<enum>I</enum><header>Opioid Crisis Response Act</header><section id="id0CCCAA9484F0486399B9BE2526BBFDC7"><enum>1001.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title—</text><paragraph id="idBB6716F485A346A3B08173538ED851E5"><enum>(1)</enum><text display-inline="yes-display-inline">the terms <term>Indian Tribe</term> and <term>tribal organization</term> have the meanings given the terms <term>Indian tribe</term> and <term>tribal organization</term> in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304); and</text></paragraph><paragraph id="idDAC97687D07A4B1C81BD26EE8000F87B"><enum>(2)</enum><text>the term <term>Secretary</term> means the Secretary of Health and Human Services, unless otherwise specified.</text></paragraph></section><subtitle id="id20B8906E37664387B2CAEF678B1FC9E8"><enum>A</enum><header>Reauthorization of Cures Funding</header><section id="id2781A32552DB48D58A5FFA4A0553C73B"><enum>1101.</enum><header>State response to the opioid abuse crisis</header><subsection id="id734356DC303C4DC5A9A8C691BF740484"><enum>(a)</enum><header>In general</header><text>Section 1003 of the 21st Century Cures Act (Public Law 114–255) is amended—</text><paragraph id="id25CA52ECA4184AF2BE74EEB8308F7B6F"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="id10A21FCA1E7A4BBB8D83A6F50C34DA0B"><enum>(A)</enum><text>by striking <quote>the authorization of appropriations under subsection (b) to carry out the grant program described in subsection (c)</quote> and inserting <quote>subsection (h) to carry out the grant program described in subsection (b)</quote>; and</text></subparagraph><subparagraph id="idCF0A50B1AB7242C6945DFE40800C02D4"><enum>(B)</enum><text>by inserting <quote>and Indian Tribes</quote> after <quote>States</quote>;</text></subparagraph></paragraph><paragraph id="idCDC244190B59410CAAABCE0D7BFE4A23"><enum>(2)</enum><text>by striking subsection (b);</text></paragraph><paragraph id="id979B2EE524E44A5AB9BDD09D182DDE8E"><enum>(3)</enum><text>by redesignating subsections (c) through (e) as subsections (b) through (d), respectively;</text></paragraph><paragraph id="idE4EE345916A74A62A14DED96E52A3E7C"><enum>(4)</enum><text>by redesignating subsection (f) as subsection (j);</text></paragraph><paragraph id="idD86C8C8F36A943B989CDC66043B88208"><enum>(5)</enum><text>in subsection (b), as so redesignated—</text><subparagraph id="idAE1A3502843A4AF5A5C8E6EEE5BB64A6"><enum>(A)</enum><text>in paragraph (1)—</text><clause id="id7952ed9fe2974ed5b6d840477766f8d6"><enum>(i)</enum><text>in the paragraph heading, by inserting <quote><header-in-text level="paragraph" style="OLC">and Indian Tribe</header-in-text></quote> after <quote><header-in-text level="paragraph" style="OLC">State</header-in-text></quote>;</text></clause><clause id="idD732681044784898B69496E52AD2351C"><enum>(ii)</enum><text>by striking <quote>States for the purpose of addressing the opioid abuse crisis within such States</quote> and inserting <quote>States and Indian Tribes for the purpose of addressing the opioid abuse crisis within such States and Indian Tribes</quote>;</text></clause><clause id="id490806356ff1406b9d89ee238026428e"><enum>(iii)</enum><text>by inserting <quote>or Indian Tribes</quote> after <quote>preference to States</quote>; and</text></clause><clause id="id2250F61FDF0B4B8D85DCA2BD8C8E81F9"><enum>(iv)</enum><text>by inserting before the period of the second sentence <quote>or other Indian Tribes, as applicable</quote>;</text></clause></subparagraph><subparagraph id="id50933A2CF0784C828F835E7DC86F3AB4"><enum>(B)</enum><text>in paragraph (2)—</text><clause id="id18F611AEDA524C9EA618E45DB8533BA8"><enum>(i)</enum><text>in the matter preceding subparagraph (A), by striking <quote>to a State</quote>;</text></clause><clause id="id10807E5074D04985834561F537D9D075"><enum>(ii)</enum><text>in subparagraph (A), by striking <quote>State</quote>;</text></clause><clause id="id97997EDACFD94A29BFAB421DCD9BD6D2"><enum>(iii)</enum><text>in subparagraph (C), by inserting <quote>preventing diversion of controlled substances,</quote> after <quote>treatment programs,</quote>; and</text></clause><clause id="id5B7F81390E704810B49AF41687C3CB44"><enum>(iv)</enum><text>in subparagraph (E), by striking <quote>as the State determines appropriate, related to addressing the opioid abuse crisis within the State</quote> and inserting <quote>as the State or Indian Tribe determines appropriate, related to addressing the opioid abuse crisis within the State, including directing resources in accordance with local needs related to substance use disorders</quote>;</text></clause></subparagraph></paragraph><paragraph id="id8EF8E6955B8C421C98331F1214A2FBC1"><enum>(6)</enum><text>in subsection (c), as so redesignated, by striking <quote>subsection (c)</quote> and inserting <quote>subsection (b)</quote>;</text></paragraph><paragraph id="id4AD0BBB63DAF405085CBD73D9563CA1F"><enum>(7)</enum><text>in subsection (d), as so redesignated—</text><subparagraph id="id50B4EF3FA83A44DD81E6589DE21D6219"><enum>(A)</enum><text>in the matter preceding paragraph (1), by striking <quote>the authorization of appropriations under subsection (b)</quote> and inserting <quote>subsection (h)</quote>; and</text></subparagraph><subparagraph id="id1A8390C01374400680BAE827CC3AE0B1"><enum>(B)</enum><text>in paragraph (1), by striking <quote>subsection (c)</quote> and inserting <quote>subsection (b)</quote>; and</text></subparagraph></paragraph><paragraph id="idBAFD5BBEACAF4F94BBBECE881057D48A"><enum>(8)</enum><text>by inserting after subsection (d), as so redesignated, the following:</text><quoted-block display-inline="no-display-inline" id="id7A5A34996E64498BB9A773AA3B22096B" style="OLC"><subsection id="id7FC41063AF1A4A5492C5AC6E550991E8"><enum>(e)</enum><header>Indian Tribes</header><paragraph id="id6C2D01F9C13F4757BE29E723EC6ECB6F"><enum>(1)</enum><header>Definition</header><text>For purposes of this section, the term <term>Indian Tribe</term> has the meaning given the term <term>Indian tribe</term> in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).</text></paragraph><paragraph id="id72d7e17598dc42059b080f4c14f13256"><enum>(2)</enum><header>Appropriate mechanisms</header><text>The Secretary, in consultation with Indian Tribes, shall identify and establish appropriate mechanisms for Tribes to demonstrate or report the information as required under subsections (b), (c), and (d).</text></paragraph></subsection><subsection id="id0ffd232708844914a77e7658deabd93b"><enum>(f)</enum><header>Report to Congress</header><text>Not later than 1 year after the date on which amounts are first awarded after the date of enactment of the <short-title>Opioid Crisis Response Act of 2018</short-title>, pursuant to subsection (b), and annually thereafter, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report summarizing the information provided to the Secretary in reports made pursuant to subsection (c), including the purposes for which grant funds are awarded under this section and the activities of such grant recipients.</text></subsection><subsection id="id66b92df7f0144096a3f68d579fd2bffd"><enum>(g)</enum><header>Technical Assistance</header><text>The Secretary, including through the Tribal Training and Technical Assistance Center of the Substance Abuse and Mental Health Services Administration, shall provide State agencies and Indian Tribes, as applicable, with technical assistance concerning grant application and submission procedures under this section, award management activities, and enhancing outreach and direct support to rural and underserved communities and providers in addressing the opioid crisis.</text></subsection><subsection id="id3FFE994E89E34CB8B604DC6F23AE026A"><enum>(h)</enum><header>Authorization of appropriations</header><text>For purposes of carrying out the grant program under subsection (b), there is authorized to be appropriated $500,000,000 for each of fiscal years 2019 through 2021, to remain available until expended.</text></subsection><subsection id="id5965EE1B136D4E32A60782C832CB84EE"><enum>(i)</enum><header>Set aside</header><text>Of the amounts made available for each fiscal year to award grants under subsection (b) for a fiscal year, 5 percent of such amount for such fiscal year shall be made available to Indian Tribes, and up to 15 percent of such amount for such fiscal year may be set aside for States with the highest age-adjusted rate of drug overdose death based on the ordinal ranking of States according to the Director of the Centers for Disease Control and Prevention.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="id10454D0EB46D422FA8599967199903FB"><enum>(b)</enum><header>Conforming amendment</header><text>Section 1004(c) of the 21st Century Cures Act (Public Law 114–255) is amended by striking <quote>, the FDA Innovation Account, or the Account For the State Response to the Opioid Abuse Crisis</quote> and inserting <quote>or the FDA Innovation Account</quote>.</text></subsection></section></subtitle><subtitle id="id5261AFBB341140E5BD50DBC9F13B8E9A"><enum>B</enum><header>Research and Innovation</header><section id="idE872A4A163304F17B5BC048E55BDB59C"><enum>1201.</enum><header>Advancing cutting-edge research</header><text display-inline="no-display-inline">Section 402(n)(1) of the Public Health Service Act (42 U.S.C. 282(n)(1)) is amended—</text><paragraph id="idDD28FD1B7EB14C87B691B5EF6C8AFF6C"><enum>(1)</enum><text>in subparagraph (A), by striking <quote>or</quote>;</text></paragraph><paragraph id="id63242C92F83842E49FBF17A0320ED984"><enum>(2)</enum><text>in subparagraph (B), by striking the period and inserting <quote>; or</quote>; and</text></paragraph><paragraph id="id5DD8E507DAAA44AF91154BC5693A03CE"><enum>(3)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id3163764D0056404F90DD84B5E9AA0FD7" style="OLC"><subparagraph id="id523610C8F5484BEC8FFEF5E24FDDFF9A"><enum>(C)</enum><text>high impact cutting-edge research that fosters scientific creativity and increases fundamental biological understanding leading to the prevention, diagnosis, or treatment of diseases and disorders, or research urgently required to respond to a public health threat.</text></subparagraph><after-quoted-block>. </after-quoted-block></quoted-block></paragraph></section><section id="id37E9469F05804C708658CF9034D9BA53"><enum>1202.</enum><header>Pain research</header><text display-inline="no-display-inline">Section 409J(b) of the Public Health Service Act (42 U.S.C. 284q(b)) is amended—</text><paragraph id="idE79C3A447E6043F08B7217C3B9B148BE"><enum>(1)</enum><text>in paragraph (5)—</text><subparagraph id="id4924AD78853343A59912CF5798E5991C"><enum>(A)</enum><text>in subparagraph (A), by striking <quote>and treatment of pain and diseases and disorders associated with pain</quote> and inserting <quote>treatment, and management of pain and diseases and disorders associated with pain, including information on best practices for utilization of non-pharmacologic treatments, non-addictive medical products, and other drugs or devices approved or cleared by the Food and Drug Administration</quote>;</text></subparagraph><subparagraph id="idF8C2D8FDC4C043F1B9B8F60AD55FA75B"><enum>(B)</enum><text>in subparagraph (B), by striking <quote>on the symptoms and causes of pain;</quote> and inserting the following: “on—</text><quoted-block display-inline="no-display-inline" id="id0355AD0727BA4B4DBDE9848D7EBC9B8C" style="OLC"><clause id="id8EA0DD9261EA427CBE94E376ACECDDE4"><enum>(i)</enum><text>the symptoms and causes of pain, including the identification of relevant biomarkers and screening models and the epidemiology of acute and chronic pain;</text></clause><clause id="idABBCDB0C98224CD4878E675B8A63E158"><enum>(ii)</enum><text>the diagnosis, prevention, treatment, and management of acute or chronic pain, including with respect to non-pharmacologic treatments, non-addictive medical products, and other drugs or devices approved or cleared by the Food and Drug Administration; and</text></clause><clause id="id8F53D13A251B43818C7DC8229F082E42"><enum>(iii)</enum><text>risk factors for, and early warning signs of, substance use disorders; and</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph><subparagraph id="id41901DCF6C09412C88EA155D0000C4F5"><enum>(C)</enum><text>by striking subparagraphs (C) through (E) and inserting the following:</text><quoted-block display-inline="no-display-inline" id="idE31C5BF40FD1464FA1E4F55F54487EFD" style="OLC"><subparagraph id="idDAC771698B414549B4D0577786846752"><enum>(C)</enum><text>make recommendations to the Director of NIH—</text><clause id="id645107585d4d47acabf9b830f53e4c4b"><enum>(i)</enum><text>to ensure that the activities of the National Institutes of Health and other Federal agencies are free of unnecessary duplication of effort;</text></clause><clause id="id33AF65F59BED4B9FB7C09440E34589D8"><enum>(ii)</enum><text>on how best to disseminate information on pain care and epidemiological data related to acute and chronic pain; and</text></clause><clause id="id730B69DF8B3B4EDBBF0BD15DDD4F74F0"><enum>(iii)</enum><text>on how to expand partnerships between public entities and private entities to expand collaborative, cross-cutting research.</text></clause></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id6AAF429026C945B5A87793BACBB52007"><enum>(2)</enum><text>by redesignating paragraph (6) as paragraph (7); and</text></paragraph><paragraph id="id8082BB4977784CD082A83C4EB900A4A8"><enum>(3)</enum><text>by inserting after paragraph (5) the following:</text><quoted-block display-inline="no-display-inline" id="id68F5E45E02CA4B7CA9E64A07D7E06DFF" style="OLC"><paragraph id="id28F569AA50FE41A59B102AB87E2ECC11"><enum>(6)</enum><header>Report</header><text>The Director of NIH shall ensure that recommendations and actions taken by the Director with respect to the topics discussed at the meetings described in paragraph (4) are included in appropriate reports to Congress.</text></paragraph><after-quoted-block>. </after-quoted-block></quoted-block></paragraph></section><section id="id4e5ddde461aa4b188d6409c88654464a"><enum>1203.</enum><header>Report on synthetic drug use</header><subsection id="id2fbeb9c03f9e468988202cf8d1cde690"><enum>(a)</enum><header>In general</header><text>Not later than 3 years after the date of the enactment of this Act, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report on the health effects of new psychoactive substances, including synthetic drugs, by adolescents and young adults.</text></subsection><subsection id="ida1d483df869b45aca958a3b2722c8c0d"><enum>(b)</enum><header>New psychoactive substance defined</header><text>For purposes of subsection (a), the term <term>new psychoactive substance</term> means a controlled substance analogue (as defined in section 102(32) of the Controlled Substances Act (21 U.S.C. 802(32))).</text></subsection></section></subtitle><subtitle id="id5605CF5E07E44C4F9D5451FFDC887564"><enum>C</enum><header>Medical Products and Controlled Substances Safety</header><section id="id433A312FF9DD488DA3BCB1EF82DDFB77"><enum>1301.</enum><header>Clarifying FDA regulation of non-addictive pain products</header><subsection id="id7a059be066674fe9a062f291f1f0d2bf"><enum>(a)</enum><header>Public Meetings</header><text>Not later than one year after the date of enactment of this Act, the Secretary, acting through the Commissioner of Food and Drugs, shall hold not less than one public meeting to address the challenges and barriers of developing non-addictive medical products intended to treat pain or addiction, which may include—</text><paragraph id="idc33b51e42d934039ab2ff8cbe3e7687d"><enum>(1)</enum><text>the manner by which the Secretary may incorporate the risks of misuse and abuse of a controlled substance (as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802) into the risk benefit assessments under subsections (d) and (e) of section 505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355), section 510(k) of such Act (21 U.S.C. 360(k)), or section 515(c) of such Act (21 U.S.C. 360e(c)), as applicable;</text></paragraph><paragraph id="id8a35aca8fc61401ab716a9ce9516d095"><enum>(2)</enum><text>the application of novel clinical trial designs (consistent with section 3021 of the 21st Century Cures Act (Public Law 114–255)), use of real world evidence (consistent with section 505F of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355g)), and use of patient experience data (consistent with section 569C of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb–8c)) for the development of non-addictive medical products intended to treat pain or addiction;</text></paragraph><paragraph id="id9715b293e2fa4a5d9811a9d7ce8fec46"><enum>(3)</enum><text>the evidentiary standards and the development of opioid sparing data for inclusion in the labeling of medical products; and</text></paragraph><paragraph id="idbebea4abcd7247f394d2a79634d783b9"><enum>(4)</enum><text>the application of eligibility criteria under sections 506 and 515B of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 356, 360e–3) for non-addictive medical products intended to treat pain or addiction.</text></paragraph></subsection><subsection id="idb99dae58eb1d4a71a03c87afc57433f5"><enum>(b)</enum><header>Guidance</header><text>Not less than one year after the public meetings are conducted under subsection (a) the Secretary shall issue one or more final guidance documents, or update existing guidance documents, to help address challenges to developing non-addictive medical products to treat pain or addiction. Such guidance documents shall include information regarding—</text><paragraph id="idE35660F13DBA4B108FDC014B57B3C525"><enum>(1)</enum><text>how the Food and Drug Administration may apply sections 506 and 515B of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 356, 360e–3) to non-addictive medical products intended to treat pain or addiction, including the circumstances under which the Secretary—</text><subparagraph id="idefedbf1e22024e3ebc6071400e2325c0"><enum>(A)</enum><text>may apply the eligibility criteria under such sections 506 and 515B to non-addictive medical products intended to treat pain or addiction;</text></subparagraph><subparagraph id="idEEE5CFBE20B6480C8390BD5B3F713961"><enum>(B)</enum><text>considers the risk of addiction of controlled substances approved to treat pain when establishing unmet medical need; and</text></subparagraph><subparagraph id="idF7A7A1FE1AF24BA59D762764CB785CFA"><enum>(C)</enum><text>considers pain, pain control, or pain management in assessing whether a disease or condition is a serious or life-threatening disease or condition;</text></subparagraph></paragraph><paragraph id="idCE6A0CB6D2584C23967D7F3054349115"><enum>(2)</enum><text>the methods by which sponsors may evaluate acute and chronic pain, endpoints for non-addictive medical products intended to treat pain, the manner in which endpoints and evaluations of efficacy will be applied across and within review divisions, taking into consideration the etiology of the underlying disease, and the manner in which sponsors may use surrogate endpoints, intermediate endpoints, and real world evidence;</text></paragraph><paragraph id="id34BF199E51534F31AE23E7C6904C1F81"><enum>(3)</enum><text>the manner in which the Food and Drug Administration will assess evidence to support the inclusion of opioid sparing data in the labeling of non-addictive medical products intended to treat pain, including—</text><subparagraph id="id433087f472c1454fa6142c995ac79084"><enum>(A)</enum><text>data collection methodologies, including the use of novel clinical trial designs (consistent with section 3021 of the 21st Century Cures Act (Public Law 114–255)) and real world evidence (consistent with section 505F of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355g)), as appropriate, to support product labeling;</text></subparagraph><subparagraph id="idCFAEE691969E4D7D95684A8162DF7050"><enum>(B)</enum><text>ethical considerations of exposing subjects to controlled substances in clinical trials to develop opioid sparing data and considerations on data collection methods that reduce harm, which may include the reduction of opioid use as a clinical benefit;</text></subparagraph><subparagraph id="id26CF8C4B1E9940C5BC5F12EB3536CC16"><enum>(C)</enum><text>endpoints, including primary, secondary, and surrogate endpoints, to evaluate the reduction of opioid use;</text></subparagraph><subparagraph id="id09a34bdf58554273bed1eba15a157a36"><enum>(D)</enum><text>best practices for communication between sponsors and the agency on the development of data collection methods, including the initiation of data collection; and</text></subparagraph><subparagraph id="idFDE0EE01FA9F48CCA97EA57CD263EC6C"><enum>(E)</enum><text>the appropriate format in which to submit such data results to the Secretary; and</text></subparagraph></paragraph><paragraph id="id5D989E834BC94E558EC6F5437FB8FB40"><enum>(4)</enum><text>the circumstances under which the Food and Drug Administration considers misuse and abuse of a controlled substance (as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802) in making the risk benefit assessment under paragraphs (2) and (4) of subsection (d) of section 505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355) and in finding that a drug is unsafe under paragraph (1) or (2) of subsection (e) of such section.</text></paragraph></subsection><subsection id="id8EFD93B38F8B42B6813BD957BA6CB7D1"><enum>(c)</enum><header>Definitions</header><text>In this section—</text><paragraph id="id2DDAAE6EF3004EB79DD10ED749704A9F"><enum>(1)</enum><text>the term <term>medical product</term> means a drug (as defined in section 201(g)(1) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(g)(1))), biological product (as defined in section 351(i) of the Public Health Service Act (42 U.S.C. 262(i))), or device (as defined in section 201(h) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(h))); and</text></paragraph><paragraph id="id3716EC24D4554FBE89FF709C8904B03A"><enum>(2)</enum><text>the term <term>opioid sparing</term> means reducing, replacing, or avoiding the use of opioids or other controlled substances.</text></paragraph></subsection></section><section id="id2a658c26a928465788a1d2bf0172457d"><enum>1302.</enum><header>Clarifying FDA packaging authorities</header><subsection id="idE8C77C724A9E43E482C52CD6DCAF2E07"><enum>(a)</enum><header>Additional potential elements of strategy</header><text display-inline="yes-display-inline">Section 505–1(e) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355–1(e)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id3D7F048E98A24B79A879C06DA3C8236B" style="OLC"><paragraph id="idDC60806EEFEE4B85852CF7DF673B631F"><enum>(4)</enum><header>Packaging and disposal</header><text>The Secretary may require a risk evaluation mitigation strategy for a drug for which there is a serious risk of an adverse drug experience described in subparagraph (B) or (C) of subsection (b)(1), taking into consideration the factors described in subparagraphs (C) and (D) of subsection (f)(2) and in consultation with other relevant Federal agencies with authorities over drug packaging, which may include requiring that—</text><subparagraph id="id87e5d8978b0047ecb6504464cfc3f6db"><enum>(A)</enum><text>the drug be made available for dispensing to certain patients in unit dose packaging, packaging that provides a set duration, or another packaging system that the Secretary determines may mitigate such serious risk; or</text></subparagraph><subparagraph id="id817bf60e072941cd84fcd56f21f79260"><enum>(B)</enum><text>the drug be dispensed to certain patients with a safe disposal packaging or safe disposal system for purposes of rendering drugs non-retrievable (as defined in section 1300.05 of title 21, Code of Federal Regulations (or any successor regulation)) if the Secretary has determines that such safe disposal packaging or system may mitigate such serious risk and exists in sufficient quantities.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id1AA491F8163044268BA02867E790FC2F"><enum>(b)</enum><header>Assuring access and minimizing burden</header><text>Section 505–1(f)(2)(C) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355–1(f)(2)(C)) is amended—</text><paragraph id="idA0657D291A5042F1AC36163B8927C9D5"><enum>(1)</enum><text>in clause (i) by striking <quote>and</quote> at the end; and</text></paragraph><paragraph id="idD7210A02CA4D410FA477D609124BF86A"><enum>(2)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idE6517696F2F94E3A8F5C4A9CF3E7872C" style="OLC"><clause id="idF00A4C79689F41F593021DC4647EE31B"><enum>(iii)</enum><text>patients with functional needs; and</text></clause><after-quoted-block>. </after-quoted-block></quoted-block></paragraph></subsection><subsection id="id54690df4c42c469ea81a52e64172b37d"><enum>(c)</enum><header>Application to abbreviated new drug applications</header><text>Section 505–1(i) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355–1(i)) is amended—</text><paragraph id="idc380ce97bd6147dd9cbb44d85b540f28"><enum>(1)</enum><text>in paragraph (1)—</text><subparagraph id="idDE7AD9192B594B279845A8727A1938B7"><enum>(A)</enum><text>by redesignating subparagraph (B) as subparagraph (C); and</text></subparagraph><subparagraph id="id553F16CC863D497D88CB6680B21312C3"><enum>(B)</enum><text>inserting after subparagraph (A) the following:</text><quoted-block display-inline="no-display-inline" id="id505772c3d2ff4cbc86a7906e76d45e80" style="OLC"><subparagraph id="id9520c09ee52a4fe3b3b31d07159c7258"><enum>(B)</enum><text>A packaging or disposal requirement, if required under subsection (e)(4) for the applicable listed drug.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="idb1fc3893069d4069966f339b0994c6e6"><enum>(2)</enum><text>in paragraph (2)—</text><subparagraph id="id048D1D4260614BD896A7FC038437DD2A"><enum>(A)</enum><text>in subparagraph (A), by striking <quote>and</quote> at the end;</text></subparagraph><subparagraph id="idED88B9E00A5440F8882F76D25D0D0C7A"><enum>(B)</enum><text>by redesignating subparagraph (B) as subparagraph (C); and</text></subparagraph><subparagraph id="idE9036DEEA4904D0A8775BCA97E6383D7"><enum>(C)</enum><text>by inserting after subparagraph (A) the following:</text><quoted-block display-inline="no-display-inline" id="idE94316517CC34A22BEEAB32003510643" style="OLC"><subparagraph id="id3e4ed61546a94ea6a6b4f372f5275d1b"><enum>(B)</enum><text>shall permit packaging systems and safe disposal packaging or safe disposal systems that are different from those required for the applicable listed drug under subsection (e)(4); and</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection></section><section id="id243C0008D3654A89ADCEF7670BA1E5D8"><enum>1303.</enum><header>Strengthening FDA and CBP coordination and capacity</header><subsection id="idDD0841949B684792B9299E7455A70042"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary, acting through the Commissioner of Food and Drugs, shall coordinate with the Secretary of Homeland Security to carry out activities related to customs and border protection and response to illegal controlled substances and drug imports, including at sites of import (such as international mail facilities). Such Secretaries may carry out such activities through a memorandum of understanding between the Food and Drug Administration and the U.S. Customs and Border Protection.</text></subsection><subsection id="id367EB5451D3449F38B1E96B15A1709F2"><enum>(b)</enum><header>FDA import facilities and inspection capacity</header><paragraph id="idBADFE1B02E4F4ABEBFFC02644964BDE6"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">In carrying out this section, the Secretary shall, in collaboration with the Secretary of Homeland Security and the Postmaster General of the United States Postal Service, provide that import facilities in which the Food and Drug Administration operates or carries out activities related to drug imports within the international mail facilities include—</text><subparagraph id="id5FE5300CA77941FB8E30BFA012A29A49"><enum>(A)</enum><text display-inline="yes-display-inline">facility upgrades and improved capacity in order to increase and improve inspection and detection capabilities, which may include, as the Secretary determines appropriate—</text><clause id="idBBC627F13E8F429E820338339E78F886"><enum>(i)</enum><text display-inline="yes-display-inline">improvements to facilities, such as upgrades or renovations, and support for the maintenance of existing import facilities and sites to improve coordination between Federal agencies;</text></clause><clause id="idB6F6E89A9CF248A6B82F3D5600F76B99"><enum>(ii)</enum><text display-inline="yes-display-inline">the construction of, or upgrades to, laboratory capacity for purposes of detection and testing of imported goods;</text></clause><clause id="idE96414008E74465A9E9A42EF41E4DD0A"><enum>(iii)</enum><text display-inline="yes-display-inline">upgrades to the security of import facilities; and</text></clause><clause id="id90178673D8DD4BE68E0F299384AED6D6"><enum>(iv)</enum><text display-inline="yes-display-inline">innovative technology and equipment to facilitate improved and near-real-time information sharing between the Food and Drug Administration, the Department of Homeland Security, and the United States Postal Service; and</text></clause></subparagraph><subparagraph id="id9313926490AD428ABD3A90514999A490"><enum>(B)</enum><text>innovative technology, including controlled substance detection and testing equipment and other applicable technology, in order to collaborate with the U.S. Customs and Border Protection to share near-real-time information, including information about test results, as appropriate.</text></subparagraph></paragraph><paragraph id="idD6090FBFE87046C48066F9EE52D3D9BB"><enum>(2)</enum><header>Innovative technology</header><text>Any technology used in accordance with paragraph (1)(B) shall be interoperable with technology used by other relevant Federal agencies, including the U.S. Customs and Border Protection, as the Secretary determines appropriate.</text></paragraph></subsection><subsection id="id364b79fa221a4e16813d371f76dafd4b"><enum>(c)</enum><header>Report</header><text>Not later than 6 months after the date of enactment of this Act, the Secretary, in consultation with the Secretary of Homeland Security and the Postmaster General of the United States Postal Service, shall report to the relevant committees of Congress on the implementation of this section, including a summary of progress made towards near-real-time information sharing and the interoperability of such technologies.</text></subsection><subsection id="ide00741f3b0e24f1183b70b975673d2b0"><enum>(d)</enum><header>Authorization of appropriations</header><text>Out of amounts otherwise available to the Secretary, the Secretary may allocate such sums as may be necessary for purposes of carrying out this section.</text></subsection></section><section id="id563ddf458c5a45e58806f265a20601cf"><enum>1304.</enum><header>Clarifying FDA post-market authorities</header><text display-inline="no-display-inline">Section 505–1(b)(1)(E) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355–1(b)(1)(E)) is amended by striking <quote>of the drug</quote> and inserting <quote>of the drug, which may include reduced effectiveness under the conditions of use prescribed in the labeling of such drug, but which may not include reduced effectiveness that is in accordance with such labeling</quote>.</text></section><section id="ida4b32b3761cb411f9f8f5329b8808947"><enum>1305.</enum><header>Restricting entrance of illicit drugs</header><subsection id="id13D0B1462F394429B6BDF1F044202876"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary, acting through the Commissioner of Food and Drugs, upon discovering or receiving, in a package being offered for import, a controlled substance that is offered for import in violation of any requirement of the Controlled Substances Act (21 U.S.C. 801 et seq.), the Controlled Substances Import and Export Act (21 U.S.C. 951 et seq.), the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.), or any other applicable law, shall transfer such package to the U.S. Customs and Border Protection. If the Secretary identifies additional packages that appear to be the same as such package containing a controlled substance, such additional packages may also be transferred to U.S. Customs and Border Protection. The U.S. Customs and Border Protection shall receive such packages consistent with the requirements of the Controlled Substances Act (21 U.S.C. 801 et seq.).</text></subsection><subsection id="id46B2220B1CB643B4AFD929902EDA3063"><enum>(b)</enum><header>Debarment, temporary denial of approval, and suspension</header><paragraph id="id326CC2052E4046A68C3A6A88CE0504FF"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 306(b) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 335a(b)) is amended—</text><subparagraph id="id1d4f34d4e35d4cf8b5527c3640c8e1bc"><enum>(A)</enum><text>in paragraph (1)—</text><clause id="ida7bc996175344fdfa1e063dd3b38baf2"><enum>(i)</enum><text>in the matter preceding subparagraph (A), by inserting <quote>or (3)</quote> after <quote>paragraph (2)</quote>;</text></clause><clause id="id669de2b4d15041f282f0ee535479bde1"><enum>(ii)</enum><text>in subparagraph (A), by striking the comma at the end and inserting a semicolon;</text></clause><clause id="id688cc8476b0a44749dfb4e247ee8b2bd"><enum>(iii)</enum><text>in subparagraph (B), by striking <quote>, or</quote> and inserting a semicolon;</text></clause><clause id="id6b7b75a72d094fa2a1581d9362ebdb8f"><enum>(iv)</enum><text>in subparagraph (C), by striking the period and inserting <quote>; or</quote>; and</text></clause><clause id="id2413106997544e7f8b9b105f03e34f22"><enum>(v)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id8ec3476710734e2592bc3282af3cf62f" style="OLC"><subparagraph id="idd125cab7b49c41d4bd869956c3b79b1b"><enum>(D)</enum><text>a person from importing or offering for import into the United States a drug.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph><subparagraph id="iddd71181221d84d6b9168249b835fef47"><enum>(B)</enum><text>in paragraph (3)—</text><clause id="iddbf37323685842a098c3ecdd1933f159"><enum>(i)</enum><text>in the heading, by striking <quote><header-in-text level="paragraph" style="OLC">Food</header-in-text></quote>;</text></clause><clause id="idf5ef54c6436948dea052640b18d0d1bd"><enum>(ii)</enum><text>in subparagraph (A), by striking <quote>; or</quote> and inserting a semicolon;</text></clause><clause id="id9a7d5bc42356471799367d5a1ba7c059"><enum>(iii)</enum><text>in subparagraph (B), by striking the period and inserting a semicolon; and</text></clause><clause id="id63e3ee12406243ac97661585a852cbf4"><enum>(iv)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id2e9f6847107742658573b9c9dfc6ecb1" style="OLC"><subparagraph id="id565b257b49354f67bbb1d97fa603d8a1"><enum>(C)</enum><text>the person has been convicted of a felony for conduct relating to the importation into the United States of any drug or controlled substance (as defined in section 102 of the Controlled Substances Act);</text></subparagraph><subparagraph id="id8F2F96593E754857A3FA9BF6FDE2C6AC"><enum>(D)</enum><text>the person has engaged in a pattern of importing or offering for import—</text><clause id="idA2DB8677F82B4C8AB8B6A1A8C26A903E"><enum>(i)</enum><text>controlled substances that are prohibited from importation under section 401(m) of the Tariff Act of 1930 (19 U.S.C. 1401(m)); or</text></clause><clause id="id40B25CC4986841EAA52D34D76CAE32B2"><enum>(ii)</enum><text>adulterated or misbranded drugs that are—</text><subclause id="idAEC948F085484B04AEC0E7B07AE854FB"><enum>(I)</enum><text>not designated in an authorized electronic data interchange system as a product that is regulated by the Secretary; or</text></subclause><subclause id="id636F22C50A1D47E0B4C77F3B1A0FD41F"><enum>(II)</enum><text>knowingly or intentionally falsely designated in an authorized electronic data interchange system as a product that is regulated by the Secretary.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></clause></subparagraph></paragraph><paragraph commented="no" id="idd3bb784b16954d7fa6522d301e292669"><enum>(2)</enum><header>Prohibited act</header><text>Section 301(cc) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 331(cc)) is amended by inserting <quote>or a drug</quote> after <quote>food</quote>.</text></paragraph></subsection><subsection id="idedd9374a330c48b48ffd2b9b20552d5f"><enum>(c)</enum><header>Imports and exports</header><text>Section 801(a) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 381(a)) is amended—</text><paragraph id="id1834896d1a234821b0b1960aa02efd86"><enum>(1)</enum><text>by striking the second sentence;</text></paragraph><paragraph id="id826391fb02104ea7a871b10205580a26"><enum>(2)</enum><text>by striking <quote>If it appears</quote> and inserting <quote>Subject to subsection (b), if it appears</quote>;</text></paragraph><paragraph id="id0857a62eb1484005b3dc2aeeb2ded47b"><enum>(3)</enum><text>by striking <quote>regarding such article, then such article shall be refused</quote> and inserting the following: <quote>regarding such article, or (5) such article is being imported or offered for import in violation of section 301(cc), then any such article described in any of clauses (1) through (5) may be refused admission. If it appears from the examination of such samples or otherwise that the article is a counterfeit drug, such article shall be refused admission.</quote>;</text></paragraph><paragraph id="idE0F4D6A9D24F4D55967A4B81E021D47D"><enum>(4)</enum><text>by striking <quote>this Act, then such article shall be refused admission</quote> and inserting <quote>this Act, then such article may be refused admission</quote>; and</text></paragraph><paragraph id="ide4f50c48729f4f14be047ea259cbc7c2"><enum>(5)</enum><text>by striking <quote>Clause (2) of the third sentence</quote> and all that follows through the period at the end and inserting the following: <quote>Neither clause (2) nor clause (5) of the second sentence of this subsection shall be construed to prohibit the admission of narcotic drugs, the importation of which is permitted under the Controlled Substances Import and Export Act.</quote>.</text></paragraph></subsection><subsection id="id98ec9aaee896482688d77771fd3f67db"><enum>(d)</enum><header>Certain illicit articles</header><text>Section 801 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 381) is amended by adding at the end the following—</text><quoted-block display-inline="no-display-inline" id="id13a1284a68324478a843cc60d05db465" style="OLC"><subsection id="id8DAA687F97C34F55B8971DB08DF07374"><enum>(t)</enum><header>Illicit articles containing active pharmaceutical ingredients</header><paragraph id="idd3ee0a1c20b74bf1a45bf81ff40fa9d4"><enum>(1)</enum><header>In general</header><text>For purposes of this section, an article that is being imported or offered for import into the United States may be treated by the Secretary as a drug if the article—</text><subparagraph id="idc4c977b52971403dafedccce667c23b6"><enum>(A)</enum><text>is not—</text><clause id="id4cf9d49c55c9490bb264b881f78c063c"><enum>(i)</enum><text>accompanied by an electronic import entry for such article submitted using an authorized electronic data interchange system; and</text></clause><clause id="id80b7311843104790ab3d19b084eda5b8"><enum>(ii)</enum><text>designated in such a system as an article regulated by the Secretary (which may include regulation as a drug, a device, or a dietary supplement; and</text></clause></subparagraph><subparagraph id="ida9ed51f51ad642f4bee59b020f283e26"><enum>(B)</enum><text>is an ingredient that presents significant public health concern and is, or contains—</text><clause id="idd00a6c798b8b409ba09485a7cd10e407"><enum>(i)</enum><text>an active ingredient in a drug—</text><subclause id="idDBA982F0A8744ABEBBA09FCB45BA173C"><enum>(I)</enum><text>that is approved under section 505 or licensed under section 351 of the Public Health Service Act; or</text></subclause><subclause id="id8122ed57c3814ed98c18e9d91ca17735"><enum>(II)</enum><text>for which—</text><item id="id89495239321A4B1C8D718222D680483F"><enum>(aa)</enum><text>an investigational use exemption is in effect under section 505(i) of this Act or section 351(a) of the Public Health Service Act; and</text></item><item id="id961e5db041164c44bb33a46b48212e3a"><enum>(bb)</enum><text>a substantial clinical investigation has been instituted, and such investigation has been made public; or</text></item></subclause></clause><clause id="idea63c7fd0c1040a28fc3ce4a58a7561d"><enum>(ii)</enum><text>a substance that has a chemical structure that is substantially similar to the chemical structure of an active ingredient in a drug or biological product described in subclause (I) or (II) of clause (i).</text></clause></subparagraph></paragraph><paragraph id="idd2fe5751dedb405da2d6c36b84d8dd2b"><enum>(2)</enum><header>Effect</header><text>This subsection shall not be construed to bear upon any determination of whether an article is a drug within the meaning of section 201(g), other than for the purposes described in paragraph (1).</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="id3CF43D3C5D8E40D1A9C3BD3FE6A2F3B2"><enum>1306.</enum><header>First responder training</header><text display-inline="no-display-inline">Section 546 of the Public Health Service Act (42 U.S.C. 290ee–1) is amended—</text><paragraph id="idD84F7CDC477E44D68C17316685902C13"><enum>(1)</enum><text>in subsection (c)—</text><subparagraph id="idADA1C09625A94087B20217E15C084339"><enum>(A)</enum><text>in paragraph (2), by striking <quote>and</quote> at the end;</text></subparagraph><subparagraph id="id1274634E739A469D9C4D6E403752F639"><enum>(B)</enum><text>in paragraph (3), by striking the period and inserting <quote>; and</quote>; and</text></subparagraph><subparagraph id="idB477AF0D3E6D4CA6AC73CBBA8D6D3963"><enum>(C)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idB90D03D1292846A68F006E77BD137B68" style="OLC"><paragraph id="id14EC2F5F28D944F29883B702A598E8BA"><enum>(4)</enum><text>train and provide resources for first responders and members of other key community sectors on safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs to protect themselves from exposure to such drugs and respond appropriately when exposure occurs.</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id83F1DB516D9F426D82EABE71372B7A35"><enum>(2)</enum><text>in subsection (d), by striking <quote>and mechanisms for referral to appropriate treatment for an entity receiving a grant under this section</quote> and inserting <quote>mechanisms for referral to appropriate treatment, and safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs</quote>;</text></paragraph><paragraph id="id9C8B95EC5E614C63AEF6793D178B80FB"><enum>(3)</enum><text>in subsection (f)—</text><subparagraph id="id9B2596115EAA45CA91852BBB7B943840"><enum>(A)</enum><text>in paragraph (3), by striking <quote>and</quote> at the end;</text></subparagraph><subparagraph id="idD9F9AB55AC2D4D3D90B2F4F58B9A61A2"><enum>(B)</enum><text>in paragraph (4), by striking the period and inserting <quote>; and</quote>; and</text></subparagraph><subparagraph id="idF10C26BD1B0A4AA89428C4669A8F8D0E"><enum>(C)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id224CB8000CE84EC29C6A2655E196A0A0" style="OLC"><paragraph id="idCF769F08E59C4027849E6166348861CC"><enum>(5)</enum><text>the number of first responders and members of other key community sectors trained on safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs.</text></paragraph><after-quoted-block>; </after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="idBF872B1CCE9E4432819E329ED083F630"><enum>(4)</enum><text>by redesignating subsection (g) as subsection (h);</text></paragraph><paragraph id="id95E4C4C9F5AB423A8868ED49844712E5"><enum>(5)</enum><text>by inserting after subsection (f) the following:</text><quoted-block display-inline="no-display-inline" id="idC425399C9C0843FE98B8B52FB3093A8F" style="OLC"><subsection id="id0560ECE4639B42A68784487EDE9D6081"><enum>(g)</enum><header>Other key community sectors</header><text>In this section, the term <term>other key community sectors</term> includes substance abuse treatment providers, emergency medical services agencies, agencies and organizations working with prison and jail populations and offender reentry programs, health care providers, harm reduction groups, pharmacies, community health centers, tribal health facilities, and mental health providers.</text></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="id37FB03879152470AA0AFC713D99183AB"><enum>(6)</enum><text>in subsection (h), as so redesignated, by striking <quote>$12,000,000 for each of fiscal years 2017 through 2021</quote> and inserting <quote>$36,000,000 for each of fiscal years 2019 through 2023</quote>.</text></paragraph></section><section id="idab10ba3cfe064abebd275b9296ff6fdf"><enum>1307.</enum><header>Disposal of controlled substances of hospice patients</header><subsection id="id5ed8bca677cc45dcbbc21fbd2216c8ad"><enum>(a)</enum><header>In general</header><text>Section 302(g) of the Controlled Substances Act (21 U.S.C. 822(g)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id8ca359835b1e427d8f0c85c65a0cf975" style="OLC"><paragraph id="id16d80fbf819c440baeb549138efc0967" indent="up1"><enum>(5)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idDF7FB5CE3772431881191FE43058315C"><enum>(A)</enum><text>An employee of a qualified hospice program acting within the scope of employment may handle, in the place of residence of a hospice patient, any controlled substance that was lawfully dispensed to the hospice patient, for the purpose of assisting in the disposal of the controlled substance—</text><clause id="id02E7307A564A43C4AF4009E407A8BBE0" indent="up1"><enum>(i)</enum><text>after the hospice patient's death;</text></clause><clause id="id64DD65F19A7647F786A38B45C7CE71AC" indent="up1"><enum>(ii)</enum><text>if the controlled substance is expired; or</text></clause><clause id="id2EEFFFBAF2E04C38BB07881408442BF8" indent="up1"><enum>(iii)</enum><text>if—</text><subclause id="id8A7E3BE374A54C3FA04584DAA0E9A2F5"><enum>(I)</enum><text>the employee is—</text><item id="id51E370F334724AF48FDF2D24737301D8"><enum>(aa)</enum><text>the physician of the hospice patient; and</text></item><item id="id4491BAE1ADCD4DB5ABBDCCF20C0F4C2C"><enum>(bb)</enum><text>registered under section 303(f); and</text></item></subclause><subclause id="id8315D080810F4FCFB6AD25B909CC1DEE"><enum>(II)</enum><text>the hospice patient no longer requires the controlled substance because the plan of care of the hospice patient has been modified.</text></subclause></clause></subparagraph><subparagraph id="id0a425d1412b44939b7e32e80fbabb69a" indent="up1"><enum>(B)</enum><text>In this paragraph:</text><clause id="id23a8fb9a622c46a1bec01827236681e1"><enum>(i)</enum><text>The term <term>employee of a qualified hospice program</term> means a physician, physician assistant, registered nurse, or nurse practitioner who—</text><subclause id="idf72e743f077e4936aa601254f9677d40"><enum>(I)</enum><text>is employed by, or is acting pursuant to arrangements made with, a qualified hospice program; and</text></subclause><subclause id="id2ef8549a006f4f93a8da175b3dce6869"><enum>(II)</enum><text>is licensed or certified to perform such employment, or such activities arranged by the qualified hospice program, in accordance with applicable State law.</text></subclause></clause><clause id="ide277aefb56bd4b3195c17191ebd22dfd"><enum>(ii)</enum><text>The terms <term>hospice care</term> and <term>hospice program</term> have the meanings given those terms in section 1861(dd) of the Social Security Act (42 U.S.C. 1395x(dd)).</text></clause><clause id="idB14FF0F70B4742138FACBC8D624FB890"><enum>(iii)</enum><text>The term <term>hospice patient</term> means an individual receiving hospice care.</text></clause><clause id="id7d4281545a4141c9a1002fd3a3e96c96"><enum>(iv)</enum><text>The term <term>qualified hospice program</term> means a hospice program that—</text><subclause id="id413f7115116949c6a1f4e8fb886d020d"><enum>(I)</enum><text>has written policies and procedures for employees of the hospice program to use when assisting in the disposal of the controlled substances of a hospice patient in a circumstance described in clause (i), (ii), or (iii) of subparagraph (A);</text></subclause><subclause id="idf75865c1629544de9d74cf7e965ef5b2"><enum>(II)</enum><text>at the time when the controlled substances are first ordered—</text><item id="idc466b070df99427f9b6b5990fb75a8c9"><enum>(aa)</enum><text>provides a copy of the written policies and procedures to the hospice patient or hospice patient representative and the family of the hospice patient;</text></item><item id="idac92413a5b994578bfc0deb4ecab82f0"><enum>(bb)</enum><text>discusses the policies and procedures with the hospice patient or hospice patient's representative and the hospice patient's family in a language and manner that such individuals understand to ensure that such individuals are informed regarding the safe disposal of controlled substances; and</text></item><item id="ida264023b6c7c4e758ad28d62a8d5382c"><enum>(cc)</enum><text>documents in the clinical record of the hospice patient that the written policies and procedures were provided and discussed with the hospice patient or hospice patient's representative; and</text></item></subclause><subclause id="id0eb3b8278d1946919c393bb4b82875c8"><enum>(III)</enum><text>at the time when an employee of the hospice program assists in the disposal of controlled substances of a hospice patient, documents in the clinical record of the hospice patient a list of all controlled substances disposed of.</text></subclause></clause></subparagraph><subparagraph id="id5164c8d5cbf14b458da4da2509a2336d" indent="up1"><enum>(C)</enum><text>The Attorney General may, by regulation, include additional types of licensed medical professionals in the definition of the term <term>employee of a qualified hospice program</term> under subparagraph (B).</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id64908dbeaa644450bc260cfc53880bde"><enum>(b)</enum><header>No registration required</header><text>Section 302(c) of the Controlled Substances Act (21 U.S.C. 822(c)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idef756986704a4f8eb74a24a4d9a80dcd" style="OLC"><paragraph id="ide05f1ffc70ce418cb53d1f187ad76833"><enum>(4)</enum><text>An employee of a qualified hospice program for the purpose of assisting in the disposal of a controlled substance in accordance with subsection (g)(5), except as provided in subparagraph (A)(iii) of that subsection.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="idc4c9926cb98746878e6328b36fb4d7a1"><enum>(c)</enum><header>Guidance</header><text>The Attorney General may issue guidance to qualified hospice programs to assist the programs in satisfying the requirements under paragraph (5) of section 302(g) of the Controlled Substances Act (21 U.S.C. 822(g)), as added by subsection (a).</text></subsection><subsection id="ide8587e0c219e406faf4dca1cb325bfe6"><enum>(d)</enum><header>State and local authority</header><text>Nothing in this section or the amendments made by this section shall be construed to prevent a State or local government from imposing additional controls or restrictions relating to the regulation of the disposal of controlled substances in hospice care or hospice programs.</text></subsection></section><section id="idf1c4677e093f4733942ca6f04bb0001e"><enum>1308.</enum><header>GAO study and report on hospice safe drug management</header><subsection id="id261db59a26c8499581570f7235cbafb1"><enum>(a)</enum><header>Study</header><paragraph id="id2D11727E75D74454B59CD7D289030EE0"><enum>(1)</enum><header>In general</header><text>The Comptroller General of the United States (in this section referred to as the <quote>Comptroller General</quote>) shall conduct a study on the requirements applicable to and challenges of hospice programs with regard to the management and disposal of controlled substances in the home of an individual.</text></paragraph><paragraph id="idFE045864507341BDBA2C1CC5FE242A59"><enum>(2)</enum><header>Contents</header><text>In conducting the study under paragraph (1), the Comptroller General shall include—</text><subparagraph id="id367222158aea4e60bbb82d7671a666c4"><enum>(A)</enum><text>an overview of challenges encountered by hospice programs regarding the disposal of controlled substances, such as opioids, in a home setting, including any key changes in policies, procedures, or best practices for the disposal of controlled substances over time; and</text></subparagraph><subparagraph id="id83671fe33bf94ebfb228cafa7d721a1f"><enum>(B)</enum><text>a description of Federal requirements, including requirements under the Medicare program, for hospice programs regarding the disposal of controlled substances in a home setting, and oversight of compliance with those requirements.</text></subparagraph></paragraph></subsection><subsection id="id40149760f30d431c84271dcaf9210023"><enum>(b)</enum><header>Report</header><text>Not later than 18 months after the date of enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under subsection (a), together with recommendations, if any, for such legislation and administrative action as the Comptroller General determines appropriate.</text></subsection></section><section id="id1e5437f5-3d8b-48fb-9cad-84cfdeebfa62" section-type="subsequent-section"><enum>1309.</enum><header>Delivery of a controlled substance by a pharmacy to be administered by injection or implantation</header><subsection id="id089139b8-0b7a-40a4-9e59-ea86f1d4c8e7"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Controlled Substances Act is amended by inserting after section 309 (21 U.S.C. 829) the following:</text><quoted-block display-inline="no-display-inline" id="ide101ee80-f30f-45a8-91e1-acd450b98307" style="traditional"><section commented="no" display-inline="no-display-inline" id="ID2BFD0275859B44D08E29479E946D2FC0" section-type="subsequent-section"><enum>309A.</enum><header>Delivery of a controlled substance by a pharmacy to an administering practitioner</header><subsection commented="no" display-inline="yes-display-inline" id="ID46DDD5702DAA4D4B8222350828F1355F"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Notwithstanding section 102(10), a pharmacy may deliver a controlled substance to a practitioner in accordance with a prescription that meets the requirements of this title and the regulations issued by the Attorney General under this title, for the purpose of administering the controlled substance by the practitioner if—</text><paragraph id="id189921f9-bc02-4732-b599-3567e3b2dced"><enum>(1)</enum><text>the controlled substance is delivered by the pharmacy to the prescribing practitioner or the practitioner administering the controlled substance, as applicable, at the location listed on the practitioner’s certificate of registration issued under this title;</text></paragraph><paragraph id="id3be26725-4fc9-4b89-bf6c-aeeb7019aa92"><enum>(2)</enum><text>in the case of administering of the controlled substance for the purpose of maintenance or detoxification treatment under section 303(g)(2)—</text><subparagraph id="idD121FD68CECB4EC2A63E9F7E9FA32194"><enum>(A)</enum><text>the practitioner who issued the prescription is a qualifying practitioner authorized under, and acting within the scope of that section; and</text></subparagraph><subparagraph id="id4F9545E9F24F4F9E959A69151162A18A"><enum>(B)</enum><text>the controlled substance is to be administered by injection or implantation;</text></subparagraph></paragraph><paragraph id="id92dcf390-1f00-41af-b859-bd1ebcda5b54"><enum>(3)</enum><text>the pharmacy and the practitioner are authorized to conduct the activities specified in this section under the law of the State in which such activities take place;</text></paragraph><paragraph id="id55cba33d-a759-4a66-b8bb-07de1ec22e56"><enum>(4)</enum><text>the prescription is not issued to supply any practitioner with a stock of controlled substances for the purpose of general dispensing to patients;</text></paragraph><paragraph id="id015f0e63-b00d-4a33-85a8-b8e3b980d0a3"><enum>(5)</enum><text>except as provided in subsection (b), the controlled substance is to be administered only to the patient named on the prescription not later than 14 days after the date of receipt of the controlled substance by the practitioner; and</text></paragraph><paragraph id="id1f1f7a2a-3e35-4a20-a63f-cba5195d5793"><enum>(6)</enum><text>notwithstanding any exceptions under section 307, the prescribing practitioner, and the practitioner administering the controlled substance, as applicable, maintain complete and accurate records of all controlled substances delivered, received, administered, or otherwise disposed of under this section, including the persons to whom controlled substances were delivered and such other information as may be required by regulations of the Attorney General.</text></paragraph></subsection><subsection id="idE4C8EA7E1F9F429C966D2DCE5F37BCDA"><enum>(b)</enum><header>Modification of number of days before which controlled substance shall be administered</header><paragraph id="idDB326E43C5B2411F9B9C2091D15D4293"><enum>(1)</enum><header>Initial 2-year period</header><text>During the 2-year period beginning on the date of enactment of this section, the Attorney General, in coordination with the Secretary, may reduce the number of days described in subsection (a)(5) if the Attorney General determines that such reduction will—</text><subparagraph id="idF74AC19BF6FC48B3B36F7CE2F1472A50"><enum>(A)</enum><text>reduce the risk of diversion; or</text></subparagraph><subparagraph id="idFDF1B972516F40029A6B9929B716E36D"><enum>(B)</enum><text>protect the public health.</text></subparagraph></paragraph><paragraph id="id1366C57ED95942EC985244EA435D2130"><enum>(2)</enum><header>Modifications after submission of report</header><text>After the date on which the report described in subsection (c) is submitted, the Attorney General, in coordination with the Secretary, may modify the number of days described in subsection (a)(5).</text></paragraph><paragraph id="id13E1AD6804E24C87A13726548AA98E13"><enum>(3)</enum><header>Minimum number of days</header><text>Any modification under this subsection shall be for a period of not less than 7 days.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id5A681E671E684C9EB9D6B54AB1C048A8"><enum>(b)</enum><header>Study and report</header><text>Not later than 2 years after the date of enactment of this section, the Comptroller General of the United States shall conduct a study and submit to Congress a report on access to and potential diversion of controlled substances administered by injection or implantation.</text></subsection><subsection id="idcb62ef82-2aa1-4a38-a844-66a182c9e58c"><enum>(c)</enum><header>Technical and conforming amendment</header><text>The table of contents for the Comprehensive Drug Abuse Prevention and Control Act of 1970 is amended by inserting after the item relating to section 309 the following:</text><quoted-block id="id886cb12e-a728-40a6-96ad-db2eb326d01d" style="OLC"><toc><toc-entry level="section">Sec. 309A. Delivery of a controlled substance by a pharmacy to an administering practitioner.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section></subtitle><subtitle id="idEBB1E8BB5E7344ACA570B390521AFB75"><enum>D</enum><header>Treatment and Recovery</header><section id="H9B97B9F9AC2D4800A7E4C948D2FD0994" section-type="subsequent-section"><enum>1401.</enum><header>Comprehensive opioid recovery centers</header><subsection id="H8F4029BB659940E9B78E0A521A7FFCEA"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall award grants on a competitive basis to eligible entities to establish or operate a comprehensive opioid recovery center (referred to in this section as a <quote>Center</quote>). A Center may be a single entity or an integrated delivery network.