 7#a74 7b7 ,requirements ,the model programs and materials described in paragraphs 7#a7 and 7#b7 of subsection 7a7 shall address circumstances under which disclosure of substance use disorder patient records is needed to-- 7#a7 facilitate communication between substance use disorder treatment providers and other health care providers to promote and provide the best possible integrated care2 7#b7 avoid inappropriate prescribing that can lead to dangerous drug interactions1 overdose1 or relapse2 and 7#c7 notify and involve families and caregivers when individuals experience an overdose4 7c7 ,periodic updates ,the ,secretary shall-- 7#a7 periodically review and update the model program and materials identified or developed under subsection 7a72 and 7#b7 disseminate such updated programs and materials to the individuals described in subsection 7a77#a74 7d7 ,input of certain entities ,in identifying1 reviewing1 or updating the model programs and materials under this section1 the ,secretary shall solicit the input of relevant stakeholders4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section-- 7#a7 #d1jjj1jjj for fiscal year #bjai2 7#b7 #b1jjj1jjj for each of fiscal years #bjbj and #bjba2 and 7#c7 #a1jjj1jjj for each of fiscal years #bjbb and #bjbc4 ,g ,protecting ,pregnant ,women and ,infants #gjfa4 ,report on addressing maternal and infant health in the opioid crisis 7a7 ,in general ,not later than #ah months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 in coordination with the ,centers for ,disease ,control and ,prevention1 the ,national ,institutes of ,health1 the ,indian ,health ,service1 and the ,substance ,abuse and ,mental ,health ,services ,administration1 shall develop and submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report that includes-- 7#a7 information on opioid1 non-opioid1 and non-pharmacologic pain management practices during pregnancy and after pregnancy2 7#b7 recommendations for increasing public awareness and education about substance use disorders1 including opioid use disorders1 during and after pregnancy1 including available treatment resources in urban and rural areas2 7#c7 recommendations to prevent1 identify1 and reduce substance use disorders1 including opioid use disorders1 during pregnancy to improve care for pregnant women with substance use disorders and their infants2 and 7#d7 an identification of areas in need of further research with respect to acute and chronic pain management during and after pregnancy4 7b7 ,no additional funds ,no additional funds are authorized to be appropriated for purposes of carrying out subsection 7a74 #gjfb4 ,protecting moms and infants 7a7 ,report 7#a7 ,in general ,not later than #fj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and make available to the public on the ,internet website of the ,department of ,health and ,human ,services1 a report regarding the implementation of the recommendations in the strategy relating to prenatal opioid use1 including neonatal abstinence syndrome1 developed pursuant to section #b of the ,protecting ,our ,infants ,act of #bjae 7,public ,law #aad-ia74 ,such report shall include-- 7,a7 an update on the implementation of the recommendations in the strategy1 including information regarding the agencies involved in the implementation2 and 7,b7 information on additional funding or authority the ,secretary requires1 if any1 to implement the strategy1 which may include authorities needed to coordinate implementation of such strategy across the ,department of ,health and ,human ,services4 7#b7 ,periodic updates ,the ,secretary shall periodically update the report under paragraph 7#a74 7b7 ,residential treatment programs for pregnant and postpartum women ,section #ejh7s7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;bb-#a7s77 is amended by striking #af1ijj1jjj for each of fiscal years #bjag through #bjba and inserting #bi1ica1jjj for each of fiscal years #bjai through #bjbc4 #gjfc4 ,early interventions for pregnant women and infants 7a7 ,development of educational materials by ,center for ,substance ,abuse ,prevention ,section #eae7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;bb-#ba7;b77 is amended-- 7#a7 in paragraph 7#ac71 by striking and at the end2 7#b7 in paragraph 7#ad71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7#ae7 in consultation with relevant stakeholders and in collaboration with the ,director of the ,centers for ,disease ,control and ,prevention1 develop educational materials for clinicians to use with pregnant women for shared decision making regarding pain management and the prevention of substance use disorders during pregnancy4 4 7b7 ,guidelines and recommendations by ,center for ,substance ,abuse ,treatment ,section #ejg7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;bb7b77 is amended-- 7#a7 in paragraph 7#ac71 by striking and at the end2 7#b7 in paragraph 7#ad71 by striking the period at the end and inserting a semicolon2 and 7#c7 by adding at the end the following3 7#ae7 in cooperation with the ,secretary1 implement and disseminate1 as appropriate1 the recommendations in the report entitled ,protecting ,our ,infants ,act3 ,final ,strategy issued by the ,department of ,health and ,human ,services in #bjag2 and 4 7c7 ,support of partnerships by ,center for ,substance ,abuse ,treatment ,section #ejg7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;bb7b771 as amended by subsection 7b71 is further amended by adding at the end the following3 7#af7 in cooperation with relevant stakeholders1 and through public-private partnerships1 encourage education about substance use disorders for pregnant women and health care providers who treat pregnant women and babies4 4 #gjfd4 ,prenatal and postnatal health ,section #cag,l of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ac7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by amending paragraph 7#a7 to read as follows3 7#a7 to collect1 analyze1 and make available data on prenatal smoking and alcohol and other substance abuse and misuse1 including-- 7,a7 data on-- 7i7 the incidence1 prevalence1 and implications of such activities2 and 7ii7 the incidence and prevalence of implications and outcomes1 including neonatal abstinence syndrome and other maternal and child health outcomes associated with such activities2 and 7,b7 additional information or data1 as appropriate1 on family health history1 medication exposures during pregnancy1 demographic information1 such as race1 ethnicity1 geographic location1 and family history1 and other relevant information1 to inform such analysis2 2 7,b7 in paragraph 7#b7-- 7i7 by striking prevention of and inserting prevention and long-term outcomes associated with2 and 7ii7 by striking illegal drug use and inserting other substance abuse and misuse2 7,c7 in paragraph 7#c71 by striking and cessation programs2 and and inserting 1 treatment1 and cessation programs22 7,d7 in paragraph 7#d71 by striking illegal drug use4 and inserting other substance abuse and misuse2 and2 and 7,e7 by adding at the end the following3 7#e7 to issue public reports on the analysis of data described in paragraph 7#a71 including analysis of-- 7,a7 long-term outcomes of children affected by neonatal abstinence syndrome2 7,b7 health outcomes associated with prenatal smoking1 alcohol1 and substance abuse and misuse2 and 7,c7 relevant studies1 evaluations1 or information the ,secretary determines to be appropriate4 2 7#b7 in subsection 7b71 by inserting tribal entities1 after local governments12 7#c7 by redesignating subsection 7c7 as subsection 7d72 7#d7 by inserting after subsection 7b7 the following3 7c7 ,coordinating activities ,to carry out this section1 the ,secretary may-- 7#a7 provide technical and consultative assistance to entities receiving grants under subsection 7b72 7#b7 ensure a pathway for data sharing between ,states1 tribal entities1 and the ,centers for ,disease ,control and ,prevention2 7#c7 ensure data collection under this section is consistent with applicable ,state1 ,federal1 and ,tribal privacy laws2 and 7#d7 coordinate with the ,national ,coordinator for ,health ,information ,technology1 as appropriate1 to assist ,states and ,tribes in implementing systems that use standards recognized by such ,national ,coordinator1 as such recognized standards are available1 in order to facilitate interoperability between such systems and health information technology systems1 including certified health information technology4 2 and 7#e7 in subsection 7d71 as so redesignated1 by striking #bjja through #bjje and inserting #bjai through #bjbc4 #gjfe4 ,plans of safe care 7a7 ,in general ,section #aje7;a7 of the ,child ,abuse ,prevention and ,treatment ,act 7#db ,u4,s4,c4 #eajf7;a77 is amended by adding at the end the following3 7#g7 ,grants to ,states to improve and coordinate their response to ensure the safety1 permanency1 and well-being of infants affected by substance use 7,a7 ,program authorized ,the ,secretary is authorized to make grants to ,states for the purpose of assisting child welfare agencies1 social services agencies1 substance use disorder treatment agencies1 hospitals with labor and delivery units1 medical staff1 public health and mental health agencies1 and maternal and child health agencies to facilitate collaboration in developing1 updating1 implementing1 and monitoring plans of safe care described in section #ajf7;b77#b77;,b77iii74 ,section #aab7;a77#b7 shall not apply to the program authorized under this paragraph4 7,b7 ,distribution of funds 7i7 ,reservations ,of the amounts made available to carry out subparagraph 7,a71 the ,secretary shall reserve-- 7,i7 no more than #c percent for the purposes described in subparagraph 7,g72 and 7,,ii7 up to #c percent for grants to ,indian ,tribes and tribal organizations to address the needs of infants born with1 and identified as being affected by1 substance abuse or withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder and their families or caregivers1 which to the extent practicable1 shall be consistent with the uses of funds described under subparagraph 7,d74 7ii7 ,allotments to ,states and territories ,the ,secretary shall allot the amount made available to carry out subparagraph 7,a7 that remains after application of clause 7i7 to each ,state that applies for such a grant1 in an amount equal to the sum of-- 7,i7 #ejj1jjj2 and 7,,ii7 an amount that bears the same relationship to any funds made available to carry out subparagraph 7,a7 and remaining after application of clause 7i71 as the number of live births in the ,state in the previous calendar year bears to the number of live births in all ,states in such year4 7iii7 ,ratable reduction ,if the amount made available to carry out subparagraph 7,a7 is insufficient to satisfy the requirements of clause 7ii71 the ,secretary shall ratably reduce each allotment to a ,state4 7,c7 ,application ,a ,state desiring a grant under this paragraph shall submit an application to the ,secretary at such time and in such manner as the ,secretary may require4 ,such application shall include-- 7i7 a description of-- 7,i7 the impact of substance use disorder in such ,state1 including with respect to the substance or class of substances with the highest incidence of abuse in the previous year in such ,state1 including-- 7aa7 the prevalence of substance use disorder in such ,state2 7bb7 the aggregate rate of births in the ,state of infants affected by substance abuse or withdrawal symptoms or a fetal alcohol spectrum disorder 7as determined by hospitals1 insurance claims1 claims submitted to the ,state ,medicaid program1 or other records71 if available and to the extent practicable2 and 7cc7 the number of infants identified1 for whom a plan of safe care was developed1 and for whom a referral was made for appropriate services1 as reported under section #ajf7;d77#ah72 7,,ii7 the challenges the ,state faces in developing1 implementing1 and monitoring plans of safe care in accordance with section #ajf7;b77#b77;,b77iii72 7,,iii7 the ,state's lead agency for the grant program and how that agency will coordinate with relevant ,state entities and programs1 including the child welfare agency1 the substance use disorder treatment agency1 hospitals with labor and delivery units1 health care providers1 the public health and mental health agencies1 programs funded by the ,substance ,abuse and ,mental ,health ,services ,administration that provide substance use disorder treatment for women1 the ,state ,medicaid program1 the ,state agency administering the block grant program under title ,v of the ,social ,security ,act 7#db ,u4,s4,c4 #gja et seq471 the ,state agency administering the programs funded under part ,c of the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adca et seq471 the maternal1 infant1 and early childhood home visiting program under section #eaa of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa71 the ,state judicial system1 and other agencies1 as determined by the ,secretary1 and ,indian ,tribes and tribal organizations1 as appropriate1 to implement the activities under this paragraph2 7,,iv7 how the ,state will monitor local development and implementation of plans of safe care1 in accordance with section #ajf7;b77#b77;,b77iii77,,ii71 including how the ,state will monitor to ensure plans of safe care address differences between substance use disorder and medically supervised substance use1 including for the treatment of a substance use disorder2 7,v7 if applicable1 how the ,state plans to utilize funding authorized under part ,e of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fgj et seq47 to assist in carrying out any plan of safe care1 including such funding authorized under section #dga7;e7 of such ,act 7as in effect on ,october #a1 #bjah7 for mental health and substance abuse prevention and treatment services and in-home parent skill-based programs and funding authorized under such section #dgb7;j7 7as in effect on ,october #a1 #bjah7 for children with a parent in a licensed residential family-based treatment facility for substance abuse2 and 7,,vi7 an assessment of the treatment and other services and programs available in the ,state to effectively carry out any plan of safe care developed1 including identification of needed treatment1 and other services and programs to ensure the well-being of young children and their families affected by substance use disorder1 such as programs carried out under part ,c of the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adca et seq47 and comprehensive early childhood development services and programs such as ,head ,start programs2 7ii7 a description of how the ,state plans to use funds for activities described in subparagraph 7,d7 for the purposes of ensuring ,state compliance with requirements under clauses 7ii7 and 7iii7 of section #ajf7;b77#b77;,b72 and 7iii7 an assurance that the ,state will comply with requirements to refer a child identified as substance-exposed to early intervention services as required pursuant to a grant under part ,c of the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adca et seq474 7,d7 ,uses of funds ,funds awarded to a ,state under this paragraph may be used for the following activities1 which may be carried out by the ,state directly1 or through grants or subgrants1 contracts1 or cooperative agreements3 7i7 ,improving ,state and local systems with respect to the development and implementation of plans of safe care1 which-- 7,i7 shall include parent and caregiver engagement1 as required under section #ajf7;b77#b77;,b77iii77,i71 regarding available treatment and service options1 which may include resources available for pregnant1 perinatal1 and postnatal women2 and 7,,ii7 may include activities such as-- 7aa7 developing policies1 procedures1 or protocols for the administration or development of evidence-based and validated screening tools for infants who may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder and pregnant1 perinatal1 and postnatal women whose infants may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder2 7bb7 improving assessments used to determine the needs of the infant and family2 7cc7 improving ongoing case management services2 7dd7 improving access to treatment services1 which may be prior to the pregnant woman's delivery date2 and 7ee7 keeping families safely together when it is in the best interest of the child4 7ii7 ,developing policies1 procedures1 or protocols in consultation and coordination with health professionals1 public and private health facilities1 and substance use disorder treatment agencies to ensure that-- 7,i7 appropriate notification to child protective services is made in a timely manner1 as required under section #ajf7;b77#b77;,b77ii72 7,,ii7 a plan of safe care is in place1 in accordance with section #ajf7;b77#b77;,b77iii71 before the infant is discharged from the birth or health care facility2 and 7,,iii7 such health and related agency professionals are trained on how to follow such protocols and are aware of the supports that may be provided under a plan of safe care4 7iii7 ,training health professionals and health system leaders1 child welfare workers1 substance use disorder treatment agencies1 and other related professionals such as home visiting agency staff and law enforcement in relevant topics including-- 7,i7 ,state mandatory reporting laws established under section #ajf7;b77#b77;,b77i7 and the referral and process requirements for notification to child protective services when child abuse or neglect reporting is not mandated2 7,,ii7 the co-occurrence of pregnancy and substance use disorder1 and implications of prenatal exposure2 7,,iii7 the clinical guidance about treating substance use disorder in pregnant and postpartum women2 7,,iv7 appropriate screening and interventions for infants affected by substance use disorder1 withdrawal symptoms1 or a fetal alcohol spectrum disorder and the requirements under section #ajf7;b77#b77;,b77iii72 and 7,v7 appropriate multigenerational strategies to address the mental health needs of the parent and child together4 7iv7 ,establishing partnerships1 agreements1 or memoranda of understanding between the lead agency and other entities 7including health professionals1 health facilities1 child welfare professionals1 juvenile and family court judges1 substance use and mental disorder treatment programs1 early childhood education programs1 maternal and child health and early intervention professionals 7including home visiting providers71 peer-to-peer recovery programs such as parent mentoring programs1 and housing agencies7 to facilitate the implementation of1 and compliance with1 section #ajf7;b77#b7 and clause 7ii7 of this subparagraph1 in areas which may include-- 7,i7 developing a comprehensive1 multi-disciplinary assessment and intervention process for infants1 pregnant women1 and their families who are affected by substance use disorder1 withdrawal symptoms1 or a fetal alcohol spectrum disorder1 that includes meaningful engagement with and takes into account the unique needs of each family and addresses differences between medically supervised substance use1 including for the treatment of substance use disorder1 and substance use disorder2 7,,ii7 ensuring that treatment approaches for serving infants1 pregnant women1 and perinatal and postnatal women whose infants may be affected by substance use1 withdrawal symptoms1 or a fetal alcohol spectrum disorder1 are designed to1 where appropriate1 keep infants with their mothers during both inpatient and outpatient treatment2 and 7,,iii7 increasing access to all evidence-based medication-assisted treatment approved by the ,food and ,drug ,administration1 behavioral therapy1 and counseling services for the treatment of substance use disorders1 as appropriate4 7v7 ,developing and updating systems of technology for improved data collection and monitoring under section #ajf7;b77#b77;,b77iii71 including existing electronic medical records1 to measure the outcomes achieved through the plans of safe care1 including monitoring systems to meet the requirements of this ,act and submission of performance measures4 7,e7 ,reporting ,each ,state that receives funds under this paragraph1 for each year such funds are received1 shall submit a report to the ,secretary1 disaggregated by geographic location1 economic status1 and major racial and ethnic groups1 except that such disaggregation shall not be required if the results would reveal personally identifiable information on1 with respect to infants identified under section #ajf7;b77#b77;,b77ii7-- 7i7 the number who experienced removal associated with parental substance use2 7ii7 the number who experienced removal and subsequently are reunified with parents1 and the length of time between such removal and reunification2 7iii7 the number who are referred to community providers without a child protection case2 7iv7 the number who receive services while in the care of their birth parents2 7v7 the number who receive post-reunification services within #a year after a reunification has occurred2 and 7vi7 the number who experienced a return to out-of-home care within #a year after reunification4 7,f7 ,secretary's report to ,congress ,the ,secretary shall submit an annual report to the ,committee on ,health1 ,education1 ,labor1 and ,pensions and the ,committee on ,appropriations of the ,senate and the ,committee on ,education and the ,workforce and the ,committee on ,appropriations of the ,house of ,representatives that includes the information described in subparagraph 7,e7 and recommendations or observations on the challenges1 successes1 and lessons derived from implementation of the grant program4 7,g7 ,assisting ,states' implementation ,the ,secretary shall use the amount reserved under subparagraph 7,b77i77,i7 to provide written guidance and technical assistance to support ,states in complying with and implementing this paragraph1 which shall include-- 7i7 technical assistance1 including programs of in-depth technical assistance1 to additional ,states1 territories1 and ,indian ,tribes and tribal organizations in accordance with the substance-exposed infant initiative developed by the ,national ,center on ,substance ,abuse and ,child ,welfare2 7ii7 guidance on the requirements of this ,act with respect to infants born with and identified as being affected by substance use or withdrawal symptoms or fetal alcohol spectrum disorder1 as described in clauses 7ii7 and 7iii7 of section #ajf7;b77#b77;,b71 including by-- 7,i7 enhancing ,states' understanding of requirements and flexibilities under the law1 including by clarifying key terms2 7,,ii7 addressing state-identified challenges with developing1 implementing1 and monitoring plans of safe care1 including those reported under subparagraph 7,c77i77,,ii72 7,,iii7 disseminating best practices on implementation of plans of safe care1 on such topics as differential response1 collaboration and coordination1 and identification and delivery of services for different populations1 while recognizing needs of different populations and varying community approaches across ,states2 and 7,,iv7 helping ,states improve the long-term safety and well-being of young children and their families2 7iii7 supporting ,state efforts to develop information technology systems to manage plans of safe care2 and 7iv7 preparing the ,secretary's report to ,congress described in subparagraph 7,f74 7,h7 ,sunset ,the authority under this paragraph shall sunset on ,september #cj1 #bjbc4 4 7b7 ,repeal ,the ,abandoned ,infants ,assistance ,act of #aihh 7#db ,u4,s4,c4 #eaag;aa et seq47 is repealed4 ,h ,substance ,use ,disorder ,treatment ,workforce #gjga4 ,loan repayment program for substance use disorder treatment workforce ,title ,,vii of the ,public ,health ,service ,act is amended-- 7#a7 by redesignating part ,f as part ,g2 and 7#b7 by inserting after part ,e 7#db ,u4,s4,c4 #bidn et seq47 the following3 ,f ,substance ,use ,disorder ,treatment ,workforce #gha4 ,loan repayment program for substance use disorder treatment workforce 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall carry out a program under which-- 7#a7 the ,secretary enters into agreements with individuals to make payments in accordance with subsection 7b7 on the principal of and interest on any eligible loan2 and 7#b7 the individuals each agree to the requirements of service in substance use disorder treatment employment1 as described in subsection 7d74 7b7 ,payments ,for each year of obligated service by an individual pursuant to an agreement under subsection 7a71 the ,secretary shall make a payment to such individual as follows3 7#a7 ,service in a shortage area ,the ,secretary shall pay-- 7,a7 for each year of obligated service by an individual pursuant to an agreement under subsection 7a71 #a_/f of the principal of and interest on each eligible loan of the individual which is outstanding on the date the individual began service pursuant to the agreement2 and 7,b7 for completion of the sixth and final year of such service1 the remainder of such principal and interest4 7#b7 ,maximum amount ,the total amount of payments under this section to any individual shall not exceed #bej1jjj4 7c7 ,eligible loans ,the loans eligible for repayment under this section are each of the following3 7#a7 ,any loan for education or training for a substance use disorder treatment employment4 7#b7 ,any loan under part ,e of title ,,viii 7relating to nursing student loans74 7#c7 ,any ,federal ,direct ,stafford ,loan1 ,federal ,direct ,,plus ,loan1 ,federal ,direct ,unsubsidized ,stafford ,loan1 or ,federal ,direct ,consolidation ,loan 7as such terms are used in section #dee of the ,higher ,education ,act of #aife74 7#d7 ,any ,federal ,perkins ,loan under part ,e of title ,i of the ,higher ,education ,act of #aife4 7#e7 ,any other ,federal loan as determined appropriate by the ,secretary4 7d7 ,requirements of service ,any individual receiving payments under this program as required by an agreement under subsection 7a7 shall agree to an annual commitment to full-time employment1 with no more than #a year passing between any #b years of covered employment1 in substance use disorder treatment employment in the ,united ,states in-- 7#a7 a ,mental ,health ,professional ,shortage ,area1 as designated under section #ccb2 or 7#b7 a county 7or a municipality1 if not contained within any county7 where the mean drug overdose death rate per #ajj1jjj people over the past #c years for which official data is available from the ,state1 is higher than the most recent available national average overdose death rate per #ajj1jjj people1 as reported by the ,centers for ,disease ,control and ,prevention4 7e7 ,ineligibility for double benefits ,no borrower may1 for the same service1 receive a reduction of loan obligations or a loan repayment under both-- 7#a7 this section2 and 7#b7 any ,federally supported loan forgiveness program1 including under section #cch;,b1 #cch;,i1 or #hdf of this ,act1 or section #dbh;,j1 #dbh,l1 #dee7m71 or #dfj of the ,higher ,education ,act of #aife4 7f7 ,breach 7#a7 ,liquidated damages formula ,the ,secretary may establish a liquidated damages formula to be used in the event of a breach of an agreement entered into under subsection 7a74 7#b7 ,limitation ,the failure by an individual to complete the full period of service obligated pursuant to such an agreement1 taken alone1 shall not constitute a breach of the agreement1 so long as the individual completed in good faith the years of service for which payments were made to the individual under this section4 7g7 ,additional criteria ,the ,secretary-- 7#a7 may establish such criteria and rules to carry out this section as the ,secretary determines are needed and in addition to the criteria and rules specified in this section2 and 7#b7 shall give notice to the committees specified in subsection 7h7 of any criteria and rules so established4 7h7 ,report to ,congress ,not later than #e years after the date of enactment of this section1 and every other year thereafter1 the ,secretary shall prepare and submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate a report on-- 7#a7 the number and location of borrowers who have qualified for loan repayments under this section2 and 7#b7 the impact of this section on the availability of substance use disorder treatment employees nationally and in shortage areas and counties described in subsection 7d74 7i7 ,definition ,in this section3 7#a7 ,the terms ,indian tribe and tribal organization have the meanings given those terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7#b7 ,the term municipality means a city1 town1 or other public body created by or pursuant to ,state law1 or an ,indian tribe4 7#c7 ,the term substance use disorder treatment employment means full-time employment 7including a fellowship7-- 7,a7 where the primary intent and function of the position is the direct treatment or recovery support of patients with or in recovery from a substance use disorder1 including master's level social workers1 psychologists1 counselors1 marriage and family therapists1 psychiatric mental health practitioners1 occupational therapists1 psychology doctoral interns1 and behavioral health paraprofessionals and physicians1 physician assistants1 and nurses1 who are licensed or certified in accordance with applicable ,state and ,federal laws2 and 7,b7 which is located at a substance use disorder treatment program1 private physician practice1 hospital or health system-affiliated inpatient treatment center or outpatient clinic 7including an academic medical center-affiliated treatment program71 correctional facility or program1 youth detention center or program1 inpatient psychiatric facility1 crisis stabilization unit1 community health center1 community mental health or other specialty community behavioral health center1 recovery center1 school1 community-based organization1 telehealth platform1 migrant health center1 health program or facility operated by an ,indian tribe or tribal organization1 ,federal medical facility1 or any other facility as determined appropriate for purposes of this section by the ,secretary4 7j7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #be1jjj1jjj for each of fiscal years #bjai through #bjbc4 4 #gjgb4 ,clarification regarding service in schools and other community-based settings ,subpart ,,iii of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl et seq47 is amended by adding at the end the following3 #cch,n4 ,clarification regarding service in schools and other community-based settings 7a7 ,schools and community-based settings ,an entity to which a participant in the ,scholarship ,program or the ,loan ,repayment ,program 7referred to in this section as a participant7 is assigned under section #ccc may direct such participant to provide service as a behavioral or mental health professional at a school or other community-based setting located in a health professional shortage area4 7b7 ,obligated service 7#a7 ,in general ,any service described in subsection 7a7 that a participant provides may count towards such participant's completion of any obligated service requirements under the ,scholarship ,program or the ,loan ,repayment ,program1 subject to any limitation imposed under paragraph 7#b74 7#b7 ,limitation ,the ,secretary may impose a limitation on the number of hours of service described in subsection 7a7 that a participant may credit towards completing obligated service requirements1 provided that the limitation allows a member to credit service described in subsection 7a7 for not less than #ej percent of the total hours required to complete such obligated service requirements4 7c7 ,rule of construction ,the authorization under subsection 7a7 shall be notwithstanding any other provision of this subpart or subpart ,,ii4 4 #gjgc4 ,programs for health care workforce 7a7 ,program for education and training in pain care ,section #gei of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bid;i7 is amended-- 7#a7 in subsection 7a71 by striking hospices1 and other public and private entities and inserting hospices1 tribal health programs 7as defined in section #d of the ,indian ,health ,care ,improvement ,act71 and other public and nonprofit private entities2 7#b7 in subsection 7b7-- 7,a7 in the matter preceding paragraph 7#a71 by striking award may be made under subsection 7a7 only if the applicant for the award agrees that the program carried out with the award will include and inserting entity receiving an award under this section shall develop a comprehensive education and training plan that includes2 7,b7 in paragraph 7#a7-- 7i7 by inserting preventing1 after diagnosing12 and 7ii7 by inserting non-addictive medical products and non-pharmacologic treatments and after including2 7,c7 in paragraph 7#b7-- 7i7 by inserting ,federal1 ,state1 and local after applicable2 and 7ii7 by striking the degree to which and all that follows through effective pain care and inserting opioids2 7,d7 in paragraph 7#c71 by inserting 1 integrated1 evidence-based pain management1 and1 as appropriate1 non-pharmacotherapy before the semicolon2 7,e7 in paragraph 7#d71 by striking 2 and and inserting 22 and 7,f7 by striking paragraph 7#e7 and inserting the following3 7#e7 recent findings1 developments1 and advancements in pain care research and the provision of pain care1 which may include non-addictive medical products and non-pharmacologic treatments intended to treat pain2 and 7#f7 the dangers of opioid abuse and misuse1 detection of early warning signs of opioid use disorders 7which may include best practices related to screening for opioid use disorders1 training on screening1 brief intervention1 and referral to treatment71 and safe disposal options for prescription medications 7including such options provided by law enforcement or other innovative deactivation mechanisms74 2 7#c7 in subsection 7d71 by inserting prevention1 after diagnosis12 and 7#d7 in subsection 7e71 by striking #bjaj through #bjab and inserting #bjai through #bjbc4 7b7 ,mental and behavioral health education and training program ,section #gef of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bid;e-#a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#a71 by inserting 1 trauma1 after focus on child and adolescent mental health2 and 7,b7 in paragraphs 7#b7 and 7#c71 by inserting trauma-informed care and before substance use disorder prevention and treatment services2 and 7#b7 in subsection 7f71 by striking #bjah through #bjbb and inserting #bjai through #bjbc4 ,i ,preventing ,overdoses ,while in ,emergency ,rooms #gjha4 ,program to support coordination and continuation of care for drug overdose patients 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall identify or facilitate the development of best practices for-- 7#a7 emergency treatment of known or suspected drug overdose2 7#b7 the use of recovery coaches1 as appropriate1 to encourage individuals who experience a non-fatal overdose to seek treatment for substance use disorder and to support coordination and continuation of care2 7#c7 coordination and continuation of care and treatment1 including1 as appropriate1 through referrals1 of individuals after a drug overdose2 and 7#d7 the provision or prescribing of overdose reversal medication1 as appropriate4 7b7 ,grant establishment and participation 7#a7 ,in general ,the ,secretary shall award grants on a competitive basis to eligible entities to support implementation of voluntary programs for care and treatment of individuals after a drug overdose1 as appropriate1 which may include implementation of the best practices described in subsection 7a74 7#b7 ,eligible entity ,in this section1 the term eligible entity means-- 7,a7 a ,state substance abuse agency2 7,b7 an ,indian ,tribe or tribal organization2 or 7,c7 an entity that offers treatment or other services for individuals in response to1 or following1 drug overdoses or a drug overdose1 such as an emergency department1 in consultation with a ,state substance abuse agency4 7#c7 ,application ,an eligible entity desiring a grant under this section shall submit an application to the ,secretary1 at such time and in such manner as the ,secretary may require1 that includes-- 7,a7 evidence that such eligible entity carries out1 or is capable of contracting and coordinating with other community entities to carry out1 the activities described in paragraph 7#d72 7,b7 evidence that such eligible entity will work with a recovery community organization to recruit1 train1 hire1 mentor1 and supervise recovery coaches and fulfill the requirements described in paragraph 7#d77;,a72 and 7,c7 such additional information as the ,secretary may require4 7#d7 ,use of grant funds ,an eligible entity awarded a grant under this section shall use such grant funds to-- 7,a7 hire or utilize recovery coaches to help support recovery1 including by-- 7i7 connecting patients to a continuum of care services1 such as-- 7,i7 treatment and recovery support programs2 7,,ii7 programs that provide non-clinical recovery support services2 7,,iii7 peer support networks2 7,,iv7 recovery community organizations2 7,v7 health care providers1 including physicians and other providers of behavioral health and primary care2 7,,vi7 education and training providers2 7,,vii7 employers2 7,,viii7 housing services2 and 7,,ix7 child welfare agencies2 7ii7 providing education on overdose prevention and overdose reversal to patients and families1 as appropriate2 7iii7 providing follow-up services for patients after an overdose to ensure continued recovery and connection to support services2 7iv7 collecting and evaluating outcome data for patients receiving recovery coaching services2 and 7v7 providing other services the ,secretary determines necessary to help ensure continued connection with recovery support services1 including culturally appropriate services1 as applicable2 7,b7 establish policies and procedures1 pursuant to ,federal and ,state law1 that address the provision of overdose reversal medication1 the administration of all drugs or devices approved or cleared under the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cja et seq47 and all biological products licensed under section #cea of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfb7 to treat substance use disorder1 and subsequent continuation of1 or referral to1 evidence-based treatment for patients with a substance use disorder who have experienced a non-fatal drug overdose1 in order to support long-term treatment1 prevent relapse1 and reduce recidivism and future overdose2 and 7,c7 establish integrated models of care for individuals who have experienced a non-fatal drug overdose which may include patient assessment1 follow up1 and transportation to and from treatment facilities4 7#e7 ,additional permissible uses ,in addition to the uses described in paragraph 7#d71 a grant awarded under this section may be used1 directly or through contractual arrangements1 to provide-- 7,a7 all drugs or devices approved or cleared under the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cja et seq47 and all biological products licensed under section #cea of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfb7 to treat substance use disorders or reverse overdose1 pursuant to ,federal and ,state law2 7,b7 withdrawal and detoxification services that include patient evaluation1 stabilization1 and preparation for treatment of substance use disorder1 including treatment described in subparagraph 7,a71 as appropriate2 or 7,c7 mental health services provided by a certified professional who is licensed and qualified by education1 training1 or experience to assess the psychosocial background of patients1 to contribute to the appropriate treatment plan for patients with substance use disorder1 and to monitor patient progress4 7#f7 ,preference ,in awarding grants under this section1 the ,secretary shall give preference to eligible entities that meet any or all of the following criteria3 7,a7 ,the eligible entity is a critical access hospital 7as defined in section #ahfa7mm77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7mm77#a7771 a low volume hospital 7as defined in section #ahhf7;d77#ab77;,c77i7 of such ,act 7#db ,u4,s4,c4 #acieww7d77#ab77;,c77i7771 a sole community hospital 7as defined in section #ahhf7;d77#e77;,d77iii7 of such ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,d77iii7771 or a hospital that receives disproportionate share hospital payments under section #ahhf7;d77#e77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f774 7,b7 ,the eligible entity is located in a ,state with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate1 as determined by the ,director of the ,centers for ,disease ,control and ,prevention1 or under the jurisdiction of an ,indian ,tribe with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate1 as determined through appropriate mechanisms as determined by the ,secretary in consultation with ,indian ,tribes4 7,c7 ,the eligible entity demonstrates that recovery coaches will be placed in both health care settings and community settings4 7#g7 ,period of grant ,a grant awarded to an eligible entity under this section shall be for a period of not more than #e years4 7c7 ,definitions ,in this section3 7#a7 ,indian ,tribe2 tribal organization ,the terms ,indian ,tribe and tribal organization have the meanings given the terms ,indian tribe and tribal organization in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#b7 ,recovery coach the term recovery coach means an individual-- 7,a7 with knowledge of1 or experience with1 recovery from a substance use disorder2 and 7,b7 who has completed training from1 and is determined to be in good standing by1 a recovery services organization capable of conducting such training and making such determination4 7#c7 ,recovery community organization ,the term recovery community organization has the meaning given such term in section #edg7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;ee-#b7;a774 7d7 ,reporting requirements 7#a7 ,reports by grantees ,each eligible entity awarded a grant under this section shall submit to the ,secretary an annual report for each year for which the entity has received such grant that includes information on-- 7,a7 the number of individuals treated by the entity for non-fatal overdoses1 including the number of non-fatal overdoses where overdose reversal medication was administered2 7,b7 the number of individuals administered medication-assisted treatment by the entity2 7,c7 the number of individuals referred by the entity to other treatment facilities after a non-fatal overdose1 the types of such other facilities1 and the number of such individuals admitted to such other facilities pursuant to such referrals2 and 7,d7 the frequency and number of patients with reoccurrences1 including readmissions for non-fatal overdoses and evidence of relapse related to substance use disorder4 7#b7 ,report by ,secretary ,not later than #e years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report that includes an evaluation of the effectiveness of the grant program carried out under this section with respect to long term health outcomes of the population of individuals who have experienced a drug overdose1 the percentage of patients treated or referred to treatment by grantees1 and the frequency and number of patients who experienced relapse1 were readmitted for treatment1 or experienced another overdose4 7e7 ,privacy ,the requirements of this section1 including with respect to data reporting and program oversight1 shall be subject to all applicable ,federal and ,state privacy laws4 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #aj1jjj1jjj for each of fiscal years #bjai through #bjbc4 ,j ,alternatives to ,opioids in the ,emergency ,department #gjia4 ,emergency department alternatives to opioids demonstration program 7a7 ,demonstration program grants 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall carry out a demonstration program for purposes of awarding grants to hospitals and emergency departments1 including freestanding emergency departments1 to develop1 implement1 enhance1 or study alternatives to opioids for pain management in such settings4 7#b7 ,eligibility ,to be eligible to receive a grant under paragraph 7#a71 a hospital or emergency department shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7#c7 ,geographic distribution ,in awarding grants under this section1 the ,secretary shall seek to ensure geographical distribution among grant recipients4 7#d7 ,use of funds ,grants under paragraph 7#a7 shall be used to-- 7,a7 target treatment approaches for painful conditions frequently treated in such settings2 7,b7 train providers and other hospital personnel on protocols or best practices related to the use and prescription of opioids and alternatives to opioids for pain management in the emergency department2 and 7,c7 develop or continue strategies to provide alternatives to opioids1 as appropriate4 7b7 ,additional demonstration program ,the ,secretary may carry out a demonstration program similar to the program under subsection 7a7 for other acute care settings4 7c7 ,consultation ,the ,secretary shall implement a process for recipients of grants under subsection 7a7 or 7b7 to share evidence-based and best practices and promote consultation with persons having robust knowledge1 including emergency departments and physicians that have successfully implemented programs that use alternatives to opioids for pain management1 as appropriate1 such as approaches studied through the ,national ,center for ,complimentary and ,integrative ,health or other institutes and centers at the ,national ,institutes of ,health1 as appropriate4 ,the ,secretary shall offer to each recipient of a grant under subsection 7a7 or 7b7 technical assistance as necessary4 7d7 ,technical assistance ,the ,secretary shall identify or facilitate the development of best practices on alternatives to opioids for pain management and provide technical assistance to hospitals and other acute care settings on alternatives to opioids for pain management4 ,the technical assistance provided shall be for the purpose of-- 7#a7 utilizing information from recipients of a grant under subsection 7a7 or 7b7 that have successfully implemented alternatives to opioids programs2 7#b7 identifying or facilitating the development of best practices on the use of alternatives to opioids1 which may include pain-management strategies that involve non-addictive medical products1 non-pharmacologic treatments1 and technologies or techniques to identify patients at risk for opioid use disorder2 7#c7 identifying or facilitating the development of best practices on the use of alternatives to opioids that target common painful conditions and include certain patient populations1 such as geriatric patients1 pregnant women1 and children2 and 7#d7 disseminating information on the use of alternatives to opioids to providers in acute care settings1 which may include emergency departments1 outpatient clinics1 critical access hospitals1 ,federally qualified health centers1 ,indian ,health ,service health facilities1 and tribal hospitals4 7e7 ,report to the ,secretary ,each recipient of a grant under this section shall submit to the ,secretary 7during the period of such grant7 annual reports on the progress of the program funded through the grant4 ,these reports shall include1 in accordance with all applicable ,state and ,federal privacy laws-- 7#a7 a description of and specific information about the opioid alternative pain management programs1 including the demographic characteristics of patients who were treated with an alternative pain management protocol1 implemented in hospitals1 emergency departments1 and other acute care settings2 7#b7 data on the opioid alternative pain management strategies used1 including the number of opioid prescriptions written-- 7,a7 during a baseline period before the program began2 or 7,b7 at various stages of the program2 and 7#c7 data on patients who were eventually prescribed opioids after alternative pain management protocols and treatments were utilized2 and 7#d7 any other information the ,secretary determines appropriate4 7f7 ,report to ,congress ,not later than #a year after completion of the demonstration program under this section1 the ,secretary shall submit a report to the ,congress on the results of the demonstration program and include in the report-- 7#a7 the number of applications received and the number funded2 7#b7 a summary of the reports described in subsection 7e71 including data that allows for comparison of programs2 and 7#c7 recommendations for broader implementation of pain management strategies that encourage the use of alternatives to opioids in hospitals1 emergency departments1 or other acute care settings4 7g7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjai through #bjba4 ,k ,treatment1 ,education1 and ,community ,help ,to ,combat ,addiction #gaja4 ,establishment of regional centers of excellence in substance use disorder education ,part ,d of title ,v of the ,public ,health ,service ,act1 as amended by section #gjca1 is further amended by adding at the end the following new section3 #eea4 ,regional centers of excellence in substance use disorder education 7a7 ,in general ,the ,secretary1 in consultation with appropriate agencies1 shall award cooperative agreements to eligible entities for the designation of such entities as ,regional ,centers of ,excellence in ,substance ,use ,disorder ,education for purposes of improving health professional training resources with respect to substance use disorder prevention1 treatment1 and recovery4 7b7 ,eligibility ,to be eligible to receive a cooperative agreement under subsection 7a71 an entity shall-- 7#a7 be an accredited entity that offers education to students in various health professions1 which may include-- 7,a7 a teaching hospital2 7,b7 a medical school2 7,c7 a certified behavioral health clinic2 or 7,d7 any other health professions school1 school of public health1 or ,cooperative ,extension ,program at institutions of higher education1 as defined in section #aja of the ,higher ,education ,act of #aife1 engaged in the prevention1 treatment1 or recovery of substance use disorders2 7#b7 demonstrate community engagement and partnerships with community stakeholders1 including entities that train health professionals1 mental health counselors1 social workers1 peer recovery specialists1 substance use treatment programs1 community health centers1 physician offices1 certified behavioral health clinics1 research institutions1 and law enforcement2 and 7#c7 submit to the ,secretary an application containing such information1 at such time1 and in such manner1 as the ,secretary may require4 7c7 ,activities ,an entity receiving an award under this section shall develop1 evaluate1 and distribute evidence-based resources regarding the prevention and treatment of1 and recovery from1 substance use disorders4 ,such resources may include information on-- 7#a7 the neurology and pathology of substance use disorders2 7#b7 advancements in the treatment of substance use disorders2 7#c7 techniques and best practices to support recovery from substance use disorders2 7#d7 strategies for the prevention and treatment of1 and recovery from substance use disorders across patient populations2 and 7#e7 other topic areas that are relevant to the objectives described in subsection 7a74 7d7 ,geographic distribution ,in awarding cooperative agreements under subsection 7a71 the ,secretary shall take into account regional differences among eligible entities and shall make an effort to ensure geographic distribution4 7e7 ,evaluation ,the ,secretary shall evaluate each project carried out by an entity receiving an award under this section and shall disseminate the findings with respect to each such evaluation to appropriate public and private entities4 7f7 ,funding ,there is authorized to be appropriated to carry out this section1 #d1jjj1jjj for each of fiscal years #bjai through #bjbc4 4 #gajb4 ,youth prevention and recovery 7a7 ,substance abuse treatment services for children1 adolescents1 and young adults ,section #ead of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;bb-#g7 is amended-- 7#a7 in the section heading1 by striking children and adolescents and inserting children1 adolescents1 and young adults2 7#b7 in subsection 7a77#b71 by striking children1 including and inserting children1 adolescents1 and young adults1 including2 and 7#c7 by striking children and adolescents each place it appears and inserting children1 adolescents1 and young adults4 7b7 ,resource center ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary1 except as otherwise provided71 in consultation with the ,secretary of ,education and other heads of agencies1 including the ,assistant ,secretary for ,mental ,health and ,substance ,use and the ,administrator of the ,health ,resources and ,services ,administration1 as appropriate1 shall establish a resource center to provide technical support to recipients of grants under subsection 7c74 7c7 ,youth prevention and recovery initiative 7#a7 ,in general ,the ,secretary1 in consultation with the ,secretary of ,education1 shall administer a program to provide support for communities to support the prevention of1 treatment of1 and recovery from1 substance use disorders for children1 adolescents1 and young adults4 7#b7 ,definitions ,in this subsection3 7,a7 ,eligible entity ,the term eligible entity means-- 7i7 a local educational agency that is seeking to establish or expand substance use prevention or recovery support services at one or more high schools2 7ii7 a ,state educational agency2 7iii7 an institution of higher education 7or consortia of such institutions71 which may include a recovery program at an institution of higher education2 7iv7 a local board or one-stop operator2 7v7 a nonprofit organization with appropriate expertise in providing services or programs for children1 adolescents1 or young adults1 excluding a school2 7vi7 a ,state1 political subdivision of a ,state1 ,indian tribe1 or tribal organization2 or 7vii7 a high school or dormitory serving high school students that receives funding from the ,bureau of ,indian ,education4 7,b7 ,foster care ,the term foster care has the meaning given such term in section #acee4bj7;a7 of title #de1 ,code of ,federal ,regulations 7or any successor regulations74 7,c7 ,high school ,the term high school has the meaning given such term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7,d7 ,homeless youth ,the term homeless youth has the meaning given the term homeless children or youths in section #gbe of the ,mc,kinney-,vento ,homeless ,assistance ,act 7#db ,u4,s4,c4 #aadcd;a74 7,e7 ,indian tribe2 tribal organization ,the terms ,indian tribe and tribal organization have the meanings given such terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7,f7 ,institution of higher education ,the term institution of higher education has the meaning given such term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja7 and includes a postsecondary vocational institution as defined in section #ajb7;c7 of such ,act 7#bj ,u4,s4,c4 #ajjb7;c774 7,g7 ,local educational agency ,the term local educational agency has the meaning given such term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7,h7 ,local board2 one-stop operator ,the terms local board and one-stop operator have the meanings given such terms in section #c of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb74 7,i7 ,out-of-school youth ,the term out-of-school youth has the meaning given such term in section #abi7;a77#a77;,b7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cafd7;a77#a77;,b774 7,j7 ,recovery program ,the term recovery program means a program-- 7i7 to help children1 adolescents1 or young adults who are recovering from substance use disorders to initiate1 stabilize1 and maintain healthy and productive lives in the community2 and 7ii7 that includes peer-to-peer support delivered by individuals with lived experience in recovery1 and communal activities to build recovery skills and supportive social networks4 7,k7 ,state educational agency ,the term ,state educational agency has the meaning given such term in section #haja of the ,elementary and ,secondary ,education ,act 7#bj ,u4,s4,c4 #ghja74 7#c7 ,best practices ,the ,secretary1 in consultation with the ,secretary of ,education1 shall-- 7,a7 identify or facilitate the development of evidence-based best practices for prevention of substance misuse and abuse by children1 adolescents1 and young adults1 including for specific populations such as youth in foster care1 homeless youth1 out-of-school youth1 and youth who are at risk of or have experienced trafficking that address-- 7i7 primary prevention2 7ii7 appropriate recovery support services2 7iii7 appropriate use of medication-assisted treatment for such individuals1 if applicable1 and ways of overcoming barriers to the use of medication-assisted treatment in such population2 and 7iv7 efficient and effective communication1 which may include the use of social media1 to maximize outreach efforts2 7,b7 disseminate such best practices to ,state educational agencies1 local educational agencies1 schools and dormitories funded by the ,bureau of ,indian ,education1 institutions of higher education1 recovery programs at institutions of higher education1 local boards1 one-stop operators1 family and youth homeless providers1 and nonprofit organizations1 as appropriate2 7,c7 conduct a rigorous evaluation of each grant funded under this subsection1 particularly its impact on the indicators described in paragraph 7#g77;,b72 and 7,d7 provide technical assistance for grantees under this subsection4 7#d7 ,grants authorized ,the ,secretary1 in consultation with the ,secretary of ,education1 shall award #c-year grants1 on a competitive basis1 to eligible entities to enable such entities1 in coordination with ,indian tribes1 if applicable1 and ,state agencies responsible for carrying out substance use disorder prevention and treatment programs1 to carry out evidence-based programs for-- 7,a7 prevention of substance misuse and abuse by children1 adolescents1 and young adults1 which may include primary prevention2 7,b7 recovery support services for children1 adolescents1 and young adults1 which may include counseling1 job training1 linkages to community-based services1 family support groups1 peer mentoring1 and recovery coaching2 or 7,c7 treatment or referrals for treatment of substance use disorders1 which may include the use of medication-assisted treatment1 as appropriate4 7#e7 ,special consideration ,in awarding grants under this subsection1 the ,secretary shall give special consideration to the unique needs of tribal1 urban1 suburban1 and rural populations4 7#f7 ,application ,to be eligible for a grant under this subsection1 an entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 ,such application shall include-- 7,a7 a description of-- 7i7 the impact of substance use disorders in the population that will be served by the grant program2 7ii7 how the eligible entity has solicited input from relevant stakeholders1 which may include faculty1 teachers1 staff1 families1 students1 and experts in substance use disorder prevention1 treatment1 and recovery in developing such application2 7iii7 the goals of the proposed project1 including the intended outcomes2 7iv7 how the eligible entity plans to use grant funds for evidence-based activities1 in accordance with this subsection to prevent1 provide recovery support for1 or treat substance use disorders amongst such individuals1 or a combination of such activities2 and 7v7 how the eligible entity will collaborate with relevant partners1 which may include ,state educational agencies1 local educational agencies1 institutions of higher education1 juvenile justice agencies1 prevention and recovery support providers1 local service providers1 including substance use disorder treatment programs1 providers of mental health services1 youth serving organizations1 family and youth homeless providers1 child welfare agencies1 and primary care providers1 in carrying out the grant program2 and 7,b7 an assurance that the eligible entity will participate in the evaluation described in paragraph 7#c77;,c74 7#g7 ,reports to the ,secretary ,each eligible entity awarded a grant under this subsection shall submit to the ,secretary a report at such time and in such manner as the ,secretary may require4 ,such report shall include-- 7,a7 a description of how the eligible entity used grant funds1 in accordance with this subsection1 including the number of children1 adolescents1 and young adults reached through programming2 and 7,b7 a description1 including relevant data1 of how the grant program has made an impact on the intended outcomes described in paragraph 7#f77;,a77iii71 including-- 7i7 indicators of student success1 which1 if the eligible entity is an educational institution1 shall include student well-being and academic achievement2 7ii7 substance use disorders amongst children1 adolescents1 and young adults1 including the number of overdoses and deaths amongst children1 adolescents1 and young adults served by the grant during the grant period2 and 7iii7 other indicators1 as the ,secretary determines appropriate4 7#h7 ,report to ,congress ,the ,secretary shall1 not later than ,october #a1 #bjbb1 submit a report to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce and the ,committee on ,education and the ,workforce of the ,house of ,representatives a report summarizing the effectiveness of the grant program under this subsection1 based on the information submitted in reports required under paragraph 7#g74 7#i7 ,authorization of appropriations ,there is authorized to be appropriated #aj1jjj1jjj to carry out this subsection for each of fiscal years #bjai through #bjbc4 ,l ,information from ,national ,mental ,health and ,substance ,use ,policy ,laboratory #gaaa4 ,information from ,national ,mental ,health and ,substance ,use ,policy ,laboratory ,section #eja;,a7b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;aa-#j7;b77 is amended-- 7#a7 in paragraph 7#e77;,c71 by striking 2 and at the end and inserting a semicolon2 7#b7 by redesignating paragraph 7#f7 as paragraph 7#g72 and 7#c7 by inserting after paragraph 7#e7 the following3 7#f7 issue and periodically update information for entities applying for grants or cooperative agreements from the ,substance ,abuse and ,mental ,health ,services ,administration in order to-- 7,a7 encourage the implementation and replication of evidence-based practices2 and 7,b7 provide technical assistance to applicants for funding1 including with respect to justifications for such programs and activities2 and 4 ,m ,comprehensive ,opioid ,recovery ,centers #gaba4 ,comprehensive opioid recovery centers 7a7 ,in general ,part ,d of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd et seq471 as amended by sections #gjca and #gaja1 is further amended by adding at the end the following new section3 #eeb4 ,comprehensive opioid recovery centers 7a7 ,in general ,the ,secretary shall award grants on a competitive basis to eligible entities to establish or operate a comprehensive opioid recovery center 7referred to in this section as a ,center74 ,a ,center may be a single entity or an integrated delivery network4 7b7 ,grant period 7#a7 ,in general ,a grant awarded under subsection 7a7 shall be for a period of not less than #c years and not more than #e years4 7#b7 ,renewal ,a grant awarded under subsection 7a7 may be renewed1 on a competitive basis1 for additional periods of time1 as determined by the ,secretary4 ,in determining whether to renew a grant under this paragraph1 the ,secretary shall consider the data submitted under subsection 7h74 7c7 ,minimum number of ,centers ,the ,secretary shall allocate the amounts made available under subsection 7j7 such that not fewer than #aj grants may be awarded4 ,not more than one grant shall be made to entities in a single ,state for any one period4 7d7 ,application 7#a7 ,eligible entity ,an entity is eligible for a grant under this section if the entity offers treatment and other services for individuals with a substance use disorder4 7#b7 ,submission of application ,in order to be eligible for a grant under subsection 7a71 an entity shall submit an application to the ,secretary at such time and in such manner as the ,secretary may require4 ,such application shall include-- 7,a7 evidence that such entity carries out1 or is capable of coordinating with other entities to carry out1 the activities described in subsection 7g72 and 7,b7 such other information as the ,secretary may require4 7e7 ,priority ,in awarding grants under subsection 7a71 the ,secretary shall give priority to eligible entities-- 7#a7 located in a ,state with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate1 as determined by the ,director of the ,centers for ,disease ,control and ,prevention2 or 7#b7 serving an ,indian ,tribe 7as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act7 with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate1 as determined through appropriate mechanisms determined by the ,secretary in consultation with ,indian ,tribes4 7f7 ,preference ,in awarding grants under subsection 7a71 the ,secretary may give preference to eligible entities utilizing technology-enabled collaborative learning and capacity building models1 including such models as defined in section #b of the ,expanding ,capacity for ,health ,outcomes ,act 7,public ,law #aad-bgj2 #acj ,stat4 #acie71 to conduct the activities described in this section4 7g7 ,center activities ,each ,center shall1 at a minimum1 carry out the following activities directly1 through referral1 or through contractual arrangements1 which may include carrying out such activities through technology-enabled collaborative learning and capacity building models described in subsection 7f73 7#a7 ,treatment and recovery services ,each ,center shall-- 7,a7 ,ensure that intake1 evaluations1 and periodic patient assessments meet the individualized clinical needs of patients1 including by reviewing patient placement in treatment settings to support meaningful recovery4 7,b7 ,provide the full continuum of treatment services1 including-- 7i7 all drugs and devices approved or cleared under the ,federal ,food1 ,drug1 and ,cosmetic ,act and all biological products licensed under section #cea of this ,act to treat substance use disorders or reverse overdoses1 pursuant to ,federal and ,state law2 7ii7 medically supervised withdrawal management1 that includes patient evaluation1 stabilization1 and readiness for and entry into treatment2 7iii7 counseling provided by a program counselor or other certified professional who is licensed and qualified by education1 training1 or experience to assess the psychological and sociological background of patients1 to contribute to the appropriate treatment plan for the patient1 and to monitor patient progress2 7iv7 treatment1 as appropriate1 for patients with co-occurring substance use and mental disorders2 7v7 testing1 as appropriate1 for infections commonly associated with illicit drug use2 7vi7 residential rehabilitation1 and outpatient and intensive outpatient programs2 7vii7 recovery housing2 7viii7 community-based and peer recovery support services2 7ix7 job training1 job placement assistance1 and continuing education assistance to support reintegration into the workforce2 and 7x7 other best practices to provide the full continuum of treatment and services1 as determined by the ,secretary4 7,c7 ,ensure that all programs covered by the ,center include medication-assisted treatment1 as appropriate1 and do not exclude individuals receiving medication-assisted treatment from any service4 7,d7 ,periodically conduct patient assessments to support sustained and clinically significant recovery1 as defined by the ,assistant ,secretary for ,mental ,health and ,substance ,use4 7,e7 ,provide onsite access to medication1 as appropriate1 and toxicology services2 for purposes of carrying out this section4 7,f7 ,operate a secure1 confidential1 and interoperable electronic health information system4 7,g7 ,offer family support services such as child care1 family counseling1 and parenting interventions to help stabilize families impacted by substance use disorder1 as appropriate4 7#b7 ,outreach ,each ,center shall carry out outreach activities regarding the services offered through the ,centers1 which may include-- 7,a7 training and supervising outreach staff1 as appropriate1 to work with ,state and local health departments1 health care providers1 the ,indian ,health ,service1 ,state and local educational agencies1 schools funded by the ,indian ,bureau of ,education1 institutions of higher education1 ,state and local workforce development boards1 ,state and local community action agencies1 public safety officials1 first responders1 ,indian ,tribes1 child welfare agencies1 as appropriate1 and other community partners and the public1 including patients1 to identify and respond to community needs2 7,b7 ensuring that the entities described in subparagraph 7,a7 are aware of the services of the ,center2 and 7,c7 disseminating and making publicly available1 including through the internet1 evidence-based resources that educate professionals and the public on opioid use disorder and other substance use disorders1 including co-occurring substance use and mental disorders4 7h7 ,data reporting and program oversight ,with respect to a grant awarded under subsection 7a71 not later than #ij days after the end of the first year of the grant period1 and annually thereafter for the duration of the grant period 7including the duration of any renewal period for such grant71 the entity shall submit data1 as appropriate1 to the ,secretary regarding-- 7#a7 the programs and activities funded by the grant2 7#b7 health outcomes of the population of individuals with a substance use disorder who received services from the ,center1 evaluated by an independent program evaluator through the use of outcomes measures1 as determined by the ,secretary2 7#c7 the retention rate of program participants2 and 7#d7 any other information that the ,secretary may require for the purpose of--ensuring that the ,center is complying with all the requirements of the grant1 including providing the full continuum of services described in subsection 7g77#a77;,b74 7i7 ,privacy ,the provisions of this section1 including with respect to data reporting and program oversight1 shall be subject to all applicable ,federal and ,state privacy laws4 7j7 ,authorization of appropriations ,there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjai through #bjbc for purposes of carrying out this section4 4 7b7 ,reports to ,congress 7#a7 ,preliminary report ,not later than #c years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit to ,congress a preliminary report that analyzes data submitted under section #eeb7;h7 of the ,public ,health ,service ,act1 as added by subsection 7a74 7#b7 ,final report ,not later than #b years after submitting the preliminary report required under paragraph 7#a71 the ,secretary of ,health and ,human ,services shall submit to ,congress a final report that includes-- 7,a7 an evaluation of the effectiveness of the comprehensive services provided by the ,centers established or operated pursuant to section #eeb of the ,public ,health ,service ,act1 as added by subsection 7a71 with respect to health outcomes of the population of individuals with substance use disorder who receive services from the ,center1 which shall include an evaluation of the effectiveness of services for treatment and recovery support and to reduce relapse1 recidivism1 and overdose2 and 7,b7 recommendations1 as appropriate1 regarding ways to improve ,federal programs related to substance use disorders1 which may include dissemination of best practices for the treatment of substance use disorders to health care professionals4 ,n ,trauma-,informed ,care #gaca4 ,,cdc surveillance and data collection for child1 youth1 and adult trauma 7a7 ,data collection ,the ,director of the ,centers for ,disease ,control and ,prevention 7referred to in this section as the ,director7 may1 in cooperation with the ,states1 collect and report data on adverse childhood experiences through the ,behavioral ,risk ,factor ,surveillance ,system1 the ,youth ,risk ,behavior ,surveillance ,system1 and other relevant public health surveys or questionnaires4 7b7 ,timing ,the collection of data under subsection 7a7 may occur biennially4 7c7 ,data from rural areas ,the ,director shall encourage each ,state that participates in collecting and reporting data under subsection 7a7 to collect and report data from rural areas within such ,state1 in order to generate a statistically reliable representation of such areas4 7d7 ,data from tribal areas ,the ,director may1 in cooperation with ,indian ,tribes 7as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act7 and pursuant to a written request from an ,indian ,tribe1 provide technical assistance to such ,indian ,tribe to collect and report data on adverse childhood experiences through the ,behavioral ,risk ,factor ,surveillance ,system1 the ,youth ,risk ,behavior ,surveillance ,system1 or another relevant public health survey or questionnaire4 7e7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #b1jjj1jjj for each of fiscal years #bjai through #bjbc4 #gacb4 ,task force to develop best practices for trauma-informed identification1 referral1 and support 7a7 ,establishment ,there is established a task force1 to be known as the ,interagency ,task ,force on ,trauma-,informed ,care 7in this section referred to as the task force7 that shall identify1 evaluate1 and make recommendations regarding-- 7#a7 best practices with respect to children and youth1 and their families as appropriate1 who have experienced or are at risk of experiencing trauma2 and 7#b7 ways in which ,federal agencies can better coordinate to improve the ,federal response to families impacted by substance use disorders and other forms of trauma4 7b7 ,membership 7#a7 ,composition ,the task force shall be composed of the heads of the following ,federal departments and agencies1 or their designees3 7,a7 ,the ,centers for ,medicare ,medicaid ,services4 7,b7 ,the ,substance ,abuse and ,mental ,health ,services ,administration4 7,c7 ,the ,agency for ,healthcare ,research and ,quality4 7,d7 ,the ,centers for ,disease ,control and ,prevention4 7,e7 ,the ,indian ,health ,service4 7,f7 ,the ,department of ,veterans ,affairs4 7,g7 ,the ,national ,institutes of ,health4 7,h7 ,the ,food and ,drug ,administration4 7,i7 ,the ,health ,resources and ,services ,administration4 7,j7 ,the ,department of ,defense4 7,k7 ,the ,office of ,minority ,health of the ,department of ,health and ,human ,services4 7,l7 ,the ,administration for ,children and ,families4 7,m7 ,the ,office of the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services4 7,n7 ,the ,office for ,civil ,rights of the ,department of ,health and ,human ,services4 7,o7 ,the ,office of ,juvenile ,justice and ,delinquency ,prevention of the ,department of ,justice4 7,p7 ,the ,office of ,community ,oriented ,policing ,services of the ,department of ,justice4 7,q7 ,the ,office on ,violence ,against ,women of the ,department of ,justice4 7,r7 ,the ,national ,center for ,education ,evaluation and ,regional ,assistance of the ,department of ,education4 7,s7 ,the ,national ,center for ,special ,education ,research of the ,institute of ,education ,science4 7,t7 ,the ,office of ,elementary and ,secondary ,education of the ,department of ,education4 7,u7 ,the ,office for ,civil ,rights of the ,department of ,education4 7,v7 ,the ,office of ,special ,education and ,rehabilitative ,services of the ,department of ,education4 7,w7 ,the ,bureau of ,indian ,affairs of the ,department of the ,interior4 7,x7 ,the ,veterans ,health ,administration of the ,department of ,veterans ,affairs4 7,y7 ,the ,office of ,special ,needs ,assistance ,programs of the ,department of ,housing and ,urban ,development4 7,z7 ,the ,office of ,head ,start of the ,administration for ,children and ,families4 7,,aa7 ,the ,children's ,bureau of the ,administration for ,children and ,families4 7,,bb7 ,the ,bureau of ,indian ,education of the ,department of the ,interior4 7,,cc7 ,such other ,federal agencies as the ,secretaries determine to be appropriate4 7#b7 ,date of appointments ,the heads of ,federal departments and agencies shall appoint the corresponding members of the task force not later than #fj days after the date of enactment of this ,act4 7#c7 ,chairperson ,the task force shall be chaired by the ,assistant ,secretary for ,mental ,health and ,substance ,use1 or the ,assistant ,secretary's designee4 7c7 ,task force duties ,the task force shall-- 7#a7 solicit input from stakeholders1 including frontline service providers1 educators1 mental health professionals1 researchers1 experts in infant1 child1 and youth trauma1 child welfare professionals1 and the public1 in order to inform the activities under paragraph 7#b72 and 7#b7 identify1 evaluate1 make recommendations1 and update such recommendations not less than annually1 to the general public1 the ,secretary of ,education1 the ,secretary of ,health and ,human ,services1 the ,secretary of ,labor1 the ,secretary of the ,interior1 the ,attorney ,general1 and other relevant cabinet ,secretaries1 and ,congress regarding-- 7,a7 a set of evidence-based1 evidence-informed1 and promising best practices with respect to-- 7i7 prevention strategies for individuals at risk of experiencing or being exposed to trauma1 including trauma as a result of exposure to substance use2 7ii7 the identification of infants1 children and youth1 and their families as appropriate1 who have experienced or are at risk of experiencing trauma2 7iii7 the expeditious referral to and implementation of trauma-informed practices and supports that prevent and mitigate the effects of trauma1 which may include whole-family and multi-generational approaches2 and 7iv7 community based or multi-generational practices that support children and their families2 7,b7 a national strategy on how the task force and member agencies will collaborate1 prioritize options for1 and implement a coordinated approach1 which may include-- 7i7 data sharing2 7ii7 providing support to infants1 children1 and youth1 and their families as appropriate1 who have experienced or are at risk of experiencing trauma2 7iii7 identifying options for coordinating existing grants that support infants1 children1 and youth1 and their families as appropriate1 who have experienced1 or are at risk of experiencing1 exposure to substance use or other trauma1 including trauma related to substance use2 and 7iv7 other ways to improve coordination1 planning1 and communication within and across ,federal agencies1 offices1 and programs1 to better serve children and families impacted by substance use disorders2 and 7,c7 existing ,federal authorities at the ,department of ,education1 ,department of ,health and ,human ,services1 ,department of ,justice1 ,department of ,labor1 ,department of the ,interior1 and other relevant agencies1 and specific ,federal grant programs to disseminate best practices on1 provide training in1 or deliver services through1 trauma-informed practices1 and disseminate such information-- 7i7 in writing to relevant program offices at such agencies to encourage grant applicants in writing to use such funds1 where appropriate1 for trauma-informed practices2 and 7ii7 to the general public through the internet website of the task force4 7d7 ,best practices ,in identifying1 evaluating1 and recommending the set of best practices under subsection 7c71 the task force shall-- 7#a7 include guidelines for providing professional development and education for front-line services providers1 including school personnel1 early childhood education program providers1 providers from child- or youth-serving organizations1 housing and homeless providers1 primary and behavioral health care providers1 child welfare and social services providers1 juvenile and family court personnel1 health care providers1 individuals who are mandatory reporters of child abuse or neglect1 trained nonclinical providers 7including peer mentors and clergy71 and first responders1 in-- 7,a7 understanding and identifying early signs and risk factors of trauma in infants1 children1 and youth1 and their families as appropriate1 including through screening processes and services2 7,b7 providing practices to prevent and mitigate the impact of trauma1 including by fostering safe and stable environments and relationships2 and 7,c7 developing and implementing policies1 procedures1 or systems that-- 7i7 are designed to quickly refer infants1 children1 youth1 and their families as appropriate1 who have experienced or are at risk of experiencing trauma to the appropriate trauma-informed screening and support and age-appropriate treatment1 and to ensure such infants1 children1 youth1 and family members receive such support2 7ii7 utilize and develop partnerships with early childhood education programs1 local social services organizations1 such as organizations serving youth1 and clinical mental health or other health care providers with expertise in providing support services and age-appropriate trauma-informed and evidence-based treatment aimed at preventing or mitigating the effects of trauma2 7iii7 educate children and youth to-- 7,i7 understand and identify the signs1 effects1 or symptoms of trauma2 and 7,,ii7 build the resilience and coping skills to mitigate the effects of experiencing trauma2 7iv7 promote and support multi-generational practices that assist parents1 foster parents1 and kinship and other caregivers in accessing resources related to1 and developing environments conducive to1 the prevention and mitigation of trauma2 and 7v7 collect and utilize data from screenings1 referrals1 or the provision of services and supports to evaluate outcomes and improve processes for trauma-informed services and supports that are culturally sensitive1 linguistically appropriate1 and specific to age ranges and sex1 as applicable2 7#b7 recommend best practices that are designed to avoid unwarranted custody loss or criminal penalties for parents or guardians in connection with infants1 children1 and youth who have experienced or are at risk of experiencing trauma2 and 7#c7 recommend opportunities for local- and ,state-level partnerships that-- 7,a7 are designed to quickly identify and refer children and families1 as appropriate1 who have experienced or are at risk of experiencing exposure to trauma1 including related to substance use2 7,b7 utilize and develop partnerships with early childhood education programs1 local social services organizations1 and health care