,,ii #aaith ,,congress #ast ,session ,s4 #ffe ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #bj1 #bjbe,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 the ,health ,engagement ,hub ,demonstration ,program to increase access to treatment for opioid use disorder and other substance use disorders1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,fatal ,overdose ,reduction ,act of #bjbe4 #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 opioid use disorder and other substance use disorders 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#c77;,a7 7which may be further defined and interpreted by the ,secretary as necessary to carry out the demonstration program7 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 the required items and services described in paragraph 7#c77;,b7 7which may be further defined and interpreted by the ,secretary as necessary to carry out the demonstration program7 that are provided by a certified ,health ,engagement ,hub participating in the demonstration program to individuals who are eligible for medical assistance under a ,state plan under this title or under a waiver of such plan4 ,such guidance shall specify that the prospective payment system established by a ,state shall only apply to the required items and services described in paragraph 7#c77;,b77i7 that are provided in accordance with the requirements applicable under this title to the provision of such services to individuals who are eligible for medical assistance under the ,state plan under this title or under a waiver of such plan4 7,c7 ,clarification regarding payment for furnishing medical assistance for prescribed drugs or covered outpatient drugs ,statements that1 with respect to the provision of medical assistance for prescribed drugs or covered outpatient drugs 7as defined in section #aibg7k77 by a certified ,health ,engagement ,hub to individuals who are eligible for medical assistance under the ,state plan under this title or under a waiver of such plan and in accordance with the requirements applicable under this title-- 7i7 the prospective payment system established by a ,state for purposes of the demonstration program shall not include payment for such medical assistance 7other than with respect to the service of providing a prescription or administering a drug if needed72 and 7ii7 a certified ,health ,engagement ,hub that provides medical assistance for prescribed drugs or covered outpatient drugs 7as so defined7 shall not be precluded from receiving payment under the ,state plan under this title or under a waiver of such plan for the provision of such medical assistance1 that is in addition to1 and separate from1 any payment made to the certified ,health ,engagement ,hub under such prospective payment system4 7,d7 ,eligibility of an ,indian tribe1 tribal organization1 ,urban ,indian organization1 or consortia ,such requirements as the ,secretary determines appropriate for an ,indian ,tribe or ,tribal organization1 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act71 a tribal consortia1 or an ,urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act71 to apply for1 and be selected to participate in1 the demonstration program4 ,to the extent practicable1 such requirements shall be similar to the requirements applicable to a ,state desiring to participate 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 satisfy the following requirements3 7i7 ,the organization demonstrates that the organization is equipped to serve individuals who are eligible for medical assistance under a ,state plan under this title or under a waiver of such plan 7including individuals who are eligible for such assistance but are not enrolled in such ,state plan or waiver71 as well as uninsured individuals 7as defined in section #aijb7ss771 and provide such populations with access to a range of social and medical services1 in a drop-in manner and without prior appointment4 7ii7 ,the organization provides 7in a manner reflecting person-centered care7 the services specified in subparagraph 7,b7 which1 if not available directly through the organization1 are provided or referred through partnerships or formal contracts with other providers4 7iii7 ,the organization demonstrates that in selecting the location for the ,health ,engagement ,hub1 the organization prioritized placement in communities disproportionately impacted by overdose and other harms related to substance use disorder 7as further defined by the ,secretary71 including rural areas1 geographically isolated areas within the ,state1 tribal areas1 urban centers with under-resourced behavioral health infrastructure1 communities with significant numbers of individuals experiencing homelessness1 and communities negatively impacted by the criminal-legal system4 7iv7 ,the organization uses evidence-based models to increase engagement and improve outcomes for individuals with opioid use disorder or other substance use disorders1 such as social work empowerment models1 motivational interviewing models1 shared decision-making