,,ii #aahth ,,congress #b;d ,session ,s4 #ddcj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #bc1 #bjbd,ms4 ,cantwell 7for herself and ,mr4 ,cassidy7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to establish a ,health ,engagement ,hub demonstration program to increase access to treatment for opiate use disorder and other drug use treatment1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,fatal ,overdose ,reduction ,act of #bjbd4 #b4 ,health ,engagement ,hub demonstration program under ,medicaid ,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 7cc7 ,health ,engagement ,hub demonstration program 7#a7 ,authority ,the ,secretary shall conduct a demonstration program 7referred to in this subsection as the demonstration program7 for the purpose of increasing access to treatment for opiate use disorder and other drug use treatment through the establishment of ,health ,engagement ,hubs that meet the criteria published by the ,secretary under paragraph 7#b77;,a74 7#b7 ,publication of guidance ,not later than #f months after the date of enactment of this subsection1 the ,secretary shall publish the following3 7,a7 ,certification criteria ,the criteria described in paragraph 7#c7 for an organization to be certified by a ,state as a ,health ,engagement ,hub for purposes of participating in the demonstration program4 7,b7 ,prospective payment system ,guidance for ,states selected to participate in the demonstration program to use to establish a prospective payment system for services permitted under paragraph 7#c77;,b7 that are provided by a certified ,health ,engagement ,hub participating in the demonstration program4 7#c7 ,criteria for certification of ,health ,engagement ,hubs 7,a7 ,general requirements ,in order to be certified as a ,health ,engagement ,hub1 an organization shall-- 7i7 demonstrate that the organization is able to serve as an all-in-one location where individuals who are eligible for medical assistance under a ,state plan under this title or under a waiver of such plan who seek treatment for opiate use disorder or other drug use may access a range of social and medical services1 in a drop-in manner and without prior appointment or proof of payment2 7ii7 provide the services specified in subparagraph 7,b7 7in a manner reflecting person-centered care7 which1 if not available directly through the organization1 shall be provided through formal relationships with other providers2 7iii7 demonstrate that in selecting the location for the ,health ,engagement ,hub1 the organization prioritized placement in communities disproportionately impacted by overdose1 health issues1 and other harms related to drug use1 as well as areas that are medically underserved1 rural1 geographically isolated areas1 tribal areas1 or urban centers with under-resourced behavioral health infrastructure1 including disadvantaged communities based on race1 individuals experiencing homelessness1 and communities negatively impacted by the criminal-legal system2 7iv7 give priority to establishing or adopting evidence-based models to increase engagement or improve outcomes for individuals with active1 ongoing substance use1 such as social work empowerment models approved by the ,secretary1 motivational interviewing models approved by the ,secretary1 or shared decision making models approved by the ,secretary2 and 7v7 meet-- 7,i7 the minimum staffing requirements described in subparagraph 7,c72 7,,ii7 the experience requirement described in subparagraph 7,d72 and 7,,iii7 the community advisory board requirement described in subparagraph 7,e74 7,b7 ,scope of services ,the services specified in this subparagraph are the following3 7i7 ,required services 7,i7 ,harm reduction services and supplies provided directly by the organization or under an arrangement with an organization that offers harm reduction services 7which may include a syringe service program1 a ,federally-qualified health center1 a community health center1 a ,tribal health program1 or an opioid treatment program that offers such services71 that include-- 7aa7 overdose education and naloxone distribution2 7bb7 safer drug use education and supplies2 7cc7 safer-sex supplies2 7dd7 emotional support and counseling services to reduce harms associated with substance use1 including trauma-informed care2 and 7ee7 access or referral to medications and drugs approved by the ,food and ,drug ,administration for treatment of opioid use disorder with a strong evidence base of significantly reducing mortality 7such as methadone and buprenorphine7 and other substances1 including stimulants1 within #d hours4 7,,ii7 ,substance use disorder screening and brief intervention4 7,,iii7 ,patient-centered and patient-driven physical and behavioral health care that has walk-in availability1 is offered during non-traditional hours1 including evenings and weekends1 and includes-- 7aa7 shared decision making for patients and providers for opioid use disorder1 stimulant use disorder1 or both1 under which a