Comprehensive Addiction Resources Emergency Act of 2021
This bill establishes programs, grants, and other activities to address substance use disorders.
Specifically, the Department of Health and Human Services (HHS) must establish a program for purchasing and distributing opioid overdose reversal drugs for states and Indian tribes.
HHS must also award grants for and otherwise support
In addition, HHS must issue model standards of care for treatment services and recovery residences and may award grants for training health care professionals. The bill also supports prevention and treatment services for workers, addiction and pain management research, and data collection on substance use disorders.
Further, dispensers, distributors, and manufacturers of schedule II controlled substances (e.g., oxycodone), with the exception of opioid treatment programs, must certify that they maintain effective drug diversion controls. Violators are subject to specified civil and criminal penalties. Collected penalties shall be used for the grant programs and other substance use disorder activities established under the bill.
To provide emergency assistance to States, territories, Tribal nations, 
 and local areas affected by substance use disorder, including the use 
 of opioids and stimulants, and to make financial assistance available 
to States, territories, Tribal nations, local areas, public or private 
 nonprofit entities, and certain health providers, to provide for the 
    development, organization, coordination, and operation of more 
  effective and cost efficient systems for the delivery of essential 
services to individuals with substance use disorder and their families.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Comprehensive 
Addiction Resources Emergency Act of 2021''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Purpose.
Sec. 3. Amendment to the Public Health Service Act.
                 ``TITLE XXXIV--SUBSTANCE USE RESOURCES

    ``Subtitle A--Local Substance Use Emergency Relief Grant Program

        ``Sec. 3401. Establishment of program of grants.
        ``Sec. 3402. Planning council.
        ``Sec. 3403. Amount of grant, use of amounts, and funding 
                            agreement.
        ``Sec. 3404. Application.
        ``Sec. 3405. Technical assistance.
        ``Sec. 3406. Authorization of appropriations.
 ``Subtitle B--State and Tribal Substance Use Disorder Prevention and 
                       Intervention Grant Program

        ``Sec. 3411. Establishment of program of grants.
        ``Sec. 3412. Amount of grant, use of amounts, and funding 
                            agreement.
        ``Sec. 3413. Application.
        ``Sec. 3414. Technical assistance.
        ``Sec. 3415. Authorization of appropriations.
                   ``Subtitle C--Other Grant Program

        ``Sec. 3421. Establishment of grant program.
        ``Sec. 3422. Use of amounts.
        ``Sec. 3423. Technical assistance.
        ``Sec. 3424. Planning and development grants.
        ``Sec. 3425. Authorization of appropriations.
  ``Subtitle D--Innovation, Training, and Health Systems Strengthening

        ``Sec. 3431. Special projects of national significance.
        ``Sec. 3432. Education and training centers.
        ``Sec. 3433. Substance use disorder treatment provider capacity 
                            under the Medicaid program.
        ``Sec. 3434. Programs to support employees.
        ``Sec. 3435. Improving and expanding care.
        ``Sec. 3436. Naloxone distribution program.
        ``Sec. 3437. Additional funding for the National Institutes of 
                            Health.
        ``Sec. 3438. Additional funding for the Centers for Disease 
                            Control and Prevention.
        ``Sec. 3439. Definitions.
Sec. 4. Amendments to the Controlled Substances Act.
Sec. 5. General limitation on use of funds.
Sec. 6. Federal drug demand reduction activities.

SEC. 2. PURPOSE.

    It is the purpose of this Act to provide emergency assistance to 
States, territories, Tribal nations, and local areas that are 
disproportionately affected substance use disorder, including the use 
of opioids and stimulants, and to make financial assistance available 
to States, territories, Tribal nations, local areas, public or private 
nonprofit entities, and certain health providers, to provide for the 
development, organization, coordination, and operation of more 
effective and cost efficient systems for the delivery of essential 
services to individuals with substance use disorder, including with co-
occurring mental health and substance use disorders, and their 
families.

SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

                 ``TITLE XXXIV--SUBSTANCE USE RESOURCES

    ``Subtitle A--Local Substance Use Emergency Relief Grant Program

``SEC. 3401. ESTABLISHMENT OF PROGRAM OF GRANTS.

    ``(a) In General.--The Secretary shall award grants to eligible 
localities for the purpose of addressing substance use within such 
localities.
    ``(b) Eligibility.--
            ``(1) In general.--To be eligible to receive a grant under 
        subsection (a) a locality shall--
                    ``(A) be--
                            ``(i) a county that can demonstrate that 
                        the rate of drug overdose deaths per 100,000 
                        population in the county during the most recent 
                        3-year period for which such data are available 
                        was not less than the rate of such deaths for 
                        the county that ranked at the 67th percentile 
                        of all counties, as determined by the 
                        Secretary;
                            ``(ii) a county that can demonstrate that 
                        the number of drug overdose deaths during the 
                        most recent 3-year period for which such data 
                        are available was not less than the number of 
                        such deaths for the county that ranked at the 
                        90th percentile of all counties, as determined 
                        by the Secretary;
                            ``(iii) a county that encompasses an 
                        undeserved area, defined as a health 
                        professional shortage area (as defined in 
                        section 332(a)(1)(A)) and a medically 
                        underserved area (according to a designation 
                        under section 330(b)(3)(A)), that can 
                        demonstrate a high burden of both fatal and 
                        non-fatal drug overdoses in a manner determined 
                        by the Secretary; or
                            ``(iv) a city that is located within a 
                        county described in clause (i), (ii), or (iii) 
                        that meets the requirements of paragraph (3); 
                        and
                    ``(B) submit to the Secretary an application in 
                accordance with section 3404.
            ``(2) Multiple contiguous counties.--In the case of an 
        eligible county that is contiguous to one or more other 
        eligible counties within the same State, the group of counties 
        shall--
                    ``(A) be considered as a single eligible county for 
                purposes of a grant under this section;
                    ``(B) submit a single application under section 
                3404;
                    ``(C) form a joint planning council (for the 
                purposes of section 3402); and
                    ``(D) establish, through intergovernmental 
                agreements, an administrative mechanism to allocate 
                funds and substance use disorder treatment services 
                under the grant based on--
                            ``(i) the number and rate of drug overdose 
                        deaths and nonfatal drug overdoses in each of 
                        the counties that compose the eligible county;
                            ``(ii) the severity of need for services in 
                        each such county; and
                            ``(iii) the health and support personnel 
                        needs of each such county.
            ``(3) Cities and counties within multiple contiguous 
        counties.--
                    ``(A) In general.--A city that is within an 
                eligible county described in paragraph (1), or a county 
                or group of counties that is within a group of counties 
                determined to be an eligible county under paragraph 
                (2), shall be eligible to receive a grant under section 
                3401 if such city or county or group of counties meets 
                the requirements of subparagraph (B).
                    ``(B) Requirements.--A city or county meets the 
                requirements of this subparagraph if such city or 
                county--
                            ``(i) except as provided in subparagraph 
                        (C), has a population of not less than 50,000 
                        residents;
                            ``(ii) meets the requirements of paragraph 
                        (1)(A);
                            ``(iii) submits an application under 
                        section 3404;
                            ``(iv) establishes a planning council (for 
                        purposes of section 3402); and
                            ``(v) establishes an administrative 
                        mechanism to allocate funds and services under 
                        the grant based on--
                                    ``(I) the number and rate of drug 
                                overdose deaths and nonfatal drug 
                                overdoses in the city or county;
                                    ``(II) the severity of need for 
                                substance use disorder treatment 
                                services in the city or county; and
                                    ``(III) the health and support 
                                personnel needs of the city or county.
                    ``(C) Population exception.--A city or county or 
                group of counties that does not meet the requirements 
                of subparagraph (B)(i) may apply to the Secretary for a 
                waiver of such requirement. Such application shall 
                demonstrate--
                            ``(i) that the needs of the population to 
                        be served are distinct or that addressing 
                        substance use in the service area would be best 
                        served by the formation of an independent 
                        council; and
                            ``(ii) that the city or county or group of 
                        counties has the capacity to administer the 
                        funding received under this subtitle.
                    ``(D) Minimum funding.--A city or county that meets 
                the requirement of this paragraph and receives a grant 
                under section 3401 shall be entitled to an amount of 
                funding under the grant in an amount that is not less 
                than the amount determined under section 3403(a) with 
                respect to such city or county.
            ``(4) Independent city.--Independent cities that are not 
        located within the territory of a county shall be treated as 
        eligible counties for purposes of this subtitle.
            ``(5) Political subdivisions.--With respect to States that 
        do not have a local county system of governance, the Secretary 
        shall determine the local political subdivisions within such 
        States that are eligible to receive a grant under section 3401 
        and such subdivisions shall be treated as eligible counties for 
        purposes of this subtitle.
            ``(6) Determinations where there is a lack of data.--The 
        Secretary shall establish eligibility and allocation criteria 
        related to the prevalence of drug overdose deaths, the 
        mortality rate from drug overdoses, and that provides an 
        equivalent measure of need for funding for cities and counties 
        for which the data described in paragraph (1)(A) or (2)(D)(i) 
        is not available.
            ``(7) Data from tribal areas.--The Secretary, acting 
        through the Indian Health Service, shall consult with Indian 
        Tribes and confer with urban Indian organizations to establish 
        eligibility and allocation criteria that provide an equivalent 
        measure of need for Tribal and urban Indian areas for which the 
        data described in paragraph (1)(A) or (2)(D)(i) are not 
        available or do not apply.
            ``(8) Study.--Not later than 3 years after the date of 
        enactment of this title, the Comptroller General shall conduct 
        a study to determine whether the data utilized for purposes of 
        paragraph (1)(A) provide the most precise measure of local area 
        need related to substance use and addiction prevalence and 
        whether additional data would provide more precise measures of 
        substance use and addiction prevalence in local areas. Such 
        study shall identify barriers to collecting or analyzing such 
        data, and make recommendations for revising the indicators used 
        under such paragraph to determine eligibility in order to 
        direct funds to the local areas in most need of funding to 
        provide assistance related to substance use and addiction.
            ``(9) Reference.--For purposes of this subtitle, the term 
        `eligible local area' includes--
                    ``(A) a city or county described in paragraph (1);
                    ``(B) multiple contiguous counties described in 
                paragraph (2);
                    ``(C) cities or counties within multiple contiguous 
                counties described in paragraph (3);
                    ``(D) an independent city described in paragraph 
                (4); and
                    ``(E) a political subdivision described in 
                paragraph (5).
    ``(c) Administration.--
            ``(1) In general.--Assistance made available under a grant 
        awarded under this section shall be directed to the chief 
        elected official of the eligible local area who shall 
        administer the grant funds.
            ``(2) Multiple contiguous counties.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), in the case of an eligible county 
                described in subsection (b)(2), assistance made 
                available under a grant awarded under this section 
                shall be directed to the chief elected official of the 
                particular county designated in the application 
                submitted for the grant under section 3404. Such chief 
                elected official shall be the administrator of the 
                grant.
                    ``(B) State administration.--Notwithstanding 
                subparagraph (A), the eligible county described in 
                subsection (b)(2) may elect to designate the chief 
                elected State official of the State in which the 
                eligible county is located as the administrator of the 
                grant funds.

``SEC. 3402. PLANNING COUNCIL.

    ``(a) Establishment.--To be eligible to receive a grant under 
section 3401, the chief elected official of the eligible local area 
shall establish or designate a substance use disorder treatment and 
services planning council that shall, to the maximum extent 
practicable--
            ``(1) be representative of the demographics of the 
        population of individuals with substance use disorder in the 
        area; and
            ``(2) include representatives of--
                    ``(A) health care providers, including Federally-
                qualified health centers, rural health clinics, Indian 
                health programs as defined in section 4 of the Indian 
                Health Care Improvement Act, urban Indian organizations 
                as defined in section 4 of the Indian Health Care 
                Improvement Act, and facilities operated by the 
                Department of Veterans Affairs;
                    ``(B) Native Hawaiian organizations as defined in 
                section 11 of the Native Hawaiian Health Care Act of 
                1988;
                    ``(C) community-based health, harm reduction, or 
                addiction service organizations, including, where 
                applicable, representatives of Drug Free Communities 
                Coalition grantees;
                    ``(D) social service providers, including providers 
                of housing and homelessness services and recovery 
                residence providers;
                    ``(E) mental health care providers;
                    ``(F) local public health agencies;
                    ``(G) individuals with substance use disorder and 
                individuals who use drugs;
                    ``(H) individuals in recovery from substance use 
                disorders;
                    ``(I) State governments, including the State 
                Medicaid agency and the Single State Agency for 
                Substance Abuse Services;
                    ``(J) local governments;
                    ``(K) non-elected community leaders;
                    ``(L) substance use disorder treatment providers, 
                including physician addiction specialists;
                    ``(M) Indian tribes and tribal organizations as 
                defined in section 4 of the Indian Self-Determination 
                and Education Assistance Act;
                    ``(N) Urban Indians as defined in section 4 of the 
                Indian Health Care Improvement Act;
                    ``(O) historically underserved groups and 
                subpopulations;
                    ``(P) individuals who were formerly incarcerated;
                    ``(Q) organizations serving individuals who are 
                currently incarcerated or in pre-trial detention or 
                were formerly incarcerated;
                    ``(R) Federal agencies;
                    ``(S) organizations that provide drug prevention 
                programs and services to youth at risk of substance 
                use;
                    ``(T) medical examiners or coroners;
                    ``(U) labor unions and the workplace community;
                    ``(V) local fire departments and emergency medical 
                services;
                    ``(W) the lesbian, gay, bisexual, transgender, 
                queer (LGBTQ) community; and
                    ``(X) certified or accredited addiction recovery 
                community organizations.
    ``(b) Method of Providing for Council.--
            ``(1) In general.--In providing for a council for purposes 
        of subsection (a), the chief elected official of the eligible 
        local area may establish the council directly or designate an 
        existing entity to serve as the council, subject to paragraph 
        (2).
            ``(2) Consideration regarding designation of council.--In 
        making a determination of whether to establish or designate a 
        council under paragraph (1), the chief elected official shall 
        give priority to the designation of an existing entity that has 
        demonstrated experience in the provision of health and support 
        services to individuals with substance use disorder within the 
        eligible local area, that has a structure that recognizes the 
        Federal trust responsibility when spending Federal health care 
        dollars, and that has demonstrated a commitment to respecting 
        the obligation of government agencies using Federal dollars to 
        consult with Indian tribes and confer with urban Indian 
        organizations.
            ``(3) Designation of existing entity.--If an existing 
        entity is designated to serve as the council under this 
        section, the membership of the entity shall comply with the 
        requirements of subsection (a)(1) before it performs any of the 
        duties set forth in subsection (e).
            ``(4) Joint council.--The Secretary shall establish a 
        process to permit an eligible local area that is not contiguous 
        with any other eligible local area to form a joint planning 
        council with such other eligible local area or areas, as long 
        as such areas are located in geographical proximity to each 
        other, as determined by the Secretary, and submit a joint 
        application under section 3404.
            ``(5) Joint council across state lines.--Eligible local 
        areas may form a joint planning council with other eligible 
        local areas across State lines if such areas are located in 
        geographical proximity to each other, as determined by the 
        Secretary, submit a joint application under section 3404, and 
        establish intergovernmental agreements to allow the 
        administration of the grant across State lines.
    ``(c) Membership.--Members of the planning council established or 
designated under subsection (a) shall--
            ``(1) be nominated and selected through an open process;
            ``(2) elect from among their membership a chair and vice 
        chair;
            ``(3) include at least one representative from Indian 
        tribes located within any eligible local area that receives 
        funding under the grant program established in section 3401;
            ``(4) include at least 1 individual with a history of 
        substance use disorder;
            ``(5) include at least 1 representative from a nonprofit 
        substance use disorder service provider, at least 1 
        representative of an urban Indian organization, at least 1 
        physician addiction specialist, and at least 1 representative 
        from an organization providing harm reduction services;
            ``(6) include at least 1 representative of a Native 
        Hawaiian organization (as defined in section 11 of the Native 
        Hawaiian Health Care Act of 1988) when the Native Hawaiian 
        population exceeds 10 percent; and
            ``(7) serve not more than 3 consecutive years on the 
        planning council.
    ``(d) Membership Terms.--Members of the planning council 
established or designated under subsection (a) may serve additional 
terms if nominated and selected through the process established in 
subsection (c)(1).
    ``(e) Duties.--The planning council established or designated under 
subsection (a) shall--
            ``(1) establish priorities for the allocation of grant 
        funds within the eligible local area that emphasize reducing 
        drug use rates, overdose, substance use disorder, and health 
        conditions associated with drug use such as human 
        immunodeficiency virus, hepatitis B, and hepatitis C through 
        evidence-based interventions in both community and criminal 
        justice settings and that are based on--
                    ``(A) the use by the grantee of substance use 
                disorder prevention, intervention, treatment, and 
                recovery strategies that comply with best practices 
                identified by the Secretary;
                    ``(B) the demonstrated or probable cost-
                effectiveness of proposed substance use disorder 
                prevention, intervention, treatment, and recovery 
                services;
                    ``(C) the health priorities of the communities 
                within the eligible local area that are affected by 
                substance use;
                    ``(D) the priorities and needs of individuals with 
                substance use disorder; and
                    ``(E) the availability of other governmental and 
                non-governmental services;
            ``(2) ensure the use of grant funds will advance any 
        existing State or local plan regarding the provision of 
        substance use disorder treatment services to individuals with 
        substance use disorder;
            ``(3) in the absence of a State or local plan, work with 
        local public health agencies to develop a comprehensive plan 
        for the organization and delivery of substance use disorder 
        prevention and treatment services;
            ``(4) regularly assess the efficiency of the administrative 
        mechanism in rapidly allocating funds to support evidence-based 
        substance use disorder prevention and treatment services in the 
        areas of greatest need within the eligible local area;
            ``(5) work with local public health agencies to determine 
        the size and demographics of the population of individuals with 
        substance use disorders and the types of substance use that are 
        most prevalent in the eligible local area;
            ``(6) work with local public health agencies to determine 
        the needs of such population, including the need for substance 
        use disorder prevention, intervention, treatment, harm 
        reduction, and recovery services;
            ``(7) work with local public agencies to determine the 
        disparities in access to services among affected subpopulations 
        and historically underserved communities, including 
        infrastructure and capacity shortcomings of providers that 
        contribute to these disparities;
            ``(8) work with local public agencies to establish methods 
        for obtaining input on community needs and priorities, 
        including by partnering with organizations that serve targeted 
        communities experiencing high addictive substance-related 
        health disparities to gather data using culturally attuned data 
        collection methodologies;
            ``(9) coordinate with Federal grantees that provide 
        substance use disorder prevention and treatment services within 
        the eligible local area; and
            ``(10) annually assess the effectiveness of the substance 
        use disorder prevention and treatment services being supported 
        by the grant received by the eligible local area, including, to 
        the extent possible--
                    ``(A) reductions in the rates of substance use, 
                overdose, and death from substance use;
                    ``(B) rates of discontinuation from substance use 
                disorder treatment services and rates of sustained 
                recovery;
                    ``(C) long-term outcomes among individuals 
                receiving treatment for substance use disorders; and
                    ``(D) the availability and use of substance use 
                disorder treatment services needed by individuals with 
                substance use disorders over their lifetimes.
    ``(f) Conflicts of Interest.--
            ``(1) In general.--The planning council under subsection 
        (a) may not be directly involved in the administration of a 
        grant under section 3401.
            ``(2) Required agreements.--An individual may serve on the 
        planning council under subsection (a) only if the individual 
        agrees that if the individual has a financial interest in an 
        entity, if the individual is an employee of a public or private 
        entity, or if the individual is a member of a public or private 
        organization, and such entity or organization is seeking 
        amounts from a grant under section 3401, the individual will 
        not, with respect to the purpose for which the entity seeks 
        such amounts, participate (directly or in an advisory capacity) 
        in the process of selecting entities to receive such amounts 
        for such purpose.
    ``(g) Grievance Procedures.--A planning council under subsection 
(a) shall develop procedures for addressing grievances with respect to 
funding under this subtitle, including procedures for submitting 
grievances that cannot be resolved to binding arbitration. Such 
procedures shall be described in the by-laws of the planning council.
    ``(h) Public Deliberations.--With respect to a planning council 
under subsection (a), in accordance with criteria established by the 
Secretary, the following applies:
            ``(1) The meetings of the council shall be open to the 
        public and shall be held only after adequate notice to the 
        public.
            ``(2) The records, reports, transcripts, minutes, agenda, 
        or other documents which were made available to or prepared for 
        or by the council shall be available for public inspection and 
        copying at a single location.
            ``(3) Detailed minutes of each meeting of the council shall 
        be kept. The accuracy of all minutes shall be certified to by 
        the chair of the council.
            ``(4) This subparagraph does not apply to any disclosure of 
        information of a personal nature that would constitute a 
        clearly unwarranted invasion of personal privacy, including any 
        disclosure of medical information or personnel matters.
    ``(i) Neutrality Towards Organized Labor.--
            ``(1) In general.--In carrying out duties under subsection 
        (e), planning councils shall, to the extent practicable, 
        prioritize the distribution of grant funds to grantees that 
        have--
                    ``(A)(i) a collective bargaining agreement; or
                    ``(ii) an explicit policy not to deter employees 
                with respect to--
                            ``(I) labor organizing for the employees 
                        engaged in the covered activities; and
                            ``(II) such employees' choice to form and 
                        join labor organizations; and
                    ``(B) policies that require--
                            ``(i) the posting and maintenance of 
                        notices in the workplace to such employees of 
                        their rights under the National Labor Relations 
                        Act (29 U.S.C. 151 et seq.);
                            ``(ii) that such employees are, at the 
                        beginning of their employment, provided notice 
                        and information regarding the employees' rights 
                        under such Act; and
                            ``(iii) the employer to voluntarily 
                        recognize a union in cases where a majority of 
                        such workers of the employer have joined and 
                        requested representation.
            ``(2) Limitation.--This subsection does not apply to Indian 
        tribes.