services aimed at preventing or mitigating the effects of exposure to trauma1 including related to substance use2 7,c7 offer community-based prevention activities1 including educating families and children on the effects of exposure to trauma1 such as trauma related to substance use1 and how to build resilience and coping skills to mitigate those effects2 7,d7 in accordance with ,federal privacy protections1 utilize non-personally-identifiable data from screenings1 referrals1 or the provision of services and supports to evaluate and improve processes addressing exposure to trauma1 including related to substance use2 and 7,e7 are designed to prevent separation and support reunification of families if in the best interest of the child4 7e7 ,operating plan ,not later than #abj days after the date of enactment of this ,act1 the task force shall hold the first meeting4 ,not later than #b years after such date of enactment1 the task force shall submit to the ,secretary of ,education1 ,secretary of ,health and ,human ,services1 ,secretary of ,labor1 ,secretary of the ,interior1 the ,attorney ,general1 and ,congress an operating plan for carrying out the activities of the task force described in subsection 7c77#b74 ,such operating plan shall include-- 7#a7 a list of specific activities that the task force plans to carry out for purposes of carrying out duties described in subsection 7c77#b71 which may include public engagement2 7#b7 a plan for carrying out the activities under subsection 7c77#b72 7#c7 a list of members of the task force and other individuals who are not members of the task force that may be consulted to carry out such activities2 7#d7 an explanation of ,federal agency involvement and coordination needed to carry out such activities1 including any statutory or regulatory barriers to such coordination2 7#e7 a budget for carrying out such activities2 7#f7 a proposed timeline for implementing recommendations and efforts identified under subsection 7c72 and 7#g7 other information that the task force determines appropriate as related to its duties4 7f7 ,final report ,not later than #c years after the date of the first meeting of the task force1 the task force shall submit to the general public1 ,secretary of ,education1 ,secretary of ,health and ,human ,services1 ,secretary of ,labor1 ,secretary of the ,interior1 the ,attorney ,general1 other relevant cabinet ,secretaries1 the ,committee on ,energy and ,commerce and the ,committee on ,education and the ,workforce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 and ,congress1 a final report containing all of the findings and recommendations required under this section1 and shall make such report available online in an accessible format4 7g7 ,additional reports ,in addition to the final report under subsection 7f74 the task force shall submit-- 7#a7 a report to ,congress identifying any recommendations identified under subsection 7c7 that require additional legislative authority to implement2 and 7#b7 a report to the ,governors describing the opportunities for local- and ,state-level partnerships1 professional development1 or best practices recommended under subsection 7d77#c74 7h7 ,definitions ,in this section-- 7#a7 the term early childhood education program has the meaning given such term in section #ajc of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajjc72 7#b7 ,the term ,governor means the chief executive officer of a ,state2 and 7#c7 the term ,state means each of the several ,states1 the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico1 the ,virgin ,islands1 ,guam1 ,american ,samoa1 and the ,commonwealth of the ,northern ,mariana ,islands4 7i7 ,sunset ,the task force shall sunset on the date that is #fj days after the submission of the final report under subsection 7f71 but not later than ,september #cj1 #bjbc4 #gacc4 ,national ,child ,traumatic ,stress ,initiative ,section #ehb7;j7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;hh-#a7;j77 7relating to grants to address the problems of persons who experience violence-related stress7 is amended by striking #df1hhg1jjj for each of fiscal years #bjah through #bjbb and inserting #fc1hhg1jjj for each of fiscal years #bjai through #bjbc4 #gacd4 ,grants to improve trauma support services and mental health care for children and youth in educational settings 7a7 ,grants1 contracts1 and cooperative agreements authorized ,the ,secretary1 in coordination with the ,assistant ,secretary for ,mental ,health and ,substance ,use1 is authorized to award grants to1 or enter into contracts or cooperative agreements with1 ,state educational agencies1 local educational agencies1 ,indian ,tribes 7as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act7 or their tribal educational agencies1 a school operated by the ,bureau of ,indian ,education1 a ,regional ,corporation1 or a ,native ,hawaiian educational organization1 for the purpose of increasing student access to evidence-based trauma support services and mental health care by developing innovative initiatives1 activities1 or programs to link local school systems with local trauma-informed support and mental health systems1 including those under the ,indian ,health ,service4 7b7 ,duration ,with respect to a grant1 contract1 or cooperative agreement awarded or entered into under this section1 the period during which payments under such grant1 contract or agreement are made to the recipient may not exceed #d years4 7c7 ,use of funds ,an entity that receives a grant1 contract1 or cooperative agreement under this section shall use amounts made available through such grant1 contract1 or cooperative agreement for evidence-based activities1 which shall include any of the following3 7#a7 ,collaborative efforts between school-based service systems and trauma-informed support and mental health service systems to provide1 develop1 or improve prevention1 screening1 referral1 and treatment and support services to students1 such as providing trauma screenings to identify students in need of specialized support4 7#b7 ,to implement schoolwide positive behavioral interventions and supports1 or other trauma-informed models of support4 7#c7 ,to provide professional development to teachers1 teacher assistants1 school leaders1 specialized instructional support personnel1 and mental health professionals that-- 7,a7 fosters safe and stable learning environments that prevent and mitigate the effects of trauma1 including through social and emotional learning2 7,b7 improves school capacity to identify1 refer1 and provide services to students in need of trauma support or behavioral health services2 or 7,c7 reflects the best practices for trauma-informed identification1 referral1 and support developed by the ,task ,force under section #gacb4 7#d7 ,services at a full-service community school that focuses on trauma-informed supports1 which may include a full-time site coordinator1 or other activities consistent with section #dfbe of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #gbge74 7#e7 ,engaging families and communities in efforts to increase awareness of child and youth trauma1 which may include sharing best practices with law enforcement regarding trauma-informed care and working with mental health professionals to provide interventions1 as well as longer term coordinated care within the community for children and youth who have experienced trauma and their families4 7#f7 ,to provide technical assistance to school systems and mental health agencies4 7#g7 ,to evaluate the effectiveness of the program carried out under this section in increasing student access to evidence-based trauma support services and mental health care4 7#h7 ,to establish partnerships with or provide subgrants to ,head ,start agencies 7including ,early ,head ,start agencies71 public and private preschool programs1 child care programs 7including home-based providers71 or other entities described in subsection 7a71 to include such entities described in this paragraph in the evidence-based trauma initiatives1 activities1 support services1 and mental health systems established under this section in order to provide1 develop1 or improve prevention1 screening1 referral1 and treatment and support services to young children and their families4 7d7 ,applications ,to be eligible to receive a grant1 contract1 or cooperative agreement under this section1 an entity described in subsection 7a7 shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may reasonably require1 which shall include the following3 7#a7 ,a description of the innovative initiatives1 activities1 or programs to be funded under the grant1 contract1 or cooperative agreement1 including how such program will increase access to evidence-based trauma support services and mental health care for students1 and1 as applicable1 the families of such students4 7#b7 ,a description of how the program will provide linguistically appropriate and culturally competent services4 7#c7 ,a description of how the program will support students and the school in improving the school climate in order to support an environment conducive to learning4 7#d7 ,an assurance that-- 7,a7 persons providing services under the grant1 contract1 or cooperative agreement are adequately trained to provide such services2 and 7,b7 teachers1 school leaders1 administrators1 specialized instructional support personnel1 representatives of local ,indian ,tribes or tribal organizations as appropriate1 other school personnel1 and parents or guardians of students participating in services under this section will be engaged and involved in the design and implementation of the services4 7#e7 ,a description of how the applicant will support and integrate existing school-based services with the program in order to provide mental health services for students1 as appropriate4 7#f7 ,a description of the entities in the community with which the applicant will partner or to which the applicant will provide subgrants in accordance with subsection 7c77#h74 7e7 ,interagency agreements 7#a7 ,local interagency agreements ,to ensure the provision of the services described in subsection 7c71 a recipient of a grant1 contract1 or cooperative agreement under this section1 or their designee1 shall establish a local interagency agreement among local educational agencies1 agencies responsible for early childhood education programs1 ,head ,start agencies 7including ,early ,head ,start agencies71 juvenile justice authorities1 mental health agencies1 child welfare agencies1 and other relevant agencies1 authorities1 or entities in the community that will be involved in the provision of such services4 7#b7 ,contents ,in ensuring the provision of the services described in subsection 7c71 the local interagency agreement shall specify with respect to each agency1 authority1 or entity that is a party to such agreement-- 7,a7 the financial responsibility for the services2 7,b7 the conditions and terms of responsibility for the services1 including quality1 accountability1 and coordination of the services2 and 7,c7 the conditions and terms of reimbursement among such agencies1 authorities1 or entities1 including procedures for dispute resolution4 7f7 ,evaluation ,the ,secretary shall reserve not more than #c percent of the funds made available under subsection 7l7 for each fiscal year to-- 7#a7 conduct a rigorous1 independent evaluation of the activities funded under this section2 and 7#b7 disseminate and promote the utilization of evidence-based practices regarding trauma support services and mental health care4 7g7 ,distribution of awards ,the ,secretary shall ensure that grants1 contracts1 and cooperative agreements awarded or entered into under this section are equitably distributed among the geographical regions of the ,united ,states and among tribal1 urban1 suburban1 and rural populations4 7h7 ,rule of construction ,nothing in this section shall be construed-- 7#a7 to prohibit an entity involved with a program carried out under this section from reporting a crime that is committed by a student to appropriate authorities2 or 7#b7 to prevent ,federal1 ,state1 and tribal law enforcement and judicial authorities from exercising their responsibilities with regard to the application of ,federal1 tribal1 and ,state law to crimes committed by a student4 7i7 ,supplement1 not supplant ,any services provided through programs carried out under this section shall supplement1 and not supplant1 existing mental health services1 including any special education and related services provided under the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adjj et seq474 7j7 ,consultation with ,indian ,tribes ,in carrying out subsection 7a71 the ,secretary shall1 in a timely manner1 meaningfully consult with ,indian ,tribes and their representatives to ensure notice of eligibility4 7k7 ,definitions ,in this section3 7#a7 ,elementary school ,the term elementary school has the meaning given such term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#b7 ,evidence-based ,the term evidence-based has the meaning given such term in section #haja7ba77;,a77i7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja7ba77;,a77i774 7#c7 ,native ,hawaiian educational organization ,the term ,native ,hawaiian educational organization has the meaning given such term in section #fbjg of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #geag74 7#d7 ,local educational agency ,the term local educational agency has the meaning given such term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#e7 ,regional ,corporation ,the term ,regional ,corporation has the meaning given the term in section #c of the ,alaska ,native ,claims ,settlement ,act 7#dc ,u4,s4,c4 #afjb774 7#f7 ,school ,the term school means a public elementary school or public secondary school4 7#g7 ,school leader ,the term school leader has the meaning given such term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#h7 ,secondary school ,the term secondary school has the meaning given such term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#i7 ,secretary ,the term ,secretary means the ,secretary of ,education4 7#aj7 ,specialized instructional support personnel ,the term specialized instructional support personnel has the meaning given such term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#aa7 ,state educational agency ,the term ,state educational agency has the meaning given such term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7l7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #ej1jjj1jjj for each of fiscal years #bjai through #bjbc4 #gace4 ,recognizing early childhood trauma related to substance abuse 7a7 ,dissemination of information ,the ,secretary of ,health and ,human ,services shall disseminate information1 resources1 and1 if requested1 technical assistance to early childhood care and education providers and professionals working with young children on-- 7#a7 ways to properly recognize children who may be impacted by trauma1 including trauma related to substance use by a family member or other adult2 and 7#b7 how to respond appropriately in order to provide for the safety and well-being of young children and their families4 7b7 ,goals ,the information1 resources1 and technical assistance provided under subsection 7a7 shall-- 7#a7 educate early childhood care and education providers and professionals working with young children on understanding and identifying the early signs and risk factors of children who might be impacted by trauma1 including trauma due to exposure to substance use2 7#b7 suggest age-appropriate communication tools1 procedures1 and practices for trauma-informed care1 including ways to prevent or mitigate the effects of trauma2 7#c7 provide options for responding to children impacted by trauma1 including due to exposure to substance use1 that consider the needs of the child and family1 including recommending resources and referrals for evidence-based services to support such family2 and 7#d7 promote whole-family and multi-generational approaches to keep families safely together when it is in the best interest of the child4 7c7 ,coordination ,the ,secretary of ,health and ,human ,services shall coordinate with the task force to develop best practices for trauma-informed identification1 referral1 and support authorized under section #gacb in disseminating the information1 resources1 and technical assistance described under subsection 7b74 7d7 ,rule of construction ,such information1 resources1 and if applicable1 technical assistance1 shall not be construed to amend the requirements under-- 7#a7 the ,child ,care and ,development ,block ,grant ,act of #aiij 7#db ,u4,s4,c4 #iheh et seq472 7#b7 the ,head ,start ,act 7#db ,u4,s4,c4 #ihca et seq472 or 7#c7 the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adjj et seq474 ,o ,eliminating ,opioid ,related ,infectious ,diseases #gada4 ,reauthorization and expansion of program of surveillance and education regarding infections associated with illicit drug use and other risk factors ,section #cag,n of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ae7 is amended to read as follows3 #cag,n4 ,surveillance and education regarding infections associated with illicit drug use and other risk factors 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may 7directly or through grants to public and nonprofit private entities7 provide for programs for the following3 7#a7 ,to cooperate with ,states and ,indian tribes in implementing or maintaining a national system to determine the incidence of infections commonly associated with illicit drug use1 such as viral hepatitis1 human immunodeficiency virus1 and infective endocarditis1 and to assist the ,states in determining the prevalence of such infections1 which may include the reporting of cases of such infections4 7#b7 ,to identify1 counsel1 and offer testing to individuals who are at risk of infections described in paragraph 7#a7 resulting from illicit drug use1 receiving blood transfusions prior to ,july #aiib1 or other risk factors4 7#c7 ,to provide appropriate referrals for counseling1 testing1 and medical treatment of individuals identified under paragraph 7#b7 and to ensure1 to the extent practicable1 the provision of appropriate follow-up services4 7#d7 ,to develop and disseminate public information and education programs for the detection and control of infections described in paragraph 7#a71 with priority given to high-risk populations as determined by the ,secretary4 7#e7 ,to improve the education1 training1 and skills of health professionals in the detection and control of infections described in paragraph 7#a71 including to improve coordination of treatment of substance use disorders and infectious diseases1 with priority given to substance use disorder treatment providers1 pediatricians and other primary care providers1 obstetrician-gynecologists1 and infectious disease clinicians1 including ,,hiv clinicians4 7b7 ,laboratory procedures ,the ,secretary may 7directly or through grants to public and nonprofit private entities7 carry out programs to provide for improvements in the quality of clinical-laboratory procedures regarding infections described in subsection 7a77#a74 7c7 ,definition ,in this section1 the term ,indian tribe has the meaning given that term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7d7 ,authorization of appropriations ,for the purpose of carrying out this section1 there are authorized to be appropriated #dj1jjj1jjj for each of the fiscal years #bjai through #bjbc4 4 ,p ,peer ,support ,communities of ,recovery #gaea4 ,building communities of recovery ,section #edg of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;ee-#b7 is amended to read as follows3 #edg4 ,building communities of recovery 7a7 ,definition ,in this section1 the term recovery community organization means an independent nonprofit organization that-- 7#a7 mobilizes resources within and outside of the recovery community1 which may include through a peer support network1 to increase the prevalence and quality of long-term recovery from substance use disorders2 and 7#b7 is wholly or principally governed by people in recovery for substance use disorders who reflect the community served4 7b7 ,grants authorized ,the ,secretary shall award grants to recovery community organizations to enable such organizations to develop1 expand1 and enhance recovery services4 7c7 ,federal share ,the ,federal share of the costs of a program funded by a grant under this section may not exceed #he percent4 7d7 ,use of funds ,grants awarded under subsection 7b7-- 7#a7 shall be used to develop1 expand1 and enhance community and statewide recovery support services2 and 7#b7 may be used to-- 7,a7 build connections between recovery networks1 including between recovery community organizations and peer support networks1 and with other recovery support services1 including-- 7i7 behavioral health providers2 7ii7 primary care providers and physicians2 7iii7 educational and vocational schools2 7iv7 employers2 7v7 housing services2 7vi7 child welfare agencies2 and 7vii7 other recovery support services that facilitate recovery from substance use disorders1 including non-clinical community services2 7,b7 reduce stigma associated with substance use disorders2 and 7,c7 conduct outreach on issues relating to substance use disorders and recovery1 including-- 7i7 identifying the signs of substance use disorder2 7ii7 the resources available to individuals with substance use disorder and to families of an individual with a substance use disorder1 including programs that mentor and provide support services to children2 7iii7 the resources available to help support individuals in recovery2 and 7iv7 related medical outcomes of substance use disorders1 the potential of acquiring an infection commonly associated with illicit drug use1 and neonatal abstinence syndrome among infants exposed to opioids during pregnancy4 7e7 ,special consideration ,in carrying out this section1 the ,secretary shall give special consideration to the unique needs of rural areas1 including areas with an age-adjusted rate of drug overdose deaths that is above the national average and areas with a shortage of prevention and treatment services4 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #e1jjj1jjj for each of fiscal years #bjai through #bjbc4 4 #gaeb4 ,peer support technical assistance center ,title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd et seq47 is amended by inserting after section #edg the following3 #edg;,a4 ,peer support technical assistance center 7a7 ,establishment ,the ,secretary1 acting through the ,assistant ,secretary1 shall establish or operate a ,national ,peer-,run ,training and ,technical ,assistance ,center for ,addiction ,recovery ,support 7referred to in this section as the ,center74 7b7 ,functions ,the ,center established under subsection 7a7 shall provide technical assistance and support to recovery community organizations and peer support networks1 including such assistance and support related to-- 7#a7 training on identifying-- 7,a7 signs of substance use disorder2 7,b7 resources to assist individuals with a substance use disorder1 or resources for families of an individual with a substance use disorder2 and 7,c7 best practices for the delivery of recovery support services2 7#b7 the provision of translation services1 interpretation1 or other such services for clients with limited ,english speaking proficiency2 7#c7 data collection to support research1 including for translational research2 7#d7 capacity building2 and 7#e7 evaluation and improvement1 as necessary1 of the effectiveness of such services provided by recovery community organizations4 7c7 ,best practices ,the ,center established under subsection 7a7 shall periodically issue best practices for use by recovery community organizations and peer support networks4 7d7 ,recovery community organization ,in this section1 the term recovery community organization has the meaning given such term in section #edg4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #a1jjj1jjj for each of fiscal years #bjai through #bjbc4 4 ,q ,creating ,opportunities that ,necessitate ,new and ,enhanced ,connections ,that ,improve ,opioid ,navigation ,strategies #gafa4 ,preventing overdoses of controlled substances 7a7 ,in general ,part ,j of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;b et seq47 is amended by inserting after section #cib 7#db ,u4,s4,c4 #bhj;b-#a7 the following3 #cib;,a4 ,preventing overdoses of controlled substances 7a7 ,evidence-,based prevention grants 7#a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention may-- 7,a7 to the extent practicable1 carry out and expand any evidence-based prevention activities described in paragraph 7#b72 7,b7 provide training and technical assistance to ,states1 localities1 and ,indian tribes for purposes of carrying out such activity2 and 7,c7 award grants to ,states1 localities1 and ,indian tribes for purposes of carrying out such activity4 7#b7 ,evidence-based prevention activities ,an evidence-based prevention activity described in this paragraph is any of the following activities3 7,a7 ,improving the efficiency and use of a new or currently operating prescription drug monitoring program1 including by-- 7i7 encouraging all authorized users 7as specified by the ,state or other entity7 to register with and use the program2 7ii7 enabling such users to access any updates to information collected by the program in as close to real-time as possible2 7iii7 improving the ease of use of such program2 7iv7 providing for a mechanism for the program to notify authorized users of any potential misuse or abuse of controlled substances and any detection of inappropriate prescribing or dispensing practices relating to such substances2 7v7 encouraging the analysis of prescription drug monitoring data for purposes of providing de-identified1 aggregate reports based on such analysis to ,state public health agencies1 ,state substance abuse agencies1 ,state licensing boards1 and other appropriate ,state agencies1 as permitted under applicable ,federal and ,state law and the policies of the prescription drug monitoring program and not containing any protected health information1 to prevent inappropriate prescribing1 drug diversion1 or abuse and misuse of controlled substances1 and to facilitate better coordination among agencies2 7vi7 enhancing interoperability between the program and any health information technology 7including certified health information technology71 including by integrating program data into such technology2 7vii7 updating program capabilities to respond to technological innovation for purposes of appropriately addressing the occurrence and evolution of controlled substance overdoses2 7viii7 facilitating and encouraging data exchange between the program and the prescription drug monitoring programs of other ,states2 7ix7 enhancing data collection and quality1 including improving patient matching and proactively monitoring data quality2 7x7 providing prescriber and dispenser practice tools1 including prescriber practice insight reports for practitioners to review their prescribing patterns in comparison to such patterns of other practitioners in the specialty2 and 7xi7 meeting the purpose of the program established under section #cii,o1 as described in section #cii,o7a74 7,b7 ,promoting community or health system interventions4 7,c7 ,evaluating interventions to prevent controlled substance overdoses4 7,d7 ,implementing projects to advance an innovative prevention approach with respect to new and emerging public health crises and opportunities to address such crises1 such as enhancing public education and awareness on the risks associated with opioids4 7#c7 ,additional grants ,the ,director may award grants to ,states1 localities1 and ,indian ,tribes-- 7,a7 to carry out innovative projects for grantees to rapidly respond to controlled substance misuse1 abuse1 and overdoses1 including changes in patterns of controlled substance use2 and 7,b7 for any other evidence-based activity for preventing controlled substance misuse1 abuse1 and overdoses as the ,director determines appropriate4 7#d7 ,research ,the ,director1 in coordination with the ,assistant ,secretary for ,mental ,health and ,substance ,use and the ,national ,mental ,health and ,substance ,use ,policy ,laboratory established under section #eja;,a1 as appropriate and applicable1 may conduct studies and evaluations to address substance use disorders1 including preventing substance use disorders or other related topics the ,director determines appropriate4 7b7 ,enhanced controlled substance overdose data collection1 analysis1 and dissemination grants 7#a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention may-- 7,a7 to the extent practicable1 carry out any controlled substance overdose data collection activities described in paragraph 7#b72 7,b7 provide training and technical assistance to ,states1 localities1 and ,indian tribes for purposes of carrying out such activity2 7,c7 award grants to ,states1 localities1 and ,indian tribes for purposes of carrying out such activity2 and 7,d7 coordinate with the ,assistant ,secretary for ,mental ,health and ,substance ,use to collect data pursuant to section #eje7;d77#a77;,a7 7relating to the number of individuals admitted to emergency departments as a result of the abuse of alcohol or other drugs74 7#b7 ,controlled substance overdose data collection and analysis activities ,a controlled substance overdose data collection1 analysis1 and dissemination activity described in this paragraph is any of the following activities3 7,a7 ,improving the timeliness of reporting data to the public1 including data on fatal and nonfatal overdoses of controlled substances4 7,b7 ,enhancing the comprehensiveness of controlled substance overdose data by collecting information on such overdoses from appropriate sources such as toxicology reports1 autopsy reports1 death scene investigations1 and emergency departments4 7,c7 ,modernizing the system for coding causes of death related to controlled substance overdoses to use an electronic-based system4 7,d7 ,using data to help identify risk factors associated with controlled substance overdoses4 7,e7 ,supporting entities involved in providing information on controlled substance overdoses1 such as coroners1 medical examiners1 and public health laboratories to improve accurate testing and standardized reporting of causes and contributing factors to controlled substances overdoses and analysis of various opioid analogues to controlled substance overdoses4 7,f7 ,working to enable and encourage the access1 exchange1 and use of information regarding controlled substance overdoses among data sources and entities4 7c7 ,definitions ,in this section3 7#a7 ,controlled substance ,the term controlled substance has the meaning given that term in section #ajb of the ,controlled ,substances ,act4 7#b7 ,indian tribe ,the term ,indian tribe has the meaning given that term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7d7 ,authorization of appropriations ,for purposes of carrying out this section1 section #cii,o of this ,act1 and section #ajb of the ,comprehensive ,addiction and ,recovery ,act of #bjaf 7,public ,law #aad-aih71 there is authorized to be appropriated #dif1jjj1jjj for each of fiscal years #bjai through #bjbc4 4 7b7 ,education and awareness ,section #ajb of the ,comprehensive ,addiction and ,recovery ,act of #bjaf 7,public ,law #aad-aih7 is amended-- 7#a7 by amending subsection 7a7 to read as follows3 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention and in coordination with the heads of other departments and agencies1 shall advance education and awareness regarding the risks related to misuse and abuse of opioids1 as appropriate1 which may include developing or improving existing programs1 conducting activities1 and awarding grants that advance the education and awareness of-- 7#a7 the public1 including patients and consumers-- 7,a7 generally2 and 7,b7 regarding such risks related to unused opioids and the dispensing options under section #cji7;f7 of the ,controlled ,substances ,act1 as applicable2 and 7#b7 providers1 which may include-- 7,a7 providing for continuing education on appropriate prescribing practices2 7,b7 education related to applicable ,state or local prescriber limit laws1 information on the use of non-addictive alternatives for pain management1 and the use of overdose reversal drugs1 as appropriate2 7,c7 disseminating and improving the use of evidence-based opioid prescribing guidelines across relevant health care settings1 as appropriate1 and updating guidelines as necessary2 7,d7 implementing strategies1 such as best practices1 to encourage and facilitate the use of prescriber guidelines1 in accordance with ,state and local law2 7,e7 disseminating information to providers about prescribing options for controlled substances1 including such options under section #cji7;f7 of the ,controlled ,substances ,act1 as applicable2 and 7,f7 disseminating information1 as appropriate1 on the ,national ,pain ,strategy developed by or in consultation with the ,assistant ,secretary for ,health2 and 7#c7 other appropriate entities4 2 and 7#b7 in subsection 7b7-- 7,a7 by striking opioid abuse each place such term appears and inserting opioid misuse and abuse2 and 7,b7 in paragraph 7#b71 by striking safe disposal of prescription medications and other and inserting non-addictive treatment options1 safe disposal options for prescription medications1 and other applicable4 #gafb4 ,prescription drug monitoring program ,section #cii,o of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g-#c7 is amended to read as follows3 #cii,o4 ,prescription drug monitoring program 7a7 ,program 7#a7 ,in general ,each fiscal year1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 in coordination with the heads of other departments and agencies as appropriate1 shall support ,states or localities for the purpose of improving the efficiency and use of ,p,d,m,ps1 including-- 7,a7 establishment and implementation of a ,,pdmp2 7,b7 maintenance of a ,,pdmp2 7,c7 improvements to a ,,pdmp by-- 7i7 enhancing functional components to work toward-- 7,i7 universal use of ,p,d,m,ps among providers and their delegates1 to the extent that ,state laws allow2 7,,ii7 more timely inclusion of data within a ,,pdmp2 7,,iii7 active management of the ,,pdmp1 in part by sending proactive or unsolicited reports to providers to inform prescribing2 and 7,,iv7 ensuring the highest level of ease in use of and access to ,p,d,m,ps by providers and their delegates1 to the extent that ,state laws allow2 7ii7 in consultation with the ,office of the ,national ,coordinator for ,health ,information ,technology1 improving the intrastate interoperability of ,p,d,m,ps by-- 7,i7 making ,p,d,m,ps more actionable by integrating ,p,d,m,ps within electronic health records and health information technology infrastructure2 and 7,,ii7 linking ,,pdmp data to other data systems within the ,state1 including-- 7aa7 the data of pharmacy benefit managers1 medical examiners and coroners1 and the ,state's ,medicaid program2 7bb7 worker's compensation data2 and 7cc7 prescribing data of providers of the ,department of ,veterans ,affairs and the ,indian ,health ,service within the ,state2 7iii7 in consultation with the ,office of the ,national ,coordinator for ,health ,information ,technology1 improving the interstate interoperability of ,p,d,m,ps through-- 7,i7 sharing of dispensing data in near-real time across ,state lines2 and 7,,ii7 integration of automated queries for multistate ,,pdmp data and analytics into clinical workflow to improve the use of such data and analytics by practitioners and dispensers2 or 7iv7 improving the ability to include treatment availability resources and referral capabilities within the ,,pdmp4 7#b7 ,legislation ,as a condition on the receipt of support under this section1 the ,secretary shall require a ,state or locality to demonstrate that it has enacted legislation or regulations-- 7,a7 to provide for the implementation of the ,,pdmp2 and 7,b7 to permit the imposition of appropriate penalties for the unauthorized use and disclosure of information maintained by the ,,pdmp4 7b7 ,,pdmp strategies ,the ,secretary shall encourage a ,state or locality1 in establishing1 improving1 or maintaining a ,,pdmp1 to implement strategies that improve-- 7#a7 the reporting of dispensing in the ,state or locality of a controlled substance to an ultimate user so the reporting occurs not later than #bd hours after the dispensing event2 7#b7 the consultation of the ,,pdmp by each prescribing practitioner1 or their designee1 in the ,state or locality before initiating treatment with a controlled substance1 or any substance as required by the ,state to be reported to the ,,pdmp1 and over the course of ongoing treatment for each prescribing event2 7#c7 the consultation of the ,,pdmp before dispensing a controlled substance1 or any substance as required by the ,state to be reported to the ,,pdmp2 7#d7 the proactive notification to a practitioner when patterns indicative of controlled substance misuse by a patient1 including opioid misuse1 are detected2 7#e7 the availability of data in the ,,pdmp to other ,states1 as allowable under ,state law2 and 7#f7 the availability of nonidentifiable information to the ,centers for ,disease ,control and ,prevention for surveillance1 epidemiology1 statistical research1 or educational purposes4 7c7 ,drug misuse and abuse ,in consultation with practitioners1 dispensers1 and other relevant and interested stakeholders1 a ,state receiving support under this section-- 7#a7 shall establish a program to notify practitioners and dispensers of information that will help to identify and prevent the unlawful diversion or misuse of controlled substances2 7#b7 may1 to the extent permitted under ,state law1 notify the appropriate authorities responsible for carrying out drug diversion investigations if the ,state determines that information in the ,,pdmp maintained by the ,state indicates an unlawful diversion or abuse of a controlled substance2 7#c7 may conduct analyses of controlled substance program data for purposes of providing appropriate ,state agencies with aggregate reports based on such analyses in as close to real-time as practicable1 regarding prescription patterns flagged as potentially presenting a risk of misuse1 abuse1 addiction1 overdose1 and other aggregate information1 as appropriate and in compliance with applicable ,federal and ,state laws and provided that such reports shall not include protected health information2 and 7#d7 may access information about prescriptions1 such as claims data1 to ensure that such prescribing and dispensing history is updated in as close to real-time as practicable1 in compliance with applicable ,federal and ,state laws and provided that such information shall not include protected health information4 7d7 ,evaluation and reporting ,as a condition on receipt of support under this section1 the ,state shall report on interoperability with ,p,d,m,ps of other ,states and ,federal agencies1 where appropriate1 intrastate interoperability with health information technology systems such as electronic health records1 health information exchanges1 and e-prescribing1 where appropriate1 and whether or not the ,state provides automatic1 up-to-date1 or daily information about a patient when a practitioner 7or the designee of a practitioner1 where permitted7 requests information about such patient4 7e7 ,evaluation and reporting ,a ,state receiving support under this section shall provide the ,secretary with aggregate nonidentifiable information1 as permitted by ,state law1 to enable the ,secretary-- 7#a7 to evaluate the success of the ,state's program in achieving the purpose described in subsection 7a72 or 7#b7 to prepare and submit to the ,congress the report required by subsection 7i77#b74 7f7 ,education and access to the monitoring system ,a ,state receiving support under this section shall take steps to-- 7#a7 facilitate prescribers and dispensers1 and their delegates1 as permitted by ,state law1 to use the ,,pdmp1 to the extent practicable2 and 7#b7 educate prescribers and dispensers1 and their delegates on the benefits of the use of ,p,d,m,ps4 7g7 ,electronic format ,the ,secretary may issue guidelines specifying a uniform electronic format for the reporting1 sharing1 and disclosure of information pursuant to ,p,d,m,ps4 ,to the extent possible1 such guidelines shall be consistent with standards recognized by the ,office of the ,national ,coordinator for ,health ,information ,technology4 7h7 ,rules of construction 7#a7 ,functions otherwise authorized by law ,nothing in this section shall be construed to restrict the ability of any authority1 including any local1 ,state1 or ,federal law enforcement1 narcotics control1 licensure1 disciplinary1 or program authority1 to perform functions otherwise authorized by law4 7#b7 ,additional privacy protections ,nothing in this section shall be construed as preempting any ,state from imposing any additional privacy protections4 7#c7 ,federal privacy requirements ,nothing in this section shall be construed to supersede any ,federal privacy or confidentiality requirement1 including the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law #ajd-aia2 #aaj ,stat4 #bjcc7 and section #edc of this ,act4 7#d7 ,no ,federal private cause of action ,nothing in