patient and provider discuss the patient's diagnosis and condition together and evaluate treatment options together2 7bb7 primary mental health and substance use disorder services1 including screening1 assessment1 and referrals to higher levels of care2 7cc7 wound care2 7dd7 infectious disease vaccination1 screening1 testing1 and1 to the extent practicable1 treatment 7including for ,,hiv1 sexually transmitted infections1 and hepatitis testing and treatment72 7ee7 access or referral to sexual and reproductive health services2 7ff7 assessment and linkage or referrals to psychiatric services and other specialty care2 and 7gg7 secure medication storage and inventory policies and procedures for patients experiencing homelessness or housing insecurity4 7,,iv7 ,care coordination1 complex case management1 and other case management1 care navigation1 and care coordination services that may include-- 7aa7 education and assistance with obtaining housing1 transportation1 and other public assistance benefits1 including enrollment in the ,state plan under this title or under a waiver of such plan2 7bb7 identification services 7such as assistance with obtaining a government-recognized form of identification72 7cc7 employment counseling2 7dd7 recovery support counseling2 7ee7 family reunification services2 and 7ff7 criminal-legal services4 7,v7 ,all services that may be provided under the ,outreach ,site_/,street ,place of ,service code 7,,pos ,code #bg as of ,october #a1 #bjbc7 7or a successor place of service code74 7,,vi7 ,community health outreach and navigation services to engage with and conduct outreach to community members that is provided by outreach and engagement staff described in subparagraph 7,c77i77,,iv74 7ii7 ,optional services 7,i7 ,services and supplies to meet basic needs1 including food1 clothing1 and hygiene supplies4 7,,ii7 ,evidence-based and culturally appropriate behavioral health services4 7,,iii7 ,medication management for physical and mental health conditions4 7,c7 ,minimum staffing requirements 7i7 ,in general ,the minimum staffing requirements specified in this subparagraph are the following3 7,i7 ,at least #a part-time or full-time health care provider who is licensed to practice in the ,state and is licensed1 registered1 or otherwise permitted1 by the ,united ,states to prescribe controlled substances 7as defined in section #ajb of the ,controlled ,substances ,act7 in the course of professional practice4 7,,ii7 ,at least #a part-time or full-time registered professional nurse or licensed practical nurse who can provide medication management1 medical case management1 care coordination1 wound care1 vaccine administration1 and community-based outreach4 7,,iii7 ,at least #a part-time or full-time licensed behavioral health staff who is qualified to assess and provide counseling and treatment recommendations for substance use and mental health diagnoses4 7,,iv7 ,full-time outreach1 engagement1 and ongoing care navigation staff1 including peer counselors1 community health workers1 and recovery coaches4 ,at least #ej percent of such staff shall be individuals with a personal history of drug use4 7ii7 ,staffing through arrangements with partner agencies ,an organization may enter into an arrangement with a partner agency1 such as a ,federally-qualified health center1 to satisfy the minimum staffing requirements specified in clause 7i74 7,d7 ,experience ,an organization shall have a demonstrated history of at least #ab months of service provision to individuals who use drugs1 including those who continue with substance use while receiving health and social services4 7,e7 ,community advisory board ,an organization shall have a community advisory board composed of individuals with a history of substance use1 or who continue with substance use1 that meets1 at a minimum1 on-- 7i7 a monthly basis1 to review program utilization data and provide feedback to the organization2 and 7ii7 on a quarterly basis1 with the executives or board of directors of the organization to provide input on service delivery and receive feedback on actions taken based on previous feedback provided by the community advisory board4 7#d7 ,planning grants 7,a7 ,in general ,not later than #a year after the date of enactment of this subsection1 the ,secretary shall award planning grants to ,states for the purpose of developing proposals to participate in the demonstration program4 7,b7 ,amount of grant ,the amount of a grant awarded to a ,state under this paragraph shall be sufficient to pay #ajj percent of the actual costs expended by a ,state to carry out the activities required under subparagraph 7,c74 7,c7 ,use of funds ,a ,state awarded a planning grant under this paragraph shall solicit input on the development of a proposal to participate in the demonstration program from patients1 providers1 harm reduction service providers1 social service providers1 and other stakeholders1 with respect to-- 7i7 identifying and certifying organizations as ,health ,engagement ,hubs for purposes of participating in the demonstration program2 and 7ii7 establishing a prospective payment system for services provided by a certified ,health ,engagement ,hub participating in the demonstration program1 in accordance with the guidance issued under paragraph 7#b77;,b74 7,d7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary such sums as are necessary to carry out this paragraph1 to remain available until expended4 7#e7 ,state demonstration programs 7,a7 ,in general ,not later than #b years after the date of enactment of this subsection1 the ,secretary shall solicit applications solely from the ,states awarded a planning grant under paragraph 7#d7 to participate in the demonstration program4 7,b7 ,application requirements ,an application to participate in the demonstration program shall include the following3 7i7 ,a description of1 including the estimated number of individuals in1 the target population to be served by the ,state under the demonstration program4 7ii7 ,an assurance that at least #a_/b of the ,health ,engagement ,hubs in the ,state shall be located in-- 7,i7 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 ,prevention2 or 7,,ii7 an area of the ,state that is designated under section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act as a mental health professional shortage area4 7iii7 ,a description of the prospective payment system that is to be tested under the demonstration program4 7iv7 ,a list of the certified ,health ,engagement ,hubs located in the ,state that will participate in the demonstration program4 7v7 ,verification that each such certified ,health ,engagement ,hub satisfies the requirements described in paragraph 7#c77;,a74 7vi7 ,a description of the scope of the services that will be paid for under the prospective payment system 7which includes at a minimum the required services described in paragraph 7#c77;,b77i77 that is to be tested under the demonstration program4 7vii7 ,verification that the ,state has agreed to pay for such services at the at the rate established under the prospective payment system4 7viii7 ,any other information that the ,secretary may require relating to the demonstration program with respect to determining the soundness of the proposed prospective payment system4 7,c7 ,selection criteria 7i7 ,in general ,the ,secretary shall select from among the applications submitted at least #aj ,states to participate in the demonstration program based on geographic and demographic diversity4 7ii7 ,priority ,in addition to the criteria specified in clause 7i71 the ,secretary shall prioritize selecting ,states with the highest rates of opioid- or stimulant-involved overdose death rates4 7,d7 ,length of demonstration programs ,a ,state selected to participate in the demonstration program shall participate in the program for a #b-year period4 7,e7 ,waiver of certain requirements ,the ,secretary shall waive section #aijb7;a77#a7 7relating to statewideness71 section #aijb7;a77#aj77;,b7 7relating to comparability71 and any other provision of this title which would be directly contrary to the authority under this subsection as may be necessary for a ,state to participate in the demonstration program in accordance with this paragraph4 7,f7 ,payments to ,states 7i7 ,in general ,the ,secretary shall pay a ,state participating in the demonstration program the ,federal matching percentage specified in clause 7ii7 for amounts expended by the ,state for medical assistance for services provided through certified ,health ,engagement ,hubs to individuals enrolled under the ,state plan 7or under a waiver of such plan7 consisting of medications and drugs approved by the ,food and ,drug ,administration for treatment of opioid use disorder and other substances1 including stimulants1 and the services specified by the ,state in its application under subparagraph 7,b77vi71 at the rate established under the prospective payment system established by the ,state for purposes of the demonstration program4 7ii7 ,federal matching percentage ,the ,federal matching percentage specified in this clause is-- 7,i7 with respect to medical assistance described in clause 7i7 that is furnished to a newly eligible individual described in paragraph 7#b7 of section #aije7y71 the matching rate applicable under paragraph 7#a7 of that section2 and 7,,ii7 with respect to medical assistance described in clause 7i7 that is furnished to an individual who is not a newly eligible individual 7as so described71 but who is eligible for medical assistance under the ,state plan under this title or under a waiver of such plan1 the enhanced ,,fmap applicable to the ,state under section #baje7;b74 7iii7 ,application ,payments to ,states made under this subparagraph shall be considered to have been made under1 and are subject to1 the requirements of this section4 7#f7 ,reports 7,a7 ,annual ,state reports 7i7 ,in general ,each ,state selected to participate in the demonstration program under paragraph 7#e7 shall