``SEC. 3403. AMOUNT OF GRANT, USE OF AMOUNTS, AND FUNDING AGREEMENT.

    ``(a) Amount of Grant.--
            ``(1) Grants based on relative need of area.--
                    ``(A) In general.--In carrying out this subtitle, 
                the Secretary shall make a grant for each eligible 
                local area for which an application under section 3404 
                has been approved. Each such grant shall be made in an 
                amount determined in accordance with paragraph (3).
                    ``(B) Expedited distribution.--Not later than 90 
                days after an appropriation becomes available to carry 
                out this subtitle for a fiscal year, the Secretary 
                shall disburse 53 percent of the amount made available 
                under section 3406 for carrying out this subtitle for 
                such fiscal year through grants to eligible local areas 
                under section 3401, in accordance with subparagraphs 
                (C) and (D).
                    ``(C) Amount.--
                            ``(i) In general.--Subject to the extent of 
                        amounts made available in appropriations Acts, 
                        a grant made for purposes of this subparagraph 
                        to an eligible local area shall be made in an 
                        amount equal to the product of--
                                    ``(I) an amount equal to the amount 
                                available for distribution under 
                                subparagraph (B) for the fiscal year 
                                involved; and
                                    ``(II) the percentage constituted 
                                by the ratio of the distribution factor 
                                for the eligible local area to the sum 
                                of the respective distribution factors 
                                for all eligible local areas,
                        which product shall then, as applicable, be 
                        increased under subparagraph (D).
                            ``(ii) Distribution factor.--For purposes 
                        of clause (i)(II), the term `distribution 
                        factor' means--
                                    ``(I) an amount equal to--
                                            ``(aa) the estimated number 
                                        of drug overdose deaths in the 
                                        eligible local area, as 
                                        determined under clause (iii); 
                                        or
                                            ``(bb) the estimated number 
                                        of non-fatal drug overdoses in 
                                        the eligible local area, as 
                                        determined under clause (iv),
                                as determined by the Secretary based on 
                                which distribution factor (item (aa) or 
                                (bb)) will result in the eligible local 
                                area receiving the greatest amount of 
                                funds; or
                                    ``(II) in the case of an eligible 
                                local area for which the data described 
                                in subclause (I) are not available, an 
                                amount determined by the Secretary--
                                            ``(aa) based on other data 
                                        the Secretary determines 
                                        appropriate; and
                                            ``(bb) that is related to 
                                        the prevalence of non-fatal 
                                        drug overdoses, drug overdose 
                                        deaths, and the mortality rate 
                                        from drug overdoses and 
                                        provides an equivalent measure 
                                        of need for funding.
                            ``(iii) Number of drug overdose deaths.--
                        The number of drug overdose deaths determined 
                        under this clause for an eligible county for a 
                        fiscal year for purposes of clause (ii) is the 
                        number of drug overdose deaths during the most 
                        recent 3-year period for which such data are 
                        available.
                            ``(iv) Number of non-fatal drug 
                        overdoses.--The number of non-fatal drug 
                        overdose deaths determined under this clause 
                        for an eligible county for a fiscal year for 
                        purposes of clause (ii) may be determined by 
                        using data including emergency department 
                        syndromic data, visits, other emergency medical 
                        services for drug-related causes, or Overdose 
                        Detection Mapping Application Program (ODMAP) 
                        data during the most recent 3-year period for 
                        which such data are available.
                            ``(v) Study.--Not later than 3 years after 
                        the date of enactment of this title, the 
                        Comptroller General shall conduct a study to 
                        determine whether the data utilized for 
                        purposes of clause (ii) provide the most 
                        precise measure of local area need related to 
                        substance use and addiction prevalence in local 
                        areas and whether additional data would provide 
                        more precise measures of substance use and 
                        addiction prevalence in local areas. Such study 
                        shall identify barriers to collecting or 
                        analyzing such data, and make recommendations 
                        for revising the distribution factors used 
                        under such clause to determine funding levels 
                        in order to direct funds to the local areas in 
                        most need of funding to provide substance use 
                        disorder treatment services.
                            ``(vi) Reductions in amounts.--If a local 
                        area that is an eligible local area for a year 
                        loses such eligibility in a subsequent year 
                        based on the failure to meet the requirements 
                        of paragraph (1)(A) or (6) of section 3401(b), 
                        such area will remain eligible to receive--
                                    ``(I) for such subsequent year, an 
                                amount equal to 80 percent of the 
                                amount received under the grant in the 
                                previous year; and
                                    ``(II) for the second such 
                                subsequent year, an amount equal to 50 
                                percent of the amount received in the 
                                previous year.
            ``(2) Supplemental grants.--
                    ``(A) In general.--The Secretary shall disburse the 
                remainder of amounts not disbursed under paragraph (1) 
                for such fiscal year for the purpose of making grants 
                to cities and counties whose application under section 
                3404--
                            ``(i) contains a report concerning the 
                        dissemination of emergency relief funds under 
                        paragraph (1) and the plan for utilization of 
                        such funds, if applicable;
                            ``(ii) demonstrates the need in such local 
                        area, on an objective and quantified basis, for 
                        supplemental financial assistance to combat 
                        substance use disorder;
                            ``(iii) demonstrates the existing 
                        commitment of local resources of the area, both 
                        financial and in-kind, to preventing, treating, 
                        and managing substance use disorder and 
                        supporting sustained recovery;
                            ``(iv) demonstrates the ability of the area 
                        to utilize such supplemental financial 
                        resources in a manner that is immediately 
                        responsive and cost effective;
                            ``(v) demonstrates that resources will be 
                        allocated in accordance with the local 
                        demographic incidence of substance use 
                        disorders and drug overdose mortality;
                            ``(vi) demonstrates the inclusiveness of 
                        affected communities and individuals with 
                        substance use disorders, including those 
                        communities and individuals that are 
                        disproportionately affected or historically 
                        underserved;
                            ``(vii) demonstrates the manner in which 
                        the proposed services are consistent with the 
                        local needs assessment and the State plan 
                        approved by the Secretary pursuant to section 
                        1932(b);
                            ``(viii) demonstrates success in 
                        identifying individuals with substance use 
                        disorders; and
                            ``(ix) demonstrates that support for 
                        substance use disorder prevention and treatment 
                        services is organized to maximize the value to 
                        the population to be served with an appropriate 
                        mix of substance use disorder prevention and 
                        treatment services and attention to transition 
                        in care.
                    ``(B) Amount.--
                            ``(i) In general.--The amount of each grant 
                        made for purposes of this paragraph shall be 
                        determined by the Secretary. In making such 
                        determination, the Secretary shall consider--
                                    ``(I) the rate of drug overdose 
                                deaths per 100,000 population in the 
                                eligible local area; and
                                    ``(II) the increasing need for 
                                substance use disorder treatment 
                                services, including relative rates of 
                                increase in the number of drug 
                                overdoses or drug overdose deaths, or 
                                recent increases in drug overdoses or 
                                drug overdose deaths since data were 
                                provided under section 3401(b), if 
                                applicable.
                            ``(ii) Demonstrated need.--The factors 
                        considered by the Secretary in determining 
                        whether a local area has a demonstrated need 
                        for purposes of clause (i)(II) may include any 
                        or all of the following:
                                    ``(I) The unmet need for substance 
                                use disorder treatment services, 
                                including factors identified in 
                                subparagraph (B)(i)(II).
                                    ``(II) Relative rates of increase 
                                in the number of drug overdoses or drug 
                                overdose deaths.
                                    ``(III) The relative rates of 
                                increase in the number of drug 
                                overdoses or drug overdose deaths 
                                within new or emerging subpopulations.
                                    ``(IV) The current prevalence of 
                                substance use disorders.
                                    ``(V) Relevant factors related to 
                                the cost and complexity of delivering 
                                substance use disorder treatment 
                                services to individuals in the eligible 
                                local area.
                                    ``(VI) The impact of co-morbid 
                                factors, including co-occurring 
                                conditions, determined relevant by the 
                                Secretary.
                                    ``(VII) The prevalence of 
                                homelessness among individuals with 
                                substance use disorders.
                                    ``(VIII) The relevant factors that 
                                limit access to health care, including 
                                geographic variation, adequacy of 
                                health insurance coverage, and language 
                                barriers.
                                    ``(IX) The impact of a decline in 
                                the amount received pursuant to 
                                paragraph (1) on substance use disorder 
                                treatment services available to all 
                                individuals with substance use 
                                disorders identified and eligible under 
                                this subtitle.
                                    ``(X) The increasing incidence in 
                                conditions related to substance use, 
                                including hepatitis C, human 
                                immunodeficiency virus, hepatitis B and 
                                other infections associated with 
                                injection drug use.
                    ``(C) Application of provisions.--A local area that 
                receives a grant under this paragraph--
                            ``(i) shall use amounts received in 
                        accordance with subsection (b);
                            ``(ii) shall not have to meet the eligible 
                        criteria in section 3401(b); and
                            ``(iii) shall not have to establish a 
                        planning council under section 3402.
            ``(3) Amount of grant to tribal governments.--
                    ``(A) Indian tribes.--In this section, the term 
                `Indian tribe' has the meaning given such term in 
                section 4 of the Indian Self-Determination and 
                Education Assistance Act.
                    ``(B) Formula funds.--The Secretary, acting through 
                the Indian Health Service, shall use 10 percent of the 
                amount available under section 3406 for each fiscal 
                year to provide formula funds to Indian tribes 
                disproportionately affected by substance use, in an 
                amount determined pursuant to a formula and eligibility 
                criteria developed by the Secretary in consultation 
                with Indian tribes, for the purposes of addressing 
                substance use.
                    ``(C) Payment of funds.--At the option of an Indian 
                tribe the Secretary shall pay funds under this section 
                through a contract, cooperative agreement, or compact 
                under, as applicable, title I or V of the Indian Self-
                Determination and Education Assistance Act.
                    ``(D) Use of amounts.--Notwithstanding any 
                requirements in this section, an Indian tribe may use 
                amounts provided under funds awarded under this 
                paragraph for the uses identified in subsection (b) and 
                any other activities determined appropriate by the 
                Secretary, in consultation with Indian tribes. An 
                Indian tribe shall not be required to allocate funds 
                and services in accordance with the goals, priorities, 
                or objectives established by a planning council under 
                section 3402.
    ``(b) Use of Amounts.--
            ``(1) Requirements.--The Secretary may not make a grant 
        under section 3401 to an eligible local area unless the chief 
        elected official of the area agrees that--
                    ``(A) the allocation of funds and services within 
                the area under the grant will be made in accordance 
                with the priorities established by the planning 
                council; and
                    ``(B) funds provided under this grant will be 
                expended for--
                            ``(i) prevention services described in 
                        paragraph (3);
                            ``(ii) core medical services described in 
                        paragraph (4);
                            ``(iii) recovery and support services 
                        described in paragraph (5);
                            ``(iv) early intervention services 
                        described in paragraph (6);
                            ``(v) harm reduction services described in 
                        paragraph (7);
                            ``(vi) financial assistance with health 
                        insurance described in paragraph (8); and
                            ``(vii) administrative expenses described 
                        in paragraph (9).
            ``(2) Direct financial assistance.--
                    ``(A) In general.--An eligible local area shall use 
                amounts received under a grant under section 3401 to 
                provide direct financial assistance to eligible 
                entities or providers for the purpose of providing 
                prevention services, core medical services, recovery 
                and support services, early intervention services, and 
                harm reduction services.
                    ``(B) Appropriate entities.--Direct financial 
                assistance may be provided under subparagraph (A) to 
                public or nonprofit entities, other eligible Medicaid 
                providers if more than half of their patients are 
                diagnosed with a substance use disorder and covered by 
                Medicaid, or other private for-profit entities if such 
                entities are the only available provider of quality 
                substance use disorder treatment services in the area.
                    ``(C) Limitation.--An eligible local area (not 
                including tribal areas) may not provide direct 
                financial assistance to any entity or provider that 
                provides medication for addiction treatment if that 
                entity or provider does not also offer mental health 
                services or psychotherapy by licensed clinicians 
                through a referral or onsite.
                    ``(D) Neutrality towards organized labor.--
                            ``(i) In general.--In carrying out duties 
                        under this section, eligible local areas shall, 
                        to the extent practicable, prioritize the 
                        distribution of grant funds to grantees that 
                        have--
                                    ``(I)(aa) a collective bargaining 
                                agreement; or
                                    ``(bb) an explicit policy not to 
                                deter employees with respect to--
                                            ``(AA) labor organizing for 
                                        the employees engaged in the 
                                        covered activities; and
                                            ``(BB) such employees' 
                                        choice to form and join labor 
                                        organizations; and
                                    ``(II) policies that require--
                                            ``(aa) the posting and 
                                        maintenance of notices in the 
                                        workplace to such employees of 
                                        their rights under the National 
                                        Labor Relations Act (29 U.S.C. 
                                        151 et seq.);
                                            ``(bb) that such employees 
                                        are, at the beginning of their 
                                        employment, provided notice and 
                                        information regarding the 
                                        employees' rights under such 
                                        Act; and
                                            ``(cc) the employer to 
                                        voluntarily recognize a union 
                                        in cases where a majority of 
                                        such workers of the employer 
                                        have joined and requested 
                                        representation.
                            ``(ii) Limitation.--This subsection does 
                        not apply to Indian tribes.
            ``(3) Prevention services.--
                    ``(A) In general.--For purposes of this section, 
                the term `prevention services' means evidence-based 
                services, programs, or multi-sector strategies to 
                prevent substance use disorder (including education 
                campaigns, community-based prevention programs, risk 
                identification programs, opioid diversion, collection 
                and disposal of unused opioids, services to at-risk 
                populations, and trauma support services).
                    ``(B) Limit.--An eligible local area may use not to 
                exceed 20 percent of the amount of the grant under 
                section 3401 for prevention services. An eligible local 
                area may apply to the Secretary for a waiver of this 
                subparagraph.
            ``(4) Core medical services.--For purposes of this section, 
        the term `core medical services' means the following evidence-
        based services provided to individuals with substance use 
        disorder or at risk for developing substance use disorder, 
        including through the use of telemedicine or a hub and spoke 
        model:
                    ``(A) Substance use disorder treatments, as more 
                fully described in section 3439, including assessment 
                of disease presence, severity, and co-occurring 
                conditions, treatment planning, clinical stabilization 
                services, withdrawal management and detoxification, 
                intensive inpatient treatment, intensive outpatient 
                treatment, outpatient treatment, residential inpatient 
                services, treatment for co-occurring mental health and 
                substance use disorders, and all drugs approved by the 
                Food and Drug Administration for the treatment of 
                substance use disorder.
                    ``(B) Outpatient and ambulatory health services, 
                including those administered by Federally-qualified 
                health centers, rural health clinics, tribal clinics 
                and hospitals, urban Indian organizations, certified 
                community behavioral health clinics (as described in 
                section 223 of the Protecting Access to Medicare Act), 
                Native Hawaiian organizations (as defined in section 11 
                of the Native Hawaiian Health Care Act of 1988), and 
                comprehensive opioid recovery centers (as described in 
                section 552 of this Act).
                    ``(C) Hospice services.
                    ``(D) Mental health services.
                    ``(E) Opioid overdose reversal drug products 
                procurement, distribution, and training.
                    ``(F) Pharmaceutical assistance and diagnostic 
                testing related to the management of substance use 
                disorders and co-morbid conditions.
                    ``(G) Home- and community-based health services.
                    ``(H) Comprehensive Case Management and care 
                coordination, including substance use disorder 
                treatment adherence services.
                    ``(I) Health insurance enrollment and cost-sharing 
                assistance in accordance with paragraph (8).
                    ``(J) Programs that hire, employ, train, and 
                dispatch licensed health care professionals, mental 
                health professionals, harm reduction providers, or 
                community health workers to respond in lieu of law 
                enforcement officers in emergencies and that ensure a 
                licensed health care professional is a member of the 
                team that responds in lieu of law enforcement officers 
                in emergencies in which--
                            ``(i) an individual calling 911, the 
                        National Suicide Hotline, or another emergency 
                        hotlines states that a person is experiencing a 
                        drug overdose or is otherwise under the 
                        influence of a legal or illegal substance; or
                            ``(ii) a law enforcement officer, other 
                        first responder, or other individual identifies 
                        a person as being (or possibly being) under the 
                        influence of a legal or illegal substance.
            ``(5) Recovery and support services.--For purposes of this 
        section, the term `recovery and support services' means 
        services that are provided to individuals with substance use 
        disorder, including residential recovery housing, mental health 
        services, long term recovery services, 24/7 hotline crisis 
        center support, medical transportation services, respite care 
        for persons caring for individuals with substance use disorder, 
        child care and family services while an individual is receiving 
        inpatient treatment services or at the time of outpatient 
        services, outreach services, peer recovery services, nutrition 
        services, and referrals for job training and career services, 
        housing, legal services, and child care and family services. 
        The entities through which such services may be provided 
        include local and tribal authorities that provide child care, 
        housing, community development, and other recovery and support 
        services, so long as they do not exclude individuals on the 
        basis that such individuals receive medication for addiction 
        treatment.
            ``(6) Early intervention services.--For purposes of this 
        section, the term `early intervention services' means services 
        to provide screening and connection to the appropriate level of 
        substance use disorder and mental health treatment (including 
        same-day connection), counseling provided to individuals who 
        have misused substances, who have experienced an overdose, or 
        are at risk of developing substance use disorder, the provision 
        of referrals to facilitate the access of such individuals to 
        core medical services or recovery and support services for 
        substance use disorder, and rapid access to medication for 
        addiction treatment in the setting of recent overdose. The 
        entities through which such services may be provided include 
        emergency rooms, fire departments and emergency medical 
        services, detention facilities, prisons and jails, homeless 
        shelters, health care points of entry specified by eligible 
        local areas, Federally-qualified health centers, workforce 
        agencies and job centers, youth development centers, tribal 
        clinics and hospitals, urban Indian organizations, and rural 
        health clinics.
            ``(7) Harm reduction services.--For purposes of this 
        section, the term `harm reduction services' means services 
        provided to individuals engaging in substance use 
        scientifically accepted to reduce the risk of infectious 
        disease transmission, overdose, or death, including by 
        increasing access to health care, housing, and recovery and 
        support services, including syringe services programs. Such 
        term includes evidence-based services.
            ``(8) Affordable health insurance coverage.--An eligible 
        local area may use amounts provided under a grant awarded under 
        section 3401 to establish a program of financial assistance to 
        assist eligible individuals with substance use disorder in--
                    ``(A) enrolling in health insurance coverage; or
                    ``(B) affording health care services, including 
                assistance paying cost-sharing amounts, including 
                premiums.
            ``(9) Administration and planning.--An eligible local area 
        (not including tribal areas) shall not use in excess of 15 
        percent of amounts received under a grant under section 3401 
        for administration, accounting, reporting, and program 
        oversight functions, including the development of systems to 
        improve data collection and data sharing, in the first year of 
        receiving the grant, and shall not use in excess of 10 percent 
        of amounts received under a grant under section 3401 for such 
        activities in subsequent years.
            ``(10) Incarcerated individuals.--Amounts received under a 
        grant under section 3401 may be used to provide substance use 
        disorder treatment services, including medication for addiction 
        treatment, to individuals who are currently incarcerated or in 
        pre-trial detention.
    ``(c) Required Terms.--
            ``(1) Requirement of status as medicaid provider.--
                    ``(A) Provision of service.--Subject to 
                subparagraph (B), the Secretary may not make a grant 
                under section 3401 for the provision of substance use 
                disorder treatment services under this section in an 
                eligible local area unless, in the case of any such 
                service that is available pursuant to the State plan 
                approved under title XIX of the Social Security Act for 
                the State--
                            ``(i) the political subdivision involved 
                        will provide the service directly, and the 
                        political subdivision has entered into a 
                        participation agreement under the State plan 
                        and is qualified to receive payments under such 
                        plan; or
                            ``(ii) the eligible local area involved--
                                    ``(I) will enter into agreements 
                                with public or nonprofit entities, or 
                                other Medicaid providers if more than 
                                half of their patients are diagnosed 
                                with a substance use disorder and 
                                covered by Medicaid, under which such 
                                entities and other providers will 
                                provide the service, and such entities 
                                and other providers have entered into 
                                such a participation agreement and are 
                                qualified to receive such payments; and
                                    ``(II) demonstrates that it will 
                                ensure that such entities and other 
                                providers providing the service will 
                                seek payment for each such service 
                                rendered in accordance with the usual 
                                payment schedule under the State plan.
                    ``(B) Waiver.--
                            ``(i) In general.--In the case of an entity 
                        making an agreement pursuant to subparagraph 
                        (A)(ii) regarding the provision of substance 
                        use disorder treatment services, the 
                        requirement established in such subparagraph 
                        shall be waived by the substance use planning 
                        council for the area involved if the entity 
                        does not, in providing health care services, 
                        impose a charge or accept reimbursement 
                        available from any third-party payor, including 
                        reimbursement under any insurance policy or 
                        under any Federal or State health benefits 
                        program. A waiver under this subparagraph shall 
                        not be longer than 2 years in duration and 
                        shall not be renewed.
                            ``(ii) Determination.--A determination by 
                        the substance use planning council of whether 
                        an entity referred to in clause (i) meets the 
                        criteria for a waiver under such clause shall 
                        be made without regard to whether the entity 
                        accepts voluntary donations for the purpose of 
                        providing services to the public.
            ``(2) Required terms for expanding and improving care.--A 
        funding agreement for a grant under this section shall--
                    ``(A) ensure that funds received under the grant 
                will not be utilized to make payments for any item or 
                service to the extent that payment has been made, or 
                can reasonably be expected to be made, with respect to 
                that item or service under a State compensation 
                program, under an insurance policy, or under any 
                Federal or State health benefits program (except for a 
                program administered by, or providing the services of, 
                the Indian Health Service); and
                    ``(B) ensure that all entities providing substance 
                use disorder treatment services with assistance made 
                available under the grant offer all drugs approved by 
                the Food and Drug Administration for the treatment of 
                substance use disorder for which the applicant offers 
                treatment, in accordance with section 3435.
            ``(3) Additional required terms.--A funding agreement for a 
        grant under this section is that--
                    ``(A) funds received under the grant will be 
                utilized to supplement not supplant other Federal, 
                State, or local funds made available in the year for 
                which the grant is awarded to provide substance use 
                disorder treatment services to individuals with 
                substance use disorder, including funds for each of 
                prevention services, core medical services, recovery 
                and support services, early intervention services, harm 
                reduction services, mental health services, and 
                administrative expenses;
                    ``(B) political subdivisions within the eligible 
                local area will maintain the level of expenditures by 
                such political subdivisions for substance use disorder 
                treatment services at a level that is at least equal to 
                the level of such expenditures by such political 
                subdivisions for the preceding fiscal year, including 
                expenditures for each of prevention services, core 
                medical services, recovery and support services, early 
                intervention services, harm reduction services, mental 
                health services, and administrative expenses;
                    ``(C) political subdivisions within the eligible 
                local area will not use funds received under a grant 
                awarded under section 3401 in maintaining the level of 
                substance use disorder treatment services as required 
                in subparagraph (B);
                    ``(D) substance use disorder treatment services 
                provided with assistance made available under the grant 
                will be provided without regard--
                            ``(i) to the ability of the individual to 
                        pay for such services; and
                            ``(ii) to the current or past health 
                        condition of the individual to be served;
                    ``(E) substance use disorder treatment services 
                will be provided in a setting that is accessible to 
                low-income individuals with substance use disorders and 
                to individuals with substance use disorders residing in 
                rural areas;
                    ``(F) a program of outreach will be provided to 
                low-income individuals with substance use disorders to 
                inform such individuals of substance use disorder 
                treatment services and to individuals with substance 
                use disorders residing in rural areas;
                    ``(G) Indian tribes are included in planning for 
                the use of grant funds and the Federal trust 
                responsibility is upheld at all levels of program 
                administration; and
                    ``(H) the confidentiality of individuals receiving 
                substance use disorder treatment services will be 
                maintained in a manner not inconsistent with applicable 
                law.