</text></subsection><subsection id="HD4D6B9EC36594415AA14798BD02D17FC"><enum>(b)</enum><header>Grant period</header><paragraph id="HC0A7389BB74C480D9318F0D2F5E4D665"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">A grant awarded under subsection (a) shall be for a period not more than 5 years.</text></paragraph><paragraph id="HC32BDCB1458246448F2D33F08AFFD3F7"><enum>(2)</enum><header>Renewal</header><text>A grant awarded under subsection (a) may be renewed, on a competitive basis, for additional periods of time, as determined by the Secretary. In determining whether to renew a grant under this paragraph, the Secretary shall consider the data submitted under subsection (h).</text></paragraph></subsection><subsection commented="no" id="HBBA3AAB7AE0B40A3AAF76C99F0D5D96C"><enum>(c)</enum><header>Minimum number of grants</header><text display-inline="yes-display-inline">The Secretary shall allocate the amounts made available under subsection (j) such that not fewer than 10 grants may be awarded. Not more than one grant shall be made to entities in a single State for any one period.</text></subsection><subsection id="HF2281EBE70AD4D96B6BE747B4EF1AC9D"><enum>(d)</enum><header>Application</header><paragraph id="idF94954DF81F740B5BC0DE979C64409D9"><enum>(1)</enum><header>Eligible entity</header><text>An entity is eligible for a grant under this section if the entity offers treatment and other services for individuals with a substance use disorder.</text></paragraph><paragraph id="id2F7DFA27894941298E7855077FDB3FE0"><enum>(2)</enum><header>Submission of application</header><text>In order to be eligible for a grant under subsection (a), an entity shall submit an application to the Secretary at such time and in such manner as the Secretary may require. Such application shall include—</text><subparagraph id="H0CC10558C2BB4D44BBB7C22C3C1E8342"><enum>(A)</enum><text>evidence that such entity carries out, or is capable of coordinating with other entities to carry out, the activities described in subsection (g); and</text></subparagraph><subparagraph id="H566DEF7A79FD4FB6A5614E65705F437B"><enum>(B)</enum><text>such other information as the Secretary may require.</text></subparagraph></paragraph></subsection><subsection id="HC16FD740406A4FD697909026CC493B66"><enum>(e)</enum><header>Priority</header><text>In awarding grants under subsection (a), the Secretary shall give priority to eligible entities located in a State or Indian Tribe with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, as determined by the Director of the Centers for Disease Control and Prevention.</text></subsection><subsection id="idD3FB7F90C5444FD39115A6801CA1EEA8"><enum>(f)</enum><header>Preference</header><text>In awarding grants under subsection (a), the Secretary may give preference to eligible entities utilizing technology-enabled collaborative learning and capacity building models, including such models as defined in section 2 of the Expanding Capacity for Health Outcomes Act (Public Law 114–270; 130 Stat. 1395), to conduct the activities described in this section.</text></subsection><subsection id="HF8DD1FBD82B6472BB4F7C4DD1EE518CF"><enum>(g)</enum><header>Center activities</header><text>Each Center shall, at a minimum, carry out the following activities directly, through referral, or through contractual arrangements, which may include carrying out such activities through technology-enabled collaborative learning and capacity building models described in subsection (f):</text><paragraph id="HEBAAAB8110084906BDE8894F155E8177"><enum>(1)</enum><header>Treatment and recovery services</header><text display-inline="yes-display-inline">Each Center shall—</text><subparagraph id="HC925266A10C84E4E9B76EAC6BA8A3AD3"><enum>(A)</enum><text display-inline="yes-display-inline">ensure that intake and evaluations meet the individualized clinical needs of patients, including by offering assessments for services and care recommendations through independent, evidence-based verification processes for reviewing patient placement in treatment settings;</text></subparagraph><subparagraph id="H43BCF139192F41C991CC4BAB85398F4A"><enum>(B)</enum><text>provide the full continuum of treatment services, including—</text><clause commented="no" id="H82FFA2CF144C43CBBA627B2AFA7DD337"><enum>(i)</enum><text>all drugs approved by the Food and Drug Administration to treat substance use disorders, pursuant to Federal and State law;</text></clause><clause id="H0220F714AFB447BF98FF0EA327F63CF2"><enum>(ii)</enum><text>medically supervised withdrawal management that includes patient evaluation, stabilization, and readiness for and entry into treatment;</text></clause><clause id="H79C620943CC2456899E8B7C7AB584297"><enum>(iii)</enum><text>counseling provided by a program counselor or other certified professional who is licensed and qualified by education, training, or experience to assess the psychological and sociological background of patients, to contribute to the appropriate treatment plan for the patient, and to monitor patient progress;</text></clause><clause id="idEE6B0CF9932B4EA28854C2088245A372"><enum>(iv)</enum><text>treatment, as appropriate, for patients with co-occurring substance use and mental disorders;</text></clause><clause id="id2214a08afd56441bb46b8c97bf13fda4"><enum>(v)</enum><text>testing, as appropriate, for infections commonly associated with illicit drug use;</text></clause><clause id="HE3FD871FCAF54446B663E241BEEF9112"><enum>(vi)</enum><text>residential rehabilitation, and outpatient and intensive outpatient programs;</text></clause><clause id="H1975036649BC4ED881048C6BDDEAE36F"><enum>(vii)</enum><text>recovery housing;</text></clause><clause id="H34FC837649BD40A3A11548FF0305E171"><enum>(viii)</enum><text>community-based and peer recovery support services;</text></clause><clause id="H8624807F83714704BC692FA8F9F19678"><enum>(ix)</enum><text>job training, job placement assistance, and continuing education assistance to support reintegration into the workforce; and</text></clause><clause id="H1E98EECC2C334C65A876CA1B4406A21B"><enum>(x)</enum><text>other best practices to provide the full continuum of treatment and services, as determined by the Secretary;</text></clause></subparagraph><subparagraph id="idE8A88AB6332C43BD8CCCAD1CF01AE292"><enum>(C)</enum><text>ensure that all programs covered by the Center include medication-assisted treatment, as appropriate, and do not exclude individuals receiving medication-assisted treatment from any service;</text></subparagraph><subparagraph id="id7834DD9D51544B47BBC32AFF72F62F36"><enum>(D)</enum><text>periodically conduct patient assessments to support sustained and clinically significant recovery, as defined by the Assistant Secretary for Mental Health and Substance Use;</text></subparagraph><subparagraph id="H99FF731613B9409093B502BADF6D05C3"><enum>(E)</enum><text>administer an onsite pharmacy and provide toxicology services, for purposes of carrying out this section; and</text></subparagraph><subparagraph id="H6A9F769EB5E040B5A33BF235F07135B0"><enum>(F)</enum><text>operate a secure, confidential, and interoperable electronic health information system.</text></subparagraph></paragraph><paragraph id="id3d3e0adbc194410290606faf85ea0945"><enum>(2)</enum><header>Outreach</header><text>Each Center shall carry out outreach activities to publicize the services offered through the Centers, which may include—</text><subparagraph id="id22037ec837624cacb78b544b049e5416"><enum>(A)</enum><text>training and supervising outreach staff, as appropriate, to work with State and local health departments, health care providers, the Indian Health Service, State and local educational agencies, schools funded by the Indian Bureau of Education, institutions of higher education, State and local workforce development boards, State and local community action agencies, public safety officials, first responders, Indian Tribes, child welfare agencies, as appropriate, and other community partners and the public, including patients, to identify and respond to community needs;</text></subparagraph><subparagraph id="idA1F9BF9DFFAB44D1B0BCF9CA0E4EE302"><enum>(B)</enum><text>ensuring that the entities described in subparagraph (A) are aware of the services of the Center; and</text></subparagraph><subparagraph id="id3a6fb6d434c44a9c97b56ea16488c94a"><enum>(C)</enum><text>disseminating and making publicly available, including through the internet, evidence-based resources that educate professionals and the public on opioid use disorder and other substance use disorders, including co-occurring substance use and mental disorders.</text></subparagraph></paragraph></subsection><subsection id="H5914733961AA43A48ACC38651105E6B0"><enum>(h)</enum><header>Data reporting and program oversight</header><text>With respect to a grant awarded under subsection (a), not later than 90 days after the end of the first year of the grant period, and annually thereafter for the duration of the grant period (including the duration of any renewal period for such grant), the entity shall submit data, as appropriate, to the Secretary regarding—</text><paragraph id="HBA419BC7FBD642D389EAB80A25208FE2"><enum>(1)</enum><text>the programs and activities funded by the grant;</text></paragraph><paragraph id="HB66BF80314484C91B64D4D570D5C1B25"><enum>(2)</enum><text>health outcomes of the population of individuals with a substance use disorder who received services from the Center, evaluated by an independent program evaluator through the use of outcomes measures, as determined by the Secretary;</text></paragraph><paragraph id="id805B71A20B65400DBA3BCB9495DC6A98"><enum>(3)</enum><text>the retention rate of program participants; and</text></paragraph><paragraph id="H6966B5ABDCA44B21B100917651C22454"><enum>(4)</enum><text>any other information that the Secretary may require for the purpose of ensuring that the Center is complying with all the requirements of the grant, including providing the full continuum of services described in subsection (g)(1)(B).</text></paragraph></subsection><subsection id="id4101fa2df4d54b179d51dbafaf7be146"><enum>(i)</enum><header>Privacy</header><text>The provisions of this section, including with respect to data reporting and program oversight, shall be subject to all applicable Federal and State privacy laws.</text></subsection><subsection id="H7A6750A43E1B488B9E11503A67F58E3D"><enum>(j)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 2023 for purposes of carrying out this section.</text></subsection><subsection id="H5F729769DE31434B8A2D8CFF464B0F56"><enum>(k)</enum><header>Reports to Congress</header><paragraph id="H1DD3242533BB4251B31BA90765CBC14B"><enum>(1)</enum><header>Preliminary report</header><text display-inline="yes-display-inline">Not later than 3 years after the date of the enactment of this Act, the Secretary shall submit to Congress a preliminary report that analyzes data submitted under subsection (h).</text></paragraph><paragraph id="H2C6190A7B3E5423CA4173DD35605CF71"><enum>(2)</enum><header>Final report</header><text>Not later than 2 years after submitting the preliminary report required under paragraph (1), the Secretary shall submit to Congress a final report that includes—</text><subparagraph id="HDBA0CAAD165542E49DB5F7C6B210D2BB"><enum>(A)</enum><text>an evaluation of the effectiveness of the comprehensive services provided by the Centers established or operated pursuant to this section with respect to health outcomes of the population of individuals with substance use disorder who receive services from the Center, which shall include an evaluation of the effectiveness of services for treatment and recovery support and to reduce relapse, recidivism, and overdose; and</text></subparagraph><subparagraph id="HC31BA44415774088A713BB3300040473"><enum>(B)</enum><text>recommendations, as appropriate, regarding ways to improve Federal programs related to substance use disorders, which may include dissemination of best practices for the treatment of substance use disorders to health care professionals.</text></subparagraph></paragraph></subsection></section><section id="HB59BECDB0B244CD09D25E03FAD96C834"><enum>1402.</enum><header>Program to support coordination and continuation of care for drug overdose patients</header><subsection id="H666D13E41F8F4FB1A16D70346E929CC6"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall identify or facilitate the development of best practices for—</text><paragraph id="id0DE61820558E49B1B579689A5B7E0637"><enum>(1)</enum><text display-inline="yes-display-inline">emergency treatment of known or suspected drug overdose;</text></paragraph><paragraph id="id702B70F629384034B306BFFBBFB062FA"><enum>(2)</enum><text>the use of recovery coaches, as appropriate, to encourage individuals who experience a non-fatal overdose to seek treatment for substance use disorder and to support coordination and continuation of care;</text></paragraph><paragraph id="idAC920E26059A43CAA3B9AC16E77259F7"><enum>(3)</enum><text>coordination and continuation of care and treatment, including, as appropriate, through referrals, of individuals after an opioid overdose; and</text></paragraph><paragraph id="id9938EC050286433CA3DD1A3E09B66187"><enum>(4)</enum><text>the provision of overdose reversal medication, as appropriate.</text></paragraph></subsection><subsection id="HD30FFC3081084B928A17C3EC53D81517"><enum>(b)</enum><header>Grant establishment and participation</header><paragraph id="H5CF1E3DF8D1A444B9DA406A893FE6344"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall award grants on a competitive basis to eligible entities to support implementation of voluntary programs for care and treatment of individuals after an opioid overdose, as appropriate, which may include implementation of the best practices described in subsection (a).</text></paragraph><paragraph id="id9e037ec0effb4d4fb08f23f5b23aa60f"><enum>(2)</enum><header>Eligible entity</header><text>In this section, the term <term>eligible entity</term> means—</text><subparagraph id="idC8A959F71E4E4483806BE8B02DD5D3B2"><enum>(A)</enum><text>a State alcohol or drug agency;</text></subparagraph><subparagraph id="id0A2B123EB78547F48DB1AEB93E94B5B6"><enum>(B)</enum><text>an Indian Tribe or tribal organization; or</text></subparagraph><subparagraph id="id193852DD4C4246BAA4701C663629117D"><enum>(C)</enum><text>an entity that offers treatment or other services for individuals in response to, or following, drug overdoses or a drug overdose, in consultation with a State alcohol and drug agency.</text></subparagraph></paragraph><paragraph id="H551D279DDBE9442EB4FCF2B293E07604"><enum>(3)</enum><header>Application</header><text display-inline="yes-display-inline">An eligible entity desiring a grant under this section shall submit an application to the Secretary, at such time and in such manner as the Secretary may require, that includes—</text><subparagraph commented="no" id="id1810C90598C54D4CB70732CF24C0862D"><enum>(A)</enum><text>evidence that such eligible entity carries out, or is capable of contracting and coordinating with other community entities to carry out, the activities described in paragraph (4);</text></subparagraph><subparagraph commented="no" id="id6B5D2CA4C89F48DFB28741617A76B744"><enum>(B)</enum><text>evidence that such eligible entity will work with a recovery community organization to recruit, train, hire, mentor, and supervise recovery coaches and fulfill the requirements described in paragraph (4)(A); and</text></subparagraph><subparagraph commented="no" id="id0CF77E72236C4D98BC39E7FC73E6D069"><enum>(C)</enum><text>such additional information as the Secretary may require.</text></subparagraph></paragraph><paragraph commented="no" id="idF59D55EBFFBF487AAC343064FF8B7194"><enum>(4)</enum><header>Use of grant funds</header><text>An eligible entity awarded a grant under this section shall use such grant funds to—</text><subparagraph id="idf352b1946163441ebe8591a660c29548"><enum>(A)</enum><text>hire or utilize recovery coaches to help support recovery, including by—</text><clause id="idc4c9ca1401cd42418e824b024ae33b68"><enum>(i)</enum><text>connecting patients to a continuum of care services, such as—</text><subclause id="idAA347EE68AB14089BB623CFDC31211DB"><enum>(I)</enum><text>treatment and recovery support programs;</text></subclause><subclause id="idF092C264640446CC9C6F94F61AD3D31F"><enum>(II)</enum><text>programs that provide non-clinical recovery support services;</text></subclause><subclause id="idCE03226340F44A4FBCD99DC708DBFABF"><enum>(III)</enum><text>peer support networks;</text></subclause><subclause id="id4DF2D2592015416D9380D49B174C3638"><enum>(IV)</enum><text>recovery community organizations;</text></subclause><subclause id="id57FD099486F748E397CB8A50CF06D510"><enum>(V)</enum><text>health care providers, including physicians and other providers of behavioral health and primary care;</text></subclause><subclause id="id6c4f9b15f4cd49778119cf2aa85b8d38"><enum>(VI)</enum><text>education and training providers;</text></subclause><subclause id="id4ee56355996f45da8fa1d54d64482c88"><enum>(VII)</enum><text>employers;</text></subclause><subclause id="id7302ff5a0373452aa03c558071c3c744"><enum>(VIII)</enum><text>housing services; and</text></subclause><subclause id="idc0369ba94ff04be78bf4604624c64a4c"><enum>(IX)</enum><text>child welfare agencies;</text></subclause></clause><clause id="id3dc6b88f6f7143b09b2cd2616116b803"><enum>(ii)</enum><text>providing education on overdose prevention and overdose reversal to patients and families, as appropriate;</text></clause><clause id="id5d240aa1140040f0b6107a0ef3aa641e"><enum>(iii)</enum><text>providing follow-up services for patients after an overdose to ensure continued recovery and connection to support services;</text></clause><clause id="id69f55aab7d334f0d95a069ba430aa319"><enum>(iv)</enum><text>collecting and evaluating outcome data for patients receiving recovery coaching services; and</text></clause><clause id="id1de5c56186494e1c8b354fe3fb5d1473"><enum>(v)</enum><text>providing other services the Secretary determines necessary to help ensure continued connection with recovery support services, including culturally appropriate services, as applicable;</text></clause></subparagraph><subparagraph id="idFF0BBF11FB5948459B7799365FEBA197"><enum>(B)</enum><text>establish policies and procedures, pursuant to Federal and State law, that address the provision of overdose reversal medication, the administration of all drugs approved by the Food and Drug Administration to treat substance use disorder, and subsequent continuation of, or referral to, evidence-based treatment for patients with a substance use disorder who have experienced a non-fatal drug overdose, in order to support long-term treatment, prevent relapse, and reduce recidivism and future overdose; and</text></subparagraph><subparagraph id="idF232895A287B4A12AB2A280F84B94A16"><enum>(C)</enum><text>establish integrated models of care for individuals who have experienced a non-fatal drug overdose which may include patient assessment, follow up, and transportation to and from treatment facilities.</text></subparagraph></paragraph><paragraph id="H2767A4AAF451414A86AFC4DFED75B4F4"><enum>(5)</enum><header>Additional permissible uses</header><text>In addition to the uses described in paragraph (4), a grant awarded under this section may be used, directly or through contractual arrangements, to provide—</text><subparagraph id="idddb6c4c1aa024024bd3c194e6724187d"><enum>(A)</enum><text>all drugs approved by the Food and Drug Administration to treat substance use disorders, pursuant to Federal and State law;</text></subparagraph><subparagraph id="idCC558C4BB44042BD9395CBDF954AD1EB"><enum>(B)</enum><text>withdrawal and detoxification services that include patient evaluation, stabilization, and preparation for treatment of substance use disorder, including treatment described in subparagraph (A), as appropriate; or</text></subparagraph><subparagraph id="id524C000C9D01463BA0B6272ED222A4B1"><enum>(C)</enum><text>mental health services provided by a program counselor, social worker, therapist, or other certified professional who is licensed and qualified by education, training, or experience to assess the psychosocial background of patients, to contribute to the appropriate treatment plan for patients with substance use disorder, and to monitor patient progress.</text></subparagraph></paragraph><paragraph id="id2185B3C75A314D0BB479086BBB8082D7"><enum>(6)</enum><header>Preference</header><text>In awarding grants under this section, the Secretary shall give preference to eligible entities that meet any or all of the following criteria:</text><subparagraph id="HCB9E1C0B2F03444DBFCC7159B541B8D1"><enum>(A)</enum><text>The eligible entity is a critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act (42 U.S.C. 1395x(mm)(1))), a low volume hospital (as defined in section 1886(d)(12)(C)(i) of such Act (42 U.S.C. 1395ww(d)(12)(C)(i))), or a sole community hospital (as defined in section 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 1395ww(d)(5)(D)(iii))).</text></subparagraph><subparagraph id="H2982B79C87894BD6A3DFD0C3F40F7CA7"><enum>(B)</enum><text display-inline="yes-display-inline">The eligible entity is located in a State, or under the jurisdiction of an Indian Tribe, with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, as determined by the Director of the Centers for Disease Control and Prevention.</text></subparagraph><subparagraph id="idB36D0F12B69B4F7F8974F821955BB72D"><enum>(C)</enum><text>The eligible entity demonstrates that recovery coaches will be placed in both health care settings and community settings.</text></subparagraph></paragraph><paragraph id="H480C3492FF2D4934A993635959A8E423"><enum>(7)</enum><header>Period of grant</header><text display-inline="yes-display-inline">A grant awarded to an eligible entity under this section shall be for a period of not more than 5 years.</text></paragraph></subsection><subsection id="id7485205bd9234b6980d80997c023f888"><enum>(c)</enum><header>Definitions</header><text>In this section:</text><paragraph id="id8FB430640D154AA999F5D7F3CB63ACF3"><enum>(1)</enum><header>Recovery coach</header><text>the term <term>recovery coach</term> means an individual—</text><subparagraph id="id142422bbd0bb4435afdf0ade2a4ede6f"><enum>(A)</enum><text>with knowledge of, or experience with, recovery from a substance use disorder; and</text></subparagraph><subparagraph id="id0b966bd364fc48b082d084a9a97f776d"><enum>(B)</enum><text>who has completed training from, and is determined to be in good standing by, a recovery services organization capable of conducting such training and making such determination.</text></subparagraph></paragraph><paragraph id="idcf285e49eae9467eb726a7e35c6d6ceb"><enum>(2)</enum><header>Recovery community organization</header><text>The term <term>recovery community organization</term> has the meaning given such term in section 547(a) of the Public Health Service Act (42 U.S.C. 290ee–2(a)).</text></paragraph><paragraph id="id9fc0555da5564ba18495739700a932c7"><enum>(3)</enum><header>State alcohol and drug agency</header><text>The term <term>State alcohol and drug agency</term> means the principal agency of a State that is responsible for carrying out the block grant for prevention and treatment of substance abuse under subpart II of part B of title XIX of the Public Health Service Act (42 U.S.C. 300x–21 et seq.)</text></paragraph></subsection><subsection id="HF3CC2AF96BAA470AB5E8961AD20742DA"><enum>(d)</enum><header>Reporting requirements</header><paragraph id="H5DAFA1EEA9D146A0A4DCCA1F79D7BBAB"><enum>(1)</enum><header>Reports by grantees</header><text display-inline="yes-display-inline">Each eligible entity awarded a grant under this section shall submit to the Secretary an annual report for each year for which the entity has received such grant that includes information on—</text><subparagraph id="H7F4779385020442A8FFF07575EE3BAD3"><enum>(A)</enum><text display-inline="yes-display-inline">the number of individuals treated by the entity for non-fatal overdoses, including the number of non-fatal overdoses where overdose reversal medication was administered;</text></subparagraph><subparagraph id="H4A1358A394ED41128FE42BA6615E27D5"><enum>(B)</enum><text>the number of individuals administered medication-assisted treatment by the entity;</text></subparagraph><subparagraph id="H5900D297AB2F4ADBAE43D2A1DCDB7A10"><enum>(C)</enum><text>the number of individuals referred by the entity to other treatment facilities after a non-fatal overdose, the types of such other facilities, and the number of such individuals admitted to such other facilities pursuant to such referrals; and</text></subparagraph><subparagraph id="HF75FF45F226A498D87D763C2BC144441"><enum>(D)</enum><text display-inline="yes-display-inline">the frequency and number of patients with reoccurrences, including readmissions for non-fatal overdoses and evidence of relapse related to substance use disorder.</text></subparagraph></paragraph><paragraph commented="no" id="H1E39BB538401496CAAFABB327912355D"><enum>(2)</enum><header>Report by Secretary</header><text display-inline="yes-display-inline">Not later than 5 years after the date of enactment of this Act, the Secretary shall submit to Congress a report that includes an evaluation of the effectiveness of the grant program carried out under this section with respect to long term health outcomes of the population of individuals who have experienced a drug overdose, the percentage of patients treated or referred to treatment by grantees, and the frequency and number of patients who experienced relapse, were readmitted for treatment, or experienced another overdose.</text></paragraph></subsection><subsection commented="no" id="id23C8A6BBFF0046F4A69CD02E419DE8A1"><enum>(e)</enum><header>Privacy</header><text>The requirements of this section, including with respect to data reporting and program oversight, shall be subject to all applicable Federal and State privacy laws.</text></subsection><subsection commented="no" id="idDDCDF39C56EC4C26A93735FFD986B369"><enum>(f)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2019 through 2023.</text></subsection></section><section id="id46F8CD98CDCA434FAE42ECEE42F65D00"><enum>1403.</enum><header>Alternatives to opioids</header><subsection id="idB72B80E8B08349BEBC4BF0ACB1A50637"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall, directly or through grants to, or contracts with, public and private entities, provide technical assistance to hospitals and other acute care settings on alternatives to opioids for pain management. The technical assistance provided shall be for the purpose of—</text><paragraph id="id35dc0a30004b46f58748028be1592c05"><enum>(1)</enum><text>utilizing information from acute care providers including emergency departments and other providers that have successfully implemented alternatives to opioids programs, promoting non-addictive protocols and medications while appropriately limiting the use of opioids;</text></paragraph><paragraph id="id82908b2557ec4cd58c66e9391b6b397a"><enum>(2)</enum><text>identifying or facilitating the development of best practices on the use of alternatives to opioids, which may include pain-management strategies that involve non-addictive medical products, non-pharmacologic treatments, and technologies or techniques to identify patients at risk for opioid use disorder;</text></paragraph><paragraph id="id7aa356a905e74627af8b480bc2fb1429"><enum>(3)</enum><text>identifying or facilitating the development of best practices on the use of alternatives to opioids that target common painful conditions and include certain patient populations, such as geriatric patients, pregnant women, and children;</text></paragraph><paragraph id="idEE7099197FCA4009A6DB1540E9C39474"><enum>(4)</enum><text>disseminating information on the use of alternatives to opioids to providers in acute care settings, which may include emergency departments, outpatient clinics, critical access hospitals, Federally qualified health centers, Indian Health Service health facilities, and tribal hospitals; and</text></paragraph><paragraph id="idB70CADFB3AED4EDE811ECE951502A16F"><enum>(5)</enum><text>collecting data and reporting on health outcomes associated with the use of alternatives to opioids.</text></paragraph></subsection><subsection id="id8888566F7FA64B7186E1D9BE9E1F4AB8"><enum>(b)</enum><header>Pain management and funding</header><paragraph id="idCDA323401F66489CA4A998BCA0489A3F"><enum>(1)</enum><header>In general</header><text>The Secretary shall award grants to hospitals and other acute care settings relating to alternatives to opioids for pain management.</text></paragraph><paragraph id="idB03CA1DF7F7242CC9C8252AE7D26BB5A"><enum>(2)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated $5,000,000 for each of fiscal years 2019 through 2023 for purposes of carrying out this section.</text></paragraph></subsection></section><section id="idEB71496F4ABE4DADB41C8E54706255B7"><enum>1404.</enum><header>Building communities of recovery</header><text display-inline="no-display-inline">Section 547 of the Public Health Service Act (42 U.S.C. 290ee–2) is amended to read as follows:</text><quoted-block display-inline="no-display-inline" id="id4160144B28214B989F75B7F173576D7E" style="OLC"><section commented="no" display-inline="no-display-inline" id="HAAC556448DC04407A650EAA9CF954433" section-type="subsequent-section"><enum>547.</enum><header display-inline="yes-display-inline">Building communities of recovery</header><subsection commented="no" display-inline="no-display-inline" id="H8D80E509C00F4C308E276FA7987D670E"><enum>(a)</enum><header>Definition</header><text>In this section, the term <term>recovery community organization</term> means an independent nonprofit organization that—</text><paragraph commented="no" display-inline="no-display-inline" id="HFDBA39098AA244AF8BE61C8CECF8A714"><enum>(1)</enum><text>mobilizes resources within and outside of the recovery community, which may include through a peer support network, to increase the prevalence and quality of long-term recovery from substance use disorders; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H7B27478BE6524786A2A71761D1CAB245"><enum>(2)</enum><text>is wholly or principally governed by people in recovery for substance use disorders who reflect the community served.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HC5CCE42CC7954AC3AB55F4BBE00056F5"><enum>(b)</enum><header>Grants authorized</header><text>The Secretary shall award grants to recovery community organizations to enable such organizations to develop, expand, and enhance recovery services.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="H32B62C9CD7B9497CAFE8AA3FD3CCC92C"><enum>(c)</enum><header>Federal share</header><text>The Federal share of the costs of a program funded by a grant under this section may not exceed 85 percent.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="H66745B714F1A4DEDA1B88E17D518319B"><enum>(d)</enum><header>Use of funds</header><text>Grants awarded under subsection (b)—</text><paragraph commented="no" display-inline="no-display-inline" id="H82714B3FA41C401695357930D7E4D260"><enum>(1)</enum><text>shall be used to develop, expand, and enhance community and statewide recovery support services; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HE2155E7288FC4282808259A2AABE44A4"><enum>(2)</enum><text>may be used to—</text><subparagraph commented="no" display-inline="no-display-inline" id="H38C198E13B8A427EADDD228EFC21A261"><enum>(A)</enum><text>build connections between recovery networks, including between recovery community organizations and peer support networks, and with other recovery support services, including—</text><clause commented="no" display-inline="no-display-inline" id="HF0BA4FC1E59F400B9D025B22E102DEAF"><enum>(i)</enum><text>behavioral health providers;</text></clause><clause commented="no" display-inline="no-display-inline" id="H9000CDEE06214064B6AB0F8806721260"><enum>(ii)</enum><text>primary care providers and physicians;</text></clause><clause commented="no" display-inline="no-display-inline" id="id0E030EDF14BC439E8432570EE785E20E"><enum>(iii)</enum><text>educational and vocational schools;</text></clause><clause commented="no" display-inline="no-display-inline" id="HECD87F1A08D74395B144F0DE97C350FD"><enum>(iv)</enum><text>employers;</text></clause><clause commented="no" display-inline="no-display-inline" id="HAD45F00C8D354EEF9B5CA7E000D06B31"><enum>(v)</enum><text>housing services;</text></clause><clause commented="no" display-inline="no-display-inline" id="H5F268385C66242F49D59F172A0BE94A1"><enum>(vi)</enum><text>child welfare agencies; and</text></clause><clause commented="no" display-inline="no-display-inline" id="HC7929674C7754323B02D5F56674170C3"><enum>(vii)</enum><text>other recovery support services that facilitate recovery from substance use disorders, including non-clinical community services;</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H50B56BE7B17F4FB2BDC1C86182B14AA1"><enum>(B)</enum><text>reduce the stigma associated with substance use disorders; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H24426EA7E7B84B258652CD6FC955ED3D"><enum>(C)</enum><text>conduct outreach on issues relating to substance use disorders and recovery, including—</text><clause commented="no" display-inline="no-display-inline" id="H2017986EDDD84D92AEF72425AA06004C"><enum>(i)</enum><text>identifying the signs of substance use disorder;</text></clause><clause commented="no" display-inline="no-display-inline" id="HBE5E7C6EEB1240E29A4D7D633279F250"><enum>(ii)</enum><text>the resources available to individuals with substance use disorder and to families of an individual with a substance use disorder, including programs that mentor and provide support services to children;</text></clause><clause commented="no" display-inline="no-display-inline" id="H30523E5B84ED43EBB60038AB5B5044E8"><enum>(iii)</enum><text>the resources available to help support individuals in recovery; and</text></clause><clause commented="no" display-inline="no-display-inline" id="HD99595D6505F4CC289A5EC0972DFA701"><enum>(iv)</enum><text>related medical outcomes of substance use disorders, the potential of acquiring an infection commonly associated with illicit drug use, and neonatal abstinence syndrome among infants exposed to opioids during pregnancy.</text></clause></subparagraph></paragraph></subsection><subsection id="id6c22dc87c43442e2b7e6dae57f445661"><enum>(e)</enum><header>Special consideration</header><text>In carrying out this section, the Secretary shall give special consideration to the unique needs of rural areas, including areas with an age-adjusted rate of drug overdose deaths that is above the national average and areas with a shortage of prevention and treatment services.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="HEB3233AF9E434EC080CD11A6DD8B2F3C"><enum>(f)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id1510BC8614404C36842D3A29B32C3AFC"><enum>1405.</enum><header>Peer support technical assistance center</header><subsection id="id9127C48F9DB84B1DA4AEC57B1C0C83E9"><enum>(a)</enum><header>Establishment</header><text>The Secretary, acting through the Assistant Secretary for Mental Health and Substance Abuse, shall establish or operate a National Peer-Run Training and Technical Assistance Center for Addiction Recovery Support (referred to in this subsection as the <quote>Center</quote>).</text></subsection><subsection id="ida378111bc0a54ca3bc56f7bef423ac12"><enum>(b)</enum><header>Functions</header><text>The Center established under subsection (a) shall provide technical assistance and support to recovery community organizations and peer support networks, including such assistance and support related to—</text><paragraph id="id1ff4c36dfef94a22a0882f2bdda4f36a"><enum>(1)</enum><text>training on identifying—</text><subparagraph id="id9E6A4F7F5F9C49D4A3CDCBEBE87382E1"><enum>(A)</enum><text>signs of substance use disorder;</text></subparagraph><subparagraph id="id528B1F56E6764858A4712C3768511C84"><enum>(B)</enum><text>resources to assist individuals with a substance use disorder, or resources for families of an individual with a substance use disorder; and</text></subparagraph><subparagraph id="id0BCC1AF5E0464D85A9797A22F04EF075"><enum>(C)</enum><text>best practices for the delivery of recovery support services;</text></subparagraph></paragraph><paragraph id="id0D318339249B47ABB7EE04E11A715CF8"><enum>(2)</enum><text>the provision of translation services, interpretation, or other such services for clients with limited English speaking proficiency;</text></paragraph><paragraph id="idE85C9B5893494DB8ACFF6E7E7C05EC70"><enum>(3)</enum><text>data collection to support research, including for translational research;</text></paragraph><paragraph id="id78465605604E454480EC734448AFDB8A"><enum>(4)</enum><text>capacity building; and</text></paragraph><paragraph id="id750DAE17674F4930918B3ABB6CE3CBE7"><enum>(5)</enum><text>evaluation and improvement, as necessary, of the effectiveness of such services provided by recovery community organizations (as defined in section 547 of the Public Health Service Act).</text></paragraph></subsection><subsection id="id01087C5E352147B2B7A441BEB485BD56"><enum>(c)</enum><header>Best practices</header><text>The Center established under subsection (a) shall periodically issue best practices for use by recovery community organizations and peer support networks.</text></subsection><subsection id="id2FAF2AD59C1A4530B96F521B70C6B0B7"><enum>(d)</enum><header>Recovery community organization</header><text>In this section, the term <term>recovery community organization</term> has the meaning given such term in section 547 of the Public Health Service Act.</text></subsection><subsection id="id91E93C2678F54688937D5F4C5D3088DA"><enum>(e)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2019 through 2023.</text></subsection></section><section commented="no" id="idF2E2D0EBA5024F1C84D1D56D82AE1A00"><enum>1406.</enum><header>Medication-assisted treatment for recovery from addiction</header><subsection id="idA54B223556184A1985E7CCA644B1E585"><enum>(a)</enum><header>Waivers for maintenance treatment or detoxification</header><text display-inline="yes-display-inline">Section 303(g)(2)(G)(ii) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)(ii)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id806AC04CCD764BEBACC74DFEBCC2B0CA" style="OLC"><subclause id="id24c814d2e3784bbea7acd334ffa127f2" indent="up2"><enum>(VIII)</enum><text>The physician graduated in good standing from an accredited school of allopathic medicine or osteopathic medicine in the United States during the 5-year period immediately preceding the date on which the physician submits to the Secretary a written notification under subparagraph (B) and successfully completed a comprehensive allopathic or osteopathic medicine curriculum or accredited medical residency that—</text><item id="id15146B7FF6DF4AF8A53B8E69DEEBA95D"><enum>(aa)</enum><text>included not less than 24 hours of training on treating and managing opioid-dependent patients; and</text></item><item id="id2D92F265CB4D41E6AB544F6B5DBB322E"><enum>(bb)</enum><text>included, at a minimum—</text><subitem id="id7868cdf3451f4f3d80b4de86d89a506b"><enum>(AA)</enum><text>the training described in items (aa) through (gg) of subclause (IV); and</text></subitem><subitem id="id6DF4372BA1EE4E4B85A33498F1CA377D"><enum>(BB)</enum><text>training with respect to any other best practice the Secretary determines should be included in the curriculum, which may include training on pain management, including assessment and appropriate use of opioid and non-opioid alternatives.</text></subitem></item></subclause><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="idD7EB1487639B420DA292F50D9263EF4C"><enum>(b)</enum><header>Treatment for children</header><text>The Secretary shall consider ways to ensure that an adequate number of physicians who meet the requirements under the amendment made by subsection (a) and have a specialty in pediatrics, or the treatment of children or of adolescents, are granted a waiver under section 303(g)(2) of the Controlled Substances Act (21 U.S.C. 823(g)(2)) to treat children and adolescents with substance use disorders.</text></subsection><subsection id="id1D16F259945F4B268BAD535A78D07E75"><enum>(c)</enum><header>Technical amendment</header><text>Section 102(24) of the Controlled Substances Act (21 U.S.C. 802(24)) is amended by striking <quote>Health, Education, and Welfare</quote> and inserting <quote>Health and Human Services</quote>.</text></subsection></section><section id="idBD102A8CC7314F25B61713FB99D857AE" section-type="subsequent-section"><enum>1407.</enum><header>Grant program</header><subsection id="id1B3BE33E993C42269287D69648597078"><enum>(a)</enum><header>In general</header><text>The Secretary shall establish a grant program under which the Secretary may make grants to accredited schools of allopathic medicine or osteopathic medicine and teaching hospitals located in the United States to support the development of curricula that meet the requirements under subclause (VIII) of section 303(g)(2)(G)(ii) of the Controlled Substances Act, as added by section 1406(a) of this Act.</text></subsection><subsection id="id622B627BFEF3449FA46BA403250BD572"><enum>(b)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated for grants under subsection (a), $4,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section><section id="id4520931097e64c0e8bf6de9a7fe666e9"><enum>1408.</enum><header>Allowing for more flexibility with respect to medication-assisted treatment for opioid use disorders</header><text display-inline="no-display-inline">Subclause (II) of section 303(g)(2)(B)(iii) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(B)(iii)) is amended to read as follows:</text><quoted-block display-inline="no-display-inline" id="idf52f6d6bbce84f918703e9f9b102ca93" style="OLC"><subclause id="id57b399a8d54e4aac90d0ca7a43f2d67b" indent="up3"><enum>(II)</enum><text>The applicable number is—</text><item id="idb30717f597d94b5ab25d1f71e995f98c"><enum>(aa)</enum><text>100 if, not sooner than 1 year after the date on which the practitioner submitted the initial notification, the practitioner submits a second notification to the Secretary of the need and intent of the practitioner to treat up to 100 patients; or</text></item><item id="idb6bff8685a2c4c8d9d042762335dfe72"><enum>(bb)</enum><text>275 if the practitioner meets the requirements specified in section 8.610 of title 42, Code of Federal Regulations (or successor regulations).</text></item></subclause><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="idEB505672E59E4474A1CAD63225C69C6F"><enum>1409.</enum><header>National recovery housing best practices</header><subsection id="id342DC5D0281A4AAE820D5A906CE21432"><enum>(a)</enum><header>Best practices for operating recovery housing</header><paragraph id="id90E138E64D984B34871D63B4281D0E4F"><enum>(1)</enum><header>In general</header><text>The Secretary, in consultation with the individuals and entities described in paragraph (2), shall identify or facilitate the development of best practices, which may include model laws for implementing suggested minimum standards, for operating recovery housing.</text></paragraph><paragraph id="id2B8EDC3D54344D0E977B7A8099003C47"><enum>(2)</enum><header>Consultation</header><text>In carrying out the activities described in paragraph (1) the Secretary shall consult with, as appropriate—</text><subparagraph id="id6b0af8314b3540d382c13e3ede24fe4d"><enum>(A)</enum><text>relevant divisions of the Department of Health and Human Services, including the Substance Abuse and Mental Health Services Administration, the Office of Inspector General, the Indian Health Service, and the Centers for Medicare & Medicaid Services;</text></subparagraph><subparagraph id="idf03c1ef1fb824cab9f12e85e61043301"><enum>(B)</enum><text>the Secretary of Housing and Urban Development;</text></subparagraph><subparagraph id="idad33e95f61604977bae38d938c758019"><enum>(C)</enum><text>directors or commissioners, as applicable, of State health departments, tribal health departments, State Medicaid programs, and State insurance agencies;</text></subparagraph><subparagraph id="id5cbf2f3f878a4f22a7100a2505ee31cb"><enum>(D)</enum><text>representatives of health insurance issuers;</text></subparagraph><subparagraph id="id13ecd984d32d431185f72ff6e38157a5"><enum>(E)</enum><text>national accrediting entities and reputable providers of, and analysts of, recovery housing services, including Indian Tribes, tribal organizations, and tribally designated housing entities that provide recovery housing services, as applicable;</text></subparagraph><subparagraph id="ida59b1128c3fb4b1b826828fbae3a7f25"><enum>(F)</enum><text>individuals with a history of substance use disorder; and</text></subparagraph><subparagraph id="ide920142b8fcc42a48bd4b3ecd66ab00b"><enum>(G)</enum><text>other stakeholders identified by the Secretary.</text></subparagraph></paragraph></subsection><subsection id="idA002750BADC4482988D4088E04A6EDBF"><enum>(b)</enum><header>Identification of fraudulent recovery housing operators</header><paragraph id="id6b612cc3f24c494fb435c19013f5f564"><enum>(1)</enum><header>In general</header><text>The Secretary, in consultation with the individuals and entities described in paragraph (2), shall identify or facilitate the development of common indicators that could be used to identify potentially fraudulent recovery housing operators.</text></paragraph><paragraph id="idf72f4affe1c044a1aff757b73d20a6d6"><enum>(2)</enum><header>Consultation</header><text>In carrying out the activities described in paragraph (1), the Secretary shall consult with, as appropriate—</text><subparagraph id="id4c022b6731d849699d1e2c928f241e78"><enum>(A)</enum><text>relevant divisions of the Department of Health and Human Services, including the Substance Abuse and Mental Health Services Administration, the Office of Inspector General, the Indian Health Service, and the Centers for Medicare & Medicaid Services;</text></subparagraph><subparagraph id="id70f916a88cb74797a78088e9356aa07a"><enum>(B)</enum><text>the Attorney General;</text></subparagraph><subparagraph id="iddec845f8d00b4b4a95d1cd7a0e5166e5"><enum>(C)</enum><text>the Secretary of Housing and Urban Development;</text></subparagraph><subparagraph id="id342dbc7773c44ad48599b83184303820"><enum>(D)</enum><text>directors or commissioners, as applicable, of State health departments, tribal health departments, State Medicaid programs, and State insurance agencies;</text></subparagraph><subparagraph id="idc4594ce2d95542fc8a60568111711499"><enum>(E)</enum><text>representatives of health insurance issuers;</text></subparagraph><subparagraph id="id763eb88606e446eca3557569af583451"><enum>(F)</enum><text>national accrediting entities and reputable providers of, and analysts of, recovery housing services, including Indian Tribes, tribal organizations, and tribally designated housing entities that provide recovery housing services, as applicable;</text></subparagraph><subparagraph id="idACB752856FCD4D7AA6A5E813F975C5B1"><enum>(G)</enum><text>individuals with a history of substance use disorder; and</text></subparagraph><subparagraph id="idBAF340100E5E4DA5BF51A7932DC323D7"><enum>(H)</enum><text>other stakeholders identified by the Secretary.</text></subparagraph></paragraph><paragraph id="id6A95059B213E4AE68FC7C2AC6E2C0028"><enum>(3)</enum><header>Requirements</header><subparagraph id="id24c34bcf759541dbb75741531a99bccd"><enum>(A)</enum><header>Practices for identification and reporting</header><text>In carrying out the activities described in this subsection, the Secretary shall consider how law enforcement, public and private payers, and the public can best identify and report fraudulent recovery housing operators.</text></subparagraph><subparagraph id="idd37dd463b248411499d9636b9806a862"><enum>(B)</enum><header>Factors to be considered</header><text>In carrying out the activities described in this subsection, the Secretary shall consider identifying or developing indicators regarding—</text><clause id="id993c00927ed244529f0e5a75c1c91285"><enum>(i)</enum><text>unusual billing practices;</text></clause><clause id="idb2440366296d4536aea0ece99c93eddd"><enum>(ii)</enum><text>average lengths of stays;</text></clause><clause id="id8704fc6a6b474dc19ef82eab964418d7"><enum>(iii)</enum><text>excessive levels of drug testing (in terms of cost or frequency);</text></clause><clause id="id7e268c5a1de84810bad8f3fa6f412f4f"><enum>(iv)</enum><text>unusually high levels of recidivism; and</text></clause><clause id="idb4e03615a392400294afa213f1a1da18"><enum>(v)</enum><text>any other factors identified by the Secretary.</text></clause></subparagraph></paragraph></subsection><subsection id="idABA22E0A7E8F47AE8EC89C37D30FB6BC"><enum>(c)</enum><header>Dissemination</header><text>The Secretary shall, as appropriate, disseminate the best practices identified or developed under subsection (a), and the common indicators identified or developed under subsection (b), to—</text><paragraph id="id416D43DB5E4C47ABB400CDDCAEC05CD7"><enum>(1)</enum><text>State agencies, which may include the provision of technical assistance to State agencies seeking to adopt or implement such best practices;</text></paragraph><paragraph id="id7354D9AABF6B466AA26BA52E0BF83E94"><enum>(2)</enum><text>Indian Tribes, tribal organizations, and tribally designated housing entities;</text></paragraph><paragraph id="idE393B342C7E143C7862BE2C1D2558BA7"><enum>(3)</enum><text>the Attorney General;</text></paragraph><paragraph id="id35636E2F24C14BE191EEB3B9C2EE4347"><enum>(4)</enum><text>the Secretary of Labor;</text></paragraph><paragraph id="id11C9C80503BB4276AF1CB7DC0BCF1D33"><enum>(5)</enum><text>the Secretary of Housing and Urban Development;</text></paragraph><paragraph id="id68A734FC6564430CA430565B9686BDE6"><enum>(6)</enum><text>State and local law enforcement agencies;</text></paragraph><paragraph id="idE0BB4AB1751A41E592FF72F98A1838C4"><enum>(7)</enum><text>health insurance issuers;</text></paragraph><paragraph id="idC50B81F775D645C29FFED1F0188574C6"><enum>(8)</enum><text>recovery housing entities; and</text></paragraph><paragraph id="id60477B17F0F047EAB3653587B87C19AF"><enum>(9)</enum><text>the public.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idDF9C9421712D4F35A80C10F9FAFAD5AE"><enum>(d)</enum><header>Requirements</header><text display-inline="yes-display-inline">In carrying out the activities under subsections (a) and (b), the Secretary, in consultation with appropriate stakeholders as described in each such subsection, shall consider how recovery housing is able to support recovery and prevent relapse, recidivism, or overdose (including overdose death), including by improving access and adherence to treatment, including medication-assisted treatment.</text></subsection><subsection id="id9393c124c6ce477a8fb49ea4eebb8c51"><enum>(e)</enum><header>Rule of construction</header><text>Nothing in this section shall be construed to provide the Secretary with the authority to require States to adhere to minimum standards in the State oversight of recovery housing.</text></subsection><subsection id="idee23893f2f36400d9dc495ad14ce5161"><enum>(f)</enum><header>Definitions</header><text>In this section—</text><paragraph id="id6854E4DB17E74A7B931B09F001D34ED7"><enum>(1)</enum><text>the term <term>recovery housing</term> means a shared living environment free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders; and</text></paragraph><paragraph id="id816338C541964DD5A86003002E927871"><enum>(2)</enum><text>the term <term>tribally designated housing entity</term> has the meaning given such term in section 4 of the Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103).</text></paragraph></subsection></section><section id="id6C3D6FF7245641D580C5C97CC09BC60C"><enum>1410.</enum><header>Addressing economic and workforce impacts of the opioid crisis</header><subsection id="id667D1CC9171C455D81D8930026C4D254"><enum>(a)</enum><header>Definitions</header><text>Except as otherwise expressly provided, in this section:</text><paragraph id="idCCADDF3D4A1043FDA6BAAAAF32176F3E"><enum>(1)</enum><header>WIOA definitions</header><text>The terms <term>core program</term>, <term>individual with a barrier to employment</term>, <term>local area</term>, <term>local board</term>, <term>one-stop operator</term>, <term>outlying area</term>, <term>State</term>, <term>State board</term>, and <term>supportive services</term> have the meanings given the terms in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102).</text></paragraph><paragraph id="id88C47324D6CB422B826C4661E2954296"><enum>(2)</enum><header>Education provider</header><text>The term <term>education provider</term> means—</text><subparagraph id="id03CF4816EB8C4D09BA0512C671F8FDBF"><enum>(A)</enum><text>an institution of higher education, as defined in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001); or</text></subparagraph><subparagraph id="id8F68F608CA624A599E4579D73AECA7E5"><enum>(B)</enum><text>a postsecondary vocational institution, as defined in section 102(c) of such Act (20 U.S.C. 1002(c)).</text></subparagraph></paragraph><paragraph id="id23481B475E2F4A5FB4E951888E1C22D3"><enum>(3)</enum><header>Eligible entity</header><text>The term <term>eligible entity</term> means—</text><subparagraph id="id3EC642CF46304045BA55E9BAA38C9A3D"><enum>(A)</enum><text>a State workforce agency;</text></subparagraph><subparagraph id="idFF69EF4444254BFEB34E03272E4DA0F2"><enum>(B)</enum><text>an outlying area; or</text></subparagraph><subparagraph id="id718C6221A3A04B12B590269655A3904F"><enum>(C)</enum><text>a Tribal entity.</text></subparagraph></paragraph><paragraph id="id69380A31FB0D42978479AAB74F329D4B"><enum>(4)</enum><header>Participating partnership</header><text>The term <term>participating partnership</term> means a partnership—</text><subparagraph id="id6AFC73B20F6F404EAFC4A0C2D782DA9E"><enum>(A)</enum><text>evidenced by a written contract or agreement; and</text></subparagraph><subparagraph id="id8FEF7D0921BE4064AA855426E891F21B"><enum>(B)</enum><text>including, as members of the partnership, a local board receiving a subgrant under subsection (d) and 1 or more of the following:</text><clause id="id458C15948DAB485D8CE5175BA13500BB"><enum>(i)</enum><text>The eligible entity.</text></clause><clause id="id520B67CC06AC41A3AEDCFAE292C059E0"><enum>(ii)</enum><text>A treatment provider.</text></clause><clause id="idBB5A595AEBEE4CF7B78934B06DB0FD0B"><enum>(iii)</enum><text>An employer or industry organization.</text></clause><clause id="id2CE36D8A747E4F1B9F14CFD991216BC3"><enum>(iv)</enum><text>An education provider.</text></clause><clause id="id2984C43301354CD0B0A403693F43C384"><enum>(v)</enum><text>A legal service or law enforcement organization.</text></clause><clause id="id17745D3D894D416A8F96E132D090A675"><enum>(vi)</enum><text>A faith-based or community-based organization.</text></clause><clause id="id3C2743F89D444F75B4CE07C65AE26B37"><enum>(vii)</enum><text>Other State or local agencies, including counties or local governments.</text></clause><clause id="id3D3313E2C0954D85BD5763699341E0AA"><enum>(viii)</enum><text>Other organizations, as determined to be necessary by the local board.</text></clause><clause id="idE5682538C8214432A0A410033F6F00CB"><enum>(ix)</enum><text>Indian Tribes or tribal organizations.</text></clause></subparagraph></paragraph><paragraph commented="no" id="id1DBDDDEF21BF41F587EC182554C074BE"><enum>(5)</enum><header>Program participant</header><text>The term <term>program participant</term> means an individual who—</text><subparagraph commented="no" id="id17B06F8D70184A9FB5A369482514559E"><enum>(A)</enum><text>is a member of a population of workers described in subsection (e)(2) that is served by a participating partnership through the pilot program under this section; and</text></subparagraph><subparagraph commented="no" id="id23BFE776915F468683BDC510CD596FC3"><enum>(B)</enum><text>enrolls with the applicable participating partnership to receive any of the services described in subsection (e)(3).</text></subparagraph></paragraph><paragraph commented="no" id="id2B4CBD4616614B1D8E941697C0EEF756"><enum>(6)</enum><header>Provider of peer recovery support services</header><text>The term <term>provider of peer recovery support services</term> means a provider that delivers peer recovery support services through an organization described in section 547(a) of the Public Health Service Act (42 U.S.C. 290ee–2(a)).</text></paragraph><paragraph id="idF88751E1BC234C9B9DA7E2F299FB5EAD"><enum>(7)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Labor.</text></paragraph><paragraph id="idC59D1C2F7CD0497C9D47EA004F0111F2"><enum>(8)</enum><header>State workforce agency</header><text>The term <term>State workforce agency</term> means the lead State agency with responsibility for the administration of a program under chapter 2 or 3 of subtitle B of title I of the Workforce Innovation and Opportunity Act (29 U.S.C. 3161 et seq., 3171 et seq.).</text></paragraph><paragraph commented="no" id="id96DFF413DC6441F795EF1F364AFE1FC1"><enum>(9)</enum><header>Substance use disorder</header><text>The term <term>substance use disorder</term> has the meaning given such term by the Assistant Secretary for Mental Health and Substance Use.</text></paragraph><paragraph id="idB714F580952B425694944D75D737E353"><enum>(10)</enum><header>Treatment provider</header><text>The term <term>treatment provider</term>—</text><subparagraph id="id6b49f24060784c9c8aef249596733409"><enum>(A)</enum><text>means a health care provider that—</text><clause id="id74678818A60F42A7824B6F2C7063E109"><enum>(i)</enum><text>offers services for treating substance use disorders and is licensed in accordance with applicable State law to provide such services; and</text></clause><clause id="id0b67210e40b44ed7bf7f408bf5570044"><enum>(ii)</enum><text>accepts health insurance for such services, including coverage under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); and</text></clause></subparagraph><subparagraph id="id6f809dff890c4618b85a722fa3456dc5"><enum>(B)</enum><text>may include—</text><clause id="id625b29fd7a5444b3a14e5777082c84b9"><enum>(i)</enum><text>a nonprofit provider of peer recovery support services;</text></clause><clause id="id72870370b6e449df86280296fe34c059"><enum>(ii)</enum><text>a community health care provider;</text></clause><clause id="id0cdb71fe67ff4395a9e7db3923c4cd10"><enum>(iii)</enum><text>a Federally qualified health center (as defined in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x));</text></clause><clause commented="no" id="idfe6f5df4e37c460cb8d8915e257dfa93"><enum>(iv)</enum><text>an Indian health program (as defined in section 3 of the Indian Health Care Improvement Act (25 U.S.C. 1603)), including an Indian health program that serves an urban center (as defined in such section); and</text></clause><clause id="id7ffa09771b9e4f8698659481e7ac7682"><enum>(v)</enum><text>a Native Hawaiian health center (as defined in section 12 of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11711)).</text></clause></subparagraph></paragraph><paragraph id="id880B04D8CB2547F896CFE6A99E247298"><enum>(11)</enum><header>Tribal entity</header><text>The term <term>Tribal entity</term> includes any Indian Tribe, tribal organization, Indian-controlled organization serving Indians, Native Hawaiian organization, or Alaska Native entity, as such terms are defined or used in section 166 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3221).</text></paragraph></subsection><subsection id="id5BCF508DD2C04A39A7476468153EB2BC"><enum>(b)</enum><header>Pilot program and grants authorized</header><paragraph id="id9624661137474F88BF6A068AAEFA122B"><enum>(1)</enum><header>In general</header><text>The Secretary, in consultation with the Secretary of Health and Human Services, shall carry out a pilot program to address economic and workforce impacts associated with a high rate of a substance use disorder. In carrying out the pilot program, the Secretary shall make grants, on a competitive basis, to eligible entities to enable such entities to make subgrants to local boards to address the economic and workforce impacts associated with a high rate of a substance use disorder.