this section shall be construed to create a ,federal private cause of action4 7i7 ,progress report ,not later than #c years after the date of enactment of this section1 the ,secretary shall-- 7#a7 complete a study that-- 7,a7 determines the progress of grantees in establishing and implementing ,p,d,m,ps consistent with this section2 7,b7 provides an analysis of the extent to which the operation of ,p,d,m,ps has-- 7i7 reduced inappropriate use1 abuse1 diversion of1 and overdose with1 controlled substances2 7ii7 established or strengthened initiatives to ensure linkages to substance use disorder treatment services2 or 7iii7 affected patient access to appropriate care in ,states operating ,p,d,m,ps2 7,c7 determine the progress of grantees in achieving interstate interoperability and intrastate interoperability of ,p,d,m,ps1 including an assessment of technical1 legal1 and financial barriers to such progress and recommendations for addressing these barriers2 7,d7 determines the progress of grantees in implementing near real-time electronic ,p,d,m,ps2 7,e7 provides an analysis of the privacy protections in place for the information reported to the ,,pdmp in each ,state or locality receiving support under this section and any recommendations of the ,secretary for additional ,federal or ,state requirements for protection of this information2 7,f7 determines the progress of ,states or localities in implementing technological alternatives to centralized data storage1 such as peer-to-peer file sharing or data pointer systems1 in ,p,d,m,ps and the potential for such alternatives to enhance the privacy and security of individually identifiable data2 and 7,g7 evaluates the penalties that ,states or localities have enacted for the unauthorized use and disclosure of information maintained in ,p,d,m,ps1 and the criteria used by the ,secretary to determine whether such penalties qualify as appropriate for purposes of subsection 7a77#b72 and 7#b7 submit a report to the ,congress on the results of the study4 7j7 ,advisory council 7#a7 ,establishment ,a ,state or locality may establish an advisory council to assist in the establishment1 improvement1 or maintenance of a ,,pdmp consistent with this section4 7#b7 ,limitation ,a ,state or locality may not use ,federal funds for the operations of an advisory council to assist in the establishment1 improvement1 or maintenance of a ,,pdmp4 7#c7 ,sense of ,congress ,it is the sense of the ,congress that1 in establishing an advisory council to assist in the establishment1 improvement1 or maintenance of a ,,pdmp1 a ,state or locality should consult with appropriate professional boards and other interested parties4 7k7 ,definitions ,for purposes of this section3 7#a7 ,the term controlled substance means a controlled substance 7as defined in section #ajb of the ,controlled ,substances ,act7 in schedule ,,ii1 ,,iii1 or ,,iv of section #bjb of such ,act4 7#b7 ,the term dispense means to deliver a controlled substance to an ultimate user by1 or pursuant to the lawful order of1 a practitioner1 irrespective of whether the dispenser uses the ,internet or other means to effect such delivery4 7#c7 ,the term dispenser means a physician1 pharmacist1 or other person that dispenses a controlled substance to an ultimate user4 7#d7 ,the term interstate interoperability with respect to a ,,pdmp means the ability of the ,,pdmp to electronically share reported information with another ,state if the information concerns either the dispensing of a controlled substance to an ultimate user who resides in such other ,state1 or the dispensing of a controlled substance prescribed by a practitioner whose principal place of business is located in such other ,state4 7#e7 ,the term intrastate interoperability with respect to a ,,pdmp means the integration of ,,pdmp data within electronic health records and health information technology infrastructure or linking of a ,,pdmp to other data systems within the ,state1 including the ,state's ,medicaid program1 workers' compensation programs1 and medical examiners or coroners4 7#f7 ,the term nonidentifiable information means information that does not identify a practitioner1 dispenser1 or an ultimate user and with respect to which there is no reasonable basis to believe that the information can be used to identify a practitioner1 dispenser1 or an ultimate user4 7#g7 ,the term ,,pdmp means a prescription drug monitoring program that is ,state-controlled4 7#h7 ,the term practitioner means a physician1 dentist1 veterinarian1 scientific investigator1 pharmacy1 hospital1 or other person licensed1 registered1 or otherwise permitted1 by the ,united ,states or the jurisdiction in which the individual practices or does research1 to distribute1 dispense1 conduct research with respect to1 administer1 or use in teaching or chemical analysis1 a controlled substance in the course of professional practice or research4 7#i7 ,the term ,state means each of the #ej ,states1 the ,district of ,columbia1 and any commonwealth or territory of the ,united ,states4 7#aj7 ,the term ultimate user means a person who has obtained from a dispenser1 and who possesses1 a controlled substance for the person's own use1 for the use of a member of the person's household1 or for the use of an animal owned by the person or by a member of the person's household4 7#aa7 ,the term clinical workflow means the integration of automated queries for prescription drug monitoring programs data and analytics into health information technologies such as electronic health record systems1 health information exchanges1 and_/or pharmacy dispensing software systems1 thus streamlining provider access through automated queries4 4 ,r ,review of substance use disorder treatment providers receiving ,federal funding #gaga4 ,review of substance use disorder treatment providers receiving ,federal funding 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct a review of entities that receive ,federal funding for the provision of substance use disorder treatment services4 ,the review shall include3 7#a7 ,the length of time the entity has provided substance use disorder treatment services and the geographic area served by the entity4 7#b7 ,a detailed analysis of the patient population served by the entity1 including but not limited to the number of patients1 types of diagnosed substance use disorders and the demographic information of such patients1 including sex1 race1 ethnicity1 and socioeconomic status4 7#c7 ,detailed information on the types of substance use disorders for which the entity has the experience1 capability1 and capacity to provide such services4 7#d7 ,an analysis of how the entity handles patients requiring treatment for a substance use disorder that the organization is not able to treat4 7#e7 ,an analysis of what is needed in order to improve the entity's ability to meet the addiction treatment needs of the communities served by that entity4 7#f7 ,based on the identified needs of the communities served1 a description of unmet needs and inadequate services and how such needs and services could be better addressed to treat individuals with methamphetamine1 cocaine1 including crack cocaine1 heroin1 opioid1 and other substance use disorders4 7b7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,secretary shall develop and submit to ,congress a plan to direct appropriate resources to entities that provide substance use disorder treatment services in order to address inadequacies in services or funding identified through the survey described in subsection 7a74 ,s ,other health provisions #gaha4 ,state response to the opioid abuse crisis 7a7 ,in general ,section #ajjc of the #bast ,century ,cures ,act 7,public ,law #aad-bee7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking the authorization of appropriations under subsection 7b7 to carry out the grant program described in subsection 7c7 and inserting subsection 7h7 to carry out the grant program described in subsection 7b72 and 7,b7 by inserting and ,indian ,tribes after ,states2 7#b7 by striking subsection 7b72 7#c7 by redesignating subsections 7c7 through 7e7 as subsections 7b7 through 7d71 respectively2 7#d7 by redesignating subsection 7f7 as subsection 7j72 7#e7 in subsection 7b71 as so redesignated-- 7,a7 in paragraph 7#a7-- 7i7 in the paragraph heading1 by inserting and tribal after ,state2 7ii7 by striking ,states for the purpose of addressing the opioid abuse crisis within such ,states and inserting ,states and ,indian ,tribes for the purpose of addressing the opioid abuse crisis within such ,states and ,indian ,tribes2 7iii7 by inserting or ,indian ,tribes after preference to ,states2 and 7iv7 by inserting before the period of the second sentence or other ,indian ,tribes1 as applicable2 and 7,b7 in paragraph 7#b7-- 7i7 in the matter preceding subparagraph 7,a71 by striking to a ,state2 7ii7 in subparagraph 7,a71 by striking ,improving ,state and inserting ,establishing or improving2 7iii7 in subparagraph 7,c71 by inserting preventing diversion of controlled substances1 after treatment programs12 and 7iv7 in subparagraph 7,e71 by striking as the ,state determines appropriate1 related to addressing the opioid abuse crisis within the ,state and inserting as the ,state or ,indian ,tribe determines appropriate1 related to addressing the opioid abuse crisis within the ,state or ,indian ,tribe1 including directing resources in accordance with local needs related to substance use disorders2 7#f7 in subsection 7c71 as so redesignated1 by striking subsection 7c7 and inserting subsection 7b72 7#g7 in subsection 7d71 as so redesignated-- 7,a7 in the matter preceding paragraph 7#a71 by striking the authorization of appropriations under subsection 7b7 and inserting subsection 7h72 and 7,b7 in paragraph 7#a71 by striking subsection 7c7 and inserting subsection 7b72 and 7#h7 by inserting after subsection 7d71 as so redesignated1 the following3 7e7 ,indian ,tribes 7#a7 ,definition ,for purposes of this section1 the term ,indian ,tribe has the meaning given the term ,indian tribe in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#b7 ,appropriate mechanisms ,the ,secretary1 in consultation with ,indian ,tribes1 shall identify and establish appropriate mechanisms for ,tribes to demonstrate or report the information as required under subsections 7b71 7c71 and 7d74 7f7 ,report to ,congress ,not later than #a year after the date on which amounts are first awarded after the date of enactment of this subsection1 pursuant to subsection 7b71 and annually thereafter1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report summarizing the information provided to the ,secretary in reports made pursuant to subsection 7c71 including the purposes for which grant funds are awarded under this section and the activities of such grant recipients4 7g7 ,technical ,assistance ,the ,secretary1 including through the ,tribal ,training and ,technical ,assistance ,center of the ,substance ,abuse and ,mental ,health ,services ,administration1 shall provide ,state agencies and ,indian ,tribes1 as applicable1 with technical assistance concerning grant application and submission procedures under this section1 award management activities1 and enhancing outreach and direct support to rural and underserved communities and providers in addressing the opioid crisis4 7h7 ,authorization of appropriations ,for purposes of carrying out the grant program under subsection 7b71 there is authorized to be appropriated #ejj1jjj1jjj for each of fiscal years #bjai through #bjba1 to remain available until expended4 7i7 ,set aside ,of the amounts made available for each fiscal year to award grants under subsection 7b7 for a fiscal year1 #e percent of such amount for such fiscal year shall be made available to ,indian ,tribes1 and up to #ae percent of such amount for such fiscal year may be set aside for ,states with the highest age-adjusted rate of drug overdose death based on the ordinal ranking of ,states according to the ,director of the ,centers for ,disease ,control and ,prevention4 4 7b7 ,conforming amendment ,section #ajjd7;c7 of the #bast ,century ,cures ,act 7,public ,law #aad-bee7 is amended by striking 1 the ,,fda ,innovation ,account1 or the ,account ,for the ,state ,response to the ,opioid ,abuse ,crisis and inserting or the ,,fda ,innovation ,account4 #gahb4 ,report on investigations regarding parity in mental health and substance use disorder benefits 7a7 ,in general ,section #acjjc of the #bast ,century ,cures ,act 7,public ,law #aad-bee7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking with findings of any serious violation regarding and inserting concerning2 and 7,b7 by inserting and the ,committee on ,education and the ,workforce after ,energy and ,commerce2 and 7#b7 in subsection 7b77#a7-- 7,a7 by inserting complaints received and number of before closed2 and 7,b7 by inserting before the period 1 and1 for each such investigation closed1 which agency conducted the investigation1 whether the health plan that is the subject of the investigation is fully insured or not fully insured and a summary of any coordination between the applicable ,state regulators and the ,department of ,labor1 the ,department of ,health and ,human ,services1 or the ,department of the ,treasury1 and references to any guidance provided by the agencies addressing the category of violation committed4 7b7 ,applicability ,the amendments made by subsection 7a7 shall apply with respect to the second annual report required under such section #acjjc and each such annual report thereafter4 #gahc4 ,,career ,act 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in consultation with the ,secretary of ,labor1 shall continue or establish a program to support individuals in substance use disorder treatment and recovery to live independently and participate in the workforce4 7b7 ,grants authorized ,in carrying out the activities under this section1 the ,secretary shall1 on a competitive basis1 award grants for a period of not more than #e years to entities to enable such entities to carry out evidence-based programs to help individuals in substance use disorder treatment and recovery to live independently and participate in the workforce4 ,such entities shall coordinate1 as applicable1 with ,indian tribes or tribal organizations 7as applicable71 ,state boards and local boards 7as defined in section #c of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb71 lead ,state agencies with responsibility for a workforce investment activity 7as defined in such section #c71 and ,state agencies responsible for carrying out substance use disorder prevention and treatment programs4 7c7 ,priority 7#a7 ,in general ,in awarding grants under this section1 the ,secretary shall give priority based on the ,state in which the entity is located4 ,priority shall be given among ,states according to a formula based on the rates described in paragraph 7#b7 and weighted as described in paragraph 7#c74 7#b7 ,rates ,the rates described in this paragraph are the following3 7,a7 ,the amount by which the rate of drug overdose deaths in the ,state1 adjusted for age1 is above the national overdose mortality rate1 as determined by the ,director of the ,centers for ,disease ,control and ,prevention4 7,b7 ,the amount by which the rate of unemployment for the ,state1 based on data provided by the ,bureau of ,labor ,statistics for the preceding #e calendar years for which there is available data1 is above the national average4 7,c7 ,the amount by which rate of labor force participation in the ,state1 based on data provided by the ,bureau of ,labor ,statistics for the preceding #e calendar years for which there is available data1 is below the national average4 7#c7 ,weighting ,the rates described in paragraph 7#b7 shall be weighted as follows3 7,a7 ,the rate described in paragraph 7#b77;,a7 shall be weighted #gj percent4 7,b7 ,the rate described in paragraph 7#b77;,b7 shall be weighted #ae percent4 7,c7 ,the rate described in paragraph 7#b77;,c7 shall be weighted #ae percent4 7d7 ,preference ,in awarding grants under this section1 the ,secretary shall give preference to entities located in areas within ,states with the greatest need1 with such need based on the highest mortality rate related to substance use disorder4 7e7 ,definitions ,in this section3 7#a7 ,eligible entity ,the term eligible entity means an entity that offers treatment or recovery services for individuals with substance use disorders1 and partners with one or more local or ,state stakeholders1 which may include local employers1 community organizations1 the local workforce development board1 local and ,state governments1 and ,indian ,tribes or tribal organizations1 to support recovery1 independent living1 and participation in the workforce4 7#b7 ,indian ,tribes2 tribal organization ,the terms ,indian ,tribe and tribal organization have the meanings given the terms ,indian tribe and tribal organization in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#c7 ,state ,the term ,state includes only the several ,states and the ,district of ,columbia4 7f7 ,applications ,an eligible entity shall submit an application at such time and in such manner as the ,secretary may require4 ,in submitting an application1 the entity shall demonstrate the ability to partner with local stakeholders1 which may include local employers1 community stakeholders1 the local workforce development board1 local and ,state governments1 and ,indian ,tribes or tribal organizations1 as applicable1 to-- 7#a7 identify gaps in the workforce due to the prevalence of substance use disorders2 7#b7 in coordination with statewide employment and training activities1 including coordination and alignment of activities carried out by entities provided grant funds under section #hjda1 help individuals in recovery from a substance use disorder transition into the workforce1 including by providing career services1 training services as described in paragraph 7#b7 of section #acd7;c7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cagd7;c771 and related services described in section #acd7;a77#c7 of such ,act 7#db ,u4,s4,c4 #cagd7;a772 and 7#c7 assist employers with informing their employees of the resources1 such as resources related to substance use disorders that are available to their employees4 7g7 ,use of funds ,an entity receiving a grant under this section shall use the funds to conduct one or more of the following activities3 7#a7 ,hire case managers1 care coordinators1 providers of peer recovery support services1 as described in section #edg7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;ee-#b7;a771 or other professionals1 as appropriate1 to provide services that support treatment1 recovery1 and rehabilitation1 and prevent relapse1 recidivism1 and overdose1 including by encouraging-- 7,a7 the development and strengthening of daily living skills2 and 7,b7 the use of counseling1 care coordination1 and other services1 as appropriate1 to support recovery from substance use disorders4 7#b7 ,implement or utilize innovative technologies1 which may include the use of telemedicine4 7#c7 ,in coordination with the lead ,state agency with responsibility for a workforce investment activity or local board described in subsection 7b71 provide-- 7,a7 short-term prevocational training services2 and 7,b7 training services that are directly linked to the employment opportunities in the local area or the planning region4 7h7 ,support for ,state strategy ,an eligible entity shall include in its application under subsection 7f7 information describing how the services and activities proposed in such application are aligned with the ,state1 outlying area1 or ,tribal strategy1 as applicable1 for addressing issues described in such application and how such entity will coordinate with existing systems to deliver services as described in such application4 7i7 ,data reporting and program oversight ,each eligible entity awarded a grant under this section shall submit to the ,secretary a report at such time and in such manner as the ,secretary may require4 ,such report shall include a description of-- 7#a7 the programs and activities funded by the grant2 7#b7 outcomes of the population of individuals with a substance use disorder the grantee served through activities described in subsection 7g72 and 7#c7 any other information that the ,secretary may require for the purpose of ensuring that the grantee is complying with all of the requirements of the grant4 7j7 ,reports to ,congress 7#a7 ,preliminary report ,not later than #b years after the end of the first year of the grant period under this section1 the ,secretary shall submit to ,congress a preliminary report that analyzes reports submitted under subsection 7i74 7#b7 ,final report ,not later than #b years after submitting the preliminary report required under paragraph 7#a71 the ,secretary shall submit to ,congress a final report that includes-- 7,a7 a description of how the grant funding was used1 including the number of individuals who received services under subsection 7g77#c7 and an evaluation of the effectiveness of the activities conducted by the grantee with respect to outcomes of the population of individuals with substance use disorder who receive services from the grantee2 and 7,b7 recommendations related to best practices for health care professionals to support individuals in substance use disorder treatment or recovery to live independently and participate in the workforce4 7k7 ,authorization of appropriations ,there is authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjai through #bjbc for purposes of carrying out this section4 ,,viii ,miscellaneous ,a ,synthetics ,trafficking and ,overdose ,prevention #hjja4 ,short title ,this subtitle may be cited as the ,synthetics ,trafficking and ,overdose ,prevention ,act of #bjah or ,,stop ,act of #bjah4 #hjjb4 ,customs fees 7a7 ,in general ,section #acjca7;b77#i7 of the ,consolidated ,omnibus ,budget ,reconciliation ,act of #aihe 7#ai ,u4,s4,c4 #eh;c7b77#i77 is amended by adding at the end the following3 7,d7 7i7 ,with respect to the processing of items that are sent to the ,united ,states through the international postal network by ,inbound ,express ,mail service or ,inbound ,,ems 7as that service is described in the mail classification schedule referred to in section #cfca of title #ci1 ,united ,states ,code71 the following payments are required3 7,i7 #a per ,inbound ,,ems item4 7,,ii7 ,if an ,inbound ,,ems item is formally entered1 the fee provided for under subsection 7a77#i71 if applicable4 7ii7 ,notwithstanding section #dea of the ,tariff ,act of #aicj 7#ai ,u4,s4,c4 #adea71 the payments required by clause 7i71 as allocated pursuant to clause 7iii77,i71 shall be the only payments required for reimbursement of ,u4,s4 ,customs and ,border ,protection for customs services provided in connection with the processing of an ,inbound ,,ems item4 7iii7 7,i7 ,the payments required by clause 7i77,i7 shall be allocated as follows3 7aa7 #ej percent of the amount of the payments shall be paid on a quarterly basis by the ,united ,states ,postal ,service to the ,commissioner of ,u4,s4 ,customs and ,border ,protection in accordance with regulations prescribed by the ,secretary of the ,treasury to reimburse ,u4,s4 ,customs and ,border ,protection for customs services provided in connection with the processing of ,inbound ,,ems items4 7bb7 #ej percent of the amount of the payments shall be retained by the ,postal ,service to reimburse the ,postal ,service for services provided in connection with the customs processing of ,inbound ,,ems items4 7,,ii7 ,payments received by ,u4,s4 ,customs and ,border ,protection under subclause 7,i77aa7 shall1 in accordance with section #ebd of the ,tariff ,act of #aicj 7#ai ,u4,s4,c4 #aebd71 be deposited in the ,customs ,user ,fee ,account and used to directly reimburse each appropriation for the amount paid out of that appropriation for the costs incurred in providing services to international mail facilities4 ,amounts deposited in accordance with the preceding sentence shall be available until expended for the provision of such services4 7,,iii7 ,payments retained by the ,postal ,service under subclause 7,i77bb7 shall be used to directly reimburse the ,postal ,service for the costs incurred in providing services in connection with the customs processing of ,inbound ,,ems items4 7iv7 ,beginning in fiscal year #bjba1 the ,secretary1 in consultation with the ,postmaster ,general1 may adjust1 not more frequently than once each fiscal year1 the amount described in clause 7i77,i7 to an amount commensurate with the costs of services provided in connection with the customs processing of ,inbound ,,ems items1 consistent with the obligations of the ,united ,states under international agreements4 4 7b7 ,conforming amendments ,section #acjca7;a7 of the ,consolidated ,omnibus ,budget ,reconciliation ,act of #aihe 7#ai ,u4,s4,c4 #eh;c7a77 is amended-- 7#a7 in paragraph 7#f71 by inserting 7other than an item subject to a fee under subsection 7b77#i77;,d77 after customs officer2 and 7#b7 in paragraph 7#aj7-- 7,a7 in subparagraph 7,c71 in the matter preceding clause 7i71 by inserting 7other than ,inbound ,,ems items described in subsection 7b77#i77;,d77 after release2 and 7,b7 in the flush at the end1 by inserting or of ,inbound ,,ems items described in subsection 7b77#i77;,d71 after 7,c714 7c7 ,effective date ,the amendments made by this section shall take effect on ,january #a1 #bjbj4 #hjjc4 ,mandatory advance electronic information for postal shipments 7a7 ,mandatory advance electronic information 7#a7 ,in general ,section #cdc7;a77#c77,k7 of the ,trade ,act of #bjjb 7,public ,law #ajg-baj2 #ai ,u4,s4,c4 #bjga note7 is amended to read as follows3 7,k7 7i7 ,the ,secretary shall prescribe regulations requiring the ,united ,states ,postal ,service to transmit the information described in paragraphs 7#a7 and 7#b7 to the ,commissioner of ,u4,s4 ,customs and ,border ,protection for international mail shipments by the ,postal ,service 7including shipments to the ,postal ,service from foreign postal operators that are transported by private carrier7 consistent with the requirements of this subparagraph4 7ii7 ,in prescribing regulations under clause 7i71 the ,secretary shall impose requirements for the transmission to the ,commissioner of information described in paragraphs 7#a7 and 7#b7 for mail shipments described in clause 7i7 that are comparable to the requirements for the transmission of such information imposed on similar non-mail shipments of cargo1 taking into account the parameters set forth in subparagraphs 7,a7 through 7,j74 7iii7 ,the regulations prescribed under clause 7i7 shall require the transmission of the information described in paragraphs 7#a7 and 7#b7 with respect to a shipment as soon as practicable in relation to the transportation of the shipment1 consistent with subparagraph 7,h74 7iv7 ,regulations prescribed under clause 7i7 shall allow for the requirements for the transmission to the ,commissioner of information described in paragraphs 7#a7 and 7#b7 for mail shipments described in clause 7i7 to be implemented in phases1 as appropriate1 by-- 7,i7 setting incremental targets for increasing the percentage of such shipments for which information is required to be transmitted to the ,commissioner2 and 7,,ii7 taking into consideration-- 7aa7 the risk posed by such shipments2 7bb7 the volume of mail shipped to the ,united ,states by or through a particular country2 and 7cc7 the capacities of foreign postal operators to provide that information to the ,postal ,service4 7v7 7,i7 ,notwithstanding clause 7iv71 the ,postal ,service shall1 not later than ,december #ca1 #bjah1 arrange for the transmission to the ,commissioner of the information described in paragraphs 7#a7 and 7#b7 for not less than #gj percent of the aggregate number of mail shipments1 including #ajj percent of mail shipments from the ,people's ,republic of ,china1 described in clause 7i74 7,,ii7 ,if the requirements of subclause 7,i7 are not met1 the ,comptroller ,general of the ,united ,states shall submit to the appropriate congressional committees1 not later than ,june #cj1 #bjai1 a report-- 7aa7 assessing the reasons for the failure to meet those requirements2 and 7bb7 identifying recommendations to improve the collection by the ,postal ,service of the information described in paragraphs 7#a7 and 7#b74 7vi77,i7 ,notwithstanding clause 7iv71 the ,postal ,service shall1 not later than ,december #ca1 #bjbj1 arrange for the transmission to the ,commissioner of the information described in paragraphs 7#a7 and 7#b7 for #ajj percent of the aggregate number of mail shipments described in clause 7i74 7,,ii7 ,the ,commissioner1 in consultation with the ,postmaster ,general1 may determine to exclude a country from the requirement described in subclause 7,i7 to transmit information for mail shipments described in clause 7i7 from the country if the ,commissioner determines that the country-- 7aa7 does not have the capacity to collect and transmit such information2 7bb7 represents a low risk for mail shipments that violate relevant ,united ,states laws and regulations2 and 7cc7 accounts for low volumes of mail shipments that can be effectively screened for compliance with relevant ,united ,states laws and regulations through an alternate means4 7,,iii7 ,the ,commissioner shall1 at a minimum on an annual basis1 re-evaluate any determination made under subclause 7,,ii7 to exclude a country from the requirement described in subclause 7,i74 ,if1 at any time1 the ,commissioner determines that a country no longer meets the requirements under subclause 7,,ii71 the ,commissioner may not further exclude the country from the requirement described in subclause 7,i74 7,,iv7 ,the ,commissioner shall1 on an annual basis1 submit to the appropriate congressional committees-- 7aa7 a list of countries with respect to which the ,commissioner has made a determination under subclause 7,,ii7 to exclude the countries from the requirement described in subclause 7,i72 and 7bb7 information used to support such determination with respect to such countries4 7vii7 7,i7 ,the ,postmaster ,general shall1 in consultation with the ,commissioner1 refuse any shipments received after ,december #ca1 #bjbj1 for which the information described in paragraphs 7#a7 and 7#b7 is not transmitted as required under this subparagraph1 except as provided in subclause 7,,ii74 7,,ii7 ,if remedial action is warranted in lieu of refusal of shipments pursuant to subclause 7,i71 the ,postmaster ,general and the ,commissioner shall take remedial action with respect to the shipments1 including destruction1 seizure1 controlled delivery or other law enforcement initiatives1 or correction of the failure to provide the information described in paragraphs 7#a7 and 7#b7 with respect to the shipments4 7viii7 ,nothing in this subparagraph shall be construed to limit the authority of the ,secretary to obtain information relating to international mail shipments from private carriers or other appropriate parties4 7ix7 ,in this subparagraph1 the term appropriate congressional committees means-- 7,i7 the ,committee on ,finance and the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate2 and 7,,ii7 the ,committee on ,ways and ,means1 the ,committee on ,oversight and ,government ,reform1 and the ,committee on ,homeland ,security of the ,house of ,representatives4 4 7#b7 ,joint strategic plan on mandatory advance information ,not later than #fj days after the date of the enactment of this ,act1 the ,secretary of ,homeland ,security and the ,postmaster ,general shall develop and submit to the appropriate congressional committees a joint strategic plan detailing specific performance measures for achieving-- 7,a7 the transmission of information as required by section #cdc7;a77#c77,k7 of the ,trade ,act of #bjjb1 as amended by paragraph 7#a72 and 7,b7 the presentation by the ,postal ,service to ,u4,s4 ,customs and ,border ,protection of all mail targeted by ,u4,s4 ,customs and ,border ,protection for inspection4 7b7 ,capacity building 7#a7 ,in general ,section #cdc7;a7 of the ,trade ,act of #bjjb 7,public ,law #ajg-baj2 #ai ,u4,s4,c4 #bjga note7 is amended by adding at the end the following3 7#e7 ,capacity building 7,a7 ,in general ,the ,secretary1 with the concurrence of the ,secretary of ,state1 and in coordination with the ,postmaster ,general and the heads of other ,federal agencies1 as appropriate1 may provide technical assistance1 equipment1 technology1 and training to enhance the capacity of foreign postal operators-- 7i7 to gather and provide the information required by paragraph 7#c77,k72 and 7ii7 to otherwise gather and provide postal shipment information related to-- 7,i7 terrorism2 7,,ii7 items the importation or introduction of which into the ,united ,states is prohibited or restricted1 including controlled substances2 and 7,,iii7 such other concerns as the ,secretary determines appropriate4 7,b7 ,provision of equipment and technology ,with respect to the provision of equipment and technology under subparagraph 7,a71 the ,secretary may lease1 loan1 provide1 or otherwise assist in the deployment of such equipment and technology under such terms and conditions as the ,secretary may prescribe1 including nonreimbursable loans or the transfer of ownership of equipment and technology4 4 7#b7 ,joint strategic plan on capacity building ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,homeland ,security and the ,postmaster ,general shall1 in consultation with the ,secretary of ,state1 jointly develop and submit to the appropriate congressional committees a joint strategic plan-- 7,a7 detailing the extent to which ,u4,s4 ,customs and ,border ,protection and the ,united ,states ,postal ,service are engaged in capacity building efforts under section #cdc7;a77#e7 of the ,trade ,act of #bjjb1 as added by paragraph 7#a72 7,b7 describing plans for future capacity building efforts2 and 7,c7 assessing how capacity building has increased the ability of ,u4,s4 ,customs and ,border ,protection and the ,postal ,service to advance the goals of this subtitle and the amendments made by this subtitle4 7c7 ,report and consultations by ,secretary of ,homeland ,security and ,postmaster ,general 7#a7 ,report ,not later than #ahj days after the date of the enactment of this ,act1 and annually thereafter until #c years after the ,postmaster ,general has met the requirement under clause 7vi7 of subparagraph 7,k7 of section #cdc7;a77#c7 of the ,trade ,act of #bjjb1 as amended by subsection 7a77#a71 the ,secretary of ,homeland ,security and the ,postmaster ,general shall1 in consultation with the ,secretary of ,state1 jointly submit to the appropriate congressional committees a report on compliance with that subparagraph that includes the following3 7,a7 ,an assessment of the status of the regulations required to be promulgated under that subparagraph4 7,b7 ,an update regarding new and existing agreements reached with foreign postal operators for the transmission of the information required by that subparagraph4 7,c7 ,a summary of deliberations between the ,united ,states ,postal ,service and foreign postal operators with respect to issues relating to the transmission of that information4 7,d7 ,a summary of the progress made in achieving the transmission of that information for the percentage of shipments required by that subparagraph4 7,e7 ,an assessment of the quality of that information being received by foreign postal operators1 as determined by the ,secretary of ,homeland ,security1 and actions taken to improve the quality of that information4 7,f7 ,a summary of policies established by the ,universal ,postal ,union that may affect the ability of the ,postmaster ,general to obtain the transmission of that information4 7,g7 ,a summary of the use of technology to detect illicit synthetic opioids and other illegal substances in international mail parcels and planned acquisitions and advancements in such technology4 7,h7 ,such other information as the ,secretary of ,homeland ,security and the ,postmaster ,general consider appropriate with respect to obtaining the transmission of information required by that subparagraph4 7#b7 ,consultations ,not later than #ahj days after the date of the enactment of this ,act1 and every #ahj days thereafter until the ,postmaster ,general has met the requirement under clause 7vi7 of section #cdc7;a77#c77,k7 of the ,trade ,act of #bjjb1 as amended by subsection 7a77#a71 to arrange for the transmission of information with respect to #ajj percent of the aggregate number of mail shipments described in clause 7i7 of that section1 the ,secretary of ,homeland ,security and the ,postmaster ,general shall provide briefings to the appropriate congressional committees on the progress made in achieving the transmission of that information for that percentage of shipments4 7d7 ,government ,accountability ,office report ,not later than ,june #cj1 #bjai1 the ,comptroller ,general of the ,united ,states shall submit to the appropriate congressional committees a report-- 7#a7 assessing the progress of the ,united ,states ,postal ,service in achieving the transmission of the information required by subparagraph 7,k7 of section #cdc7;a77#c7 of the ,trade ,act of #bjjb1 as amended by subsection 7a77#a71 for the percentage of shipments required by that subparagraph2 7#b7 assessing the quality of the information received from foreign postal operators for targeting purposes2 7#c7 assessing the specific percentage of targeted mail presented by the ,postal ,service to ,u4,s4 ,customs and ,border ,protection for inspection2 7#d7 describing the costs of collecting the information required by such subparagraph 7,k7 from foreign postal operators and the costs of implementing the use of that information2 7#e7 assessing the benefits of receiving that information with respect to international mail shipments2 7#f7 assessing the feasibility of assessing a customs fee under section #acjca7;b77#i7 of the ,consolidated ,omnibus ,budget ,reconciliation ,act of #aihe1 as amended by section #hjjb1 on international mail shipments other than ,inbound ,express ,mail service in a manner consistent with the obligations of the ,united ,states under international agreements2 and 7#g7 identifying recommendations1 including recommendations for legislation1 to improve the compliance of the ,postal ,service with such subparagraph 7,k71 including an assessment of whether the detection of illicit synthetic opioids in the international mail would be improved by-- 7,a7 requiring the ,postal ,service to serve as the consignee for international mail shipments containing goods2 or 7,b7 designating a customs broker to act as an importer of record for international mail shipments containing goods4 7e7 ,technical correction ,section #cdc of the ,trade ,act of #bjjb 7,public ,law #ajg-baj2 #ai ,u4,s4,c4 #bjga note7 is amended in the section heading by striking advanced and inserting advance4 7f7 ,appropriate congressional committees defined ,in this section1 the term appropriate congressional committees means-- 7#a7 the ,committee on ,finance and the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate2 and 7#b7 the ,committee on ,ways and ,means1 the ,committee on ,oversight and ,government ,reform1 and the ,committee on ,homeland ,security of the ,house of ,representatives4 #hjjd4 ,international postal agreements 7a7 ,existing agreements 7#a7 ,in general ,in the event that any provision of this subtitle1 or any amendment made by this subtitle1 is determined to be in violation of obligations of the ,united ,states under any postal treaty1 convention1 or other international agreement related to international postal services1 or any amendment to such an agreement1 the ,secretary of ,state should negotiate to amend the relevant provisions of the agreement so that the ,united ,states is no longer in violation of the agreement4 7#b7 ,rule of construction ,nothing in this subsection shall be construed to permit delay in the implementation of this subtitle or any amendment made by this subtitle4 7b7 ,future agreements 7#a7 ,consultations ,before entering into1 on or after the date of the enactment of this ,act1 any postal treaty1 convention1 or other international agreement related to international postal services1 or any amendment to such an agreement1 that is related to the ability of the ,united ,states to secure the provision of advance electronic information by foreign postal operators1 the ,secretary of ,state should consult with the appropriate congressional committees 7as defined in section #hjjc7;f774 7#b7 ,expedited negotiation of new agreement ,to the extent that any new postal treaty1 convention1 or other international agreement related to international postal services would improve the ability of the ,united ,states to secure the provision of advance electronic information by foreign postal operators as required by regulations prescribed under section #cdc7;a77#c77,k7 of the ,trade ,act of #bjjb1 as amended by section #hjjc7;a77#a71 the ,secretary of ,state should expeditiously conclude such an agreement4 #hjje4 ,cost recoupment 7a7 ,in general ,the ,united ,states ,postal ,service shall1 to the extent practicable and otherwise recoverable by law1 ensure that all costs associated with complying with this subtitle and amendments made by this subtitle are charged directly to foreign shippers or foreign postal operators4 7b7 ,costs not considered revenue ,the recovery of costs under subsection 7a7 shall not be deemed revenue for purposes of subchapter ,i and ,,ii of chapter #cf of title #ci1 ,united ,states ,code1 or regulations prescribed under that chapter4 #hjjf4 ,development of technology to detect illicit narcotics 7a7 ,in general ,the ,postmaster ,general and the ,commissioner of ,u4,s4 ,customs and ,border ,protection1 in coordination with the heads of other agencies as appropriate1 shall collaborate to identify and develop technology for the detection of illicit fentanyl1 other synthetic opioids1 and other narcotics and psychoactive substances entering the ,united ,states by mail4 7b7 ,outreach to private sector ,the ,postmaster ,general and the ,commissioner shall conduct outreach to private sector entities to gather information regarding the current state of technology to identify areas for innovation relating to the detection of illicit fentanyl1 other synthetic opioids1 and other narcotics and psychoactive substances entering the ,united ,states4 #hjjg4 ,civil penalties for postal shipments ,section #dcf of the ,tariff ,act of #aicj 7#ai ,u4,s4,c4 #adcf7 is amended by adding at the end the following new subsection3 7e7 ,civil penalties for postal shipments 7#a7 ,civil penalty ,a civil penalty shall be imposed against the ,united ,states ,postal ,service if the ,postal ,service accepts a shipment in violation of section #cdc7;a77#c77,k77vii77,i7 of the ,trade ,act of #bjjb4 7#b7 ,modification of civil penalty 7,a7 ,in general ,u4,s4 ,customs and ,border ,protection shall reduce or dismiss a civil penalty imposed pursuant to paragraph 7#a7 if ,u4,s4 ,customs and ,border ,protection determines that the ,united ,states ,postal ,service-- 7i7 has a low error rate in compliance with section #cdc7;a77#c77,k7 of the ,trade ,act of #bjjb2 7ii7 is cooperating with ,u4,s4 ,customs and ,border ,protection with respect to the violation of section #cdc7;a77#c77,k77vii77,i7 of the ,trade ,act of #bjjb2 or 7iii7 has taken remedial action to prevent future violations of section #cdc7;a77#c77,k77vii77,i7 of the ,trade ,act of #bjjb4 7,b7 ,written notification ,u4,s4 ,customs and ,border ,protection shall issue a written notification to the ,postal ,service with respect to each exercise of the authority of subparagraph 7,a7 to reduce or dismiss a civil penalty imposed pursuant to paragraph 7#a74 7#c7 ,ongoing lack of compliance ,if ,u4,s4 ,customs and ,border ,protection determines that the ,united ,states ,postal ,service-- 7,a7 has repeatedly committed violations of section #cdc7;a77#c77,k77vii77,i7 of the ,trade ,act of #bjjb1 7,b7 has failed to cooperate with ,u4,s4 ,customs and ,border ,protection with respect to violations of section #cdc7;a77#c77,k77vii77,i7 of the ,trade ,act of #bjjb1 and 7,c7 has an increasing error rate in compliance with section #cdc7;a77#c77,k7 of the ,trade ,act of #bjjb1 civil penalties may be imposed against the ,united ,states ,postal ,service until corrective action1 satisfactory to ,u4,s4 ,customs and ,border ,protection1 is taken4 4 #hjjh4 ,report on violations of arrival1 reporting1 entry1 and clearance requirements and falsity or lack of manifest 7a7 ,in general ,the ,commissioner of ,u4,s4 ,customs and ,border ,protection shall submit to the appropriate congressional committees an annual report that contains the information described in subsection 7b7 with respect to each violation of section #dcf of the ,tariff ,act of #aicj 7#ai ,u4,s4,c4 #adcf71 as amended by section #hjjg1 and section #ehd of such ,act 7#ai ,u4,s4,c4 #aehd7 that occurred during the previous year4 7b7 ,information described ,the information described in this subsection is the following3 7#a7 ,the name and address of the violator4 7#b7 ,the specific violation that was committed4 7#c7 ,the location or port of entry through which the items were transported4 7#d7 ,an inventory of the items seized1 including a description of the items and the quantity seized4 7#e7 ,the location from which the items originated4 7#f7 ,the entity responsible for the apprehension or seizure1 organized by location or port of entry4 7#g7 ,the amount of penalties assessed by ,u4,s4 ,customs and ,border ,protection1 organized by name of the violator and location or port of entry4 7#h7 ,the amount of penalties that ,u4,s4 ,customs and ,border ,protection could have levied1 organized by name of the violator and location or port of entry4 7#i7 ,the rationale for negotiating lower penalties1 organized by name of the violator and location or port of entry4 7c7 ,appropriate congressional committees defined ,in this section1 the term appropriate congressional committees means-- 7#a7 the ,committee on ,finance and the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate2 and 7#b7 the ,committee on ,ways and ,means1 the ,committee on ,oversight and ,government ,reform1 and the ,committee on ,homeland ,security of the ,house of ,representatives4 #hjji4 ,effective date2 regulations 7a7 ,effective date ,this subtitle and the amendments made by this subtitle 7other than the amendments made by section #hjjb7 shall take effect on the date of the enactment of this ,act4 7b7 ,regulations ,not later than #a year after the date of the enactment of this ,act1 such regulations as are necessary to carry out this subtitle and the amendments made by this subtitle shall be prescribed4 ,b ,opioid ,addiction ,recovery ,fraud ,prevention #hjba4 ,short title ,this subtitle may be cited as the ,opioid ,addiction ,recovery ,fraud ,prevention ,act of #bjah4 #hjbb4 ,definitions ,for purposes of this subtitle only1 and not be construed or applied as to challenge or affect the characterization1 definition1 or treatment under any other statute1 regulation1 or rule3 7#a7 ,substance use disorder treatment product ,the term substance use disorder treatment product means a product for use or marketed for use in the treatment1 cure1 or prevention of a substance use disorder1 including an opioid use disorder4 7#b7 ,substance use disorder treatment service ,the term substance use disorder treatment service means a service that purports to provide referrals to treatment1 treatment1 or recovery housing for people diagnosed with1 having1 or purporting to have a substance use disorder1 including an opioid use disorder4 #hjbc4 ,unfair or deceptive acts or practices with respect to substance use disorder treatment service and products 7a7 ,unlawful activity ,it is unlawful to engage in an unfair or deceptive act or practice with respect to any substance use disorder treatment service or substance use disorder treatment product4 7b7 ,enforcement by the ,federal ,trade ,commission 7#a7 ,unfair or deceptive acts or practices ,a violation of subsection 7a7 shall be treated as a violation of a rule under section #ah of the ,federal ,trade ,commission ,act 7#ae ,u4,s4,c4 #eg;a7 regarding unfair or deceptive acts or practices4 7#b7 ,powers of the ,federal ,trade ,commission 7,a7 ,in general ,the ,federal ,trade ,commission shall enforce this section in the same manner1 by the same means1 and with the same jurisdiction1 powers1 and duties as though all applicable terms and provisions of the ,federal ,trade ,commission ,act 7#ae ,u4,s4,c4 #da et seq47 were incorporated into and made a part of this section4 7,b7 ,privileges and immunities ,any person who violates subsection 7a7 shall be subject to the penalties and entitled to the privileges and immunities provided in the ,federal ,trade ,commission ,act as though all applicable terms and provisions of the ,federal ,trade ,commission ,act 7#ae ,u4,s4,c4 #da et seq47 were incorporated and made part of this section4 7c7 ,authority preserved ,nothing in this subtitle shall be construed to limit the authority of the ,federal ,trade ,commission or the ,food and ,drug ,administration under any other provision of law4 ,c ,addressing economic and workforce impacts of the opioid crisis #hjda4 ,addressing economic and workforce impacts of the opioid crisis 7a7 ,definitions ,except as otherwise expressly provided1 in this section3 7#a7 ,,wioa definitions ,the terms core program1 individual with a barrier to employment1 local area1 local board1 one-stop operator1 outlying area1 ,state1 ,state board1 and supportive services have the meanings given the terms in section #c of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb74 7#b7 ,education provider ,the term education provider means-- 7,a7 an institution of higher education1 as defined in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja72 or 7,b7 a postsecondary vocational institution1 as defined in section #ajb7;c7 of such ,act 7#bj ,u4,s4,c4 #ajjb7;c774 7#c7 ,eligible entity ,the term eligible entity means-- 7,a7 a ,state workforce agency2 7,b7 an outlying area2 or 7,c7 a ,tribal entity4 7#d7 ,participating partnership ,the term participating partnership means a partnership-- 7,a7 evidenced by a written contract or agreement2 and 7,b7 including1 as members of the partnership1 a local board receiving a subgrant under subsection 7d7 and #a or more of the following3 7i7 ,the eligible entity4 7ii7 ,a treatment provider4 7iii7 ,an employer or industry organization4 7iv7 ,an education provider4 7v7 ,a legal service or law enforcement organization4 7vi7 ,a faith-based or community-based organization4 7vii7 ,other ,state or local agencies1 including counties or local governments4 7viii7 ,other organizations1 as determined to be necessary by the local board4 7ix7 ,indian ,tribes or tribal organizations4 7#e7 ,program participant ,the term program participant means an individual who-- 7,a7 is a member of a population of workers described in subsection 7e77#b7 that is served by a participating partnership through the pilot program under this section2 and 7,b7 enrolls with the applicable participating partnership to receive any of the services described in subsection 7e77#c74 7#f7 ,provider of peer recovery support services ,the term provider of peer recovery support services means a provider that delivers peer recovery support services through an organization described in section #edg7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;ee-#b7;a774 7#g7 ,secretary ,the term ,secretary means the ,secretary of ,labor4 7#h7 ,state workforce agency ,the term ,state workforce agency means the lead ,state agency with responsibility for the administration of a program under chapter #b or #c of subtitle ,b of title ,i of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cafa et seq41 #caga et seq474 7#i7 ,substance use disorder ,the term substance use disorder has the meaning given such term by the ,assistant ,secretary for ,mental ,health and ,substance ,use4 7#aj7 ,treatment provider ,the term treatment provider-- 7,a7 means a health care provider that-- 7i7 offers services for treating substance use disorders and is licensed in accordance with applicable ,state law to provide such services2 and 7ii7 accepts health insurance for such services1 including coverage under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 and 7,b7 may include-- 7i7 a nonprofit provider of peer recovery support services2 7ii7 a community health care provider2 7iii7 a ,federally qualified health center 7as defined in section #ahfa7;aa7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex772 7iv7 an ,indian health program 7as defined in section #c of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc771 including an ,indian health program that serves an urban center 7as defined in such section72 and 7v7 a ,native ,hawaiian health center 7as defined in section #ab of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagaa774 7#aa7 ,tribal entity ,the term ,tribal entity includes any ,indian ,tribe1 tribal organization1 ,indian-controlled organization serving ,indians1 ,native ,hawaiian organization1 or ,alaska ,native entity1 as such terms are defined or used in section #aff of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cbba74 7b7 ,pilot program and grants authorized 7#a7 ,in general ,the ,secretary1 in consultation with the ,secretary of ,health and ,human ,services1 shall carry out a pilot program to address economic and workforce impacts associated with a high rate of a substance use disorder4 ,in carrying out the pilot program1 the ,secretary shall make grants1 on a competitive basis1 to eligible entities to enable such entities to make subgrants to local boards to address the economic and workforce impacts associated with a high rate of a substance use disorder4 7#b7 ,grant amounts ,the ,secretary shall make each such grant in an amount that is not less than #ejj1jjj1 and not more than #e1jjj1jjj1 for a fiscal year4 7c7 ,grant applications 7#a7 ,in general ,an eligible entity applying for a grant under this section shall submit an application to the ,secretary at such time and in such form and manner as the ,secretary may reasonably require1 including the information described in this subsection4 7#b7 ,significant impact on community by opioid and substance use disorder-related problems 7,a7 ,demonstration ,an eligible entity shall include in the application-- 7i7 information that demonstrates significant impact on the community by problems related to opioid abuse or another substance use disorder1 by-- 7,i7 identifying the counties1 communities1 regions1 or local areas that have been significantly impacted and will be served through the grant 7each referred to in this section as a service area72 and 7,,ii7 demonstrating for each such service area1 an increase equal to or greater than the national increase in such problems1 between-- 7aa7 #aiii2 and 7bb7 #bjaf or the latest year for which data are available2 and 7ii7 a description of how the eligible entity will prioritize support for significantly impacted service areas described in clause 7i77,i74 7,b7 ,information ,to meet the requirements described in subparagraph 7,a77i77,,ii71 the eligible entity may use information including data on-- 7i7 the incidence or prevalence of opioid abuse and other substance use disorders2 7ii7 the age-adjusted rate of drug overdose deaths1 as determined by the ,director of the ,centers for ,disease ,control and ,prevention2 7iii7 the rate of non-fatal hospitalizations related to opioid abuse or other substance use disorders2 7iv7 the number of arrests or convictions1 or a relevant law enforcement statistic1 that reasonably shows an increase in opioid abuse or another substance use disorder2 or 7v7 in the case of an eligible entity described in subsection 7a77#c77;,c71 other alternative relevant data as determined appropriate by the ,secretary4 7,c7 ,support for state strategy ,the eligible entity may include in the application information describing how the proposed services and activities are aligned with the ,state1 outlying area1 or ,tribal strategy1 as applicable1 for addressing problems described in subparagraph 7,a7 in specific service areas or across the ,state1 outlying area1 or ,tribal land4 7#c7 ,economic and employment conditions demonstrate additional ,federal support needed 7,a7 ,demonstration ,an eligible entity shall include in the application information that demonstrates that a high rate of a substance use disorder has caused1 or is coincident to-- 7i7 an economic or employment downturn in the service area2 or 7ii7 persistent economically depressed conditions in such service area4 7,b7 ,information ,to meet the requirements of subparagraph 7,a71 an eligible entity may use information including-- 7i7 documentation of any layoff1 announced future layoff1 legacy industry decline1 decrease in an employment or labor market participation rate1 or economic impact1 whether or not the result described in this clause is overtly related to a high rate of a substance use disorder2 7ii7 documentation showing decreased economic activity related to1 caused by1 or contributing to a high rate of a substance use disorder1 including a description of how the service area has been impacted1 or will be impacted1 by such a decrease2 7iii7 information on economic indicators1 labor market analyses1 information from public announcements1 and demographic and industry data2 7iv7 information on rapid response activities 7as defined in section #c of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb77 that have been or will be conducted1 including demographic data gathered by employer or worker surveys or through other methods2 7v7 data or documentation1 beyond anecdotal evidence1 showing that employers face challenges filling job vacancies due to a lack of skilled workers able to pass a drug test2 or 7vi7 any additional relevant data or information on the economy1 workforce1 or another aspect of the service area to support the application4 7d7 ,subgrant authorization and application process 7#a7 ,subgrants authorized 7,a7 ,in general ,an eligible entity receiving a grant under subsection 7b7-- 7i7 may use not more than #e percent of the grant funds for the administrative costs of carrying out the grant2 7ii7 in the case of an eligible entity described in subparagraph 7,a7 or 7,b7 of subsection 7a77#c71 shall use the remaining grant funds to make subgrants to local entities in the service area to carry out the services and activities described in subsection 7e72 and 7iii7 in the case of an eligible entity described in subsection 7a77#c77;,c71 shall use the remaining grant funds to carry out the services and activities described in subsection 7e74 7,b7 ,equitable distribution ,in making subgrants under this subsection1 an eligible entity shall ensure1 to the extent practicable1 the equitable distribution of subgrants1 based on-- 7i7 geography 7such as urban and rural distribution72 and 7ii7 significantly impacted service areas as described in subsection 7c77#b74 7,c7 ,timing of subgrant funds distribution ,an eligible entity making subgrants under this subsection shall disburse subgrant funds to a local board receiving a subgrant from the eligible entity by the later of-- 7i7 the date that is #ij days after the date on which the ,secretary makes the funds available to the eligible entity2 or 7ii7 the date that is #ae days after the date that the eligible entity makes the subgrant under subparagraph 7,a77ii74 7#b7 ,subgrant application 7,a7 ,in general ,a local board desiring to receive a subgrant under this subsection from an eligible entity shall submit an application at such time and in such manner as the eligible entity may reasonably require1 including the information described in this paragraph4 7,b7 ,contents ,each application described in subparagraph 7,a7 shall include-- 7i7 an analysis of the estimated performance of the local board in carrying out the proposed services and activities under the subgrant-- 7,i7 based on-- 7aa7 primary indicators of performance described in section #aaf7;c77#a77;,a77i7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cada7;c77#a77;,a77i71 to assess estimated effectiveness of the proposed services and activities1 including the estimated number of individuals with a substance use disorder who may be served by the proposed services and activities2 7bb7 the record of the local board in serving individuals with a barrier to employment2 and 7cc7 the ability of the local board to establish a participating partnership2 and 7,,ii7 which may include or utilize-- 7aa7 data from the ,national ,center for ,health ,statistics of the ,centers for ,disease ,control and ,prevention2 7bb7 data from the ,center for ,behavioral ,health ,statistics and ,quality of the ,substance ,abuse and ,mental ,health ,services ,administration2 7cc7 ,state vital statistics2 7dd7 municipal police department records2 7ee7 reports from local coroners2 or 7ff7 other relevant data2 and 7ii7 in the case of a local board proposing to serve a population described in subsection 7e77#b77;,b71 a demonstration of the workforce shortage in the professional area to be addressed under the subgrant 7which may include substance use disorder treatment and related services1 non-addictive pain therapy and pain management services1 mental health care treatment services1 emergency response services1 or mental health care71 which shall include information that can demonstrate such a shortage1 such as-- 7,i7 the distance between-- 7aa7 communities affected by opioid abuse or another substance use disorder2 and 7bb7 facilities or professionals offering services in the professional area2 or 7,,ii7 the maximum capacity of facilities or professionals to serve individuals in an affected community1 or increases in arrests related to opioid or another substance use disorder1 overdose deaths1 or nonfatal overdose emergencies in the community4 7e7 ,subgrant services and activities 7#a7 ,in general ,each local board that receives a subgrant under subsection 7d7 shall carry out the services and activities described in this subsection through a participating partnership4 7#b7 ,selection of ,population to be served ,a participating partnership shall elect to provide services and activities under the subgrant to one or both of the following populations of workers3 7,a7 ,workers1 including dislocated workers1 individuals with barriers to employment1 new entrants in the workforce1 or incumbent workers 7employed or underemployed71 each of whom-- 7i7 is directly or indirectly affected by a high rate of a substance use disorder2 and 7ii7 voluntarily confirms that the worker1 or a friend or family member of the worker1 has a history of opioid abuse or another substance use disorder4 7,b7 ,workers1 including dislocated workers1 individuals with barriers to employment1 new entrants in the workforce1 or incumbent workers 7employed or underemployed71 who-- 7i7 seek to transition to professions that support individuals with a substance use disorder or at risk for developing such disorder1 such as professions that provide-- 7,i7 substance use disorder treatment and related services2 7,,ii7 services offered through providers of peer recovery support services2 7,,iii7 non-addictive pain therapy and pain management services2 7,,iv7 emergency response services2 or 7,v7 mental health care2 and 7ii7 need new or upgraded skills to better serve such a population of struggling or at-risk individuals4 7#c7 ,services and activities ,each participating partnership shall use funds available through a subgrant under this subsection to carry out #a or more of the following3 7,a7 ,engaging employers ,engaging with employers to-- 7i7 learn about the skill and hiring requirements of employers2 7ii7 learn about the support needed by employers to hire and retain program participants1 and other individuals with a substance use disorder1 and the support needed by such employers to obtain their commitment to testing creative solutions to employing program participants and such individuals2 7iii7 connect employers and workers to on-the-job or customized training programs before or after layoff to help facilitate reemployment2 7iv7 connect employers with an education provider to develop classroom instruction to complement on-the-job learning for program participants and such individuals2 7v7 help employers develop the curriculum design of a work-based learning program for program participants and such individuals2 7vi7 help employers employ program participants or such individuals engaging in a work-based learning program for a transitional period before hiring such a program participant or individual for full-time employment of not less than #cj hours a week2 or 7vii7 connect employers to program participants receiving concurrent outpatient treatment and job training services4 7,b7 ,screening services ,providing screening services1 which may include-- 7i7 using an evidence-based screening method to screen each individual seeking participation in the pilot program to determine whether the individual has a substance use disorder2 7ii7 conducting an assessment of each such individual to determine the services needed for such individual to obtain or retain employment1 including an assessment of strengths and general work readiness2 or 7iii7 accepting walk-ins or referrals from employers1 labor organizations1 or other entities recommending individuals to participate in such program4 7,c7 ,individual treatment and employment plan ,developing an individual treatment and employment plan for each program participant-- 7i7 in coordination1 as appropriate1 with other programs serving the participant such as the core programs within the workforce development system under the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #caja et seq472 and 7ii7 which shall include providing a case manager to work with each participant to develop the plan1 which may include-- 7,i7 identifying employment and career goals2 7,,ii7 exploring career pathways that lead to in-demand industries and sectors1 as determined by the ,state board and the head of the ,state workforce agency or1 as applicable1 the ,tribal entity2 7,,iii7 setting appropriate achievement objectives to attain the employment and career goals identified under subclause 7,i72 or 7,,iv7 developing the appropriate combination of services to enable the participant to achieve the employment and career goals identified under subclause 7,i74 7,d7 ,outpatient treatment and recovery care ,in the case of a participating partnership serving program participants described in paragraph 7#b77;,a7 with a substance use disorder1 providing individualized and group outpatient treatment and recovery services for such program participants that are offered during the day and evening1 and on weekends4 ,such treatment and recovery services-- 7i7 shall be based on a model that utilizes combined behavioral interventions and other evidence-based or evidence-informed interventions2 and 7ii7 may include additional services such as-- 7,i7 health1 mental health1 addiction1 or other forms of outpatient treatment that may impact a substance use disorder and co-occurring conditions2 7,,ii7 drug testing for a current substance use disorder prior to enrollment in career or training services or prior to employment2 7,,iii7 linkages to community services1 including services offered by partner organizations designed to support program participants2 or 7,,iv7 referrals to health care1 including referrals to substance use disorder treatment and mental health services4 7,e7 ,supportive services ,providing supportive services1 which shall include services such as-- 7i7 coordinated wraparound services to provide maximum support for program participants to assist the program participants in maintaining employment and recovery for not less than #ab months1 as appropriate2 7ii7 assistance in establishing eligibility for assistance under ,federal1 ,state1 ,tribal1 and local programs providing health services1 mental health services1 vocational services1 housing services1 transportation services1 social services1 or services through early childhood education programs 7as defined in section #ajc of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajjc772 7iii7 services offered through providers of peer recovery support services2 7iv7 networking and mentorship opportunities2 or 7v7 any supportive services determined necessary by the local board4 7,f7 ,career and job training services ,offering career services and training services1 and related services1 concurrently or sequentially with the services provided under subparagraphs 7,b7 through 7,e74 ,such services shall include the following3 7i7 ,services provided to program participants who are in a pre-employment stage of the program1 which may include-- 7,i7 initial education and skills assessments2 7,,ii7 traditional classroom training funded through individual training accounts under chapter #c of subtitle ,b of title ,i of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #caga et seq472 7,,iii7 services to promote employability skills such as punctuality1 personal maintenance skills1 and professional conduct2 7,,iv7 in-depth interviewing and evaluation to identify employment barriers and to develop individual employment plans2 7,v7 career planning that includes-- 7aa7 career pathways leading to in-demand1 high-wage jobs2 and 7bb7 job coaching1 job matching1 and job placement services2 7,,vi7 provision of payments and fees for employment and training-related applications1 tests1 and certifications2 or 7,,vii7 any other appropriate career service or training service described in section #acd7;c7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cagd7;c774 7ii7 ,services provided to program participants during their first #f months of employment to ensure job retention1 which may include-- 7,i7 case management and support services1 including a continuation of the services described in clause 7i72 7,,ii7 a continuation of skills training1 and career and technical education1 described in clause 7i7 that is conducted in collaboration with the employers of such participants2 7,,iii7 mentorship services and job retention support for such participants2 or 7,,iv7 targeted training for managers and workers working with such participants 7such as mentors71 and human resource representatives in the business in which such participants are employed4 7iii7 ,services to assist program participants in maintaining employment for not less than #ab months1 as appropriate4 7,g7 ,proven and promising practices ,leading efforts in the service area to identify and promote proven and promising strategies and initiatives for meeting the needs of employers and program participants4 7#d7 ,limitations ,a participating partnership may not use-- 7,a7 more than #aj percent of the funds received under a subgrant under subsection 7d7 for the administrative costs of the partnership2 7,b7 more than #aj percent of the funds received under such subgrant for the provision of treatment and recovery services1 as described in paragraph 7#c77;,d72 and 7,c7 more than #aj percent of the funds received under such subgrant for the provision of supportive services described in paragraph 7#c77;,e7 to program participants4 7f7 ,performance accountability 7#a7 ,reports ,the ,secretary shall establish quarterly reporting requirements for recipients of grants and subgrants under this section that1 to the extent practicable1 are based on the performance accountability system under section #aaf of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cada7 and1 in the case of a grant awarded to an eligible entity described in subsection 7a77#c77;,c71 section #aff7;h7 of such ,act 7#bi ,u4,s4,c4 #cbba7;h771 including the indicators described in subsection 7c77#a77;,a77i7 of such section #aaf and the requirements for local area performance reports under subsection 7d7 of such section #aaf4 7#b7 ,evaluations 7,a7 ,authority to enter into agreements ,the ,secretary shall ensure that an independent evaluation is conducted on the pilot program carried out under this section to determine the impact of the program on employment of individuals with substance use disorders4 ,the ,secretary shall enter into an agreement with eligible entities receiving grants under this section to pay for all or part of such evaluation4 7,b7 ,methodologies to be used ,the independent evaluation required under this paragraph shall use experimental designs using random assignment or1 when random assignment is not feasible1 other reliable1 evidence-based research methodologies that allow for the strongest possible causal inferences4 7g7 ,funding 7#a7 ,covered fiscal year ,in this subsection1 the term covered fiscal year means any of fiscal years #bjai through #bjbc4 7#b7 ,using funding for national dislocated worker grants ,subject to paragraph 7#d7 and notwithstanding section #acb7;a77#b77;,a7 and subtitle ,d of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cagb7;a77#b77;,a71 #cbba et seq471 the ,secretary may use1 to carry out the pilot program under this section for a covered fiscal year-- 7,a7 funds made available to carry out section #agj of such ,act 7#bi ,u4,s4,c4 #cbbe7 for that fiscal year2 7,b7 funds made available to carry out section #agj of such ,act that remain available for that fiscal year2 and 7,c7 funds that remain available under section #agb7;f7 of such ,act 7#bi ,u4,s4,c4 #cbbg7;f774 7#c7 ,availability of funds ,funds appropriated under section #acf7;c7 of such ,act 7#bi ,u4,s4,c4 #caha7;c77 and made available to carry out section #agj of such ,act for a fiscal year shall remain available for use under paragraph 7#b7 for a subsequent fiscal year until expended4 7#d7 ,limitation ,the ,secretary may not use more than #ajj1jjj1jjj of the funds described in paragraph 7#b7 for any covered fiscal year under this section4 ,d ,peer support counseling program for women veterans #hjea4 ,peer support counseling program for women veterans 7a7 ,in general ,section #agbj;,f7j7 of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new paragraph3 7#d7 7,a7 ,as part of the counseling program under this subsection1 the ,secretary shall emphasize appointing peer support counselors for women veterans4 ,to the degree practicable1 the ,secretary shall seek to recruit women peer support counselors with expertise in-- 7i7 female gender-specific issues and services2 7ii7 the provision of information about services and benefits provided under laws administered by the ,secretary2 or 7iii7 employment mentoring4 7,b7 ,to the degree practicable1 the ,secretary shall emphasize facilitating peer support counseling for women veterans who are eligible for counseling and services under section #agbj;,d of this title1 have post-traumatic stress disorder or suffer from another mental health condition1 are homeless or at risk of becoming homeless1 or are otherwise at increased risk of suicide1 as determined by the ,secretary4 7,c7 ,the ,secretary shall conduct outreach to inform women veterans about the program and the assistance available under this paragraph4 7,d7 ,in carrying out this paragraph1 the ,secretary shall coordinate with such community organizations1 ,state and local governments1 institutions of higher education1 chambers of commerce1 local business organizations1 organizations that provide legal assistance1 and other organizations as the ,secretary considers appropriate4 7,e7 ,in carrying out this paragraph1 the ,secretary shall provide adequate training for peer support counselors1 including training carried out under the national program of training required by section #cjd7;c7 of the ,caregivers and ,veterans ,omnibus ,health ,services ,act of #bjaj 7#ch ,u4,s4,c4 #agab;,a note74 4 7b7 ,funding ,the ,secretary of ,veterans ,affairs shall carry out paragraph 7#d7 of section #agbj;,f7j7 of title #ch1 ,united ,states ,code1 as added by subsection 7a71 using funds otherwise made available to the ,secretary4 ,no additional funds are authorized to be appropriated by reason of such paragraph4 7c7 ,report to ,congress ,not later than #b years after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall submit to the ,committees on ,veterans' ,affairs of the ,senate and ,house of ,representatives a report on the peer support counseling program under section #agbj;,f7j7 of title #ch1 ,united ,states ,code1 as amended by this section4 ,such report shall include-- 7#a7 the number of peer support counselors in the program2 7#b7 an assessment of the effectiveness of the program2 and 7#c7 a description of the oversight of the program4 ,e ,treating ,barriers to ,prosperity #hjfa4 ,short title ,this subtitle may be cited as the ,treating ,barriers to ,prosperity ,act of #bjah4 #hjfb4 ,drug abuse mitigation initiative 7a7 ,in general ,chapter #ade of title #dj1 ,united ,states ,code1 is amended by inserting after section #adeji the following3 #adeaj4 ,drug abuse mitigation initiative 7a7 ,in general ,the ,appalachian ,regional ,commission may provide technical assistance to1 make grants to1 enter into contracts with1 or otherwise provide amounts to individuals or entities in the ,appalachian region for projects and activities to address drug abuse1 including opioid abuse1 in the region1 including projects and activities-- 7#a7 to facilitate the sharing of best practices among ,states1 counties1 and other experts in the region with respect to reducing such abuse2 7#b7 to initiate or expand programs designed to eliminate or reduce the harm to the workforce and economic growth of the region that results from such abuse2 7#c7 to attract and retain relevant health care services1 businesses1 and workers2 and 7#d7 to develop relevant infrastructure1 including broadband infrastructure that supports the use of telemedicine4 7b7 ,limitation on available amounts ,of the cost of any activity eligible for a grant under this section-- 7#a7 not more than #ej percent may be provided from amounts appropriated to carry out this section2 and 7#b7 notwithstanding paragraph 7#a7-- 7,a7 in the case of a project to be carried out in a county for which a distressed county designation is in effect under section #adebf1 not more than #hj percent may be provided from amounts appropriated to carry out this section2 and 7,b7 in the case of a project to be carried out in a county for which an at-risk designation is in effect under section #adebf1 not more than #gj percent may be provided from amounts appropriated to carry out this section4 7c7 ,sources of assistance ,subject to subsection 7b71 a grant provided under this section may be provided from amounts made available to carry out this section in combination with amounts made available-- 7#a7 under any other ,federal program 7subject to the availability of subsequent appropriations72 or 7#b7 from any other source4 7d7 ,federal share ,notwithstanding any provision of law limiting the ,federal share under any other ,federal program1 amounts made available to carry out this section may be used to increase that ,federal share1 as the ,appalachian ,regional ,commission determines to be appropriate4 4 7b7 ,clerical amendment ,the analysis for chapter #ade of title #dj1 ,united ,states ,code1 is amended by inserting after the item relating to section #adeji the following3 #adeaj4 ,drug abuse mitigation initiative4 4 ,f ,pilot program to help individuals in recovery from a substance use disorder become stably housed #hjga4 ,pilot program to help individuals in recovery from a substance use disorder become stably housed 7a7 ,authorization of appropriations ,there is authorized to be appropriated under this section such sums as may be necessary for each of fiscal years #bjai through #bjbc for assistance to ,states to provide individuals in recovery from a substance use disorder stable1 temporary housing for a period of not more than #b years or until the individual secures permanent housing1 whichever is earlier4 7b7 ,allocation of appropriated amounts 7#a7 ,in general ,the amounts appropriated or otherwise made available to ,states under this section shall be allocated based on a funding formula established by the ,secretary of ,housing and ,urban ,development 7referred to in this section as the ,secretary7 not later than #fj days after the date of enactment of this ,act4 7#b7 ,criteria 7,a7 ,in general ,the funding formula required under paragraph 7#a7 shall ensure that any amounts appropriated or otherwise made available under this section are allocated to ,states with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate1 according to the ,centers for ,disease ,control and ,prevention4 7,b7 ,priority 7i7 ,in general ,among such ,states1 priority shall be given to ,states with the greatest need1 as such need is determined by the ,secretary based on the following factors1 and weighting such factors as described in clause 7ii73 7,i7 ,the highest average rates of unemployment based on data provided by the ,bureau of ,labor ,statistics for calendar years #bjac through #bjag4 7,,ii7 ,the lowest average labor force participation rates based on data provided by the ,bureau of ,labor ,statistics for calendar years #bjac through #bjag4 7,,iii7 ,the highest age-adjusted rates of drug overdose deaths based on data from the ,centers for ,disease ,control and ,prevention4 7ii7 ,weighting ,the factors described in clause 7i7 shall be weighted as follows3 7,i7 ,the rate described in clause 7i77,i7 shall be weighted at #ae percent4 7,,ii7 ,the rate described in clause 7i77,,ii7 shall be weighted at #ae percent4 7,,iii7 ,the rate described in clause 7i77,,iii7 shall be weighted at #gj percent4 7#c7 ,distribution ,amounts appropriated or otherwise made available under this section shall be distributed according to the funding formula established by the ,secretary under paragraph 7#a7 not later than #cj days after the establishment of such formula4 7c7 ,use of funds 7#a7 ,in general ,any ,state that receives amounts pursuant to this section shall expend at least #cj percent of such funds within one year of the date funds become available to the grantee for obligation4 7#b7 ,priority ,any ,state that receives amounts pursuant to this section shall distribute such amounts giving priority to entities with the greatest need and ability to deliver effective assistance in a timely manner4 7#c7 ,administrative costs ,any ,state that receives amounts pursuant to this section may use up to #e percent of any grant for administrative costs4 7d7 ,rules of construction 7#a7 ,in general ,except as otherwise provided by this section1 amounts appropriated1 or amounts otherwise made available to ,states under this section shall be treated as though such funds were community development block grant funds under title ,i