submit an annual report to the ,secretary on the demonstration program that includes the following3 7,i7 ,an assessment of the extent to which ,health ,engagement ,hubs funded under the demonstration program have increased access to treatment for opiate use disorder and other drug use treatment1 health services for individuals who use drugs1 and other social services under ,state plans under this title or under waivers of such plans in the area or areas of ,states targeted by the demonstration program compared to other areas of the ,state4 7,,ii7 ,an assessment on the impact of ,health ,engagement ,hubs on reducing opioid and stimulant overdose mortality rates and the rate of adherence to prescribed medication for opioid use1 hospitalization rates1 and housing status for the population served by a ,health ,engagement ,hub as compared to populations that are not served by a ,health ,engagement ,hub4 7,,iii7 ,a description of the successes of the demonstration program4 7,,iv7 ,recommendations for improvements to the demonstration program1 including whether the demonstration program should be continued1 expanded1 modified1 or terminated4 7ii7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there are appropriated such sums as are necessary1 to remain available until expended1 for purposes of making payments to ,states for expenditures attributable to collecting and reporting the information required under this subparagraph4 7,b7 ,reports to congress 7i7 ,in general ,the ,secretary shall submit an annual report to ,congress that describes the information1 findings1 and recommendations in the annual ,state reports submitted to the ,secretary under subparagraph 7,a74 7ii7 ,implementation evaluation results ,the ,secretary shall include with the first #c annual reports submitted by the ,secretary under this subparagraph the findings and conclusions of the implementation evaluation required by paragraph 7#g74 7#g7 ,implementation evaluation 7,a7 ,in general ,the ,secretary shall solicit public input and fund an implementation evaluation of the planning grants awarded under paragraph 7#d7 and the initial set of ,states selected for the demonstration program under paragraph 7#e7 to determine the reach1 effectiveness1 adoption1 and implementation of the demonstration program in each such ,state to document the degree to which the services were implemented as intended and allow for a complete assessment of the impact of the ,health ,engagement ,hubs in each such ,state4 7,b7 ,requirements 7i7 ,information ,the evaluation shall include information on the characteristics of the individuals who receive services1 service utilization metrics over time 7including by staff role71 and input from interviews with such individuals and staff4 7ii7 ,eligible entities ,in order to be eligible to conduct the evaluation1 an entity shall have documented experience conducting implementation evaluations of health and social services programs for individuals who use drugs4 7,c7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary such sums as are necessary to carry out this paragraph1 to remain available until expended4 4 #c4 ,government ,accountability ,office report 7a7 ,in general ,not later than #f months after the conclusion of the demonstration program established under subsection 7cc7 of section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b71 as added by section #b1 the ,comptroller ,general of the ,united ,states shall conduct and publish a comparative analysis on the impacts of the health engagement hubs certified under such program 7in this section referred to as health engagement hubs7 compared to the impacts of other opioid treatment programs and health care organizations that offer behavioral health care or substance use disorder services4 7b7 ,content of analysis ,the analysis required under this section shall include the following3 7#a7 ,data and information analyzing differences in rates among individuals who receive behavioral health care or substance use disorder services through a health engagement hub and among individuals who receive such care or services through a program or organization referred to in subsection 7a7 for each of the following factors3 7,a7 ,changes in rates of mortality4 7,b7 ,changes in rates of recidivism4 7,c7 ,rates of relapse4 7,d7 ,rates of hospital and emergency department utilization4 7,e7 ,frequency of visits for care or services4 7,f7 ,rates of successful intervention through the administration of buprenorphine or other medication approved by the ,food and ,drug ,administration for the treatment of substance use disorder4 7#b7 ,data and information comparing the racial and socioeconomic demographics1 housing status1 employment1 and other metrics1 as recommended by the ,secretary of ,health and ,human ,services1 of the population groups that receive behavioral health care or substance use disorder services through a health engagement hub or through a program or organization referred to in subsection 7a74