models1 and other evidence-based recovery and support services4 7v7 ,the organization demonstrates that the organization is equipped to provide-- 7,i7 overdose education and distribution of a drug or device approved or cleared under the ,federal ,food1 ,drug1 and ,cosmetic ,act for emergency reversal of known or suspected opioid overdose 7such as naloxone72 7,,ii7 safer substance use education and supplies2 7,,iii7 safer-sex supplies2 7,,iv7 emotional support and counseling services to reduce harms associated with substance use1 using a trauma-informed approach2 and 7,v7 access1 within #d hours of the arrival of an individual with opioid use disorder or other substance use disorder at a ,health ,engagement ,hub1 to drugs approved under section #eje of the ,federal ,food1 ,drug1 and ,cosmetic ,act and biological products licensed under section #cea of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfb7 for treatment of opioid use disorder or substance use disorder with a strong evidence base of significantly reducing mortality1 directly or through partnerships or formal contracts with other providers in a manner that insures consistency of care and care coordination4 7vi7 ,the organization demonstrates that the organization is equipped to provide1 as selected by the organization1 #a or more services to address health-related social needs1 which may include-- 7,i7 identification services 7such as assistance with obtaining a government-recognized form of identification72 7,,ii7 employment counseling2 7,,iii7 recovery support services1 including services that promote a process of change through which individuals improve their health and wellness1 live self-directed lives1 and strive to reach their full potential through career1 education1 or community-building2 7,,iv7 family reunification services1 including services that help the reunification of family members separated by the legal system or foster system2 and 7,v7 criminal-legal services1 including the provision of legal clinical consultation1 legal information and advice1 legal referrals1 and legal advocacy or retainer4 7vii7 ,the organization demonstrates that the organization is equipped to 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 7viii7 ,the organization agrees to provide services to an uninsured individual 7as defined in section #aijb7ss771 with fees for such services imposed on a sliding scale basis that-- 7,i7 is developed at the discretion of a certified ,health ,engagement ,hub or the ,state2 7,,ii7 is based on an individual's ability to pay2 and 7,,iii7 provides that the organization shall not reject or limit services on the basis of an individual's ability to pay or place of residence4 7,b7 ,scope of items and services ,the items and services specified in this subparagraph are the following1 subject to the requirements applicable under this title to the provision of such items and services3 7i7 ,required items and services paid for through the prospective payment system 7,i7 ,harm reduction services and supplies4 7,,ii7 ,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 primary mental health and substance use disorder services1 as defined by the ,secretary1 including screening1 assessment1 and referrals to higher levels of care2 7bb7 shared decision-making for patients and providers for opioid use disorder or substance use disorder under which a patient and provider discuss the patient's diagnosis and condition together and evaluate treatment options together2 7cc7 wound care and supplies2 7dd7 infectious disease vaccination1 screening1 testing1 and1 to the extent practicable1 treatment 7including for ,,hiv1 sexually transmitted infections1 and hepatitis72 7ee7 sexual and reproductive health services provided directly or through partnerships or formal contracts with other providers2 and 7ff7 secure medication storage and inventory policies and procedures for patients experiencing homelessness or housing insecurity4 7,,iii7 ,medication management1 as specified by the ,state1 including with respect to the types of conditions for which medication management must be at a minimum available4 7,,iv7 ,targeted case management4 7,v7 ,peer support services4 7,,vi7 ,community health outreach and navigation services1 including services that guide patients through social and health care systems to connect with services and service providers that the patients need4 7ii7 ,prescribed drugs and covered outpatient drugs paid separate from the prospective payment system ,directly or through partnerships or formal contracts with other providers1 prescribed drugs and covered outpatient drugs 7as defined in section #aibg7k77 for which medical assistance is available under the ,state plan under this title or under a waiver of such plan that are provided in accordance with requirements applicable under this title and1 if applicable1 a rebate agreement in effect under section #aibg4 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 where the ,health ,engagement ,hub is located 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 