</text></paragraph><paragraph id="idA65A02495D554C74968C915273981712"><enum>(2)</enum><header>Grant amounts</header><text>The Secretary shall make each such grant in an amount that is not less than $500,000, and not more than $5,000,000, for a fiscal year.</text></paragraph></subsection><subsection id="idA4100A3979CA40E59A54A13A0B53CB7F"><enum>(c)</enum><header>Grant applications</header><paragraph id="idCA06E53CDE2549D7B08A52F604549545"><enum>(1)</enum><header>In general</header><text>An eligible entity applying for a grant under this section shall submit an application to the Secretary at such time and in such form and manner as the Secretary may reasonably require, including the information described in this subsection.</text></paragraph><paragraph id="id0AC44F51DE6C4542A120A02342B19F33"><enum>(2)</enum><header>Significant impact on community by opioid and substance use disorder-related problems</header><subparagraph id="idB65F61BCEF8541EF827A5AE801469DBA"><enum>(A)</enum><header>Demonstration</header><text>An eligible entity shall include in the application—</text><clause id="id9F0BC56EEDD64A5BAB2A71943E169E0C"><enum>(i)</enum><text>information that demonstrates significant impact on the community by problems related to opioid abuse or another substance use disorder, by—</text><subclause id="id7B23746F17DE4C188E225204DE1BB1C6"><enum>(I)</enum><text>identifying the counties, communities, regions, or local areas that have been significantly impacted and will be served through the grant (each referred to in this section as a <quote>service area</quote>); and</text></subclause><subclause id="id4B984A3D73694213B30AD0DE3C192F87"><enum>(II)</enum><text>demonstrating for each such service area, an increase equal to or greater than the national increase in such problems, between—</text><item id="id00AF82F1777F4ABFA55D1544131436E5"><enum>(aa)</enum><text>1999; and</text></item><item id="id0A5AC025330644999A96309F304BDB84"><enum>(bb)</enum><text>2016 or the latest year for which data are available; and</text></item></subclause></clause><clause id="id0D381B4B1EFF479C846F41D2337845F0"><enum>(ii)</enum><text>a description of how the eligible entity will prioritize support for significantly impacted service areas described in clause (i)(I).</text></clause></subparagraph><subparagraph id="id24234426CA12432CAD659A82318C081C"><enum>(B)</enum><header>Information</header><text>To meet the requirements described in subparagraph (A)(i)(II), the eligible entity may use information including data on—</text><clause id="id953B0235D675455F8CAFDB4FCDAA5D1A"><enum>(i)</enum><text>the incidence or prevalence of opioid abuse and other substance use disorders;</text></clause><clause id="id919A074F073C418794FB6F7F41302201"><enum>(ii)</enum><text>the age-adjusted rate of drug overdose deaths, as determined by the Director of the Centers for Disease Control and Prevention;</text></clause><clause id="id12360E4C6BFD4C9E87F06A850060605D"><enum>(iii)</enum><text>the rate of non-fatal hospitalizations related to opioid abuse or other substance use disorders;</text></clause><clause id="id5135D0A6D0C9435886120F100DE903EF"><enum>(iv)</enum><text>the number of arrests or convictions, or a relevant law enforcement statistic, that reasonably shows an increase in opioid abuse or another substance use disorder; or</text></clause><clause id="idaa0fda19ad0c46cdb06008eba54d5d49"><enum>(v)</enum><text>in the case of an eligible entity described in subsection (a)(3)(C), other alternative relevant data as determined appropriate by the Secretary.</text></clause></subparagraph><subparagraph id="id288c475f4c6b431eb66d1bf52b265e2d"><enum>(C)</enum><header>Support for state strategy</header><text>The eligible entity may include in the application information describing how the proposed services and activities are aligned with the State, outlying area, or Tribal strategy, as applicable, for addressing problems described in subparagraph (A) in specific service areas or across the State, outlying area, or Tribal land.</text></subparagraph></paragraph><paragraph id="id9D4325196BEC415FB29D68736FFCC504"><enum>(3)</enum><header>Economic and employment conditions demonstrate additional Federal support needed</header><subparagraph id="idE04BC169C44044AF9289A87A93E8B9F1"><enum>(A)</enum><header>Demonstration</header><text>An eligible entity shall include in the application information that demonstrates that a high rate of a substance use disorder has caused, or is coincident to—</text><clause id="idA2775885802C400C83EFB0A70B766136"><enum>(i)</enum><text>an economic or employment downturn in the service area; or</text></clause><clause id="ide9ef770ed0a94473b948a4163a5ad40d"><enum>(ii)</enum><text>persistent economically depressed conditions in such service area.</text></clause></subparagraph><subparagraph id="idF069FBB491984EC6A1C0FE21B0823D07"><enum>(B)</enum><header>Information</header><text>To meet the requirements of subparagraph (A), an eligible entity may use information including—</text><clause id="id79B75549EBA3476C928DF1D23DBBE7D0"><enum>(i)</enum><text>documentation of any layoff, announced future layoff, legacy industry decline, decrease in an employment or labor market participation rate, or economic impact, whether or not the result described in this clause is overtly related to a high rate of a substance use disorder;</text></clause><clause id="idB3A1338313314BC5BB3850C3A2F7AF94"><enum>(ii)</enum><text>documentation showing decreased economic activity related to, caused by, or contributing to a high rate of a substance use disorder, including a description of how the service area has been impacted, or will be impacted, by such a decrease;</text></clause><clause id="idA7490AFABC744BC0ACE94F230C4191D7"><enum>(iii)</enum><text>information on economic indicators, labor market analyses, information from public announcements, and demographic and industry data;</text></clause><clause id="id3245D4B2A56A48D3B5FD1AB88E0FB70D"><enum>(iv)</enum><text>information on rapid response activities (as defined in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102)) that have been or will be conducted, including demographic data gathered by employer or worker surveys or through other methods;</text></clause><clause id="id946DCE75BA504EBBAB7F9EDD73658AF7"><enum>(v)</enum><text>data or documentation, beyond anecdotal evidence, showing that employers face challenges filling job vacancies due to a lack of skilled workers able to pass a drug test; or</text></clause><clause id="idE5B0463805074801A469BB1363CEE923"><enum>(vi)</enum><text>any additional relevant data or information on the economy, workforce, or another aspect of the service area to support the application.</text></clause></subparagraph></paragraph></subsection><subsection id="idCAD6E17306D24055A8C4197F6C32DA17"><enum>(d)</enum><header>Subgrant authorization and application process</header><paragraph id="id57DFA75DDBF04CD0AA68ECF3EF95F8B4"><enum>(1)</enum><header>Subgrants authorized</header><subparagraph id="id6960503346024A0681420D624928C229"><enum>(A)</enum><header>In general</header><text>An eligible entity receiving a grant under subsection (b)—</text><clause id="idCC5043D8790E403EAA95AAC926BF469D"><enum>(i)</enum><text>may use not more than 5 percent of the grant funds for the administrative costs of carrying out the grant;</text></clause><clause id="idBA615C4677814B258FACE66E3193403C"><enum>(ii)</enum><text>in the case of an eligible entity described in subparagraph (A) or (B) of subsection (a)(3), shall use the remaining grant funds to make subgrants to local entities in the service area to carry out the services and activities described in subsection (e); and</text></clause><clause id="id9c113d811eec4581b3b373e8fbf05253"><enum>(iii)</enum><text>in the case of an eligible entity described in subsection (a)(3)(C), shall use the remaining grant funds to carry out the services and activities described in subsection (e).</text></clause></subparagraph><subparagraph id="ida1bd808f729d4db69b4bbba589ddad00"><enum>(B)</enum><header>Equitable distribution</header><text>In making subgrants under this subsection, an eligible entity shall ensure, to the extent practicable, the equitable distribution of subgrants, based on—</text><clause id="idee3b7b8375b44be2a9a5e9ac2b11c92f"><enum>(i)</enum><text>geography (such as urban and rural distribution); and</text></clause><clause id="idfad683b739dd4958bab8d9c65535b0b0"><enum>(ii)</enum><text>significantly impacted service areas as described in subsection (c)(2).</text></clause></subparagraph><subparagraph id="idbcb2dffb13174bcba6b4bf0d59c991fc"><enum>(C)</enum><header>Timing of subgrant funds distribution</header><text>An eligible entity making subgrants under this subsection shall disburse subgrant funds to a local board receiving a subgrant from the eligible entity by the later of—</text><clause id="id8AB7A71618CF4FFA8A41D4C0FD13396F"><enum>(i)</enum><text>the date that is 90 days after the date on which the Secretary makes the funds available to the eligible entity; or</text></clause><clause id="id90B1098C7EFF4D808C7C003FE51E51DD"><enum>(ii)</enum><text>the date that is 15 days after the date that the eligible entity makes the subgrant under subparagraph (A)(ii).</text></clause></subparagraph></paragraph><paragraph id="idD89E810E56D44263A6D777BF41DF206F"><enum>(2)</enum><header>Subgrant application</header><subparagraph id="id98AF656BA54544B48725AA5C4B5C1A8D"><enum>(A)</enum><header>In general</header><text>A local board desiring to receive a subgrant under this subsection from an eligible entity shall submit an application at such time and in such manner as the eligible entity may reasonably require, including the information described in this paragraph.</text></subparagraph><subparagraph id="id0BDC1811FD2B491284B7815D339C8F97"><enum>(B)</enum><header>Contents</header><text>Each application described in subparagraph (A) shall include—</text><clause id="idF486A73596C241BB9710058A77456294"><enum>(i)</enum><text>an analysis of the estimated performance of the local board in carrying out the proposed services and activities under the subgrant—</text><subclause id="id81F81ABBE5EF4202B63B2F6ED0252E5C"><enum>(I)</enum><text>based on—</text><item id="idFBCF00BE5551432BAD2B20D2D9D70F4E"><enum>(aa)</enum><text>primary indicators of performance described in section 116(c)(1)(A)(i) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3141(c)(1)(A)(i), to assess estimated effectiveness of the proposed services and activities, including the estimated number of individuals with a substance use disorder who may be served by the proposed services and activities;</text></item><item id="id061D2C67E6994CFDADD17D9FAA732D90"><enum>(bb)</enum><text>the record of the local board in serving individuals with a barrier to employment; and</text></item><item id="id5872D5C7FDCE4CA4A7FB09E76C856439"><enum>(cc)</enum><text>the ability of the local board to establish a participating partnership; and</text></item></subclause><subclause commented="no" id="id36A9DAC1A3D04344BAE1AB87E38E15BE"><enum>(II)</enum><text>which may include or utilize—</text><item id="id5A8C4164DD30469AA236D55C2BAE71B8"><enum>(aa)</enum><text>data from the National Center for Health Statistics of the Centers for Disease Control and Prevention;</text></item><item id="id082DB549118047D9854BEB109717FFE8"><enum>(bb)</enum><text>data from the Center for Behavioral Health Statistics and Quality of the Substance Abuse and Mental Health Services Administration;</text></item><item id="id15236CB954F44E6DB61BFDED25884A23"><enum>(cc)</enum><text>State vital statistics;</text></item><item id="id3ABDCF6A00A14BFFB4894FF4B9C3BBD7"><enum>(dd)</enum><text>municipal police department records;</text></item><item id="idA3E59C01EF0A4E28AAD50AACE4266496"><enum>(ee)</enum><text>reports from local coroners; or</text></item><item commented="no" id="id9C085BD0393E40E78A698F2FC7EB7409"><enum>(ff)</enum><text>other relevant data; and</text></item></subclause></clause><clause id="idf41a08593ba243a98460e2df2ded98f3"><enum>(ii)</enum><text>in the case of a local board proposing to serve a population described in subsection (e)(2)(B), a demonstration of the workforce shortage in the professional area to be addressed under the subgrant (which may include substance use disorder treatment and related services, non-addictive pain therapy and pain management services, mental health care treatment services, emergency response services, or mental health care), which shall include information that can demonstrate such a shortage, such as—</text><subclause id="id30a08ee73d4244a0a5a8b1d3a8c700b6"><enum>(I)</enum><text>the distance between—</text><item id="id31a6c191c8604f24a9612606dd25944b"><enum>(aa)</enum><text>communities affected by opioid abuse or another substance use disorder; and</text></item><item id="id569f19a7c8b147dea811d8a16eac566a"><enum>(bb)</enum><text>facilities or professionals offering services in the professional area; or</text></item></subclause><subclause id="id646a6550f8b843cd905c46b36b52d504"><enum>(II)</enum><text>the maximum capacity of facilities or professionals to serve individuals in an affected community, or increases in arrests related to opioid or another substance use disorder, overdose deaths, or nonfatal overdose emergencies in the community.</text></subclause></clause></subparagraph></paragraph></subsection><subsection id="id25976AFF8FA44886A25C14D6D7DFFB0C"><enum>(e)</enum><header>Subgrant services and activities</header><paragraph id="idEDF10F5F8F364B1C8BD6B9DE60BD4F42"><enum>(1)</enum><header>In general</header><text>Each local board that receives a subgrant under subsection (d) shall carry out the services and activities described in this subsection through a participating partnership.</text></paragraph><paragraph id="id49B70E1AE85340A7AA18FBCAC66EE5B1"><enum>(2)</enum><header>Selection of Population to be served</header><text>A participating partnership shall elect to provide services and activities under the subgrant to one or both of the following populations of workers:</text><subparagraph id="idD03F472F173E42BDB30503292B5FB98B"><enum>(A)</enum><text>Workers, including dislocated workers, individuals with barriers to employment, new entrants in the workforce, or incumbent workers (employed or underemployed), each of whom—</text><clause id="id38519E9B1E244078A63C37EDFB60BA99"><enum>(i)</enum><text>is directly or indirectly affected by a high rate of a substance use disorder; and</text></clause><clause id="idE377387CE7484F69B96B9C2693EF5705"><enum>(ii)</enum><text>voluntarily confirms that the worker, or a friend or family member of the worker, has a history of opioid abuse or another substance use disorder.</text></clause></subparagraph><subparagraph id="idFA0014D43993471699854A41458D1CFE"><enum>(B)</enum><text>Workers, including dislocated workers, individuals with barriers to employment, new entrants in the workforce, or incumbent workers (employed or underemployed), who—</text><clause id="id5DA3B2EF1B7643C0AA16EAAA9462EDA7"><enum>(i)</enum><text>seek to transition to professions that support individuals with a substance use disorder or at risk for developing such disorder, such as professions that provide—</text><subclause id="idBECDC3B657DB47E3B7B2AE486121467C"><enum>(I)</enum><text>substance use disorder treatment and related services;</text></subclause><subclause id="id63B2229C226D4D98A70992DA8BA6E5DE"><enum>(II)</enum><text>services offered through providers of peer recovery support services;</text></subclause><subclause id="id6B217588C12A4C84A99548EC37CA6162"><enum>(III)</enum><text>non-addictive pain therapy and pain management services;</text></subclause><subclause id="idA073F168CA3C48C19321AB2A282186FD"><enum>(IV)</enum><text>emergency response services; or</text></subclause><subclause id="idCB8C54D9FAB14F909187C8C2968727F7"><enum>(V)</enum><text>mental health care; and</text></subclause></clause><clause id="idA8CF2FF349F24505A45901D400AA6011"><enum>(ii)</enum><text>need new or upgraded skills to better serve such a population of struggling or at-risk individuals.</text></clause></subparagraph></paragraph><paragraph id="id5302CA69D4ED4F1E85687A55FD66276C"><enum>(3)</enum><header>Services and activities</header><text>Each participating partnership shall use funds available through a subgrant under this subsection to carry out 1 or more of the following:</text><subparagraph id="id366DD1B6BD564E869D521F351A342CF3"><enum>(A)</enum><header>Engaging employers</header><text>Engaging with employers to—</text><clause id="idB7DF6ADA82254ED3922551F29F4C96B8"><enum>(i)</enum><text>learn about the skill and hiring requirements of employers;</text></clause><clause id="id3BDAAF851E8F44A481D5A919E7DC53CC"><enum>(ii)</enum><text>learn about the support needed by employers to hire and retain program participants, and other individuals with a substance use disorder, and the support needed by such employers to obtain their commitment to testing creative solutions to employing program participants and such individuals;</text></clause><clause id="idF094B327FE2247DEAC32C301250644DE"><enum>(iii)</enum><text>connect employers and workers to on-the-job or customized training programs before or after layoff to help facilitate reemployment;</text></clause><clause id="id3F6EACF718DF4F688D5EA1A4902263BA"><enum>(iv)</enum><text>connect employers with an education provider to develop classroom instruction to complement on-the-job learning for program participants and such individuals;</text></clause><clause id="idB03A94CF6DA0485A858CAD832D9DE94B"><enum>(v)</enum><text>help employers develop the curriculum design of a work-based learning program for program participants and such individuals;</text></clause><clause id="id6F0E45D13E424D8AA9309E2397387868"><enum>(vi)</enum><text>help employers employ program participants or such individuals engaging in a work-based learning program for a transitional period before hiring such a program participant or individual for full-time employment of not less than 30 hours a week; or</text></clause><clause id="idfec82b7260d940439de26d52d50c1065"><enum>(vii)</enum><text>connect employers to program participants receiving concurrent outpatient treatment and job training services.</text></clause></subparagraph><subparagraph id="idA12D0086059A40B4AFB9763FE10E7D0D"><enum>(B)</enum><header>Screening services</header><text>Providing screening services, which may include—</text><clause id="id4051D3FF50144A18A7E21618D1557F28"><enum>(i)</enum><text>using an evidence-based screening method to screen each individual seeking participation in the pilot program to determine whether the individual has a substance use disorder;</text></clause><clause id="idE87E082FBFBF4584A6EE71D666255EDE"><enum>(ii)</enum><text>conducting an assessment of each such individual to determine the services needed for such individual to obtain or retain employment, including an assessment of strengths and general work readiness; or</text></clause><clause id="idB1F07A098E094A8DA94C8FEED9D7CE32"><enum>(iii)</enum><text>accepting walk-ins or referrals from employers, labor organizations, or other entities recommending individuals to participate in such program.</text></clause></subparagraph><subparagraph id="id11139E365FCD4F48AC34A6EBF57E5662"><enum>(C)</enum><header>Individual treatment and employment plan</header><text>Developing an individual treatment and employment plan for each program participant—</text><clause id="idFDBD1DE9B47B4A2495F8456E7C2918D4"><enum>(i)</enum><text>in coordination, as appropriate, with other programs serving the participant such as the core programs within the workforce development system under the Workforce Innovation and Opportunity Act (29 U.S.C. 3101 et seq.); and</text></clause><clause id="id870FB3253064449EA47C2D26DBC7EAEE"><enum>(ii)</enum><text>which shall include providing a case manager to work with each participant to develop the plan, which may include—</text><subclause id="idD8999840E39241E09DE93302D1288E79"><enum>(I)</enum><text>identifying employment and career goals;</text></subclause><subclause commented="no" id="id83348C505899443C8ED6177D1DAB2D25"><enum>(II)</enum><text>exploring career pathways that lead to in-demand industries and sectors, as determined by the State board and the head of the State workforce agency or, as applicable, the Tribal entity;</text></subclause><subclause id="id2D04EF75F9C4416084E0611F46BBD782"><enum>(III)</enum><text>setting appropriate achievement objectives to attain the employment and career goals identified under subclause (I); or</text></subclause><subclause id="id77CE6952115A406BBD5C6704014A1D34"><enum>(IV)</enum><text>developing the appropriate combination of services to enable the participant to achieve the employment and career goals identified under subclause (I).</text></subclause></clause></subparagraph><subparagraph id="id156E034854024A748592EC8F6F7D74D9"><enum>(D)</enum><header>Outpatient treatment and recovery care</header><text>In the case of a participating partnership serving program participants described in paragraph (2)(A) with a substance use disorder, providing individualized and group outpatient treatment and recovery services for such program participants that are offered during the day and evening, and on weekends. Such treatment and recovery services—</text><clause id="id8FA4E73BA25C433DAB43943E96D247E9"><enum>(i)</enum><text>shall be based on a model that utilizes combined behavioral interventions and other evidence-based or evidence-informed interventions; and</text></clause><clause id="id3B2FF39701A54B349F81ED8D72D05647"><enum>(ii)</enum><text>may include additional services such as—</text><subclause id="id6E55F5F302A443419F4C1492C5D7C31A"><enum>(I)</enum><text>health, mental health, addiction, or other forms of outpatient treatment that may impact a substance use disorder and co-occurring conditions;</text></subclause><subclause id="id1BD612CD202A409AB70E80E66AE1404C"><enum>(II)</enum><text>drug testing for a current substance use disorder prior to enrollment in career or training services or prior to employment;</text></subclause><subclause id="id972EA08D77074EDBBDCD6DE23E5DD294"><enum>(III)</enum><text>linkages to community services, including services offered by partner organizations designed to support program participants; or</text></subclause><subclause id="id6C2389898DB34F7C923A93DFCD1A79DD"><enum>(IV)</enum><text>referrals to health care, including referrals to substance use disorder treatment and mental health services.</text></subclause></clause></subparagraph><subparagraph id="id849FD7BB7629445895C62E17A3381684"><enum>(E)</enum><header>Supportive services</header><text>Providing supportive services, which shall include services such as—</text><clause id="id2FFF19FA433640DA949B385242DBACDD"><enum>(i)</enum><text>coordinated wraparound services to provide maximum support for program participants to assist the program participants in maintaining employment and recovery for not less than 12 months, as appropriate;</text></clause><clause id="id334E2AC4B1964E3F96390092D42050EC"><enum>(ii)</enum><text>assistance in establishing eligibility for assistance under Federal, State, Tribal, and local programs providing health services, mental health services, vocational services, housing services, transportation services, social services, or services through early childhood education programs (as defined in section 103 of the Higher Education Act of 1965 (20 U.S.C. 1003));</text></clause><clause id="id0ED27AF8969F407BBCE3727BCD9D001F"><enum>(iii)</enum><text>services offered through providers of peer recovery support services;</text></clause><clause id="id7B2C4ADE4774483CAB17CB5E8A3675CA"><enum>(iv)</enum><text>networking and mentorship opportunities; or</text></clause><clause id="id3E5EDFEED273468EB879F2EDE358D6C5"><enum>(v)</enum><text>any supportive services determined necessary by the local board.</text></clause></subparagraph><subparagraph id="id47CB4C42A2794F378F558CD92AC7DCE3"><enum>(F)</enum><header>Career and job training services</header><text>Offering career services and training services, and related services, concurrently or sequentially with the services provided under subparagraphs (B) through (E). Such services shall include the following:</text><clause id="id49E1D9C7EFF943DC8ED63DAA035DA6FC"><enum>(i)</enum><text>Services provided to program participants who are in a pre-employment stage of the program, which may include—</text><subclause id="idC184AC37CCF8413D8DD68FA6A89C439E"><enum>(I)</enum><text>initial education and skills assessments;</text></subclause><subclause id="idD96FA692C7E74348814E3FCF794FA46B"><enum>(II)</enum><text>traditional classroom training funded through individual training accounts under chapter 3 of subtitle B of title I of the Workforce Innovation and Opportunity Act (29 U.S.C. 3171 et seq.);</text></subclause><subclause id="id54A18F3E13B84322889B4C8496CB113E"><enum>(III)</enum><text>services to promote employability skills such as punctuality, personal maintenance skills, and professional conduct;</text></subclause><subclause id="id2346219B4A8A4E2C8446317BDBB991C3"><enum>(IV)</enum><text>in-depth interviewing and evaluation to identify employment barriers and to develop individual employment plans;</text></subclause><subclause id="id9FE226D3589748898C061FE5DE90FC95"><enum>(V)</enum><text>career planning that includes—</text><item id="idED7D418DFB0B4776995208948D93A846"><enum>(aa)</enum><text>career pathways leading to in-demand, high-wage jobs; and</text></item><item id="idDE9898E02A234B5CB08802DE5D046D17"><enum>(bb)</enum><text>job coaching, job matching, and job placement services;</text></item></subclause><subclause id="idD24B47D22E71478C9AE9050AD3E205C5"><enum>(VI)</enum><text>provision of payments and fees for employment and training-related applications, tests, and certifications; or</text></subclause><subclause id="id4D32DCAB08A74A87B47D63F457EA28EB"><enum>(VII)</enum><text>any other appropriate career service or training service described in section 134(c) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3174(c)).</text></subclause></clause><clause id="idADD411D142E44447996C97328BE1C693"><enum>(ii)</enum><text>Services provided to program participants during their first 6 months of employment to ensure job retention, which may include—</text><subclause id="id1F6F1CEC0959436D8743FDF1056E1E75"><enum>(I)</enum><text>case management and support services, including a continuation of the services described in clause (i);</text></subclause><subclause id="id91E105760AEE4F42A6F1412286A7C062"><enum>(II)</enum><text>a continuation of skills training, and career and technical education, described in clause (i) that is conducted in collaboration with the employers of such participants;</text></subclause><subclause id="idB14E9EA255914EC7AC9A40F8043D51EC"><enum>(III)</enum><text>mentorship services and job retention support for such participants; or</text></subclause><subclause id="id1A8EAF59F6494EEFB712CD77F97A9B2B"><enum>(IV)</enum><text>targeted training for managers and workers working with such participants (such as mentors), and human resource representatives in the business in which such participants are employed.</text></subclause></clause><clause id="id198320492FB34E0D91986004DEF7FB5F"><enum>(iii)</enum><text>Services to assist program participants in maintaining employment for not less than 12 months, as appropriate.</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id3EEF19A57257479BB0E761D918C30CC0"><enum>(G)</enum><header display-inline="yes-display-inline">Proven and promising practices</header><text display-inline="yes-display-inline">Leading efforts in the service area to identify and promote proven and promising strategies and initiatives for meeting the needs of employers and program participants.</text></subparagraph></paragraph><paragraph id="id7DEA86F4BD374941BD2257E2253C3B62"><enum>(4)</enum><header>Limitations</header><text>A participating partnership may not use—</text><subparagraph id="idFB90EE7B1B1B4AD49953EFBDEAEA8695"><enum>(A)</enum><text>more than 10 percent of the funds received under a subgrant under subsection (d) for the administrative costs of the partnership;</text></subparagraph><subparagraph id="id42BA2E63E0F44BE0A9F4266CB3953259"><enum>(B)</enum><text>more than 10 percent of the funds received under such subgrant for the provision of treatment and recovery services, as described in paragraph (3)(D); and</text></subparagraph><subparagraph id="idF3D486CE92664D38BEFF2B2AF46BA693"><enum>(C)</enum><text>more than 10 percent of the funds received under such subgrant for the provision of supportive services described in paragraph (3)(E) to program participants.</text></subparagraph></paragraph></subsection><subsection id="id9B01897B07574275B2D31C7B0C42E9C7"><enum>(f)</enum><header>Performance accountability</header><paragraph id="id0D043463EDB5462986E46D56AF55DF5C"><enum>(1)</enum><header>Reports</header><text>The Secretary shall establish quarterly reporting requirements for recipients of grants and subgrants under this section that, to the extent practicable, are based on the performance accountability system under section 116 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3141) and, in the case of a grant awarded to an eligible entity described in subsection (a)(3)(C), section 166(h) of such Act (29 U.S.C. 3221(h)), including the indicators described in subsection (c)(1)(A)(i) of such section 116 and the requirements for local area performance reports under subsection (d) of such section 116.</text></paragraph><paragraph id="id2E098EA7BBF647C6B83D2F87C88D15AA"><enum>(2)</enum><header>Evaluations</header><subparagraph id="idCC7FAF30C9A74AE1A8D6701D3A928C6C"><enum>(A)</enum><header>Authority to enter into agreements</header><text>The Secretary shall ensure that an independent evaluation is conducted on the pilot program carried out under this section to determine the impact of the program on employment of individuals with substance use disorders. The Secretary shall enter into an agreement with eligible entities receiving grants under this section to pay for all or part of such evaluation.</text></subparagraph><subparagraph id="id9B42B1EAE9304D5B91639E92CE0EAD59"><enum>(B)</enum><header>Methodologies to be used</header><text>The independent evaluation required under this paragraph shall use experimental designs using random assignment or, when random assignment is not feasible, other reliable, evidence-based research methodologies that allow for the strongest possible causal inferences.</text></subparagraph></paragraph></subsection><subsection id="idD78EBA070D59484C97CF37CA08B1792F"><enum>(g)</enum><header>Funding</header><paragraph id="id91E29CB8F13E4E76A35106AAE328FE94"><enum>(1)</enum><header>Covered fiscal year</header><text>In this subsection, the term <term>covered fiscal year</term> means any of fiscal years 2018 through 2023.</text></paragraph><paragraph id="id06F84D2CA9AF4BC487217921EADAC279"><enum>(2)</enum><header>Using funding for national dislocated worker grants</header><text>Subject to paragraph (4) and notwithstanding section 132(a)(2)(A) and subtitle D of the Workforce Innovation and Opportunity Act (29 U.S.C. 3172(a)(2)(A), 3221 et seq.), the Secretary may use, to carry out the pilot program under this section for a covered fiscal year—</text><subparagraph id="id2CA21A1D8EA54A53B1D906D01B330311"><enum>(A)</enum><text>funds made available to carry out section 170 of such Act (29 U.S.C. 3225) for that fiscal year;</text></subparagraph><subparagraph id="idF859929E502B47F7858A75A3D7A5D36D"><enum>(B)</enum><text>funds made available to carry out section 170 of such Act that remain available for that fiscal year; and</text></subparagraph><subparagraph id="idCFAD22E146CA4A909C871F3283EA1C5E"><enum>(C)</enum><text>funds that remain available under section 172(f) of such Act (29 U.S.C. 3227(f)).</text></subparagraph></paragraph><paragraph id="id2E7021DE24184AE1880FC1E32550E993"><enum>(3)</enum><header>Availability of funds</header><text>Funds appropriated under section 136(c) of such Act (29 U.S.C. 3181(c)) and made available to carry out section 170 of such Act for a fiscal year shall remain available for use under paragraph (2) for a subsequent fiscal year until expended.</text></paragraph><paragraph id="id9D848644BE2B4C85AE71584DB4969A5B"><enum>(4)</enum><header>Limitation</header><text>The Secretary may not use more than $100,000,000 of the funds described in paragraph (2) for any covered fiscal year under this section.</text></paragraph></subsection></section><section id="id433AD342E12D470FA7018B5D8CF60ABE"><enum>1411.</enum><header>Career Act</header><subsection id="idd47b4e072e1d4516a0e90dee86e4c7c5"><enum>(a)</enum><header>In general</header><text>The Secretary, in consultation with the Secretary of Labor, shall continue or establish a program to support individuals in recovery from a substance use disorder transition to independent living and the workforce.</text></subsection><subsection id="iddd70e8da6ffa4cc5b68a923e7cef2f70"><enum>(b)</enum><header>Grants authorized</header><text>In carrying out the activities under this section, the Secretary shall, on a competitive basis, award grants for a period of not more than 5 years to entities to enable such entities to carry out evidence-based programs to help individuals in recovery from a substance use disorder transition from treatment to independent living and the workforce. Such entities shall coordinate, as applicable, with Indian tribes or tribal organizations (as applicable), State boards and local boards (as defined in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102), lead State agencies with responsibility for a workforce investment activity (as defined in such section 3), and State agencies responsible for carrying out substance use disorder prevention and treatment programs.</text></subsection><subsection id="id033e38193503457d8a9acb7a2ff3b584"><enum>(c)</enum><header>Priority</header><text>In awarding grants under this section, the Secretary shall give priority to entities located in a State with—</text><paragraph id="id4284f7975f28436f93317d035f04bef7"><enum>(1)</enum><text>an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, as determined by the Director of the Centers for Disease Control and Prevention;</text></paragraph><paragraph id="id4ff528cbe83841de93daf2579abfbb62"><enum>(2)</enum><text>a rate of unemployment, based on data provided by the Bureau of Labor Statistics for calendar years 2013 through 2017, that is above the national average; and</text></paragraph><paragraph id="id69c9f50a8b0d42f5aafb06b0e2848519"><enum>(3)</enum><text>a rate of labor force participation, based on data provided by the Bureau of Labor Statistics for calendar years 2013 through 2017, that is below the national average.</text></paragraph></subsection><subsection id="id3d145c991a6b4e57922ba77aec33c117"><enum>(d)</enum><header>Preference</header><text>In awarding grants under this section, the Secretary shall, as appropriate, give preference to entities located in an area with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate.</text></subsection><subsection id="id9923567f9cf34bdf9cb465c88cb2f9d7"><enum>(e)</enum><header>Applications</header><text>An eligible entity shall submit an application at such time and in such manner as the Secretary may require. In submitting an application, the entity shall demonstrate the ability to partner with local stakeholders, which may include local employers, community stakeholders, the local workforce development board, and local and State governments, to—</text><paragraph id="ideece7eea792849cface299c8cc5109df"><enum>(1)</enum><text>identify gaps in the workforce due to the prevalence of substance use disorders;</text></paragraph><paragraph id="id62dc6bb35f9346f3b723dced3848681f"><enum>(2)</enum><text>in coordination with statewide employment and training activities, including coordination and alignment of activities carried out by entities provided grant funds under section 1410, help individuals in recovery from a substance use disorder transition into the workforce, including by providing career services, training services as described in paragraph (2) of section 134(c) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3174(c)), and related services described in section 134(a)(3) of such Act (42 U.S.C. 3174(a)); and</text></paragraph><paragraph id="id8000e00c395f40b9af9195b64f72022b"><enum>(3)</enum><text>assist employers with informing their employees of the resources, such as resources related to substance use disorders that are available to their employees.</text></paragraph></subsection><subsection id="idd946385f98c44bc4aab30613f986c8ec"><enum>(f)</enum><header>Use of funds</header><text>An entity receiving a grant under this section shall use the funds to conduct one or more of the following activities:</text><paragraph id="idfb57a1d3ca6e434d8e66311d776b4e8a"><enum>(1)</enum><text>Hire case managers, care coordinators, providers of peer recovery support services, as described in section 547(a) of the Public Health Service Act (42 U.S.C. 290ee–2(a)), or other professionals, as appropriate, to provide services that support treatment, recovery, and rehabilitation, and prevent relapse, recidivism, and overdose, including by encouraging—</text><subparagraph id="ide78bb9c9210945dc8df85402d0142e27"><enum>(A)</enum><text>the development of daily living skills; and</text></subparagraph><subparagraph id="id21b9fd75c092443f88af288b0619706c"><enum>(B)</enum><text>the use of counseling, care coordination, and other services, as appropriate, to support recovery from substance use disorders.</text></subparagraph></paragraph><paragraph id="idc6beb1388cbc4bfb8e2cc6fe9db13f1e"><enum>(2)</enum><text>Implement or utilize innovative technologies, which may include the use of telemedicine.</text></paragraph><paragraph id="id1A178263796048CEAEA69E3F7C91BF0A"><enum>(3)</enum><text>In coordination with the lead State agency with responsibility for a workforce investment activity or local board described in subsection (b), provide—</text><subparagraph id="id703F3A7A506B425393B27DCAF77FBDFF"><enum>(A)</enum><text>short-term prevocational training services; and</text></subparagraph><subparagraph id="idD973A93DE141496490E21DE623009C53"><enum>(B)</enum><text>training services that are directly linked to the employment opportunities in the local area or the planning region.</text></subparagraph></paragraph></subsection><subsection id="ide2bc506e25c74f65a063596ba841a89a"><enum>(g)</enum><header>Support for State strategy</header><text>An eligible entity shall include in its application under subsection (e) information describing how the services and activities proposed in such application are aligned with the State, outlying area, or Tribal strategy, as applicable, for addressing issues described in such application and how such entity will coordinate with existing systems to deliver services as described in such application.</text></subsection><subsection id="id144738a84c504270ad5f3837c024d946"><enum>(h)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated such sums as may be necessary for each of fiscal years 2019 through 2023 for purposes of carrying out this section.</text></subsection></section><section id="id7497450c5ab44692bb9fa4831544b78d"><enum>1412.</enum><header>Pilot program to help individuals in recovery from a substance use disorder become stably housed</header><subsection id="id1fa04a10df6b48d4ac168a46e5a42252"><enum>(a)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated under this section such sums as may be necessary for each of fiscal years 2019 through 2023 for assistance to States to provide individuals in recovery from a substance use disorder stable, temporary housing for a period of not more than 2 years or until the individual secures permanent housing, whichever is earlier.</text></subsection><subsection id="idd59ecf59d0ec4395b042cfe4b5f78de9"><enum>(b)</enum><header>Allocation of appropriated amounts</header><paragraph id="id8F43F81A972E42768E7EAE4BCF40F65C"><enum>(1)</enum><header>In general</header><text>The amounts appropriated or otherwise made available to States under this section shall be allocated based on a funding formula established by the Secretary of Housing and Urban Development (referred to in this section as the <quote>Secretary</quote>) not later than 60 days after the date of enactment of this Act.</text></paragraph><paragraph id="id8287D72FF8C54045BF0E6DEA6261387E"><enum>(2)</enum><header>Criteria</header><text>The funding formula required under paragraph (1) shall ensure that any amounts appropriated or otherwise made available under this section are allocated to States with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, according to the Centers for Disease Control and Prevention. Among such States, priority shall be given to States with the greatest need, as such need is determined by the Secretary based on—</text><subparagraph id="id6D805C83920643119CF180D4B11808D0"><enum>(A)</enum><text>the highest average rates of unemployment based on data provided by the Bureau of Labor Statistics for calendar years 2013 through 2017;</text></subparagraph><subparagraph id="idb414aaf98250488a8f4bee24fd98f533"><enum>(B)</enum><text>the lowest average labor force participation rates based on data provided by the Bureau of Labor Statistics for calendar years 2013 through 2017; and</text></subparagraph><subparagraph id="ide6426667ef124dd9bfd5f309a1245497"><enum>(C)</enum><text>the highest prevalence of opioid use disorder based on data provided by the Substance Abuse and Mental Health Services Administration for calendar years 2013 through 2017.</text></subparagraph></paragraph><paragraph id="id0a3ddb1ef1d14408b4e18511bd0113da"><enum>(3)</enum><header>Distribution</header><text>Amounts appropriated or otherwise made available under this section shall be distributed according to the funding formula established by the Secretary under paragraph (1) not later than 30 days after the establishment of such formula.</text></paragraph></subsection><subsection id="id2fa5d388bb5b4b6fbd63e3c5e9b2f5be"><enum>(c)</enum><header>Use of funds</header><paragraph id="id5169732E4BA7477F84BDEB1F9931B44D"><enum>(1)</enum><header>In general</header><text>Any State that receives amounts pursuant to this section shall expend at least 30 percent of such funds within one year of the date funds become available to the grantee for obligation.</text></paragraph><paragraph id="idEB808A3428BE41679F54CAB17C9865B2"><enum>(2)</enum><header>Priority</header><text>Any State that receives amounts pursuant to this section shall distribute such amounts giving priority to entities with the greatest need and ability to deliver effective assistance in a timely manner.</text></paragraph><paragraph id="id647003dd945845ad87c11275c61e6f8c"><enum>(3)</enum><header>Administrative costs</header><text>Any State that receives amounts pursuant to this section may use up to 5 percent of any grant for administrative costs.</text></paragraph></subsection><subsection id="id4353f49b82e44eb58a83ea87f52726de"><enum>(d)</enum><header>Rules of construction</header><paragraph id="id30A98E0251A54F11A3BDF63AF175C49A"><enum>(1)</enum><header>In general</header><text>Except as otherwise provided by this section, amounts appropriated, or amounts otherwise made available to States under this section shall be treated as though such funds were community development block grant funds under title I of the Housing and Community Development Act of 1974 (42 U.S.C. 5301 et seq.).</text></paragraph><paragraph id="idf60a2cbfd82b4a138857f10457105115"><enum>(2)</enum><header>No match</header><text>No matching funds shall be required in order for a State to receive any amounts under this section.</text></paragraph></subsection><subsection id="id7cd64a9237cf463ca6a62e5d4af09d02"><enum>(e)</enum><header>Authority to waive or specify alternative requirements</header><paragraph id="id7ABBB5BA89304FD4AE2449A2863F6BA2"><enum>(1)</enum><header>In general</header><text>In administering any amounts appropriated or otherwise made available under this section, the Secretary may waive or specify alternative requirements for any provision of any statute or regulation in connection with the obligation by the Secretary or the use of funds except for requirements related to fair housing, nondiscrimination, labor standards, and the environment, upon a finding that such a waiver is necessary to expedite or facilitate the use of such funds.</text></paragraph><paragraph id="id063eb11b578c498586c45400fea9a520"><enum>(2)</enum><header>Notice</header><text>The Secretary shall provide written notice of its intent to exercise the authority to specify alternative requirements under paragraph (1) to the Committee on Banking, Housing, and Urban Affairs of the Senate and the Committee on Financial Services of the House of Representatives not later than 5 business days before such exercise of authority occurs.</text></paragraph></subsection><subsection id="id8137e6ea704e4968801436630063cce4"><enum>(f)</enum><header>Technical assistance</header><text>For the 2-year period following the date of enactment of this Act, the Secretary may use not more than 2 percent of the funds made available under this section for technical assistance to grantees.</text></subsection><subsection id="idFB6D6CB639CF483AB309A4CE0B8E0616"><enum>(g)</enum><header>State</header><text>For purposes of this section the term <term>State</term> includes any State as defined in section 102 of the Housing and Community Development Act of 1974 (42 U.S.C. 5302) and the District of Columbia.</text></subsection></section><section id="id6223BD2F3501468995C028751C87C849"><enum>1413.</enum><header>Youth prevention and recovery</header><subsection commented="no" id="H1C97B8C8275F47CA9BCCE32DC1C00E32"><enum>(a)</enum><header> Substance abuse treatment services for children, adolescents, and young adults</header><text display-inline="yes-display-inline">Section 514 of the Public Health Service Act (42 U.S.C. 290bb–7) is amended—</text><paragraph id="H66E37256A00D41D88F59E182E3CA784A"><enum>(1)</enum><text>in the section heading, by striking <quote><header-in-text level="section" style="OLC">children and adolescents</header-in-text></quote> and inserting <quote><header-in-text level="section" style="OLC">children, adolescents, and young adults</header-in-text></quote>;</text></paragraph><paragraph id="HAD41C9F5C6674DB7AF414012DF01903F"><enum>(2)</enum><text display-inline="yes-display-inline">in subsection (a)(2), by striking <quote>children, including</quote> and inserting <quote>children, adolescents, and young adults, including</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HEAB046361D394FD5B1B4CCA192AC3694"><enum>(3)</enum><text>by striking <quote>children and adolescents</quote> each place it appears and inserting <quote>children, adolescents, and young adults</quote>.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idC3901B514CD54E59AC511B4A0CB780D5"><enum>(b)</enum><header>Resource center</header><text>The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use and, as appropriate, in consultation with the Secretary of Education and other agencies, shall establish a resource center to provide technical support to recipients of grants under subsection (c).</text></subsection><subsection commented="no" display-inline="no-display-inline" id="idCCB65CC6A9A74D7FBAE3510F236D6563"><enum>(c)</enum><header>Youth prevention and recovery initiative</header><paragraph commented="no" display-inline="no-display-inline" id="id0AC08A2D763B446D8E119AB5A46E65C0"><enum>(1)</enum><header>In general</header><text>The Secretary, in consultation with the Secretary of Education, shall administer a program to provide support for communities to support the prevention of, treatment of, and recovery from, substance use disorders for children, adolescents, and young adults.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id9A0EF083354E43138E413AA1E9132493"><enum>(2)</enum><header>Definitions</header><text>In this subsection:</text><subparagraph commented="no" display-inline="no-display-inline" id="idE0B675738CFE456FA087006E6E9AF0DC"><enum>(A)</enum><header>Eligible entity</header><text>The term <term>eligible entity</term> means—</text><clause commented="no" display-inline="no-display-inline" id="id21864EDDCE88454594161D7D3429DBB6"><enum>(i)</enum><text>a local educational agency that is seeking to establish or expand substance use prevention or recovery support services at one or more high schools;</text></clause><clause commented="no" display-inline="no-display-inline" id="id1363B315276947E0AA23A0CEC4EEEDA1"><enum>(ii)</enum><text>a State educational agency;</text></clause><clause commented="no" display-inline="no-display-inline" id="id3585E0D7D46F4E588AA1DF571B2355DC"><enum>(iii)</enum><text>an institution of higher education (or consortia of such institutions), which may include a recovery program at an institution of higher education;</text></clause><clause commented="no" display-inline="no-display-inline" id="idA2006B70CB864EC3900F94C6B9B2B3B8"><enum>(iv)</enum><text>a local board or one-stop operator;</text></clause><clause commented="no" display-inline="no-display-inline" id="id6DEF2BD19C82480CA0B1806A02C0A5F8"><enum>(v)</enum><text>a nonprofit organization with appropriate expertise in providing services or programs for children, adolescents, or young adults, excluding a school;</text></clause><clause commented="no" display-inline="no-display-inline" id="id864D3F5C08F547BA9C6813BAE502ACDD"><enum>(vi)</enum><text>a State, political subdivision of a State, Indian Tribe, or tribal organization; or</text></clause><clause commented="no" display-inline="no-display-inline" id="id40011D7F30114B2E977A7C0BD68A0922"><enum>(vii)</enum><text>a high school or dormitory serving high school students that receives funding from the Bureau of Indian Education.</text></clause></subparagraph><subparagraph id="id61f67a0e410a4cb2aa182b8ab1f01b76"><enum>(B)</enum><header>Evidence-based</header><text>The term <term>evidence-based</term> has the meaning given such term in section 8101 of the Elementary and Secondary Education Act (20 U.S.C. 7801).</text></subparagraph><subparagraph id="id3997141288CE438591F4D6576710E6F1"><enum>(C)</enum><header>Foster care</header><text>The term <term>foster care</term> has the meaning given such term in section 1355.20(a) of title 45, Code of Federal Regulations (or any successor regulations).</text></subparagraph><subparagraph id="id04620be64ece409e8e7f61297cbd3a80"><enum>(D)</enum><header>High school</header><text>The term <term>high school</term> has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).</text></subparagraph><subparagraph id="id97b345b248fd49abbd7c3b7f67cd7c17"><enum>(E)</enum><header>Homeless youth</header><text>The term <term>homeless youth</term> has the meaning given the term <quote>homeless children or youths</quote> in section 725 of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11434a);</text></subparagraph><subparagraph id="idc60b847fabc1425ab1b9b107240026b7"><enum>(F)</enum><header>Institution of higher education</header><text>The term <term>institution of higher education</term> has the meaning given such term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001) and includes a <quote>postsecondary vocational institution</quote> as defined in section 102(c) of such Act (20 U.S.C. 1002(c)).</text></subparagraph><subparagraph id="idf2ccee8ea8fc4a40b94ef79716f39de2"><enum>(G)</enum><header>Local educational agency</header><text>The term <term>local educational agency</term> has the meaning given the term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).</text></subparagraph><subparagraph id="id97c65dab373e4f1dbdd481e0f30c4bc0"><enum>(H)</enum><header>Local board; one-stop operator</header><text>The terms <term>local board</term> and <term>one-stop operator</term> have the meanings given such terms in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102).</text></subparagraph><subparagraph id="id22d85aa6d9d44fa892c45187855f51da"><enum>(I)</enum><header>Out of School Youth</header><text>The term <term>out-of-school youth</term> has the meaning given such term in section 129(a)(1)(B) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3164(a)(1)(B)).</text></subparagraph><subparagraph id="id7bdba12b3c05445f823aa8b677d95496"><enum>(J)</enum><header>Recovery program</header><text>The term <term>recovery program</term> means a program—</text><clause id="id6d9b9760c29c4ab8b5ebf6c2f78701f6"><enum>(i)</enum><text>to help children, adolescents, or young adults who are recovering from substance use disorders to initiate, stabilize, and maintain healthy and productive lives in the community; and</text></clause><clause id="id652418c1b1a24b91811b210bbea73f19"><enum>(ii)</enum><text>that includes peer-to-peer support delivered by individuals with lived experience in recovery, and communal activities to build recovery skills and supportive social networks.</text></clause></subparagraph><subparagraph id="id15d121ca04274784a7ef6892827262fc"><enum>(K)</enum><header>State Educational Agency</header><text>The term <term>State educational agency</term> has the meaning given the term in section 8101 of the Elementary and Secondary Education Act (20 U.S.C. 7801).</text></subparagraph></paragraph><paragraph id="idA3E5526071094AEF9CF0302B494F804B"><enum>(3)</enum><header>Best practices</header><text>The Secretary, in consultation with the Secretary of Education, shall—</text><subparagraph id="id6E4C7839A9C74C27B92189331CEDB107"><enum>(A)</enum><text>identify or facilitate the development of evidence-based best practices for prevention of substance misuse and abuse by children, adolescents, and young adults, including for specific populations such as youth in foster care, homeless youth, out-of-school youth, and youth who are at risk of or have experienced trafficking that address—</text><clause id="id1E704C91EA6F4562807DE2A2AD204B49"><enum>(i)</enum><text>primary prevention;</text></clause><clause id="id6565AC3E282D45AF98E5755B57C0508B"><enum>(ii)</enum><text>appropriate recovery support services;</text></clause><clause id="idF088B8300B484FA29E6C8B53AA11FB51"><enum>(iii)</enum><text>appropriate use of medication-assisted treatment for such individuals, if applicable, and ways of overcoming barriers to the use of medication-assisted treatment in such population; and</text></clause><clause id="id4C1D21599D3847ED8A40C5039F440F58"><enum>(iv)</enum><text>efficient and effective communication, which may include the use of social media, to maximize outreach efforts;</text></clause></subparagraph><subparagraph id="idCEC849C2D1D6448D826D43E478EB513F"><enum>(B)</enum><text>disseminate such best practices to State educational agencies, local educational agencies, schools and dormitories funded by the Bureau of Indian Education, institutions of higher education, recovery programs at institutions of higher education, local boards, one-stop operators, family and youth homeless providers, and nonprofit organizations, as appropriate;</text></subparagraph><subparagraph id="idA256E96365314BAD882A76C04C4642C3"><enum>(C)</enum><text>conduct a rigorous evaluation of each grant funded under this subsection, particularly its impact on the indicators described in paragraph (8)(B); and</text></subparagraph><subparagraph id="id07DD024EEEF5475DAC2E92E161272A40"><enum>(D)</enum><text>provide technical assistance for grantees under this subsection.</text></subparagraph></paragraph><paragraph id="idee92879b4ce34965825fa720f41c62c3"><enum>(4)</enum><header>Grants authorized</header><text>The Secretary, in consultation with the Secretary of Education, shall award 3-year grants, on a competitive basis, to eligible entities to enable such entities, in coordination with Indian Tribes, if applicable, and State agencies responsible for carrying out substance use disorder prevention and treatment programs, to carry out evidence-based programs for—</text><subparagraph id="id718032fd9cb84bf0938c58710dbf52b0"><enum>(A)</enum><text>prevention of substance misuse and abuse by children, adolescents, and young adults, which may include primary prevention;</text></subparagraph><subparagraph id="id3476851cbe3d4277b17aab7502fdb585"><enum>(B)</enum><text>recovery support services for children, adolescents, and young adults, which may include counseling, job training, linkages to community-based services, family support groups, peer mentoring, and recovery coaching; or</text></subparagraph><subparagraph id="id25fe5502913c41afa7ff07cbe9b57ad8"><enum>(C)</enum><text>treatment or referrals for treatment of substance use disorders, which may include the use of medication-assisted treatment, as appropriate.</text></subparagraph></paragraph><paragraph id="id8c0f1b477d96485e98035a00f1cfb6ad"><enum>(5)</enum><header>Special consideration</header><text>In awarding grants under this subsection, the Secretary shall give special consideration to the unique needs of tribal, urban, suburban, and rural populations.</text></paragraph><paragraph id="id4eb1acb8492f4a62976ef428611a2b6f"><enum>(6)</enum><header>Application</header><text>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. Such application shall include—</text><subparagraph id="id650b03c3d2d34b52a7c623fc6f6320c4"><enum>(A)</enum><text>a description of—</text><clause id="idB6D5DD97439745588A754F9193D26F53"><enum>(i)</enum><text>the impact of substance use disorders in the population that will be served by the grant program;</text></clause><clause id="id79135d8245b540ad88c529d489cd9f77"><enum>(ii)</enum><text>how the eligible entity has solicited input from relevant stakeholders, which may include faculty, teachers, staff, families, students, and experts in substance use prevention and treatment in developing such application;</text></clause><clause id="id3F774A8B4D16475D834FAD9E9BA0FE7F"><enum>(iii)</enum><text>the goals of the proposed project, including the intended outcomes;</text></clause><clause id="id66FF5CCF932047E788F01DC7D2690B80"><enum>(iv)</enum><text>how the eligible entity plans to use grant funds for evidence-based activities, in accordance with this subsection to prevent, provide recovery support for, or treat substance use disorders amongst such individuals, or a combination of such activities; and</text></clause><clause id="id426463eccd3e4b8d85417ab4cfaaf12f"><enum>(v)</enum><text>how the eligible entity will collaborate with relevant partners, which may include State educational agencies, local educational agencies, institutions of higher education, juvenile justice agencies, prevention and recovery support providers, local service providers, including substance use disorder treatment programs, providers of mental health services, youth serving organizations, family and youth homeless providers, child welfare agencies, and primary care providers, in carrying out the grant program; and</text></clause></subparagraph><subparagraph id="id3CC1659BD41547CFA7FA9EC756859972"><enum>(B)</enum><text>an assurance that the eligible entity will participate in the evaluation described in paragraph (3)(C).</text></subparagraph></paragraph><paragraph id="id9b0f63ee14b14b8f9caa69a21ac929b4"><enum>(7)</enum><header>Priority</header><text>In awarding grants under this subsection, the Secretary shall give priority to eligible entities that propose to use grant funds for activities that meet the criteria described in subclauses (I) and (II) of section 8101(21)(A)(i) of the Elementary and Secondary Education Act (20 U.S.C. 7801(21)(A)(i)).