of the ,housing and ,community ,development ,act of #aigd 7#db ,u4,s4,c4 #ecja et seq474 7#b7 ,no match ,no matching funds shall be required in order for a ,state to receive any amounts under this section4 7e7 ,authority to waive or specify alternative requirements 7#a7 ,in general ,in administering any amounts appropriated or otherwise made available under this section1 the ,secretary may waive or specify alternative requirements to any provision under title ,i of the ,housing and ,community ,development ,act of #aigd 7#db ,u4,s4,c4 #ecja et seq47 except for requirements related to fair housing1 nondiscrimination1 labor standards1 the environment1 and requirements that activities benefit persons of low- and moderate-income1 upon a finding that such a waiver is necessary to expedite or facilitate the use of such funds4 7#b7 ,notice of intent ,the ,secretary shall provide written notice of its intent to exercise the authority to specify alternative requirements under paragraph 7#a7 to the ,committee on ,banking1 ,housing1 and ,urban ,affairs of the ,senate and the ,committee on ,financial ,services of the ,house of ,representatives not later than #ae business days before such exercise of authority occurs4 7#c7 ,notice to the public ,the ,secretary shall provide written notice of its intent to exercise the authority to specify alternative requirements under paragraph 7#a7 to the public via notice1 on the internet website of the ,department of ,housing and ,urban ,development1 and by other appropriate means1 not later than #ae business days before such exercise of authority occurs4 7f7 ,technical assistance ,for the #b-year period following the date of enactment of this ,act1 the ,secretary may use not more than #b percent of the funds made available under this section for technical assistance to grantees4 7g7 ,state ,for purposes of this section the term ,state includes any ,state as defined in section #ajb of the ,housing and ,community ,development ,act of #aigd 7#db ,u4,s4,c4 #ecjb7 and the ,district of ,columbia4 ,g ,human ,services #hjha4 ,supporting family-focused residential treatment 7a7 ,definitions ,in this section3 7#a7 ,family-focused residential treatment program ,the term family-focused residential treatment program means a trauma-informed residential program primarily for substance use disorder treatment for pregnant and postpartum women and parents and guardians that allows children to reside with such women or their parents or guardians during treatment to the extent appropriate and applicable4 7#b7 ,medicaid program ,the term ,medicaid program means the program established under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#d7 ,title ,,iv-,e program ,the term title ,,iv-,e program means the program for foster care1 prevention1 and permanency established under part ,e of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fgj et seq474 7b7 ,guidance on family-focused residential treatment programs 7#a7 ,in general ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary1 in consultation with divisions of the ,department of ,health and ,human ,services administering substance use disorder or child welfare programs1 shall develop and issue guidance to ,states identifying opportunities to support family-focused residential treatment programs for the provision of substance use disorder treatment4 ,before issuing such guidance1 the ,secretary shall solicit input from representatives of ,states1 health care providers with expertise in addiction medicine1 obstetrics and gynecology1 neonatology1 child trauma1 and child development1 health plans1 recipients of family-focused treatment services1 and other relevant stakeholders4 7#b7 ,additional requirements ,the guidance required under paragraph 7#a7 shall include descriptions of the following3 7,a7 ,existing opportunities and flexibilities under the ,medicaid program1 including under waivers authorized under section #aaae or #aiae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae1 #acifn71 for ,states to receive ,federal ,medicaid funding for the provision of substance use disorder treatment for pregnant and postpartum women and parents and guardians and1 to the extent applicable1 their children1 in family-focused residential treatment programs4 7,b7 ,how ,states can employ and coordinate funding provided under the ,medicaid program1 the title ,,iv-,e program1 and other programs administered by the ,secretary to support the provision of treatment and services provided by a family-focused residential treatment facility such as substance use disorder treatment and services1 including medication-assisted treatment1 family1 group1 and individual counseling1 case management1 parenting education and skills development1 the provision1 assessment1 or coordination of care and services for children1 including necessary assessments and appropriate interventions1 non-emergency transportation for necessary care provided at or away from a program site1 transitional services and supports for families leaving treatment1 and other services4 7,c7 ,how ,states can employ and coordinate funding provided under the ,medicaid program and the title ,,iv-,e program 7including as amended by the ,family ,first ,prevention ,services ,act enacted under title ,,vii of division ,e of ,public ,law #aae-abc1 and particularly with respect to the authority under subsections 7a77#b77;,c7 and 7j7 of section #dgb and section #dgd7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fgb1 #fgd7;a77#a77 7as amended by section #ejgab of ,public ,law #aae-abc7 to provide foster care maintenance payments for a child placed with a parent who is receiving treatment in a licensed residential family-based treatment facility for a substance use disorder7 to support placing children with their parents in family-focused residential treatment programs4 #hjhb4 ,improving recovery and reunifying families 7a7 ,family ,recovery and ,reunification ,program ,replication ,project ,section #dce of the ,social ,security ,act 7#db ,u4,s4,c4 #fbi;e7 is amended by adding at the end the following3 7e7 ,family ,recovery and ,reunification ,program ,replication ,project 7#a7 ,purpose ,the purpose of this subsection is to provide resources to the ,secretary to support the conduct and evaluation of a family recovery and reunification program replication project 7referred to in this subsection as the project7 and to determine the extent to which such programs may be appropriate for use at different intervention points 7such as when a child is at risk of entering foster care or when a child is living with a guardian while a parent is in treatment74 ,the family recovery and reunification program conducted under the project shall use a recovery coach model that is designed to help reunify families and protect children by working with parents or guardians with a substance use disorder who have temporarily lost custody of their children4 7#b7 ,program components ,the family recovery and reunification program conducted under the project shall adhere closely to the elements and protocol determined to be most effective in other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children and1 consistent with such elements and protocol1 shall provide such items and services as-- 7,a7 assessments to evaluate the needs of the parent or guardian2 7,b7 assistance in receiving the appropriate benefits to aid the parent or guardian in recovery2 7,c7 services to assist the parent or guardian in prioritizing issues identified in assessments1 establishing goals for resolving such issues that are consistent with the goals of the treatment provider1 child welfare agency1 courts1 and other agencies involved with the parent or guardian or their children1 and making a coordinated plan for achieving such goals2 7,d7 home visiting services coordinated with the child welfare agency and treatment provider involved with the parent or guardian or their children2 7,e7 case management services to remove barriers for the parent or guardian to participate and continue in treatment1 as well as to re-engage a parent or guardian who is not participating or progressing in treatment2 7,f7 access to services needed to monitor the parent's or guardian's compliance with program requirements2 7,g7 frequent reporting between the treatment provider1 child welfare agency1 courts1 and other agencies involved with the parent or guardian or their children to ensure appropriate information on the parent's or guardian's status is available to inform decision-making2 and 7,h7 assessments and recommendations provided by a recovery coach to the child welfare caseworker responsible for documenting the parent's or guardian's progress in treatment and recovery as well as the status of other areas identified in the treatment plan for the parent or guardian1 including a recommendation regarding the expected safety of the child if the child is returned to the custody of the parent or guardian that can be used by the caseworker and a court to make permanency decisions regarding the child4 7#c7 ,responsibilities of the secretary 7,a7 ,in general ,the ,secretary shall1 through a grant or contract with #a or more entities1 conduct and evaluate the family recovery and reunification program under the project4 7,b7 ,requirements ,in identifying #a or more entities to conduct the evaluation of the family recovery and reunification program1 the ,secretary shall-- 7i7 determine that the area or areas in which the program will be conducted have sufficient substance use disorder treatment providers and other resources 7other than those provided with funds made available to carry out the project7 to successfully conduct the program2 7ii7 determine that the area or areas in which the program will be conducted have enough potential program participants1 and will serve a sufficient number of parents or guardians and their children1 so as to allow for the formation of a control group1 evaluation results to be adequately powered1 and preliminary results of the evaluation to be available within #d years of the program's implementation2 7iii7 provide the entity or entities with technical assistance for the program design1 including by working with #a or more entities that are or have been involved in recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children so as to make sure the program conducted under the project adheres closely to the elements and protocol determined to be most effective in such other recovery coaching programs2 7iv7 assist the entity or entities in securing adequate coaching1 treatment1 child welfare1 court1 and other resources needed to successfully conduct the family recovery and reunification program under the project2 and 7v7 ensure the entity or entities will be able to monitor the impacts of the program in the area or areas in which it is conducted for at least #e years after parents or guardians and their children are randomly assigned to participate in the program or to be part of the program's control group4 7#d7 ,evaluation requirements 7,a7 ,in general ,the ,secretary1 in consultation with the entity or entities conducting the family recovery and reunification program under the project1 shall conduct an evaluation to determine whether the program has been implemented effectively and resulted in improvements for children and families4 ,the evaluation shall have #c components3 a pilot phase1 an impact study1 and an implementation study4 7,b7 ,pilot phase ,the pilot phase component of the evaluation shall consist of the ,secretary providing technical assistance to the entity or entities conducting the family recovery and reunification program under the project to ensure-- 7i7 the program's implementation adheres closely to the elements and protocol determined to be most effective in other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children2 and 7ii7 random assignment of parents or guardians and their children to be participants in the program or to be part of the program's control group is being carried out4 7,c7 ,impact study ,the impact study component of the evaluation shall determine the impacts of the family recovery and reunification program conducted under the project on the parents and guardians and their children participating in the program4 ,the impact study component shall-- 7i7 be conducted using an experimental design that uses a random assignment research methodology2 7ii7 consistent with previous studies of other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children1 measure outcomes for parents and guardians and their children over multiple time periods1 including for a period of #e years2 and 7iii7 include measurements of family stability and parent1 guardian1 and child safety for program participants and the program control group that are consistent with measurements of such factors for participants and control groups from previous studies of other recovery coaching programs so as to allow results of the impact study to be compared with the results of such prior studies1 including with respect to comparisons between program participants and the program control group regarding-- 7,i7 safe family reunification2 7,,ii7 time to reunification2 7,,iii7 permanency 7such as through measures of reunification1 adoption1 or placement with guardians72 7,,iv7 safety 7such as through measures of subsequent maltreatment72 7,v7 parental or guardian treatment persistence and engagement2 7,,vi7 parental or guardian substance use2 7,,vii7 juvenile delinquency2 7,,viii7 cost2 and 7,,ix7 other measurements agreed upon by the ,secretary and the entity or entities operating the family recovery and reunification program under the project4 7,d7 ,implementation study ,the implementation study component of the evaluation shall be conducted concurrently with the conduct of the impact study component and shall include1 in addition to such other information as the ,secretary may determine1 descriptions and analyses of-- 7i7 the adherence of the family recovery and reunification program conducted under the project to other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children2 and 7ii7 the difference in services received or proposed to be received by the program participants and the program control group4 7,e7 ,report ,the ,secretary shall publish on an internet website maintained by the ,secretary the following information3 7i7 ,a report on the pilot phase component of the evaluation4 7ii7 ,a report on the impact study component of the evaluation4 7iii7 ,a report on the implementation study component of the evaluation4 7iv7 ,a report that includes-- 7,i7 analyses of the extent to which the program has resulted in increased reunifications1 increased permanency1 case closures1 net savings to the ,state or ,states involved 7taking into account both costs borne by ,states and the ,federal government71 or other outcomes1 or if the program did not produce such outcomes1 an analysis of why the replication of the program did not yield such results2 7,,ii7 if1 based on such analyses1 the ,secretary determines the program should be replicated1 a replication plan2 and 7,,iii7 such recommendations for legislation and administrative action as the ,secretary determines appropriate4 7#e7 ,appropriation ,in addition to any amounts otherwise made available to carry out this subpart1 out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there are appropriated #ae1jjj1jjj for fiscal year #bjai to carry out the project1 which shall remain available through fiscal year #bjbf4 4 7b7 ,clarification of payer of last resort application to child welfare prevention and family services ,section #dga7;e77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7;e77#aj771 as added by section #ejgaa7;a77#b7 of division ,e of ,public ,law #aae-abc1 is amended-- 7#a7 in subparagraph 7,a71 by inserting 1 nor shall the provision of such services or programs be construed to permit the ,state to reduce medical or other assistance available to a recipient of such services or programs after under this ,act2 and 7#b7 by adding at the end the following3 7,c7 ,payer of last resort ,in carrying out its responsibilities to ensure access to services or programs under this subsection1 the ,state agency shall not be considered to be a legally liable third party for purposes of satisfying a financial commitment for the cost of providing such services or programs with respect to any individual for whom such cost would have been paid for from another public or private source but for the enactment of this subsection 7except that whenever considered necessary to prevent a delay in the receipt of appropriate early intervention services by a child or family in a timely fashion1 funds provided under section #dgd7;a77#f7 may be used to pay the provider of services or programs pending reimbursement from the public or private source that has ultimate responsibility for the payment74 4 7c7 ,effective date ,the amendments made by subsection 7b7 shall take effect as if included in section #ejgaa of division ,e of ,public ,law #aae-abc4 #hjhc4 ,building capacity for family-focused residential treatment 7a7 ,definitions ,in this section3 7#a7 ,eligible entity ,the term eligible entity means a ,state1 county1 local1 or tribal health or child welfare agency1 a private nonprofit organization1 a research organization1 a treatment service provider1 an institution of higher education 7as defined under section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja771 or another entity specified by the ,secretary4 7#b7 ,family-focused residential treatment program ,the term family-focused residential treatment program means a trauma-informed residential program primarily for substance use disorder treatment for pregnant and postpartum women and parents and guardians that allows children to reside with such women or their parents or guardians during treatment to the extent appropriate and applicable4 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7b7 ,support for the development of evidence-based family-focused residential treatment programs 7#a7 ,authority to award grants ,the ,secretary shall award grants to eligible entities for purposes of developing1 enhancing1 or evaluating family-focused residential treatment programs to increase the availability of such programs that meet the requirements for promising1 supported1 or well-supported practices specified in section #dga7;e77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7;e77#d77;,c777 7as added by the ,family ,first ,prevention ,services ,act enacted under title ,,vii of division ,e of ,public ,law #aae-abc74 7#b7 ,evaluation requirement ,the ,secretary shall require any evaluation of a family-focused residential treatment program by an eligible entity that uses funds awarded under this section for all or part of the costs of the evaluation be designed to assist in the determination of whether the program may qualify as a promising1 supported1 or well-supported practice in accordance with the requirements of such section #dga7;e77#d77;,c74 7c7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary to carry out this section1 #bj1jjj1jjj for fiscal year #bjai1 which shall remain available through fiscal year #bjbc4 ,h ,reauthorizing and ,extending ,grants for ,recovery from ,opioid ,use ,programs #hjia4 ,short title ,this subtitle may be cited as the ,reauthorizing and ,extending ,grants for ,recovery from ,opioid ,use ,programs ,act of #bjah or the ,,regroup ,act of #bjah4 #hjib4 ,reauthorization of the comprehensive opioid abuse grant program ,section #ajja7;a77#bg7 of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajbfa7;a77#bg77 is amended by striking through #bjba and inserting and #bjah1 and #ccj1jjj1jjj for each of fiscal years #bjai through #bjbc4 ,i ,fighting ,opioid ,abuse in ,transportation #haja4 ,short title ,this subtitle may be cited as the ,fighting ,opioid ,abuse in ,transportation ,act4 #hajb4 ,alcohol and controlled substance testing of mechanical employees 7a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,transportation shall publish a rule in the ,federal ,register revising the regulations promulgated under section #bjadj of title #di1 ,united ,states ,code1 to cover all employees of railroad carriers who perform mechanical activities4 7b7 ,definition of mechanical activities ,for the purposes of the rule under subsection 7a71 the ,secretary shall define the term mechanical activities by regulation4 #hajc4 ,department of ,transportation public drug and alcohol testing database 7a7 ,in general ,subject to subsection 7c71 the ,secretary of ,transportation shall-- 7#a7 not later than ,march #ca1 #bjai1 establish and make publicly available on its website a database of the drug and alcohol testing data reported by employers for each mode of transportation2 and 7#b7 update the database annually4 7b7 ,contents ,the database under subsection 7a7 shall include1 for each mode of transportation-- 7#a7 the total number of drug and alcohol tests by type of substance tested2 7#b7 the drug and alcohol test results by type of substance tested2 7#c7 the reason for the drug or alcohol test1 such as pre-employment1 random1 post-accident1 reasonable suspicion or cause1 return-to-duty1 or follow-up1 by type of substance tested2 and 7#d7 the number of individuals who refused testing4 7c7 ,commercially sensitive data ,the ,department of ,transportation shall not release any commercially sensitive data or personally identifiable data furnished by an employer under this section unless the data is aggregated or otherwise in a form that does not identify the employer providing the data4 7d7 ,savings clause ,nothing in this section may be construed as limiting or otherwise affecting the requirements of the ,secretary of ,transportation to adhere to requirements applicable to confidential business information and sensitive security information1 consistent with applicable law4 #hajd4 ,,gao report on ,department of ,transportation's collection and use of drug and alcohol testing data 7a7 ,in general ,not later than #b years after the date the ,department of ,transportation public drug and alcohol testing database is established under section #hajc1 the ,comptroller ,general of the ,united ,states shall-- 7#a7 review the ,department of ,transportation ,drug and ,alcohol ,testing ,management ,information ,system2 and 7#b7 submit to the ,committee on ,commerce1 ,science1 and ,transportation of the ,senate and the ,committee on ,transportation and ,infrastructure of the ,house of ,representatives a report on the review1 including recommendations under subsection 7c74 7b7 ,contents ,the report under subsection 7a7 shall include-- 7#a7 a description of the process the ,department of ,transportation uses to collect and record drug and alcohol testing data submitted by employers for each mode of transportation2 7#b7 an assessment of whether and1 if so1 how the ,department of ,transportation uses the data described in paragraph 7#a7 in carrying out its responsibilities2 and 7#c7 an assessment of the ,department of ,transportation public drug and alcohol testing database under section #hajc4 7c7 ,recommendations ,the report under subsection 7a7 may include recommendations regarding-- 7#a7 how the ,department of ,transportation can best use the data described in subsection 7b77#a72 7#b7 any improvements that could be made to the process described in subsection 7b77#a72 7#c7 whether and1 if so1 how the ,department of ,transportation public drug and alcohol testing database under section #hajc could be made more effective2 and 7#d7 such other recommendations as the ,comptroller ,general considers appropriate4 #haje4 ,transportation ,workplace ,drug and ,alcohol ,testing ,program2 addition of fentanyl and other substances 7a7 ,mandatory ,guidelines for ,federal ,workplace ,drug ,testing ,programs 7#a7 ,in general ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7,a7 determine whether a revision of the ,mandatory ,guidelines for ,federal ,workplace ,drug ,testing ,programs to expand the opiate category on the list of authorized substance testing to include fentanyl is justified1 based on the reliability and cost-effectiveness of available testing2 and 7,b7 consider whether to include with the determination under subparagraph 7,a7 a separate determination on whether a revision of the ,mandatory ,guidelines for ,federal ,workplace ,drug ,testing ,programs to expand the list of substances authorized for testing to include any other drugs or other substances listed in schedule ,i and ,,ii of section #bjb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hab7 is justified based on the criteria described in subparagraph 7,a74 7#b7 ,revision of guidelines ,if an expansion of the substance list is determined to be justified under paragraph 7#a71 the ,secretary of ,health and ,human ,services shall-- 7,a7 notify the ,committee on ,commerce1 ,science1 and ,transportation of the ,senate and the ,committee on ,transportation and ,infrastructure of the ,house of ,representatives of the determination2 and 7,b7 publish in the ,federal ,register1 not later than #ah months after the date of the determination under that paragraph1 a final notice of the revision of the ,mandatory ,guidelines for ,federal ,workplace ,drug ,testing ,programs to expand the list of substances authorized to be tested to include the substance or substances determined to be justified for inclusion4 7#c7 ,report ,if an expansion of the substance list is determined not to be justified under paragraph 7#a71 the ,secretary of ,health and ,human ,services shall submit to the ,committee on ,commerce1 ,science1 and ,transportation of the ,senate and the ,committee on ,transportation and ,infrastructure of the ,house of ,representatives a report explaining1 in detail1 the reasons the expansion of the list of authorized substances is not justified4 7b7 ,department of ,transportation drug-testing panel ,if an expansion is determined to be justified under subsection 7a77#a71 the ,secretary of ,transportation shall publish in the ,federal ,register1 not later than #ah months after the date the final notice is published under subsection 7a77#b71 a final rule revising part #dj of title #di1 ,code of ,federal ,regulations1 to include such substances in the ,department of ,transportation's drug-testing panel1 consistent with the ,mandatory ,guidelines for ,federal ,workplace ,drug ,testing ,programs as revised by the ,secretary of ,health and ,human ,services under subsection 7a74 7c7 ,savings provision ,nothing in this section may be construed as-- 7#a7 delaying the publication of the notices described in sections #hajf and #hajg of this ,act until the ,secretary of ,health and ,human ,services makes a determination or publishes a notice under this section2 or 7#b7 limiting or otherwise affecting any authority of the ,secretary of ,health and ,human ,services or the ,secretary of ,transportation to expand the list of authorized substance testing to include an additional substance4 #hajf4 ,status reports on hair testing guidelines 7a7 ,in general ,not later than #fj days after the date of enactment of this ,act1 and annually thereafter until the date that the ,secretary of ,health and ,human ,services publishes in the ,federal ,register a final notice of scientific and technical guidelines for hair testing in accordance with section #edjb7;b7 of the ,fixing ,america's ,surface ,transportation ,act 7,public ,law #aad-id2 #abi ,stat4 #acab71 the ,secretary of ,health and ,human ,services shall submit to the ,committee on ,commerce1 ,science1 and ,transportation of the ,senate and the ,committee on ,transportation and ,infrastructure of the ,house of ,representatives a report on-- 7#a7 the status of the hair testing guidelines2 7#b7 an explanation for why the hair testing guidelines have not been issued2 and 7#c7 an estimated date of completion of the hair testing guidelines4 7b7 ,requirement ,to the extent practicable and consistent with the objective of the hair testing described in subsection 7a7 to detect illegal or unauthorized use of substances by the individual being tested1 the final notice of scientific and technical guidelines under that subsection1 as determined by the ,secretary of ,health and ,human ,services1 shall eliminate the risk of positive test results1 of the individual being tested1 caused solely by the drug use of others and not caused by the drug use of the individual being tested4 #hajg4 ,mandatory ,guidelines for ,federal ,workplace ,drug ,testing ,programs using ,oral ,fluid 7a7 ,deadline ,not later than ,december #ca1 #bjah1 the ,secretary of ,health and ,human ,services shall publish in the ,federal ,register a final notice of the ,mandatory ,guidelines for ,federal ,workplace ,drug ,testing ,programs using ,oral ,fluid1 based on the notice of proposed mandatory guidelines published in the ,federal ,register on ,may #ae1 #bjae 7#id ,,fr #bhjed74 7b7 ,requirement ,to the extent practicable and consistent with the objective of the testing described in subsection 7a7 to detect illegal or unauthorized use of substances by the individual being tested1 the final notice of scientific and technical guidelines under that subsection1 as determined by the ,secretary of ,health and ,human ,services1 shall eliminate the risk of positive test results1 of the individual being tested1 caused solely by the drug use of others and not caused by the drug use of the individual being tested4 7c7 ,rule of construction ,nothing in this section may be construed as requiring the ,secretary of ,health and ,human ,services to reissue a notice of proposed mandatory guidelines to carry out subsection 7a74 #hajh4 ,electronic recordkeeping 7a7 ,deadline ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7#a7 ensure that each certified laboratory that requests approval for the use of completely paperless electronic ,federal ,drug ,testing ,custody and ,control ,forms from the ,national ,laboratory ,certification ,program's ,electronic ,custody and ,control ,form systems receives approval for those completely paperless electronic forms instead of forms that include any combination of electronic traditional handwritten signatures executed on paper forms2 and 7#b7 establish a deadline for a certified laboratory to request approval under paragraph 7#a74 7b7 ,savings clause ,nothing in this section may be construed as limiting or otherwise affecting any authority of the ,secretary of ,health and ,human ,services to grant approval to a certified laboratory for use of completely paperless electronic ,federal ,drug ,testing ,custody and ,control ,forms1 including to grant approval outside of the process under subsection 7a74 7c7 ,electronic signatures ,not later than #ah months after the date of the deadline under subsection 7a77#b71 the ,secretary of ,transportation shall issue a final rule revising part #dj of title #di1 ,code of ,federal ,regulations1 to authorize1 to the extent practicable1 the use of electronic signatures or digital signatures executed to electronic forms instead of traditional handwritten signatures executed on paper forms4 #haji4 ,status reports on ,commercial ,driver's ,license ,drug and ,alcohol ,clearinghouse 7a7 ,in general ,not later than #fj days after the date of enactment of this ,act1 and annually thereafter until the compliance date1 the ,administrator of the ,federal ,motor ,carrier ,safety ,administration shall submit to the ,committee on ,commerce1 ,science1 and ,transportation of the ,senate and the ,committee on ,transportation and ,infrastructure of the ,house of ,representatives a status report on implementation of the final rule for the ,commercial ,driver's ,license ,drug and ,alcohol ,clearinghouse 7#ha ,,fr #hgfhf71 including-- 7#a7 an updated schedule1 including benchmarks1 for implementing the final rule as soon as practicable1 but not later than the compliance date2 and 7#b7 a description of each action the ,federal ,motor ,carrier ,safety ,administration is taking to implement the final rule before the compliance date4 7b7 ,definition of compliance date ,in this section1 the term compliance date means the earlier of-- 7#a7 ,january #f1 #bjbj2 or 7#b7 the date that the national clearinghouse required under section #cacjf;a of title #di1 ,united ,states ,code1 is operational4 ,j ,eliminating ,kickbacks in ,recovery #haba4 ,short title ,this subtitle may be cited as the ,eliminating ,kickbacks in ,recovery ,act of #bjah4 #habb4 ,criminal penalties 7a7 ,in general ,chapter #aa of title #ah1 ,united ,states ,code1 is amended by inserting after section #bai the following3 #bbj4 ,illegal remunerations for referrals to recovery homes1 clinical treatment facilities1 and laboratories 7a7 ,offense ,except as provided in subsection 7b71 whoever1 with respect to services covered by a health care benefit program1 in or affecting interstate or foreign commerce1 knowingly and willfully-- 7#a7 solicits or receives any remuneration 7including any kickback1 bribe1 or rebate7 directly or indirectly1 overtly or covertly1 in cash or in kind1 in return for referring a patient or patronage to a recovery home1 clinical treatment facility1 or laboratory2 or 7#b7 pays or offers any remuneration 7including any kickback1 bribe1 or rebate7 directly or indirectly1 overtly or covertly1 in cash or in kind-- 7,a7 to induce a referral of an individual to a recovery home1 clinical treatment facility1 or laboratory2 or 7,b7 in exchange for an individual using the services of that recovery home1 clinical treatment facility1 or laboratory1 shall be fined not more than #bjj1jjj1 imprisoned not more than #aj years1 or both1 for each occurrence4 7b7 ,applicability ,subsection 7a7 shall not apply to-- 7#a7 a discount or other reduction in price obtained by a provider of services or other entity under a health care benefit program if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity2 7#b7 a payment made by an employer to an employee or independent contractor 7who has a bona fide employment or contractual relationship with such employer7 for employment1 if the employee's payment is not determined by or does not vary by-- 7,a7 the number of individuals referred to a particular recovery home1 clinical treatment facility1 or laboratory2 7,b7 the number of tests or procedures performed2 or 7,c7 the amount billed to or received from1 in part or in whole1 the health care benefit program from the individuals referred to a particular recovery home1 clinical treatment facility1 or laboratory2 7#c7 a discount in the price of an applicable drug of a manufacturer that is furnished to an applicable beneficiary under the ,medicare coverage gap discount program under section #ahfj;,d-#ad;,a7g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad;a7g772 7#d7 a payment made by a principal to an agent as compensation for the services of the agent under a personal services and management contract that meets the requirements of section #ajja4ieb7;d7 of title #db1 ,code of ,federal ,regulations1 as in effect on the date of enactment of this section2 7#e7 a waiver or discount 7as defined in section #ajja4ieb7;h77#e7 of title #db1 ,code of ,federal ,regulations1 or any successor regulation7 of any coinsurance or copayment by a health care benefit program if-- 7,a7 the waiver or discount is not routinely provided2 and 7,b7 the waiver or discount is provided in good faith2 7#f7 a remuneration described in section #aabh;,b7b77#c77;,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77#c77;,i772 7#g7 a remuneration made pursuant to an alternative payment model 7as defined in section #ahcc7z77#c77;,c7 of the ,social ,security ,act7 or pursuant to a payment arrangement used by a ,state1 health insurance issuer1 or group health plan if the ,secretary of ,health and ,human ,services has determined that such arrangement is necessary for care coordination or value-based care2 or 7#h7 any other payment1 remuneration1 discount1 or reduction as determined by the ,attorney ,general1 in consultation with the ,secretary of ,health and ,human ,services1 by regulation4 7c7 ,regulations ,the ,attorney ,general1 in consultation with the ,secretary of ,health and ,human ,services1 may promulgate regulations to clarify the exceptions described in subsection 7b74 7d7 ,preemption 7#a7 ,federal law ,this section shall not apply to conduct that is prohibited under section #aabh;,b of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b74 7#b7 ,state law ,nothing in this section shall be construed to occupy the field in which any provisions of this section operate to the exclusion of ,state laws on the same subject matter4 7e7 ,definitions ,in this section-- 7#a7 the terms applicable beneficiary and applicable drug have the meanings given those terms in section #ahfj;,d-#ad;,a7g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad;a7g772 7#b7 the term clinical treatment facility means a medical setting 1 other than a hospital1 that provides detoxification1 risk reduction1 outpatient treatment and care1 residential treatment1 or rehabilitation for substance use1 pursuant to licensure or certification under ,state law2 7#c7 the term health care benefit program has the meaning given the term in section #bd7;b72 7#d7 the term laboratory has the meaning given the term in section #cec of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfc;a72 and 7#e7 the term recovery home means a shared living environment that is1 or purports to be1 free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders4 4 7b7 ,clerical amendment ,the table of sections for chapter #aa of title #ah1 ,united ,states ,code1 is amended by inserting after the item related to section #bai the following3 #bbj4 ,illegal remunerations for referrals to recovery homes1 clinical treatment facilities1 and laboratories4 4 ,k ,substance ,abuse ,prevention #hbja4 ,short title ,this subtitle may be cited as the ,substance ,abuse ,prevention ,act of #bjah4 #hbjb4 ,reauthorization of the ,office of ,national ,drug ,control ,policy 7a7 ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#a7 ,in general ,the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agja et seq471 as in effect on ,september #bi1 #bjjc1 and as amended by the laws described in paragraph 7#b71 is revived and restored4 7#b7 ,laws described ,the laws described in this paragraph are3 7,a7 ,the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #bjjf 7,public ,law #aji-dfi2 #abj ,stat4 #cejb74 7,b7 ,the ,presidential ,appointment ,efficiency and ,streamlining ,act of #bjaa 7,public ,law #aab-aff2 #abf ,stat4 #abhc74 7b7 ,reauthorization 7#a7 ,in general ,section #gad of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agaa7 is amended by striking such sums as may be necessary for each of fiscal years #bjjf through #bjaj and inserting #ah1djj1jjj for each of fiscal years #bjah through #bjbc4 7#b7 ,repeal of termination ,the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agja et seq47 is amended by striking section #gae 7#ba ,u4,s4,c4 #agab74 #hbjc4 ,reauthorization of the ,drug-,free ,communities ,program 7a7 ,revival of national narcotics leadership act of #aihh 7#a7 ,in general ,chapter #b of the ,national ,narcotics ,leadership ,act of #aihh 7#ba ,u4,s4,c4 #aeba et seq471 except for subchapter ,,ii 7#ba ,u4,s4,c4 #aeda et seq471 as in effect on ,september #bi1 #aiig1 and as amended by the laws described in paragraph 7#b71 is revived and restored4 7#b7 ,laws described ,the laws described in this paragraph are3 7,a7 ,public ,law #ajg-hb 7#aae ,stat4 #had74 7,b7 ,the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #bjjf 7,public ,law #aji-dfi3 #abj ,stat4 #cejb71 as amended by paragraph 7#d74 7#c7 ,amendment to termination provision ,section #ajji of the ,national ,narcotics ,leadership ,act of #aihh 7#ba ,u4,s4,c4 #ajef7 is amended by inserting and sections #ajba through #ajce after section #ajjg4 7#d7 ,technical correction 7,a7 ,in general ,title ,,viii of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #bjjf 7,public ,law #aji-dfi2 #abj ,stat4 #cece7 is amended by striking ,drug-,free ,communities ,act of #aiig each place it appears and inserting ,national ,narcotics ,leadership ,act of #aihh4 7,b7 ,effective date ,the amendments made by subparagraph 7,a7 shall take effect as though enacted as part of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #bjjf 7,public ,law #aji-dfi2 #abj ,stat4 #cejb74 7b7 ,amendment to ,national ,narcotics ,leadership ,act of #aihh ,chapter #b of subtitle ,a of title ,i of the ,national ,narcotics ,leadership ,act of #aihh 7#ba ,u4,s4,c4 #aeba et seq47 is amended-- 7#a7 in section #ajbb 7#ba ,u4,s4,c4 #aebb71 by striking substance abuse each place it appears and inserting substance use and misuse2 7#b7 in section #ajbc 7#ba ,u4,s4,c4 #aebc71 by striking paragraph 7#i7 and inserting the following3 7#i7 ,substance use and misuse ,the term substance use and misuse means-- 7,a7 the illegal use or misuse of drugs1 including substances for which a listing is effect under any of schedules ,i through ,v under section #bjb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hab72 7,b7 the misuse of inhalants or over-the-counter drugs2 or 7,c7 the use of alcohol1 tobacco1 or other related product as such use is prohibited by ,state or local law4 2 7#c7 in section #ajbd 7#ba ,u4,s4,c4 #aebd71 by striking subsections 7a7 and 7b7 and inserting the following3 7a7 ,in general ,there is authorized to be appropriated to the ,office of ,national ,drug ,control ,policy to carry out this chapter #ii1jjj1jjj for each of fiscal years #bjah through #bjbc4 7b7 ,administrative costs ,not more than #h percent of the funds appropriated to carry out this chapter may be used by the ,office of ,national ,drug ,control ,policy to pay administrative costs associated with the responsibilities of the ,office under this chapter4 2 7#d7 in subchapter ,i 7#ba ,u4,s4,c4 #aeca et seq47-- 7,a7 by striking substance abuse each place it appears and inserting substance use and misuse2 and 7,b7 in section #ajcb7;b77#a77;,a7 7#ba ,u4,s4,c4 #aecb7;b77#a77;,a771 by striking clause 7iii7 and inserting the following3 7iii7 ,renewal grants ,subject to clause 7iv71 the ,administrator may award a renewal grant to a grant recipient under this subparagraph for each fiscal year of the #d-;fiscal-year period following the first fiscal year for which the initial additional grant is awarded in an amount not to exceed the following3 7,i7 ,for the first and second fiscal years of the #d-;fiscal-year period1 the amount of the non-,federal funds1 including in-kind contributions1 raised by the coalition for the applicable fiscal year is not less than #abe percent of the amount awarded4 7,,ii7 ,for the third and fourth fiscal tears of the #d-;fiscal-year period1 the amount of the non-,federal funds1 including in-kind contributions1 raised by the coalition for the applicable fiscal year is not less than #aej percent of the amount awarded4 2 and 7#e7 by striking subchapter ,,ii 7#ba ,u4,s4,c4 #aeda et seq474 #hbjd4 ,reauthorization of the ,national ,community ,anti-,drug ,coalition ,institute ,section #d of ,public ,law #ajg-hb 7#ba ,u4,s4,c4 #aeba note7 is amended to read as follows3 #d4 ,authorization for ,national ,community ,antidrug ,coalition ,institute 7a7 ,in general ,the ,director shall1 using amounts authorized to be appropriated by subsection 7d71 make a competitive grant to provide for the continuation of the ,national ,community ,anti-drug ,coalition ,institute4 7b7 ,eligible organizations ,an organization eligible for the grant under subsection 7a7 is any national nonprofit organization that represents1 provides technical assistance and training to1 and has special expertise and broad1 national-level experience in community antidrug coalitions under this subchapter4 7c7 ,use of grant amount ,the organization that receives the grant under subsection 7a7 shall continue a ,national ,community ,anti-,drug ,coalition ,institute to-- 7#a7 provide education1 training1 and technical assistance for coalition leaders and community teams1 with emphasis on the development of coalitions serving economically disadvantaged areas2 7#b7 develop and disseminate evaluation tools1 mechanisms1 and measures to better assess and document coalition performance measures and outcomes2 and 7#c7 bridge the gap between research and practice by translating knowledge from research into practical information4 7d7 ,authorization of appropriations ,the ,director shall1 using amounts authorized to be appropriated by section #ajcb of the ,national ,narcotics ,leadership ,act of #aihh 7#ae ,u4,s4,c4 #aecb71 make a grant of #b million under subsection 7a71 for each of the fiscal years #bjah through #bjbc4 4 #hbje4 ,reauthorization of the ,high-,intensity ,drug ,trafficking ,area ,program ,section #gjg of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjf7 is amended-- 7#a7 in subsection 7f71 by striking no ,federal and all that follows through programs4 and inserting the following3 not more than a total of #e percent of ,federal funds appropriated for the ,program are expended for substance use disorder treatment programs and drug prevention programs42 7#b7 in subsection 7p7-- 7,a7 in paragraph 7#d71 by striking and at the end2 7,b7 in paragraph 7#e71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following3 7#f7 #bhj1jjj1jjj for each of fiscal years #bjah through #bjbc4 2 and 7#c7 in subsection 7q7-- 7,a7 by striking paragraph 7#b7 and inserting the following3 7#b7 ,required uses ,the funds used under paragraph 7#a7 shall be used to ensure the safety of neighborhoods and the protection of communities1 including the prevention of the intimidation of witnesses of illegal drug distribution and related activities and the establishment of1 or support for1 programs that provide protection or assistance to witnesses in court proceedings4 2 and 7,b7 by adding at the end the following3 7#c7 ,best practice models ,the ,director shall work with ,h,i,d,t,as to develop and maintain best practice models to assist ,state1 local1 and ,tribal governments in addressing witness safety1 relocation1 financial and housing assistance1 or any other services related to witness protection or assistance in cases of illegal drug distribution and related activities4 ,the ,director shall ensure dissemination of the best practice models to each ,,hidta4 4 #hbjf4 ,reauthorization of drug court program ,section #ajja7;a77#be77;,a7 of title ,i of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajbfa7;a77#be77;,a77 is amended by striking ,except as provided and all that follows and inserting the following3 ,except as provided in subparagraph 7,c71 there is authorized to be appropriated to carry out part ,,ee #ge1jjj1jjj for each of fiscal years #bjah through #bjbc44 #hbjg4 ,drug court training and technical assistance ,section #gje of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjd7 is amended by adding at the end the following3 7e7 ,drug court training and technical assistance program 7#a7 ,grants authorized ,the ,director may make a grant to a nonprofit organization for the purpose of providing training and technical assistance to drug courts4 7#b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #b1jjj1jjj for each of fiscal years #bjah through #bjbc4 4 #hbjh4 ,drug overdose response strategy ,section #gjg of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjf7 is amended by adding at the end the following3 7r7 ,drug overdose response strategy implementation ,the ,director may use funds appropriated to carry out this section to implement a drug overdose response strategy in high intensity drug trafficking areas on a nationwide basis by-- 7#a7 coordinating multi-disciplinary efforts to prevent1 reduce1 and respond to drug overdoses1 including the uniform reporting of fatal and non-fatal overdoses to public health and safety officials2 7#b7 increasing data sharing among public safety and public health officials concerning drug-related abuse trends1 including new psychoactive substances1 and related crime2 and 7#c7 enabling collaborative deployment of prevention1 intervention1 and enforcement resources to address substance use addiction and narcotics trafficking4 4 #hbji4 ,protecting law enforcement officers from accidental exposure ,section #gjg of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjf71 as amended by section #hbjh1 is amended by adding at the end the following3 7s7 ,supplemental grants ,the ,director is authorized to use not more than #aj1jjj1jjj of the amounts otherwise appropriated to carry out this section to provide supplemental competitive grants to high intensity drug trafficking areas that have experienced high seizures of fentanyl and new psychoactive substances for the purposes of-- 7#a7 purchasing portable equipment to test for fentanyl and other substances2 7#b7 training law enforcement officers and other first responders on best practices for handling fentanyl and other substances2 and 7#c7 purchasing protective equipment1 including overdose reversal drugs4 4 #hbaj4 ,,cops ,anti-,meth ,program ,section #agja of title ,i of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajcha7 is amended-- 7#a7 by redesignating subsection 7k7 as subsection 7l72 and 7#b7 by inserting after subsection 7j7 the following3 7k7 ,,cops ,anti-,meth ,program ,the ,attorney ,general shall use amounts otherwise appropriated to carry out this section for a fiscal year 7beginning with fiscal year #bjai7 to make competitive grants1 in amounts of not less than #a1jjj1jjj for such fiscal year1 to ,state law enforcement agencies with high seizures of precursor chemicals1 finished methamphetamine1 laboratories1 and laboratory dump seizures for the purpose of locating or investigating illicit activities1 such as precursor diversion1 laboratories1 or methamphetamine traffickers4 4 #hbaa4 ,,cops anti-heroin task force program ,section #agja of title ,i of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajcha7 is amended-- 7#a7 by redesignating subsection 7l71 as so redesignated by section #hbaj1 as subsection 7m72 and 7#b7 by inserting after subsection 7k71 as added by section #hbaj1 the following3 7l7 ,cops anti-heroin task force program ,the ,attorney ,general shall use amounts otherwise appropriated to carry out this section1 or other amounts as appropriated1 for a fiscal year 7beginning with fiscal year #bjai7 to make competitive grants to ,state law enforcement agencies in ,states with high per capita rates of primary treatment admissions1 for the purpose of locating or investigating illicit activities1 through ,statewide collaboration1 relating to the distribution of heroin1 fentanyl1 or carfentanil or relating to the unlawful distribution of prescription opioids4 4 #hbab4 ,comprehensive ,addiction and ,recovery ,act education and awareness ,title ,,vii of the ,comprehensive ,addiction and ,recovery ,act of #bjaf 7,public ,law #aad-aih2 #acj ,stat4 #gce7 is amended by adding at the end the following3 #gji4 ,services for families and patients in crisis 7a7 ,in general ,the ,secretary of ,health and ,human ,services may make grants to entities that focus on addiction and substance use disorders and specialize in family and patient services1 advocacy for patients and families1 and educational information4 7b7 ,allowable uses ,a grant awarded under this section may be used for nonprofit national1 ,state1 or local organizations that engage in the following activities3 7#a7 ,expansion of resource center services with professional1 clinical staff that provide1 for families and individuals impacted by a substance use disorder1 support1 access to treatment resources1 brief assessments1 medication and overdose prevention education1 compassionate listening services1 recovery support or peer specialists1 bereavement and grief support1 and case management4 7#b7 ,continued development of health information technology systems that leverage new and upcoming technology and techniques for prevention1 intervention1 and filling resource gaps in communities that are underserved4 7#c7 ,enhancement and operation of treatment and recovery resources1 easy-to-read scientific and evidence-based education on addiction and substance use disorders1 and other informational tools for families and individuals impacted by a substance use disorder and community stakeholders1 such as law enforcement agencies4 7#d7 ,provision of training and technical assistance to ,state and local governments1 law enforcement agencies1 health care systems1 research institutions1 and other stakeholders4 7#e7 ,expanding upon and implementing educational information using evidence-based information on substance use disorders4 7#f7 ,expansion of training of community stakeholders1 law enforcement officers1 and families across a broad-range of addiction1 health1 and related topics on substance use disorders1 local issues and community-specific issues related to the drug epidemic4 7#g7 ,program evaluation4 4 #hbac4 ,reimbursement of substance use disorder treatment professionals ,not later than ,january #a1 #bjbj1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report examining how substance use disorder services are reimbursed4 #hbad4 ,sobriety ,treatment and ,recovery ,teams 7,,start7 ,title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd et seq47 is amended by adding at the end the following3 #eej4 ,sobriety ,treatment and ,recovery ,teams 7a7 ,in general ,the ,secretary may make grants to ,states1 units of local government1 or tribal governments to establish or expand ,sobriety ,treatment ,and ,recovery ,team 7referred to in this section as ,,start7 or other similar programs to determine the effectiveness of pairing social workers or mentors with families that are struggling with a substance use disorder and child abuse or neglect in order to help provide peer support1 intensive treatment1 and child welfare services to such families4 7b7 ,allowable uses ,a grant awarded under this section may be used for one or more of the following activities3 7#a7 ,training eligible staff1 including social workers1 social services coordinators1 child welfare specialists1 substance use disorder treatment professionals1 and mentors4 7#b7 ,expanding access to substance use disorder treatment services and drug testing4 7#c7 ,enhancing data sharing with law enforcement agencies1 child welfare agencies1 substance use disorder treatment providers1 judges1 and court personnel4 7#d7 ,program evaluation and technical assistance4 7c7 ,program requirements ,a ,state1 unit of local government1 or tribal government receiving a grant under this section shall-- 7#a7 serve only families for which-- 7,a7 there is an open record with the child welfare agency2 and 7,b7 substance use disorder was a reason for the record or finding described in paragraph 7#a72 and 7#b7 coordinate any grants awarded under this section with any grant awarded under section #dcg7;f7 of the ,social ,security ,act focused on improving outcomes for children affected by substance abuse4 7d7 ,technical assistance ,the ,secretary may reserve not more than #e percent of funds provided under this section to provide technical assistance on the establishment or expansion of programs funded under this section from the ,national ,center on ,substance ,abuse and ,child ,welfare4 4 #hbae4 ,provider education ,not later than #fj days after the date of enactment of this ,act1 the ,attorney ,general1 in consultation with the ,secretary of ,health and ,human ,services1 shall complete the plan related to medical registration coordination required by ,senate ,report #aad-bci1 which accompanied the ,veterans ,care ,financial ,protection ,act of #bjag 7,public ,law #aae-aca2 #acb ,stat4 #ccd74 #hbaf4 ,definitions ,section #gjb of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agja7 is amended-- 7#a7 by striking paragraphs 7#e71 7#ab71 and 7#ac72 7#b7 by redesignating paragraph 7#aa7 as paragraph 7#ag72 7#c7 by redesignating paragraphs 7#i7 and 7#aj7 as paragraphs 7#ad7 and 7#ae71 respectively2 7#d7 by redesignating paragraphs 7#f71 7#g71 and 7#h7 as paragraphs 7#aj71 7#aa71 and 7#ab71 respectively2 7#e7 by redesignating paragraphs 7#a71 7#b71 7#c71 and 7#d7 as paragraphs 7#c71 7#d71 7#e71 and 7#f71 respectively2 7#f7 by inserting before paragraph 7#c71 as so redesignated1 the following3 7#a7 ,agency ,the term agency has the meaning given the term executive agency in section #ajb of title #ca1 ,united ,states ,code4 7#b7 ,appropriate congressional committees 7,a7 ,in general ,the term appropriate congressional committees means-- 7i7 the ,committee on the ,judiciary1 the ,committee on ,appropriations1 and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate2 and 7ii7 the ,committee on ,oversight and ,government ,reform1 the ,committee on the ,judiciary1 the ,committee on ,energy and ,commerce1 and the ,committee on ,appropriations of the ,house of ,representatives4 7,b7 ,submission to ,congress ,any submission to ,congress shall mean submission to the appropriate congressional committees4 2 7#g7 by amending paragraph 7#c71 as so redesignated1 to read as follows3 7#c7 ,demand reduction ,the term demand reduction means any activity conducted by a ,national ,drug ,control ,program ,agency1 other than an enforcement activity1 that is intended to reduce or prevent the use of drugs or support1 expand1 or provide treatment and recovery efforts1 including-- 7,a7 education about the dangers of illicit drug use2 7,b7 services1 programs1 or strategies to prevent substance use disorder1 including evidence-based education campaigns1 community-based prevention programs1 collection and disposal of unused prescription drugs1 and services to at-risk populations to prevent or delay initial use of an illicit drug2 7,c7 substance use disorder treatment2 7,d7 support for long-term recovery from substance use disorders2 7,e7 drug-free workplace programs2 7,f7 drug testing1 including the testing of employees2 7,g7 interventions for illicit drug use and dependence2 7,h7 expanding availability of access to health care services for the treatment of substance use disorders2 7,i7 international drug control coordination and cooperation with respect to activities described in this paragraph2 7,j7 pre- and post-arrest criminal justice interventions such as diversion programs1 drug courts1 and the provision of evidence-based treatment to individuals with substance use disorders who are arrested or under some form of criminal justice supervision1 including medication assisted treatment2 7,k7 other coordinated and joint initiatives among ,federal1 ,state1 local1 and ,tribal agencies to promote comprehensive drug control strategies designed to reduce the demand for1 and the availability of1 illegal drugs2 7,l7 international illicit drug use education1 prevention1 treatment1 recovery1 research1 rehabilitation activities1 and interventions for illicit drug use and dependence2 and 7,m7 research related to illicit drug use and any of the activities described in this paragraph4 2 7#h7 by inserting after paragraph 7#f71 as so redesignated1 the following3 7#g7 ,emerging drug threat ,the term emerging drug threat means the occurrence of a new and growing trend in the use of an illicit drug or class of drugs1 including rapid expansion in the supply of or demand for such drug4 7#h7 ,illicit drug use2 illicit drugs2 illegal drugs ,the terms illicit drug use1 illicit drugs1 and illegal drugs include the illegal or illicit use of prescription drugs4 7#i7 ,law enforcement ,the term law enforcement or drug law enforcement means all efforts by a ,federal1 ,state1 local1 or ,tribal government agency to enforce the drug laws of the ,united ,states or any ,state1 including investigation1 arrest1 prosecution1 and incarceration or other punishments or penalties4 2 7#i7 by amending paragraph 7#aa71 as so redesignated1 to read as follows3 7#aa7 ,national drug control program agency ,the term ,national ,drug ,control ,program ,agency means any agency 7or bureau1 office1 independent agency1 board1 division1 commission1 subdivision1 unit1 or other component thereof7 that is responsible for implementing any aspect of the ,national ,drug ,control ,strategy1 including any agency that receives ,federal funds to implement any aspect of the ,national ,drug ,control ,strategy1 but does not include any agency that receives funds for drug control activity solely under the ,national ,intelligence ,program or the ,joint ,military ,intelligence ,program4 2 7#aj7 in paragraph 7#ab71 as so redesignated-- 7,a7 by inserting or ,strategy before means2 and 7,b7 by inserting 1 including any report1 plan1 or strategy required to be incorporated into or issued concurrently with such strategy before the period at the end2 7#aa7 by inserting after paragraph 7#ab71 as so redesignated1 the following3 7#ac7 ,nonprofit organization ,the term nonprofit organization means an organization that is described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf and exempt from tax under section #eja7;a7 of such ,code4 2 7#ab7 in paragraph 7#ad71 as so redesignated1 by striking ,unless the context clearly indicates otherwise1 the and inserting ,the2 7#ac7 by inserting after paragraph 7#ae71 as so redesignated1 the following3 7#af7 ,substance use disorder treatment ,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 2 and 7#ad7 in paragraph 7#ag71 as so redesignated-- 7,a7 by redesignating subparagraphs 7,b71 7,c71 7,d71 and 7,e71 as subparagraphs 7,c71 7,d71 7,e71 and 7,f71 respectively2 7,b7 by inserting after subparagraph 7,a7 the following3 7,b7 domestic law enforcement2 2 7,c7 in subparagraph 7,e71 as so redesignated1 by striking and at the end2 7,d7 in subparagraph 7,f71 as so redesignated1 by striking the period at the end and inserting a semicolon2 and 7,e7 by adding at the end the following3 7,g7 activities to prevent the diversion of drugs for their illicit use2 and 7,h7 research related to any of the activities described in this paragraph4 4 #hbag4 ,amendments to administration of the ,office 7a7 ,responsibilities of ,office ,section #gjc7;a7 of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjb7;a77 is amended-- 7#a7 by striking paragraph 7#a7 and inserting the following3 7#a7 lead the national drug control effort1 including coordinating with the ,national ,drug ,control ,program ,agencies2 2 7#b7 in paragraph 7#b71 by inserting before the semicolon the following3 1 including the ,national ,drug ,control ,strategy2 7#c7 in paragraph 7#c71 by striking and at the end2 and 7#d7 by striking paragraph 7#d7 and all that follows through the ,national ,academy of ,sciences4 and inserting the following3 7#d7 evaluate the effectiveness of national drug control policy efforts1 including the ,national ,drug ,control ,program ,agencies' program1 by developing and applying specific goals and performance measurements and monitoring the agencies' program-level spending2 7#e7 identify and respond to emerging drug threats related to illicit drug use2 7#f7 administer the ,drug-,free ,communities ,program1 the ,high-,intensity ,drug ,trafficking ,areas ,program1 and other grant programs directly authorized to be administered by the ,office in furtherance of the ,national ,drug ,control ,strategy2 and 7#g7 facilitate broad-scale information sharing and data standardization among ,federal1 ,state1 and local entities to support the national drug control efforts4 4 7b7 ,ethics guidelines ,section #gjc7;d7 of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjb7;d77 is amended by adding at the end the following3 7#d7 ,ethics guidelines ,the ,director shall establish written guidelines setting forth the criteria to be used in determining whether a gift or donation should be declined under this subsection because the acceptance of the gift or donation would-- 7,a7 reflect unfavorably upon the ability of the ,director or the ,office1 or any employee of the ,office1 to carry out responsibilities or official duties under this chapter in a fair and objective manner2 or 7,b7 compromise the integrity or the appearance of integrity of programs or services provided under this chapter or of any official involved in those programs or services4 7#e7 ,registry of gifts ,the ,director shall maintain a list of-- 7,a7 the source and amount of each gift or donation accepted by the ,office2 and 7,b7 the source and amount of each gift or donation accepted by a contractor to be used in its performance of a contract for the ,office4 7#f7 ,report to ,congress ,the ,director shall include in the annual assessment under section #gjf7;g7 a copy of the registry maintained under paragraph 7#e74 4 7c7 ,appointment of ,director and ,deputy ,director ,section #gjd7;a7 of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjc7;a77 is amended-- 7#a7 in paragraph 7#a71 by striking subparagraphs 7,a71 7,b71 and 7,c71 and inserting the following3 7,a7 ,director 7i7 ,in general ,there shall be at the head of the ,office a ,director who shall hold the same rank and status as the head of an executive department listed in section #aja of title #e1 ,united ,states ,code4 7ii7 ,appointment ,the ,director shall be appointed by the ,president1 by and with the advice and consent of the ,senate1 and shall serve at the pleasure of the ,president4 7,b7 ,deputy ,director ,there shall be a ,deputy ,director who shall report directly to the ,director1 and who shall be appointed by the ,president1 and shall serve at the pleasure of the ,president4 7,c7 ,coordinators ,the following coordinators shall be appointed by the ,director3 7i7 ,performance ,budget ,coordinator1 as described in section #gjd7;c77#d74 7ii7 ,interdiction ,coordinator1 as described in section #gaa4 7iii7 ,emerging and ,continuing ,threats ,coordinator1 as described in section #gji4 7iv7 ,state1 ,local1 and ,tribal ,affairs ,coordinator1 to carry out the activities described in section #gjd7;j74 7v7 ,demand ,reduction ,coordinator1 as described in subparagraph 7,d74 7,d7 ,demand ,reduction ,coordinator ,the ,director shall designate or appoint a ,united ,states ,demand ,reduction ,coordinator to be responsible for the activities described in section #gjb7c74 ,the ,director shall determine whether the coordinator position is a noncareer appointee in the ,senior ,executive ,service or a career appointee in a position at level #ae of the ,general ,schedule 7or equivalent74 2 7#b7 in paragraph 7#e71 by striking such official and inserting such officer or employee2 and 7#c7 by adding at the end the following3 7#f7 ,prohibition on the use of funds for ballot initiatives ,no funds authorized under this title may be obligated for the purpose of expressly advocating the passage or defeat of a ,state or local ballot initiative4 4 7d7 ,consultation ,section #gjd7;b7 of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjc7;b77 is amended-- 7#a7 in paragraph 7#ai71 by striking 2 and and inserting a semicolon2 7#b7 in paragraph 7#bj71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7#ba7 in order to formulate the national drug control policies1 goals1 objectives1 and priorities-- 7,a7 shall consult with and assist-- 7i7 ,state and local governments2 7ii7 ,national ,drug ,control ,program ,agencies2 7iii7 each committee1 working group1 council1 or other entity established under this chapter1 as appropriate2 7iv7 the public2 7v7 appropriate congressional committees2 and 7vi7 any other person in the discretion of the ,director2 and 7,b7 may-- 7i7 establish advisory councils2 7ii7 acquire data from agencies2 and 7iii7 request data from any other entity4 4 7e7 ,national ,drug ,control ,program ,budget ,section #gjd7;c7 of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjc7;c77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in subparagraph 7,a71 by striking paragraph 7#a77;,c72 and inserting the following3 paragraph 7#a77;,c7 and include-- 7i7 the funding level for each ,national ,drug ,control ,program agency2 and 7ii7 alternative funding structures that could improve progress on achieving the goals fo the ,national ,drug ,control ,strategy2 and 2 7,b7 in subparagraph 7,b71 strike the ,president2 and and inserting the ,president and ,congress42 and 7,c7 by striking subparagraph 7,c72 7#b7 in paragraph 7#c77;,e71 by striking clause 7ii7 and inserting the following3 7ii7 ,certification ,the ,director shall-- 7,i7 review each budget submission submitted under subparagraph 7,a72 7,,ii7 based on the review under clause 7i71 make a determination as to whether the budget submission of a ,national ,drug ,control ,program agency includes the funding levels and initiatives described in subparagraph 7,b72 and 7,,iii7 submit to the appropriate congressional committees-- 7aa7 a written statement that either-- 7,,aa7 certifies that the budget submission includes sufficient funding2 or 7,,bb7 decertifies the budget submission as not including sufficient funding2 7bb7 a copy of the description made under subparagraph 7,b72 and 7cc7 the budget recommendations made under subsection 7b77#h74 2 and 7#c7 by adding at the end the following3 7#e7 ,performance-budget coordinator 7,a7 ,designation ,the ,director shall designate or appoint a ,united ,states ,performance-,budget ,coordinator to-- 7i7 ensure the ,director has sufficient information necessary to analyze the performance of each ,national ,drug ,control ,program ,agency1 the impact ,federal funding has had on the goals in the ,strategy1 and the likely contributions to the goals of the ,strategy based on funding levels of each ,national ,drug ,control ,program ,agency1 to make an independent assessment of the budget request of each agency under this subsection2 7ii7 advise the ,director on agency budgets1 performance measures and targets1 and additional data and research needed to make informed policy decisions under this section and section #gjf2 and 7iii7 other duties as may be determined by the ,director with respect to measuring or assessing performance or agency budgets4 7,b7 ,determination of position ,the ,director shall determine whether the coordinator position is a noncareer appointee in the ,senior ,executive ,service or a career appointee in a position at level #ae of the ,general ,schedule 7or equivalent74 7#f7 ,budget estimate or request submission to ,congress ,whenever the ,director submits any budget estimate or request to the ,president or the ,office of ,management and ,budget1 the ,director shall concurrently transmit to the appropriate congressional committees a detailed statement of the budgetary needs of the ,office to execute its mission based on the good-faith assessment of the ,director4 4 7f7 ,powers and responsibilities of the ,director ,section #gjd of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjc7 is amended-- 7#a7 in subsection 7d77#h7-- 7,a7 in subparagraph 7,d71 by striking and at the end2 7,b7 in subparagraph 7,e7-- 7i7 in clause 7i7-- 7,i7 by striking ,congress1 including to the ,committees on ,appropriations of the ,senate and the ,house of ,representatives1 the authorizing committees for the ,office1 and inserting the appropriate congressional committees2 and 7,,ii7 by striking or agencies2 7ii7 in clause 7ii7-- 7,i7 by striking ,congress and inserting the appropriate congressional committees2 and 7,,ii7 by adding and at the end2 and 7iii7 by adding at the end the following3 7iii7 funds may only be used for-- 7,i7 expansion of demand reduction activities2 7,,ii7 interdiction of illicit drugs on the high seas1 in ,united ,states territorial waters1 and at ,united ,states ports of entry by officers and employees of ,national ,drug ,control ,program ,agencies and domestic and foreign law enforcement officers2 7,,iii7 accurate assessment and monitoring of international drug production and interdiction programs and policies2 7,,iv7 activities to facilitate and enhance the sharing of domestic and foreign intelligence information among ,national ,drug ,control ,program ,agencies related to the production and trafficking of drugs in the ,united ,states and foreign countries2 and 7,v7 research related to any of these activities4 2 7#b7 in subsection 7e77#b77;,a71 by striking ,notwithstanding any other provision of law and inserting ,subject to the availability of appropriations2 and 7#c7 by adding at the end the following3 7i7 ,model ,acts ,program 7#a7 ,in general ,the ,director shall provide for or shall enter into an agreement with a nonprofit organization to-- 7,a7 advise ,states on establishing laws and policies to address illicit drug use issues2 and 7,b7 revise such model ,state drug laws and draft supplementary model ,state laws to take into consideration changes in illicit drug use issues in the ,state involved4 7#b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #a1bej1jjj for each of fiscal years #bjah through #bjbc4 7j7 ,state1 ,local1 and ,tribal ,affairs ,coordinator ,the ,director shall designate or appoint a ,united ,states ,state1 ,local1 and ,tribal ,affairs ,coordinator to perform the duties of the ,office outlined in this section and #gjf and such other duties as may be determined by the ,director with respect to coordination of drug control efforts between agencies and ,state1 local1 and ,tribal governments4 ,the ,director shall determine whether the coordinator position is a noncareer appointee in the ,senior ,executive ,service or a career appointee in a position at level #ae of the ,general ,schedule 7or equivalent74 7k7 ,harm reduction programs ,when developing the national drug control policy1 any policy of the ,director1 including policies relating to syringe exchange programs for intravenous drug users1 shall be based on the best available medical and scientific evidence regarding the effectiveness of such policy in promoting individual health and preventing the spread of infectious disease and the impact of such policy on drug addiction and use4 ,in making any policy relating to harm reduction programs1 the ,director shall consult with the ,national ,institutes of ,health and the ,national ,academy of ,sciences4 4 7g7 ,accounting of funds expended ,section #gje of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjd7;d771 as amended by section #hbjg is further amended-- 7#a7 by amending subsection 7d7 to read as follows3 7d7 ,accounting of ,funds ,expended 7#a7 ,in general ,not later than ,february #a of each year1 in accordance with guidance issued by the ,director1 the head of each ,national ,drug ,control ,program ,agency shall submit to the ,director a detailed accounting of all funds expended by the agency for ,national ,drug ,control ,program activities during the previous fiscal year and shall ensure such detailed accounting is authenticated for the previous fiscal year by the ,inspector ,general for such agency prior to the submission to the ,director as frequently as determined by the ,inspector ,general but not less frequently that every #c years4 7#b7 ,submission to ,congress ,the ,director shall submit to ,congress not later than ,april #a of each year the information submitted to the ,director under paragraph 7#a74 2 and 7#b7 by adding at the end the following3 7f7 ,tracking system for federally funded grant programs 7#a7 ,establishment ,the ,director1 or the head of an agency designated by the ,director1 in coordination with the ,secretary of ,health and ,human ,services1 shall track federally-funded grant programs to-- 7,a7 ensure the public has electronic access to information identifying3 7i7 all drug control grants and pertinent identifying information for each grant2 7ii7 any available performance metrics1 evaluations1 or other information indicating the effectiveness of such programs2 7,b7 facilitate efforts to identify duplication1 overlap1 or gaps in funding to provide increased accountability of ,federally-funded grants for substance use disorder treatment1 prevention1 and enforcement2 and 7,c7 identify barriers in the grant application process impediments that applicants currently have in the grant application process with applicable agencies4 7#b7 ,national ,drug ,control ,agencies ,the head of each ,national ,drug ,control ,program ,agency shall provide to the ,director a complete list of all drug control program grant programs and any other relevant information for inclusion in the system developed under paragraph 7#a7 and annually update such list4 7#c7 ,updating existing systems ,the ,director may meet the requirements of this subsection by utilizing1 updating1 or improving existing ,federal information systems to ensure they meet the requirements of this subsection4 7#d7 ,report ,not later than #c years after the date of enactment of this subsection1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report examining implementation of this subsection4 4 7h7 ,technical and conforming amendment ,section #aaje of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #bjjf 7#ba ,u4,s4,c4 #agja note7 is repealed4 #hbah4 ,emerging threats committee1 plan1 and media campaign 7a7 ,in general ,section #gji of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjh7 is amended to read as follows3 #gji4 ,emerging threats committee1 plan1 and media campaign 7a7 ,emerging threats coordinator ,the ,director shall designate or appoint a ,united ,states ,emerging and ,continuing ,threats ,coordinator to perform the duties of that position described in this section and such other duties as may be determined by the ,director4 ,the ,director shall determine whether the coordinator position is a noncareer appointee in the ,senior ,executive ,service or a career appointee in a position at level #ae of the ,general ,schedule 7or equivalent74 7b7 ,emerging threats committee 7#a7 ,in general ,the ,emerging ,threats ,committee shall-- 7,a7 monitor evolving and emerging drug threats in the ,united ,states2 7,b7 identify and discuss evolving and emerging drug trends in the ,united ,states using the criteria required to be established under paragraph 7#f72 7,c7 assist in the formulation of and oversee implementation of any plan described in subsection 7d72 7,d7 provide such other advice to the ,coordinator and ,director concerning strategy and policies for emerging drug threats and trends as the ,committee determines to be appropriate2 and 7,e7 disseminate and facilitate the sharing with ,federal1 ,state1 local1 and ,tribal officials and other entities as determined by the ,director of pertinent information and data relating to-- 7i7 recent trends in drug supply and demand2 7ii7 fatal and nonfatal overdoses2 7iii7 demand for and availability of evidence-based substance use disorder treatment1 including the extent of the unmet treatment need1 and treatment admission trends2 7iv7 recent trends in drug interdiction1 supply1 and demand from ,state1 local1 and ,tribal law enforcement agencies2 and 7v7 other subject matter as determined necessary by the ,director4 7#b7 ,chairperson ,the ,director shall designate one of the members of the ,emerging ,threats ,committee to serve as ,chairperson4 7#c7 ,members ,the ,director shall appoint other members of the ,committee1 which shall include-- 7,a7 representatives from ,national ,drug ,control ,program ,agencies or other agencies2 7,b7 representatives from ,state1 local1 and ,tribal governments2 and 7,c7 representatives from other entities as designated by the ,director4 7#d7 ,meetings ,the members of the ,emerging ,threats ,committee shall meet1 in person and not through any delegate or representative1 not less frequently than once per calendar year1 before ,june #a4 ,at the call of the ,director or the ,chairperson1 the ,emerging ,threats ,committee may hold additional meetings as the members may choose4 7#e7 ,contract1 agreement1 and other authority ,the ,director may award contracts1 enter into interagency agreements1 manage individual projects1 and conduct other activities in support of the identification of emerging drug threats and in support of the development1 implementation1 and assessment of any ,emerging ,threat ,response ,plan4 7#f7 ,criteria to identify emerging drug threats ,not later than #ahj days after the date on which the ,committee first meets1 the ,committee shall develop and recommend to the ,director criteria to be used to identify an emerging drug threat or the termination of an emerging drug threat designation based on information gathered by the ,committee1 statistical data1 and other evidence4 7c7 ,designation 7#a7 ,in general ,the ,director1 in consultation with the ,coordinator1 the ,committee1 and the head of each ,national ,drug ,control ,program ,agency1 may designate an emerging drug threat in the ,united ,states4 7#b7 ,standards for designation ,the ,director1 in consultation with the ,coordinator1 shall promulgate and make publicly available standards by which a designation under paragraph 7#a7 and the termination of such designation may be made4 ,in developing such standards1 the ,director shall consider the recommendations of the committee and other criteria the ,director considers to be appropriate4 7#c7 ,public statement required ,the ,director shall publish a public written statement on the portal of the ,office explaining the designation of an emerging drug threat or the termination of such designation and shall notify the appropriate congressional committees of the availability of such statement when a designation or termination of such designation has been made4 7d7 ,plan 7#a7 ,public availability of plan ,not later than #ij days after making a designation under subsection 7c71 the ,director shall publish and make publicly available an ,emerging ,threat ,response ,plan and notify the ,president and the appropriate congressional committees of such plan's availability4 7#b7 ,timing ,concurrently with the annual submissions under section #gjf7;g71 the ,director shall update the plan and report on implementation of the plan1 until the ,director issues the public statement required under subsection 7c77#c7 to terminate the emerging drug threat designation4 7#c7 ,contents of an emerging threat response plan ,the ,director shall include in the plan required under this subsection-- 7,a7 a comprehensive strategic assessment of the emerging drug threat1 including the current availability of1 demand for1 and effectiveness of evidence-based prevention1 treatment1 and enforcement programs and efforts to respond to the emerging drug threat2 7,b7 comprehensive1 research-based1 short- and long-term1 quantifiable goals for addressing the emerging drug threat1 including for reducing the supply of the drug designated as the emerging drug threat and for expanding the availability and effectiveness of evidence-based substance use disorder treatment and prevention programs to reduce the demand for the emerging drug threat2 7,c7 performance measures pertaining to the plan's goals1 including quantifiable and measurable objectives and specific targets2 7,d7 the level of funding needed to implement the plan1 including whether funding is available to be reprogrammed or transferred to support