``SEC. 3404. APPLICATION.

    ``(a) Application.--To be eligible to receive a grant under section 
3401, an eligible local area shall prepare and submit to the Secretary 
an application in such form, and containing such information, as the 
Secretary shall require, including--
            ``(1) a complete accounting of the disbursement of any 
        prior grants received under this subtitle by the applicant and 
        the results achieved by these expenditures and a demonstration 
        that funds received from a grant under this subtitle in the 
        prior year were expended in accordance with local priorities 
        developed by the local planning council established under 
        section 3402, except that the planning council requirement 
        shall not apply with respect to areas receiving supplemental 
        grant funds under section 3403(a)(2);
            ``(2) establishment of goals and objectives to be achieved 
        with grant funds provided under this subtitle, including 
        targets and milestones that are intended to be met, the 
        activities that will be undertaken to achieve those targets, 
        the number of individuals likely to be served by the funds 
        sought, including demographic data on the populations to be 
        served, and an explanation of how these goals and objectives 
        advance the State plan approved by the Secretary pursuant to 
        section 1932(b);
            ``(3) a demonstration that the local area will use funds in 
        a manner that provides substance use disorder treatment 
        services in compliance with the evidence-based standards 
        developed in accordance with section 3435, including providing 
        all drugs approved by the Food and Drug Administration for the 
        treatment of substance use disorder;
            ``(4) a demonstration that resources provided under the 
        grant will be allocated in accordance with the local 
        demographic incidence of substance use, including allocations 
        for services for children, youths, and women;
            ``(5) an explanation of how income, asset, and medical 
        expense criteria will be established and applied to those who 
        qualify for assistance under the program;
            ``(6) where practical, an explanation of how an eligible 
        local area shall coordinate with local public health 
        departments in the distribution of funding; and
            ``(7) for any prior funding received under this section, 
        data provided in such form as the Secretary shall require 
        detailing, at a minimum, the extent to which the activities 
        supported by the funding met the goals and objectives specified 
        in the application for the funding, the number of individuals 
        who accessed medication for treatment by age, gender, sexual 
        orientation, race, disability status, and other demographic 
        criteria relevant to the program, and the effect of the program 
        on overdose rates and rates of death due to overdose in the 
        local area served by the program.
    ``(b) Requirements Regarding Imposition of Charges for Services.--
            ``(1) In general.--The Secretary may not make a grant under 
        section 3401 to an eligible local area unless the eligible 
        local area provides assurances that in the provision of 
        substance use disorder treatment services with assistance 
        provided under the grant--
                    ``(A) in the case of individuals with an income 
                less than or equal to 150 percent of the official 
                poverty level, the provider will not impose charges on 
                any such individual for the services provided under the 
                grant;
                    ``(B) in the case of individuals with an income 
                greater than 150 percent of the official poverty level, 
                the provider will impose a charge on each such 
                individual according to a schedule of charges made 
                available to the public;
                    ``(C) in the case of individuals with an income 
                greater than 150 percent of the official poverty level 
                but not exceeding 200 percent of such poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 2 percent of the annual 
                gross income of the individual;
                    ``(D) in the case of individuals with an income 
                greater than 200 percent of the official poverty level 
                but not exceeding 250 percent of such poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 4 percent of the annual 
                gross income of the individual involved;
                    ``(E) in the case of individuals with an income 
                greater than 250 percent of the official poverty level 
                but not exceeding 300 percent of such poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 6 percent of the annual 
                gross income of the individual involved;
                    ``(F) in the case of individuals with an income 
                greater than 300 percent of the official poverty level 
                but not exceeding 400 percent of such poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 8.5 percent of the 
                annual gross income of the individual involved;
                    ``(G) in the case of individuals with an income 
                greater than 400 percent of the official poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 8.5 percent of the 
                annual gross income of the individual involved; and
                    ``(H) in the case of eligible American Indian and 
                Alaska Native individuals as defined by section 447.50 
                of title 42, Code of Federal Regulations (as in effect 
                on July 1, 2010), the provider will not impose any 
                charges for substance use disorder treatment services, 
                including any charges or cost-sharing prohibited by 
                section 1402(d) of the Patient Protection and 
                Affordable Care Act.
            ``(2) Charges.--With respect to compliance with the 
        assurances made under paragraph (1), an eligible local area 
        may, in the case of individuals subject to a charge--
                    ``(A) assess the amount of the charge in the 
                discretion of the area, including imposing only a 
                nominal charge for the provision of substance use 
                disorder treatment services, subject to the provisions 
                of the paragraph regarding public schedules and 
                regarding limitations on the maximum amount of charges; 
                and
                    ``(B) take into consideration the total medical 
                expenses of individuals in assessing the amount of the 
                charge, subject to such provisions.
            ``(3) Aggregate charges.--The Secretary may not make a 
        grant under section 3401 to an eligible local area unless the 
        area agrees that the limitations on charges for substance use 
        disorder treatment services under this subsection applies to 
        the annual aggregate of charges imposed for such services, 
        however the charges are characterized, includes enrollment 
        fees, premiums, deductibles, cost sharing, co-payments, co-
        insurance costs, or any other charges.
    ``(c) Indian Tribes.--Any application requirements for grants 
distributed in accordance with section 3403(a)(3) shall be developed by 
the Secretary in consultation with Indian tribes.

``SEC. 3405. TECHNICAL ASSISTANCE.

    ``The Secretary shall, beginning on the date of enactment of this 
title, provide technical assistance, including assistance from other 
grantees, contractors or subcontractors under this title to assist 
newly eligible local areas in the establishment of planning councils 
and, to assist entities in complying with the requirements of this 
subtitle in order to make such areas eligible to receive a grant under 
this subtitle. The Secretary may make planning grants available to 
eligible local areas, in an amount not to exceed $75,000, for any area 
that is projected to be eligible for funding under section 3401 in the 
following fiscal year. Such grant amounts shall be deducted from the 
first year formula award to eligible local areas accepting such grants.

``SEC. 3406. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this 
subtitle--
            ``(1) $3,300,000,000 for fiscal year 2022;
            ``(2) $3,300,000,000 for fiscal year 2023;
            ``(3) $3,300,000,000 for fiscal year 2024;
            ``(4) $3,300,000,000 for fiscal year 2025;
            ``(5) $3,300,000,000 for fiscal year 2026;
            ``(6) $3,300,000,000 for fiscal year 2027;
            ``(7) $3,300,000,000 for fiscal year 2028;
            ``(8) $3,300,000,000 for fiscal year 2029;
            ``(9) $3,300,000,000 for fiscal year 2030; and
            ``(10) $3,300,000,000 for fiscal year 2031.

 ``Subtitle B--State and Tribal Substance Use Disorder Prevention and 
                       Intervention Grant Program

``SEC. 3411. ESTABLISHMENT OF PROGRAM OF GRANTS.

    ``The Secretary shall award grants to States, territories, and 
tribal governments for the purpose of addressing substance use within 
such States.

``SEC. 3412. AMOUNT OF GRANT, USE OF AMOUNTS, AND FUNDING AGREEMENT.