</text></paragraph><paragraph id="id1f866fc6c8a24b86ac1d43dd01b6819f"><enum>(8)</enum><header>Reports to the Secretary</header><text>Each eligible entity awarded a grant under this subsection shall submit to the Secretary a report at such time and in such manner as the Secretary may require. Such report shall include—</text><subparagraph id="id361c7101a58d49a6b757d59942e5cf97"><enum>(A)</enum><text>a description of how the eligible entity used grant funds, in accordance with this subsection, including the number of children, adolescents, and young adults reached through programming; and</text></subparagraph><subparagraph id="id17e35b9e4956496eb6e852ff8a5a1bcf"><enum>(B)</enum><text>a description, including relevant data, of how the grant program has made an impact on the intended outcomes described in paragraph (6)(A)(iii), including—</text><clause id="id087dd94d36fb471b8d31274f2bbbb3f9"><enum>(i)</enum><text>indicators of student success, which, if the eligible entity is an educational institution, shall include student well-being and academic achievement;</text></clause><clause id="id9a3e2ac85ce24498be6b15546250b689"><enum>(ii)</enum><text>substance use disorders amongst children, adolescents, and young adults, including the number of overdoses and deaths amongst children, adolescents, and young adults during the grant period; and</text></clause><clause id="idA29DA1889DEB46C7A7BB349240426DFE"><enum>(iii)</enum><text>other indicators, as the Secretary determines appropriate.</text></clause></subparagraph></paragraph><paragraph id="id589550FD32C54E4FB2CF1241AE7C8640"><enum>(9)</enum><header>Report to Congress</header><text>The Secretary shall, not later than October 1, 2022, submit a report to the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce and the Committee on Education and the Workforce of the House of Representatives, a report summarizing the effectiveness of the grant program under this subsection, based on the information submitted in reports required under paragraph (8).</text></paragraph><paragraph id="idf497a6fd6f144025a12a1fd5cd4470c1"><enum>(10)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated such sums as may be necessary to carry out this subsection for each of fiscal years 2019 through 2023.</text></paragraph></subsection></section><section id="id2e5ee1a6b645412ebde410105f2259b7"><enum>1414.</enum><header>Plans of safe care</header><text display-inline="no-display-inline">Section 105(a) of the Child Abuse Prevention and Treatment Act (42 U.S.C. 5106(a)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id1e80ccdaae7b46ada28a8a541893e925" style="OLC"><paragraph id="id2196B23870CD4192BB32E821CEFD4E4A"><enum>(7)</enum><header>Grants to States to improve and coordinate their response to ensure the safety, permanency, and well-being of infants affected by substance use</header><subparagraph id="id36bc6d4bd1dd467aa4ec455f90b3e58b"><enum>(A)</enum><header>Program authorized</header><text>The Secretary shall make grants to States for the purpose of assisting child welfare agencies, social services agencies, substance use disorder treatment agencies, hospitals with labor and delivery units, medical staff, public health and mental health agencies, and maternal and child health agencies to facilitate collaboration in developing, updating, implementing, and monitoring plans of safe care described in section 106(b)(2)(B)(iii).</text></subparagraph><subparagraph id="id50100c73d8e64cd2935b51d66aada74c"><enum>(B)</enum><header>Distribution of funds</header><clause id="ideea730aa12af409b937ef06cadf4b29f"><enum>(i)</enum><header>Reservations</header><text>Of the amounts appropriated under subparagraph (H), the Secretary shall reserve—</text><subclause id="id912C1554AFE140C9A1A9F916FF0D56CF"><enum>(I)</enum><text>no more than 3 percent for the purposes described in subparagraph (G); and</text></subclause><subclause id="id1C9844550D424BA796440735D56BFD1F"><enum>(II)</enum><text>up to 3 percent for grants to Indian Tribes and tribal organizations to address the needs of infants born with, and identified as being affected by, substance abuse or withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder and their families or caregivers, which to the extent practicable, shall be consistent with the uses of funds described under subparagraph (D).</text></subclause></clause><clause id="id65c70c225f36426096540908c9a57d33"><enum>(ii)</enum><header>Allotments to States and territories</header><text>The Secretary shall allot the amount appropriated under subparagraph (H) that remains after application of clause (i) to each State that applies for such a grant, in an amount equal to the sum of—</text><subclause id="idda87802a91cb4efdb8d027651e7be2be"><enum>(I)</enum><text>$500,000; and</text></subclause><subclause id="id48d930a741a04aeaa08326c8cb804688"><enum>(II)</enum><text>an amount that bears the same relationship to any funds appropriated under subparagraph (H) and remaining after application of clause (i), as the number of live births in the State in the previous calendar year bears to the number of live births in all States in such year.</text></subclause></clause><clause id="ida3b0658921bf4cb69f003655a7db5dda"><enum>(iii)</enum><header>Ratable reduction</header><text>If the amount appropriated under subparagraph (H) is insufficient to satisfy the requirements of clause (ii), the Secretary shall ratably reduce each allotment to a State.</text></clause></subparagraph><subparagraph id="id8b5ef5c4d1f64fdc964f353ef7848db9"><enum>(C)</enum><header>Application</header><text>A State desiring a grant under this paragraph shall submit an application to the Secretary at such time and in such manner as the Secretary may require. Such application shall include—</text><clause id="id1edba0394f1c49d487cd6a47c9863706"><enum>(i)</enum><text>a description of—</text><subclause id="id8C6BB55480A64A31AC5EF013CC87F995"><enum>(I)</enum><text>the impact of substance use disorder in such State, including with respect to the substance or class of substances with the highest incidence of abuse in the previous year in such State, including—</text><item id="id727B2EB990C84540ADF745EFCDAAD790"><enum>(aa)</enum><text>the prevalence of substance use disorder in such State;</text></item><item commented="no" id="id216232E08B0947A8AE33AA4C452AE956"><enum>(bb)</enum><text>the aggregate rate of births in the State of infants affected by substance abuse or withdrawal symptoms or a fetal alcohol spectrum disorder (as determined by hospitals, insurance claims, claims submitted to the State Medicaid program, or other records), if available and to the extent practicable; and</text></item><item commented="no" id="id2BE90B587B464856AAEC91E71B162FCF"><enum>(cc)</enum><text>the number of infants identified, for whom a plan of safe care was developed, and for whom a referral was made for appropriate services, as reported under section 106(d)(18);</text></item></subclause><subclause id="id8437352ccb7c46b9bc71c158e522f5b9"><enum>(II)</enum><text>the challenges the State faces in developing, implementing, and monitoring plans of safe care in accordance with section 106(b)(2)(B)(iii);</text></subclause><subclause id="id531a59878b27469d9c0df970e5ddb1cc"><enum>(III)</enum><text>the State’s lead agency for the grant program and how that agency will coordinate with relevant State entities and programs, including the child welfare agency, the substance use disorder treatment agency, hospitals with labor and delivery units, health care providers, the public health and mental health agencies, programs funded by the Substance Abuse and Mental Health Services Administration that provide substance use disorder treatment for women, the State Medicaid program, the State agency administering the block grant program under title V of the Social Security Act (42 U.S.C. 701 et seq.), the State agency administering the programs funded under part C of the Individuals with Disabilities Education Act (20 U.S.C. 1431 et seq.), the maternal, infant, and early childhood home visiting program under section 511 of the Social Security Act (42 U.S.C. 711), the State judicial system, and other agencies, as determined by the Secretary, and Indian Tribes and tribal organizations, as appropriate;</text></subclause><subclause id="id979d7d8f6ad24fdaa42652ad42dee24a"><enum>(IV)</enum><text>how the State will monitor local development and implementation of plans of safe care, in accordance with section 106(b)(2)(B)(iii)(II), including how the State will monitor to ensure plans of safe care address differences between substance use disorder and medically supervised substance use, including for the treatment of a substance use disorder;</text></subclause><subclause id="idded360e12a9042ecb81fc94d6e8bb354"><enum>(V)</enum><text>how the State meets the requirements of section 1927 of the Public Health Service Act (42 U.S.C. 300x–27);</text></subclause><subclause id="id4721BECA60564674AC7809307DA7156B"><enum>(VI)</enum><text>how the State plans to utilize funding authorized under part E of title IV of the Social Security Act (42 U.S.C. 670 et seq.) to assist in carrying out any plan of safe care, including such funding authorized under section 471(e) of such Act (as in effect on October 1, 2018) for mental health and substance abuse prevention and treatment services and in-home parent skill-based programs and funding authorized under such section 472(j) (as in effect on October 1, 2018) for children with a parent in a licensed residential family-based treatment facility for substance abuse; and</text></subclause><subclause id="idBE98B5DF75404A009BC6C920FEA8BA08"><enum>(VII)</enum><text>an assessment of the treatment and other services and programs available in the State, to effectively carry out any plan of safe care developed, including identification of needed treatment, and other services and programs to ensure the well-being of young children and their families affected by substance use disorder, such as programs carried out under part C of the Individuals with Disabilities Education Act and comprehensive early childhood development services and programs such as Head Start programs;</text></subclause></clause><clause id="ide008b7d682734c94825b20c32d29f702"><enum>(ii)</enum><text>a description of how the State plans to use funds for activities described in subparagraph (D) for the purposes of ensuring State compliance with requirements under clauses (ii) and (iii) of section 106(b)(2)(B); and</text></clause><clause id="id82db32e5464a41ca8c564018b2f4b0aa"><enum>(iii)</enum><text>an assurance that the State will—</text><subclause id="id0e9486d208bc4b2f8190a78d9d217917"><enum>(I)</enum><text>comply with this Act and parts B and E of title IV of the Social Security Act (42 U.S.C. 621 et seq., 670 et seq.); and</text></subclause><subclause id="iddba991dc341d49e6a2bec2bfd04b8ad1"><enum>(II)</enum><text>comply with requirements to refer a child identified as substance-exposed to early intervention services as required pursuant to a grant under part C of the Individuals with Disabilities Education Act (20 U.S.C. 1431 et seq.).</text></subclause></clause></subparagraph><subparagraph id="idb11f54671bab4fc7b3f2b87a83c95526"><enum>(D)</enum><header>Uses of funds</header><text>Funds awarded to a State under this paragraph may be used for the following activities, which may be carried out by the State directly, or through grants or subgrants, contracts, or cooperative agreements:</text><clause id="id9b8713ff905349f1af7b298bfb5768c6"><enum>(i)</enum><text>Improving State and local systems with respect to the development and implementation of plans of safe care, which—</text><subclause id="id9A7E0E11C12E4F82A7C7C4ED11CDBCBB"><enum>(I)</enum><text>shall include parent and caregiver engagement, as required under section 106(b)(2)(B)(iii)(I), regarding available treatment and service options, which may include resources available for pregnant, perinatal, and postnatal women; and</text></subclause><subclause id="idB92D3BD229D84F20B74D4C6E6D39FC11"><enum>(II)</enum><text>may include activities such as—</text><item id="idDA0B8B0943BE4D4C9E065CE98425145B"><enum>(aa)</enum><text>developing policies, procedures, or protocols for the administration or development of evidence-based and validated screening tools for infants who may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder and pregnant, perinatal, and postnatal women whose infants may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder;</text></item><item id="id990EF3902B0F46A5A078AF38905CBEA4"><enum>(bb)</enum><text>improving assessments used to determine the needs of the infant and family;</text></item><item id="id84E862D42E624D8E940FF6E14CC57A1F"><enum>(cc)</enum><text>improving ongoing case management services; and</text></item><item id="idC75778DD2E354D7DA799C97A8CDDAFE4"><enum>(dd)</enum><text>improving access to treatment services, which may be prior to the pregnant woman’s delivery date.</text></item></subclause></clause><clause id="id1bfa6405d0874266838feeb0cef50ac7"><enum>(ii)</enum><text>Developing policies, procedures, or protocols in consultation and coordination with health professionals, public and private health facilities, and substance use disorder treatment agencies to ensure that—</text><subclause id="id6AE0992ABA5C40C780D1D92CC6640700"><enum>(I)</enum><text>appropriate notification to child protective services is made in a timely manner;</text></subclause><subclause id="idCD2871BAED3D4167AC7144DC4BC2AF03"><enum>(II)</enum><text>a plan of safe care is in place, in accordance with section 106(b)(2)(B)(iii), before the infant is discharged from the birth or health care facility; and</text></subclause><subclause id="idA02DBDC71A2849F4A193C03E61AA1106"><enum>(III)</enum><text>such health and related agency professionals are trained on how to follow such protocols and are aware of the supports that may be provided under a plan of safe care.</text></subclause></clause><clause id="idb780e3cb16b84354b29ae0c42803e852"><enum>(iii)</enum><text>Training health professionals and health system leaders, child welfare workers, substance use disorder treatment agencies, and other related professionals such as home visiting agency staff and law enforcement in relevant topics including—</text><subclause id="id4632209F20394E2DB47F5C695E72E9BB"><enum>(I)</enum><text>State mandatory reporting laws and the referral and process requirements for notification to child protective services when child abuse or neglect reporting is not mandated;</text></subclause><subclause id="idA91DA8B864C34574A0621B8940868616"><enum>(II)</enum><text>the co-occurrence of pregnancy and substance use disorder, and implications of prenatal exposure;</text></subclause><subclause id="idAD79DF513E2D446DB9B6ED716C89B6A4"><enum>(III)</enum><text>the clinical guidance about treating substance use disorder in pregnant and postpartum women;</text></subclause><subclause id="id07D3DECFFA9D4D22B4E1E63628F4A379"><enum>(IV)</enum><text>appropriate screening and interventions for infants affected by substance use disorder, withdrawal symptoms, or a fetal alcohol spectrum disorder and the requirements under section 106(b)(2)(B)(iii); and</text></subclause><subclause commented="no" id="id14B1201AB6F7403B9D85E638A06D291A"><enum>(V)</enum><text>appropriate multigenerational strategies to address the mental health needs of the parent and child together.</text></subclause></clause><clause id="ida3a4080476e64a62afc412dbd1209218"><enum>(iv)</enum><text>Establishing partnerships, agreements, or memoranda of understanding between the lead agency and health professionals, health facilities, child welfare professionals, juvenile and family court judges, substance use and mental disorder treatment programs, early childhood education programs, and maternal and child health and early intervention professionals, including home visiting providers, peer-to-peer recovery programs such as parent mentoring programs, and housing agencies to facilitate the implementation of, and compliance with section 106(b)(2) and clause (ii) of this subparagraph, in areas which may include—</text><subclause id="idC4BF5CE96F79493384FEF9F26361227B"><enum>(I)</enum><text>developing a comprehensive, multi-disciplinary assessment and intervention process for infants, pregnant women, and their families who are affected by substance use disorder, withdrawal symptoms, or a fetal alcohol spectrum disorder, that includes meaningful engagement with and takes into account the unique needs of each family and addresses differences between medically supervised substance use, including for the treatment of substance use disorder, and substance use disorder;</text></subclause><subclause id="id319400cf977c4e5db3b299431ef3b141"><enum>(II)</enum><text>ensuring that treatment approaches for serving infants, pregnant women, and perinatal and postnatal women whose infants may be affected by substance use, withdrawal symptoms, or a fetal alcohol spectrum disorder, are designed to, where appropriate, keep infants with their mothers during both inpatient and outpatient treatment; and</text></subclause><subclause id="id0589E49CD24141EEA19F4213A35E722A"><enum>(III)</enum><text>increasing access to all evidence-based medication-assisted treatment approved by the Food and Drug Administration, behavioral therapy, and counseling services for the treatment of substance use disorders, as appropriate.</text></subclause></clause><clause id="idf941db6ce9464a1081dee82dc72e55d7"><enum>(v)</enum><text>Developing and updating systems of technology for improved data collection and monitoring under section 106(b)(2)(B)(iii), including existing electronic medical records, to measure the outcomes achieved through the plans of safe care, including monitoring systems to meet the requirements of this Act and submission of performance measures.</text></clause></subparagraph><subparagraph id="id48f7be6743eb46d5b0a962e2a70c929c"><enum>(E)</enum><header>Reporting</header><text>Each State that receives funds under this paragraph, for each year such funds are received, shall submit a report to the Secretary, disaggregated by geographic location, economic status, and major racial and ethnic groups, except that such disaggregation shall not be required if the results would reveal personally identifiable information on, with respect to infants identified under section 106(b)(2)(B)(ii)—</text><clause id="idB2E7727E0A7C4CDFB3B049B02C3BCAF1"><enum>(i)</enum><text>the number who experienced removal associated with parental substance use;</text></clause><clause id="id10B441EA08DC4C93B4EF9E06344E708C"><enum>(ii)</enum><text>the number who experienced removal and subsequently are reunified with parents, and the length of time between such removal and reunification;</text></clause><clause id="idE872F34074CB401185995ABFCEE81DAF"><enum>(iii)</enum><text>the number who are referred to community providers without a child protection case;</text></clause><clause id="id1E713A6B04354D88953EB0BC96419422"><enum>(iv)</enum><text>the number who receive services while in the care of their birth parents;</text></clause><clause id="idC4E3709D1EB44FF99DDAD5D0223D1987"><enum>(v)</enum><text>the number who receive post-reunification services within 1 year after a reunification has occurred; and</text></clause><clause id="id8bcfa6c19c334dd8b59e64fe8433dc0a"><enum>(vi)</enum><text>the number who experienced a return to out-of-home care within 1 year after reunification.</text></clause></subparagraph><subparagraph id="id20035ea1206841b9a9fbe985398ac2eb"><enum>(F)</enum><header>Secretary’s report to congress</header><text>The Secretary shall submit an annual report to the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate and the Committee on Education and the Workforce and the Committee on Appropriations of the House of Representatives that includes the information described in subparagraph (E) and recommendations or observations on the challenges, successes, and lessons derived from implementation of the grant program.</text></subparagraph><subparagraph id="idb30383a2af294beabd3d26e87268dc8c"><enum>(G)</enum><header>Reservation of funds</header><text>The Secretary shall use the amount reserved under subparagraph (B)(i)(I) for the purposes of—</text><clause id="id44afb4c4206042aab31dcc60cf1f0424"><enum>(i)</enum><text>providing technical assistance, including programs of in-depth technical assistance, to additional States, territories, and Indian Tribes and tribal organizations in accordance with the substance-exposed infant initiative developed by the National Center on Substance Abuse and Child Welfare;</text></clause><clause id="iddfc2dfa5c45f4d39ab93dbeea30f8852"><enum>(ii)</enum><text>issuing guidance on the requirements of this Act with respect to infants born with and identified as being affected by substance use or withdrawal symptoms or fetal alcohol spectrum disorder, as described in clauses (ii) and (iii) of section 106(b)(2)(B), including by—</text><subclause id="idc78453c272a140d688d578ce3a4bc4bd"><enum>(I)</enum><text>clarifying key terms; and</text></subclause><subclause id="idc82a5bfb680349f8a44b3a1b77512c68"><enum>(II)</enum><text>disseminating best practices on implementation of plans of safe care, on such topics as differential response, collaboration and coordination, and identification and delivery of services for different populations;</text></subclause></clause><clause id="id5b4cc2889c6d492791db82fd8ce081e8"><enum>(iii)</enum><text>supporting State efforts to develop information technology systems to manage plans of safe care; and</text></clause><clause id="id39636d96d7374cd2b93bcfd9cd5c61c2"><enum>(iv)</enum><text>preparing the Secretary’s report to Congress described in subparagraph (F).</text></clause></subparagraph><subparagraph id="idbdfd31af58474c37aec597f228da411d"><enum>(H)</enum><header>Authorization of appropriations</header><text>To carry out the program under this paragraph, there is authorized to be appropriated $60,000,000 for each of fiscal years 2019 through 2023.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="HF0174FC92A164CB8AC59D999436B841A"><enum>1415.</enum><header>Regulations relating to special registration for telemedicine</header><text display-inline="no-display-inline">Section 311(h) of the Controlled Substances Act (21 U.S.C. 831(h)) is amended by striking paragraph (2) and inserting the following:</text><quoted-block display-inline="no-display-inline" id="id27492D4BED0E4EF995FEB235FBF92B52" style="traditional"><paragraph id="id3F16D56B498A4BE9AE0282534A880E13"><enum>(2)</enum><header>Regulations</header><subparagraph id="idA5912326E3164F28BCC62FC23662510B"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of the <short-title>Opioid Crisis Response Act of 2018</short-title>, in consultation with the Secretary, and in accordance with the procedure described in subparagraph (B), the Attorney General shall promulgate final regulations specifying—</text><clause id="idBE7D015303C646219A995DE2105F1985"><enum>(i)</enum><text display-inline="yes-display-inline">the limited circumstances in which a special registration under this subsection may be issued; and</text></clause><clause id="id210D8165D7A04F00B37EB088034D741B"><enum>(ii)</enum><text display-inline="yes-display-inline">the procedure for obtaining a special registration under this subsection.</text></clause></subparagraph><subparagraph id="idA7D4899B64E548A19605EE68D54529D1"><enum>(B)</enum><header>Procedure</header><text>In promulgating final regulations under subparagraph (A), the Attorney General shall—</text><clause id="ide5669ffa8bea400893bf217b6fe5500e"><enum>(i)</enum><text>issue a notice of proposed rulemaking that includes a copy of the proposed regulations;</text></clause><clause id="id5CA7348487C641FDA0F2448719A83B3D"><enum>(ii)</enum><text>provide a period of not less than 60 days for comments on the proposed regulations;</text></clause><clause id="id68fe7d527b594726b10f88e190290076"><enum>(iii)</enum><text>finalize the proposed regulation not later than 6 months after the close of the comment period; and</text></clause><clause id="idCA424FEB1FB34C2DAAF9C68AD9747A14"><enum>(iv)</enum><text>publish the final regulations not later than 30 days before the effective date of the final regulations.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id109E27CF78EA48E1803DD441AF0A32EF"><enum>1416.</enum><header>National Health Service Corps behavioral and mental health professionals providing obligated service in schools and other community-based settings</header><text display-inline="no-display-inline">Subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254<italic>l </italic>et seq.) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idAB214DD0E4E343039841578FDD92544B" style="OLC"><section id="id9C4CC340BF054E7AB76D700C2ECBEFBA"><enum>338N.</enum><header>Behavioral and mental health professionals providing obligated service in schools and other community-based settings</header><subsection id="idE0CE9AD68CDF40918FC4604ABDE3658A"><enum>(a)</enum><header>Schools and community-based settings</header><text>An entity to which a participant in the Scholarship Program or the Loan Repayment Program (referred to in this section as a <quote>participant</quote>) is assigned under section 333 may direct such participant to provide service as a behavioral or mental health professional at a school or other community-based setting located in a health professional shortage area.</text></subsection><subsection id="idCA98BF2325EB4A8E9FA83E1C2011835F"><enum>(b)</enum><header>Obligated service</header><paragraph id="id6668C24A5BE34732BC64BAA0C9823263"><enum>(1)</enum><header>In general</header><text>Any service described in subsection (a) that a participant provides may count towards such participant's completion of any obligated service requirements under the Scholarship Program or the Loan Repayment Program, subject to any limitation imposed under paragraph (2).</text></paragraph><paragraph id="id06154EB07F484BC1BA7197C0BE17EADC"><enum>(2)</enum><header>Limitation</header><text>The Secretary may impose a limitation on the number of hours of service described in subsection (a) that a participant may credit towards completing obligated service requirements, provided that the limitation allows a member to credit service described in subsection (a) for not less than 50 percent of the total hours required to complete such obligated service requirements.</text></paragraph></subsection><subsection id="idE7E0A6710F4E46C09BC45E7B5E2B401E"><enum>(c)</enum><header>Rule of construction</header><text>The authorization under subsection (a) shall be notwithstanding any other provision of this subpart or subpart II.</text></subsection></section><after-quoted-block>. </after-quoted-block></quoted-block></section><section id="idEB95B6AF95DF40FE93ACBD43B7664967"><enum>1417.</enum><header>Loan repayment for substance use disorder treatment providers</header><subsection id="idBB61BA16655C48B79D378E548652514E"><enum>(a)</enum><header>Loan repayment for substance use treatment providers</header><text display-inline="yes-display-inline">The Secretary shall enter into contracts under section 338B of the Public Health Service Act (42 U.S.C. 254l–1) with eligible health professionals providing substance use disorder treatment services in substance use disorder treatment facilities, as defined by the Secretary.</text></subsection><subsection id="id408ea1925ce54b9fa11f701d0601c0c6"><enum>(b)</enum><header>Provision of substance use disorder treatment</header><text>In carrying out the activities described in subsection (a)—</text><paragraph id="idad4d4f3c6f114902bc9384a2c6cc35d8"><enum>(1)</enum><text>each such facility shall be located in or serving a mental health professional shortage area designated under section 332 of the Public Health Service Act (42 U.S.C. 254e), or, as the Secretary determines appropriate, an area with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate;</text></paragraph><paragraph id="id29eb0c7ecf9242dfb765620a0e426cd3"><enum>(2)</enum><text>section 331(a)(3)(D) of such Act (42 U.S.C. 254d(a)(3)(D)) shall be applied as if the term <term>primary health services</term> includes health services regarding substance use disorder treatment and infections associated with illicit drug use;</text></paragraph><paragraph id="id103647a89d5746a7aadb763f2642ea89"><enum>(3)</enum><text>section 331(a)(3)(E)(i) of such Act (42 U.S.C. 254d(a)(3)(E)(i)) shall be applied as if the term <term>behavioral and mental health professionals</term> includes master's level, licensed substance use disorder treatment counselors, and other relevant professionals or paraprofessionals, as the Secretary determines appropriate; and</text></paragraph><paragraph id="id8c777771d59b46ff8bebfa6361058973"><enum>(4)</enum><text>such professionals and facilities shall provide—</text><subparagraph id="idbcd9f5de08b14c13920cd9314d456f99"><enum>(A)</enum><text>directly, or through the use of telehealth technology, and pursuant to Federal and State law, counseling by a program counselor or other certified professional who is licensed and qualified by education, training, or experience to assess the psychological and sociological background of patients, to contribute to the appropriate treatment plan for the patient, and to monitor progress; and</text></subparagraph><subparagraph id="id02cd27d7d36b4983a2ed77956ebae762"><enum>(B)</enum><text>medication-assisted treatment, including, to the extent practicable, all drugs approved by the Food and Drug Administration to treat substance use disorders, pursuant to Federal and State law.</text></subparagraph></paragraph></subsection><subsection id="id2f93f7b40f5044a1a8bade5230d08ede"><enum>(c)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section $25,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section><section id="ida8ac151fab1c49b0b8da63c1a53775b3"><enum>1418.</enum><header>Protecting moms and infants</header><subsection id="idE1137AB2AE7B4C9DAEB1999FF8AB68F1"><enum>(a)</enum><header>Report</header><paragraph id="idBB4283B65BB249ACAAFE8DFB47B2D3AD"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 60 days after the date of enactment of this Act, the Secretary shall submit to the appropriate committees of Congress and make available to the public on the internet website of the Department of Health and Human Services a report regarding the implementation of the recommendations in the strategy relating to prenatal opioid use, including neonatal abstinence syndrome, developed pursuant to section 2 of the Protecting Our Infants Act of 2015 (Public Law 114–91). Such report shall include—</text><subparagraph id="id83E13A46627F41E1840CE741964EC8EE"><enum>(A)</enum><text display-inline="yes-display-inline">an update on the implementation of the recommendations in the strategy, including information regarding the agencies involved in the implementation; and</text></subparagraph><subparagraph id="id4748EBB6B0284A43BF436BD021B8D2CE"><enum>(B)</enum><text display-inline="yes-display-inline">information on additional funding or authority the Secretary requires, if any, to implement the strategy, which may include authorities needed to coordinate implementation of such strategy across the Department of Health and Human Services.</text></subparagraph></paragraph><paragraph id="id9066E8883183450B867935C715A73252"><enum>(2)</enum><header>Periodic updates</header><text>The Secretary shall periodically update the report under paragraph (1).</text></paragraph></subsection><subsection id="id61D05BCCEC05493F9E442B5788629FC3"><enum>(b)</enum><header>Residential treatment programs for pregnant and postpartum women</header><text display-inline="yes-display-inline">Section 508(s) of the Public Health Service Act (42 U.S.C. 290bb–1(s)) is amended by striking <quote>$16,900,000 for each of fiscal years 2017 through 2021</quote> and inserting <quote>$29,931,000 for each of fiscal years 2019 through 2023</quote>.</text></subsection></section><section id="HF7C77631D62345AE81384E9E0790136F"><enum>1419.</enum><header>Early interventions for pregnant women and infants</header><subsection id="HC5313C29C89A43BAA48F14AF75277247"><enum>(a)</enum><header>Development of educational materials by Center for Substance Abuse Prevention</header><text display-inline="yes-display-inline">Section 515(b) of the Public Health Service Act (42 U.S.C. 290bb–21(b)) is amended—</text><paragraph id="H7AD6AFA28A144743B595D2D93DC83837"><enum>(1)</enum><text>in paragraph (13), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H7CC4DDC559D5431C87404316D60513D5"><enum>(2)</enum><text>in paragraph (14), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph id="H502B0D06439B452F8B444C8589A06023"><enum>(3)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="H260F86A1F2D84B3FA596396C4D653EBB" style="OLC"><paragraph id="HFA3019BECFAB4CA8867CFEB2944217D5"><enum>(15)</enum><text display-inline="yes-display-inline">in cooperation with relevant stakeholders and the Director of the Centers for Disease Control and Prevention, develop educational materials for clinicians to use with pregnant women for shared decisionmaking regarding pain management during pregnancy.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="HB4F6C53ADFA24AF2931EF758425215CF"><enum>(b)</enum><header>Guidelines and recommendations by Center for Substance Abuse Treatment</header><text>Section 507(b) of the Public Health Service Act (42 U.S.C. 290bb(b)) is amended—</text><paragraph id="HED667F5AD0DB4564B628331546157906"><enum>(1)</enum><text>in paragraph (13), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H529CAAFBF5BB4A8682C0CE83AD870DD1"><enum>(2)</enum><text>in paragraph (14), by striking the period at the end and inserting a semicolon; and</text></paragraph><paragraph id="H216280156E684EC8BB4038A8372B0692"><enum>(3)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="HEBBCA86701204DA9B785B518ECDBF704" style="OLC"><paragraph id="H13BDDE4E1FBA49CDA21F5AC1EB376528"><enum>(15)</enum><text display-inline="yes-display-inline">in cooperation with the Secretary, implement and disseminate, as appropriate, the recommendations in the report entitled <quote>Protecting Our Infants Act: Final Strategy</quote> issued by the Department of Health and Human Services in 2017; and</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="HC287CFA4C19B445EA58A6B5BF92D1390"><enum>(c)</enum><header>Support of partnerships by Center for Substance Abuse Treatment</header><text>Section 507(b) of the Public Health Service Act (42 U.S.C. 290bb(b)), as amended by subsection (b), is further amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="H60C2D8D841B34D1C8F2E099A087E8EB1" style="OLC"><paragraph id="HAA480A255437495396257AFF81D10512"><enum>(16)</enum><text display-inline="yes-display-inline">in cooperation with relevant stakeholders, support public-private partnerships to assist with education about, and support with respect to, substance use disorder for pregnant women and health care providers who treat pregnant women and babies.</text></paragraph><after-quoted-block>. </after-quoted-block></quoted-block></subsection></section><section id="id0AFAE36D062E4D85B0886BAB8D75006D"><enum>1420.</enum><header>Report on investigations regarding parity in mental health and substance use disorder benefits</header><subsection id="id015B651770614FC8977C4C45FFD15180"><enum>(a)</enum><header>In general</header><text>Section 13003 of the 21st Century Cures Act (Public Law 114–255) is amended—</text><paragraph id="id8F2AA462E08F40F988827A7DEB8BB1E0"><enum>(1)</enum><text>in subsection (a), by striking <quote>with findings of any serious violation regarding</quote> and inserting <quote>concerning</quote>; and</text></paragraph><paragraph id="id051389EA3C514F76A0B1D1393B7F8ACF"><enum>(2)</enum><text>in subsection (b)(1)—</text><subparagraph id="idB7941A2E441346FA89595EDB5F67D91D"><enum>(A)</enum><text>by inserting <quote>complaints received and number of</quote> before <quote>closed</quote>; and</text></subparagraph><subparagraph id="idEC260E9C1E764B76981E336C2B0A5165"><enum>(B)</enum><text>by inserting before the period <quote>, and, for each such investigation closed, which agency conducted the investigation, whether the health plan that is the subject of the investigation is fully insured or not fully insured and a summary of any coordination between the applicable State regulators and the Department of Labor, the Department of Health and Human Services, or the Department of the Treasury, and references to any guidance provided by the agencies addressing the category of violation committed</quote>.</text></subparagraph></paragraph></subsection><subsection id="id9F5FE18BC17949998ECDF527785D2915"><enum>(b)</enum><header>Applicability</header><text>The amendments made by subsection (a) shall apply with respect to the second annual report required under such section 13003 and each such annual report thereafter.</text></subsection></section></subtitle><subtitle id="id2992F1C7577C4BF89320631A9F059863"><enum>E</enum><header>Prevention</header><section id="idA382B0BD730849A08967C8A02B9B5EF0"><enum>1501.</enum><header>Study on prescribing limits</header><text display-inline="no-display-inline">Not later than 2 years after the date of enactment of this Act, the Secretary, in consultation with the Attorney General, shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report on the impact of Federal and State laws and regulations that limit the length, quantity, or dosage of opioid prescriptions. Such report shall address—</text><paragraph id="idBE97E5B1983D445CB0BE81DCFE59484A"><enum>(1)</enum><text display-inline="yes-display-inline">the impact of such limits on—</text><subparagraph id="idCB7B9A7ACD154789AB9C2C731AA12ABF"><enum>(A)</enum><text display-inline="yes-display-inline">the incidence and prevalence of overdose related to prescription opioids;</text></subparagraph><subparagraph id="id68397a49c7174125bcd4fb0bb0bdc108"><enum>(B)</enum><text>the incidence and prevalence of overdose related to illicit opioids;</text></subparagraph><subparagraph id="id9F125D56B1BE4871BA74CBD8AC1961C8"><enum>(C)</enum><text>the prevalence of opioid use disorders;</text></subparagraph><subparagraph id="id797334C915B0411983590E98E3859EEC"><enum>(D)</enum><text>medically appropriate use of, and access to, opioids, including any impact on travel expenses and pain management outcomes for patients, whether such limits are associated with significantly higher rates of negative health outcomes, including suicide, and whether the impact of such limits differs based on the clinical indication for which opioids are prescribed;</text></subparagraph></paragraph><paragraph id="id647C352F08604490B8CF89B54173AE21"><enum>(2)</enum><text>whether such limits lead to a significant increase in burden for prescribers of opioids or prescribers of treatments for opioid use disorder, including any impact on patient access to treatment, and whether any such burden is mitigated by any factors such as electronic prescribing or telemedicine; and</text></paragraph><paragraph id="idC7B47C5FC97D405DA415DE91837367E1"><enum>(3)</enum><text>the impact of such limits on diversion or misuse of any controlled substance in schedule II, III, or IV of section 202(c) of the Controlled Substances Act (21 U.S.C. 812(c)).</text></paragraph></section><section id="id056A5A345D00420188CE4EA6A5FA2D55"><enum>1502.</enum><header>Programs for health care workforce</header><subsection id="id3C5EA240E1E74BD8A00A322B43FE7FC4"><enum>(a)</enum><header>Program for education and training in pain care</header><text display-inline="yes-display-inline">Section 759 of the Public Health Service Act (42 U.S.C. 294i) is amended—</text><paragraph id="idf4a89a0a0f5e40119ef1680ee77c067e"><enum>(1)</enum><text>in subsection (a), by striking <quote>hospices, and other public and private entities</quote> and inserting <quote>hospices, tribal health programs (as defined in section 4 of the Indian Health Care Improvement Act), and other public and nonprofit private entities</quote>;</text></paragraph><paragraph id="id3DE92BC2C9464944AF868575F2119CD4"><enum>(2)</enum><text>in subsection (b)—</text><subparagraph id="id4B0567D6A6DF44A684DB6A340BA44843"><enum>(A)</enum><text>in the matter preceding paragraph (1), by striking <quote>award may be made under subsection (a) only if the applicant for the award agrees that the program carried out with the award will include</quote> and inserting <quote>entity receiving an award under this section shall develop a comprehensive education and training plan that includes</quote>;</text></subparagraph><subparagraph id="id8C8067385E34434CBC79D9A702CEEB31"><enum>(B)</enum><text>in paragraph (1)—</text><clause id="id93D768F2D64742A2BEC926BCBB9A0A75"><enum>(i)</enum><text>by inserting <quote>preventing,</quote> after <quote>diagnosing,</quote>; and</text></clause><clause id="idCD5710397E544621B233A6AB1EAB0940"><enum>(ii)</enum><text>by inserting <quote>non-addictive medical products and non-pharmacologic treatments and</quote> after <quote>including</quote>;</text></clause></subparagraph><subparagraph id="idB7D34816D75D47BB87B5A2F6CE3CA48E"><enum>(C)</enum><text>in paragraph (2)—</text><clause id="idB41943FC417E479196F36CC23680E6FA"><enum>(i)</enum><text>by inserting <quote>Federal, State, and local</quote> after <quote>applicable</quote>; and</text></clause><clause id="id9E95DABC1ECD40BCAE6F5E27832F65EF"><enum>(ii)</enum><text>by striking <quote>the degree to which</quote> and all that follows through <quote>effective pain care</quote> and inserting <quote>opioids</quote>;</text></clause></subparagraph><subparagraph id="id6B8235C2478341D2A815D47B5F4605B3"><enum>(D)</enum><text>in paragraph (3), by inserting <quote>, integrated, evidence-based pain management, and, as appropriate, non-pharmacotherapy</quote> before the semicolon;</text></subparagraph><subparagraph id="idF885B4A757DB4584A9C2B370C13E1D8C"><enum>(E)</enum><text>in paragraph (4), by striking <quote>; and</quote> and inserting <quote>;</quote>; and</text></subparagraph><subparagraph id="id027450BDC6B94B65871AE503F6ACF259"><enum>(F)</enum><text>by striking paragraph (5) and inserting the following:</text><quoted-block display-inline="no-display-inline" id="id245E7364912C40E7A6405D6B15C44D58" style="OLC"><paragraph id="idFDDA8B7A4E4C46ABA1B92B8E511B806D"><enum>(5)</enum><text>recent findings, developments, and advancements in pain care research and the provision of pain care, which may include non-addictive medical products and non-pharmacologic treatments intended to treat pain; and</text></paragraph><paragraph id="idF8B9260A85844421B5779944624C2DD2"><enum>(6)</enum><text>the dangers of opioid abuse and misuse, detection of early warning signs of opioid use disorders (which may include best practices related to screening for opioid use disorders, training on screening, brief intervention, and referral to treatment), and safe disposal options for prescription medications (including such options provided by law enforcement or other innovative deactivation mechanisms).</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id2AB67E29C06F49BD8C4196FD6B6DFF18"><enum>(3)</enum><text>in subsection (d), by inserting <quote>prevention,</quote> after <quote>diagnosis,</quote>; and</text></paragraph><paragraph id="id0FD7933D6302418B91F02F67A1DA837E"><enum>(4)</enum><text>in subsection (e), by striking <quote>2010 through 2012</quote> and inserting <quote>2019 through 2023</quote>.</text></paragraph></subsection><subsection id="id5ae40742e3e54bf29da55b6c333e4051"><enum>(b)</enum><header>Mental and behavioral health education and training program</header><text>Section 756(a) of the Public Health Service Act (42 U.S.C. 294e–1(a)) is amended—</text><paragraph id="id90ab590ec70f42388357c7f49e634e1a"><enum>(1)</enum><text>in paragraph (1), by inserting <quote>, trauma,</quote> after <quote>focus on child and adolescent mental health</quote>; and</text></paragraph><paragraph id="idea93bd2edbc3404ebf1aea9dd1d80fe2"><enum>(2)</enum><text>in paragraphs (2) and (3), by inserting <quote>trauma-informed care and</quote> before <quote>substance use disorder prevention and treatment services</quote>.</text></paragraph></subsection></section><section id="id52C8DE82A10A4C52AE2BF631C8F93205"><enum>1503.</enum><header>Education and awareness campaigns</header><text display-inline="no-display-inline">Section 102 of the Comprehensive Addiction and Recovery Act of 2016 (Public Law 114–198) is amended—</text><paragraph id="id4D445A22FCB446BC8575AAE9CB9D766A"><enum>(1)</enum><text>by amending subsection (a) to read as follows:</text><quoted-block display-inline="no-display-inline" id="id60A808BC929D45DB910E99FC64512206" style="OLC"><subsection id="id36A477D771314B40ACDED60CD2CB28A3"><enum>(a)</enum><header>In general</header><text>The Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention and in coordination with the heads of other departments and agencies, shall advance education and awareness regarding the risks related to misuse and abuse of opioids, as appropriate, which may include developing or improving existing programs, conducting activities, and awarding grants that advance the education and awareness of—</text><paragraph id="idA6D0E8DF1C80485191D2FEF399F3BD37"><enum>(1)</enum><text>the public, including patients and consumers;</text></paragraph><paragraph id="id9B94C783D29E466F932DCF2FED7B5EBB"><enum>(2)</enum><text>patients, consumers, and other appropriate members of the public, regarding such risks related to unused opioids and the dispensing options under section 309(f) of the Controlled Substances Act, as applicable;</text></paragraph><paragraph id="id80C9AC54422F48D88620B1177D6DEEA8"><enum>(3)</enum><text>providers, which may include—</text><subparagraph id="id9B8F63E8AA714073BB9B471D2625E049"><enum>(A)</enum><text>providing for continuing education on appropriate prescribing practices;</text></subparagraph><subparagraph id="id5F9429A3E3434A42A0AC919F9407EEE0"><enum>(B)</enum><text>education related to applicable State or local prescriber limit laws, information on the use of non-addictive alternatives for pain management, and the use of overdose reversal drugs, as appropriate;</text></subparagraph><subparagraph id="id079513AEB26A48C0941118F17FB12A3A"><enum>(C)</enum><text>disseminating and improving the use of evidence-based opioid prescribing guidelines across relevant health care settings, as appropriate, and updating guidelines as necessary;</text></subparagraph><subparagraph id="id3F5926473D8041AFAD7F250024A354BE"><enum>(D)</enum><text>implementing strategies, such as best practices, to encourage and facilitate the use of prescriber guidelines, in accordance with State and local law;</text></subparagraph><subparagraph id="id665E475F1A614E5181ED2D20D6AA9C9B"><enum>(E)</enum><text>disseminating information to providers about prescribing options for controlled substances, including such options under section 309(f) of the Controlled Substances Act, as applicable; and</text></subparagraph><subparagraph id="idE8BBB8B8A39F429087FDC0BC7B2B120A"><enum>(F)</enum><text>disseminating information, as appropriate, on the National Pain Strategy developed by or in consultation with the Assistant Secretary for Health; and</text></subparagraph></paragraph><paragraph id="id137929D08B0F4B22810CCFC1E53DE65C"><enum>(4)</enum><text>other appropriate entities.</text></paragraph></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="idBD31C92BF4DE406A806F352F0058BE6D"><enum>(2)</enum><text>in subsection (b)—</text><subparagraph id="idB97B0773436C40EDAD6B0CEA4EB013F1"><enum>(A)</enum><text>by striking <quote>opioid abuse</quote> each place such term appears and inserting <quote>opioid misuse and abuse</quote>; and</text></subparagraph><subparagraph id="id7AF51C9A6DEE492FA20317C9D0BB1133"><enum>(B)</enum><text>in paragraph (2), by striking <quote>safe disposal of prescription medications and other</quote> and inserting <quote>non-addictive treatment options, safe disposal options for prescription medications, and other applicable</quote>.</text></subparagraph></paragraph></section><section id="idBAC2D1D46F4A43E385AF651062766CD5"><enum>1504.</enum><header>Enhanced controlled substance overdoses data collection, analysis, and dissemination</header><text display-inline="no-display-inline">Part J of title III of the Public Health Service Act is amended by inserting after section 392 (42 U.S.C. 280b–1) the following:</text><quoted-block display-inline="no-display-inline" id="idB1278A622FD74CF4AEF44D45581B7705" style="OLC"><section id="idB37ADFB0790C4C3ABD9BB802A9A03A49"><enum>392A.</enum><header>Enhanced controlled substance overdoses data collection, analysis, and dissemination</header><subsection id="id9ddd5b57f46d4a60895af287776cc05d"><enum>(a)</enum><header>In general</header><text>The Director of the Centers for Disease Control and Prevention, using the authority provided to the Director under section 392, may—</text><paragraph id="id072779bb7cdc4781a78b03a8c90e8223"><enum>(1)</enum><text>to the extent practicable, carry out and expand any controlled substance overdose data collection, analysis, and dissemination activity described in subsection (b);</text></paragraph><paragraph id="id3f2cc7ec18e64edc8191c569e8bc8143"><enum>(2)</enum><text>provide training and technical assistance to States, localities, and Indian Tribes for the purpose of carrying out any such activity; and</text></paragraph><paragraph id="id0d8136d181744e8aba9ad6cd82cee539"><enum>(3)</enum><text>award grants to States, localities, and Indian Tribes for the purpose of carrying out any such activity.</text></paragraph></subsection><subsection id="ide66909d2f6774d2e9f5efaec5a72c542"><enum>(b)</enum><header>Controlled substance overdose data collection and analysis activities</header><text>A controlled substance overdose data collection, analysis, and dissemination activity described in this subsection is any of the following activities:</text><paragraph id="id65871372ea474cfdaa64d25dd50ddb8a"><enum>(1)</enum><text>Improving the timeliness of reporting aggregate data to the public, including data on fatal and nonfatal controlled substance overdoses.</text></paragraph><paragraph id="id3eca175d0b434c248af0823ad9cec10e"><enum>(2)</enum><text>Enhancing the comprehensiveness of controlled substance overdose data by collecting information on such overdoses from appropriate sources such as toxicology reports, autopsy reports, death scene investigations, and emergency department services.</text></paragraph><paragraph id="idc3dca686f2384432ab4c27785b367e0b"><enum>(3)</enum><text>Modernizing the system for coding causes of death related to controlled substance overdoses to use an electronic-based system.</text></paragraph><paragraph id="idcc79878897ef43bd87dc5a9beba69039"><enum>(4)</enum><text>Using data to help identify risk factors associated with controlled substance overdoses, including the delivery of certain health care services.</text></paragraph><paragraph id="idf9dfef427aec42acaa05e574af771a84"><enum>(5)</enum><text>Supporting entities involved in reporting information on controlled substance overdoses, such as coroners and medical examiners, to improve accurate testing and standardized reporting of causes and contributing factors of such overdoses, and analysis of various opioid analogues to controlled substance overdoses.</text></paragraph><paragraph id="id74a1041e8b734bb09af1e82c351b80a6"><enum>(6)</enum><text>Working to enable and encourage the access, exchange, and use of data regarding controlled substances overdoses among data sources and entities.</text></paragraph></subsection><subsection id="id4ADDA5688A794A0FA3DBE247FB2A4306"><enum>(c)</enum><header>Definitions</header><text>In this section—</text><paragraph id="id1FC7A594FE08460B87E4E25833C53A71"><enum>(1)</enum><text>the term <term>controlled substance</term> has the meaning given that term in section 102 of the Controlled Substances Act; and</text></paragraph><paragraph id="id85608046BA704B37B0CB455DED7BD39D"><enum>(2)</enum><text>the term <term>Indian Tribe</term> has the meaning given the term <term>Indian tribe</term> in section 4 of the Indian Self-Determination and Education Assistance Act.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id9765edf84a8244419eaba375f9ddad0a"><enum>1505.</enum><header>Preventing overdoses of controlled substances</header><text display-inline="no-display-inline">Part J of title III of the Public Health Service Act (42 U.S.C. 280b et seq.), as amended by section 504, is further amended by inserting after section 392A the following:</text><quoted-block display-inline="no-display-inline" id="id22DCC190072C424DB392512D0D0B1DF7" style="OLC"><section id="id3c0707b69c5e415899cdd45edac579a3"><enum>392B.</enum><header>Preventing overdoses of controlled substances</header><subsection id="id5F4D2DCC985345869EAA9173B92294E6"><enum>(a)</enum><header>Prevention activities</header><paragraph id="id18c4f79c432f4d0486ee1fcc5977fe19"><enum>(1)</enum><header>In general</header><text>The Director of the Centers for Disease Control and Prevention (referred to in this section as the <quote>Director</quote>), using the authority provided to the Director under section 392, may—</text><subparagraph id="id96beebfeb562437d8aff2396fd2bfe26"><enum>(A)</enum><text>to the extent practicable, carry out and expand any prevention activity described in paragraph (2);</text></subparagraph><subparagraph id="idba9bded7fd874b24ae99b30693b5da87"><enum>(B)</enum><text>provide training and technical assistance to States, localities, and Indian Tribes to carry out any such activity; and</text></subparagraph><subparagraph id="id49F9D8C1B2224A0882AD4AEC68A7ADBE"><enum>(C)</enum><text>award grants to States, localities, and Indian Tribes for the purpose of carrying out any such activity.</text></subparagraph></paragraph><paragraph id="id7996db687e95476f8729fb0f7af0e07d"><enum>(2)</enum><header>Prevention activities</header><text>A prevention activity described in this paragraph is an activity to improve the efficiency and use of a new or currently operating prescription drug monitoring program, such as—</text><subparagraph id="id3330934992d643588b060ae5f67c5429"><enum>(A)</enum><text>encouraging all authorized users (as specified by the State or other entity) to register with and use the program;</text></subparagraph><subparagraph id="id94c031ed989a44fcba14c4b688677f04"><enum>(B)</enum><text>enabling such users to access any data updates in as close to real-time as practicable;</text></subparagraph><subparagraph id="id7cddd3d3783542b2bcff046b06ab5a3f"><enum>(C)</enum><text>providing for a mechanism for the program to notify authorized users of any potential misuse or abuse of controlled substances and any detection of inappropriate prescribing or dispensing practices relating to such substances;</text></subparagraph><subparagraph id="idb72958fa68874931a7054cc2e298627c"><enum>(D)</enum><text>encouraging the analysis of prescription drug monitoring data for purposes of providing de-identified, aggregate reports based on such analysis to State public health agencies, State alcohol and drug agencies, State licensing boards, and other appropriate State agencies, as permitted under applicable Federal and State law and the policies of the prescription drug monitoring program and not containing any protected health information, to prevent inappropriate prescribing, drug diversion, or abuse and misuse of controlled substances, and to facilitate better coordination among agencies;</text></subparagraph><subparagraph id="id66032C5F76B5434B8B1D03E121A7AED2"><enum>(E)</enum><text>enhancing interoperability between the program and any health information technology (including certified health information technology), including by integrating program data into such technology;</text></subparagraph><subparagraph id="id834e00c96ac14cbda44716dd5c0f5ade"><enum>(F)</enum><text>updating program capabilities to respond to technological innovation for purposes of appropriately addressing the occurrence and evolution of controlled substance overdoses;</text></subparagraph><subparagraph id="idA15F99F416C6492181774511E70AF1C3"><enum>(G)</enum><text>developing or enhancing data exchange with other sources such as the Medicaid agency, the Medicare program, pharmacy benefit managers, coroners’ reports, and workers’ compensation data;</text></subparagraph><subparagraph id="idbddb1f61f9c54d728f56c3374a21b47e"><enum>(H)</enum><text>facilitating and encouraging data exchange between the program and the prescription drug monitoring programs of other States;</text></subparagraph><subparagraph id="id3a7484c5c7f54804b336daf4324b11c4"><enum>(I)</enum><text>enhancing data collection and quality, including improving patient matching and proactively monitoring data quality; and</text></subparagraph><subparagraph id="id43717B08C79D4C91B6CBFD154BB3CDA3"><enum>(J)</enum><text>providing prescriber and dispenser practice tools, including prescriber practice insight reports for practitioners to review their prescribing patterns in comparison to such patters of other practitioners in the specialty.</text></subparagraph></paragraph></subsection><subsection id="id202a4dbda0264cbe93e66a7a212990b4"><enum>(b)</enum><header>Additional grants</header><text>The Director may award grants to States, localities, and Indian Tribes—</text><paragraph id="idd76f9c0aff134510816b8d3d78985c2d"><enum>(1)</enum><text>to carry out innovative projects for grantees to rapidly respond to controlled substance misuse, abuse, and overdoses, including changes in patterns of controlled substance use; and</text></paragraph><paragraph id="idce1e28aa1dd84ccc932f606d493dde02"><enum>(2)</enum><text>for any other evidence-based activity for preventing controlled substance misuse, abuse, and overdoses as the Director determines appropriate.</text></paragraph></subsection><subsection id="idcb4f0a2c73b441d0adc336a29a42060c"><enum>(c)</enum><header>Research</header><text>The Director, in coordination with the Assistant Secretary for Mental Health and Substance Use and the National Mental Health and Substance Use Policy Laboratory established under section 501A, as appropriate and applicable, may conduct studies and evaluations to address substance use disorders, including preventing substance use disorders or other related topics the Director determines appropriate.</text></subsection><subsection id="id09c6ac6831c8419c9801501257c3ca54"><enum>(d)</enum><header>Public and prescriber education</header><text>Pursuant to section 102 of the Comprehensive Addiction and Recovery Act of 2016, the Director may advance the education and awareness of prescribers and the public regarding the risk of abuse and misuse of prescription opioids.</text></subsection><subsection id="ide5bfc6d8378f4391adb8980285e4de1b"><enum>(e)</enum><header>Definitions</header><text>In this section—</text><paragraph id="id4096D0B85E54466BAF1088727BDDA907"><enum>(1)</enum><text>the term <term>controlled substance</term> has the meaning given that term in section 102 of the Controlled Substances Act; and</text></paragraph><paragraph id="id30A3BCDA03614B03B158104EEB18CA91"><enum>(2)</enum><text>the term <term>Indian Tribe</term> has the meaning given the term <term>Indian tribe</term> in section 4 of the Indian Self-Determination and Education Assistance Act.</text></paragraph></subsection><subsection id="idf2d401769e384759b2d715a0e84559ae"><enum>(f)</enum><header>Authorization of appropriations</header><text>For purposes of carrying out this section, section 392A of this Act, and section 102 of the Comprehensive Addiction and Recovery Act of 2016, there is authorized to be appropriated $486,000,000 for each of fiscal years 2019 through 2024.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id27c00e7b95fc435ea1ec2dfddee559d5"><enum>1506.</enum><header>CDC surveillance and data collection for child, youth, and adult trauma</header><subsection id="ida2e513c141394e14b6b10368a1ae89eb"><enum>(a)</enum><header>Data collection</header><text>The Director of the Centers for Disease Control and Prevention (referred to in this section as the <quote>Director</quote>) may, in cooperation with the States, collect and report 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.