,,ii #aahth ,,congress #ast ,session ,s4 #cafe ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,october #cj1 #bjbc,mr4 ,padilla 7for himself and ,mr4 ,markey7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to help persons in the ,united ,states experiencing homelessness and significant behavioral health issues1 including substance use disorder1 by authorizing a grant program within the ,department of ,health and ,human ,services to assist ,state and local governments1 continuums of care1 community-based organizations that administer both health and homelessness services1 and providers of services to people experiencing homelessness1 better coordinate health care and homelessness services1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,homelessness and ,behavioral ,health ,care ,coordination ,act of #bjbc4 #b4 ,findings ,congress finds the following3 7#a7 ,the ,united ,states has a homelessness crisis1 with more than #ehb1jjj people experiencing homelessness on a single night according to the ,department of ,housing and ,urban ,development's #bjbb ,annual ,homeless ,assessment ,report to ,congress4 7#b7 ,while the lack of affordable housing is the primary driver of homelessness1 behavioral health conditions1 including substance use disorder1 can exacerbate homelessness and can also be a consequence of homelessness4 7#c7 ,research shows that people experiencing homelessness have higher rates of substance use disorder than people with housing stability4 ,some people who experience homelessness use substances to cope with the trauma and deprivations of their circumstances1 but substance use disorder frequently makes it more difficult for people experiencing homelessness to secure permanent housing4 7#d7 ,many individuals with substance use disorder who experience homelessness have co-occurring illnesses4 ,the combined effect of physical illness1 mental illness1 and lack of housing results in higher mortality rates for individuals experiencing homelessness4 7#e7 ,safely and securely housing individuals who are experiencing both homelessness and behavioral health issues1 including substance use disorder1 often requires supportive services and close coordination between housing and social service providers1 in addition to low-barrier1 affordable housing4 ,subsidized housing is critical1 but not enough--access to additional voluntary person-centered supportive services is needed4 7#f7 ,it is imperative that when people experiencing homelessness choose to seek help that housing as well as health care and person-centered supportive services be coordinated1 particularly given their acute needs and the significant costs incurred by communities for law enforcement1 correctional1 and emergency department care for failing to do so4 7#g7 ,while participation in health care and person-centered supportive services should not be a requirement for people experiencing homelessness to receive housing1 access to such services can be beneficial in securing and successfully maintaining stable housing4 7#h7 ,integration of health and homelessness services to achieve optimal outcomes for people experiencing homelessness1 significant behavioral health conditions such as substance use disorder1 and other health conditions can be challenging for ,state and local governments1 continuums of care1 and community-based organizations that administer both health and homelessness services and providers of homelessness services4 7#i7 ,capacity-building is needed to create systems-level linkages between the #b sets of services to allow for smoother pathways and simpler navigation4 7#aj7 ,black1 ,hispanic1 and ,indigenous people are disproportionately underserved by person-centered supportive services4 ,in order to address critical services deficits and affirmatively serve protected classes of people with significant behavioral health conditions1 including substance use disorder1 who are experiencing homelessness1 the grant program established under this ,act can be used to build the capacities of providers of homelessness services that have demonstrated cultural competencies in service provision and a record of serving ,black1 ,hispanic1 and ,indigenous people and other underserved populations experiencing homelessness that also suffer from substance use disorder4 #c4 ,definitions ,in this ,act3 7#a7 ,behavioral health ,the term behavioral health includes mental health and substance use4 7#b7 ,eligible entity ,the term eligible entity means an entity described in section #c7;c77#d7 that is eligible for a competitive grant under section #d4 7#c7 ,indian ,tribe ,the term ,indian ,tribe has the meaning given the term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#d7 ,person experiencing homelessness ,the term person experiencing homelessness has the same meaning as the terms homeless1 homeless individual1 and homeless person1 as defined in section #ajc of the ,mc,kinney-,vento ,homeless ,assistance ,act 7#db ,u4,s4,c4 #aacjb74 7#e7 ,public housing agency ,the term public housing agency has the meaning given the term in section #c7;b77#f7 of the ,united ,states ,housing ,act of #aicg 7#db ,u4,s4,c4 #adcg;a7b77#f774 7#f7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#g7 ,substance use disorder ,the term substance use disorder means the disorder that occurs when the recurrent use of alcohol or drugs1 or both1 causes clinically significant impairment1 including health problems1 disability1 and failure to meet major responsibilities at work1 school1 or home4 7#h7 ,tribal organization ,the term ,tribal organization-- 7,a7 has the meaning given the term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #cejd72 and 7,b7 includes entities that serve ,native ,hawaiians1 as defined in section #cch,k7c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #beds7c774 7#i7 ,tribally designated housing entity ,the term tribally designated housing entity has the meaning given the term in section #d of the ,native ,american ,housing ,assistance and ,self-,determination ,act of #aiif 7#be ,u4,s4,c4 #dajc74 #d4 ,establishment of grant program 7a7 ,in general ,the ,secretary1 in consultation with the working group established under subsection 7b71 shall establish a grant program to award competitive grants to eligible entities in direct coordination with a continuum of care to build or increase capacity to coordinate the delivery of health care and homelessness services within the continuum of care4 7b7 ,working group 7#a7 ,establishment ,the ,secretary shall establish an interagency working group to provide advice and coordinate