    ``(a) Amount of Grant to States and Territories.--
            ``(1) In general.--
                    ``(A) Expedited distribution.--Not later than 90 
                days after an appropriation becomes available, the 
                Secretary shall disburse 50 percent of the amount made 
                available under section 3415 for carrying out this 
                subtitle for such fiscal year through grants to States 
                under section 3411, in accordance with subparagraphs 
                (B) and (C).
                    ``(B) Minimum allotment.--Subject to the amount 
                made available under section 3415, the amount of a 
                grant under section 3411 for--
                            ``(i) each of the 50 States, the District 
                        of Columbia, and Puerto Rico for a fiscal year 
                        shall be the greater of--
                                    ``(I) $2,000,000; or
                                    ``(II) an amount determined under 
                                the subparagraph (C); and
                            ``(ii) each territory other than Puerto 
                        Rico for a fiscal year shall be the greater 
                        of--
                                    ``(I) $500,000; or
                                    ``(II) an amount determined under 
                                the subparagraph (C).
                    ``(C) Determination.--
                            ``(i) Formula.--For purposes of 
                        subparagraph (B), the amount referred to in 
                        this subparagraph for a State (including a 
                        territory) for a fiscal year is--
                                    ``(I) an amount equal to the amount 
                                made available under section 3415 for 
                                the fiscal year involved for grants 
                                pursuant to subparagraph (B); and
                                    ``(II) the percentage constituted 
                                by the sum of--
                                            ``(aa) the product of 0.85 
                                        and the ratio of the State 
                                        distribution factor for the 
                                        State or territory to the sum 
                                        of the respective distribution 
                                        factors for all States; and
                                            ``(bb) the product of 0.15 
                                        and the ratio of the non-local 
                                        distribution factor for the 
                                        State or territory (as 
                                        determined under clause (iv)) 
                                        to the sum of the respective 
                                        non-local distribution factors 
                                        for all States or territories.
                            ``(ii) State distribution factor.--For 
                        purposes of clause (i)(II)(aa), the term `State 
                        distribution factor' means an amount equal to--
                                    ``(I) the estimated number of drug 
                                overdose deaths in the State, as 
                                determined under clause (iii); or
                                    ``(II) the number of non-fatal drug 
                                overdoses in the State, as determined 
                                under clause (iv),
                        as determined by the Secretary based on which 
                        distribution factor (subclause (I) or (II)) 
                        will result in the State receiving the greatest 
                        amount of funds.
                            ``(iii) Number of drug overdoses.--For 
                        purposes of clause (ii), the number of drug 
                        overdose deaths determined under this clause 
                        for a State for a fiscal year is the number of 
                        drug overdose deaths during the most recent 3-
                        year period for which such data are available.
                            ``(iv) Number of non-fatal drug 
                        overdoses.--The number of non-fatal drug 
                        overdose deaths determined under this clause 
                        for a State for a fiscal year for purposes of 
                        clause (ii) may be determined by using data 
                        including emergency department syndromic data, 
                        visits, other emergency medical services for 
                        drug-related causes, or Overdose Detection 
                        Mapping Application Program (ODMAP) data during 
                        the most recent 3-year period for which such 
                        data are available.
                            ``(v) Non-local distribution factors.--For 
                        purposes of clause (i)(II)(bb), the term `non-
                        local distribution factor' means an amount 
                        equal to the sum of--
                                    ``(I) the number of drug overdose 
                                deaths in the State involved, as 
                                determined under clause (iii), or the 
                                number of non-fatal drug overdoses in 
                                the State, based on the criteria used 
                                by the State under clause (ii); less
                                    ``(II) the total number of drug 
                                overdose deaths or non-fatal drug 
                                overdoses that are within areas in such 
                                State or territory that are eligible 
                                counties under section 3401.
                            ``(vi) Study.--Not later than 3 years after 
                        the date of enactment of this title, the 
                        Comptroller General shall conduct a study to 
                        determine whether the data utilized for 
                        purposes of clause (ii) provide the most 
                        precise measure of State need related to 
                        substance use and addiction prevalence and 
                        whether additional data would provide more 
                        precise measures the levels of substance use 
                        and addiction prevalent in States. Such study 
                        shall identify barriers to collecting or 
                        analyzing such data, and make recommendations 
                        for revising the distribution factors used 
                        under such clause to determine funding levels 
                        in order to direct funds to the States in most 
                        need of funding to provide substance use 
                        disorder treatment services.
            ``(2) Supplemental grants.--
                    ``(A) In general.--Subject to subparagraph (C), the 
                Secretary shall disburse the remainder of amounts not 
                disbursed under paragraph (1) for such fiscal year for 
                the purpose of making grants to States whose 
                application--
                            ``(i) contains a report concerning the 
                        dissemination of emergency relief funds under 
                        paragraph (1) and the plan for utilization of 
                        such funds, if applicable;
                            ``(ii) demonstrates the need in such State, 
                        on an objective and quantified basis, for 
                        supplemental financial assistance to combat 
                        substance use disorder;
                            ``(iii) demonstrates the existing 
                        commitment of local resources of the State, 
                        both financial and in-kind, to preventing, 
                        treating, and managing substance use disorder 
                        and supporting sustained recovery;
                            ``(iv) demonstrates the ability of the 
                        State to utilize such supplemental financial 
                        resources in a manner that is immediately 
                        responsive and cost effective;
                            ``(v) demonstrates that resources will be 
                        allocated in accordance with the local 
                        demographic incidence of substances use 
                        disorders and drug overdose mortality;
                            ``(vi) demonstrates the inclusiveness of 
                        affected communities and individuals with 
                        substance use disorders, including those 
                        communities and individuals that are 
                        disproportionately affected or historically 
                        underserved;
                            ``(vii) demonstrates the manner in which 
                        the proposed services are consistent with the 
                        local needs assessment and the State plan 
                        approved by the Secretary pursuant to section 
                        1932(b);
                            ``(viii) demonstrates success in 
                        identifying individuals with substance use 
                        disorders; and
                            ``(ix) demonstrates that support for 
                        substance use disorder prevention and treatment 
                        services is organized to maximize the value to 
                        the population to be served with an appropriate 
                        mix of substance use disorder treatment 
                        services and attention to transition in care.
                    ``(B) Amount.--
                            ``(i) In general.--The amount of each grant 
                        made for purposes of this paragraph shall be 
                        determined by the Secretary. In making such 
                        determination, the Secretary shall consider--
                                    ``(I) the rate of drug overdose 
                                deaths per 100,000 population in the 
                                State; and
                                    ``(II) the increasing need for 
                                substance use disorder treatment 
                                services, including relative rates of 
                                increase in the number of drug 
                                overdoses or drug overdose deaths, or 
                                recent increases in drug overdoses or 
                                drug overdose deaths since the data 
                                were reported under section 3413, if 
                                applicable.
                            ``(ii) Demonstrated need.--The factors 
                        considered by the Secretary in determining 
                        whether a State has a demonstrated need for 
                        purposes of subparagraph (A)(ii) may include 
                        any or all of the following:
                                    ``(I) The unmet need for such 
                                services, including the factors 
                                identified in clause (i)(II).
                                    ``(II) Relative rates of increase 
                                in the number of drug overdoses or drug 
                                overdose deaths.
                                    ``(III) The relative rates of 
                                increase in the number of drug 
                                overdoses or drug overdose deaths 
                                within new or emerging subpopulations.
                                    ``(IV) The current prevalence of 
                                substance use disorders.
                                    ``(V) Relevant factors related to 
                                the cost and complexity of delivering 
                                substance use disorder treatment 
                                services to individuals in the State.
                                    ``(VI) The impact of co-morbid 
                                factors, including co-occurring 
                                conditions, determined relevant by the 
                                Secretary.
                                    ``(VII) The prevalence of 
                                homelessness among individuals with 
                                substance use disorder.
                                    ``(VIII) The relevant factors that 
                                limit access to health care, including 
                                geographic variation, adequacy of 
                                health insurance coverage, and language 
                                barriers.
                                    ``(IX) The impact of a decline in 
                                the amount received pursuant to 
                                paragraph (1) on substance use disorder 
                                treatment services available to all 
                                individuals with substance use 
                                disorders identified and eligible under 
                                this subtitle.
                                    ``(X) The increasing incidence in 
                                conditions related to substance use, 
                                including hepatitis C, human 
                                immunodeficiency virus, hepatitis B and 
                                other infections associated with 
                                injection drug use.
                    ``(C) Model standards.--
                            ``(i) Preference.--In determining whether a 
                        State will receive funds under this paragraph, 
                        except as provided in clause (ii), the 
                        Secretary shall give preference to States that 
                        have adopted the model standards for each 
                        substance use disorder treatment service and 
                        recovery residence developed in accordance with 
                        subsections (a) and (b) of section 3435.
                            ``(ii) Requirement.--Effective beginning in 
                        fiscal year 2024, the Secretary shall not award 
                        a grant under this paragraph to a State unless 
                        that State has adopted the model standards for 
                        each of substance use disorder treatment 
                        services and recovery residences developed in 
                        accordance with subsections (a) and (b) of 
                        section 3435.
                    ``(D) Continuum of care.--
                            ``(i) Preference.--In determining whether a 
                        State will receive funds under this paragraph, 
                        except as provided in clause (ii), the 
                        Secretary shall give preference to States that 
                        have carried out the requirements to ensure a 
                        continuum of services in accordance with 
                        section 3435(d).
                            ``(ii) Requirement.--Effective beginning in 
                        fiscal year 2024, the Secretary shall not award 
                        a grant under this paragraph to a State unless 
                        that State has carried out the requirements to 
                        ensure a continuum of services in accordance 
                        with section 3435(d).
                    ``(E) Utilization management for medication for 
                addiction treatment.--
                            ``(i) Preference.--In determining whether a 
                        State will receive funds under this paragraph, 
                        the Secretary shall give preference to States 
                        that have prohibited prior authorization and 
                        step therapy requirements for at least 1 drug 
                        in each class approved by the Food and Drug 
                        Administration for the treatment of substance 
                        use disorder.
                            ``(ii) Additional preferences.--Additional 
                        preference shall be given to States that have 
                        prohibited prior authorization and step therapy 
                        requirements for 2 or more drugs in each class 
                        approved by the Food and Drug Administration 
                        for the treatment of substance use disorder.
                            ``(iii) Definitions.--In this subparagraph:
                                    ``(I) Prior authorization.--The 
                                term `prior authorization' means the 
                                process by which a health insurance 
                                issuer or pharmacy benefit management 
                                company determines the medical 
                                necessity of otherwise covered health 
                                care services prior to the rendering of 
                                such health care services. Such term 
                                includes any health insurance issuer's 
                                or utilization review entity's 
                                requirement that a subscriber or health 
                                care provider notify the issuer or 
                                entity prior to providing a health care 
                                service.
                                    ``(II) Step therapy.--The term 
                                `step therapy' means a protocol or 
                                program that establishes the specific 
                                sequence in which prescription drugs 
                                for a medical condition that are 
                                medically appropriate for a particular 
                                patient are authorized by a health 
                                insurance issuer or prescription drug 
                                management company.
            ``(3) Amount of grant to tribal governments.--
                    ``(A) Indian tribes.--In this section, the term 
                `Indian tribe' has the meaning given such term in 
                section 4 of the Indian Self-Determination and 
                Education Assistance Act.
                    ``(B) Formula funds.--The Secretary, acting through 
                the Indian Health Service, shall use 10 percent of the 
                amount available under section 3415 for each fiscal 
                year to provide formula funds to Indian tribes in an 
                amount determined pursuant to a formula and eligibility 
                criteria developed by the Secretary in consultation 
                with Indian tribes, for the purposes of addressing 
                substance use.
                    ``(C) Payment of funds.--At the option of an Indian 
                tribe the Secretary shall pay funds under this section 
                through a contract, cooperative agreement, or compact 
                under, as applicable, title I or V of the Indian Self-
                Determination and Education Assistance Act.
                    ``(D) Use of amounts.--Notwithstanding any 
                requirements in this section, an Indian tribe may use 
                amounts provided under funds awarded under this 
                paragraph for the uses identified in subsection (b) and 
                any other activities determined appropriate by the 
                Secretary, in consultation with Indian tribes.
    ``(b) Use of Amounts.--
            ``(1) In general.--A State or tribe may use amounts 
        provided under grants awarded under section 3411 for--
                    ``(A) prevention services described in paragraph 
                (3);
                    ``(B) core medical services described in paragraph 
                (4);
                    ``(C) recovery and support services described in 
                paragraph (5);
                    ``(D) early intervention services described in 
                paragraph (6);
                    ``(E) harm reduction services described in 
                paragraph (7);
                    ``(F) financial assistance with health insurance as 
                described in paragraph (8); and
                    ``(G) administrative expenses described in 
                paragraph (9).
            ``(2) Direct financial assistance.--
                    ``(A) In general.--A State or tribe may use amounts 
                received under a grant under section 3411 to provide 
                direct financial assistance to eligible entities or 
                other eligible Medicaid providers for the purpose of 
                providing prevention services, core medical services, 
                recovery and support services, early intervention 
                services, and harm reduction services.
                    ``(B) Appropriate entities.--Direct financial 
                assistance may be provided under subparagraph (A) to 
                public or nonprofit entities, other Medicaid providers 
                if more than half of their patients are diagnosed with 
                a substance use disorder and covered by Medicaid, or 
                other private for-profit entities if such entities are 
                the only available provider of quality substance use 
                disorder treatment services in the area.
                    ``(C) Limitation.--A State may not provide direct 
                financial assistance to any entity or provider that 
                provides medication for addiction treatment if that 
                entity or provider does not also offer mental health 
                services or psychotherapy by licensed clinicians 
                through a referral or onsite.
                    ``(D) Neutrality towards organized labor.--
                            ``(i) In general.--In carrying out duties 
                        under this section, States shall, to the extent 
                        practicable, prioritize the distribution of 
                        grant funds to grantees that have--
                                    ``(I)(aa) a collective bargaining 
                                agreement; or
                                    ``(bb) an explicit policy not to 
                                deter employees with respect to--
                                            ``(AA) labor organizing for 
                                        the employees engaged in the 
                                        covered activities; and
                                            ``(BB) such employees' 
                                        choice to form and join labor 
                                        organizations; and
                                    ``(II) policies that require--
                                            ``(aa) the posting and 
                                        maintenance of notices in the 
                                        workplace to such employees of 
                                        their rights under the National 
                                        Labor Relations Act (29 U.S.C. 
                                        151 et seq.);
                                            ``(bb) that such employees 
                                        are, at the beginning of their 
                                        employment, provided notice and 
                                        information regarding the 
                                        employees' rights under such 
                                        Act; and
                                            ``(cc) the employer to 
                                        voluntarily recognize a union 
                                        in cases where a majority of 
                                        such workers of the employer 
                                        have joined and requested 
                                        representation.
                            ``(ii) Limitation.--This subsection does 
                        not apply to Indian tribes.
            ``(3) Prevention services.--
                    ``(A) In general.--For purposes of this section, 
                the term `prevention services' means evidence-based 
                services, programs, or multi-sector strategies to 
                prevent substance use disorder (including education 
                campaigns, community-based prevention programs, risk-
                identification programs, opioid diversion, collection 
                and disposal of unused opioids, services to at-risk 
                populations, and trauma support services).
                    ``(B) Limit.--A State may use not to exceed 20 
                percent of the amount of the grant under section 3411 
                for prevention services. A State may apply to the 
                Secretary for a waiver of this subparagraph.
            ``(4) Core medical services.--For purposes of this section, 
        the term `core medical services' means the following evidence-
        based services when provided to individuals with substance use 
        disorder or at risk for developing substance use disorder, 
        including through the use of telemedicine or a hub and spoke 
        model:
                    ``(A) Substance use disorder treatment, as 
                described in section 3439(4), including assessment of 
                disease presence, severity, and co-occurring 
                conditions, treatment planning, clinical stabilization 
                services, withdrawal management and detoxification, 
                intensive inpatient treatment, intensive outpatient 
                treatment, outpatient treatment, residential inpatient 
                services, treatment for co-occurring mental health and 
                substance use disorders, and all drugs approved by the 
                Food and Drug Administration for the treatment of 
                substance use disorder.
                    ``(B) Outpatient and ambulatory health services, 
                including those administered by Federally-qualified 
                health centers, rural health clinics, tribal clinics 
                and hospitals, urban Indian organizations, certified 
                community behavioral health clinics (as described in 
                section 223 of the Protecting Access to Medicare Act), 
                and comprehensive opioid recovery centers (as described 
                in section 552 of this Act).
                    ``(C) Hospice services.
                    ``(D) Mental health services.
                    ``(E) Opioid overdose reversal drug products 
                procurement, distribution, and training.
                    ``(F) Pharmaceutical assistance related to the 
                management of substance-use disorders and co-morbid 
                conditions.
                    ``(G) Home- and community-based health services.
                    ``(H) Comprehensive Case Management and care 
                coordination, including substance use disorder 
                treatment adherence services.
                    ``(I) Health insurance enrollment and cost-sharing 
                assistance in accordance with paragraph (8).
                    ``(J) Programs that hire, employ, train, and 
                dispatch licensed health care professionals, mental 
                health professionals, harm reduction providers, or 
                community health workers to respond in lieu of law 
                enforcement officers in emergencies and that ensure a 
                licensed health care professional is a member of the 
                team that responds in lieu of law enforcement officers 
                in emergencies in which--
                            ``(i) an individual calling 911, the 
                        National Suicide Hotline, or another emergency 
                        hotlines states that a person is experiencing a 
                        drug overdose or is otherwise under the 
                        influence of a legal or illegal substance; or
                            ``(ii) a law enforcement officer, other 
                        first responder, or other individual identifies 
                        a person as being (or possibly being) under the 
                        influence of a legal or illegal substance.
            ``(5) Recovery and support services.--For purposes of this 
        section, the term `recovery and support services' means 
        services including residential recovery housing, mental health 
        services, long term recovery services, 24/7 hotline crisis 
        center services, medical transportation services, respite care 
        for persons caring for individuals with substance use disorder, 
        child care and family services while an individual is receiving 
        inpatient treatment services or at the time of outpatient 
        services, outreach services, peer recovery services, nutrition 
        services, and referrals for job training and career services, 
        housing, legal services, and child care and family services. 
        The entities through which such services may be provided 
        include State, local, and tribal authorities that provide child 
        care, housing, community development, and other recovery and 
        support services, so long as they do not exclude individuals on 
        the basis that such individuals receive medication for 
        addiction treatment.
            ``(6) Early intervention services.--For purposes of this 
        section, the term `early intervention services' means services 
        to provide screening and connection to the appropriate level of 
        substance use disorder and mental health treatment (including 
        same-day connection), counseling provided to individuals who 
        have misused substances, who have experienced an overdose, or 
        are at risk of developing substance use disorder, the provision 
        of referrals to facilitate the access of such individuals to 
        core medical services or recovery and support services for 
        substance use disorder, and rapid access to medication for 
        addiction treatment in the setting of recent overdose. The 
        entities through which such services may be provided include 
        emergency rooms, fire departments and emergency medical 
        services, detention facilities, prisons and jails, homeless 
        shelters, health care points of entry specified by eligible 
        local areas, Federally-qualified health centers, workforce 
        agencies and job centers, youth development centers, tribal 
        clinics and hospitals, urban Indian organizations, and rural 
        health clinics.
            ``(7) Harm reduction services.--For purposes of this 
        section, the term `harm reduction services' means services 
        provided to individuals engaging in substance use 
        scientifically accepted to reduce the risk of infectious 
        disease transmission, overdose, or death, including by 
        increasing access to health care, housing, recovery, and 
        support services, including syringe services programs. Such 
        term includes evidence-based services.
            ``(8) Affordable health insurance coverage.--A State may 
        use amounts provided under a grant awarded under section 3411 
        to establish a program of financial assistance to assist 
        eligible individuals with substance use disorder in--
                    ``(A) enrolling in health insurance coverage; or
                    ``(B) affording health care services, including 
                assistance paying cost-sharing amounts, including 
                premiums.
            ``(9) Administration and planning.--A State shall not use 
        in excess of 10 percent of amounts received under a grant under 
        section 3411 for administration, accounting, reporting, and 
        program oversight functions, including the development of 
        systems to improve data collection and data sharing.
            ``(10) Incarcerated individuals.--Amounts received under a 
        grant under section 3411 may be used to provide substance use 
        disorder treatment services, including medication for addiction 
        treatment, to individuals who are currently incarcerated or in 
        pre-trial detention.
    ``(c) Required Terms.--
            ``(1) Requirement of status as medicaid provider.--
                    ``(A) Provision of service.--Subject to 
                subparagraph (B), the Secretary may not make a grant 
                under section 3411 for the provision of substance use 
                disorder treatment services under this section in a 
                State unless, in the case of any such service that is 
                available pursuant to the State plan approved under 
                title XIX of the Social Security Act for the State--
                            ``(i)(I) the State will enter into an 
                        agreement with a political subdivision, under 
                        which the political subdivision will provide 
                        the service directly, and the political 
                        subdivision has entered into a participation 
                        agreement under the State plan and is qualified 
                        to receive payments under such plan; or
                            ``(II) the State will enter into agreements 
                        with public or nonprofit entities, or other 
                        Medicaid providers if more than half of their 
                        patients are diagnosed with a substance use 
                        disorder and covered by Medicaid, under which 
                        such entities and other providers will provide 
                        the service, and such entities and other 
                        providers have entered into such a 
                        participation agreement and are qualified to 
                        receive such payments; and
                            ``(III) the State ensures the political 
                        subdivision under clause (i)(I) or the public 
                        or nonprofit private entities and other 
                        providers under clause (i)(II) will seek 
                        payment for each such service rendered in 
                        accordance with the usual payment schedule 
                        under the State plan.
                    ``(B) Waiver.--
                            ``(i) In general.--In the case of an entity 
                        making an agreement pursuant to subparagraph 
                        (A)(ii) regarding the provision of substance 
                        use disorder treatment services, the 
                        requirement established in such subparagraph 
                        shall be waived by the State if the entity does 
                        not, in providing health care services, impose 
                        a charge or accept reimbursement available from 
                        any third-party payor, including reimbursement 
                        under any insurance policy or under any Federal 
                        or State health benefits program. A waiver 
                        under this subparagraph shall not be longer 
                        than 2 years in duration and shall not be 
                        renewed.
                            ``(ii) Determination.--A determination by 
                        the State of whether an entity referred to in 
                        clause (i) meets the criteria for a waiver 
                        under such clause shall be made without regard 
                        to whether the entity accepts voluntary 
                        donations for the purpose of providing services 
                        to the public.
            ``(2) Required terms for expanding and improving care.--A 
        funding agreement for a grant under this section shall--
                    ``(A) ensure that funds received under the grant 
                will not be utilized to make payments for any item or 
                service to the extent that payment has been made, or 
                can reasonably be expected to be made, with respect to 
                that item or service under a State compensation 
                program, under an insurance policy, or under any 
                Federal or State health benefits program (except for a 
                program administered by, or providing the services of, 
                the Indian Health Service); and
                    ``(B) ensure that all entities providing substance 
                use disorder treatment services with assistance made 
                available under the grant shall offer all drugs 
                approved by the Food and Drug Administration for the 
                treatment of substance use disorder for which the 
                applicant offers treatment, in accordance with section 
                3435.
            ``(3) Additional required terms.--A funding agreement for a 
        grant under this section is that--
                    ``(A) funds received under the grant will be 
                utilized to supplement not supplant other Federal, 
                State, or local funds made available in the year for 
                which the grant is awarded to provide substance use 
                disorder treatment services to individuals with 
                substance use disorder, including funds for each of 
                prevention services, core medical services, recovery 
                and support services, early intervention services, harm 
                reduction services, mental health services, and 
                administrative expenses;
                    ``(B) political subdivisions within the State will 
                maintain the level of expenditures by such political 
                subdivisions for substance use disorder treatment 
                services at a level that is at least equal to the level 
                of such expenditures by such political subdivisions for 
                the preceding fiscal year including expenditures for 
                each of prevention services, core medical services, 
                recovery and support services, early intervention 
                services, harm reduction services, mental health 
                services, and administrative expenses;
                    ``(C) political subdivisions within the State will 
                not use funds received under a grant awarded under 
                section 3411 in maintaining the level of substance use 
                disorder treatment services as required in subparagraph 
                (B);
                    ``(D) substance use disorder treatment services 
                provided with assistance made available under the grant 
                will be provided without regard--
                            ``(i) to the ability of the individual to 
                        pay for such services; and
                            ``(ii) to the current or past health 
                        condition of the individual to be served;
                    ``(E) substance use disorder treatment services 
                will be provided in a setting that is accessible to 
                low-income individuals with substance use disorders and 
                to individuals with substance use disorders residing in 
                rural areas;
                    ``(F) a program of outreach will be provided to 
                low-income individuals with substance use disorders to 
                inform such individuals of substance use disorder 
                treatment services and to individuals with substance 
                use disorders residing in rural areas;
                    ``(G) Indian tribes are included in planning for 
                the use of grant funds and the Federal trust 
                responsibility is upheld at all levels of program 
                administration; and
                    ``(H) the confidentiality of individuals receiving 
                substance use disorder treatment services will be 
                maintained in a manner not inconsistent with applicable 
                law.