</text></subsection><subsection id="idf1423bd1ae71406d9dddf0dcb0f5132a"><enum>(b)</enum><header>Timing</header><text>The collection of data under subsection (a) may occur in fiscal year 2019 and every 2 years thereafter.</text></subsection><subsection id="id6b30d32f2e2d4320b6d3f0633d3aad22"><enum>(c)</enum><header>Data from rural areas</header><text>The Director shall encourage each State that participates in collecting and reporting data under subsection (a) to collect and report data from tribal and rural areas within such State, in order to generate a statistically reliable representation of such areas.</text></subsection><subsection id="idcd215e3790834395a34fcbd9853699b8"><enum>(d)</enum><header>Data from tribal areas</header><text>The Director may, in cooperation with Indian Tribes and pursuant to a written request from an Indian Tribe, provide technical assistance to such Indian Tribe to collect and report data on adverse childhood experiences through the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior Surveillance System, or another relevant public health survey or questionnaire.</text></subsection><subsection id="id2CF3965FB2284A79B74448E8993274F1"><enum>(e)</enum><header>Authorization of appropriations</header><text>To carry out this section, there is authorized to be appropriated such sums as may be necessary for the period of fiscal years 2019 through 2021.</text></subsection></section><section id="idB9433AF5F8394E6D8E0AD7AEF3370E58"><enum>1507.</enum><header>Reauthorization of NASPER</header><text display-inline="no-display-inline">Section 399O of the Public Health Service Act (42 U.S.C. 280g–3) is amended—</text><paragraph id="id2ADEC45FB999411BB57C70C684AF5F9B"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="id09F28660B50D419E9605DA73B4365580"><enum>(A)</enum><text>in paragraph (1), in the matter preceding subparagraph (A), by striking <quote>in consultation with the Administrator of the Substance Abuse and Mental Health Services Administration and Director of the Centers for Disease Control and Prevention</quote> and inserting <quote>in coordination with the Director of the Centers for Disease Control and the heads of other departments and agencies as appropriate</quote>; and</text></subparagraph><subparagraph id="idD378730CA3814548BFAC42D4AECB2708"><enum>(B)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idFE1BD00C64D440F581374E4067BDBEAA" style="OLC"><paragraph id="id72D779C22EB04069B55F75B0075FC6AB"><enum>(4)</enum><header>States and local governments</header><subparagraph id="id1f477201c1a143e6a26f276916733816"><enum>(A)</enum><header>In general</header><text>In the case of a State that does not have a prescription drug monitoring program, a county or other unit of local government within the State that has a prescription drug monitoring program shall be treated as a State for purposes of this section, including for purposes of eligibility for grants under paragraph (1).</text></subparagraph><subparagraph id="ida4f38049810944e2a1078c14af1bd165"><enum>(B)</enum><header>Plan for interoperability</header><text>For purposes of meeting the interoperability requirements under subsection (c)(3), a county or other unit of local government shall submit a plan outlining the methods such county or unit of local government will use to ensure the capability of data sharing with other counties and units of local government within the State and with other States, as applicable.</text></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="idD491230462A4434FB54FADCDF9082440"><enum>(2)</enum><text>in subsection (c)—</text><subparagraph id="id5A2833686AC544EF8AE5555FE8661091"><enum>(A)</enum><text>in paragraph (1)(A)(iii)—</text><clause id="id503662D589184301823C7D18DE5093E0"><enum>(i)</enum><text>by inserting <quote>as such standards become available,</quote> after <quote>interoperability standards,</quote>; and</text></clause><clause id="id06EBA3E26E034355ACC70E99E0125745"><enum>(ii)</enum><text>by striking <quote>generated or identified by the Secretary or his or her designee</quote> and inserting <quote>recognized by the Office of the National Coordinator for Health Information Technology</quote>; and</text></clause></subparagraph><subparagraph id="id157AAB85F66049B99E7AC637ECC1D652"><enum>(B)</enum><text>in paragraph (3)(A), by inserting <quote>including electronic health records,</quote> after <quote>technology systems,</quote>;</text></subparagraph></paragraph><paragraph id="id8B16723E484A4E918CE61D4D2A3B604B"><enum>(3)</enum><text>in subsection (d)(1), by striking <quote>not later than 1 week after the date of such dispensing</quote> and inserting <quote>in as close to real time as practicable</quote>;</text></paragraph><paragraph id="id59513B28283749418C1DDC35177347A5"><enum>(4)</enum><text>in subsection (f)—</text><subparagraph id="idBC7533BABDF941099AC1E62FEAB4ADAA"><enum>(A)</enum><text>in paragraph (1)(D), by striking <quote>medicaid</quote> and inserting <quote>Medicaid</quote>; and</text></subparagraph><subparagraph id="idA3595167E0F049A3BDC085AFFC86F86D"><enum>(B)</enum><text>in paragraph (2)—</text><clause id="idBCA6CC8728A645A1948B99EE9E37CC52"><enum>(i)</enum><text>in subparagraph (A), by striking <quote>and</quote> at the end;</text></clause><clause id="id513B79598E824CB38DB4B603DC8BC0F7"><enum>(ii)</enum><text>in subparagraph (B), by striking the period and inserting a semicolon; and</text></clause><clause id="id04F54C0185474501BA62A82765A807E9"><enum>(iii)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id7DBFD578465E46DB865C695CD6ADA59A" style="OLC"><subparagraph id="id755B9B54EC4E4A47AF0C4794C55A0A33"><enum>(C)</enum><text>may conduct analyses of controlled substance program data for purposes of providing appropriate State agencies with aggregate reports based on such analyses in as close to real-time as practicable, regarding prescription patterns flagged as potentially presenting a risk of misuse, abuse, addiction, overdose, and other aggregate information, as appropriate and in compliance with applicable Federal and State laws and provided that such reports shall not include protected health information; and</text></subparagraph><subparagraph id="id416740DD088841DDA4BC9F4AF0DEF34B"><enum>(D)</enum><text>may access information about prescriptions, such as claims data, to ensure that such prescribing and dispensing history is updated in as close to real-time as practicable, in compliance with applicable Federal and State laws and provided that such information shall not include protected health information.</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></clause></subparagraph></paragraph><paragraph id="id2556A6B1820E4BC9A4DCDC5A01F40BF1"><enum>(5)</enum><text>in subsection (i), by inserting <quote>, in collaboration with the National Coordinator for Health Information Technology and the Director of the National Institute of Standards and Technology,</quote> after <quote>The Secretary</quote>; and</text></paragraph><paragraph id="idE5E7559B9251411FBB24307BD8DC8C32"><enum>(6)</enum><text>in subsection (n), by striking <quote>2021</quote> and inserting <quote>2026</quote>.</text></paragraph></section><section id="idb0d423213cb64a5c8bf8f112cc215fb3"><enum>1508.</enum><header>Jessie’s law</header><subsection id="idf470e9d8fe7943c3af26cc25a5b35f22"><enum>(a)</enum><header>Best practices</header><paragraph id="idad134c851acf48b1a2889fcb91620f5d"><enum>(1)</enum><header>In general</header><text>Not later than 1 year after the date of enactment of this Act, the Secretary, in consultation with appropriate stakeholders, including a patient with a history of opioid use disorder, an expert in electronic health records, an expert in the confidentiality of patient health information and records, and a health care provider, shall identify or facilitate the development of best practices regarding—</text><subparagraph id="id1881d33b8c264079a7d332dfe4be0ca1"><enum>(A)</enum><text>the circumstances under which information that a patient has provided to a health care provider regarding such patient’s history of opioid use disorder should, only at the patient’s request, be prominently displayed in the medical records (including electronic health records) of such patient;</text></subparagraph><subparagraph id="id5161a7ca6dba43dc9e2925890fae14cb"><enum>(B)</enum><text>what constitutes the patient’s request for the purpose described in subparagraph (A); and</text></subparagraph><subparagraph id="id6dc0f5e191a145a1913cc670895f6b76"><enum>(C)</enum><text>the process and methods by which the information should be so displayed.</text></subparagraph></paragraph><paragraph id="id606bb0a0afe64b0b81b09b1aed6ff7ff"><enum>(2)</enum><header>Dissemination</header><text>The Secretary shall disseminate the best practices developed under paragraph (1) to health care providers and State agencies.</text></paragraph></subsection><subsection id="id36f85c0c8ae048e1872b5c4cfc4fe245"><enum>(b)</enum><header>Requirements</header><text>In identifying or facilitating the development of best practices under subsection (a), as applicable, the Secretary, in consultation with appropriate stakeholders, shall consider the following:</text><paragraph id="ida3a9145b286a4552b186734e6dbdbe7d"><enum>(1)</enum><text>The potential for addiction relapse or overdose, including overdose death, when opioid medications are prescribed to a patient recovering from opioid use disorder.</text></paragraph><paragraph id="id629772c773a548468bae421ec3283a11"><enum>(2)</enum><text>The benefits of displaying information about a patient’s opioid use disorder history in a manner similar to other potentially lethal medical concerns, including drug allergies and contraindications.</text></paragraph><paragraph id="id17af81262b7b42578a8c536990a12654"><enum>(3)</enum><text>The importance of prominently displaying information about a patient’s opioid use disorder when a physician or medical professional is prescribing medication, including methods for avoiding alert fatigue in providers.</text></paragraph><paragraph id="id17e329f9400e44d4b6dc7f4cff91e595"><enum>(4)</enum><text>The importance of a variety of appropriate medical professionals, including physicians, nurses, and pharmacists, having access to information described in this section when prescribing or dispensing opioid medication, consistent with Federal and State laws and regulations.</text></paragraph><paragraph id="id28fe3993adf345c19b414fc3c00f66ac"><enum>(5)</enum><text>The importance of protecting patient privacy, including the requirements related to consent for disclosure of substance use disorder information under all applicable laws and regulations.</text></paragraph><paragraph id="idE94AFF71256B4775AEA9EDFAB1F98175"><enum>(6)</enum><text>All applicable Federal and State laws and regulations.</text></paragraph></subsection></section><section id="id79C50FF831C24A9CAC79B9CC52FBB2ED"><enum>1509.</enum><header>Development and dissemination of model training programs for substance use disorder patient records</header><subsection id="id490740ac80924680845b11306e35c7a5"><enum>(a)</enum><header>Initial programs and materials</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary, in consultation with appropriate experts, shall identify the following model programs and materials (or if no such programs or materials exist, recognize private or public entities to develop and disseminate such programs and materials):</text><paragraph id="id3e279cd6bc084cfda9e88619b942491c"><enum>(1)</enum><text>Model programs and materials for training health care providers (including physicians, emergency medical personnel, psychiatrists, psychologists, counselors, therapists, nurse practitioners, physician assistants, behavioral health facilities and clinics, care managers, and hospitals, including individuals such as general counsels or regulatory compliance staff who are responsible for establishing provider privacy policies) concerning the permitted uses and disclosures, consistent with the standards and regulations governing the privacy and security of substance use disorder patient records promulgated by the Secretary under section 543 of the Public Health Service Act (42 U.S.C. 290dd–2) for the confidentiality of patient records.</text></paragraph><paragraph id="id189d049c6d934ab9bbce649dad30eed0"><enum>(2)</enum><text>Model programs and materials for training patients and their families regarding their rights to protect and obtain information under the standards and regulations described in paragraph (1).</text></paragraph></subsection><subsection id="id3105CB003E8B458BB94813D5EF2AFA49"><enum>(b)</enum><header>Requirements</header><text>The model programs and materials described in paragraphs (1) and (2) of subsection (a) shall address circumstances under which disclosure of substance use disorder patient records is needed to—</text><paragraph id="idd295560fddc84427921c09adf475725d"><enum>(1)</enum><text>facilitate communication between substance use disorder treatment providers and other health care providers to promote and provide the best possible integrated care;</text></paragraph><paragraph id="id210f832e39464de7afa50e12120e5f4f"><enum>(2)</enum><text>avoid inappropriate prescribing that can lead to dangerous drug interactions, overdose, or relapse; and</text></paragraph><paragraph id="id52999abc7802426ab839558d10a2b98a"><enum>(3)</enum><text>notify and involve families and caregivers when individuals experience an overdose.</text></paragraph></subsection><subsection id="ide5ae5a6513b3465197fbb8e4ee51f55c"><enum>(c)</enum><header>Periodic updates</header><text>The Secretary shall—</text><paragraph id="id76dab2f6dcf34d2aae7586da64294220"><enum>(1)</enum><text>periodically review and update the model program and materials identified or developed under subsection (a); and</text></paragraph><paragraph id="idf3268d91a5b64815bdfbd8f04756591a"><enum>(2)</enum><text>disseminate such updated programs and materials to the individuals described in subsection (a)(1).</text></paragraph></subsection><subsection id="id731b8c1cffec4c5998cf2b02cc3fb2c4"><enum>(d)</enum><header>Input of certain entities</header><text>In identifying, reviewing, or updating the model programs and materials under this section, the Secretary shall solicit the input of relevant stakeholders.</text></subsection><subsection id="id807f53782d2b424e9c15f28359167f9f"><enum>(e)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2019 through 2023.</text></subsection></section><section id="idDE2D26FA23EE481C9F53922F78AF3A75"><enum>1510.</enum><header>Communication with families during emergencies</header><subsection id="idA95344319A964C43A64FF876537CB8A6"><enum>(a)</enum><header>Promoting Awareness of Authorized Disclosures during Emergencies</header><text display-inline="yes-display-inline">The Secretary shall annually notify health care providers regarding permitted disclosures during emergencies, including overdoses, of certain health information to families and caregivers under Federal health care privacy laws and regulations.</text></subsection><subsection id="idCA74AF000B9346A28E2C135D700B7096"><enum>(b)</enum><header>Use of material</header><text display-inline="yes-display-inline">For the purposes of carrying out subsection (a), the Secretary may use material produced under section 1509 of this Act or under section 11004 of the 21st Century Cures Act (42 U.S.C. 1320d–2 note).</text></subsection></section><section id="id1224A42D216E47BB99BDEAA24B5631CF"><enum>1511.</enum><header>Prenatal and postnatal health</header><text display-inline="no-display-inline">Section 317L of the Public Health Service Act (42 U.S.C. 247b–13) is amended—</text><paragraph id="id7BB4C54320A84C7A84A2D8FA071DEEBD"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="idEAD70C1DF4A44E689ABD4A66F89ADABC"><enum>(A)</enum><text>by amending paragraph (1) to read as follows:</text><quoted-block display-inline="no-display-inline" id="id74CE7E2EEC6C405CA2E8B9D70B53EB81" style="OLC"><paragraph id="id343A44157CE84486A4AD2BA0E4D2D916"><enum>(1)</enum><text>to collect, analyze, and make available data on prenatal smoking and alcohol and substance abuse and misuse, including—</text><subparagraph id="idDFE6C86D51DD4028B28C77A462593171"><enum>(A)</enum><text>data on—</text><clause id="id6B9716794893493791DF0767A67009E3"><enum>(i)</enum><text>the incidence, prevalence, and implications of such activities; and</text></clause><clause id="id2753F2C5FFA14759890493E0BC289394"><enum>(ii)</enum><text>the incidence and prevalence of implications and outcomes, including neonatal abstinence syndrome and other maternal and child health outcomes associated with such activities; and</text></clause></subparagraph><subparagraph id="id911527534BD54802AEB29D5EE51577C8"><enum>(B)</enum><text>to inform such analysis, additional information or data on family health history, medication exposures during pregnancy, demographic information, such as race, ethnicity, geographic location, and family history, and other relevant information, as appropriate;</text></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph><subparagraph id="id8426D4941B0944608C66797FDCE06AB3"><enum>(B)</enum><text>in paragraph (2)—</text><clause id="id1783541E773F4F8395B4BC1D7D93602A"><enum>(i)</enum><text>by striking <quote>prevention of</quote> and inserting <quote>prevention and long-term outcomes associated with</quote>; and</text></clause><clause id="id499CC2F85BD34BC9BD1C5CB738A68082"><enum>(ii)</enum><text>by striking <quote>illegal drug use</quote> and inserting <quote>substance abuse and misuse</quote>;</text></clause></subparagraph><subparagraph id="idE0DA96CA3BDF421288B782DC11D7055E"><enum>(C)</enum><text>in paragraph (3), by striking <quote>and cessation programs; and</quote> and inserting <quote>, treatment, and cessation programs;</quote>;</text></subparagraph><subparagraph id="id54292BDC27584938BDB9E528BE1DE363"><enum>(D)</enum><text>in paragraph (4), by striking <quote>illegal drug use.</quote> and inserting <quote>substance abuse and misuse; and</quote>; and</text></subparagraph><subparagraph id="idBB46C26E743046B8A95B546F6CBC07D6"><enum>(E)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id756F233F812C4E9EB568FD86E129838E" style="OLC"><paragraph id="idEAE8313BC66A406AB8AE5E2FF0698801"><enum>(5)</enum><text>to issue public reports on the analysis of data described in paragraph (1), including analysis of—</text><subparagraph id="idd725c0e8579d4a9ca91737889c2d8f57"><enum>(A)</enum><text>long-term outcomes of children affected by neonatal abstinence syndrome;</text></subparagraph><subparagraph id="id737e374a759b4292a79a7be6cdfda137"><enum>(B)</enum><text>health outcomes associated with prenatal smoking, alcohol, and substance abuse and misuse; and</text></subparagraph><subparagraph id="idbabae9a993324d659d9297f46e1008bc"><enum>(C)</enum><text>relevant studies, evaluations, or information the Secretary determines to be appropriate.</text></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id49552DA854C043A8B8DE521BB399E4B5"><enum>(2)</enum><text>in subsection (b), by inserting <quote>tribal entities,</quote> after <quote>local governments,</quote>;</text></paragraph><paragraph id="id2ECF8F94F78342A989DCC6EE8029F55C"><enum>(3)</enum><text>by redesignating subsection (c) as subsection (d);</text></paragraph><paragraph id="id6BD733F398A5426BBADC0439CB7E10D6"><enum>(4)</enum><text>by inserting after subsection (b) the following:</text><quoted-block display-inline="no-display-inline" id="id7953CF6FA6AC46888ADB2AB8C49A66D2" style="OLC"><subsection id="id6CC7C5B626B2474780DD5C161329E8E6"><enum>(c)</enum><header>Coordinating activities</header><text>To carry out this section, the Secretary may—</text><paragraph id="id72A9422D9B40416F926B724F5F8EE33A"><enum>(1)</enum><text>provide technical and consultative assistance to entities receiving grants under subsection (b);</text></paragraph><paragraph id="idB26D480872F8446397B14B203FCB006E"><enum>(2)</enum><text>ensure a pathway for data sharing between States, tribal entities, and the Centers for Disease Control and Prevention;</text></paragraph><paragraph id="idB579971B11874966B3CD224DD8769048"><enum>(3)</enum><text>ensure data collection under this section is consistent with applicable State, Federal, and Tribal privacy laws; and</text></paragraph><paragraph id="id4227BA76A0C546E2B17A0192FDA0EA89"><enum>(4)</enum><text>coordinate with the National Coordinator for Health Information Technology, as appropriate, to assist States and Tribes in implementing systems that use standards recognized by such National Coordinator, as such recognized standards are available, in order to facilitate interoperability between such systems and health information technology systems, including certified health information technology.</text></paragraph></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="id035311EADDB14C7AA02DCDD7C87AC448"><enum>(5)</enum><text>in subsection (d), as so redesignated, by striking <quote>2001 through 2005</quote> and inserting <quote>2019 through 2023</quote>.</text></paragraph></section><section id="id894caec65d7745bfb7eaac169f942c35"><enum>1512.</enum><header>Surveillance and education regarding infections associated with illicit drug use and other risk factors</header><text display-inline="no-display-inline">Section 317N of the Public Health Service Act (42 U.S.C. 247b–15) is amended—</text><paragraph id="id8486B78F5DA74B568904FAE12D428B1D"><enum>(1)</enum><text>by amending the section heading to read as follows: <quote><header-in-text level="section" style="OLC">Surveillance and education regarding infections associated with illicit drug use and other risk factors</header-in-text></quote>;</text></paragraph><paragraph id="id42631D3F91884C7586136B5DAC7B0013"><enum>(2)</enum><text>in subsection (a)—</text><subparagraph id="id180D7269FF43454C903B4447197D0961"><enum>(A)</enum><text>in the matter preceding paragraph (1), by inserting <quote>activities</quote> before the colon;</text></subparagraph><subparagraph id="id04022EEEE73944FC8F9F7AB29B135E3D"><enum>(B)</enum><text>in paragraph (1)—</text><clause id="id6E6CDDE16D954ACE99FEE75621F8DAC8"><enum>(i)</enum><text>by inserting <quote>or maintaining</quote> after <quote>implementing</quote>;</text></clause><clause id="id1539498B997D417AB238A504C84C4846"><enum>(ii)</enum><text>by striking <quote>hepatitis C virus infection (in this section referred to as <quote>HCV infection</quote>)</quote> and inserting <quote>infections commonly associated with illicit drug use, which may include viral hepatitis, human immunodeficiency virus, and infective endocarditis,</quote>; and</text></clause><clause id="id342099EAFFF449C09D3F38CB3D987CED"><enum>(iii)</enum><text>by striking <quote>such infection</quote> and all that follows through the period at the end and inserting <quote>such infections, which may include the reporting of cases of such infections.</quote>;</text></clause></subparagraph><subparagraph id="idB738FE77AD104319990D1C6AFB73B612"><enum>(C)</enum><text>in paragraph (2), by striking <quote>HCV infection</quote> and all that follows through the period at the end and inserting <quote>infections as a result of illicit drug use, receiving blood transfusions prior to July 1992, or other risk factors.</quote>;</text></subparagraph><subparagraph id="id091B564CB920444FBA66F2805EABD593"><enum>(D)</enum><text>in paragraphs (4) and (5), by striking <quote>HCV infection</quote> each place such term appears and inserting <quote>infections described in paragraph (1)</quote>; and</text></subparagraph><subparagraph id="id617AB9CE620D489BB468E8D466599814"><enum>(E)</enum><text>in paragraph (5), by striking <quote>pediatricians and other primary care physicians, and obstetricians and gynecologists</quote> and inserting <quote>substance use disorder treatment providers, pediatricians, other primary care providers, and obstetrician-gynecologists</quote>;</text></subparagraph></paragraph><paragraph id="id715E3824D22E4748BFD1D6DF71125E15"><enum>(3)</enum><text>in subsection (b)—</text><subparagraph id="idDE63AAF11E5A4C0C889E9EA5291470C7"><enum>(A)</enum><text>by striking <quote>directly and</quote> and inserting <quote>directly or</quote>; and</text></subparagraph><subparagraph id="id7074F2F3FB934F6F8A882F409CF493FD"><enum>(B)</enum><text>by striking <quote>hepatitis C,</quote> and all that follows through the period at the end and inserting <quote>infections described in subsection (a)(1).</quote>; and</text></subparagraph></paragraph><paragraph id="id437D05531BEF471B8C8BF49C9A6070E9"><enum>(4)</enum><text>in subsection (c), by striking <quote>such sums as may be necessary for each of the fiscal years 2001 through 2005</quote> and inserting <quote>$40,000,000 for each of fiscal years 2019 through 2023</quote>.</text></paragraph></section><section id="id122EC9015A204152A8B1D164ACA79A2D"><enum>1513.</enum><header>Task force to develop best practices for trauma-informed identification, referral, and support</header><subsection id="id48276928CA304F17B88D6FA2E530DAB8"><enum>(a)</enum><header>Establishment</header><text>There is established a task force, to be known as the Interagency Task Force on Trauma-Informed Care (in this section referred to as the <quote>task force</quote>) that shall identify, evaluate, and make recommendations regarding best practices with respect to children and youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma.</text></subsection><subsection id="id3DB078ACA2C44D9FABF86C96AFEAF92C"><enum>(b)</enum><header>Membership</header><paragraph commented="no" id="id0E74A8CAFCA448B1BB3B3D48402E6A1E"><enum>(1)</enum><header>Composition</header><text>The task force shall be composed of the heads of the following Federal departments and agencies, or their designees:</text><subparagraph commented="no" id="id54380FD1340D496FA4DA2413F8A00FC2"><enum>(A)</enum><text>The Centers for Medicare & Medicaid Services.</text></subparagraph><subparagraph commented="no" id="id20F8D6F92E7E43F9985F0F8837C8AEA0"><enum>(B)</enum><text>The Substance Abuse and Mental Health Services Administration.</text></subparagraph><subparagraph commented="no" id="id0cbb5a4b877148c086ff0d9a5fb9111c"><enum>(C)</enum><text>The Agency for Healthcare Research and Quality.</text></subparagraph><subparagraph commented="no" id="id74c401869fca40b490a192a37b058dc2"><enum>(D)</enum><text>The Centers for Disease Control and Prevention.</text></subparagraph><subparagraph commented="no" id="id16a18fa56c3945258afb273d64021271"><enum>(E)</enum><text>The Indian Health Service.</text></subparagraph><subparagraph commented="no" id="id6fbfa875254b414fb8b1a5486504bbe1"><enum>(F)</enum><text>The Department of Veterans Affairs.</text></subparagraph><subparagraph commented="no" id="id4d5109e72d384f369213be9048239c5b"><enum>(G)</enum><text>The National Institutes of Health.</text></subparagraph><subparagraph commented="no" id="ida83245c9d909469b86bb909829acfb84"><enum>(H)</enum><text>The Food and Drug Administration.</text></subparagraph><subparagraph commented="no" id="id6b712c4492534281b55f0d0dedc6c530"><enum>(I)</enum><text>The Health Resources and Services Administration.</text></subparagraph><subparagraph commented="no" id="id8be878271219413e9d34a2dac2313b21"><enum>(J)</enum><text>The Department of Defense.</text></subparagraph><subparagraph commented="no" id="id1a59369b5fa34bb39cf3c39ecd4b8608"><enum>(K)</enum><text>The Office of Minority Health.</text></subparagraph><subparagraph commented="no" id="id8754A80F2EC24B09A2136AFE1F917DC6"><enum>(L)</enum><text>The Administration for Children and Families.</text></subparagraph><subparagraph commented="no" id="id9ccec11133c044879a19d971886b7e7f"><enum>(M)</enum><text>The Office of the Assistant Secretary for Planning and Evaluation.</text></subparagraph><subparagraph commented="no" id="id717d954206a64b48b36d30e58b9c11f6"><enum>(N)</enum><text>The Office for Civil Rights of the Department of Health and Human Services.</text></subparagraph><subparagraph commented="no" id="idC30E772B18A94BC49C2FD31790F0C093"><enum>(O)</enum><text>The Office of Juvenile Justice and Delinquency Prevention of the Department of Justice.</text></subparagraph><subparagraph commented="no" id="id99989395FE884C35B6B14517B6EAD784"><enum>(P)</enum><text>The Office of Community Oriented Policing Services of the Department of Justice.</text></subparagraph><subparagraph commented="no" id="idEE44B44792874B5AAA2759AF63590354"><enum>(Q)</enum><text>The Office on Violence Against Women of the Department of Justice.</text></subparagraph><subparagraph commented="no" id="idBCCFBA7B54E54887BAEE5D0995D22CEE"><enum>(R)</enum><text>The National Center for Education Evaluation and Regional Assistance of the Department of Education.</text></subparagraph><subparagraph commented="no" id="id828f157e966d400792994f988dc2a14b"><enum>(S)</enum><text>The National Center for Special Education Research of the Institute of Education Science.</text></subparagraph><subparagraph commented="no" id="id88F0EDC5475B4A9EB0752BFB61F8BA6D"><enum>(T)</enum><text>The Office of Elementary and Secondary Education of the Department of Education.</text></subparagraph><subparagraph commented="no" id="idf53ce1a081224258ae03dc6a8f419d20"><enum>(U)</enum><text>The Office for Civil Rights of the Department of Education.</text></subparagraph><subparagraph commented="no" id="idd3bf5342c3e04db49c782f32c8093b73"><enum>(V)</enum><text>The Office of Special Education and Rehabilitative Services of the Department of Education.</text></subparagraph><subparagraph commented="no" id="id4884A91A9528468AA3A514ED8D3F1F7A"><enum>(W)</enum><text>The Bureau of Indian Affairs of the Department of the Interior.</text></subparagraph><subparagraph commented="no" id="idA712B748D7CC42388D4B6809C3AE6928"><enum>(X)</enum><text>The Veterans Health Administration of the Department of Veterans Affairs.</text></subparagraph><subparagraph commented="no" id="id1B1FDA83C5F34F6F81E53EDD9D843303"><enum>(Y)</enum><text>The Office of Special Needs Assistance Programs of the Department of Housing and Urban Development.</text></subparagraph><subparagraph id="id5ec95f625ac14bd5acf38596d954d11a"><enum>(Z)</enum><text>The Office of Head Start of the Administration for Children and Families.</text></subparagraph><subparagraph id="id29df5ac957dc4794bb02d4e13f7bc54e"><enum>(AA)</enum><text>The Children’s Bureau of the Administration for Children and Families.</text></subparagraph><subparagraph id="id228852F993BF4AF3A1698AFBD8038434"><enum>(BB)</enum><text>The Bureau of Indian Education of the Department of the Interior.</text></subparagraph><subparagraph commented="no" id="idFC206F42E89F4CDCA30652213159D8AA"><enum>(CC)</enum><text>Such other Federal agencies as the Secretaries determine to be appropriate.</text></subparagraph></paragraph><paragraph id="id7F6BD62EE4EB4AB28498E69293D97E39"><enum>(2)</enum><header>Date of appointments</header><text>The heads of Federal departments and agencies shall appoint the corresponding members of the task force not later than 6 months after the date of enactment of this Act.</text></paragraph><paragraph id="id1FA2F3B5572A4CA9870CDD1CAEBAFD43"><enum>(3)</enum><header>Chairperson</header><text>The task force shall be chaired by the Assistant Secretary for Mental Health and Substance Use.</text></paragraph></subsection><subsection id="id25FCE2A39783482E837F7FB52817A088"><enum>(c)</enum><header>Task force duties</header><text>The task force shall—</text><paragraph id="id9B263C0E17BC4458A39CC1AA28526639"><enum>(1)</enum><text>solicit input from stakeholders, including frontline service providers, educators, mental health professionals, researchers, experts in infant, child, and youth trauma, child welfare professionals, and the public, in order to inform the activities under paragraph (2); and</text></paragraph><paragraph id="id5266D2AA3CCF436FA0B82AB786D0BD1C"><enum>(2)</enum><text>identify, evaluate, make recommendations, and update such recommendations not less than annually, to the general public, the Secretary of Education, the Secretary of Health and Human Services, the Secretary of Labor, the Secretary of the Interior, the Attorney General, and other relevant cabinet Secretaries, and Congress regarding—</text><subparagraph id="idD6C4C74347D54759A7A93FA67927D221"><enum>(A)</enum><text>a set of evidence-based, evidence-informed, and promising best practices with respect to—</text><clause id="idC7C91177E7174FD1AAD844473C0BB9C5"><enum>(i)</enum><text>the identification of infants, children and youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma; and</text></clause><clause id="idB7564D9028344ED1B03095E0DD9BD4C5"><enum>(ii)</enum><text>the expeditious referral to and implementation of trauma-informed practices and supports that prevent and mitigate the effects of trauma;</text></clause></subparagraph><subparagraph id="id9A90D5DB4D1B43D3BB20D512A5C12A12"><enum>(B)</enum><text>a national strategy on how the task force and member agencies will collaborate, prioritize options for, and implement a coordinated approach which may include data sharing and the awarding of grants that support infants, children, and youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma; and</text></subparagraph><subparagraph id="id797b7609dbb84d0eb3eb7e3d2fc878b2"><enum>(C)</enum><text>existing Federal authorities at the Department of Education, Department of Health and Human Services, Department of Justice, Department of Labor, Department of the Interior, and other relevant agencies, and specific Federal grant programs to disseminate best practices on, provide training in, or deliver services through, trauma-informed practices, and disseminate such information—</text><clause id="id0A084442DD5C4C32B3FBD7CBB4690F76"><enum>(i)</enum><text>in writing to relevant program offices at such agencies to encourage grant applicants in writing to use such funds, where appropriate, for trauma-informed practices; and</text></clause><clause id="idF578FD03FE8740DF88AC9BAE32244F67"><enum>(ii)</enum><text>to the general public through the internet website of the task force.</text></clause></subparagraph></paragraph></subsection><subsection id="id74B9F9D6FDDD4801BD0AD9A958789504"><enum>(d)</enum><header>Best practices</header><text>In identifying, evaluating, and recommending the set of best practices under subsection (c), the task force shall—</text><paragraph id="id9A273E28CFE74594A31B81FA448178A9"><enum>(1)</enum><text>include guidelines for providing professional development for front-line services providers, including school personnel, early childhood education program providers, providers from child- or youth-serving organizations, housing and homeless providers, primary and behavioral health care providers, child welfare and social services providers, juvenile and family court personnel, health care providers, individuals who are mandatory reporters of child abuse or neglect, trained nonclinical providers (including peer mentors and clergy), and first responders, in—</text><subparagraph id="id9BCB0C95A0FA44C5AD95B3350ACA7BD5"><enum>(A)</enum><text>understanding and identifying early signs and risk factors of trauma in infants, children, and youth, and their families as appropriate, including through screening processes;</text></subparagraph><subparagraph id="idfbae4a2bb9cb4a06b81a7a37d75da6f2"><enum>(B)</enum><text>providing practices to prevent and mitigate the impact of trauma, including by fostering safe and stable environments and relationships; and</text></subparagraph><subparagraph id="idb16473c3074241c3ab7c397ed7a6f10b"><enum>(C)</enum><text>developing and implementing policies, procedures, or systems that—</text><clause id="idD0AC82F78A1B4BDC951E06F8830DD834"><enum>(i)</enum><text>are designed to quickly refer infants, children, youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma to the appropriate trauma-informed screening and support, including age-appropriate treatment, and to ensure such infants, children, youth, and family members receive such support;</text></clause><clause id="idDA265ECE434B4BB39A9C149D3067455A"><enum>(ii)</enum><text>utilize and develop partnerships with early childhood education programs, local social services organizations, such as organizations serving youth, and clinical mental health or health care service providers with expertise in providing support services (including age-appropriate trauma-informed and evidence-based treatment) aimed at preventing or mitigating the effects of trauma;</text></clause><clause id="id0A24A08C3D0D4EB186616857175EBFED"><enum>(iii)</enum><text>educate children and youth to—</text><subclause id="idC052AA2063FA442BB7751659706DED5B"><enum>(I)</enum><text>understand and identify the signs, effects, or symptoms of trauma; and</text></subclause><subclause id="idB53C262899414AE98771689A24A23356"><enum>(II)</enum><text>build the resilience and coping skills to mitigate the effects of experiencing trauma;</text></subclause></clause><clause id="idDDDA988129E341E0A7FFA916DE21B403"><enum>(iv)</enum><text>promote and support multi-generational practices that assist parents, foster parents, and kinship and other caregivers in accessing resources related to, and developing environments conducive to, the prevention and mitigation of trauma; and</text></clause><clause id="id7ED181AB7F5543309889D5ED3DC537BF"><enum>(v)</enum><text>collect and utilize data from screenings, referrals, or the provision of services and supports to evaluate and improve processes for trauma-informed support and outcomes that are culturally sensitive, linguistically appropriate, and specific to age ranges and sex, as applicable; and</text></clause></subparagraph></paragraph><paragraph id="id90D0DB4EDE254EF99408AE1EC87A008E"><enum>(2)</enum><text>recommend best practices that are designed to avoid unwarranted custody loss or criminal penalties for parents or guardians in connection with infants, children, and youth who have experienced or are at risk of experiencing trauma.</text></paragraph></subsection><subsection id="id612C953D40074A18AABC7618B9081265"><enum>(e)</enum><header>Operating plan</header><text>Not later than 1 year after the date of enactment of this Act, the task force shall hold the first meeting. Not later than 2 years after such date of enactment, the task force shall submit to the Secretary of Education, Secretary of Health and Human Services, Secretary of Labor, Secretary of the Interior, the Attorney General, and Congress an operating plan for carrying out the activities of the task force described in subsection (c)(2). Such operating plan shall include—</text><paragraph id="id9391f442140745e6a31db83d079684bd"><enum>(1)</enum><text>a list of specific activities that the task force plans to carry out for purposes of carrying out duties described in subsection (c)(2), which may include public engagement;</text></paragraph><paragraph id="ida42a4bea73904cbdb00698421197f9bf"><enum>(2)</enum><text>a plan for carrying out the activities under subsection (c)(2);</text></paragraph><paragraph id="id56f1eadf713f4a33a085da44ddb97a64"><enum>(3)</enum><text>a list of members of the task force and other individuals who are not members of the task force that may be consulted to carry out such activities;</text></paragraph><paragraph id="id89c66e16523440c0b71ee6e9f82374c2"><enum>(4)</enum><text>an explanation of Federal agency involvement and coordination needed to carry out such activities, including any statutory or regulatory barriers to such coordination;</text></paragraph><paragraph id="id635c47c85e504b26b24dc6fb5265b467"><enum>(5)</enum><text>a budget for carrying out such activities; and</text></paragraph><paragraph id="id97d3e24ee11d44848b963e915ba5ef6a"><enum>(6)</enum><text>other information that the task force determines appropriate.</text></paragraph></subsection><subsection id="ide3f647c23a9e4b548162dba22de29a0d"><enum>(f)</enum><header>Final report</header><text>Not later than 3 years after the date of the first meeting of the task force, the task force shall submit to the general public, Secretary of Education, Secretary of Health and Human Services, Secretary of Labor, Secretary of the Interior, the Attorney General, and other relevant cabinet Secretaries, and Congress, a final report containing all of the findings and recommendations required under this section.</text></subsection><subsection id="id755594341DC249DBA359D51A7E5CE71F"><enum>(g)</enum><header>Definition</header><text>In this section, the term <term>early childhood education program</term> has the meaning given such term in section 103 of the Higher Education Act of 1965 (20 U.S.C. 1003).</text></subsection><subsection commented="no" display-inline="no-display-inline" id="idD24EE8C2FC0B45CDB56D3C7D265AD814"><enum>(h)</enum><header>Authorization of appropriations</header><text>To carry out this section, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2019 through 2022.</text></subsection><subsection id="id6cbbe3725c534198940d819a725b8695"><enum>(i)</enum><header>Sunset</header><text>The task force shall on the date that is 60 days after the submission of the final report under subsection (f), but not later than September 30, 2022.</text></subsection></section><section id="ida427a4eddff24b1cb430b18e5496b210"><enum>1514.</enum><header>Grants to improve trauma support services and mental health care for children and youth in educational settings</header><subsection id="idfa9747e9727f4cc38cb230321c9c3e37"><enum>(a)</enum><header>Grants, contracts, and cooperative agreements authorized</header><text>The Secretary, in coordination with the Assistant Secretary for Mental Health and Substance Use, is authorized to award grants to, or enter into contracts or cooperative agreements with, State educational agencies, local educational agencies, Head Start agencies (including Early Head Start agencies), State or local agencies that administer public preschool programs, Indian Tribes or their tribal educational agencies, a school operated by the Bureau of Indian Education, a Regional Corporation (as defined in section 3 of the Alaska Native Claims Settlement Act (43 U.S.C. 1602)), or a Native Hawaiian educational organization (as defined in section 6207 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7517)), for the purpose of increasing student access to evidence-based trauma support services and mental health care by developing innovative initiatives, activities, or programs to link local school systems with local trauma-informed support and mental health systems, including those under the Indian Health Service.</text></subsection><subsection id="idcb7c82c127404526845864e2308bf4c3"><enum>(b)</enum><header>Duration</header><text>With respect to a grant, contract, or cooperative agreement awarded or entered into under this section, the period during which payments under such grant, contract or agreement are made to the recipient may not exceed 4 years.</text></subsection><subsection id="ideb6aecf10c364575bcf3101bca04fa46"><enum>(c)</enum><header>Use of funds</header><text>An entity that receives a grant, contract, or cooperative agreement under this section shall use amounts made available through such grant, contract, or cooperative agreement for evidence-based activities, which shall include any of the following:</text><paragraph id="ide1897cd8067e4ffb8d46b87f1541df75"><enum>(1)</enum><text>Collaborative efforts between school-based service systems and trauma-informed support and mental health service systems to provide, develop, or improve prevention, screening, referral, and treatment and support services to students, such as by providing universal trauma screenings to identify students in need of specialized support.</text></paragraph><paragraph id="id9cb09ffefb044418ae7db7409dd76b5a"><enum>(2)</enum><text>To implement schoolwide multi-tiered positive behavioral interventions and supports, or other trauma-informed models of support.</text></paragraph><paragraph id="ide8430e29fe2244e297fba1815d9007b7"><enum>(3)</enum><text>To provide professional development to teachers, teacher assistants, school leaders, specialized instructional support personnel, and mental health professionals that—</text><subparagraph id="idA25E29EAA6F14C389DE7E802238AB0F2"><enum>(A)</enum><text>fosters safe and stable learning environments that prevent and mitigate the effects of trauma, including through social and emotional learning;</text></subparagraph><subparagraph id="ida8315a1b77ba417d8253c7adea6bf1c6"><enum>(B)</enum><text>improves school capacity to identify, refer, and provide services to students in need of trauma support or behavioral health services; or</text></subparagraph><subparagraph id="id4A2E2779A2B440A980AA5CE9895041BF"><enum>(C)</enum><text>reflects the best practices developed by the Interagency Task Force on Trauma-Informed Care established under section 513.</text></subparagraph></paragraph><paragraph commented="no" id="idaa51321993fb41329fc298d85d26048e"><enum>(4)</enum><text>To create or enhance services at a full-service community school that focuses on trauma-informed supports, which may include establishing a school-site advisory team, managing, coordinating, or delivering pipeline services, hiring a full-time site coordinator, or other activities consistent with section 4625 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7275).</text></paragraph><paragraph commented="no" id="id3E7D84EC20824C70B605285E761FD1CC"><enum>(5)</enum><text>Engaging families and communities in efforts to increase awareness of child and youth trauma, which may include sharing best practices with law enforcement regarding trauma-informed care and working with mental health professionals to provide interventions, as well as longer term coordinated care within the community for children and youth who have experienced trauma and their families.</text></paragraph><paragraph id="id2A1CB228AAD04A84A88E575418D81891"><enum>(6)</enum><text>To provide technical assistance to school systems and mental health agencies.</text></paragraph><paragraph id="idf8d3779befe04dd993f6faf81615c98d"><enum>(7)</enum><text>To evaluate the effectiveness of the program carried out under this section in increasing student access to evidence-based trauma support services and mental health care.</text></paragraph></subsection><subsection id="id1731d55991ef49c584e35412c682adee"><enum>(d)</enum><header>Applications</header><text>To be eligible to receive a grant, contract, or cooperative agreement under this section, an entity described in subsection (a) shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require, which shall include the following:</text><paragraph id="idb4b0dfc31f224564b30366cc7481f448"><enum>(1)</enum><text>A description of the innovative initiatives, activities, or programs to be funded under the grant, contract, or cooperative agreement, including how such program will increase access to evidence-based trauma support services and mental health care for students, and, as applicable, the families of such students.</text></paragraph><paragraph id="id3ae9dd22bdeb4eff820c4b49ebe03fca"><enum>(2)</enum><text>A description of how the program will provide linguistically appropriate and culturally competent services.</text></paragraph><paragraph id="id33be912d93cf41569b596d2d364a98dd"><enum>(3)</enum><text>A description of how the program will support students and the school in improving the school climate in order to support an environment conducive to learning.</text></paragraph><paragraph id="idd9bf1c5297004f1bb3b3a582224a2551"><enum>(4)</enum><text>An assurance that—</text><subparagraph id="id361947d2d503431f845526847434f9dc"><enum>(A)</enum><text>persons providing services under the grant, contract, or cooperative agreement are adequately trained to provide such services; and</text></subparagraph><subparagraph id="id7ec499387a4b4d7ead1022aa4b21a723"><enum>(B)</enum><text>teachers, school leaders, administrators, specialized instructional support personnel, representatives of local Indian Tribes or tribal organizations as appropriate, other school personnel, and parents or guardians of students participating in services under this section will be engaged and involved in the design and implementation of the services.</text></subparagraph></paragraph><paragraph id="id16057766767c402295a151a7c5a9478c"><enum>(5)</enum><text>A description of how the applicant will support and integrate existing school-based services with the program in order to provide mental health services for students, as appropriate.</text></paragraph></subsection><subsection id="idc21233f27ce8471793a51d7c57f6afc9"><enum>(e)</enum><header>Interagency agreements</header><paragraph id="idd09e236c8d9b441eaeda2d8c8dca6496"><enum>(1)</enum><header>Designation of lead agency</header><text>A recipient of a grant, contract, or cooperative agreement under this section shall designate a lead agency to direct the establishment of an interagency agreement among local educational agencies, agencies responsible for early childhood education programs, juvenile justice authorities, mental health agencies, child welfare agencies, and other relevant entities in the State or Indian Tribe, in collaboration with local entities.</text></paragraph><paragraph id="id80bb7fa23838463099a600d64ba6d6d8"><enum>(2)</enum><header>Contents</header><text>The interagency agreement shall ensure the provision of the services described in subsection (c), specifying with respect to each agency, authority, or entity—</text><subparagraph id="idc58b1993340d4c5d80c390c0194aca3e"><enum>(A)</enum><text>the financial responsibility for the services;</text></subparagraph><subparagraph id="id7c1bc76ad1344320a7a172d731c0f108"><enum>(B)</enum><text>the conditions and terms of responsibility for the services, including quality, accountability, and coordination of the services; and</text></subparagraph><subparagraph id="idc2fb935ced8646c987dbc9974a0e2498"><enum>(C)</enum><text>the conditions and terms of reimbursement among the agencies, authorities, or entities that are parties to the interagency agreement, including procedures for dispute resolution.</text></subparagraph></paragraph></subsection><subsection id="id4294d968deab4ee6952c18955ccb5d1e"><enum>(f)</enum><header>Evaluation</header><text>The Secretary shall reserve not to exceed 3 percent of the funds made available under subsection (l) for each fiscal year to—</text><paragraph id="idC08C42C9F6044B3BAF819E3B592B5E03"><enum>(1)</enum><text>conduct a rigorous, independent evaluation of the activities funded under this section; and</text></paragraph><paragraph id="id6BDEC476EF4142C19215EEDC30347183"><enum>(2)</enum><text>disseminate and promote the utilization of evidence-based practices regarding trauma support services and mental health care.</text></paragraph></subsection><subsection id="id228d7a8dbe1f4fddb2e152b9ce4a6416"><enum>(g)</enum><header>Distribution of awards</header><text>The Secretary shall ensure that grants, contracts, and cooperative agreements awarded or entered into under this section are equitably distributed among the geographical regions of the United States and among tribal, urban, suburban, and rural populations.</text></subsection><subsection id="id224ce072f8304c8ea2dd4263cef86fe2"><enum>(h)</enum><header>Rule of construction</header><text>Nothing in this section shall be construed—</text><paragraph id="id96d81c50711543c2b300805f4a7c968b"><enum>(1)</enum><text>to prohibit an entity involved with a program carried out under this section from reporting a crime that is committed by a student to appropriate authorities; or</text></paragraph><paragraph id="id7febd3de05b541e3b6f452a58f221866"><enum>(2)</enum><text>to prevent Federal, State, and tribal law enforcement and judicial authorities from exercising their responsibilities with regard to the application of Federal, tribal, and State law to crimes committed by a student.</text></paragraph></subsection><subsection id="id0c731a784c8149e9aa68720743f8d869"><enum>(i)</enum><header>Supplement, not supplant</header><text>Any services provided through programs carried out under this section shall supplement, and not supplant, existing mental health services, including any special education and related services provided under the Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.).</text></subsection><subsection id="ida096b9bc80a747b78495885afdfcfe88"><enum>(j)</enum><header>Consultation with indian Tribes</header><text>In carrying out subsection (a), the Secretary shall, in a timely manner, meaningfully consult, engage, and cooperate with Indian Tribes and their representatives to ensure notice of eligibility.</text></subsection><subsection id="idDA9C020C3C354C5EBA71323C9D578A4D"><enum>(k)</enum><header>Definitions</header><text>In this section:</text><paragraph id="id2222D5A0F7844951BC5958AE5D9023FA"><enum>(1)</enum><header>Elementary or secondary school</header><text>The term <term>elementary or secondary school</term> means a public elementary and secondary school as such term is defined in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).</text></paragraph><paragraph commented="no" id="id8F29C6940BA14AB5BD346F6D4F86940F"><enum>(2)</enum><header>Evidence-based</header><text>The term <term>evidence-based</term> has the meaning given such term in section 8101(21)(A)(i) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801(21)(A)(i)).</text></paragraph><paragraph id="id440e7f87835b432c86c16a6b64ac4784"><enum>(3)</enum><header>Native Hawaiian educational organization</header><text>The term <term>Native Hawaiian educational organization</term> has the meaning given such term in section 6207 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7517).</text></paragraph><paragraph id="idcbfb7054cff946af949aaf5d383277d5"><enum>(4)</enum><header>Pipeline services</header><text>The term <term>pipeline services</term> has the meaning given such term in section 4622 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7517).</text></paragraph><paragraph id="id20DDA3CCEC9B4D33BE70020A5924B611"><enum>(5)</enum><header>School leader</header><text>The term <term>school leader</term> has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).</text></paragraph><paragraph id="id330FBDFC9B43489D90BC1774F3ACFBB6"><enum>(6)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Education.</text></paragraph><paragraph id="idc80f1cb33775442984359c3ca18dd081"><enum>(7)</enum><header>Specialized instructional support personnel</header><text>The term <term>specialized instructional support personnel</term> has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id5E038BB0618D45B69BA0218E7A35E2A7"><enum>(l)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2019 through 2023.</text></subsection></section><section id="id7d9e76558732405086d6c71a0e1d1509"><enum>1515.</enum><header>National Child Traumatic Stress Initiative</header><text display-inline="no-display-inline">Section 582(j) of the Public Health Service Act (42 U.S.C. 290hh–1(j)) (relating to grants to address the problems of persons who experience violence-related stress) is amended by striking <quote>$46,887,000 for each of fiscal years 2018 through 2022</quote> and inserting <quote>$53,887,000 for each of fiscal years 2019 through 2023</quote>.</text></section><section id="id74384eeb7346473bb19c75ac7b7790e6"><enum>1516.</enum><header>National milestones to measure success in curtailing the opioid crisis</header><subsection id="idef1624d1d33c47b0ba940f69b76be68c"><enum>(a)</enum><header>In general</header><text>Not later than 180 days after the date of enactment of this Act, the Secretary, in consultation with the Administrator of the Drug Enforcement Administration and the Director of the Office of National Drug Control Policy, shall develop or identify existing national indicators (referred to in this section as the <quote>national milestones</quote>) to measure success in curtailing the opioid crisis, with the goal of significantly reversing the incidence and prevalence of opioid misuse and abuse, and opioid-related morbidity and mortality in the United States within 5 years of such date of enactment.</text></subsection><subsection id="ide9d2da3f4b74488abf41d65d60acc041"><enum>(b)</enum><header>National milestones to end the opioid crisis</header><text>The national milestones under subsection (a) shall include the following:</text><paragraph id="id16d0b3566b394a6d86781b958df097e3"><enum>(1)</enum><text>Not fewer than 10 indicators or metrics to accurately and expediently measure progress in meeting the goal described in subsection (a), which shall, as appropriate, include, indicators or metrics related to—</text><subparagraph id="ide62d885e612c4a77941cfe02e53952df"><enum>(A)</enum><text>the number of fatal and non-fatal opioid overdoses;</text></subparagraph><subparagraph id="idf5f6ceba758e48038d9cb5753a94e07f"><enum>(B)</enum><text>the number of emergency room visits related to opioid misuse and abuse;</text></subparagraph><subparagraph id="id5278b386555a4474bb79ab3d36a298ca"><enum>(C)</enum><text>the number of individuals in sustained recovery from opioid use disorder;</text></subparagraph><subparagraph id="id11f29e39130c47d58795e855de8f8323"><enum>(D)</enum><text>the number of infections associated with illicit drug use, such as HIV, viral hepatitis, and infective endocarditis, and available capacity for treating such infections;</text></subparagraph><subparagraph id="id719f75bc7ebc408c8d33df94f9cec9dd"><enum>(E)</enum><text>the number of providers prescribing medication assisted treatment for opioid use disorders, including in primary care settings, community health centers, jails, and prisons;</text></subparagraph><subparagraph id="idc4a66b7c3b3744fa951c351a9ab00893"><enum>(F)</enum><text>the number of individuals receiving treatment for opioid use disorder; and</text></subparagraph><subparagraph id="id1bd1e9d8eafe43768a05c81fa86e1f7e"><enum>(G)</enum><text>additional indicators or metrics, as appropriate, such as metrics pertaining to specific populations, including women and children, American Indians and Alaskan Natives, individuals living in rural and non-urban areas, and justice-involved populations, that would further clarify the progress made in addressing the opioid misuse and abuse crisis.</text></subparagraph></paragraph><paragraph id="id0f59bd2ece81419fa934826804cf2f11"><enum>(2)</enum><text>A reasonable goal, such as a percentage decrease or other specified metric, that signifies progress in meeting the goal described in subsection (a), and annual targets to help achieve that goal.</text></paragraph></subsection><subsection id="ida03b98122c074b1f8c25c99eeca4e2b1"><enum>(c)</enum><header>Consideration of other substance use disorders</header><text>In developing the national milestones under subsection (b), the Secretary shall, as appropriate, consider other substance use disorders in addition to opioid use disorder.</text></subsection><subsection id="id1F76A9C75570406C8E0B0CE0F3817269"><enum>(d)</enum><header>Extension of period</header><text>If the Secretary determines that the goal described in subsection (a) will not be achieved with respect to any indicator or metric established under subsection (b)(2) within 5 years of the date of enactment of this Act, the Secretary may extend the timeline for meeting such goal with respect to that indicator or metric. The Secretary shall include with any such extension a rationale for why additional time is needed and information on whether significant changes are needed in order to achieve such goal with respect to the indicator or metric.</text></subsection><subsection id="idb452a97df1294748b67cc7b3ccd53e70"><enum>(e)</enum><header>Annual status update</header><text>Not later than one year after the enactment of this Act, the Secretary shall make available on the internet website of the Department of Health and Human Services, and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives, an update on the progress, including expected progress in the subsequent year, in achieving the goals detailed in the national milestones. Each such update shall include the progress made in the first year or since the previous report, as applicable, in meeting each indicator or metric in the national milestones.</text></subsection></section></subtitle>