implementation of the plan or whether additional appropriations are necessary to implement the plan2 7,e7 an implementation strategy for the media campaign under subsection 7f71 including goals as described under subparagraph 7,b7 of this paragraph and performance measures1 objectives1 and targets1 as described under subparagraph 7,c7 of this paragraph2 and 7,f7 any other information necessary to inform the public of the status1 progress1 or response of an emerging drug threat4 7#d7 ,implementation 7,a7 ,in general ,not later than #abj days after the date on which a designation is made under subsection 7c71 the ,director1 in consultation with the ,president1 the appropriate congressional committees1 and the head of each ,national ,drug ,control ,program ,agency1 shall issue guidance on implementation of the plan described in this subsection to the ,national ,drug ,control ,program ,agencies and any other relevant agency determined to be necessary by the ,director4 7,b7 ,coordinator's responsibilities ,the ,coordinator shall-- 7i7 direct the implementation of the plan among the agencies identified in the plan1 ,state1 local1 and ,tribal governments1 and other relevant entities2 7ii7 facilitate information-sharing between agencies identified in the plan1 ,state1 local1 and ,tribal governments1 and other relevant entities2 and 7iii7 monitor implementation of the plan by coordinating the development and implementation of collection and reporting systems to support performance measurement and adherence to the plan by agencies identified in plan1 where appropriate4 7,c7 ,reporting ,not later than #ahj days after the date on which a designation is made under subsection 7c7 and in accordance with subparagraph 7,a71 the head of each agency identified in the plan shall submit to the ,coordinator a report on implementation of the plan4 7e7 ,evaluation of media campaign ,upon designation of an emerging drug threat1 the ,director shall evaluate whether a media campaign would be appropriate to address that threat4 7f7 ,national anti-drug media campaign 7#a7 ,in general ,the ,director shall1 to the extent feasible and appropriate1 conduct a national anti-drug media campaign 7referred to in this subtitle as the national media campaign7 in accordance with this subsection for the purposes of-- 7,a7 preventing substance abuse among people in the ,united ,states2 7,b7 educating the public about the dangers and negative consequences of substance use and abuse1 including patient and family education about the characteristics and hazards of substance abuse and methods to safeguard against substance use1 to include the safe disposal of prescription medications2 7,c7 supporting evidence-based prevention programs targeting the attitudes1 perception1 and beliefs of persons concerning substance use and intentions to initiate or continue such use2 7,d7 encouraging individuals affected by substance use disorders to seek treatment and providing such individuals with information on-- 7i7 how to recognize addiction issues2 7ii7 what forms of evidence-based treatment options are available2 and 7iii7 how to access such treatment2 7,e7 combating the stigma of addiction and substance use disorders1 including the stigma of treating such disorders with medication-assisted treatment therapies2 and 7,f7 informing the public about the dangers of any drug identified by the ,director as an emerging drug threat as appropriate4 7#b7 ,use of funds 7,a7 ,in general ,amounts made available to carry out this subsection for the national media campaign may only be used for the following3 7i7 ,the purchase of media time and space1 including the strategic planning for1 tracking1 and accounting of1 such purchases4 7ii7 ,creative and talent costs1 consistent with subparagraph 7,b77i74 7iii7 ,advertising production costs1 which may include television1 radio1 internet1 social media1 and other commercial marketing venues4 7iv7 ,testing and evaluation of advertising4 7v7 ,evaluation of the effectiveness of the national media campaign4 7vi7 ,costs of contracts to carry out activities authorized by this subsection4 7vii7 ,partnerships with professional and civic groups1 community-based organizations1 including faith-based organizations1 and government organizations related to the national media campaign4 7viii7 ,entertainment industry outreach1 interactive outreach1 media projects and activities1 public information1 news media outreach1 and corporate sponsorship and participation4 7ix7 ,operational and management expenses4 7,b7 ,specific requirements 7i7 ,creative services ,in using amounts for creative and talent costs under subparagraph 7,a77ii71 the ,director shall use creative services donated at no cost to the ,government wherever feasible and may only procure creative services for advertising-- 7,i7 responding to high-priority or emergent campaign needs that cannot timely be obtained at no cost2 or 7,,ii7 intended to reach a minority1 ethnic1 or other special audience that cannot reasonably be obtained at no cost4 7ii7 ,testing and evaluation of advertising ,in using amounts for testing and evaluation of advertising under subparagraph 7,a77iv71 the ,director shall test all advertisements prior to use in the national media campaign to ensure that the advertisements are effective with the target audience and meet industry-accepted standards4 ,the ,director may waive this requirement for advertisements using no more than #aj percent of the purchase of advertising time purchased under this subsection in a fiscal year and no more than #aj percent of the advertising space purchased under this subsection in a fiscal year1 if the advertisements respond to emergent and time-sensitive campaign needs or the advertisements will not be widely utilized in the national media campaign4 7iii7 ,consultation ,for the planning of the campaign under paragraph 7#a71 the ,director may consult with-- 7,i7 the head of any appropriate ,national ,drug ,control ,program ,agency2 7,,ii7 experts on the designated drug2 7,,iii7 ,state1 local1 and ,tribal government officials and relevant agencies2 7,,iv7 communications professionals2 7,v7 the public2 and 7,,vi7 appropriate congressional committees4 7iv7 ,evaluation of effectiveness of national media campaign ,in using amounts for the evaluation of the effectiveness of the national media campaign under subparagraph 7,a77v71 the ,director shall-- 7,i7 designate an independent entity to evaluate by ,april #bj of each year the effectiveness of the national media campaign based on data from-- 7aa7 the ,monitoring the ,future ,study published by the ,department of ,health and ,human ,services2 7bb7 the ,national ,survey on ,drug ,use and ,health2 and 7cc7 other relevant studies or publications1 as determined by the ,director1 including tracking and evaluation data collected according to marketing and advertising industry standards2 and 7,,ii7 ensure that the effectiveness of the national media campaign is evaluated in a manner that enables consideration of whether the national media campaign has contributed to changes in attitude or behaviors among the target audience with respect to substance use and such other measures of evaluation as the ,director determines are appropriate4 7#c7 ,advertising ,in carrying out this subsection1 the ,director shall ensure that sufficient funds are allocated to meet the stated goals of the national media campaign4 7#d7 ,responsibilities and functions under the program 7,a7 ,in general ,the ,director shall determine the overall purposes and strategy of the national media campaign4 7,b7 ,director 7i7 ,in general ,the ,director shall approve-- 7,i7 the strategy of the national media campaign2 7,,ii7 all advertising and promotional material used in the national media campaign2 and 7,,iii7 the plan for the purchase of advertising time and space for the national media campaign4 7ii7 ,implementation ,the ,director shall be responsible for implementing a focused national media campaign to meet the purposes set forth in paragraph 7#a7 and shall ensure-- 7,i7 information disseminated through the campaign is accurate and scientifically valid2 and 7,,ii7 the campaign is designed using strategies demonstrated to be the most effective at achieving the goals and requirements of paragraph 7#a71 which may include-- 7aa7 a media campaign1 as described in paragraph 7#b72 7bb7 local1 regional1 or population specific messaging2 7cc7 the development of websites to publicize and disseminate information2 7dd7 conducting outreach and providing educational resources for parents2 7ee7 collaborating with law enforcement agencies2 and 7ff7 providing support for school-based public health education classes to improve teen knowledge about the effects of substance use4 7#e7 ,prohibitions ,none of the amounts made available under paragraph 7#b7 may be obligated or expended for any of the following3 7,a7 ,to supplant current anti-drug community-based coalitions4 7,b7 ,to supplant pro bono public service time donated by national and local broadcasting networks for other public service campaigns4 7,c7 ,for partisan political purposes1 or to express advocacy in support of or to defeat any clearly identified candidate1 clearly identified ballot initiative1 or clearly identified legislative or regulatory proposal4 7,d7 ,to fund advertising that features any elected officials1 persons seeking elected office1 cabinet level officials1 or other ,federal officials employed pursuant to section #bac of ,schedule ,c of title #e1 ,code of ,federal ,regulations4 7,e7 ,to fund advertising that does not contain a primary message intended to reduce or prevent substance use4 7,f7 ,to fund advertising containing a primary message intended to promote support for the national media campaign or private sector contributions to the national media campaign4 7#f7 ,matching requirement 7,a7 ,in general ,amounts made available under paragraph 7#b7 for media time and space shall be matched by an equal amount of non-,federal funds for the national media campaign1 or be matched with in-kind contributions of the same value4 7,b7 ,no-cost match advertising direct relationship requirement ,the ,director shall ensure that not less than #he percent of no-cost match advertising directly relates to substance abuse prevention consistent with the specific purposes of the national media campaign4 7,c7 ,no-cost match advertising not directly related ,the ,director shall ensure that no-cost match advertising that does not directly relate to substance abuse prevention consistent with the purposes of the national media campaign includes a clear anti-drug message4 ,such message is not required to be the primary message of the match advertising4 7#g7 ,financial and performance accountability ,the ,director shall cause to be performed-- 7,a7 audits and reviews of costs of the national media campaign pursuant to section #dgjf of title #da1 ,united ,states ,code2 and 7,b7 an audit to determine whether the costs of the national media campaign are allowable under chapter #dc of title #da1 ,united ,states ,code4 7#h7 ,report to congress ,the ,director shall submit on an annual basis a report to ,congress that describes-- 7,a7 the strategy of the national media campaign and whether specific objectives of the national media campaign were accomplished2 7,b7 steps taken to ensure that the national media campaign operates in an effective and efficient manner consistent with the overall strategy and focus of the national media campaign2 7,c7 plans to purchase advertising time and space2 7,d7 policies and practices implemented to ensure that ,federal funds are used responsibly to purchase advertising time and space and eliminate the potential for waste1 fraud1 and abuse2 7,e7 all contracts entered into with a corporation1 partnership1 or individual working on behalf of the national media campaign2 7,f7 the results of any financial audit of the national media campaign2 7,g7 a description of any evidence used to develop the national media campaign2 7,h7 specific policies and steps implemented to ensure compliance with this section2 7,i7 a detailed accounting of the amount of funds obligated during the previous fiscal year for carrying out the national media campaign1 including each recipient of funds1 the purpose of each expenditure1 the amount of each expenditure1 any available outcome information1 and any other information necessary to provide a complete accounting of the funds expended2 and 7,j7 a review and evaluation of the effectiveness of the national media campaign strategy for the past year4 7#i7 ,required notice for communication from the office ,any communication1 including an advertisement1 paid for or otherwise disseminated by the ,office directly or through a contract awarded by the ,office shall include a prominent notice informing the audience that the communication was paid for by the ,office4 7g7 ,authorization of ,appropriations ,there is authorized to be appropriated to the ,office to carry out this section1 #be1jjj1jjj for each of fiscal years #bjah through #bjbc4 4 7b7 ,technical and conforming amendment ,subsection 7a7 of section #bjc of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #bjjf 7#ba ,u4,s4,c4 #agjh;a7 is repealed4 #hbai4 ,drug interdiction 7a7 ,repeal ,this first section #gaa of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agaj7 is repealed4 7b7 ,amendments ,section #gaa of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agaj71 as added by ,public ,law #aji-dfi 7#abj ,stat4 #cejg71 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#a7-- 7i7 by striking ,the ,united and inserting ,the ,director shall designate or appoint an appointee in the ,senior ,executive ,service or an appointee in a position at level #ae of the ,general ,schedule 7or equivalent7 as the ,united2 and 7ii7 by striking shall and inserting to2 7,b7 in paragraph 7#b77;,b7-- 7i7 by striking ,march #a and inserting ,september #a2 and 7ii7 by striking paragraph 7#c7 and inserting paragraph 7#d72 7,c7 in paragraph 7#c7-- 7i7 by striking also1 at his discretion12 and 7ii7 by striking the ,office of ,supply ,reduction for that purpose and inserting assist in carrying out such responsibilities2 and 7,d7 in paragraph 7#d7-- 7i7 in subparagraph 7,b71 by striking ,the ,united and inserting ,before submission of the ,national ,drug ,control ,strategy or annual assessment required under section #gjf1 as applicable1 the ,united2 7ii7 by striking subparagraphs 7,c7 and 7,e72 7iii7 by redesignating subparagraph 7,d7 as subparagraph 7,c72 7iv7 in subparagraph 7,c71 as so redesignated-- 7,i7 in the matter preceding clause 7i7-- 7aa7 by striking ,march #a and inserting ,september #a2 7bb7 by inserting the ,director1 acting through before the ,united ,states2 7cc7 by inserting a comma after ,coordinator2 7dd7 by striking a report on behalf of the ,director2 and 7ee7 by striking 1 which shall include and inserting a report that2 7,,ii7 by redesignating clauses 7i71 7ii71 and 7iii7 as subclauses 7,i71 7,,ii71 and 7,,iii71 and adjusting the margins accordingly2 7,,iii7 by inserting before subclause 7,i71 as so redesignated1 the following3 7i7 includes-- 2 7,,iv7 in clause 7i71 as so redesignated-- 7aa7 in subclause 7,i71 as so redesignated1 by inserting 1 including information about how each ,national ,drug ,control ,program agency conducting drug interdiction activities is engaging with relevant international partners after ,plan2 7bb7 in subclause 7,,ii71 as so redesignated1 by striking 1 as well as and inserting and2 7cc7 in subclause ,,iii1 as so redesignated-- 7,,aa7 by striking 1 as well as and inserting and2 and 7,,bb7 by striking the period at the end and inserting 2 and2 and 7,v7 by adding at the end the following3 7ii7 may include recommendations for changes to existing agency authorities or laws governing interagency relationships4 2 and 7v7 by adding at the end the following3 7,d7 ,classified annex ,each report required to be submitted under subparagraph 7,c7 shall be in unclassified form1 but may include a classified annex4 2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a77;,b71 by inserting and how to strengthen international partnerships to better achieve the goals of that plan after that plan2 7,b7 in paragraph 7#b7-- 7i7 in the paragraph heading1 by striking ,chairman and inserting ,chairperson2 and 7ii7 by striking chairman and inserting ,chairperson2 7,c7 in paragraph 7#c7-- 7i7 by striking prior to ,march #a and inserting before ,june #a2 7ii7 by striking either each place it appears2 7iii7 by striking current chairman and inserting ,chairperson2 and 7iv7 by striking they and inserting the members2 and 7,d7 in paragraph 7#d7-- 7i7 by striking chairman each place it appears and inserting ,chairperson2 7ii7 in the first sentence1 by striking a report2 7iii7 by inserting a report after committees2 and 7iv7 by striking the second sentence and inserting the following3 ,the report required under this paragraph shall be in unclassified form1 but may include a classified annex42 and 7#c7 by adding at the end the following3 7c7 ,international coordination ,the ,director may facilitate international drug control coordination efforts4 4 #hbbj4 ,,gao ,audit ,not later than #d years after the date of enactment of this ,act1 and every #d years thereafter1 the ,comptroller ,general of the ,united ,states shall-- 7#a7 conduct an audit relating to the programs and operations of-- 7,a7 the ,office2 and 7,b7 certain programs within the ,office1 including-- 7i7 the ,high ,intensity ,drug ,trafficking ,areas ,program2 7ii7 the ,drug-,free ,communities ,program2 and 7iii7 the campaign under section #gji7;f7 of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjh7;f772 and 7#b7 submit to the ,director and the appropriate congressional committees a report containing an evaluation of and recommendations on the-- 7,a7 policies and activities of the programs and operations subject to the audit2 7,b7 economy1 efficiency1 and effectiveness in the administration of the reviewed programs and operations2 and 7,c7 policy or management changes needed to prevent and detect fraud and abuse in such programs and operations4 #hbba4 ,national ,drug ,control ,strategy 7a7 ,in general ,section #gjf of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agje7 is amended to read as follows3 #gjf4 ,national drug control strategy 7a7 ,in general 7#a7 ,statement of drug policy priorities ,the ,director shall release a statement of drug control policy priorities in the calendar year of a ,presidential inauguration following the inauguration1 but not later than ,april #a4 7#b7 ,national drug control strategy submitted by the president ,not later than the first ,monday in ,february following the year in which the term of the ,president commences1 and every #b years thereafter1 the ,president shall submit to ,congress a ,national ,drug ,control ,strategy4 7b7 ,development of the national drug control strategy 7#a7 ,promulgation ,the ,director shall promulgate the ,national ,drug ,control ,strategy1 which shall set forth a comprehensive plan to reduce illicit drug use and the consequences of such illicit drug use in the ,united ,states by limiting the availability of and reducing the demand for illegal drugs and promoting prevention1 early intervention1 treatment1 and recovery support for individuals with substance use disorders4 7#b7 ,state and local commitment ,the ,director shall seek the support and commitment of ,state1 local1 and ,tribal officials in the formulation and implementation of the ,national ,drug ,control ,strategy4 7#c7 ,strategy based on evidence ,the ,director shall ensure the ,national ,drug ,control ,strategy is based on the best available evidence regarding the policies that are most effective in reducing the demand for and supply of illegal drugs4 7#d7 ,process for development and submission of national drug control strategy ,in developing and effectively implementing the ,national ,drug ,control ,strategy1 the ,director-- 7,a7 shall consult with-- 7i7 the heads of the ,national ,drug ,control ,program ,agencies2 7ii7 each ,coordinator listed in section #gjd2 7iii7 the ,interdiction ,committee and the ,emerging ,threats ,committee2 7iv7 the appropriate congressional committees and any other committee of jurisdiction2 7v7 ,state1 local1 and ,tribal officials2 7vi7 private citizens and organizations1 including community and faith-based organizations1 with experience and expertise in demand reduction2 7vii7 private citizens and organizations with experience and expertise in supply reduction2 and 7viii7 appropriate representatives of foreign governments2 and 7,b7 in satisfying the requirements of subparagraph 7,a71 shall ensure1 to the maximum extent possible1 that ,state1 local1 and ,tribal officials and relevant private organizations commit to support and take steps to achieve the goals and objectives of the ,national ,drug ,control ,strategy4 7c7 ,contents of the national drug control strategy 7#a7 ,in general ,the ,national ,drug ,control ,strategy submitted under subsection 7a77#b7 shall include the following3 7,a7 ,a mission statement detailing the major functions of the ,national ,drug ,control ,program4 7,b7 ,comprehensive1 research-based1 long-range1 quantifiable goals for reducing illicit drug use1 and the consequences of illicit drug use in the ,united ,states4 7,c7 ,annual quantifiable and measurable objectives and specific targets to accomplish long-term quantifiable goals that the ,director determines may be achieved during each year beginning on the date on which the ,national ,drug ,control ,strategy is submitted4 7,d7 ,a #e-year projection for the ,national ,drug ,control ,program and budget priorities4 7,e7 ,a review of international1 ,state1 local1 and private sector drug control activities to ensure that the ,united ,states pursues coordinated and effective drug control at all levels of government4 7,f7 ,a description of how each goal established under subparagraph 7,b7 will be achieved1 including for each goal-- 7i7 a list of each relevant ,national ,drug ,control ,program ,agency and each such agency's related programs1 activities1 and available assets and the role of each such program1 activity1 and asset in achieving such goal2 7ii7 a list of relevant stakeholders and each such stakeholder's role in achieving such goal2 7iii7 an estimate of ,federal funding and other resources needed to achieve such goal2 7iv7 a list of each existing or new coordinating mechanism needed to achieve such goal2 and 7v7 a description of the ,office's role in facilitating the achievement of such goal4 7,g7 ,for each year covered by the ,strategy1 a performance evaluation plan for each goal established under subparagraph 7,b7 for each ,national ,drug ,control ,program ,agency1 including-- 7i7 specific performance measures for each ,national ,drug ,control ,program ,agency2 7ii7 annual and1 to the extent practicable1 quarterly objectives and targets for each performance measure2 and 7iii7 an estimate of ,federal funding and other resources needed to achieve each performance objective and target4 7,h7 ,a list identifying existing data sources or a description of data collection needed to evaluate performance1 including a description of how the ,director will obtain such data4 7,i7 ,a list of any anticipated challenges to achieving the ,national ,drug ,control ,strategy goals and planned actions to address such challenges4 7,j7 ,a description of how each goal established under subparagraph 7,b7 was determined1 including-- 7i7 a description of each required consultation and a description of how such consultation was incorporated2 and 7ii7 data1 research1 or other information used to inform the determination to establish the goal4 7,k7 ,a description of the current prevalence of illicit drug use in the ,united ,states1 including both the availability of illicit drugs and the prevalence of substance use disorders4 7,l7 ,such other statistical data and information as the ,director considers appropriate to demonstrate and assess trends relating to illicit drug use1 the effects and consequences of illicit drug use 7including the effects on children71 supply reduction1 demand reduction1 drug-related law enforcement1 and the implementation of the ,national ,drug ,control ,strategy4 7,m7 ,a systematic plan for increasing data collection to enable real time surveillance of drug control threats1 developing analysis and monitoring capabilities1 and identifying and addressing policy questions related to the ,national ,drug ,control ,strategy and ,program1 which shall include-- 7i7 a list of policy-relevant questions for which the ,director and each ,national ,drug ,control ,program ,agency intends to develop evidence to support the ,national ,drug ,control ,program and ,strategy2 7ii7 a list of data the ,director and each ,national ,drug ,control ,program ,agency intends to collect1 use1 or acquire to facilitate the use of evidence in drug control policymaking and monitoring2 7iii7 a list of methods and analytical approaches that may be used to develop evidence to support the ,national ,drug ,control ,program and ,strategy and related policy2 7iv7 a list of any challenges to developing evidence to support policymaking1 including any barriers to accessing1 collecting1 or using relevant data2 7v7 a description of the steps the ,director and the head of each ,national ,drug ,control ,program ,agency will take to effectuate the plan2 and 7vi7 any other relevant information as determined by the ,director4 7,n7 ,a plan to expand treatment of substance use disorders1 which shall-- 7i7 identify unmet needs for treatment for substance use disorders and a strategy for closing the gap between available and needed treatment2 7ii7 describe the specific roles and responsibilities of the relevant ,national ,drug ,control ,programs for implementing the plan2 7iii7 identify the specific resources required to enable the relevant ,national ,drug ,control ,agencies to implement that strategy2 and 7iv7 identify the resources1 including private sources1 required to eliminate the unmet need for evidence-based substance use disorder treatment4 7#b7 ,consultation ,in developing the plan required under paragraph 7#a71 the ,director shall consult with the following3 7,a7 ,the public4 7,b7 ,any evaluation or analysis units and personnel of the ,office4 7,c7 ,office officials responsible for implementing privacy policy4 7,d7 ,office officials responsible for data governance4 7,e7 ,the appropriate congressional committees4 7,f7 ,any other individual or entity as determined by the ,director4 7#c7 ,additional strategies 7,a7 ,in general ,the ,director shall include in the ,national ,drug ,control ,strategy the additional strategies described under this paragraph and shall comply with the following3 7i7 ,provide a copy of the additional strategies to the appropriate congressional committees and to the ,committee on ,armed ,services and the ,committee on ,homeland ,security of the ,house of ,representatives1 and the ,committee on ,homeland ,security and ,governmental ,affairs and the ,committee on ,armed ,services of the ,senate4 7ii7 ,issue the additional strategies in consultation with the head of each relevant ,national ,drug ,control ,program ,agency1 any relevant official of a ,state1 local1 or ,tribal government1 and the government of other relevant countries4 7iii7 ,not change any existing agency authority or construe any strategy described under this paragraph to amend or modify any law governing interagency relationship but may include recommendations about changes to such authority or law4 7iv7 ,present separately from the rest of any strategy described under this paragraph any information classified under criteria established by an ,executive order1 or whose public disclosure1 as determined by the ,director or the head of any relevant ,national ,drug ,control ,program ,agency1 would be detrimental to the law enforcement or national security activities of any ,federal1 ,state1 local1 or ,tribal agency4 7,b7 ,requirement for southwest border counternarcotics strategy 7i7 ,purposes ,the ,southwest ,border ,counternarcotics ,strategy shall-- 7,i7 set forth the ,government's strategy for preventing the illegal trafficking of drugs across the international border between the ,united ,states and ,mexico1 including through ports of entry and between ports of entry on that border2 7,,ii7 state the specific roles and responsibilities of the relevant ,national ,drug ,control ,program ,agencies for implementing that strategy2 and 7,,iii7 identify the specific resources required to enable the relevant ,national ,drug ,control ,program ,agencies to implement that strategy4 7ii7 ,specific content related to drug tunnels between the ,united ,states and ,mexico ,the ,southwest ,border ,counternarcotics ,strategy shall include-- 7,i7 a strategy to end the construction and use of tunnels and subterranean passages that cross the international border between the ,united ,states and ,mexico for the purpose of illegal trafficking of drugs across such border2 and 7,,ii7 recommendations for criminal penalties for persons who construct or use such a tunnel or subterranean passage for such a purpose4 7,c7 ,requirement for ,northern ,border ,counternarcotics ,strategy 7i7 ,purposes ,the ,northern ,border ,counternarcotics ,strategy shall-- 7,i7 set forth the strategy of the ,federal ,government for preventing the illegal trafficking of drugs across the international border between the ,united ,states and ,canada1 including through ports of entry and between ports of entry on the border2 7,,ii7 state the specific roles and responsibilities of each relevant ,national ,drug ,control ,program ,agency for implementing the strategy2 7,,iii7 identify the specific resources required to enable the relevant ,national ,drug ,control ,program ,agencies to implement the strategy2 7,,iv7 be designed to promote1 and not hinder1 legitimate trade and travel2 and 7,v7 reflect the unique nature of small communities along the international border between the ,united ,states and ,canada1 ongoing cooperation and coordination with ,canadian law1 enforcement authorities1 and variations in the volumes of vehicles and pedestrians crossing through ports of entry along the international border between the ,united ,states and ,canada4 7ii7 ,specific content related to cross-border ,indian reservations ,the ,northern ,border ,counternarcotics ,strategy shall include-- 7,i7 a strategy to end the illegal trafficking of drugs to or through ,indian reservations on or near the international border between the ,united ,states and ,canada2 and 7,,ii7 recommendations for additional assistance1 if any1 needed by ,tribal law enforcement agencies relating to the strategy1 including an evaluation of ,federal technical and financial assistance1 infrastructure capacity building1 and interoperability deficiencies4 7#d7 ,classified information ,any contents of the ,national ,drug ,control ,strategy that involve information properly classified under criteria established by an ,executive order shall be presented to ,congress separately from the rest of the ,national ,drug ,control ,strategy4 7#e7 ,selection of data and information ,in selecting data and information for inclusion in the ,strategy1 the ,director shall ensure-- 7,a7 the inclusion of data and information that will permit analysis of current trends against previously compiled data and information where the ,director believes such analysis enhances long-term assessment of the ,national ,drug ,control ,strategy2 and 7,b7 the inclusion of data and information to permit a standardized and uniform assessment of the effectiveness of drug treatment programs in the ,united ,states4 7d7 ,submission of revised strategy ,the ,president may submit to ,congress a revised ,national ,drug ,control ,strategy that meets the requirements of this section-- 7#a7 at any time1 upon a determination of the ,president1 in consultation with the ,director1 that the ,national ,drug ,control ,strategy in effect is not sufficiently effective2 or 7#b7 if a new ,president or ,director takes office4 7e7 ,failure of ,director to submit ,national ,drug ,control ,strategy ,if the ,director does not submit a ,national ,drug ,control ,strategy to ,congress in accordance with subsection 7a77#b71 not later than five days after the first ,monday in ,february following the year in which the term of the ,president commences1 the ,director shall send a notification to the appropriate congressional committees-- 7#a7 explaining why the ,strategy was not submitted2 and 7#b7 specifying the date by which the ,strategy will be submitted4 7f7 ,drug control data dashboard 7#a7 ,in general ,the ,director shall collect and disseminate1 as appropriate1 such information as the ,director determines is appropriate1 but not less than the information described in this subsection4 ,the data shall be publicly available in a machine-readable format on the online portal of the ,office1 and to the extent practicable on the ,drug ,control ,data ,dashboard4 7#b7 ,establishment ,the ,director shall publish to the online portal of the office in a machine-readable1 sortable1 and searchable format1 or to the extent practicable1 establish and maintain a data dashboard on the online portal of the ,office to be known as the ,drug ,control ,data ,dashboard4 ,to the extent practicable1 when establishing the ,drug ,control ,dashboard1 the ,director shall ensure the user interface of the dashboard is constructed with modern design standards4 ,to the extent practicable1 the data made available on the dashboard shall be publicly available in a machine-readable format and searchable by year1 agency1 drug1 and location4 7#c7 ,data ,the data included in the ,drug ,control ,data ,dashboard shall be updated quarterly to the extent practicable1 but not less frequently than annually and shall include1 at a minimum1 the following3 7,a7 ,for each substance identified by the ,director as having a significant impact on the prevalence of illicit drug use-- 7i7 data sufficient to show the quantities of such substance available in the ,united ,states1 including-- 7,i7 the total amount seized and disrupted in the calendar year and each of the previous #c calendar years1 including to the extent practicable the amount seized by ,state1 local1 and ,tribal governments2 7,,ii7 the known and estimated flows into the ,united ,states from all sources in the calendar year and each of the previous #c calendar years2 7,,iii7 the total amount of known flows that could not be interdicted or disrupted in the calendar year and each of the previous #c calendar years2 7,,iv7 the known and estimated levels of domestic production in the calendar year and each of the previous three calendar years1 including the levels of domestic production if the drug is a prescription drug1 as determined under the ,federal ,food1 ,drug1 and ,cosmetic ,act1 for which a listing is in effect under section #bjb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hab72 7,v7 the average street price for the calendar year and the highest known street price during the preceding #aj-year period2 and 7,,vi7 to the extent practicable1 related prosecutions by ,state1 local1 and ,tribal governments2 7ii7 data sufficient to show the frequency of use of such substance1 including-- 7,i7 use of such substance in the workplace and productivity lost by such use2 7,,ii7 use of such substance by arrestees1 probationers1 and parolees2 7,,iii7 crime and criminal activity related to such substance2 7,,iv7 to the extent practicable1 related prosecutions by ,state1 local1 and ,tribal governments2 7,b7 ,for the calendar year and each of the previous three years data sufficient to show1 disaggregated by ,state and1 to the extent feasible1 by region within a ,state1 county1 or city1 the following3 7i7 ,the number of fatal and non-fatal overdoses caused by each drug identified under subparagraph 7,a77i74 7ii7 ,the prevalence of substance use disorders4 7iii7 ,the number of individuals who have received substance use disorder treatment1 including medication assisted treatment1 for a substance use disorder1 including treatment provided through publicly-financed health care programs4 7iv7 ,the extent of the unmet need for substance use disorder treatment1 including the unmet need for medication-assisted treatment4 7,c7 ,data sufficient to show the extent of prescription drug diversion1 trafficking1 and misuse in the calendar year and each of the previous #c calendar years4 7,d7 ,any quantifiable measures the ,director determines to be appropriate to detail progress toward the achievement of the goals of the ,national ,drug ,control ,strategy4 7g7 ,development of an annual national drug control assessment 7#a7 ,timing ,not later than the first ,monday in ,february of each year1 the ,director shall submit to the ,president1 ,congress1 and the appropriate congressional committees1 a report assessing the progress of each ,national ,drug ,control ,program ,agency toward achieving each goal1 objective1 and target contained in the ,national ,drug ,control ,strategy applicable to the prior fiscal year4 7#b7 ,process for development of the annual assessment ,not later than ,november #a of each year1 the head of each ,national ,drug ,control ,program ,agency shall submit1 in accordance with guidance issued by the ,director1 to the ,director an evaluation of progress by the agency with respect to the ,national ,drug ,control ,strategy goals using the performance measures for the agency developed under this title1 including progress with respect to-- 7,a7 success in achieving the goals of the ,national ,drug ,control ,strategy2 7,b7 success in reducing domestic and foreign sources of illegal drugs2 7,c7 success in expanding access to and increasing the effectiveness of substance use disorder treatment2 7,d7 success in protecting the borders of the ,united ,states 7and in particular the ,southwestern border of the ,united ,states7 from penetration by illegal narcotics2 7,e7 success in reducing crime associated with drug use in the ,united ,states2 7,f7 success in reducing the negative health and social consequences of drug use in the ,united ,states2 7,g7 implementation of evidence-based substance use disorder treatment and prevention programs in the ,united ,states and improvements in the adequacy and effectiveness of such programs2 and 7,h7 success in increasing the prevention of illicit drug use4 7#c7 ,contents of the annual assessment ,the ,director shall include in the annual assessment required under paragraph 7#a7-- 7,a7 a summary of each evaluation received by the ,director under paragraph 7#b72 7,b7 a summary of the progress of each ,national ,drug ,control ,program ,agency toward the ,national ,drug ,control ,strategy goals of the agency using the performance measures for the agency developed under this chapter2 7,c7 an assessment of the effectiveness of each ,national ,drug ,control ,program ,agency and program in achieving the ,national ,drug ,control ,strategy for the previous year1 including a specific evaluation of whether the applicable goals1 measures1 objectives1 and targets for the previous year were met2 and 7,d7 the assessments required under this subsection shall be based on the ,performance ,measurement ,system4 4 7b7 ,technical and conforming amendments 7#a7 ,section #gjd7;b7 of the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agjc7;b77 is amended-- 7,a7 by striking paragraphs 7#ac7 and 7#ag72 and 7,b7 in paragraph 7#ad77;,a71 by striking paragraph 7#ac7 and inserting section #gjf7;g77#b74 7#b7 ,the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #bjjf 7,public ,law #aji-dfi2 #abj ,stat4 #cejb7 is amended by striking sections #aaaj and #aaaj;,a4 #hbbb4 ,technical and conforming amendments to the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih ,the ,office of ,national ,drug ,control ,policy ,reauthorization ,act of #aiih 7#ba ,u4,s4,c4 #agja et seq47 is amended-- 7#a7 by striking section #gjc7;b7 7#ba ,u4,s4,c4 #agjb7;b772 7#b7 in section #gjd 7#ba ,u4,s4,c4 #agjc7-- 7,a7 in subsection 7c7-- 7i7 in paragraph 7#c77;,c7-- 7,i7 in the matter before clause 7i71 by inserting requests a level of funding that will not enable achievement of the goals of the ,national ,drug ,control ,strategy1 including after request that2 7,,ii7 in clause 7iii7-- 7aa7 by striking drug treatment and inserting substance use disorder prevention and treatment2 and 7bb7 by striking the semicolon at the end and inserting 2 and2 7,,iii7 by striking clauses 7iv71 7vi71 and 7vii72 7,,iv7 by redesignating clause 7v7 as clause 7iv72 and 7,v7 in clause 7iv71 as so redesignated1 by striking the semicolon and inserting a period2 7ii7 in paragraph 7#d77;,a71 by striking #a1jjj1jjj and inserting #e1jjj1jjj or #aj percent of a specific program or account2 and 7,b7 in subsection 7f7-- 7i7 by striking the first paragraph 7#e72 and 7ii7 by striking the second paragraph 7#d72 and 7#c7 by striking section #gjh 7#ba ,u4,s4,c4 #agjg74 ,l ,budgetary effects #hbca4 ,budgetary effect 7a7 ,in ,general ,the budgetary effects of this ,act shall not be entered on either ,,paygo scorecard maintained pursuant to section #d7;d7 of the ,statutory ,pay-,as-,you-,go ,act of #bjaj 7#b ,u4,s4,c4 #icc7;d774 7b7 ,senate ,,paygo ,scorecards ,the budgetary effects of this ,act shall not be entered on any ,,paygo scorecard maintained for purposes of section #dajf of ,h4 ,con4 ,res4 #ga 7#aaeth ,congress74 ,clerk4