``SEC. 3413. APPLICATION.

    ``(a) Application.--To be eligible to receive a grant under section 
3411, a State shall have in effect a State plan approved by the 
Secretary pursuant to section 1932(b), and shall prepare and submit to 
the Secretary an application in such form, and containing such 
information, as the Secretary shall require, including--
            ``(1) a complete accounting of the disbursement of any 
        prior grants received under this subtitle by the applicant and 
        the results achieved by these expenditures and a demonstration 
        that funds received from a grant under this subtitle in the 
        prior year were expended in accordance with State priorities;
            ``(2) establishment of goals and objectives to be achieved 
        with grant funds provided under this subtitle, including 
        targets and milestones that are intended to be met, the 
        activities that will be undertaken to achieve those targets, 
        and the number of individuals likely to be served by the funds 
        sought, including demographic data on the populations to be 
        served;
            ``(3) a demonstration that the State will use funds in a 
        manner that provides substance use disorder treatment services 
        in compliance with the evidence-based standards developed in 
        accordance with section 3435, including all drugs approved by 
        the Food and Drug Administration for the treatment of substance 
        use disorder;
            ``(4) a demonstration that resources provided under the 
        grant will be allocated in accordance with the local 
        demographic incidence of substance use, including allocations 
        for services for children, youths, and women;
            ``(5) an explanation of how income, asset, and medical 
        expense criteria will be established and applied to those who 
        qualify for assistance under the program; and
            ``(6) for any prior funding received under this section, 
        data provided in such form as the Secretary shall require 
        detailing, at a minimum, the extent to which the activities 
        supported by the funding met the goals and objectives specified 
        in the application for the funding, the number of individuals 
        who accessed medication for addiction treatment by age, gender, 
        sexual orientation, race, disability status, and other 
        demographic criteria relevant to the program, and the effect of 
        the program on overdose rates and rates of death due to 
        overdose in the region served by the program.
    ``(b) Requirements Regarding Imposition of Charges for Services.--
            ``(1) In general.--The Secretary may not make a grant under 
        section 3411 to a State unless the State provides assurances 
        that in the provision of services with assistance provided 
        under the grant--
                    ``(A) in the case of individuals with an income 
                less than or equal to 150 percent of the official 
                poverty level, the provider will not impose charges on 
                any such individual for the services provided under the 
                grant;
                    ``(B) in the case of individuals with an income 
                greater than 150 percent of the official poverty level, 
                the provider will impose a charge on each such 
                individual according to a schedule of charges made 
                available to the public;
                    ``(C) in the case of individuals with an income 
                greater than 150 percent of the official poverty level 
                but not exceeding 200 percent of such poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 2 percent of the annual 
                gross income of the individual;
                    ``(D) in the case of individuals with an income 
                greater than 200 percent of the official poverty level 
                but not exceeding 250 percent of such poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 4 percent of the annual 
                gross income of the individual involved;
                    ``(E) in the case of individuals with an income 
                greater than 250 percent of the official poverty level 
                but not exceeding 300 percent of such poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 6 percent of the annual 
                gross income of the individual involved;
                    ``(F) in the case of individuals with an income 
                greater than 300 percent of the official poverty level 
                but not exceeding 400 percent of such poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 8.5 percent of the 
                annual gross income of the individual involved;
                    ``(G) in the case of individuals with an income 
                greater than 400 percent of the official poverty level, 
                the provider will not, for any calendar year, impose 
                charges in an amount exceeding 8.5 percent of the 
                annual gross income of the individual involved; and
                    ``(H) in the case of eligible American Indian and 
                Alaska Native and urban Indian individuals as defined 
                by section 447.50 of title 42, Code of Federal 
                Regulations (as in effect on July 1, 2010), the 
                provider will not impose any charges for substance use 
                disorder treatment services, including any charges or 
                cost-sharing prohibited by section 1402(d) of the 
                Patient Protection and Affordable Care Act.
            ``(2) Charges.--With respect to compliance with the 
        assurances made under paragraph (1), a State may, in the case 
        of individuals subject to a charge--
                    ``(A) assess the amount of the charge in the 
                discretion of the State, including imposing only a 
                nominal charge for the provision of services, subject 
                to the provisions of the paragraph regarding public 
                schedules and regarding limitations on the maximum 
                amount of charges; and
                    ``(B) take into consideration the total medical 
                expenses of individuals in assessing the amount of the 
                charge, subject to such provisions.
            ``(3) Aggregate charges.--The Secretary may not make a 
        grant under section 3411 to a State unless the State agrees 
        that the limitations on charges for substance use disorder 
        treatment services under this subsection applies to the annual 
        aggregate of charges imposed for such services, however the 
        charges are characterized, includes enrollment fees, premiums, 
        deductibles, cost sharing, co-payments, co-insurance costs, or 
        any other charges.
    ``(c) Indian Tribes.--Any application requirements applying to 
grants distributed in accordance with section 3412(b) shall be 
developed by the Secretary in consultation with Indian tribes.

``SEC. 3414. TECHNICAL ASSISTANCE.

    ``The Secretary shall, directly or through grants or contracts, 
provide technical assistance in administering and coordinating the 
activities authorized under section 3412, including technical 
assistance for the development of State applications for supplementary 
grants authorized in section 3412(a)(2).

``SEC. 3415. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this 
subtitle--
            ``(1) $4,600,000,000 for fiscal year 2022;
            ``(2) $4,600,000,000 for fiscal year 2023;
            ``(3) $4,600,000,000 for fiscal year 2024;
            ``(4) $4,600,000,000 for fiscal year 2025;
            ``(5) $4,600,000,000 for fiscal year 2026;
            ``(6) $4,600,000,000 for fiscal year 2027;
            ``(7) $4,600,000,000 for fiscal year 2028;
            ``(8) $4,600,000,000 for fiscal year 2029;
            ``(9) $4,600,000,000 for fiscal year 2030; and
            ``(10) $4,600,000,000 for fiscal year 2031.

                   ``Subtitle C--Other Grant Program

``SEC. 3421. ESTABLISHMENT OF GRANT PROGRAM.

    ``(a) Grants.--
            ``(1) In general.--The Secretary shall award grants to 
        public entities, nonprofit entities, Indian entities, and other 
        eligible Medicaid providers for the purpose of funding 
        prevention services, core medical services, recovery and 
        support services, early intervention services, harm reduction 
        services, and administrative expenses in accordance with this 
        section.
            ``(2) Prioritization.--
                    ``(A) In general.--In awarding grants under this 
                section, the Secretary shall, to the extent 
                practicable, prioritize the distribution of grant funds 
                to grantees that have--
                            ``(i) an explicit policy not to deter 
                        employees with respect to--
                                    ``(I) labor organizing for the 
                                employees engaged in the covered 
                                activities; and
                                    ``(II) such employees' choice to 
                                form and join labor organizations; or
                            ``(ii) policies that require--
                                    ``(I) the posting and maintenance 
                                of notices in the workplace to such 
                                employees of their rights under the 
                                National Labor Relations Act (29 U.S.C. 
                                151 et seq.);
                                    ``(II) that such employees are, at 
                                the beginning of their employment, 
                                provided notice and information 
                                regarding the employees' rights under 
                                such Act; and
                                    ``(III) the employer to voluntarily 
                                recognize a union in cases where such 
                                workers of the employer have joined and 
                                requested representation.
                    ``(B) Exception.--This paragraph shall not apply to 
                Indian tribes.
    ``(b) Eligibility.--
            ``(1) Entities.--Public entities, nonprofit entities, urban 
        Indian organizations, and other Medicaid providers eligible to 
        receive a grant under subsection (a) may include--
                    ``(A) Federally-qualified health centers under 
                section 1905(l)(2)(B) of the Social Security Act;
                    ``(B) family planning clinics;
                    ``(C) rural health clinics;
                    ``(D) Indian entities, including Indian health 
                programs as defined in section 4 of the Indian Health 
                Care Improvement Act, urban Indian organizations as 
                defined in section 4 of the Indian Health Care 
                Improvement Act, and Native Hawaiian organizations as 
                defined in section 11 of the Native Hawaiian Health 
                Care Act of 1988;
                    ``(E) community-based organizations, clinics, 
                hospitals, and other health facilities that provide 
                substance use disorder treatment services;
                    ``(F) other nonprofit entities that provide 
                substance use disorder treatment services;
                    ``(G) certified community behavioral health clinics 
                and certified community behavioral health clinic 
                expansion grant recipients, under section 223 of the 
                Protecting Access to Medicare Act (42 U.S.C. 1396a 
                note); and
                    ``(H) other Medicaid providers if more than half of 
                their patients are diagnosed with a substance use 
                disorder and covered by Medicaid.
            ``(2) Underserved populations.--Entities described in 
        paragraph (1) shall serve underserved populations which may 
        include--
                    ``(A) minority populations and Indian populations;
                    ``(B) formerly incarcerated individuals;
                    ``(C) individuals with comorbidities including 
                human immunodeficiency virus, hepatitis B, hepatitis C, 
                mental health disorder or other behavioral health 
                disorders;
                    ``(D) low-income populations;
                    ``(E) people with disabilities;
                    ``(F) urban populations;
                    ``(G) rural populations;
                    ``(H) the lesbian, gay, bisexual, transgender, 
                queer (LGBTQ) community; and
                    ``(I) pregnant individuals with, or at risk of 
                developing, substance use disorder and infants with 
                neonatal abstinence syndrome.
            ``(3) Application.--To be eligible to receive a grant under 
        this section, public entities, nonprofit entities, and other 
        Medicaid providers described in this subsection shall prepare 
        and submit to the Secretary an application in such form, and 
        containing such information, as the Secretary shall require, 
        including--
                    ``(A) a complete accounting of the disbursement of 
                any prior grants received under this subtitle by the 
                applicant and the results achieved by these 
                expenditures;
                    ``(B) a comprehensive plan for the use of the 
                grant, including--
                            ``(i) a demonstration of the extent of 
                        local need for the funds sought;
                            ``(ii) a plan for providing substance use 
                        disorder treatment services that is consistent 
                        with local needs; and
                            ``(iii) goals and objectives to be achieved 
                        with grant funds provided under this section, 
                        including targets and milestones that are 
                        intended to be met and a description of the 
                        activities that will be undertaken to achieve 
                        those targets;
                    ``(C) a demonstration that the grantee will use 
                funds in a manner that provides substance use disorder 
                treatment services compliant with the evidence-based 
                standards developed in accordance with section 3435, 
                including all drugs approved by the Food and Drug 
                Administration for the treatment of substance use 
                disorder for which the applicant offers treatment, in 
                accordance with section 3435(c);
                    ``(D) information on the number of individuals to 
                be served by the funds sought, including demographic 
                data on the populations to be served;
                    ``(E) a demonstration that resources provided under 
                the grant will be allocated in accordance with the 
                local demographic incidence of substance use, including 
                allocations for services for children, youths, and 
                women;
                    ``(F) an explanation of how income, asset, and 
                medical expense criteria will be established and 
                applied to those who qualify for assistance under the 
                program; and
                    ``(G) for any prior funding received under this 
                section, data provided in such form as the Secretary 
                shall require detailing, at a minimum, the extent to 
                which the activities supported by the funding met the 
                goals and objectives specified in the application for 
                the funding, the number of individuals who accessed 
                medication for addiction treatment by age, gender, 
                race, sexual orientation, disability status, and other 
                demographic criteria relevant to the program, and the 
                effect of the program on overdose rates and rates of 
                death due to overdose in the region served by the 
                program.
            ``(4) Requirement of status as medicaid provider.--
                    ``(A) Provision of service.--Subject to 
                subparagraph (B), the Secretary may not make a grant 
                under this section for the provision of substance use 
                disorder treatment services under this section in a 
                State unless, in the case of any such service that is 
                available pursuant to the State plan approved under 
                title XIX of the Social Security Act for the State--
                            ``(i)(I) the applicant for the grant will 
                        provide the service directly, and the applicant 
                        has entered into a participation agreement 
                        under the State plan and is qualified to 
                        receive payments under such plan; or
                            ``(II) the applicant for the grant will 
                        enter into an agreement with public or 
                        nonprofit entities, Indian entities, or other 
                        Medicaid providers if more than half of their 
                        patients are diagnosed with a substance use 
                        disorder and covered by Medicaid, under which 
                        such entities and other providers will provide 
                        the substance use disorder treatment service, 
                        and such entities and other providers have 
                        entered into such a participation agreement and 
                        are qualified to receive such payments; and
                            ``(ii) the applicant ensures that payment 
                        will be sought for each such service rendered 
                        in accordance with the usual payment schedule 
                        under the State plan.
                    ``(B) Waiver.--In the case of an entity making an 
                agreement pursuant to subparagraph (A) regarding the 
                provision of substance use disorder treatment services, 
                the requirement established in such paragraph shall be 
                waived by the State if the entity does not, in 
                providing such services, impose a charge or accept 
                reimbursement available from any third-party payor, 
                including reimbursement under any insurance policy or 
                under any Federal or State health benefits program. A 
                waiver under this subparagraph shall not be longer than 
                2 years in duration and shall not be renewed.
                    ``(C) Determination.--A determination by the State 
                of whether an entity referred to in subparagraph (A) 
                meets the criteria for a waiver under such subparagraph 
                shall be made without regard to whether the entity 
                accepts voluntary donations for the purpose of 
                providing services to the public.
            ``(5) Required terms for expanding and improving care.--A 
        funding agreement for a grant under this section is that--
                    ``(A) funds received under the grant will not be 
                utilized to make payments for any item or service to 
                the extent that payment has been made, or can 
                reasonably be expected to be made, with respect to that 
                item or service under a State compensation program, 
                under an insurance policy, or under any Federal or 
                State health benefits program (except for a program 
                administered by, or providing the services of, the 
                Indian Health Service);
                    ``(B) entities providing substance use disorder 
                treatment services with assistance made available under 
                the grant shall offer all drugs approved by the Food 
                and Drug Administration for the treatment of substance 
                use disorder for which the applicant offers treatment, 
                in accordance with section 3435(c);
                    ``(C) substance use disorder treatment services 
                provided with assistance made available under the grant 
                will be provided without regard--
                            ``(i) to the ability of the individual to 
                        pay for such services; and
                            ``(ii) to the current or past health 
                        condition of the individual to be served;
                    ``(D) substance use disorder treatment services 
                will be provided in a setting that is accessible to 
                low-income individuals with substance use disorders and 
                to individuals with substance use disorders residing in 
                rural areas; and
                    ``(E) the confidentiality of individuals receiving 
                substance use disorder treatment services will be 
                maintained in a manner not inconsistent with applicable 
                law.
    ``(c) Amount of Grant to Indian Entities.--
            ``(1) Indian tribes.--In this section, the term `Indian 
        Tribe' has the meaning given such term in section 4 of the 
        Indian Self-Determination and Education Assistance Act.
            ``(2) Formula grants.--The Secretary, acting through the 
        Indian Health Service, shall use 10 percent of the amount 
        available under section 3425 for each fiscal year to provide 
        grants to Indian entities in an amount determined pursuant to 
        criteria developed by the Secretary in consultation with Indian 
        Tribes and after conferring with urban Indian organizations, 
        for the purposes of addressing substance use.
            ``(3) Use of amounts.--Notwithstanding any requirements in 
        this section, Native entities may use amounts provided under 
        grants awarded under this section for the uses identified in 
        section 3422 and any other activities determined appropriate by 
        the Secretary, in consultation with Indian Tribes.

``SEC. 3422. USE OF AMOUNTS.

    ``(a) Use of Funds.--An entity shall use amounts received under a 
grant under section 3421 to provide direct financial assistance to 
eligible entities for the purpose of delivering or enhancing--
            ``(1) prevention services described in subsection (b);
            ``(2) core medical services described in subsection (c);
            ``(3) recovery and support services described in subsection 
        (d);
            ``(4) early intervention and engagement services described 
        in subsection (e);
            ``(5) harm reduction services described in subsection (f); 
        and
            ``(6) administrative expenses described in subsection (g).
    ``(b) Prevention Services.--For purposes of this section, the term 
`prevention services' means evidence-based services, programs, or 
multi-sector strategies to prevent substance use disorder (including 
education campaigns, community-based prevention programs, risk 
identification programs, opioid diversion, collection and disposal of 
unused opioids, services to at-risk populations, and trauma support 
services).
    ``(c) Core Medical Services.--For purposes of this section, the 
term `core medical services' means the following evidence-based 
services provided to individuals with substance use disorder or at risk 
for developing substance use disorder, including through the use of 
telemedicine or a hub and spoke model:
            ``(1) Substance use disorder treatment, as more fully 
        described in section 3439(4), including assessment of disease 
        presence, severity, and co-occurring conditions, treatment 
        planning, clinical stabilization services, withdrawal 
        management and detoxification, intensive inpatient treatment, 
        intensive outpatient treatment, outpatient treatment, 
        residential inpatient services, treatment for co-occurring 
        mental health and substance use disorders, and all drugs 
        approved by the Food and Drug Administration for the treatment 
        of substance use disorder.
            ``(2) Outpatient and ambulatory health services, including 
        those administered by Federally-qualified health centers, rural 
        health clinics, tribal clinics and hospitals, urban Indian 
        organizations, certified community behavioral health clinics 
        (as described in section 223 of the Protecting Access to 
        Medicare Act), and comprehensive opioid recovery centers (as 
        described in section 552 of this Act).
            ``(3) Hospice services.
            ``(4) Mental health services.
            ``(5) Opioid overdose reversal drug products procurement, 
        distribution, and training.
            ``(6) Pharmaceutical assistance related to the management 
        of substance-use disorder and co-morbid conditions.
            ``(7) Home- and community-based health services.
            ``(8) Comprehensive Case Management and care coordination, 
        including substance use disorder treatment adherence services.
            ``(9) Health insurance enrollment and cost-sharing 
        assistance in accordance with section 3412.
            ``(10) Programs that hire, employ, train, and dispatch 
        mental health professionals, harm reduction providers, or 
        community health workers to respond in lieu of law enforcement 
        officers in emergencies in which--
                    ``(A) an individual calling 911, the National 
                Suicide Hotline, or another emergency hotlines states 
                that a person is experiencing a drug overdose or is 
                otherwise under the influence of a legal or illegal 
                substance; and
                    ``(B) a law enforcement officer, other first 
                responder, or other individual identifies a person as 
                being (or possibly being) under the influence of a 
                legal or illegal substance.
    ``(d) Recovery and Support Services.--For purposes of this section, 
the term `recovery and support services' means services that are 
provided to individuals with substance use disorder, including 
residential recovery housing, mental health services, long term 
recovery services, 24/7 hotline crisis center support, medical 
transportation services, respite care for persons caring for 
individuals with substance use disorder, child care and family services 
while an individual is receiving inpatient treatment services or at the 
time of outpatient services, outreach services, peer recovery services, 
nutrition services, and referrals for job training and career services, 
housing, legal services, and child care and family services. The 
entities through which such services may be provided include local and 
tribal authorities that provide child care, housing, community 
development, and other recovery and support services, so long as they 
do not exclude individuals on the basis that such individuals receive 
medication for addiction treatment.
    ``(e) Early Intervention Services.--For purposes of this section, 
the term `early intervention services' means services to provide 
screening and connection to the appropriate level of substance use 
disorder and mental health treatment (including same-day connection), 
counseling provided to individuals who have misused substances, who 
have experienced an overdose, or are at risk of developing substance 
use disorder, the provision of referrals to facilitate the access of 
such individuals to core medical services or recovery and support 
services for substance use disorder, and rapid access to medication for 
addiction treatment in the setting of recent overdose. The entities 
through which such services may be provided include emergency rooms, 
fire departments and emergency medical services, detention facilities, 
prisons and jails homeless shelters, health care points of entry 
specified by eligible local areas, Federally-qualified health centers, 
workforce agencies and job centers, youth development centers, tribal 
clinics and hospitals, urban Indian organizations, and rural health 
clinics.
    ``(f) Harm Reduction Services.--For purposes of this section, the 
term `harm reduction services' means services provided to individuals 
engaging in substance use that are scientifically accepted to reduce 
the risk of infectious disease transmission, overdose, or death, 
including by increasing access to health care, housing, and recovery 
and support services, including syringe services programs. Such term 
includes evidence-based services.
    ``(g) Administration and Planning.--An entity (not including tribal 
entities) shall not use in excess of 10 percent of amounts received 
under a grant under section 3421 for administration, accounting, 
reporting, and program oversight functions, including for the purposes 
of developing systems to improve data collection and data sharing.
    ``(h) Relation to Existing Emergency Medical Services.--Nothing in 
this section shall be construed to diminish or alter the rights, 
privileges, remedies, or obligations of any provider or any Federal, 
State, or local government to provide emergency medical services.