115th CONGRESS2d Session

H.R. 6

In the Senate of the United States,

September 17, 2018.

Amendment:

That the bill from the House of Representatives (H.R. 6) entitled An Act to provide for opioid use disorder prevention, recovery, and treatment, and for other purposes., do pass with the following

Strike all after the enacting clause and insert the following:

Short title; table of contents

(a)

Short title

This Act may be cited as the

Opioid Crisis Response Act of 2018

.(b)

Table of contents

The table of contents for this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—Opioid Crisis Response Act

Sec. 1001. Definitions.

Subtitle A—Reauthorization of Cures Funding

Sec. 1101. State response to the opioid abuse crisis.

Subtitle B—Research and Innovation

Sec. 1201. Advancing cutting-edge research.

Sec. 1202. Pain research.

Sec. 1203. Report on synthetic drug use.

Subtitle C—Medical Products and Controlled Substances Safety

Sec. 1301. Clarifying FDA regulation of non-addictive pain products.

Sec. 1302. Clarifying FDA packaging authorities.

Sec. 1303. Strengthening FDA and CBP coordination and capacity.

Sec. 1304. Clarifying FDA post-market authorities.

Sec. 1305. Restricting entrance of illicit drugs.

Sec. 1306. First responder training.

Sec. 1307. Disposal of controlled substances of hospice patients.

Sec. 1308. GAO study and report on hospice safe drug management.

Sec. 1309. Delivery of a controlled substance by a pharmacy to be administered by injection or implantation.

Subtitle D—Treatment and Recovery

Sec. 1401. Comprehensive opioid recovery centers.

Sec. 1402. Program to support coordination and continuation of care for drug overdose patients.

Sec. 1403. Alternatives to opioids.

Sec. 1404. Building communities of recovery.

Sec. 1405. Peer support technical assistance center.

Sec. 1406. Medication-assisted treatment for recovery from addiction.

Sec. 1407. Grant program.

Sec. 1408. Allowing for more flexibility with respect to medication-assisted treatment for opioid use disorders.

Sec. 1409. National recovery housing best practices.

Sec. 1410. Addressing economic and workforce impacts of the opioid crisis.

Sec. 1411. Career Act.

Sec. 1412. Pilot program to help individuals in recovery from a substance use disorder become stably housed.

Sec. 1413. Youth prevention and recovery.

Sec. 1414. Plans of safe care.

Sec. 1415. Regulations relating to special registration for telemedicine.

Sec. 1416. National Health Service Corps behavioral and mental health professionals providing obligated service in schools and other community-based settings.

Sec. 1417. Loan repayment for substance use disorder treatment providers.

Sec. 1418. Protecting moms and infants.

Sec. 1419. Early interventions for pregnant women and infants.

Sec. 1420. Report on investigations regarding parity in mental health and substance use disorder benefits.

Subtitle E—Prevention

Sec. 1501. Study on prescribing limits.

Sec. 1502. Programs for health care workforce.

Sec. 1503. Education and awareness campaigns.

Sec. 1504. Enhanced controlled substance overdoses data collection, analysis, and dissemination.

Sec. 1505. Preventing overdoses of controlled substances.

Sec. 1506. CDC surveillance and data collection for child, youth, and adult trauma.

Sec. 1507. Reauthorization of NASPER.

Sec. 1508. Jessie’s law.

Sec. 1509. Development and dissemination of model training programs for substance use disorder patient records.

Sec. 1510. Communication with families during emergencies.

Sec. 1511. Prenatal and postnatal health.

Sec. 1512. Surveillance and education regarding infections associated with illicit drug use and other risk factors.

Sec. 1513. Task force to develop best practices for trauma-informed identification, referral, and support.

Sec. 1514. Grants to improve trauma support services and mental health care for children and youth in educational settings.

Sec. 1515. National Child Traumatic Stress Initiative.

Sec. 1516. National milestones to measure success in curtailing the opioid crisis.

TITLE II—Finance

Sec. 2001. Short title.

Subtitle A—Medicare

Sec. 2101. Medicare opioid safety education.

Sec. 2102. Expanding the use of telehealth services for the treatment of opioid use disorder and other substance use disorders.

Sec. 2103. Comprehensive screenings for seniors.

Sec. 2104. Every prescription conveyed securely.

Sec. 2105. Standardizing electronic prior authorization for safe prescribing.

Sec. 2106. Strengthening partnerships to prevent opioid abuse.

Sec. 2107. Commit to opioid medical prescriber accountability and safety for seniors.

Sec. 2108. Fighting the opioid epidemic with sunshine.

Sec. 2109. Demonstration testing coverage of certain services furnished by opioid treatment programs.

Sec. 2110. Encouraging appropriate prescribing under Medicare for victims of opioid overdose.

Sec. 2111. Automatic escalation to external review under a Medicare part D drug management program for at-risk beneficiaries.

Sec. 2112. Testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology.

Sec. 2113. Medicare Improvement Fund.

Subtitle B—Medicaid

Sec. 2201. Caring recovery for infants and babies.

Sec. 2202. Peer support enhancement and evaluation review.

Sec. 2203. Medicaid substance use disorder treatment via telehealth.

Sec. 2204. Enhancing patient access to non-opioid treatment options.

Sec. 2205. Assessing barriers to opioid use disorder treatment.

Sec. 2206. Help for moms and babies.

Sec. 2207. Securing flexibility to treat substance use disorders.

Sec. 2208. MACPAC study and report on MAT utilization controls under State Medicaid programs.

Sec. 2209. Opioid addiction treatment programs enhancement.

Sec. 2210. Better data sharing to combat the opioid crisis.

Sec. 2211. Mandatory reporting with respect to adult behavioral health measures.

Sec. 2212. Report on innovative State initiatives and strategies to provide housing-related services and supports to individuals struggling with substance use disorders under Medicaid.

Sec. 2213. Technical assistance and support for innovative State strategies to provide housing-related supports under Medicaid.

Subtitle C—Human Services

Sec. 2301. Supporting family-focused residential treatment.

Sec. 2302. Improving recovery and reunifying families.

Sec. 2303. Building capacity for family-focused residential treatment.

Subtitle D—Synthetics Trafficking and Overdose Prevention

Sec. 2401. Short title.

Sec. 2402. Customs fees.

Sec. 2403. Mandatory advance electronic information for postal shipments.

Sec. 2404. International postal agreements.

Sec. 2405. Cost recoupment.

Sec. 2406. Development of technology to detect illicit narcotics.

Sec. 2407. Civil penalties for postal shipments.

Sec. 2408. Report on violations of arrival, reporting, entry, and clearance requirements and falsity or lack of manifest.

Sec. 2409. Effective date; regulations.

TITLE III—Judiciary

Subtitle A—Access to Increased Drug Disposal

Sec. 3101. Short title.

Sec. 3102. Definitions.

Sec. 3103. Authority to make grants.

Sec. 3104. Application.

Sec. 3105. Use of grant funds.

Sec. 3106. Eligibility for grant.

Sec. 3107. Duration of grants.

Sec. 3108. Accountability and oversight.

Sec. 3109. Duration of program.

Sec. 3110. Authorization of appropriations.

Subtitle B—Using Data To Prevent Opioid Diversion

Sec. 3201. Short title.

Sec. 3202. Purpose.

Sec. 3203. Amendments.

Sec. 3204. Report.

Subtitle C—Substance Abuse Prevention

Sec. 3301. Short title.

Sec. 3302. Reauthorization of the Office of National Drug Control Policy.

Sec. 3303. Reauthorization of the Drug-Free Communities Program.

Sec. 3304. Reauthorization of the National Community Anti-Drug Coalition Institute.

Sec. 3305. Reauthorization of the High-Intensity Drug Trafficking Area Program.

Sec. 3306. Reauthorization of drug court program.

Sec. 3307. Drug court training and technical assistance.

Sec. 3308. Drug overdose response strategy.

Sec. 3309. Protecting law enforcement officers from accidental exposure.

Sec. 3310. COPS Anti-Meth Program.

Sec. 3311. COPS anti-heroin task force program.

Sec. 3312. Comprehensive Addiction and Recovery Act education and awareness.

Sec. 3313. Protecting children with addicted parents.

Sec. 3314. Reimbursement of substance use disorder treatment professionals.

Sec. 3315. Sobriety Treatment and Recovery Teams (START).

Sec. 3316. Provider education.

Sec. 3317. Demand reduction.

Sec. 3318. Anti-drug media campaign.

Sec. 3319. Technical corrections to the office of national drug control policy reauthorization act of 1998.

Subtitle D—Synthetic Abuse and Labeling of Toxic Substances

Sec. 3401. Short title.

Sec. 3402. Controlled substance analogues.

Subtitle E—Opioid Quota Reform

Sec. 3501. Short title.

Sec. 3502. Strengthening considerations for DEA opioid quotas.

Subtitle F—Preventing Drug Diversion

Sec. 3601. Short title.

Sec. 3602. Improvements to prevent drug diversion.

Subtitle G—Sense of Congress

Sec. 3701. Sense of Congress.

TITLE IV—Commerce

Subtitle A—Fighting Opioid Abuse in Transportation

Sec. 4101. Short title.

Sec. 4102. Rail mechanical employee controlled substances and alcohol testing.

Sec. 4103. Rail yardmaster controlled substances and alcohol testing.

Sec. 4104. Department of Transportation public drug and alcohol testing database.

Sec. 4105. GAO report on Department of Transportation’s collection and use of drug and alcohol testing data.

Sec. 4106. Transportation Workplace Drug and Alcohol Testing Program; addition of fentanyl.

Sec. 4107. Status reports on hair testing guidelines.

Sec. 4108. Mandatory Guidelines for Federal Workplace Drug Testing Programs Using Oral Fluid.

Sec. 4109. Electronic recordkeeping.

Sec. 4110. Status reports on Commercial Driver's License Drug and Alcohol Clearinghouse.

Subtitle B—Opioid Addiction Recovery Fraud Prevention

Sec. 4201. Short title.

Sec. 4202. Definitions.

Sec. 4203. False or misleading representations with respect to opioid treatment programs and products.