nurse or licensed practical nurse who can provide or supervise staff providing medication management1 targeted case management1 wound care1 and vaccine administration4 7,,iii7 ,at least #a part-time or full-time licensed behavioral health staff who is qualified to assess or provide counseling about potential treatment options or about the need for treatment4 7,,iv7 ,at least #a full-time equivalent staff who is a peer support specialist1 community health worker1 or recovery coach1 with priority for hiring staff for such positions who are individuals with lived and living experience with substance use4 7,v7 ,full-time outreach1 engagement1 and ongoing care navigation staff1 including peer support specialists1 community health workers1 and recovery coaches4 ,at least #ej percent of such staff shall be individuals with lived and living experience with substance use4 7ii7 ,staffing through contractual arrangements with partner agencies ,an organization may enter into a contractual arrangement with a partner agency1 such as a ,federally-qualified health center1 to satisfy the minimum staffing requirements specified in clause 7i7 with staff who are on-site at the ,health ,engagement ,hub4 7,d7 ,experience ,an organization shall have a demonstrated history of at least #ab months of providing opioid use disorder or substance use disorder treatment services to individuals4 7,e7 ,community advisory board ,an organization shall have a community advisory board composed of individuals with lived and living experience with substance use that meets1 at a minimum-- 7i7 on 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 grants2 administration ,there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #fj1jjj1jjj to the ,secretary for purposes of implementing1 administering1 and making planning grants to ,states as soon as practicable for purposes of developing proposals to participate in the demonstration program and obtaining technical assistance from the ,secretary with respect to the design and implementation of the demonstration program1 for expenditures attributable to collecting and reporting the information and data required under paragraph 7#f77;,b71 and for administrative expenses of the ,secretary to carry out this subsection1 to remain available until expended4 7#e7 ,state demonstration programs 7,a7 ,in general ,not later than #i months after the date on which the ,secretary first awards a planning grant under paragraph 7#d71 the ,secretary shall solicit applications to participate in the demonstration program solely from ,states awarded such a grant4 7,b7 ,application requirements ,an application to participate in the demonstration program shall include the following3 7i7 ,a description of the target population 7including the estimated number of individuals in such population7 to be served by the ,state under the demonstration program4 7ii7 ,an assurance that at least #ej percent of the ,health ,engagement ,hubs in the ,state shall be located in-- 7,i7 a county 7or municipality or other unit of local government1 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 are available from the ,state1 is higher than the most recent available national average overdose death rate per #ajj1jjj people over the past #c years1 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#c74 7vi7 ,verification that the ,state has agreed to pay for the items and services required to be paid for through the prospective payment system at the rate established under the prospective payment system4 7vii7 ,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 up to #aj ,states to participate in the demonstration program4 7ii7 ,priority ,in selecting ,states to participate in the demonstration program1 the ,secretary shall prioritize selecting ,states-- 7,i7 with the highest opioid- or stimulant-involved overdose death rates2 and 7,,ii7 in a manner that ensures1 to the extent practicable1 geographic diversity across the ,united ,states4 7,d7 ,length of demonstration programs ,a ,state selected to participate in the demonstration program shall participate in the program for a #e-year period4 7,e7 ,waiver of certain requirements ,the ,secretary shall waive section #aijb7;a77#a7 7relating to statewideness7 and section #aijb7;a77#aj77;,b7 7relating to comparability7 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 ,for each quarter occurring during the period for which the demonstration program is conducted1 the ,secretary shall pay a ,state participating in the demonstration program an amount equal to #ij percent 7or1 if higher1 the ,federal medical assistance percentage otherwise applicable to the ,state and year under section #aije 7without regard to this subparagraph77 of the amounts expended by the ,state for the quarter for items and services provided by certified ,health ,engagement ,hubs 7directly or through partnerships or formal contracts with other providers7 at the rate established under the prospective payment system established by the ,state for purposes of the demonstration