along relevant existing working groups to the ,secretary in carrying out the program established under subsection 7a74 7#b7 ,composition ,the working group established under paragraph 7#a7 shall include representatives from the ,department of ,health and ,human ,services1 the ,department of ,housing and ,urban ,development1 the ,united ,states ,interagency ,council on ,homelessness1 the ,department of ,agriculture1 and the ,bureau of ,indian ,affairs1 to be appointed by the heads of such agencies4 7#c7 ,development of assistance tools ,not later than #a year after the date of enactment of this ,act1 the working group established under paragraph 7#a7 shall-- 7,a7 develop training1 tools1 and other technical assistance materials that simplify homelessness services for providers of health care and simplify health care services for providers of homelessness services by identifying the basic elements the health and homelessness sectors need to understand about the other2 and 7,b7 circulate the materials described in subparagraph 7,a7 to interested entities1 particularly eligible entities that apply for grants awarded pursuant to this ,act4 7c7 ,capacity-,building grants 7#a7 ,in general ,the ,secretary shall award #e-year grants to eligible entities1 which shall be used only to build or increase capacities to coordinate health care and homelessness services4 7#b7 ,prohibition ,none of the proceeds from the grants awarded pursuant to this ,act may be used to pay for-- 7,a7 health care1 with the exception of efforts to increase the availability of ,naloxone and provide training for the administration of ,naloxone2 or 7,b7 rent4 7#c7 ,amount ,the amount awarded to an eligible entity under a grant under this subsection shall not exceed #ejj1jjj4 7#d7 ,eligibility ,to be eligible to receive a grant under this subsection1 an entity shall-- 7,a7 be designated by a continuum of care to ensure coordination across the continuum of care geographic regions1 and which may be-- 7i7 a governmental entity at the county1 city1 regional1 or locality level2 7ii7 an ,indian ,tribe1 a tribally designated housing entity1 a ,tribal organization1 or an urban ,indian organization2 7iii7 a public housing agency administering housing choice vouchers2 or 7iv7 a nonprofit organization2 7,b7 be responsible for homelessness services2 7,c7 provide such assurances as the ,secretary shall require that1 in carrying out activities with amounts from the grant1 the entity will ensure that services are culturally competent1 meet the needs of the people being served1 and follow trauma-informed best practices to address those needs using a harm reduction approach2 and 7,d7 demonstrate how the capacity of the entity to coordinate health care and homelessness services to better serve people experiencing homelessness and significant behavioral health issues1 including substance use disorder1 can be increased through-- 7i7 the designation of a governmental official as a coordinator for making connections between health and homelessness services and developing a strategy for using those services in a holistic way to help people experiencing homelessness and behavioral health conditions such as substance use disorder1 including those with co-occurring conditions2 7ii7 improvements in infrastructure at the systems level2 7iii7 improvements in technology for voluntary remote monitoring capabilities1 including internet and video1 which can allow for more home- and community-based behavioral health care services and ensure such improvements maintain effective communication requirements for persons with disabilities and program access for persons with limited ,english proficiency2 7iv7 improvements in connections to health care services delivered by providers experienced in behavioral health care and people experiencing homelessness2 7v7 efforts to increase the availability1 and training for the administration1 of opioid antagonists indicated for emergency treatment of opioid overdose2 and 7vi7 any additional activities identified by the ,secretary that will advance the coordination of homelessness assistance1 housing1 and behavioral health care services and other health care services4 7#e7 ,eligible activities ,an eligible entity receiving a grant under this subsection may use the grant to cover costs related to-- 7,a7 hiring system coordinators2 and 7,b7 administrative costs1 including staffing costs1 technology costs1 and other such costs identified by the ,secretary4 7#f7 ,distribution of funds ,an eligible entity receiving a grant under this subsection may distribute all or a portion of the grant amounts to private nonprofit organizations1 other government entities1 ,state1 local1 or ,tribal public health departments1 community health centers or organizations1 public housing agencies1 tribally designated housing entities1 or other entities as determined by the ,secretary to carry out programs and activities in accordance with this section4 7#g7 ,oversight requirements 7,a7 ,annual reports ,not later than #f years after the date on which grant amounts are first received by an eligible entity1 the eligible entity shall submit to the ,secretary a report on the activities carried out under the grant1 which shall include1 with respect to activities carried out with grant amounts in the community served-- 7i7 measures of outcomes relating to whether people experiencing homelessness and significant behavioral health issues1 including substance use disorder1 who sought help from an entity that received a grant-- 7,i7 were housed and did not experience intermittent periods of homelessness2 7,,ii7 were voluntarily enrolled in treatment and recovery programs2 7,,iii7 experienced improvements in their health2 7,,iv7 obtained access to specific primary care providers2 and 7,v7 have health care plans that meet their individual needs1 including access to mental health and substance use disorder treatment and recovery services2 7ii7 how grant funds were used2 and 7iii7 any other matters determined appropriate by the ,secretary4 7,b7 ,rule of construction ,nothing in this subsection may be construed to condition the receipt of future housing and other services by individuals assisted with activities and services provided with grant amounts on the outcomes detailed in the reports submitted under this subsection4 7d7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #bj1jjj1jjj for each of fiscal years #bjbc through #bjbh1 of which not less than #e percent of such funds shall be awarded to ,indian ,tribes1 tribally designated housing entities1 and ,tribal organizations4