<enum>I</enum><header>Opioid Crisis Response Act</header><section id="id0CCCAA9484F0486399B9BE2526BBFDC7"><enum>1001.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title—</text><paragraph id="idBB6716F485A346A3B08173538ED851E5"><enum>(1)</enum><text display-inline="yes-display-inline">the terms <term>Indian Tribe</term> and <term>tribal organization</term> have the meanings given the terms <term>Indian tribe</term> and <term>tribal organization</term> in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304); and</text></paragraph><paragraph id="idDAC97687D07A4B1C81BD26EE8000F87B"><enum>(2)</enum><text>the term <term>Secretary</term> means the Secretary of Health and Human Services, unless otherwise specified.</text></paragraph></section><subtitle id="id20B8906E37664387B2CAEF678B1FC9E8"><enum>A</enum><header>Reauthorization of Cures Funding</header><section id="id2781A32552DB48D58A5FFA4A0553C73B"><enum>1101.</enum><header>State response to the opioid abuse crisis</header><subsection id="id734356DC303C4DC5A9A8C691BF740484"><enum>(a)</enum><header>In general</header><text>Section 1003 of the 21st Century Cures Act (Public Law 114–255) is amended—</text><paragraph id="id25CA52ECA4184AF2BE74EEB8308F7B6F"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="id10A21FCA1E7A4BBB8D83A6F50C34DA0B"><enum>(A)</enum><text>by striking <quote>the authorization of appropriations under subsection (b) to carry out the grant program described in subsection (c)</quote> and inserting <quote>subsection (h) to carry out the grant program described in subsection (b)</quote>; and</text></subparagraph><subparagraph id="idCF0A50B1AB7242C6945DFE40800C02D4"><enum>(B)</enum><text>by inserting <quote>and Indian Tribes</quote> after <quote>States</quote>;</text></subparagraph></paragraph><paragraph id="idCDC244190B59410CAAABCE0D7BFE4A23"><enum>(2)</enum><text>by striking subsection (b);</text></paragraph><paragraph id="id979B2EE524E44A5AB9BDD09D182DDE8E"><enum>(3)</enum><text>by redesignating subsections (c) through (e) as subsections (b) through (d), respectively;</text></paragraph><paragraph id="idE4EE345916A74A62A14DED96E52A3E7C"><enum>(4)</enum><text>by redesignating subsection (f) as subsection (j);</text></paragraph><paragraph id="idD86C8C8F36A943B989CDC66043B88208"><enum>(5)</enum><text>in subsection (b), as so redesignated—</text><subparagraph id="idAE1A3502843A4AF5A5C8E6EEE5BB64A6"><enum>(A)</enum><text>in paragraph (1)—</text><clause id="id7952ed9fe2974ed5b6d840477766f8d6"><enum>(i)</enum><text>in the paragraph heading, by inserting <quote><header-in-text level="paragraph" style="OLC">and Indian Tribe</header-in-text></quote> after <quote><header-in-text level="paragraph" style="OLC">State</header-in-text></quote>;</text></clause><clause id="idD732681044784898B69496E52AD2351C"><enum>(ii)</enum><text>by striking <quote>States for the purpose of addressing the opioid abuse crisis within such States</quote> and inserting <quote>States and Indian Tribes for the purpose of addressing the opioid abuse crisis within such States and Indian Tribes</quote>;</text></clause><clause id="id490806356ff1406b9d89ee238026428e"><enum>(iii)</enum><text>by inserting <quote>or Indian Tribes</quote> after <quote>preference to States</quote>; and</text></clause><clause id="id2250F61FDF0B4B8D85DCA2BD8C8E81F9"><enum>(iv)</enum><text>by inserting before the period of the second sentence <quote>or other Indian Tribes, as applicable</quote>;</text></clause></subparagraph><subparagraph id="id50933A2CF0784C828F835E7DC86F3AB4"><enum>(B)</enum><text>in paragraph (2)—</text><clause id="id18F611AEDA524C9EA618E45DB8533BA8"><enum>(i)</enum><text>in the matter preceding subparagraph (A), by striking <quote>to a State</quote>;</text></clause><clause id="id10807E5074D04985834561F537D9D075"><enum>(ii)</enum><text>in subparagraph (A), by striking <quote>State</quote>;</text></clause><clause id="id97997EDACFD94A29BFAB421DCD9BD6D2"><enum>(iii)</enum><text>in subparagraph (C), by inserting <quote>preventing diversion of controlled substances,</quote> after <quote>treatment programs,</quote>; and</text></clause><clause id="id5B7F81390E704810B49AF41687C3CB44"><enum>(iv)</enum><text>in subparagraph (E), by striking <quote>as the State determines appropriate, related to addressing the opioid abuse crisis within the State</quote> and inserting <quote>as the State or Indian Tribe determines appropriate, related to addressing the opioid abuse crisis within the State, including directing resources in accordance with local needs related to substance use disorders</quote>;</text></clause></subparagraph></paragraph><paragraph id="id8EF8E6955B8C421C98331F1214A2FBC1"><enum>(6)</enum><text>in subsection (c), as so redesignated, by striking <quote>subsection (c)</quote> and inserting <quote>subsection (b)</quote>;</text></paragraph><paragraph id="id4AD0BBB63DAF405085CBD73D9563CA1F"><enum>(7)</enum><text>in subsection (d), as so redesignated—</text><subparagraph id="id50B4EF3FA83A44DD81E6589DE21D6219"><enum>(A)</enum><text>in the matter preceding paragraph (1), by striking <quote>the authorization of appropriations under subsection (b)</quote> and inserting <quote>subsection (h)</quote>; and</text></subparagraph><subparagraph id="id1A8390C01374400680BAE827CC3AE0B1"><enum>(B)</enum><text>in paragraph (1), by striking <quote>subsection (c)</quote> and inserting <quote>subsection (b)</quote>; and</text></subparagraph></paragraph><paragraph id="idBAFD5BBEACAF4F94BBBECE881057D48A"><enum>(8)</enum><text>by inserting after subsection (d), as so redesignated, the following:</text><quoted-block display-inline="no-display-inline" id="id7A5A34996E64498BB9A773AA3B22096B" style="OLC"><subsection id="id7FC41063AF1A4A5492C5AC6E550991E8"><enum>(e)</enum><header>Indian Tribes</header><paragraph id="id6C2D01F9C13F4757BE29E723EC6ECB6F"><enum>(1)</enum><header>Definition</header><text>For purposes of this section, the term <term>Indian Tribe</term> has the meaning given the term <term>Indian tribe</term> in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).</text></paragraph><paragraph id="id72d7e17598dc42059b080f4c14f13256"><enum>(2)</enum><header>Appropriate mechanisms</header><text>The Secretary, in consultation with Indian Tribes, shall identify and establish appropriate mechanisms for Tribes to demonstrate or report the information as required under subsections (b), (c), and (d).</text></paragraph></subsection><subsection id="id0ffd232708844914a77e7658deabd93b"><enum>(f)</enum><header>Report to Congress</header><text>Not later than 1 year after the date on which amounts are first awarded after the date of enactment of the <short-title>Opioid Crisis Response Act of 2018</short-title>, pursuant to subsection (b), and annually thereafter, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report summarizing the information provided to the Secretary in reports made pursuant to subsection (c), including the purposes for which grant funds are awarded under this section and the activities of such grant recipients.</text></subsection><subsection id="id66b92df7f0144096a3f68d579fd2bffd"><enum>(g)</enum><header>Technical Assistance</header><text>The Secretary, including through the Tribal Training and Technical Assistance Center of the Substance Abuse and Mental Health Services Administration, shall provide State agencies and Indian Tribes, as applicable, with technical assistance concerning grant application and submission procedures under this section, award management activities, and enhancing outreach and direct support to rural and underserved communities and providers in addressing the opioid crisis.</text></subsection><subsection id="id3FFE994E89E34CB8B604DC6F23AE026A"><enum>(h)</enum><header>Authorization of appropriations</header><text>For purposes of carrying out the grant program under subsection (b), there is authorized to be appropriated $500,000,000 for each of fiscal years 2019 through 2021, to remain available until expended.</text></subsection><subsection id="id5965EE1B136D4E32A60782C832CB84EE"><enum>(i)</enum><header>Set aside</header><text>Of the amounts made available for each fiscal year to award grants under subsection (b) for a fiscal year, 5 percent of such amount for such fiscal year shall be made available to Indian Tribes, and up to 15 percent of such amount for such fiscal year may be set aside for States with the highest age-adjusted rate of drug overdose death based on the ordinal ranking of States according to the Director of the Centers for Disease Control and Prevention.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="id10454D0EB46D422FA8599967199903FB"><enum>(b)</enum><header>Conforming amendment</header><text>Section 1004(c) of the 21st Century Cures Act (Public Law 114–255) is amended by striking <quote>, the FDA Innovation Account, or the Account For the State Response to the Opioid Abuse Crisis</quote> and inserting <quote>or the FDA Innovation Account</quote>.</text></subsection></section></subtitle><subtitle id="id5261AFBB341140E5BD50DBC9F13B8E9A"><enum>B</enum><header>Research and Innovation</header><section id="idE872A4A163304F17B5BC048E55BDB59C"><enum>1201.</enum><header>Advancing cutting-edge research</header><text display-inline="no-display-inline">Section 402(n)(1) of the Public Health Service Act (42 U.S.C. 282(n)(1)) is amended—</text><paragraph id="idDD28FD1B7EB14C87B691B5EF6C8AFF6C"><enum>(1)</enum><text>in subparagraph (A), by striking <quote>or</quote>;</text></paragraph><paragraph id="id63242C92F83842E49FBF17A0320ED984"><enum>(2)</enum><text>in subparagraph (B), by striking the period and inserting <quote>; or</quote>; and</text></paragraph><paragraph id="id5DD8E507DAAA44AF91154BC5693A03CE"><enum>(3)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id3163764D0056404F90DD84B5E9AA0FD7" style="OLC"><subparagraph id="id523610C8F5484BEC8FFEF5E24FDDFF9A"><enum>(C)</enum><text>high impact cutting-edge research that fosters scientific creativity and increases fundamental biological understanding leading to the prevention, diagnosis, or treatment of diseases and disorders, or research urgently required to respond to a public health threat.</text></subparagraph><after-quoted-block>. </after-quoted-block></quoted-block></paragraph></section><section id="id37E9469F05804C708658CF9034D9BA53"><enum>1202.</enum><header>Pain research</header><text display-inline="no-display-inline">Section 409J(b) of the Public Health Service Act (42 U.S.C. 284q(b)) is amended—</text><paragraph id="idE79C3A447E6043F08B7217C3B9B148BE"><enum>(1)</enum><text>in paragraph (5)—</text><subparagraph id="id4924AD78853343A59912CF5798E5991C"><enum>(A)</enum><text>in subparagraph (A), by striking <quote>and treatment of pain and diseases and disorders associated with pain</quote> and inserting <quote>treatment, and management of pain and diseases and disorders associated with pain, including information on best practices for utilization of non-pharmacologic treatments, non-addictive medical products, and other drugs or devices approved or cleared by the Food and Drug Administration</quote>;</text></subparagraph><subparagraph id="idF8C2D8FDC4C043F1B9B8F60AD55FA75B"><enum>(B)</enum><text>in subparagraph (B), by striking <quote>on the symptoms and causes of pain;</quote> and inserting the following: “on—</text><quoted-block display-inline="no-display-inline" id="id0355AD0727BA4B4DBDE9848D7EBC9B8C" style="OLC"><clause id="id8EA0DD9261EA427CBE94E376ACECDDE4"><enum>(i)</enum><text>the symptoms and causes of pain, including the identification of relevant biomarkers and screening models and the epidemiology of acute and chronic pain;</text></clause><clause id="idABBCDB0C98224CD4878E675B8A63E158"><enum>(ii)</enum><text>the diagnosis, prevention, treatment, and management of acute or chronic pain, including with respect to non-pharmacologic treatments, non-addictive medical products, and other drugs or devices approved or cleared by the Food and Drug Administration; and</text></clause><clause id="id8F53D13A251B43818C7DC8229F082E42"><enum>(iii)</enum><text>risk factors for, and early warning signs of, substance use disorders; and</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph><subparagraph id="id41901DCF6C09412C88EA155D0000C4F5"><enum>(C)</enum><text>by striking subparagraphs (C) through (E) and inserting the following:</text><quoted-block display-inline="no-display-inline" id="idE31C5BF40FD1464FA1E4F55F54487EFD" style="OLC"><subparagraph id="idDAC771698B414549B4D0577786846752"><enum>(C)</enum><text>make recommendations to the Director of NIH—</text><clause id="id645107585d4d47acabf9b830f53e4c4b"><enum>(i)</enum><text>to ensure that the activities of the National Institutes of Health and other Federal agencies are free of unnecessary duplication of effort;</text></clause><clause id="id33AF65F59BED4B9FB7C09440E34589D8"><enum>(ii)</enum><text>on how best to disseminate information on pain care and epidemiological data related to acute and chronic pain; and</text></clause><clause id="id730B69DF8B3B4EDBBF0BD15DDD4F74F0"><enum>(iii)</enum><text>on how to expand partnerships between public entities and private entities to expand collaborative, cross-cutting research.</text></clause></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id6AAF429026C945B5A87793BACBB52007"><enum>(2)</enum><text>by redesignating paragraph (6) as paragraph (7); and</text></paragraph><paragraph id="id8082BB4977784CD082A83C4EB900A4A8"><enum>(3)</enum><text>by inserting after paragraph (5) the following:</text><quoted-block display-inline="no-display-inline" id="id68F5E45E02CA4B7CA9E64A07D7E06DFF" style="OLC"><paragraph id="id28F569AA50FE41A59B102AB87E2ECC11"><enum>(6)</enum><header>Report</header><text>The Director of NIH shall ensure that recommendations and actions taken by the Director with respect to the topics discussed at the meetings described in paragraph (4) are included in appropriate reports to Congress.</text></paragraph><after-quoted-block>. </after-quoted-block></quoted-block></paragraph></section><section id="id4e5ddde461aa4b188d6409c88654464a"><enum>1203.</enum><header>Report on synthetic drug use</header><subsection id="id2fbeb9c03f9e468988202cf8d1cde690"><enum>(a)</enum><header>In general</header><text>Not later than 3 years after the date of the enactment of this Act, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report on the health effects of new psychoactive substances, including synthetic drugs, by adolescents and young adults.</text></subsection><subsection id="ida1d483df869b45aca958a3b2722c8c0d"><enum>(b)</enum><header>New psychoactive substance defined</header><text>For purposes of subsection (a), the term <term>new psychoactive substance</term> means a controlled substance analogue (as defined in section 102(32) of the Controlled Substances Act (21 U.S.C. 802(32))).</text></subsection></section></subtitle><subtitle id="id5605CF5E07E44C4F9D5451FFDC887564"><enum>C</enum><header>Medical Products and Controlled Substances Safety</header><section id="id433A312FF9DD488DA3BCB1EF82DDFB77"><enum>1301.</enum><header>Clarifying FDA regulation of non-addictive pain products</header><subsection id="id7a059be066674fe9a062f291f1f0d2bf"><enum>(a)</enum><header>Public Meetings</header><text>Not later than one year after the date of enactment of this Act, the Secretary, acting through the Commissioner of Food and Drugs, shall hold not less than one public meeting to address the challenges and barriers of developing non-addictive medical products intended to treat pain or addiction, which may include—</text><paragraph id="idc33b51e42d934039ab2ff8cbe3e7687d"><enum>(1)</enum><text>the manner by which the Secretary may incorporate the risks of misuse and abuse of a controlled substance (as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802) into the risk benefit assessments under subsections (d) and (e) of section 505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355), section 510(k) of such Act (21 U.S.C. 360(k)), or section 515(c) of such Act (21 U.S.C. 360e(c)), as applicable;</text></paragraph><paragraph id="id8a35aca8fc61401ab716a9ce9516d095"><enum>(2)</enum><text>the application of novel clinical trial designs (consistent with section 3021 of the 21st Century Cures Act (Public Law 114–255)), use of real world evidence (consistent with section 505F of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355g)), and use of patient experience data (consistent with section 569C of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb–8c)) for the development of non-addictive medical products intended to treat pain or addiction;</text></paragraph><paragraph id="id9715b293e2fa4a5d9811a9d7ce8fec46"><enum>(3)</enum><text>the evidentiary standards and the development of opioid sparing data for inclusion in the labeling of medical products; and</text></paragraph><paragraph id="idbebea4abcd7247f394d2a79634d783b9"><enum>(4)</enum><text>the application of eligibility criteria under sections 506 and 515B of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 356, 360e–3) for non-addictive medical products intended to treat pain or addiction.</text></paragraph></subsection><subsection id="idb99dae58eb1d4a71a03c87afc57433f5"><enum>(b)</enum><header>Guidance</header><text>Not less than one year after the public meetings are conducted under subsection (a) the Secretary shall issue one or more final guidance documents, or update existing guidance documents, to help address challenges to developing non-addictive medical products to treat pain or addiction. Such guidance documents shall include information regarding—</text><paragraph id="idE35660F13DBA4B108FDC014B57B3C525"><enum>(1)</enum><text>how the Food and Drug Administration may apply sections 506 and 515B of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 356, 360e–3) to non-addictive medical products intended to treat pain or addiction, including the circumstances under which the Secretary—</text><subparagraph id="idefedbf1e22024e3ebc6071400e2325c0"><enum>(A)</enum><text>may apply the eligibility criteria under such sections 506 and 515B to non-addictive medical products intended to treat pain or addiction;</text></subparagraph><subparagraph id="idEEE5CFBE20B6480C8390BD5B3F713961"><enum>(B)</enum><text>considers the risk of addiction of controlled substances approved to treat pain when establishing unmet medical need; and</text></subparagraph><subparagraph id="idF7A7A1FE1AF24BA59D762764CB785CFA"><enum>(C)</enum><text>considers pain, pain control, or pain management in assessing whether a disease or condition is a serious or life-threatening disease or condition;</text></subparagraph></paragraph><paragraph id="idCE6A0CB6D2584C23967D7F3054349115"><enum>(2)</enum><text>the methods by which sponsors may evaluate acute and chronic pain, endpoints for non-addictive medical products intended to treat pain, the manner in which endpoints and evaluations of efficacy will be applied across and within review divisions, taking into consideration the etiology of the underlying disease, and the manner in which sponsors may use surrogate endpoints, intermediate endpoints, and real world evidence;</text></paragraph><paragraph id="id34BF199E51534F31AE23E7C6904C1F81"><enum>(3)</enum><text>the manner in which the Food and Drug Administration will assess evidence to support the inclusion of opioid sparing data in the labeling of non-addictive medical products intended to treat pain, including—</text><subparagraph id="id433087f472c1454fa6142c995ac79084"><enum>(A)</enum><text>data collection methodologies, including the use of novel clinical trial designs (consistent with section 3021 of the 21st Century Cures Act (Public Law 114–255)) and real world evidence (consistent with section 505F of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355g)), as appropriate, to support product labeling;</text></subparagraph><subparagraph id="idCFAEE691969E4D7D95684A8162DF7050"><enum>(B)</enum><text>ethical considerations of exposing subjects to controlled substances in clinical trials to develop opioid sparing data and considerations on data collection methods that reduce harm, which may include the reduction of opioid use as a clinical benefit;</text></subparagraph><subparagraph id="id26CF8C4B1E9940C5BC5F12EB3536CC16"><enum>(C)</enum><text>endpoints, including primary, secondary, and surrogate endpoints, to evaluate the reduction of opioid use;</text></subparagraph><subparagraph id="id09a34bdf58554273bed1eba15a157a36"><enum>(D)</enum><text>best practices for communication between sponsors and the agency on the development of data collection methods, including the initiation of data collection; and</text></subparagraph><subparagraph id="idFDE0EE01FA9F48CCA97EA57CD263EC6C"><enum>(E)</enum><text>the appropriate format in which to submit such data results to the Secretary; and</text></subparagraph></paragraph><paragraph id="id5D989E834BC94E558EC6F5437FB8FB40"><enum>(4)</enum><text>the circumstances under which the Food and Drug Administration considers misuse and abuse of a controlled substance (as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802) in making the risk benefit assessment under paragraphs (2) and (4) of subsection (d) of section 505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355) and in finding that a drug is unsafe under paragraph (1) or (2) of subsection (e) of such section.</text></paragraph></subsection><subsection id="id8EFD93B38F8B42B6813BD957BA6CB7D1"><enum>(c)</enum><header>Definitions</header><text>In this section—</text><paragraph id="id2DDAAE6EF3004EB79DD10ED749704A9F"><enum>(1)</enum><text>the term <term>medical product</term> means a drug (as defined in section 201(g)(1) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(g)(1))), biological product (as defined in section 351(i) of the Public Health Service Act (42 U.S.C. 262(i))), or device (as defined in section 201(h) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(h))); and</text></paragraph><paragraph id="id3716EC24D4554FBE89FF709C8904B03A"><enum>(2)</enum><text>the term <term>opioid sparing</term> means reducing, replacing, or avoiding the use of opioids or other controlled substances.</text></paragraph></subsection></section><section id="id2a658c26a928465788a1d2bf0172457d"><enum>1302.</enum><header>Clarifying FDA packaging authorities</header><subsection id="idE8C77C724A9E43E482C52CD6DCAF2E07"><enum>(a)</enum><header>Additional potential elements of strategy</header><text display-inline="yes-display-inline">Section 505–1(e) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355–1(e)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id3D7F048E98A24B79A879C06DA3C8236B" style="OLC"><paragraph id="idDC60806EEFEE4B85852CF7DF673B631F"><enum>(4)</enum><header>Packaging and disposal</header><text>The Secretary may require a risk evaluation mitigation strategy for a drug for which there is a serious risk of an adverse drug experience described in subparagraph (B) or (C) of subsection (b)(1), taking into consideration the factors described in subparagraphs (C) and (D) of subsection (f)(2) and in consultation with other relevant Federal agencies with authorities over drug packaging, which may include requiring that—</text><subparagraph id="id87e5d8978b0047ecb6504464cfc3f6db"><enum>(A)</enum><text>the drug be made available for dispensing to certain patients in unit dose packaging, packaging that provides a set duration, or another packaging system that the Secretary determines may mitigate such serious risk; or</text></subparagraph><subparagraph id="id817bf60e072941cd84fcd56f21f79260"><enum>(B)</enum><text>the drug be dispensed to certain patients with a safe disposal packaging or safe disposal system for purposes of rendering drugs non-retrievable (as defined in section 1300.05 of title 21, Code of Federal Regulations (or any successor regulation)) if the Secretary has determines that such safe disposal packaging or system may mitigate such serious risk and exists in sufficient quantities.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id1AA491F8163044268BA02867E790FC2F"><enum>(b)</enum><header>Assuring access and minimizing burden</header><text>Section 505–1(f)(2)(C) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355–1(f)(2)(C)) is amended—</text><paragraph id="idA0657D291A5042F1AC36163B8927C9D5"><enum>(1)</enum><text>in clause (i) by striking <quote>and</quote> at the end; and</text></paragraph><paragraph id="idD7210A02CA4D410FA477D609124BF86A"><enum>(2)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idE6517696F2F94E3A8F5C4A9CF3E7872C" style="OLC"><clause id="idF00A4C79689F41F593021DC4647EE31B"><enum>(iii)</enum><text>patients with functional needs; and</text></clause><after-quoted-block>. </after-quoted-block></quoted-block></paragraph></subsection><subsection id="id54690df4c42c469ea81a52e64172b37d"><enum>(c)</enum><header>Application to abbreviated new drug applications</header><text>Section 505–1(i) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355–1(i)) is amended—</text><paragraph id="idc380ce97bd6147dd9cbb44d85b540f28"><enum>(1)</enum><text>in paragraph (1)—</text><subparagraph id="idDE7AD9192B594B279845A8727A1938B7"><enum>(A)</enum><text>by redesignating subparagraph (B) as subparagraph (C); and</text></subparagraph><subparagraph id="id553F16CC863D497D88CB6680B21312C3"><enum>(B)</enum><text>inserting after subparagraph (A) the following:</text><quoted-block display-inline="no-display-inline" id="id505772c3d2ff4cbc86a7906e76d45e80" style="OLC"><subparagraph id="id9520c09ee52a4fe3b3b31d07159c7258"><enum>(B)</enum><text>A packaging or disposal requirement, if required under subsection (e)(4) for the applicable listed drug.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="idb1fc3893069d4069966f339b0994c6e6"><enum>(2)</enum><text>in paragraph (2)—</text><subparagraph id="id048D1D4260614BD896A7FC038437DD2A"><enum>(A)</enum><text>in subparagraph (A), by striking <quote>and</quote> at the end;</text></subparagraph><subparagraph id="idED88B9E00A5440F8882F76D25D0D0C7A"><enum>(B)</enum><text>by redesignating subparagraph (B) as subparagraph (C); and</text></subparagraph><subparagraph id="idE9036DEEA4904D0A8775BCA97E6383D7"><enum>(C)</enum><text>by inserting after subparagraph (A) the following:</text><quoted-block display-inline="no-display-inline" id="idE94316517CC34A22BEEAB32003510643" style="OLC"><subparagraph id="id3e4ed61546a94ea6a6b4f372f5275d1b"><enum>(B)</enum><text>shall permit packaging systems and safe disposal packaging or safe disposal systems that are different from those required for the applicable listed drug under subsection (e)(4); and</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection></section><section id="id243C0008D3654A89ADCEF7670BA1E5D8"><enum>1303.</enum><header>Strengthening FDA and CBP coordination and capacity</header><subsection id="idDD0841949B684792B9299E7455A70042"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary, acting through the Commissioner of Food and Drugs, shall coordinate with the Secretary of Homeland Security to carry out activities related to customs and border protection and response to illegal controlled substances and drug imports, including at sites of import (such as international mail facilities). Such Secretaries may carry out such activities through a memorandum of understanding between the Food and Drug Administration and the U.S. Customs and Border Protection.</text></subsection><subsection id="id367EB5451D3449F38B1E96B15A1709F2"><enum>(b)</enum><header>FDA import facilities and inspection capacity</header><paragraph id="idBADFE1B02E4F4ABEBFFC02644964BDE6"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">In carrying out this section, the Secretary shall, in collaboration with the Secretary of Homeland Security and the Postmaster General of the United States Postal Service, provide that import facilities in which the Food and Drug Administration operates or carries out activities related to drug imports within the international mail facilities include—</text><subparagraph id="id5FE5300CA77941FB8E30BFA012A29A49"><enum>(A)</enum><text display-inline="yes-display-inline">facility upgrades and improved capacity in order to increase and improve inspection and detection capabilities, which may include, as the Secretary determines appropriate—</text><clause id="idBBC627F13E8F429E820338339E78F886"><enum>(i)</enum><text display-inline="yes-display-inline">improvements to facilities, such as upgrades or renovations, and support for the maintenance of existing import facilities and sites to improve coordination between Federal agencies;</text></clause><clause id="idB6F6E89A9CF248A6B82F3D5600F76B99"><enum>(ii)</enum><text display-inline="yes-display-inline">the construction of, or upgrades to, laboratory capacity for purposes of detection and testing of imported goods;</text></clause><clause id="idE96414008E74465A9E9A42EF41E4DD0A"><enum>(iii)</enum><text display-inline="yes-display-inline">upgrades to the security of import facilities; and</text></clause><clause id="id90178673D8DD4BE68E0F299384AED6D6"><enum>(iv)</enum><text display-inline="yes-display-inline">innovative technology and equipment to facilitate improved and near-real-time information sharing between the Food and Drug Administration, the Department of Homeland Security, and the United States Postal Service; and</text></clause></subparagraph><subparagraph id="id9313926490AD428ABD3A90514999A490"><enum>(B)</enum><text>innovative technology, including controlled substance detection and testing equipment and other applicable technology, in order to collaborate with the U.S. Customs and Border Protection to share near-real-time information, including information about test results, as appropriate.</text></subparagraph></paragraph><paragraph id="idD6090FBFE87046C48066F9EE52D3D9BB"><enum>(2)</enum><header>Innovative technology</header><text>Any technology used in accordance with paragraph (1)(B) shall be interoperable with technology used by other relevant Federal agencies, including the U.S. Customs and Border Protection, as the Secretary determines appropriate.</text></paragraph></subsection><subsection id="id364b79fa221a4e16813d371f76dafd4b"><enum>(c)</enum><header>Report</header><text>Not later than 6 months after the date of enactment of this Act, the Secretary, in consultation with the Secretary of Homeland Security and the Postmaster General of the United States Postal Service, shall report to the relevant committees of Congress on the implementation of this section, including a summary of progress made towards near-real-time information sharing and the interoperability of such technologies.</text></subsection><subsection id="ide00741f3b0e24f1183b70b975673d2b0"><enum>(d)</enum><header>Authorization of appropriations</header><text>Out of amounts otherwise available to the Secretary, the Secretary may allocate such sums as may be necessary for purposes of carrying out this section.</text></subsection></section><section id="id563ddf458c5a45e58806f265a20601cf"><enum>1304.</enum><header>Clarifying FDA post-market authorities</header><text display-inline="no-display-inline">Section 505–1(b)(1)(E) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355–1(b)(1)(E)) is amended by striking <quote>of the drug</quote> and inserting <quote>of the drug, which may include reduced effectiveness under the conditions of use prescribed in the labeling of such drug, but which may not include reduced effectiveness that is in accordance with such labeling</quote>.</text></section><section id="ida4b32b3761cb411f9f8f5329b8808947"><enum>1305.</enum><header>Restricting entrance of illicit drugs</header><subsection id="id13D0B1462F394429B6BDF1F044202876"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary, acting through the Commissioner of Food and Drugs, upon discovering or receiving, in a package being offered for import, a controlled substance that is offered for import in violation of any requirement of the Controlled Substances Act (21 U.S.C. 801 et seq.), the Controlled Substances Import and Export Act (21 U.S.C. 951 et seq.), the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.), or any other applicable law, shall transfer such package to the U.S. Customs and Border Protection. If the Secretary identifies additional packages that appear to be the same as such package containing a controlled substance, such additional packages may also be transferred to U.S. Customs and Border Protection. The U.S. Customs and Border Protection shall receive such packages consistent with the requirements of the Controlled Substances Act (21 U.S.C. 801 et seq.).</text></subsection><subsection id="id46B2220B1CB643B4AFD929902EDA3063"><enum>(b)</enum><header>Debarment, temporary denial of approval, and suspension</header><paragraph id="id326CC2052E4046A68C3A6A88CE0504FF"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 306(b) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 335a(b)) is amended—</text><subparagraph id="id1d4f34d4e35d4cf8b5527c3640c8e1bc"><enum>(A)</enum><text>in paragraph (1)—</text><clause id="ida7bc996175344fdfa1e063dd3b38baf2"><enum>(i)</enum><text>in the matter preceding subparagraph (A), by inserting <quote>or (3)</quote> after <quote>paragraph (2)</quote>;</text></clause><clause id="id669de2b4d15041f282f0ee535479bde1"><enum>(ii)</enum><text>in subparagraph (A), by striking the comma at the end and inserting a semicolon;</text></clause><clause id="id688cc8476b0a44749dfb4e247ee8b2bd"><enum>(iii)</enum><text>in subparagraph (B), by striking <quote>, or</quote> and inserting a semicolon;</text></clause><clause id="id6b7b75a72d094fa2a1581d9362ebdb8f"><enum>(iv)</enum><text>in subparagraph (C), by striking the period and inserting <quote>; or</quote>; and</text></clause><clause id="id2413106997544e7f8b9b105f03e34f22"><enum>(v)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id8ec3476710734e2592bc3282af3cf62f" style="OLC"><subparagraph id="idd125cab7b49c41d4bd869956c3b79b1b"><enum>(D)</enum><text>a person from importing or offering for import into the United States a drug.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph><subparagraph id="iddd71181221d84d6b9168249b835fef47"><enum>(B)</enum><text>in paragraph (3)—</text><clause id="iddbf37323685842a098c3ecdd1933f159"><enum>(i)</enum><text>in the heading, by striking <quote><header-in-text level="paragraph" style="OLC">Food</header-in-text></quote>;</text></clause><clause id="idf5ef54c6436948dea052640b18d0d1bd"><enum>(ii)</enum><text>in subparagraph (A), by striking <quote>; or</quote> and inserting a semicolon;</text></clause><clause id="id9a7d5bc42356471799367d5a1ba7c059"><enum>(iii)</enum><text>in subparagraph (B), by striking the period and inserting a semicolon; and</text></clause><clause id="id63e3ee12406243ac97661585a852cbf4"><enum>(iv)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id2e9f6847107742658573b9c9dfc6ecb1" style="OLC"><subparagraph id="id565b257b49354f67bbb1d97fa603d8a1"><enum>(C)</enum><text>the person has been convicted of a felony for conduct relating to the importation into the United States of any drug or controlled substance (as defined in section 102 of the Controlled Substances Act);</text></subparagraph><subparagraph id="id8F2F96593E754857A3FA9BF6FDE2C6AC"><enum>(D)</enum><text>the person has engaged in a pattern of importing or offering for import—</text><clause id="idA2DB8677F82B4C8AB8B6A1A8C26A903E"><enum>(i)</enum><text>controlled substances that are prohibited from importation under section 401(m) of the Tariff Act of 1930 (19 U.S.C. 1401(m)); or</text></clause><clause id="id40B25CC4986841EAA52D34D76CAE32B2"><enum>(ii)</enum><text>adulterated or misbranded drugs that are—</text><subclause id="idAEC948F085484B04AEC0E7B07AE854FB"><enum>(I)</enum><text>not designated in an authorized electronic data interchange system as a product that is regulated by the Secretary; or</text></subclause><subclause id="id636F22C50A1D47E0B4C77F3B1A0FD41F"><enum>(II)</enum><text>knowingly or intentionally falsely designated in an authorized electronic data interchange system as a product that is regulated by the Secretary.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></clause></subparagraph></paragraph><paragraph commented="no" id="idd3bb784b16954d7fa6522d301e292669"><enum>(2)</enum><header>Prohibited act</header><text>Section 301(cc) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 331(cc)) is amended by inserting <quote>or a drug</quote> after <quote>food</quote>.</text></paragraph></subsection><subsection id="idedd9374a330c48b48ffd2b9b20552d5f"><enum>(c)</enum><header>Imports and exports</header><text>Section 801(a) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 381(a)) is amended—</text><paragraph id="id1834896d1a234821b0b1960aa02efd86"><enum>(1)</enum><text>by striking the second sentence;</text></paragraph><paragraph id="id826391fb02104ea7a871b10205580a26"><enum>(2)</enum><text>by striking <quote>If it appears</quote> and inserting <quote>Subject to subsection (b), if it appears</quote>;</text></paragraph><paragraph id="id0857a62eb1484005b3dc2aeeb2ded47b"><enum>(3)</enum><text>by striking <quote>regarding such article, then such article shall be refused</quote> and inserting the following: <quote>regarding such article, or (5) such article is being imported or offered for import in violation of section 301(cc), then any such article described in any of clauses (1) through (5) may be refused admission. If it appears from the examination of such samples or otherwise that the article is a counterfeit drug, such article shall be refused admission.</quote>;</text></paragraph><paragraph id="idE0F4D6A9D24F4D55967A4B81E021D47D"><enum>(4)</enum><text>by striking <quote>this Act, then such article shall be refused admission</quote> and inserting <quote>this Act, then such article may be refused admission</quote>; and</text></paragraph><paragraph id="ide4f50c48729f4f14be047ea259cbc7c2"><enum>(5)</enum><text>by striking <quote>Clause (2) of the third sentence</quote> and all that follows through the period at the end and inserting the following: <quote>Neither clause (2) nor clause (5) of the second sentence of this subsection shall be construed to prohibit the admission of narcotic drugs, the importation of which is permitted under the Controlled Substances Import and Export Act.</quote>.</text></paragraph></subsection><subsection id="id98ec9aaee896482688d77771fd3f67db"><enum>(d)</enum><header>Certain illicit articles</header><text>Section 801 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 381) is amended by adding at the end the following—</text><quoted-block display-inline="no-display-inline" id="id13a1284a68324478a843cc60d05db465" style="OLC"><subsection id="id8DAA687F97C34F55B8971DB08DF07374"><enum>(t)</enum><header>Illicit articles containing active pharmaceutical ingredients</header><paragraph id="idd3ee0a1c20b74bf1a45bf81ff40fa9d4"><enum>(1)</enum><header>In general</header><text>For purposes of this section, an article that is being imported or offered for import into the United States may be treated by the Secretary as a drug if the article—</text><subparagraph id="idc4c977b52971403dafedccce667c23b6"><enum>(A)</enum><text>is not—</text><clause id="id4cf9d49c55c9490bb264b881f78c063c"><enum>(i)</enum><text>accompanied by an electronic import entry for such article submitted using an authorized electronic data interchange system; and</text></clause><clause id="id80b7311843104790ab3d19b084eda5b8"><enum>(ii)</enum><text>designated in such a system as an article regulated by the Secretary (which may include regulation as a drug, a device, or a dietary supplement; and</text></clause></subparagraph><subparagraph id="ida9ed51f51ad642f4bee59b020f283e26"><enum>(B)</enum><text>is an ingredient that presents significant public health concern and is, or contains—</text><clause id="idd00a6c798b8b409ba09485a7cd10e407"><enum>(i)</enum><text>an active ingredient in a drug—</text><subclause id="idDBA982F0A8744ABEBBA09FCB45BA173C"><enum>(I)</enum><text>that is approved under section 505 or licensed under section 351 of the Public Health Service Act; or</text></subclause><subclause id="id8122ed57c3814ed98c18e9d91ca17735"><enum>(II)</enum><text>for which—</text><item id="id89495239321A4B1C8D718222D680483F"><enum>(aa)</enum><text>an investigational use exemption is in effect under section 505(i) of this Act or section 351(a) of the Public Health Service Act; and</text></item><item id="id961e5db041164c44bb33a46b48212e3a"><enum>(bb)</enum><text>a substantial clinical investigation has been instituted, and such investigation has been made public; or</text></item></subclause></clause><clause id="idea63c7fd0c1040a28fc3ce4a58a7561d"><enum>(ii)</enum><text>a substance that has a chemical structure that is substantially similar to the chemical structure of an active ingredient in a drug or biological product described in subclause (I) or (II) of clause (i).</text></clause></subparagraph></paragraph><paragraph id="idd2fe5751dedb405da2d6c36b84d8dd2b"><enum>(2)</enum><header>Effect</header><text>This subsection shall not be construed to bear upon any determination of whether an article is a drug within the meaning of section 201(g), other than for the purposes described in paragraph (1).</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="id3CF43D3C5D8E40D1A9C3BD3FE6A2F3B2"><enum>1306.</enum><header>First responder training</header><text display-inline="no-display-inline">Section 546 of the Public Health Service Act (42 U.S.C. 290ee–1) is amended—</text><paragraph id="idD84F7CDC477E44D68C17316685902C13"><enum>(1)</enum><text>in subsection (c)—</text><subparagraph id="idADA1C09625A94087B20217E15C084339"><enum>(A)</enum><text>in paragraph (2), by striking <quote>and</quote> at the end;</text></subparagraph><subparagraph id="id1274634E739A469D9C4D6E403752F639"><enum>(B)</enum><text>in paragraph (3), by striking the period and inserting <quote>; and</quote>; and</text></subparagraph><subparagraph id="idB477AF0D3E6D4CA6AC73CBBA8D6D3963"><enum>(C)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idB90D03D1292846A68F006E77BD137B68" style="OLC"><paragraph id="id14EC2F5F28D944F29883B702A598E8BA"><enum>(4)</enum><text>train and provide resources for first responders and members of other key community sectors on safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs to protect themselves from exposure to such drugs and respond appropriately when exposure occurs.</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id83F1DB516D9F426D82EABE71372B7A35"><enum>(2)</enum><text>in subsection (d), by striking <quote>and mechanisms for referral to appropriate treatment for an entity receiving a grant under this section</quote> and inserting <quote>mechanisms for referral to appropriate treatment, and safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs</quote>;</text></paragraph><paragraph id="id9C8B95EC5E614C63AEF6793D178B80FB"><enum>(3)</enum><text>in subsection (f)—</text><subparagraph id="id9B2596115EAA45CA91852BBB7B943840"><enum>(A)</enum><text>in paragraph (3), by striking <quote>and</quote> at the end;</text></subparagraph><subparagraph id="idD9F9AB55AC2D4D3D90B2F4F58B9A61A2"><enum>(B)</enum><text>in paragraph (4), by striking the period and inserting <quote>; and</quote>; and</text></subparagraph><subparagraph id="idF10C26BD1B0A4AA89428C4669A8F8D0E"><enum>(C)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id224CB8000CE84EC29C6A2655E196A0A0" style="OLC"><paragraph id="idCF769F08E59C4027849E6166348861CC"><enum>(5)</enum><text>the number of first responders and members of other key community sectors trained on safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs.</text></paragraph><after-quoted-block>; </after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="idBF872B1CCE9E4432819E329ED083F630"><enum>(4)</enum><text>by redesignating subsection (g) as subsection (h);</text></paragraph><paragraph id="id95E4C4C9F5AB423A8868ED49844712E5"><enum>(5)</enum><text>by inserting after subsection (f) the following:</text><quoted-block display-inline="no-display-inline" id="idC425399C9C0843FE98B8B52FB3093A8F" style="OLC"><subsection id="id0560ECE4639B42A68784487EDE9D6081"><enum>(g)</enum><header>Other key community sectors</header><text>In this section, the term <term>other key community sectors</term> includes substance abuse treatment providers, emergency medical services agencies, agencies and organizations working with prison and jail populations and offender reentry programs, health care providers, harm reduction groups, pharmacies, community health centers, tribal health facilities, and mental health providers.</text></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="id37FB03879152470AA0AFC713D99183AB"><enum>(6)</enum><text>in subsection (h), as so redesignated, by striking <quote>$12,000,000 for each of fiscal years 2017 through 2021</quote> and inserting <quote>$36,000,000 for each of fiscal years 2019 through 2023</quote>.</text></paragraph></section><section id="idab10ba3cfe064abebd275b9296ff6fdf"><enum>1307.</enum><header>Disposal of controlled substances of hospice patients</header><subsection id="id5ed8bca677cc45dcbbc21fbd2216c8ad"><enum>(a)</enum><header>In general</header><text>Section 302(g) of the Controlled Substances Act (21 U.S.C. 822(g)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id8ca359835b1e427d8f0c85c65a0cf975" style="OLC"><paragraph id="id16d80fbf819c440baeb549138efc0967" indent="up1"><enum>(5)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idDF7FB5CE3772431881191FE43058315C"><enum>(A)</enum><text>An employee of a qualified hospice program acting within the scope of employment may handle, in the place of residence of a hospice patient, any controlled substance that was lawfully dispensed to the hospice patient, for the purpose of assisting in the disposal of the controlled substance—</text><clause id="id02E7307A564A43C4AF4009E407A8BBE0" indent="up1"><enum>(i)</enum><text>after the hospice patient's death;</text></clause><clause id="id64DD65F19A7647F786A38B45C7CE71AC" indent="up1"><enum>(ii)</enum><text>if the controlled substance is expired; or</text></clause><clause id="id2EEFFFBAF2E04C38BB07881408442BF8" indent="up1"><enum>(iii)</enum><text>if—</text><subclause id="id8A7E3BE374A54C3FA04584DAA0E9A2F5"><enum>(I)</enum><text>the employee is—</text><item id="id51E370F334724AF48FDF2D24737301D8"><enum>(aa)</enum><text>the physician of the hospice patient; and</text></item><item id="id4491BAE1ADCD4DB5ABBDCCF20C0F4C2C"><enum>(bb)</enum><text>registered under section 303(f); and</text></item></subclause><subclause id="id8315D080810F4FCFB6AD25B909CC1DEE"><enum>(II)</enum><text>the hospice patient no longer requires the controlled substance because the plan of care of the hospice patient has been modified.</text></subclause></clause></subparagraph><subparagraph id="id0a425d1412b44939b7e32e80fbabb69a" indent="up1"><enum>(B)</enum><text>In this paragraph:</text><clause id="id23a8fb9a622c46a1bec01827236681e1"><enum>(i)</enum><text>The term <term>employee of a qualified hospice program</term> means a physician, physician assistant, registered nurse, or nurse practitioner who—</text><subclause id="idf72e743f077e4936aa601254f9677d40"><enum>(I)</enum><text>is employed by, or is acting pursuant to arrangements made with, a qualified hospice program; and</text></subclause><subclause id="id2ef8549a006f4f93a8da175b3dce6869"><enum>(II)</enum><text>is licensed or certified to perform such employment, or such activities arranged by the qualified hospice program, in accordance with applicable State law.</text></subclause></clause><clause id="ide277aefb56bd4b3195c17191ebd22dfd"><enum>(ii)</enum><text>The terms <term>hospice care</term> and <term>hospice program</term> have the meanings given those terms in section 1861(dd) of the Social Security Act (42 U.S.C. 1395x(dd)).</text></clause><clause id="idB14FF0F70B4742138FACBC8D624FB890"><enum>(iii)</enum><text>The term <term>hospice patient</term> means an individual receiving hospice care.</text></clause><clause id="id7d4281545a4141c9a1002fd3a3e96c96"><enum>(iv)</enum><text>The term <term>qualified hospice program</term> means a hospice program that—</text><subclause id="id413f7115116949c6a1f4e8fb886d020d"><enum>(I)</enum><text>has written policies and procedures for employees of the hospice program to use when assisting in the disposal of the controlled substances of a hospice patient in a circumstance described in clause (i), (ii), or (iii) of subparagraph (A);</text></subclause><subclause id="idf75865c1629544de9d74cf7e965ef5b2"><enum>(II)</enum><text>at the time when the controlled substances are first ordered—</text><item id="idc466b070df99427f9b6b5990fb75a8c9"><enum>(aa)</enum><text>provides a copy of the written policies and procedures to the hospice patient or hospice patient representative and the family of the hospice patient;</text></item><item id="idac92413a5b994578bfc0deb4ecab82f0"><enum>(bb)</enum><text>discusses the policies and procedures with the hospice patient or hospice patient's representative and the hospice patient's family in a language and manner that such individuals understand to ensure that such individuals are informed regarding the safe disposal of controlled substances; and</text></item><item id="ida264023b6c7c4e758ad28d62a8d5382c"><enum>(cc)</enum><text>documents in the clinical record of the hospice patient that the written policies and procedures were provided and discussed with the hospice patient or hospice patient's representative; and</text></item></subclause><subclause id="id0eb3b8278d1946919c393bb4b82875c8"><enum>(III)</enum><text>at the time when an employee of the hospice program assists in the disposal of controlled substances of a hospice patient, documents in the clinical record of the hospice patient a list of all controlled substances disposed of.</text></subclause></clause></subparagraph><subparagraph id="id5164c8d5cbf14b458da4da2509a2336d" indent="up1"><enum>(C)</enum><text>The Attorney General may, by regulation, include additional types of licensed medical professionals in the definition of the term <term>employee of a qualified hospice program</term> under subparagraph (B).</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id64908dbeaa644450bc260cfc53880bde"><enum>(b)</enum><header>No registration required</header><text>Section 302(c) of the Controlled Substances Act (21 U.S.C. 822(c)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idef756986704a4f8eb74a24a4d9a80dcd" style="OLC"><paragraph id="ide05f1ffc70ce418cb53d1f187ad76833"><enum>(4)</enum><text>An employee of a qualified hospice program for the purpose of assisting in the disposal of a controlled substance in accordance with subsection (g)(5), except as provided in subparagraph (A)(iii) of that subsection.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="idc4c9926cb98746878e6328b36fb4d7a1"><enum>(c)</enum><header>Guidance</header><text>The Attorney General may issue guidance to qualified hospice programs to assist the programs in satisfying the requirements under paragraph (5) of section 302(g) of the Controlled Substances Act (21 U.S.C. 822(g)), as added by subsection (a).</text></subsection><subsection id="ide8587e0c219e406faf4dca1cb325bfe6"><enum>(d)</enum><header>State and local authority</header><text>Nothing in this section or the amendments made by this section shall be construed to prevent a State or local government from imposing additional controls or restrictions relating to the regulation of the disposal of controlled substances in hospice care or hospice programs.</text></subsection></section><section id="idf1c4677e093f4733942ca6f04bb0001e"><enum>1308.</enum><header>GAO study and report on hospice safe drug management</header><subsection id="id261db59a26c8499581570f7235cbafb1"><enum>(a)</enum><header>Study</header><paragraph id="id2D11727E75D74454B59CD7D289030EE0"><enum>(1)</enum><header>In general</header><text>The Comptroller General of the United States (in this section referred to as the <quote>Comptroller General</quote>) shall conduct a study on the requirements applicable to and challenges of hospice programs with regard to the management and disposal of controlled substances in the home of an individual.</text></paragraph><paragraph id="idFE045864507341BDBA2C1CC5FE242A59"><enum>(2)</enum><header>Contents</header><text>In conducting the study under paragraph (1), the Comptroller General shall include—</text><subparagraph id="id367222158aea4e60bbb82d7671a666c4"><enum>(A)</enum><text>an overview of challenges encountered by hospice programs regarding the disposal of controlled substances, such as opioids, in a home setting, including any key changes in policies, procedures, or best practices for the disposal of controlled substances over time; and</text></subparagraph><subparagraph id="id83671fe33bf94ebfb228cafa7d721a1f"><enum>(B)</enum><text>a description of Federal requirements, including requirements under the Medicare program, for hospice programs regarding the disposal of controlled substances in a home setting, and oversight of compliance with those requirements.</text></subparagraph></paragraph></subsection><subsection id="id40149760f30d431c84271dcaf9210023"><enum>(b)</enum><header>Report</header><text>Not later than 18 months after the date of enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under subsection (a), together with recommendations, if any, for such legislation and administrative action as the Comptroller General determines appropriate.</text></subsection></section><section id="id1e5437f5-3d8b-48fb-9cad-84cfdeebfa62" section-type="subsequent-section"><enum>1309.</enum><header>Delivery of a controlled substance by a pharmacy to be administered by injection or implantation</header><subsection id="id089139b8-0b7a-40a4-9e59-ea86f1d4c8e7"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Controlled Substances Act is amended by inserting after section 309 (21 U.S.C. 829) the following:</text><quoted-block display-inline="no-display-inline" id="ide101ee80-f30f-45a8-91e1-acd450b98307" style="traditional"><section commented="no" display-inline="no-display-inline" id="ID2BFD0275859B44D08E29479E946D2FC0" section-type="subsequent-section"><enum>309A.</enum><header>Delivery of a controlled substance by a pharmacy to an administering practitioner</header><subsection commented="no" display-inline="yes-display-inline" id="ID46DDD5702DAA4D4B8222350828F1355F"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Notwithstanding section 102(10), a pharmacy may deliver a controlled substance to a practitioner in accordance with a prescription that meets the requirements of this title and the regulations issued by the Attorney General under this title, for the purpose of administering the controlled substance by the practitioner if—</text><paragraph id="id189921f9-bc02-4732-b599-3567e3b2dced"><enum>(1)</enum><text>the controlled substance is delivered by the pharmacy to the prescribing practitioner or the practitioner administering the controlled substance, as applicable, at the location listed on the practitioner’s certificate of registration issued under this title;</text></paragraph><paragraph id="id3be26725-4fc9-4b89-bf6c-aeeb7019aa92"><enum>(2)</enum><text>in the case of administering of the controlled substance for the purpose of maintenance or detoxification treatment under section 303(g)(2)—</text><subparagraph id="idD121FD68CECB4EC2A63E9F7E9FA32194"><enum>(A)</enum><text>the practitioner who issued the prescription is a qualifying practitioner authorized under, and acting within the scope of that section; and</text></subparagraph><subparagraph id="id4F9545E9F24F4F9E959A69151162A18A"><enum>(B)</enum><text>the controlled substance is to be administered by injection or implantation;</text></subparagraph></paragraph><paragraph id="id92dcf390-1f00-41af-b859-bd1ebcda5b54"><enum>(3)</enum><text>the pharmacy and the practitioner are authorized to conduct the activities specified in this section under the law of the State in which such activities take place;</text></paragraph><paragraph id="id55cba33d-a759-4a66-b8bb-07de1ec22e56"><enum>(4)</enum><text>the prescription is not issued to supply any practitioner with a stock of controlled substances for the purpose of general dispensing to patients;</text></paragraph><paragraph id="id015f0e63-b00d-4a33-85a8-b8e3b980d0a3"><enum>(5)</enum><text>except as provided in subsection (b), the controlled substance is to be administered only to the patient named on the prescription not later than 14 days after the date of receipt of the controlled substance by the practitioner; and</text></paragraph><paragraph id="id1f1f7a2a-3e35-4a20-a63f-cba5195d5793"><enum>(6)</enum><text>notwithstanding any exceptions under section 307, the prescribing practitioner, and the practitioner administering the controlled substance, as applicable, maintain complete and accurate records of all controlled substances delivered, received, administered, or otherwise disposed of under this section, including the persons to whom controlled substances were delivered and such other information as may be required by regulations of the Attorney General.</text></paragraph></subsection><subsection id="idE4C8EA7E1F9F429C966D2DCE5F37BCDA"><enum>(b)</enum><header>Modification of number of days before which controlled substance shall be administered</header><paragraph id="idDB326E43C5B2411F9B9C2091D15D4293"><enum>(1)</enum><header>Initial 2-year period</header><text>During the 2-year period beginning on the date of enactment of this section, the Attorney General, in coordination with the Secretary, may reduce the number of days described in subsection (a)(5) if the Attorney General determines that such reduction will—</text><subparagraph id="idF74AC19BF6FC48B3B36F7CE2F1472A50"><enum>(A)</enum><text>reduce the risk of diversion; or</text></subparagraph><subparagraph id="idFDF1B972516F40029A6B9929B716E36D"><enum>(B)</enum><text>protect the public health.