``SEC. 3423. TECHNICAL ASSISTANCE.

    ``The Secretary may, directly or through grants or contracts, 
provide technical assistance to public or nonprofit entities, Indian 
entities, and other eligible Medicaid providers regarding the process 
of submitting to the Secretary applications for grants under section 
3421, and may provide technical assistance with respect to the 
planning, development, and operation of any program or service carried 
out pursuant to such section.

``SEC. 3424. PLANNING AND DEVELOPMENT GRANTS.

    ``(a) In General.--The Secretary may provide planning grants to 
public or nonprofit entities, Indian entities, and other eligible 
Medicaid providers for purposes of assisting such entities and 
providers in expanding their capacity to provide substance use disorder 
treatment services in low-income communities and affected 
subpopulations that are underserviced with respect to such services.
    ``(b) Amount.--A grant under this section may be made in an amount 
not to exceed $150,000.

``SEC. 3425. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this 
subtitle--
            ``(1) $1,000,000,000 for fiscal year 2022;
            ``(2) $1,000,000,000 for fiscal year 2023;
            ``(3) $1,000,000,000 for fiscal year 2024;
            ``(4) $1,000,000,000 for fiscal year 2025;
            ``(5) $1,000,000,000 for fiscal year 2026;
            ``(6) $1,000,000,000 for fiscal year 2027;
            ``(7) $1,000,000,000 for fiscal year 2028;
            ``(8) $1,000,000,000 for fiscal year 2029;
            ``(9) $1,000,000,000 for fiscal year 2030; and
            ``(10) $1,000,000,000 for fiscal year 2031.

  ``Subtitle D--Innovation, Training, and Health Systems Strengthening

``SEC. 3431. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

    ``(a) In General.--The Secretary shall award grants to entities to 
administer special projects of national significance to support the 
development of innovative and original models for the delivery of 
substance use disorder treatment and harm reduction services.
    ``(b) Grants.--The Secretary shall award grants under a project 
under subsection (a) to entities eligible for grants under subtitles A, 
B, and C based on newly emerging needs of individuals receiving 
assistance under this title.
    ``(c) Replication.--The Secretary shall make information concerning 
successful models or programs developed under this section available to 
grantees under this title for the purpose of coordination, replication, 
and integration. To facilitate efforts under this section, the 
Secretary may provide for peer-based technical assistance for grantees 
funded under this section.
    ``(d) Grants to Tribal Governments.--
            ``(1) Indian tribes.--In this section, the term `Indian 
        tribe' has the meaning given such term in section 4 of the 
        Indian Self-Determination and Education Assistance Act.
            ``(2) Use of funds.--The Secretary, acting through the 
        Indian Health Service, shall use 10 percent of the amount 
        available under this section for each fiscal year to provide 
        grants to Indian tribes for the purposes of supporting the 
        development of innovative and original models for the delivery 
        of substance use disorder treatment services, including the 
        development of culturally informed care models.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            ``(1) $500,000,000 for fiscal year 2022;
            ``(2) $500,000,000 for fiscal year 2023;
            ``(3) $500,000,000 for fiscal year 2024;
            ``(4) $500,000,000 for fiscal year 2025;
            ``(5) $500,000,000 for fiscal year 2026;
            ``(6) $500,000,000 for fiscal year 2027;
            ``(7) $500,000,000 for fiscal year 2028;
            ``(8) $500,000,000 for fiscal year 2029;
            ``(9) $500,000,000 for fiscal year 2030; and
            ``(10) $500,000,000 for fiscal year 2031.

``SEC. 3432. EDUCATION AND TRAINING CENTERS.

    ``(a) In General.--The Secretary may make grants and enter into 
contracts to assist public or nonprofit entities, public or nonprofit 
schools, and academic health centers in meeting the cost of projects--
            ``(1) to train health professionals, including 
        practitioners in programs under this title and other community 
        providers, including physician addiction specialists, 
        psychologists, counselors, case managers, social workers, peer 
        recovery coaches, harm reduction workers, public health 
        workers, and community health workers, and paraprofessionals, 
        such as peer support specialists and recovery coaches, in the 
        diagnosis, treatment, and prevention of substance use disorders 
        and drug use-related health issues, including measures for the 
        prevention and treatment of co-occurring infectious diseases, 
        mental health disorders, and other conditions, and including 
        (as applicable to the type of health professional involved), 
        care for women, pregnant women, and children;
            ``(2) to train the faculty of schools of medicine, nursing, 
        public health, osteopathic medicine, dentistry, allied health, 
        social work, and mental health practice to teach health 
        professions students to screen for and provide for the needs of 
        individuals with substance use disorders or at risk of 
        substance use; and
            ``(3) to develop and disseminate curricula and resource 
        materials relating to evidence-based practices for the 
        screening, prevention, and treatment of substance use disorders 
        and drug use-related health issues, including information about 
        combating stigma, prescribing best practices, overdose 
        reversal, alternative pain therapies, and all drugs approved by 
        the Food and Drug Administration for the treatment of substance 
        use disorders, including for the purposes authorized under the 
        amendments made by section 3203 of the SUPPORT for Patients and 
        Communities Act.
    ``(b) Preference in Making Grants.--In making grants under 
subsection (a), the Secretary shall give preference to qualified 
projects that will--
            ``(1) train, or result in the training of, health 
        professionals and other community providers described in 
        subsection (a)(1), to provide substance use disorder treatments 
        for underserved groups, including minority individuals and 
        Indians with substance use disorder and other individuals who 
        are at a high risk of substance use;
            ``(2) train, or result in the training of, minority health 
        professionals and minority allied health professionals, to 
        provide substance use disorder treatment for individuals with 
        such disease;
            ``(3) train or result in the training of individuals who 
        will provide substance use disorder treatment in rural or other 
        areas that are underserved by current treatment structures;
            ``(4) train or result in the training of health 
        professionals and allied health professionals, including 
        counselors, case managers, social workers, peer recovery 
        coaches, and harm reduction workers, public health workers, and 
        community health workers, to provide treatment for infectious 
        diseases and mental health disorders co-occurring with 
        substance use disorder; and
            ``(5) train or result in the training of health 
        professionals and other community providers to provide 
        substance use disorder treatments for pregnant women, children, 
        and adolescents.
    ``(c) Native Education and Training Centers.--The Secretary shall 
use 10 percent of the amount available under subsection (d) for each 
fiscal year to provide grants authorized under this subtitle to--
            ``(1) tribal colleges and universities;
            ``(2) Indian Health Service grant funded institutions; and
            ``(3) Native partner institutions, including institutions 
        of higher education with medical training programs that partner 
        with one or more Indian tribes, tribal organizations, Native 
        Hawaiian organizations, or tribal colleges and universities to 
        train Native health professionals that will provide substance 
        use disorder treatment services in Native communities.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            ``(1) $500,000,000 for fiscal year 2022;
            ``(2) $500,000,000 for fiscal year 2023;
            ``(3) $500,000,000 for fiscal year 2024;
            ``(4) $500,000,000 for fiscal year 2025;
            ``(5) $500,000,000 for fiscal year 2026;
            ``(6) $500,000,000 for fiscal year 2027;
            ``(7) $500,000,000 for fiscal year 2028;
            ``(8) $500,000,000 for fiscal year 2029;
            ``(9) $500,000,000 for fiscal year 2030; and
            ``(10) $500,000,000 for fiscal year 2031.

``SEC. 3433. SUBSTANCE USE DISORDER TREATMENT PROVIDER CAPACITY UNDER 
              THE MEDICAID PROGRAM.

    ``(a) Projects.--
            ``(1) In general.--The Secretary shall use amounts 
        appropriated under this section to provide funding for projects 
        in any State or territory to increase substance use provider 
        capacity, as provided for in section 1903(aa) of the Social 
        Security Act.
            ``(2) Prioritizations.--
                    ``(A) In general.--In awarding grants under this 
                section, the Secretary shall, to the extent 
                practicable, prioritize the distribution of grant funds 
                to grantees that have--
                            ``(i) an explicit policy not to deter 
                        employees with respect to--
                                    ``(I) labor organizing for the 
                                employees engaged in the covered 
                                activities; and
                                    ``(II) such employees' choice to 
                                form and join labor organizations; and
                            ``(ii) policies that require--
                                    ``(I) the posting and maintenance 
                                of notices in the workplace to such 
                                employees of their rights under the 
                                National Labor Relations Act (29 U.S.C. 
                                151 et seq.);
                                    ``(II) that such employees are, at 
                                the beginning of their employment, 
                                provided notice and information 
                                regarding the employees' rights under 
                                such Act; and
                                    ``(III) the employer to voluntarily 
                                recognize a union in cases where such 
                                workers of the employer have joined and 
                                requested representation.
                    ``(B) Exception.--This paragraph shall not apply to 
                Indian tribes.
    ``(b) Amount of Grant to Indian Entities.--
            ``(1) Indian tribes.--In this section, the term `Indian 
        tribe' has the meaning given such term in section 4 of the 
        Indian Self-Determination and Education Assistance Act.
            ``(2) Urban indian organization.--In this section, the term 
        `urban Indian organization' has the meaning given such in 
        section 4 of the Indian Health Care Improvement Act.
            ``(3) Grants.--The Secretary, acting through the Indian 
        Health Service, shall use 10 percent of the amount appropriated 
        under this section for each fiscal year to award grants to 
        Indian tribes and urban Indian organizations in an amount 
        determined pursuant to criteria developed by the Secretary in 
        consultation with Indian tribes and in conference with urban 
        Indian organizations.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            ``(1) $50,000,000 for fiscal year 2022;
            ``(2) $50,000,000 for fiscal year 2023;
            ``(3) $50,000,000 for fiscal year 2024;
            ``(4) $50,000,000 for fiscal year 2025;
            ``(5) $50,000,000 for fiscal year 2026;
            ``(6) $50,000,000 for fiscal year 2027;
            ``(7) $50,000,000 for fiscal year 2028;
            ``(8) $50,000,000 for fiscal year 2029;
            ``(9) $50,000,000 for fiscal year 2030; and
            ``(10) $50,000,000 for fiscal year 2031.

``SEC. 3434. PROGRAMS TO SUPPORT EMPLOYEES.

    ``(a) Grant Program for Workers.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the National Institute for Occupational Safety and 
        Health, shall award grants to non-profit entities that meet the 
        requirements of this section to fund programs and projects to 
        assist workers who are at risk of substance use disorder, who 
        have substance use disorder, or who are recovering from 
        substance use disorder to maintain or gain employment.
            ``(2) Grants for workers.--
                    ``(A) In general.--The Secretary shall, on a 
                competitive basis, award grants for a period of not 
                more than 3 years to non-profit entities that submit an 
                application under paragraph (3) to enable such entities 
                to implement, conduct, continue, and expand evidence-
                based programs and projects to assist individuals 
                described in subparagraph (G).
                    ``(B) Use of amounts.--An entity may use amounts 
                provided under this subsection for--
                            ``(i) prevention services described in 
                        subparagraph (C), including providing education 
                        and information to workers regarding the 
                        dangers of illicit and licit drug use, non-
                        opioid pain management and non-drug pain 
                        management, or occupational injury and illness 
                        prevention;
                            ``(ii) early intervention services 
                        described in subparagraph (D) to enable 
                        individuals to maintain or gain employment;
                            ``(iii) recovery and support services 
                        described in subparagraph (E) to enable 
                        individuals to maintain or gain employment;
                            ``(iv) harm reduction services described in 
                        subparagraph (F) to enable individuals to 
                        maintain or gain employment;
                            ``(v) hiring case managers, care 
                        coordinators, and peer support specialists to 
                        assist employed individuals who are 
                        experiencing substance use disorder, or who are 
                        recovering from substance use disorder, in 
                        accessing substance use disorder treatment 
                        services; or
                            ``(vi) providing vocational, life skills, 
                        and other forms of job training to workers who 
                        are receiving substance use disorder treatment 
                        services to enable such workers to maintain or 
                        gain employment.
                    ``(C) Prevention services.--For purposes of this 
                section, the term `prevention services' means evidence-
                based services, programs, or multi-sector strategies to 
                prevent substance use disorder (including education 
                campaigns, community-based prevention programs, risk 
                identification programs, opioid diversion, collection 
                and disposal of unused opioids, services to at-risk 
                populations, and trauma support services).
                    ``(D) Recovery and support services.--For purposes 
                of this section, the term `recovery and support 
                services' means services including residential recovery 
                housing, mental health services, long term recovery 
                services, 24/7 hotline crisis center services, medical 
                transportation services, respite care for persons 
                caring for individuals with substance use disorder, 
                child care and family services while an individual is 
                receiving inpatient treatment services or at the time 
                of outpatient services, outreach services, peer 
                recovery services, nutrition services, and referrals 
                for job training and career services, housing, legal 
                services, and child care and family services so long as 
                they do not exclude individuals on the basis that such 
                individuals receive medication for addiction treatment.
                    ``(E) Early intervention services.--For purposes of 
                this section, the term `early intervention services' 
                means services to provide screening and connection to 
                the appropriate level of substance use disorder and 
                mental health treatment (including same-day 
                connection), counseling provided to individuals who 
                have misused substances, who have experienced an 
                overdose, or are at risk of developing substance use 
                disorder, the provision of referrals to facilitate the 
                access of such individuals to core medical services or 
                recovery and support services for substance use 
                disorder, and rapid access to medication for addiction 
                treatment in the setting of recent overdose.
                    ``(F) Harm reduction services.--For purposes of 
                this section, the term `harm reduction services' means 
                services provided to individuals engaging in substance 
                use scientifically accepted to reduce the risk of 
                infectious disease transmission, overdose, or death, 
                including by increasing access to health care, housing, 
                and recovery and support services, including syringe 
                services programs. Such term includes evidence-based 
                services.
                    ``(G) Individuals described.--Individuals described 
                in this subparagraph are individuals who--
                            ``(i)(I) have been employed in the 12-month 
                        period immediately preceding the date on which 
                        the determination is being made, or who are 
                        participating in an employee training or 
                        apprenticeship program; and
                            ``(II) are at high risk of developing 
                        substance use disorder, including as a result 
                        of employment in industries that experience 
                        high rates of occupational injuries and 
                        illness; or
                            ``(ii) are experiencing a substance use 
                        disorder or are in recovery from a substance 
                        use disorder.
            ``(3) Applications.--To be eligible for a grant under this 
        subsection, an entity shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require, including--
                    ``(A) a complete accounting of the disbursement of 
                any prior grants received under this title by the 
                applicant and the results achieved by such 
                expenditures;
                    ``(B) a description of the population to be served 
                with grant funds provided under this section, including 
                a description of the unique risks the population faces 
                for experiencing occupational injuries or exposure to 
                illicit substances;
                    ``(C) the goals and objectives to be achieved with 
                grant funds provided under this section, including 
                targets and milestones that are intended to be met, the 
                activities that will be undertaken to achieve those 
                targets, and the number of individuals likely to be 
                served by the grant funds, including demographic data 
                on the populations to be served;
                    ``(D) a demonstration of the ability of the 
                applicant to reach the individuals described in 
                paragraph (2)(G) and to provide services described in 
                paragraph (2)(B) included in the applicant's grant 
                application, including by partnering with local 
                stakeholders;
                    ``(E) for any prior funding received under this 
                subsection, data provided in such form as the Secretary 
                shall require detailing, at a minimum, the extent to 
                which the activities supported by the funding met the 
                goals, objectives, targets, and milestones specified in 
                the application for the funding, and the number of 
                individuals with and without substance use disorder who 
                received services supported by the funding, including 
                the services provided to these individuals, the 
                industries in which the individuals were employed when 
                they received services, and whether the individuals 
                were still employed in that same industry or in any 
                industry when the individuals ceased receiving services 
                supported by the funding; and
                    ``(F) any other information the Secretary shall 
                require.
            ``(4) Data reporting and oversight.--An entity awarded a 
        grant under this subsection shall submit to the Secretary an 
        annual report at such time and in such manner as the Secretary 
        shall require. Such report shall include, at a minimum, a 
        description of--
                    ``(A) the activities funded by the grant;
                    ``(B) the number of individuals with and without 
                substance use disorder served through activities funded 
                by the grant, including the services provided to those 
                individuals and the industries in which those 
                individuals were employed at the time they received 
                services supported by the grant;
                    ``(C) for workers experiencing substance use 
                disorder or recovering from substance use disorder 
                served by activities funded by the grant, the number of 
                individuals who maintained employment, the number of 
                individuals who gained employment, and the number of 
                individuals who failed to maintain employment over the 
                course of the reporting period; and
                    ``(D) any other information required by the 
                Secretary.
            ``(5) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection--
                    ``(A) $40,000,000 for fiscal year 2022;
                    ``(B) $40,000,000 for fiscal year 2023;
                    ``(C) $40,000,000 for fiscal year 2024;
                    ``(D) $40,000,000 for fiscal year 2025;
                    ``(E) $40,000,000 for fiscal year 2026;
                    ``(F) $40,000,000 for fiscal year 2027;
                    ``(G) $40,000,000 for fiscal year 2028;
                    ``(H) $40,000,000 for fiscal year 2029;
                    ``(I) $40,000,000 for fiscal year 2030; and
                    ``(J) $40,000,000 for fiscal year 2031.
    ``(b) Research on the Impact of Substance Use Disorder in the 
Workplace and on Direct Service Providers.--
            ``(1) Risks of substance use disorder.--The Secretary, in 
        consultation with the Director of the National Institute for 
        Occupational Safety and Health, shall conduct (directly or 
        through grants or contracts) research, experiments, and 
        demonstrations, and publish studies relating to--
                    ``(A) the risks faced by employees in various 
                occupations of developing substance use disorder and of 
                drug overdose deaths and non-fatal drug overdoses, and 
                the formulation of prevention activities tailored to 
                the risks identified in these occupations, including 
                occupational injury and illness prevention;
                    ``(B) the prevalence of substance use disorder 
                among employees in various occupations;
                    ``(C) efforts that employers may undertake to 
                assist employees who are undergoing substance use 
                disorder treatment services in maintaining employment 
                while ensuring workplaces are safe and healthful;
                    ``(D) risks of occupational exposure to opioids and 
                other illicit substances and the formulation of 
                prevention activities tailored to the risks identified; 
                and
                    ``(E) other subjects related to substance use 
                disorder in the workplace as the Secretary determines.
            ``(2) Direct service providers.--The Secretary shall 
        conduct (directly or through grants or contracts) research, 
        experiments, and demonstrations, and publish studies relating 
        to the occupational health and safety, recruitment, and 
        retention of behavioral health providers who, as part of their 
        job responsibilities, provide direct services to individuals 
        who are at risk of experiencing substance use disorder or who 
        are experiencing or recovering from substance use disorder, 
        including--
                    ``(A) identifying factors that the Secretary 
                believes may endanger the health or safety of such 
                workers, including factors that affect the risks such 
                workers face of developing substance use disorder;
                    ``(B) motivational and behavioral factors relating 
                to the field of behavioral health providers;
                    ``(C) strategies to support the recruitment and 
                retention of behavioral health providers; and
                    ``(D) other subjects related to behavioral health 
                providers engaged in direct provision of substance use 
                disorder prevention and treatment services as the 
                Secretary determines appropriate.
            ``(3) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection--
                    ``(A) $10,000,000 for fiscal year 2022;
                    ``(B) $10,000,000 for fiscal year 2023;
                    ``(C) $10,000,000 for fiscal year 2024;
                    ``(D) $10,000,000 for fiscal year 2025;
                    ``(E) $10,000,000 for fiscal year 2026;
                    ``(F) $10,000,000 for fiscal year 2027;
                    ``(G) $10,000,000 for fiscal year 2028;
                    ``(H) $10,000,000 for fiscal year 2029;
                    ``(I) $10,000,000 for fiscal year 2030; and
                    ``(J) $10,000,000 for fiscal year 2031.