program to individuals who are eligible for1 and enrolled under1 the ,state plan or under a waiver of such plan4 7ii7 ,ensuring no duplicate pps payments ,the guidance required under paragraph 7#b77;,b7 shall include guidance on how the ,secretary will determine1 if #b or more prospective payment systems may apply to a service provided by a certified ,health ,engagement ,hub 7directly or through partnerships or formal contracts with other providers7 to an individual who is eligible for1 and enrolled under1 the ,state plan or under a waiver of such plan1 which prospective payment systems shall apply for purposes of determining the amount to be paid to a ,state for a quarter under clause 7i74 7iii7 ,application ,payments made 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 ,initial implementation ,during the first #b years in which a ,state participates in the demonstration program under paragraph 7#e71 the ,state shall submit to the ,secretary such information as the ,secretary may require relating to the implementation and initial operation of the demonstration program4 7,b7 ,annual state reports 7i7 ,in general ,beginning with the #crd year in which a ,state participates in the demonstration program under paragraph 7#e71 the ,state 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 opioid use disorder and other substance use disorders1 health services for individuals who use drugs1 and other social services under the ,state's plan under this title or under a waiver of such plan in the area or areas of the ,state targeted by the demonstration program1 as compared to other areas of the ,state4 7,,ii7 ,an assessment of the extent to which ,health ,engagement ,hubs are reducing opioid and stimulant overdose mortality rates and the rate of adherence to prescribed medication for opioid use1 hospitalization rates1 recovery rates1 and housing status for the populations served by the ,health ,engagement ,hubs as compared to populations that are not served by the ,health ,engagement ,hubs4 7,,iii7 ,data and information comparing for populations served by the ,health ,engagement ,hubs the racial and socioeconomic demographics1 housing status1 employment1 and other metrics1 as recommended by the ,secretary1 of such populations4 7,,iv7 ,a description of the successes of the demonstration program4 7,v7 ,recommendations for improvements to the demonstration program1 including whether the demonstration program should be continued1 expanded1 modified1 or terminated4 7ii7 ,data availability ,each ,state selected to participate in the demonstration program under paragraph 7#e7 shall agree1 as a condition of such selection1 to cooperate with data collection for purposes of the national implementation evaluation under paragraph 7#g74 7iii7 ,information and data collection and reporting expenditures ,from amounts made available under paragraph 7#d77;,a77i71 the ,secretary shall make payments to ,states for expenditures attributable to collecting and reporting the information and data required under this subparagraph4 7,c7 ,reports to congress and the ,comptroller ,general 7i7 ,in general ,beginning with the #crd year in which a ,state participates in the demonstration program under paragraph 7#e71 the ,secretary shall submit to ,congress and the ,comptroller ,general of the ,united ,states1 and make publicly available1 an annual report 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 national implementation evaluation required by paragraph 7#g74 7#g7 ,national implementation evaluation 7,a7 ,in general ,the ,secretary shall contract with an entity that meets the requirements of subparagraph 7,b77ii7 to solicit public input and conduct a national implementation evaluation of the planning grants awarded under paragraph 7#d7 and the ,state demonstration programs under paragraph 7#e7 to determine the reach1 effectiveness1 adoption1 and implementation of the demonstration program in each such ,state and to allow for a complete assessment of the impact of ,health ,engagement ,hubs in each ,state participating in the demonstration program4 7,b7 ,requirements 7i7 ,information ,the evaluation shall include information on the characteristics of the individuals who received 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-- 7,i7 have documented experience conducting implementation evaluations of health and social services programs2 and 7,,ii7 satisfy such additional eligibility criteria as the ,secretary may establish4 4 #c4 ,government ,accountability ,office report ,not later than #ah months after receipt of the annual ,state reports and the findings and conclusions of the national implementation evaluation under paragraph 7#f77;,c7 of section #aijc7;cc7 of the ,social ,security ,act 7as added by section #b71 the ,comptroller ,general of the ,united ,states shall provide to the ,committee on ,finance of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report assessing the ,secretary's evaluation of the ,health ,engagement ,hub ,demonstration ,program established under such section4