``SEC. 3435. IMPROVING AND EXPANDING CARE.

    ``(a) Level of Care Standards for Substance Use Disorder Treatment 
Services.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of this title, the Secretary, in consultation with 
        the American Society of Addiction Medicine, State and tribal 
        officials selected by the Secretary, and other stakeholders as 
        the Secretary determines necessary, and after seeking public 
        input, shall promulgate model standards for the regulation of 
        substance use disorder treatment services.
            ``(2) Substance use disorder treatment services.--The model 
        standards promulgated under paragraph (1) shall, at a minimum--
                    ``(A) identify the types of substance use disorder 
                treatment services intended to be covered without 
                regard to whether they participate in any Federal 
                health care program (as defined in section 1128B(f) of 
                the Social Security Act) and shall not include--
                            ``(i) a private practitioner who is already 
                        licensed by a State licensing board and whose 
                        practice is limited to non-intensive outpatient 
                        care; or
                            ``(ii) any substance use disorder treatment 
                        service provided on a non-intensive outpatient 
                        basis in the office of a private practitioner 
                        who is licensed by a State licensing board;
                    ``(B) require the designation of a single State 
                agency to serve as the primary regulator in the State 
                for substance use disorder treatment services;
                    ``(C) subject to paragraph (3), require that 
                substance use disorder treatment services identified in 
                accordance with subparagraph (A), be licensed by the 
                respective States according to the standards for levels 
                of care set forth by the American Society of Addiction 
                Medicine in 2013 or an equivalent set of standards;
                    ``(D) require implementation of a process to ensure 
                that substance use disorder treatment program 
                qualifications are verified by means of an onsite 
                inspection not less frequently than every 3 years by 
                the State agency serving as the primary regulator in 
                the State for substance use disorder treatment services 
                or by an independent third party that is approved by 
                the State's primary regulator; and
                    ``(E) require that all patients leaving a 
                residential treatment program receive a written 
                transition plan prior to discharge from that level of 
                care.
            ``(3) Annual assessment.--Beginning with respect to fiscal 
        year 2022, the Secretary shall make a determination with 
        respect to each State on whether the State has adopted, for 
        each of the substance use disorder treatment services 
        identified in accordance with paragraph (2)(A), licensure 
        standards that are in compliance in all material respects with 
        the model standards promulgated in accordance with this 
        subsection. In the event the American Society of Addiction 
        Medicine revises its criteria, the Secretary shall revise the 
        national model level of care standards accordingly and 
        disseminate any such update to the States, and the States may 
        adopt any such updates to be in compliance with this 
        subsection.
    ``(b) Standards for Other Specified Matters Related to Substance 
Use Disorder Treatment Services and Recovery Residences.--
            ``(1) In general.--Not later than 2 years after the date of 
        enactment of this title, the Secretary, in consultation with 
        representatives of nonprofit service providers and State and 
        tribal officials as the Secretary determines necessary, shall 
        promulgate model standards for the regulation of--
                    ``(A) other specified matters related to substance 
                use disorder treatment services; and
                    ``(B) recovery residences.
            ``(2) Other specified matters related to substance use 
        disorder treatment services.--The model standards promulgated 
        under paragraph (1)(A) shall, at a minimum--
                    ``(A) identify the professional credentials needed 
                by each type of substance use disorder treatment 
                professional;
                    ``(B) include standards for data reporting and 
                require compilation of statewide reports;
                    ``(C) require the establishment and maintenance 
                within each State of a toll-free telephone number to 
                receive complaints from the public regarding substance 
                use disorder treatment service providers; and
                    ``(D) require the establishment and maintenance on 
                a publicly accessible internet website of a list of all 
                substance use disorder treatment services in the State 
                that have a certification in effect in accordance with 
                this section.
            ``(3) Recovery residences.--
                    ``(A) Economic relationship.--The model standards 
                promulgated under paragraph (1)(B) shall, at a minimum, 
                be applied to recovery residences that have an ongoing 
                economic relationship with any commercial substance use 
                disorder treatment service.
                    ``(B) Minimum requirements.--The model standards 
                promulgated under paragraph (1)(B), which may include 
                any model laws developed under section 550(a) shall, at 
                a minimum, identify requirements for--
                            ``(i) the designation of a single State 
                        agency to certify recovery residences;
                            ``(ii) the implementation of a process to 
                        ensure that the qualifications of recovery 
                        residences in which not fewer than 10 
                        individuals may lawfully reside are verified by 
                        means of an onsite inspection not less 
                        frequently than every 3 years by the State 
                        agency serving as the primary regulator in the 
                        State or by an independent third party that is 
                        approved by the State's primary regulator;
                            ``(iii) fire, safety, and health standards;
                            ``(iv) equipping residences with opioid 
                        overdose reversal drug products, such as 
                        naloxone and training residence owners, 
                        operators, and employees in the administration 
                        of naloxone;
                            ``(v) recovery residence owners and 
                        operators;
                            ``(vi) a written policy that prohibits the 
                        exclusion of individuals on the basis that such 
                        individuals receive drugs approved by the Food 
                        and Drug Administration for the treatment of 
                        substance use disorder;
                            ``(vii) the establishment and maintenance 
                        within each State of a toll-free telephone 
                        number to receive complaints from the public 
                        regarding recovery residences; and
                            ``(viii) the establishment and maintenance 
                        on a publicly accessible internet website of a 
                        list of all recovery residences in the State 
                        that have a certification in effect in 
                        accordance with this section.
            ``(4) Annual assessment.--Beginning with respect to fiscal 
        year 2023, the Secretary shall make a determination with 
        respect to each State on whether the State has adopted, for 
        each of the other specified substance use disorder treatment 
        services identified in this section and for recovery 
        residences, standards that are in compliance in all material 
        respects with the model standards promulgated in accordance 
        with this subsection.
    ``(c) Ensuring Access to Medication for Addiction Treatment.--
            ``(1) Medication for addiction treatment.--The Secretary 
        may not make a grant under this section unless the applicant 
        for the grant agrees to require all entities offering substance 
        use disorder treatment services under the grant to offer all 
        drugs approved by the Food and Drug Administration for the 
        treatment of substance use disorder for which the applicant 
        offers treatment.
            ``(2) Waiver.--The Secretary may grant a waiver with 
        respect to any requirement of this section if the grant 
        applicant involved--
                    ``(A) submits to the Secretary a justification for 
                such waiver containing such information as the 
                Secretary shall require; and
                    ``(B) agrees to require all entities offering 
                substance use disorder treatment services under the 
                grant to--
                            ``(i) offer, on site, at least 2 drugs 
                        approved by the Food and Drug Administration 
                        for the treatment of substance use disorder;
                            ``(ii) provide counseling to patients on 
                        the benefits and risks of all drugs approved by 
                        the Food and Drug Administration for the 
                        treatment of substance use disorder; and
                            ``(iii) maintain an affiliation agreement 
                        with a provider that can prescribe or otherwise 
                        dispense all other forms of drugs approved by 
                        the Food and Drug Administration for the 
                        treatment of substance use disorder.
            ``(3) GAO study.--Not later than 1 year after the date of 
        enactment of this title, the Comptroller General of the United 
        States shall submit to Congress a comprehensive report 
        describing any relationship between substance use rates, pain 
        management practices of the Indian Health Service, and patient 
        request denials through the purchased/referred care program of 
        the Indian Health Service.
    ``(d) Ensuring a Full Continuum of Services.--
            ``(1) In general.--Not later than 6 months after the date 
        of the enactment of this title, the Administrator of the 
        Centers for Medicare & Medicaid Services shall issue a State 
        Medicaid Director letter and tribal leader letter explaining 
        how States and tribes can ensure access to a continuum of 
        services for adults with substance use disorders who are 
        receiving medical assistance under title XIX of the Social 
        Security Act. Such letter shall describe how States can cover 
        the continuum of community-based, residential, and inpatient 
        substance use disorder services and care coordination between 
        different levels of care as medical assistance, as defined in 
        section 1905(a) of such Act, including through section 1915 of 
        such Act and through demonstration projects under section 1115 
        of such Act.
            ``(2) MACPAC analysis.--Not later than 1 year after the 
        date of the enactment of this title, the Medicaid and CHIP 
        Payment and Access Commission shall conduct an analysis, and 
        make publicly available a report containing the results of such 
        analysis, of States' coverage of substance use services for 
        Medicaid beneficiaries. Such report shall include examples of 
        promising strategies States use to cover a continuum of 
        community-based substance use services.
            ``(3) Annual assessment.--Beginning with respect to fiscal 
        year 2022, the Secretary shall make a determination with 
        respect to each State on whether the State has carried out the 
        requirements to ensure a continuum of services as described in 
        section 1915(l)(4)(C) of the Social Security Act.

``SEC. 3436. NALOXONE DISTRIBUTION PROGRAM.

    ``(a) Establishment of Program.--
            ``(1) In general.--The Secretary shall provide for the 
        purchase and delivery of federally approved opioid overdose 
        reversal drug products on behalf of each State (or Indian tribe 
        as defined in section 4 of the Indian Health Care Improvement 
        Act) that receives a grant under subtitle B. This paragraph 
        constitutes budget authority in advance of appropriations Acts, 
        and represents the obligation of the Federal Government to 
        provide for the purchase and delivery to States and Indian 
        tribes of the opioid overdose reversal drug products in 
        accordance with this paragraph.
            ``(2) Special rules where opioid overdose reversal drug 
        products are unavailable.--To the extent that a sufficient 
        quantity of opioid overdose reversal drug products are not 
        available for purchase or delivery under paragraph (1), the 
        Secretary shall provide for the purchase and delivery of the 
        available opioid overdose reversal drug products in accordance 
        with priorities established by the Secretary, with priority 
        given to States with at least one local area eligible for 
        funding under section 3401(a).
    ``(b) Negotiation of Contracts With Manufacturers.--
            ``(1) In general.--For the purpose of carrying out this 
        section, the Secretary shall negotiate and enter into contracts 
        with manufacturers of opioid overdose reversal drug products 
        consistent with the requirements of this subsection and, to the 
        maximum extent practicable, consolidate such contracting with 
        any other contracting activities conducted by the Secretary to 
        purchase opioid overdose reversal drug products. The Secretary 
        may enter into such contracts under which the Federal 
        Government is obligated to make outlays, the budget authority 
        for which is not provided for in advance in appropriations 
        Acts, for the purchase and delivery of opioid overdose reversal 
        drug products under subsection (a).
            ``(2) Authority to decline contracts.--The Secretary may 
        decline to enter into contracts under this subsection and may 
        modify or extend such contracts.
            ``(3) Contract price.--
                    ``(A) In general.--The Secretary, in negotiating 
                the prices at which opioid overdose reversal drug 
                products will be purchased and delivered from a 
                manufacturer under this subsection, shall take into 
                account quantities of opioid overdose reversal drug 
                products to be purchased by States under the option 
                under paragraph (4)(B).
                    ``(B) Negotiation of discounted price for opioid 
                overdose reversal drug products.--With respect to 
                contracts entered into for the purchase of opioid 
                overdose reversal drug products on behalf of States 
                under this subsection, the price for the purchase of 
                such drug product shall be a discounted price 
                negotiated by the Secretary.
            ``(4) Product dosage.--All opioid overdose reversal 
        products purchased under this section shall contain--
                    ``(A) for each dose, the maximum amount of active 
                pharmaceutical ingredient that acts as an opioid 
                receptor antagonist as recommended by the Food and Drug 
                Administration as an initial dose when administered by 
                one of the approved, labeled routes of administration 
                in adults; and
                    ``(B) a minimum of two doses packaged together.
            ``(5) Quantities and terms of delivery.--Under contracts 
        under this subsection--
                    ``(A) the Secretary shall provide, consistent with 
                paragraph (6), for the purchase and delivery on behalf 
                of States and Indian tribes of quantities of opioid 
                overdose reversal drug products; and
                    ``(B) each State and Indian tribe, at the option of 
                the State or tribe, shall be permitted to obtain 
                additional quantities of opioid overdose reversal drug 
                products (subject to amounts specified to the Secretary 
                by the State or tribe in advance of negotiations) 
                through purchasing the opioid overdose reversal drug 
                products from the manufacturers at the applicable price 
                negotiated by the Secretary consistent with paragraph 
                (3), if the State or tribe provides to the Secretary 
                such information (at a time and manner specified by the 
                Secretary, including in advance of negotiations under 
                paragraph (1)) as the Secretary determines to be 
                necessary, to provide for quantities of opioid overdose 
                reversal drug products for the State or tribe to 
                purchase pursuant to this subsection and to determine 
                annually the percentage of the opioid overdose reversal 
                drug market that is purchased pursuant to this section 
                and this subparagraph.
        The Secretary shall enter into the initial negotiations not 
        later than 180 days after the date of the enactment of this 
        title.
            ``(6) Charges for shipping and handling.--The Secretary may 
        enter into a contract referred to in paragraph (1) only if the 
        manufacturer involved agrees to submit to the Secretary such 
        reports as the Secretary determines to be appropriate to assure 
        compliance with the contract and if, with respect to a State 
        program under this section that does not provide for the direct 
        delivery of qualified opioid overdose reversal drug products, 
        the manufacturer involved agrees that the manufacturer will 
        provide for the delivery of the opioid overdose reversal drug 
        products on behalf of the State in accordance with such program 
        and will not impose any charges for the costs of such delivery 
        (except to the extent such costs are provided for in the price 
        established under paragraph (3)).
            ``(7) Multiple suppliers.--In the case of the opioid 
        overdose reversal drug product involved, the Secretary may, as 
        appropriate, enter into a contract referred to in paragraph (1) 
        with each manufacturer of the opioid overdose reversal drug 
        product that meets the terms and conditions of the Secretary 
        for an award of such a contract (including terms and conditions 
        regarding safety and quality). With respect to multiple 
        contracts entered into pursuant to this paragraph, the 
        Secretary may have in effect different prices under each of 
        such contracts and, with respect to a purchase by States 
        pursuant to paragraph (4)(B), each eligible State may choose 
        which of such contracts will be applicable to the purchase.
    ``(c) Use of Opioid Overdose Reversal Drug Product List.--Beginning 
not later than one year after the first contract has been entered into 
under this section, the Secretary shall use, for the purpose of the 
purchase, delivery, and administration of opioid overdose reversal drug 
products under this section, the list established (and periodically 
reviewed and, as appropriate, revised) by an advisory committee, 
established by the Secretary and located within the Centers for Disease 
Control and Prevention, which considers the cost effectiveness of each 
opioid overdose reversal drug product.
    ``(d) State Distribution of Opioid Overdose Reversal Drug 
Products.--States shall distribute opioid overdose reversal drug 
products received under this section to the following:
            ``(1) First responders and local emergency medical services 
        organizations, including volunteer emergency medical services 
        organizations.
            ``(2) Public entities with authority to administer local 
        public health services, including all local health departments, 
        for the purposes of making opioid overdose reversal drug 
        products available to--
                    ``(A) nonprofit entities, including--
                            ``(i) community-based organizations that 
                        provide substance use disorder treatments or 
                        harm reduction services;
                            ``(ii) nonprofit entities that provide 
                        substance use disorder treatments or harm 
                        reduction services; and
                            ``(iii) faith based organizations that 
                        provide substance use disorder treatments or 
                        harm reduction services;
                    ``(B) other areas of high need; and
                    ``(C) the general public.
    ``(e) State Requirements.--To be eligible to receive opioid 
overdose reversal drugs under this section, each State shall--
            ``(1) establish a program for distributing opioid overdose 
        reversal drug products to first responders, the general public, 
        and entities with authority to administer local public health 
        services, including local health departments;
            ``(2) beginning in the second year of the program, 
        demonstrate a distribution rate of a minimum of 90 percent of 
        the opioid overdose reversal drug products received under this 
        program;
            ``(3) certify to the Secretary that the State has in place 
        a Good Samaritan Law that ensures immunity from arrest and 
        prosecution, including from parole and probation violations, 
        except that the State may apply to the Secretary for a waiver 
        of the requirement of this paragraph, and such waiver if 
        granted shall not be longer than 3 years in duration and may 
        not be renewed unless the State can show progress being made 
        towards instituting a Good Samaritan Law; and
            ``(4) certify to the Secretary that the State has in place 
        additional measures that enhance access to opioid overdose 
        reversal drug products, such as laws that provide civil or 
        disciplinary immunity for medical personnel who prescribe an 
        opioid overdose reversal drug product, Third Party Prescription 
        Laws, Collaborative Practice Agreements, and Standing Orders.
    ``(f) Indian Tribe Requirements.--The Indian Health Service, in 
consultation with Indian tribes, shall determine any requirements that 
shall apply to Indian tribes receiving opioid overdose reversal drug 
products made available under this section.
    ``(g) Definitions.--For purposes of this section:
            ``(1) Collaborative practice agreement.--The term 
        `Collaborative Practice Agreement' means an agreement under 
        which a pharmacist operates under authority delegated by 
        another licensed practitioner with prescribing authority.
            ``(2) Emergency medical service.--The term `emergency 
        medical service' means resources used by a public or private 
        licensed entity to deliver medical care outside of a medical 
        facility under emergency conditions that occur as a result of 
        the condition of the patient and includes services delivered 
        (either on a compensated or volunteer basis) by an emergency 
        medical services provider or other provider that is licensed or 
        certified by the State involved as an emergency medical 
        technician, a paramedic, or an equivalent professional (as 
        determined by the State).
            ``(3) Good samaritan law.--The term `Good Samaritan Law' 
        means a law that provides criminal immunity for a person who 
        administers an opioid overdose reversal drug product, a person 
        who, in good faith, seeks medical assistance for someone 
        experiencing a drug-related overdose, or a person who 
        experiences a drug-related overdose and is in need of medical 
        assistance and, in good faith, seeks such medical assistance, 
        or is the subject of such a good faith request for medical 
        assistance.
            ``(4) Indians.--The terms `Indian', `Indian tribe', `tribal 
        organization', and `urban Indian organization' have the 
        meanings given such terms in section 4 of the Indian Health 
        Care Improvement Act.
            ``(5) Manufacturer.--The term `manufacturer' means any 
        corporation, organization, or institution, whether public or 
        private (including Federal, State, and local departments, 
        agencies, and instrumentalities), which manufactures, imports, 
        processes, or distributes under its label any opioid overdose 
        reversal drug product. The term `manufacture' means to 
        manufacture, import, process, or distribute an opioid overdose 
        reversal drug.
            ``(6) Opioid overdose reversal drug product.--The term 
        `opioid overdose reversal drug product' means a finished dosage 
        form that has been approved by the Food and Drug Administration 
        and that contains an active pharmaceutical ingredient that acts 
        as an opioid receptor antagonist. The term `opioid overdose 
        reversal drug product' includes a combination product, as 
        defined in section 3.2(e) of title 21, Code of Federal 
        Regulations.
            ``(7) Standing order.--The term `standing order' means a 
        non-patient-specific order covering administration of 
        medication by others to a patient who may be unknown to the 
        prescriber at the time of the order.
            ``(8) Third party prescription.--The term `third party 
        prescription' means an order written for medication dispensed 
        to one person with the intention that it will be administered 
        to another person.
    ``(h) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this suction--
            ``(1) $1,000,000,000 for fiscal year 2022;
            ``(2) $1,000,000,000 for fiscal year 2023;
            ``(3) $1,000,000,000 for fiscal year 2024;
            ``(4) $1,000,000,000 for fiscal year 2025;
            ``(5) $1,000,000,000 for fiscal year 2026;
            ``(6) $1,000,000,000 for fiscal year 2027;
            ``(7) $1,000,000,000 for fiscal year 2028;
            ``(8) $1,000,000,000 for fiscal year 2029;
            ``(9) $1,000,000,000 for fiscal year 2030; and
            ``(10) $1,000,000,000 for fiscal year 2031.

``SEC. 3437. ADDITIONAL FUNDING FOR THE NATIONAL INSTITUTES OF HEALTH.

    ``There is authorized to be appropriated to the National Institutes 
of Health for the purpose of conducting research on addiction and pain, 
including research to develop overdose reversal drug products, non-
opioid drug products and non-pharmacological treatments for addressing 
pain and substance use disorder, and drug products used to treat 
substance use disorder--
            ``(1) $1,000,000,000 for fiscal year 2022;
            ``(2) $1,000,000,000 for fiscal year 2023;
            ``(3) $1,000,000,000 for fiscal year 2024;
            ``(4) $1,000,000,000 for fiscal year 2025;
            ``(5) $1,000,000,000 for fiscal year 2026;
            ``(6) $1,000,000,000 for fiscal year 2027;
            ``(7) $1,000,000,000 for fiscal year 2028;
            ``(8) $1,000,000,000 for fiscal year 2029;
            ``(9) $1,000,000,000 for fiscal year 2030; and
            ``(10) $1,000,000,000 for fiscal year 2031.

``SEC. 3438. ADDITIONAL FUNDING FOR THE CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    ``(a) Improved Data Collection and Prevention of Infectious Disease 
Transmission.--
            ``(1) Data collection.--The Centers for Disease Control and 
        Prevention shall use a portion of the funding appropriated 
        under this section to ensure that all States participate in the 
        Enhanced State Opioid Overdose Surveillance program and to 
        provide technical assistance to medical examiners and coroners 
        to facilitate improved data collection on fatal overdoses 
        through such program.
            ``(2) Centers for disease control and prevention.--The 
        Centers for Disease Control and Prevention shall use amounts 
        appropriated under this section for the purpose of improving 
        data on drug overdose deaths and non-fatal drug overdoses, 
        surveillance related to addiction and substance use disorder, 
        and the prevention of transmission of infectious diseases 
        related to substance use.
            ``(3) Tribal data.--Not later than 6 months after the date 
        of enactment of this title, the Director of the Centers for 
        Disease Control and Prevention shall consult with Indian tribes 
        and confer with urban Indian organizations to develop and 
        implement strategies that improve surveillance and reporting of 
        fatal overdose deaths among American Indians and Alaska 
        Natives, including strategies that reduce the underestimation 
        of fatal overdose deaths among American Indians and Alaska 
        Natives due to undersampling or racial misclassification in 
        State and Federal public health surveillance systems.
    ``(b) Childhood Trauma.--The Centers for Disease Control and 
Prevention shall use a portion of the funding appropriated under this 
section to fund the surveillance and data collection activities 
described in section 7131 of the SUPPORT for Patients and Communities 
Act, including to encourage all States to participate in collecting and 
reporting data on adverse childhood experiences through the Behavioral 
Risk Factor Surveillance System, the Youth Risk Behavior Surveillance 
System, and other relevant public health surveys or questionnaires.
    ``(c) Worker Health Risks.--The Centers for Disease Control and 
Prevention shall use a portion of the funding appropriated under this 
section for data collection and surveillance activities on substance 
use, substance use disorders, drug overdose deaths, and non-fatal drug 
overdoses among workers, and the factors and practices that contribute 
to such use, disorders, and overdoses, including occupational injuries 
and illness as well as occupational exposure to opioids and other 
illicit and licit drugs.
    ``(d) Tribal Epidemiology Centers.--There shall be made available 
to the Indian Health Service for the purpose of funding efforts by 
Indian tribes and tribal epidemiology centers to improve data on drug 
overdose deaths and non-fatal drug overdoses, surveillance related to 
addiction and substance use disorder, and prevention of childhood 
trauma, not less than 1.5 percent of the total amount appropriated 
under this section for each fiscal year.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            ``(1) $500,000,000 for fiscal year 2022;
            ``(2) $500,000,000 for fiscal year 2023;
            ``(3) $500,000,000 for fiscal year 2024;
            ``(4) $500,000,000 for fiscal year 2025;
            ``(5) $500,000,000 for fiscal year 2026;
            ``(6) $500,000,000 for fiscal year 2027;
            ``(7) $500,000,000 for fiscal year 2028;
            ``(8) $500,000,000 for fiscal year 2029;
            ``(9) $500,000,000 for fiscal year 2030; and
            ``(10) $500,000,000 for fiscal year 2031.

``SEC. 3439. DEFINITIONS.

    ``In this title:
            ``(1) Planning council.--The term `planning council' means 
        the substance use planning council established under section 
        3402.
            ``(2) Recovery residence.--The term `recovery residence' 
        means a residential dwelling unit, or other form of group 
        housing, that is offered or advertised through any means, 
        including oral, written, electronic, or printed means, by any 
        individual or entity as a residence that provides an evidence-
        based, peer-supported living environment for individuals 
        undergoing any type of substance use disorder treatment or who 
        have received any type of substance use disorder treatment in 
        the past 3 years, including medication for addiction treatment.
            ``(3) State.--
                    ``(A) In general.--The term `State' means each of 
                the 50 States, the District of Columbia, and each of 
                the territories.
                    ``(B) Territories.--The term `territory' means each 
                of American Samoa, Guam, the Commonwealth of Puerto 
                Rico, the Commonwealth of the Northern Mariana Islands, 
                the Virgin Islands, the Republic of the Marshall 
                Islands, the Federated States of Micronesia, and Palau.
            ``(4) Substance use disorder treatment.--
                    ``(A) In general.--The term `substance use disorder 
                treatment' means an evidence-based, professionally 
                directed, deliberate, and planned regimen including 
                evaluation, observation, medical monitoring, and 
                rehabilitative services and interventions such as 
                pharmacotherapy, mental health services, and individual 
                and group counseling, on an inpatient or outpatient 
                basis, to help patients with substance use disorder 
                reach remission and maintain recovery.
                    ``(B) Types of treatment.--Substance use disorder 
                treatments shall include the following:
                            ``(i) Clinical stabilization services, 
                        which are evidence-based services provided in 
                        secure, acute care facilities (which may be 
                        referred to as `addictions receiving 
                        facilities') that, at a minimum--
                                    ``(I) provide intoxication 
                                management and stabilization services;
                                    ``(II) are operated 24 hours per 
                                day, 7 days per week; and
                                    ``(III) that serve individuals 
                                found to be substance use impaired. 
                                These can also be referred to as 
                                `Addictions receiving facilities'.
                            ``(ii) Withdrawal management and 
                        detoxification, which is a medical service that 
                        is provided on an inpatient or an outpatient 
                        basis to assist an individual in managing the 
                        process of withdrawal from the physiological 
                        and psychological effects of substance use 
                        disorder.
                            ``(iii) All outpatient, residential, and 
                        inpatient services described in section 
                        1915(l)(4)(c) of the Social Security Act.
                    ``(C) Limitation.--Substance use disorder treatment 
                providers shall not include--
                            ``(i) prevention only providers; and
                            ``(ii) a private practitioner who is 
                        licensed by a State licensing board and whose 
                        practice is limited to non-intensive outpatient 
                        care.
            ``(5) Substance use disorder treatment services.--The term 
        `substance use disorder treatment services' means any 
        prevention services, core medical services, recovery and 
        support services, early intervention services, and harm 
        reduction services authorized under this title.''.

SEC. 4. AMENDMENTS TO THE CONTROLLED SUBSTANCES ACT.

    (a) Certifications.--Part C of the Controlled Substances Act (21 
U.S.C. 821 et seq.) is amended by adding at the end the following:

    ``certifications relating to diversion controls and misbranding

    ``Sec. 313.  (a) Definitions.--In this section--
            ``(1) the term `covered dispenser'--
                    ``(A) means a dispenser--
                            ``(i) that is required to register under 
                        section 302(a)(2); and
                            ``(ii) dispenses a controlled substance in 
                        schedule II; and
                    ``(B) does not include a dispenser that is--
                            ``(i) registered to dispense opioid agonist 
                        treatment medication under section 303(g)(1); 
                        and
                            ``(ii) operating in that capacity;
            ``(2) the term `covered distributor' means a distributor--
                    ``(A) that is required to register under section 
                302(a)(1); and
                    ``(B) distributes a controlled substance in 
                schedule II;
            ``(3) the term `covered manufacturer' means a 
        manufacturer--
                    ``(A) that is required to register under section 
                302(a)(1); and
                    ``(B) manufactures a controlled substance in 
                schedule II;
            ``(4) the term `covered officer', with respect to a covered 
        person means--
                    ``(A) in the case of a covered person that is not 
                an individual--
                            ``(i) the chief executive officer of the 
                        covered person;
                            ``(ii) the president of the covered person;
                            ``(iii) the chief medical officer of the 
                        covered person; or
                            ``(iv) the chief counsel of the covered 
                        person; and
                    ``(B) in the case of a covered person that is an 
                individual, that individual; and
            ``(5) the term `covered person' means--
                    ``(A) a covered dispenser;
                    ``(B) a covered distributor; or
                    ``(C) a covered manufacturer.
    ``(b) Certifications Relating to Diversion Controls.--Not later 
than 180 days after the date of enactment of this section, and each 
year thereafter, each covered officer of a covered person shall submit 
to the Attorney General, for each controlled substance in schedule II 
dispensed, distributed, or manufactured by the covered person, a 
certification--
            ``(1) signed by the covered officer; and
            ``(2) certifying that--
                    ``(A) the covered person maintains effective 
                controls against diversion of the controlled substance 
                into channels other than legitimate medical, 
                scientific, research, or industrial channels;
                    ``(B) all information contained in any record, 
                inventory, or report required to be kept or submitted 
                to the Attorney General by the covered person under 
                section 307, or under any regulation issued under that 
                section, is accurate; and
                    ``(C) the covered person is in compliance with all 
                applicable requirements under Federal law relating to 
                reporting suspicious orders for controlled substances.
    ``(c) Certifications Relating to Misbranding.--
            ``(1) In general.--Not later than 180 days after the date 
        of enactment of this section, and each year thereafter, each 
        covered officer of a covered manufacturer shall submit to the 
        Secretary, for each controlled substance in schedule II 
        manufactured by the covered manufacturer, a certification--
                    ``(A) signed by the covered officer; and
                    ``(B) certifying that the controlled substance is 
                not misbranded, as described in section 502 of the 
                Federal Food, Drug, and Cosmetic Act (21 U.S.C. 352).
            ``(2) Notification to the attorney general.--
                    ``(A) Failure to submit certifications.--Not later 
                than 30 days after the date on which a covered officer 
                of a covered manufacturer is required to submit a 
                certification under paragraph (1) and fails to do so, 
                the Secretary shall notify the Attorney General of the 
                failure by the covered officer to submit the 
                certification.
                    ``(B) False certifications relating to 
                misbranding.--Not later than 30 days after the date on 
                which the Secretary becomes aware that a certification 
                submitted under paragraph (1) contains a materially 
                false statement or representation relating to the 
                misbranding of a controlled substance with respect to 
                the year for which the certification is submitted, the 
                Secretary shall notify the Attorney General that the 
                certification contains the materially false statement 
                or representation.''.
    (b) Offenses.--Part D of title II of the Controlled Substances Act 
(21 U.S.C. 841 et seq.) is amended by adding at the end the following:

                  ``certifications by covered officers

    ``Sec. 424.  (a) Definitions.--In this section, the terms `covered 
dispenser', `covered distributor', `covered manufacturer', `covered 
officer', and `covered person' have the meanings given those terms in 
section 313.
    ``(b) Offenses.--
            ``(1) Failure to submit certifications.--
                    ``(A) Certifications relating to diversion 
                controls.--It shall be unlawful for a covered officer 
                of a covered person to fail to submit a certification 
                required under section 313(b), without regard to the 
                state of mind of the covered officer.
                    ``(B) Certifications relating to misbranding.--It 
                shall be unlawful for a covered officer of a covered 
                manufacturer to fail to submit a certification required 
                under section 313(c)(1), without regard to the state of 
                mind of the covered officer.
            ``(2) Submission of false certifications.--
                    ``(A) False certifications relating to diversion 
                controls.--It shall be unlawful for a covered officer 
                of a covered person to submit a certification required 
                under section 313(b), without regard to the state of 
                mind of the covered officer, that contains a materially 
                false statement or representation relating to the 
                information required to be certified under that section 
                for the year for which the certification is submitted.
                    ``(B) False certifications relating to 
                misbranding.--It shall be unlawful for a covered 
                officer of a covered manufacturer to submit a 
                certification required under section 313(c)(1), without 
                regard to the state of mind of the covered officer, 
                that contains a materially false statement or 
                representation relating to the misbranding of a 
                controlled substance with respect to the year for which 
                the certification is submitted.
    ``(c) Penalties.--
            ``(1) Civil penalties.--Except as provided in paragraph 
        (2), a covered officer who violates subsection (b) shall be 
        subject to a civil penalty of not more than $25,000.
            ``(2) Criminal penalties.--A covered officer who knowingly 
        violates subsection (b)(2) shall be subject to criminal 
        penalties under section 403(d).
    ``(d) Comprehensive Addiction Resources Fund.--
            ``(1) Establishment.--There is established in the Treasury 
        a fund to be known as the `Comprehensive Addiction Resources 
        Fund'.
            ``(2) Transfer of amounts.--There shall be transferred to 
        the Comprehensive Addiction Resources Fund 100 percent of--
                    ``(A) any civil penalty paid to the United States 
                under this section; and
                    ``(B) any fine paid to the United States under 
                section 403(d) for a knowing violation of subsection 
                (b)(2) of this section.
            ``(3) Availability and use of funds.--Amounts transferred 
        to the Comprehensive Addiction Fund under paragraph (2) shall--
                    ``(A) remain available until expended; and
                    ``(B) be made available to supplement amounts 
                appropriated to carry out title XXXIV of the Public 
                Health Service Act.''.
    (c) Criminal Penalties.--Section 403 of the Controlled Substances 
Act (21 U.S.C. 843) is amended--
            (1) in subsection (d)(1)--
                    (A) by inserting ``or knowingly violates section 
                424(b)(2)'' after ``any person who violates this 
                section''; and
                    (B) by striking ``violation of this section'' and 
                inserting ``such a violation''; and
            (2) in subsection (f)--
                    (A) in paragraph (1), by striking ``or 416'' and 
                inserting ``or section 416, or knowing violations of 
                section 424(b)(2)''; and
                    (B) in paragraph (3), by inserting ``or knowing 
                violations of section 424(b)(2)'' before the period at 
                the end.
    (d) Technical and Conforming Amendments.--The table of contents for 
the Comprehensive Drug Abuse Prevention and Control Act of 1970 (Public 
Law 91-513; 84 Stat. 1236) is amended--
            (1) by inserting after the item relating to section 311 the 
        following:

``Sec. 312. Suspicious orders.
``Sec. 313. Certifications relating to diversion controls and 
                            misbranding.'';
        and
            (2) by inserting after the item relating to section 423 the 
        following:

``Sec. 424. Certifications by covered officers.''.
    (e) Effective Date.--The amendments made by subsections (b) and (c) 
of this section shall take effect on the date that is 180 days after 
the date of enactment of this Act.

SEC. 5. GENERAL LIMITATION ON USE OF FUNDS.

    Amounts appropriated or provided under this Act, or an amendment 
made by this Act, shall be used only for the public health purposes 
described in this Act (or amendments) and shall not be used to increase 
the incarceration or institutionalization of individuals with substance 
use disorder.

SEC. 6. FEDERAL DRUG DEMAND REDUCTION ACTIVITIES.

    (a) Publication of List.--
            (1) Amendment.--Section 705(f) of the Office of National 
        Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 
        1704(f)) is amended by inserting at the end the following new 
        paragraph:
            ``(5) Publication of list.--The Director shall publish 
        online a complete list of all drug control program grant 
        programs and any other relevant information included in the 
        system developed under paragraph (1).''.
            (2) Deadline and frequency.--Not later than one year after 
        the date of the enactment of this Act, and annually thereafter, 
        the Director of National Drug Control Policy shall publish the 
        list required under section 705(f)(5) of the National Drug 
        Control Act of 1998, as added by paragraph (1).
    (b) National Drug Control Strategy.--Section 706(c)(1) of the 
National Drug Control Act of 1998 (21 U.S.C. 1705(c)(1)) is amended by 
adding at the end the following new subparagraph:
                    ``(O) A review of all federally funded demand 
                reduction activities, including an evaluation of--
                            ``(i) the effectiveness of those 
                        activities;
                            ``(ii) the contribution of those activities 
                        to demand reduction activities funded by State, 
                        local, and Tribal governments; and
                            ``(iii) whether any duplication or 
                        inefficiency in federally funded demand 
                        reduction activities needs to be addressed.''.
                                 <all>
Comprehensive Addiction Resources Emergency Act of 2021
To provide emergency assistance to States, territories, Tribal nations, and local areas affected by substance use disorder, including the use of opioids and stimulants, and to make financial assistance available to States, territories, Tribal nations, local areas, public or private nonprofit entities, and certain health providers, to provide for the development, organization, coordination, and operation of more effective and cost efficient systems for the delivery of essential services to individuals with substance use disorder and their families.
Comprehensive Addiction Resources Emergency Act of 2021
Rep. Maloney, Carolyn B.