</text></subparagraph></paragraph><paragraph id="id1366C57ED95942EC985244EA435D2130"><enum>(2)</enum><header>Modifications after submission of report</header><text>After the date on which the report described in subsection (c) is submitted, the Attorney General, in coordination with the Secretary, may modify the number of days described in subsection (a)(5).</text></paragraph><paragraph id="id13E1AD6804E24C87A13726548AA98E13"><enum>(3)</enum><header>Minimum number of days</header><text>Any modification under this subsection shall be for a period of not less than 7 days.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id5A681E671E684C9EB9D6B54AB1C048A8"><enum>(b)</enum><header>Study and report</header><text>Not later than 2 years after the date of enactment of this section, the Comptroller General of the United States shall conduct a study and submit to Congress a report on access to and potential diversion of controlled substances administered by injection or implantation.</text></subsection><subsection id="idcb62ef82-2aa1-4a38-a844-66a182c9e58c"><enum>(c)</enum><header>Technical and conforming amendment</header><text>The table of contents for the Comprehensive Drug Abuse Prevention and Control Act of 1970 is amended by inserting after the item relating to section 309 the following:</text><quoted-block id="id886cb12e-a728-40a6-96ad-db2eb326d01d" style="OLC"><toc><toc-entry level="section">Sec. 309A. Delivery of a controlled substance by a pharmacy to an administering practitioner.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section></subtitle><subtitle id="idEBB1E8BB5E7344ACA570B390521AFB75"><enum>D</enum><header>Treatment and Recovery</header><section id="H9B97B9F9AC2D4800A7E4C948D2FD0994" section-type="subsequent-section"><enum>1401.</enum><header>Comprehensive opioid recovery centers</header><subsection id="H8F4029BB659940E9B78E0A521A7FFCEA"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall award grants on a competitive basis to eligible entities to establish or operate a comprehensive opioid recovery center (referred to in this section as a <quote>Center</quote>). A Center may be a single entity or an integrated delivery network.</text></subsection><subsection id="HD4D6B9EC36594415AA14798BD02D17FC"><enum>(b)</enum><header>Grant period</header><paragraph id="HC0A7389BB74C480D9318F0D2F5E4D665"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">A grant awarded under subsection (a) shall be for a period not more than 5 years.</text></paragraph><paragraph id="HC32BDCB1458246448F2D33F08AFFD3F7"><enum>(2)</enum><header>Renewal</header><text>A grant awarded under subsection (a) may be renewed, on a competitive basis, for additional periods of time, as determined by the Secretary. In determining whether to renew a grant under this paragraph, the Secretary shall consider the data submitted under subsection (h).</text></paragraph></subsection><subsection commented="no" id="HBBA3AAB7AE0B40A3AAF76C99F0D5D96C"><enum>(c)</enum><header>Minimum number of grants</header><text display-inline="yes-display-inline">The Secretary shall allocate the amounts made available under subsection (j) such that not fewer than 10 grants may be awarded. Not more than one grant shall be made to entities in a single State for any one period.</text></subsection><subsection id="HF2281EBE70AD4D96B6BE747B4EF1AC9D"><enum>(d)</enum><header>Application</header><paragraph id="idF94954DF81F740B5BC0DE979C64409D9"><enum>(1)</enum><header>Eligible entity</header><text>An entity is eligible for a grant under this section if the entity offers treatment and other services for individuals with a substance use disorder.</text></paragraph><paragraph id="id2F7DFA27894941298E7855077FDB3FE0"><enum>(2)</enum><header>Submission of application</header><text>In order to be eligible for a grant under subsection (a), an entity shall submit an application to the Secretary at such time and in such manner as the Secretary may require. Such application shall include—</text><subparagraph id="H0CC10558C2BB4D44BBB7C22C3C1E8342"><enum>(A)</enum><text>evidence that such entity carries out, or is capable of coordinating with other entities to carry out, the activities described in subsection (g); and</text></subparagraph><subparagraph id="H566DEF7A79FD4FB6A5614E65705F437B"><enum>(B)</enum><text>such other information as the Secretary may require.</text></subparagraph></paragraph></subsection><subsection id="HC16FD740406A4FD697909026CC493B66"><enum>(e)</enum><header>Priority</header><text>In awarding grants under subsection (a), the Secretary shall give priority to eligible entities located in a State or Indian Tribe with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, as determined by the Director of the Centers for Disease Control and Prevention.</text></subsection><subsection id="idD3FB7F90C5444FD39115A6801CA1EEA8"><enum>(f)</enum><header>Preference</header><text>In awarding grants under subsection (a), the Secretary may give preference to eligible entities utilizing technology-enabled collaborative learning and capacity building models, including such models as defined in section 2 of the Expanding Capacity for Health Outcomes Act (Public Law 114–270; 130 Stat. 1395), to conduct the activities described in this section.</text></subsection><subsection id="HF8DD1FBD82B6472BB4F7C4DD1EE518CF"><enum>(g)</enum><header>Center activities</header><text>Each Center shall, at a minimum, carry out the following activities directly, through referral, or through contractual arrangements, which may include carrying out such activities through technology-enabled collaborative learning and capacity building models described in subsection (f):</text><paragraph id="HEBAAAB8110084906BDE8894F155E8177"><enum>(1)</enum><header>Treatment and recovery services</header><text display-inline="yes-display-inline">Each Center shall—</text><subparagraph id="HC925266A10C84E4E9B76EAC6BA8A3AD3"><enum>(A)</enum><text display-inline="yes-display-inline">ensure that intake and evaluations meet the individualized clinical needs of patients, including by offering assessments for services and care recommendations through independent, evidence-based verification processes for reviewing patient placement in treatment settings;</text></subparagraph><subparagraph id="H43BCF139192F41C991CC4BAB85398F4A"><enum>(B)</enum><text>provide the full continuum of treatment services, including—</text><clause commented="no" id="H82FFA2CF144C43CBBA627B2AFA7DD337"><enum>(i)</enum><text>all drugs approved by the Food and Drug Administration to treat substance use disorders, pursuant to Federal and State law;</text></clause><clause id="H0220F714AFB447BF98FF0EA327F63CF2"><enum>(ii)</enum><text>medically supervised withdrawal management that includes patient evaluation, stabilization, and readiness for and entry into treatment;</text></clause><clause id="H79C620943CC2456899E8B7C7AB584297"><enum>(iii)</enum><text>counseling provided by a program counselor or other certified professional who is licensed and qualified by education, training, or experience to assess the psychological and sociological background of patients, to contribute to the appropriate treatment plan for the patient, and to monitor patient progress;</text></clause><clause id="idEE6B0CF9932B4EA28854C2088245A372"><enum>(iv)</enum><text>treatment, as appropriate, for patients with co-occurring substance use and mental disorders;</text></clause><clause id="id2214a08afd56441bb46b8c97bf13fda4"><enum>(v)</enum><text>testing, as appropriate, for infections commonly associated with illicit drug use;</text></clause><clause id="HE3FD871FCAF54446B663E241BEEF9112"><enum>(vi)</enum><text>residential rehabilitation, and outpatient and intensive outpatient programs;</text></clause><clause id="H1975036649BC4ED881048C6BDDEAE36F"><enum>(vii)</enum><text>recovery housing;</text></clause><clause id="H34FC837649BD40A3A11548FF0305E171"><enum>(viii)</enum><text>community-based and peer recovery support services;</text></clause><clause id="H8624807F83714704BC692FA8F9F19678"><enum>(ix)</enum><text>job training, job placement assistance, and continuing education assistance to support reintegration into the workforce; and</text></clause><clause id="H1E98EECC2C334C65A876CA1B4406A21B"><enum>(x)</enum><text>other best practices to provide the full continuum of treatment and services, as determined by the Secretary;</text></clause></subparagraph><subparagraph id="idE8A88AB6332C43BD8CCCAD1CF01AE292"><enum>(C)</enum><text>ensure that all programs covered by the Center include medication-assisted treatment, as appropriate, and do not exclude individuals receiving medication-assisted treatment from any service;</text></subparagraph><subparagraph id="id7834DD9D51544B47BBC32AFF72F62F36"><enum>(D)</enum><text>periodically conduct patient assessments to support sustained and clinically significant recovery, as defined by the Assistant Secretary for Mental Health and Substance Use;</text></subparagraph><subparagraph id="H99FF731613B9409093B502BADF6D05C3"><enum>(E)</enum><text>administer an onsite pharmacy and provide toxicology services, for purposes of carrying out this section; and</text></subparagraph><subparagraph id="H6A9F769EB5E040B5A33BF235F07135B0"><enum>(F)</enum><text>operate a secure, confidential, and interoperable electronic health information system.</text></subparagraph></paragraph><paragraph id="id3d3e0adbc194410290606faf85ea0945"><enum>(2)</enum><header>Outreach</header><text>Each Center shall carry out outreach activities to publicize the services offered through the Centers, which may include—</text><subparagraph id="id22037ec837624cacb78b544b049e5416"><enum>(A)</enum><text>training and supervising outreach staff, as appropriate, to work with State and local health departments, health care providers, the Indian Health Service, State and local educational agencies, schools funded by the Indian Bureau of Education, institutions of higher education, State and local workforce development boards, State and local community action agencies, public safety officials, first responders, Indian Tribes, child welfare agencies, as appropriate, and other community partners and the public, including patients, to identify and respond to community needs;</text></subparagraph><subparagraph id="idA1F9BF9DFFAB44D1B0BCF9CA0E4EE302"><enum>(B)</enum><text>ensuring that the entities described in subparagraph (A) are aware of the services of the Center; and</text></subparagraph><subparagraph id="id3a6fb6d434c44a9c97b56ea16488c94a"><enum>(C)</enum><text>disseminating and making publicly available, including through the internet, evidence-based resources that educate professionals and the public on opioid use disorder and other substance use disorders, including co-occurring substance use and mental disorders.</text></subparagraph></paragraph></subsection><subsection id="H5914733961AA43A48ACC38651105E6B0"><enum>(h)</enum><header>Data reporting and program oversight</header><text>With respect to a grant awarded under subsection (a), not later than 90 days after the end of the first year of the grant period, and annually thereafter for the duration of the grant period (including the duration of any renewal period for such grant), the entity shall submit data, as appropriate, to the Secretary regarding—</text><paragraph id="HBA419BC7FBD642D389EAB80A25208FE2"><enum>(1)</enum><text>the programs and activities funded by the grant;</text></paragraph><paragraph id="HB66BF80314484C91B64D4D570D5C1B25"><enum>(2)</enum><text>health outcomes of the population of individuals with a substance use disorder who received services from the Center, evaluated by an independent program evaluator through the use of outcomes measures, as determined by the Secretary;</text></paragraph><paragraph id="id805B71A20B65400DBA3BCB9495DC6A98"><enum>(3)</enum><text>the retention rate of program participants; and</text></paragraph><paragraph id="H6966B5ABDCA44B21B100917651C22454"><enum>(4)</enum><text>any other information that the Secretary may require for the purpose of ensuring that the Center is complying with all the requirements of the grant, including providing the full continuum of services described in subsection (g)(1)(B).</text></paragraph></subsection><subsection id="id4101fa2df4d54b179d51dbafaf7be146"><enum>(i)</enum><header>Privacy</header><text>The provisions of this section, including with respect to data reporting and program oversight, shall be subject to all applicable Federal and State privacy laws.</text></subsection><subsection id="H7A6750A43E1B488B9E11503A67F58E3D"><enum>(j)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 2023 for purposes of carrying out this section.</text></subsection><subsection id="H5F729769DE31434B8A2D8CFF464B0F56"><enum>(k)</enum><header>Reports to Congress</header><paragraph id="H1DD3242533BB4251B31BA90765CBC14B"><enum>(1)</enum><header>Preliminary report</header><text display-inline="yes-display-inline">Not later than 3 years after the date of the enactment of this Act, the Secretary shall submit to Congress a preliminary report that analyzes data submitted under subsection (h).</text></paragraph><paragraph id="H2C6190A7B3E5423CA4173DD35605CF71"><enum>(2)</enum><header>Final report</header><text>Not later than 2 years after submitting the preliminary report required under paragraph (1), the Secretary shall submit to Congress a final report that includes—</text><subparagraph id="HDBA0CAAD165542E49DB5F7C6B210D2BB"><enum>(A)</enum><text>an evaluation of the effectiveness of the comprehensive services provided by the Centers established or operated pursuant to this section with respect to health outcomes of the population of individuals with substance use disorder who receive services from the Center, which shall include an evaluation of the effectiveness of services for treatment and recovery support and to reduce relapse, recidivism, and overdose; and</text></subparagraph><subparagraph id="HC31BA44415774088A713BB3300040473"><enum>(B)</enum><text>recommendations, as appropriate, regarding ways to improve Federal programs related to substance use disorders, which may include dissemination of best practices for the treatment of substance use disorders to health care professionals.</text></subparagraph></paragraph></subsection></section><section id="HB59BECDB0B244CD09D25E03FAD96C834"><enum>1402.</enum><header>Program to support coordination and continuation of care for drug overdose patients</header><subsection id="H666D13E41F8F4FB1A16D70346E929CC6"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall identify or facilitate the development of best practices for—</text><paragraph id="id0DE61820558E49B1B579689A5B7E0637"><enum>(1)</enum><text display-inline="yes-display-inline">emergency treatment of known or suspected drug overdose;</text></paragraph><paragraph id="id702B70F629384034B306BFFBBFB062FA"><enum>(2)</enum><text>the use of recovery coaches, as appropriate, to encourage individuals who experience a non-fatal overdose to seek treatment for substance use disorder and to support coordination and continuation of care;</text></paragraph><paragraph id="idAC920E26059A43CAA3B9AC16E77259F7"><enum>(3)</enum><text>coordination and continuation of care and treatment, including, as appropriate, through referrals, of individuals after an opioid overdose; and</text></paragraph><paragraph id="id9938EC050286433CA3DD1A3E09B66187"><enum>(4)</enum><text>the provision of overdose reversal medication, as appropriate.</text></paragraph></subsection><subsection id="HD30FFC3081084B928A17C3EC53D81517"><enum>(b)</enum><header>Grant establishment and participation</header><paragraph id="H5CF1E3DF8D1A444B9DA406A893FE6344"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall award grants on a competitive basis to eligible entities to support implementation of voluntary programs for care and treatment of individuals after an opioid overdose, as appropriate, which may include implementation of the best practices described in subsection (a).</text></paragraph><paragraph id="id9e037ec0effb4d4fb08f23f5b23aa60f"><enum>(2)</enum><header>Eligible entity</header><text>In this section, the term <term>eligible entity</term> means—</text><subparagraph id="idC8A959F71E4E4483806BE8B02DD5D3B2"><enum>(A)</enum><text>a State alcohol or drug agency;</text></subparagraph><subparagraph id="id0A2B123EB78547F48DB1AEB93E94B5B6"><enum>(B)</enum><text>an Indian Tribe or tribal organization; or</text></subparagraph><subparagraph id="id193852DD4C4246BAA4701C663629117D"><enum>(C)</enum><text>an entity that offers treatment or other services for individuals in response to, or following, drug overdoses or a drug overdose, in consultation with a State alcohol and drug agency.</text></subparagraph></paragraph><paragraph id="H551D279DDBE9442EB4FCF2B293E07604"><enum>(3)</enum><header>Application</header><text display-inline="yes-display-inline">An eligible entity desiring a grant under this section shall submit an application to the Secretary, at such time and in such manner as the Secretary may require, that includes—</text><subparagraph commented="no" id="id1810C90598C54D4CB70732CF24C0862D"><enum>(A)</enum><text>evidence that such eligible entity carries out, or is capable of contracting and coordinating with other community entities to carry out, the activities described in paragraph (4);</text></subparagraph><subparagraph commented="no" id="id6B5D2CA4C89F48DFB28741617A76B744"><enum>(B)</enum><text>evidence that such eligible entity will work with a recovery community organization to recruit, train, hire, mentor, and supervise recovery coaches and fulfill the requirements described in paragraph (4)(A); and</text></subparagraph><subparagraph commented="no" id="id0CF77E72236C4D98BC39E7FC73E6D069"><enum>(C)</enum><text>such additional information as the Secretary may require.</text></subparagraph></paragraph><paragraph commented="no" id="idF59D55EBFFBF487AAC343064FF8B7194"><enum>(4)</enum><header>Use of grant funds</header><text>An eligible entity awarded a grant under this section shall use such grant funds to—</text><subparagraph id="idf352b1946163441ebe8591a660c29548"><enum>(A)</enum><text>hire or utilize recovery coaches to help support recovery, including by—</text><clause id="idc4c9ca1401cd42418e824b024ae33b68"><enum>(i)</enum><text>connecting patients to a continuum of care services, such as—</text><subclause id="idAA347EE68AB14089BB623CFDC31211DB"><enum>(I)</enum><text>treatment and recovery support programs;</text></subclause><subclause id="idF092C264640446CC9C6F94F61AD3D31F"><enum>(II)</enum><text>programs that provide non-clinical recovery support services;</text></subclause><subclause id="idCE03226340F44A4FBCD99DC708DBFABF"><enum>(III)</enum><text>peer support networks;</text></subclause><subclause id="id4DF2D2592015416D9380D49B174C3638"><enum>(IV)</enum><text>recovery community organizations;</text></subclause><subclause id="id57FD099486F748E397CB8A50CF06D510"><enum>(V)</enum><text>health care providers, including physicians and other providers of behavioral health and primary care;</text></subclause><subclause id="id6c4f9b15f4cd49778119cf2aa85b8d38"><enum>(VI)</enum><text>education and training providers;</text></subclause><subclause id="id4ee56355996f45da8fa1d54d64482c88"><enum>(VII)</enum><text>employers;</text></subclause><subclause id="id7302ff5a0373452aa03c558071c3c744"><enum>(VIII)</enum><text>housing services; and</text></subclause><subclause id="idc0369ba94ff04be78bf4604624c64a4c"><enum>(IX)</enum><text>child welfare agencies;</text></subclause></clause><clause id="id3dc6b88f6f7143b09b2cd2616116b803"><enum>(ii)</enum><text>providing education on overdose prevention and overdose reversal to patients and families, as appropriate;</text></clause><clause id="id5d240aa1140040f0b6107a0ef3aa641e"><enum>(iii)</enum><text>providing follow-up services for patients after an overdose to ensure continued recovery and connection to support services;</text></clause><clause id="id69f55aab7d334f0d95a069ba430aa319"><enum>(iv)</enum><text>collecting and evaluating outcome data for patients receiving recovery coaching services; and</text></clause><clause id="id1de5c56186494e1c8b354fe3fb5d1473"><enum>(v)</enum><text>providing other services the Secretary determines necessary to help ensure continued connection with recovery support services, including culturally appropriate services, as applicable;</text></clause></subparagraph><subparagraph id="idFF0BBF11FB5948459B7799365FEBA197"><enum>(B)</enum><text>establish policies and procedures, pursuant to Federal and State law, that address the provision of overdose reversal medication, the administration of all drugs approved by the Food and Drug Administration to treat substance use disorder, and subsequent continuation of, or referral to, evidence-based treatment for patients with a substance use disorder who have experienced a non-fatal drug overdose, in order to support long-term treatment, prevent relapse, and reduce recidivism and future overdose; and</text></subparagraph><subparagraph id="idF232895A287B4A12AB2A280F84B94A16"><enum>(C)</enum><text>establish integrated models of care for individuals who have experienced a non-fatal drug overdose which may include patient assessment, follow up, and transportation to and from treatment facilities.</text></subparagraph></paragraph><paragraph id="H2767A4AAF451414A86AFC4DFED75B4F4"><enum>(5)</enum><header>Additional permissible uses</header><text>In addition to the uses described in paragraph (4), a grant awarded under this section may be used, directly or through contractual arrangements, to provide—</text><subparagraph id="idddb6c4c1aa024024bd3c194e6724187d"><enum>(A)</enum><text>all drugs approved by the Food and Drug Administration to treat substance use disorders, pursuant to Federal and State law;</text></subparagraph><subparagraph id="idCC558C4BB44042BD9395CBDF954AD1EB"><enum>(B)</enum><text>withdrawal and detoxification services that include patient evaluation, stabilization, and preparation for treatment of substance use disorder, including treatment described in subparagraph (A), as appropriate; or</text></subparagraph><subparagraph id="id524C000C9D01463BA0B6272ED222A4B1"><enum>(C)</enum><text>mental health services provided by a program counselor, social worker, therapist, or other certified professional who is licensed and qualified by education, training, or experience to assess the psychosocial background of patients, to contribute to the appropriate treatment plan for patients with substance use disorder, and to monitor patient progress.</text></subparagraph></paragraph><paragraph id="id2185B3C75A314D0BB479086BBB8082D7"><enum>(6)</enum><header>Preference</header><text>In awarding grants under this section, the Secretary shall give preference to eligible entities that meet any or all of the following criteria:</text><subparagraph id="HCB9E1C0B2F03444DBFCC7159B541B8D1"><enum>(A)</enum><text>The eligible entity is a critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act (42 U.S.C. 1395x(mm)(1))), a low volume hospital (as defined in section 1886(d)(12)(C)(i) of such Act (42 U.S.C. 1395ww(d)(12)(C)(i))), or a sole community hospital (as defined in section 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 1395ww(d)(5)(D)(iii))).</text></subparagraph><subparagraph id="H2982B79C87894BD6A3DFD0C3F40F7CA7"><enum>(B)</enum><text display-inline="yes-display-inline">The eligible entity is located in a State, or under the jurisdiction of an Indian Tribe, with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, as determined by the Director of the Centers for Disease Control and Prevention.</text></subparagraph><subparagraph id="idB36D0F12B69B4F7F8974F821955BB72D"><enum>(C)</enum><text>The eligible entity demonstrates that recovery coaches will be placed in both health care settings and community settings.</text></subparagraph></paragraph><paragraph id="H480C3492FF2D4934A993635959A8E423"><enum>(7)</enum><header>Period of grant</header><text display-inline="yes-display-inline">A grant awarded to an eligible entity under this section shall be for a period of not more than 5 years.</text></paragraph></subsection><subsection id="id7485205bd9234b6980d80997c023f888"><enum>(c)</enum><header>Definitions</header><text>In this section:</text><paragraph id="id8FB430640D154AA999F5D7F3CB63ACF3"><enum>(1)</enum><header>Recovery coach</header><text>the term <term>recovery coach</term> means an individual—</text><subparagraph id="id142422bbd0bb4435afdf0ade2a4ede6f"><enum>(A)</enum><text>with knowledge of, or experience with, recovery from a substance use disorder; and</text></subparagraph><subparagraph id="id0b966bd364fc48b082d084a9a97f776d"><enum>(B)</enum><text>who has completed training from, and is determined to be in good standing by, a recovery services organization capable of conducting such training and making such determination.</text></subparagraph></paragraph><paragraph id="idcf285e49eae9467eb726a7e35c6d6ceb"><enum>(2)</enum><header>Recovery community organization</header><text>The term <term>recovery community organization</term> has the meaning given such term in section 547(a) of the Public Health Service Act (42 U.S.C. 290ee–2(a)).</text></paragraph><paragraph id="id9fc0555da5564ba18495739700a932c7"><enum>(3)</enum><header>State alcohol and drug agency</header><text>The term <term>State alcohol and drug agency</term> means the principal agency of a State that is responsible for carrying out the block grant for prevention and treatment of substance abuse under subpart II of part B of title XIX of the Public Health Service Act (42 U.S.C. 300x–21 et seq.)</text></paragraph></subsection><subsection id="HF3CC2AF96BAA470AB5E8961AD20742DA"><enum>(d)</enum><header>Reporting requirements</header><paragraph id="H5DAFA1EEA9D146A0A4DCCA1F79D7BBAB"><enum>(1)</enum><header>Reports by grantees</header><text display-inline="yes-display-inline">Each eligible entity awarded a grant under this section shall submit to the Secretary an annual report for each year for which the entity has received such grant that includes information on—</text><subparagraph id="H7F4779385020442A8FFF07575EE3BAD3"><enum>(A)</enum><text display-inline="yes-display-inline">the number of individuals treated by the entity for non-fatal overdoses, including the number of non-fatal overdoses where overdose reversal medication was administered;</text></subparagraph><subparagraph id="H4A1358A394ED41128FE42BA6615E27D5"><enum>(B)</enum><text>the number of individuals administered medication-assisted treatment by the entity;</text></subparagraph><subparagraph id="H5900D297AB2F4ADBAE43D2A1DCDB7A10"><enum>(C)</enum><text>the number of individuals referred by the entity to other treatment facilities after a non-fatal overdose, the types of such other facilities, and the number of such individuals admitted to such other facilities pursuant to such referrals; and</text></subparagraph><subparagraph id="HF75FF45F226A498D87D763C2BC144441"><enum>(D)</enum><text display-inline="yes-display-inline">the frequency and number of patients with reoccurrences, including readmissions for non-fatal overdoses and evidence of relapse related to substance use disorder.</text></subparagraph></paragraph><paragraph commented="no" id="H1E39BB538401496CAAFABB327912355D"><enum>(2)</enum><header>Report by Secretary</header><text display-inline="yes-display-inline">Not later than 5 years after the date of enactment of this Act, the Secretary shall submit to Congress a report that includes an evaluation of the effectiveness of the grant program carried out under this section with respect to long term health outcomes of the population of individuals who have experienced a drug overdose, the percentage of patients treated or referred to treatment by grantees, and the frequency and number of patients who experienced relapse, were readmitted for treatment, or experienced another overdose.</text></paragraph></subsection><subsection commented="no" id="id23C8A6BBFF0046F4A69CD02E419DE8A1"><enum>(e)</enum><header>Privacy</header><text>The requirements of this section, including with respect to data reporting and program oversight, shall be subject to all applicable Federal and State privacy laws.</text></subsection><subsection commented="no" id="idDDCDF39C56EC4C26A93735FFD986B369"><enum>(f)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2019 through 2023.</text></subsection></section><section id="id46F8CD98CDCA434FAE42ECEE42F65D00"><enum>1403.</enum><header>Alternatives to opioids</header><subsection id="idB72B80E8B08349BEBC4BF0ACB1A50637"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall, directly or through grants to, or contracts with, public and private entities, provide technical assistance to hospitals and other acute care settings on alternatives to opioids for pain management. The technical assistance provided shall be for the purpose of—</text><paragraph id="id35dc0a30004b46f58748028be1592c05"><enum>(1)</enum><text>utilizing information from acute care providers including emergency departments and other providers that have successfully implemented alternatives to opioids programs, promoting non-addictive protocols and medications while appropriately limiting the use of opioids;</text></paragraph><paragraph id="id82908b2557ec4cd58c66e9391b6b397a"><enum>(2)</enum><text>identifying or facilitating the development of best practices on the use of alternatives to opioids, which may include pain-management strategies that involve non-addictive medical products, non-pharmacologic treatments, and technologies or techniques to identify patients at risk for opioid use disorder;</text></paragraph><paragraph id="id7aa356a905e74627af8b480bc2fb1429"><enum>(3)</enum><text>identifying or facilitating the development of best practices on the use of alternatives to opioids that target common painful conditions and include certain patient populations, such as geriatric patients, pregnant women, and children;</text></paragraph><paragraph id="idEE7099197FCA4009A6DB1540E9C39474"><enum>(4)</enum><text>disseminating information on the use of alternatives to opioids to providers in acute care settings, which may include emergency departments, outpatient clinics, critical access hospitals, Federally qualified health centers, Indian Health Service health facilities, and tribal hospitals; and</text></paragraph><paragraph id="idB70CADFB3AED4EDE811ECE951502A16F"><enum>(5)</enum><text>collecting data and reporting on health outcomes associated with the use of alternatives to opioids.</text></paragraph></subsection><subsection id="id8888566F7FA64B7186E1D9BE9E1F4AB8"><enum>(b)</enum><header>Pain management and funding</header><paragraph id="idCDA323401F66489CA4A998BCA0489A3F"><enum>(1)</enum><header>In general</header><text>The Secretary shall award grants to hospitals and other acute care settings relating to alternatives to opioids for pain management.</text></paragraph><paragraph id="idB03CA1DF7F7242CC9C8252AE7D26BB5A"><enum>(2)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated $5,000,000 for each of fiscal years 2019 through 2023 for purposes of carrying out this section.</text></paragraph></subsection></section><section id="idEB71496F4ABE4DADB41C8E54706255B7"><enum>1404.</enum><header>Building communities of recovery</header><text display-inline="no-display-inline">Section 547 of the Public Health Service Act (42 U.S.C. 290ee–2) is amended to read as follows:</text><quoted-block display-inline="no-display-inline" id="id4160144B28214B989F75B7F173576D7E" style="OLC"><section commented="no" display-inline="no-display-inline" id="HAAC556448DC04407A650EAA9CF954433" section-type="subsequent-section"><enum>547.</enum><header display-inline="yes-display-inline">Building communities of recovery</header><subsection commented="no" display-inline="no-display-inline" id="H8D80E509C00F4C308E276FA7987D670E"><enum>(a)</enum><header>Definition</header><text>In this section, the term <term>recovery community organization</term> means an independent nonprofit organization that—</text><paragraph commented="no" display-inline="no-display-inline" id="HFDBA39098AA244AF8BE61C8CECF8A714"><enum>(1)</enum><text>mobilizes resources within and outside of the recovery community, which may include through a peer support network, to increase the prevalence and quality of long-term recovery from substance use disorders; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H7B27478BE6524786A2A71761D1CAB245"><enum>(2)</enum><text>is wholly or principally governed by people in recovery for substance use disorders who reflect the community served.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HC5CCE42CC7954AC3AB55F4BBE00056F5"><enum>(b)</enum><header>Grants authorized</header><text>The Secretary shall award grants to recovery community organizations to enable such organizations to develop, expand, and enhance recovery services.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="H32B62C9CD7B9497CAFE8AA3FD3CCC92C"><enum>(c)</enum><header>Federal share</header><text>The Federal share of the costs of a program funded by a grant under this section may not exceed 85 percent.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="H66745B714F1A4DEDA1B88E17D518319B"><enum>(d)</enum><header>Use of funds</header><text>Grants awarded under subsection (b)—</text><paragraph commented="no" display-inline="no-display-inline" id="H82714B3FA41C401695357930D7E4D260"><enum>(1)</enum><text>shall be used to develop, expand, and enhance community and statewide recovery support services; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HE2155E7288FC4282808259A2AABE44A4"><enum>(2)</enum><text>may be used to—</text><subparagraph commented="no" display-inline="no-display-inline" id="H38C198E13B8A427EADDD228EFC21A261"><enum>(A)</enum><text>build connections between recovery networks, including between recovery community organizations and peer support networks, and with other recovery support services, including—</text><clause commented="no" display-inline="no-display-inline" id="HF0BA4FC1E59F400B9D025B22E102DEAF"><enum>(i)</enum><text>behavioral health providers;</text></clause><clause commented="no" display-inline="no-display-inline" id="H9000CDEE06214064B6AB0F8806721260"><enum>(ii)</enum><text>primary care providers and physicians;</text></clause><clause commented="no" display-inline="no-display-inline" id="id0E030EDF14BC439E8432570EE785E20E"><enum>(iii)</enum><text>educational and vocational schools;</text></clause><clause commented="no" display-inline="no-display-inline" id="HECD87F1A08D74395B144F0DE97C350FD"><enum>(iv)</enum><text>employers;</text></clause><clause commented="no" display-inline="no-display-inline" id="HAD45F00C8D354EEF9B5CA7E000D06B31"><enum>(v)</enum><text>housing services;</text></clause><clause commented="no" display-inline="no-display-inline" id="H5F268385C66242F49D59F172A0BE94A1"><enum>(vi)</enum><text>child welfare agencies; and</text></clause><clause commented="no" display-inline="no-display-inline" id="HC7929674C7754323B02D5F56674170C3"><enum>(vii)</enum><text>other recovery support services that facilitate recovery from substance use disorders, including non-clinical community services;</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H50B56BE7B17F4FB2BDC1C86182B14AA1"><enum>(B)</enum><text>reduce the stigma associated with substance use disorders; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H24426EA7E7B84B258652CD6FC955ED3D"><enum>(C)</enum><text>conduct outreach on issues relating to substance use disorders and recovery, including—</text><clause commented="no" display-inline="no-display-inline" id="H2017986EDDD84D92AEF72425AA06004C"><enum>(i)</enum><text>identifying the signs of substance use disorder;</text></clause><clause commented="no" display-inline="no-display-inline" id="HBE5E7C6EEB1240E29A4D7D633279F250"><enum>(ii)</enum><text>the resources available to individuals with substance use disorder and to families of an individual with a substance use disorder, including programs that mentor and provide support services to children;</text></clause><clause commented="no" display-inline="no-display-inline" id="H30523E5B84ED43EBB60038AB5B5044E8"><enum>(iii)</enum><text>the resources available to help support individuals in recovery; and</text></clause><clause commented="no" display-inline="no-display-inline" id="HD99595D6505F4CC289A5EC0972DFA701"><enum>(iv)</enum><text>related medical outcomes of substance use disorders, the potential of acquiring an infection commonly associated with illicit drug use, and neonatal abstinence syndrome among infants exposed to opioids during pregnancy.</text></clause></subparagraph></paragraph></subsection><subsection id="id6c22dc87c43442e2b7e6dae57f445661"><enum>(e)</enum><header>Special consideration</header><text>In carrying out this section, the Secretary shall give special consideration to the unique needs of rural areas, including areas with an age-adjusted rate of drug overdose deaths that is above the national average and areas with a shortage of prevention and treatment services.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="HEB3233AF9E434EC080CD11A6DD8B2F3C"><enum>(f)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id1510BC8614404C36842D3A29B32C3AFC"><enum>1405.</enum><header>Peer support technical assistance center</header><subsection id="id9127C48F9DB84B1DA4AEC57B1C0C83E9"><enum>(a)</enum><header>Establishment</header><text>The Secretary, acting through the Assistant Secretary for Mental Health and Substance Abuse, shall establish or operate a National Peer-Run Training and Technical Assistance Center for Addiction Recovery Support (referred to in this subsection as the <quote>Center</quote>).</text></subsection><subsection id="ida378111bc0a54ca3bc56f7bef423ac12"><enum>(b)</enum><header>Functions</header><text>The Center established under subsection (a) shall provide technical assistance and support to recovery community organizations and peer support networks, including such assistance and support related to—</text><paragraph id="id1ff4c36dfef94a22a0882f2bdda4f36a"><enum>(1)</enum><text>training on identifying—</text><subparagraph id="id9E6A4F7F5F9C49D4A3CDCBEBE87382E1"><enum>(A)</enum><text>signs of substance use disorder;</text></subparagraph><subparagraph id="id528B1F56E6764858A4712C3768511C84"><enum>(B)</enum><text>resources to assist individuals with a substance use disorder, or resources for families of an individual with a substance use disorder; and</text></subparagraph><subparagraph id="id0BCC1AF5E0464D85A9797A22F04EF075"><enum>(C)</enum><text>best practices for the delivery of recovery support services;</text></subparagraph></paragraph><paragraph id="id0D318339249B47ABB7EE04E11A715CF8"><enum>(2)</enum><text>the provision of translation services, interpretation, or other such services for clients with limited English speaking proficiency;</text></paragraph><paragraph id="idE85C9B5893494DB8ACFF6E7E7C05EC70"><enum>(3)</enum><text>data collection to support research, including for translational research;</text></paragraph><paragraph id="id78465605604E454480EC734448AFDB8A"><enum>(4)</enum><text>capacity building; and</text></paragraph><paragraph id="id750DAE17674F4930918B3ABB6CE3CBE7"><enum>(5)</enum><text>evaluation and improvement, as necessary, of the effectiveness of such services provided by recovery community organizations (as defined in section 547 of the Public Health Service Act).</text></paragraph></subsection><subsection id="id01087C5E352147B2B7A441BEB485BD56"><enum>(c)</enum><header>Best practices</header><text>The Center established under subsection (a) shall periodically issue best practices for use by recovery community organizations and peer support networks.</text></subsection><subsection id="id2FAF2AD59C1A4530B96F521B70C6B0B7"><enum>(d)</enum><header>Recovery community organization</header><text>In this section, the term <term>recovery community organization</term> has the meaning given such term in section 547 of the Public Health Service Act.</text></subsection><subsection id="id91E93C2678F54688937D5F4C5D3088DA"><enum>(e)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2019 through 2023.</text></subsection></section><section commented="no" id="idF2E2D0EBA5024F1C84D1D56D82AE1A00"><enum>1406.</enum><header>Medication-assisted treatment for recovery from addiction</header><subsection id="idA54B223556184A1985E7CCA644B1E585"><enum>(a)</enum><header>Waivers for maintenance treatment or detoxification</header><text display-inline="yes-display-inline">Section 303(g)(2)(G)(ii) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)(ii)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id806AC04CCD764BEBACC74DFEBCC2B0CA" style="OLC"><subclause id="id24c814d2e3784bbea7acd334ffa127f2" indent="up2"><enum>(VIII)</enum><text>The physician graduated in good standing from an accredited school of allopathic medicine or osteopathic medicine in the United States during the 5-year period immediately preceding the date on which the physician submits to the Secretary a written notification under subparagraph (B) and successfully completed a comprehensive allopathic or osteopathic medicine curriculum or accredited medical residency that—</text><item id="id15146B7FF6DF4AF8A53B8E69DEEBA95D"><enum>(aa)</enum><text>included not less than 24 hours of training on treating and managing opioid-dependent patients; and</text></item><item id="id2D92F265CB4D41E6AB544F6B5DBB322E"><enum>(bb)</enum><text>included, at a minimum—</text><subitem id="id7868cdf3451f4f3d80b4de86d89a506b"><enum>(AA)</enum><text>the training described in items (aa) through (gg) of subclause (IV); and</text></subitem><subitem id="id6DF4372BA1EE4E4B85A33498F1CA377D"><enum>(BB)</enum><text>training with respect to any other best practice the Secretary determines should be included in the curriculum, which may include training on pain management, including assessment and appropriate use of opioid and non-opioid alternatives.</text></subitem></item></subclause><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="idD7EB1487639B420DA292F50D9263EF4C"><enum>(b)</enum><header>Treatment for children</header><text>The Secretary shall consider ways to ensure that an adequate number of physicians who meet the requirements under the amendment made by subsection (a) and have a specialty in pediatrics, or the treatment of children or of adolescents, are granted a waiver under section 303(g)(2) of the Controlled Substances Act (21 U.S.C. 823(g)(2)) to treat children and adolescents with substance use disorders.</text></subsection><subsection id="id1D16F259945F4B268BAD535A78D07E75"><enum>(c)</enum><header>Technical amendment</header><text>Section 102(24) of the Controlled Substances Act (21 U.S.C. 802(24)) is amended by striking <quote>Health, Education, and Welfare</quote> and inserting <quote>Health and Human Services</quote>.</text></subsection></section><section id="idBD102A8CC7314F25B61713FB99D857AE" section-type="subsequent-section"><enum>1407.</enum><header>Grant program</header><subsection id="id1B3BE33E993C42269287D69648597078"><enum>(a)</enum><header>In general</header><text>The Secretary shall establish a grant program under which the Secretary may make grants to accredited schools of allopathic medicine or osteopathic medicine and teaching hospitals located in the United States to support the development of curricula that meet the requirements under subclause (VIII) of section 303(g)(2)(G)(ii) of the Controlled Substances Act, as added by section 1406(a) of this Act.</text></subsection><subsection id="id622B627BFEF3449FA46BA403250BD572"><enum>(b)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated for grants under subsection (a), $4,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section><section id="id4520931097e64c0e8bf6de9a7fe666e9"><enum>1408.</enum><header>Allowing for more flexibility with respect to medication-assisted treatment for opioid use disorders</header><text display-inline="no-display-inline">Subclause (II) of section 303(g)(2)(B)(iii) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(B)(iii)) is amended to read as follows:</text><quoted-block display-inline="no-display-inline" id="idf52f6d6bbce84f918703e9f9b102ca93" style="OLC"><subclause id="id57b399a8d54e4aac90d0ca7a43f2d67b" indent="up3"><enum>(II)</enum><text>The applicable number is—</text><item id="idb30717f597d94b5ab25d1f71e995f98c"><enum>(aa)</enum><text>100 if, not sooner than 1 year after the date on which the practitioner submitted the initial notification, the practitioner submits a second notification to the Secretary of the need and intent of the practitioner to treat up to 100 patients; or</text></item><item id="idb6bff8685a2c4c8d9d042762335dfe72"><enum>(bb)</enum><text>275 if the practitioner meets the requirements specified in section 8.610 of title 42, Code of Federal Regulations (or successor regulations).</text></item></subclause><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="idEB505672E59E4474A1CAD63225C69C6F"><enum>1409.</enum><header>National recovery housing best practices</header><subsection id="id342DC5D0281A4AAE820D5A906CE21432"><enum>(a)</enum><header>Best practices for operating recovery housing</header><paragraph id="id90E138E64D984B34871D63B4281D0E4F"><enum>(1)</enum><header>In general</header><text>The Secretary, in consultation with the individuals and entities described in paragraph (2), shall identify or facilitate the development of best practices, which may include model laws for implementing suggested minimum standards, for operating recovery housing.</text></paragraph><paragraph id="id2B8EDC3D54344D0E977B7A8099003C47"><enum>(2)</enum><header>Consultation</header><text>In carrying out the activities described in paragraph (1) the Secretary shall consult with, as appropriate—</text><subparagraph id="id6b0af8314b3540d382c13e3ede24fe4d"><enum>(A)</enum><text>relevant divisions of the Department of Health and Human Services, including the Substance Abuse and Mental Health Services Administration, the Office of Inspector General, the Indian Health Service, and the Centers for Medicare & Medicaid Services;</text></subparagraph><subparagraph id="idf03c1ef1fb824cab9f12e85e61043301"><enum>(B)</enum><text>the Secretary of Housing and Urban Development;</text></subparagraph><subparagraph id="idad33e95f61604977bae38d938c758019"><enum>(C)</enum><text>directors or commissioners, as applicable, of State health departments, tribal health departments, State Medicaid programs, and State insurance agencies;</text></subparagraph><subparagraph id="id5cbf2f3f878a4f22a7100a2505ee31cb"><enum>(D)</enum><text>representatives of health insurance issuers;</text></subparagraph><subparagraph id="id13ecd984d32d431185f72ff6e38157a5"><enum>(E)</enum><text>national accrediting entities and reputable providers of, and analysts of, recovery housing services, including Indian Tribes, tribal organizations, and tribally designated housing entities that provide recovery housing services, as applicable;</text></subparagraph><subparagraph id="ida59b1128c3fb4b1b826828fbae3a7f25"><enum>(F)</enum><text>individuals with a history of substance use disorder; and</text></subparagraph><subparagraph id="ide920142b8fcc42a48bd4b3ecd66ab00b"><enum>(G)</enum><text>other stakeholders identified by the Secretary.</text></subparagraph></paragraph></subsection><subsection id="idA002750BADC4482988D4088E04A6EDBF"><enum>(b)</enum><header>Identification of fraudulent recovery housing operators</header><paragraph id="id6b612cc3f24c494fb435c19013f5f564"><enum>(1)</enum><header>In general</header><text>The Secretary, in consultation with the individuals and entities described in paragraph (2), shall identify or facilitate the development of common indicators that could be used to identify potentially fraudulent recovery housing operators.</text></paragraph><paragraph id="idf72f4affe1c044a1aff757b73d20a6d6"><enum>(2)</enum><header>Consultation</header><text>In carrying out the activities described in paragraph (1), the Secretary shall consult with, as appropriate—</text><subparagraph id="id4c022b6731d849699d1e2c928f241e78"><enum>(A)</enum><text>relevant divisions of the Department of Health and Human Services, including the Substance Abuse and Mental Health Services Administration, the Office of Inspector General, the Indian Health Service, and the Centers for Medicare & Medicaid Services;</text></subparagraph><subparagraph id="id70f916a88cb74797a78088e9356aa07a"><enum>(B)</enum><text>the Attorney General;</text></subparagraph><subparagraph id="iddec845f8d00b4b4a95d1cd7a0e5166e5"><enum>(C)</enum><text>the Secretary of Housing and Urban Development;</text></subparagraph><subparagraph id="id342dbc7773c44ad48599b83184303820"><enum>(D)</enum><text>directors or commissioners, as applicable, of State health departments, tribal health departments, State Medicaid programs, and State insurance agencies;</text></subparagraph><subparagraph id="idc4594ce2d95542fc8a60568111711499"><enum>(E)</enum><text>representatives of health insurance issuers;</text></subparagraph><subparagraph id="id763eb88606e446eca3557569af583451"><enum>(F)</enum><text>national accrediting entities and reputable providers of, and analysts of, recovery housing services, including Indian Tribes, tribal organizations, and tribally designated housing entities that provide recovery housing services, as applicable;</text></subparagraph><subparagraph id="idACB752856FCD4D7AA6A5E813F975C5B1"><enum>(G)</enum><text>individuals with a history of substance use disorder; and</text></subparagraph><subparagraph id="idBAF340100E5E4DA5BF51A7932DC323D7"><enum>(H)</enum><text>other stakeholders identified by the Secretary.</text></subparagraph></paragraph><paragraph id="id6A95059B213E4AE68FC7C2AC6E2C0028"><enum>(3)</enum><header>Requirements</header><subparagraph id="id24c34bcf759541dbb75741531a99bccd"><enum>(A)</enum><header>Practices for identification and reporting</header><text>In carrying out the activities described in this subsection, the Secretary shall consider how law enforcement, public and private payers, and the public can best identify and report fraudulent recovery housing operators.</text></subparagraph><subparagraph id="idd37dd463b248411499d9636b9806a862"><enum>(B)</enum><header>Factors to be considered</header><text>In carrying out the activities described in this subsection, the Secretary shall consider identifying or developing indicators regarding—</text><clause id="id993c00927ed244529f0e5a75c1c91285"><enum>(i)</enum><text>unusual billing practices;</text></clause><clause id="idb2440366296d4536aea0ece99c93eddd"><enum>(ii)</enum><text>average lengths of stays;</text></clause><clause id="id8704fc6a6b474dc19ef82eab964418d7"><enum>(iii)</enum><text>excessive levels of drug testing (in terms of cost or frequency);</text></clause><clause id="id7e268c5a1de84810bad8f3fa6f412f4f"><enum>(iv)</enum><text>unusually high levels of recidivism; and</text></clause><clause id="idb4e03615a392400294afa213f1a1da18"><enum>(v)</enum><text>any other factors identified by the Secretary.</text></clause></subparagraph></paragraph></subsection><subsection id="idABA22E0A7E8F47AE8EC89C37D30FB6BC"><enum>(c)</enum><header>Dissemination</header><text>The Secretary shall, as appropriate, disseminate the best practices identified or developed under subsection (a), and the common indicators identified or developed under subsection (b), to—</text><paragraph id="id416D43DB5E4C47ABB400CDDCAEC05CD7"><enum>(1)</enum><text>State agencies, which may include the provision of technical assistance to State agencies seeking to adopt or implement such best practices;</text></paragraph><paragraph id="id7354D9AABF6B466AA26BA52E0BF83E94"><enum>(2)</enum><text>Indian Tribes, tribal organizations, and tribally designated housing entities;</text></paragraph><paragraph id="idE393B342C7E143C7862BE2C1D2558BA7"><enum>(3)</enum><text>the Attorney General;</text></paragraph><paragraph id="id35636E2F24C14BE191EEB3B9C2EE4347"><enum>(4)</enum><text>the Secretary of Labor;</text></paragraph><paragraph id="id11C9C80503BB4276AF1CB7DC0BCF1D33"><enum>(5)</enum><text>the Secretary of Housing and Urban Development;</text></paragraph><paragraph id="id68A734FC6564430CA430565B9686BDE6"><enum>(6)</enum><text>State and local law enforcement agencies;</text></paragraph><paragraph id="idE0BB4AB1751A41E592FF72F98A1838C4"><enum>(7)</enum><text>health insurance issuers;</text></paragraph><paragraph id="idC50B81F775D645C29FFED1F0188574C6"><enum>(8)</enum><text>recovery housing entities; and</text></paragraph><paragraph id="id60477B17F0F047EAB3653587B87C19AF"><enum>(9)</enum><text>the public.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idDF9C9421712D4F35A80C10F9FAFAD5AE"><enum>(d)</enum><header>Requirements</header><text display-inline="yes-display-inline">In carrying out the activities under subsections (a) and (b), the Secretary, in consultation with appropriate stakeholders as described in each such subsection, shall consider how recovery housing is able to support recovery and prevent relapse, recidivism, or overdose (including overdose death), including by improving access and adherence to treatment, including medication-assisted treatment.</text></subsection><subsection id="id9393c124c6ce477a8fb49ea4eebb8c51"><enum>(e)</enum><header>Rule of construction</header><text>Nothing in this section shall be construed to provide the Secretary with the authority to require States to adhere to minimum standards in the State oversight of recovery housing.</text></subsection><subsection id="idee23893f2f36400d9dc495ad14ce5161"><enum>(f)</enum><header>Definitions</header><text>In this section—</text><paragraph id="id6854E4DB17E74A7B931B09F001D34ED7"><enum>(1)</enum><text>the term <term>recovery housing</term> means a shared living environment free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders; and</text></paragraph><paragraph id="id816338C541964DD5A86003002E927871"><enum>(2)</enum><text>the term <term>tribally designated housing entity</term> has the meaning given such term in section 4 of the Native American Housing Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103).</text></paragraph></subsection></section><section id="id6C3D6FF7245641D580C5C97CC09BC60C"><enum>1410.</enum><header>Addressing economic and workforce impacts of the opioid crisis</header><subsection id="id667D1CC9171C455D81D8930026C4D254"><enum>(a)</enum><header>Definitions</header><text>Except as otherwise expressly provided, in this section:</text><paragraph id="idCCADDF3D4A1043FDA6BAAAAF32176F3E"><enum>(1)</enum><header>WIOA definitions</header><text>The terms <term>core program</term>, <term>individual with a barrier to employment</term>, <term>local area</term>, <term>local board</term>, <term>one-stop operator</term>, <term>outlying area</term>, <term>State</term>, <term>State board</term>, and <term>supportive services</term> have the meanings given the terms in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102).</text></paragraph><paragraph id="id88C47324D6CB422B826C4661E2954296"><enum>(2)</enum><header>Education provider</header><text>The term <term>education provider</term> means—</text><subparagraph id="id03CF4816EB8C4D09BA0512C671F8FDBF"><enum>(A)</enum><text>an institution of higher education, as defined in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001); or</text></subparagraph><subparagraph id="id8F68F608CA624A599E4579D73AECA7E5"><enum>(B)</enum><text>a postsecondary vocational institution, as defined in section 102(c) of such Act (20 U.S.C. 1002(c)).</text></subparagraph></paragraph><paragraph id="id23481B475E2F4A5FB4E951888E1C22D3"><enum>(3)</enum><header>Eligible entity</header><text>The term <term>eligible entity</term> means—</text><subparagraph id="id3EC642CF46304045BA55E9BAA38C9A3D"><enum>(A)</enum><text>a State workforce agency;</text></subparagraph><subparagraph id="idFF69EF4444254BFEB34E03272E4DA0F2"><enum>(B)</enum><text>an outlying area; or</text></subparagraph><subparagraph id="id718C6221A3A04B12B590269655A3904F"><enum>(C)</enum><text>a Tribal entity.</text></subparagraph></paragraph><paragraph id="id69380A31FB0D42978479AAB74F329D4B"><enum>(4)</enum><header>Participating partnership</header><text>The term <term>participating partnership</term> means a partnership—</text><subparagraph id="id6AFC73B20F6F404EAFC4A0C2D782DA9E"><enum>(A)</enum><text>evidenced by a written contract or agreement; and</text></subparagraph><subparagraph id="id8FEF7D0921BE4064AA855426E891F21B"><enum>(B)</enum><text>including, as members of the partnership, a local board receiving a subgrant under subsection (d) and 1 or more of the following:</text><clause id="id458C15948DAB485D8CE5175BA13500BB"><enum>(i)</enum><text>The eligible entity.</text></clause><clause id="id520B67CC06AC41A3AEDCFAE292C059E0"><enum>(ii)</enum><text>A treatment provider.</text></clause><clause id="idBB5A595AEBEE4CF7B78934B06DB0FD0B"><enum>(iii)</enum><text>An employer or industry organization.</text></clause><clause id="id2CE36D8A747E4F1B9F14CFD991216BC3"><enum>(iv)</enum><text>An education provider.</text></clause><clause id="id2984C43301354CD0B0A403693F43C384"><enum>(v)</enum><text>A legal service or law enforcement organization.</text></clause><clause id="id17745D3D894D416A8F96E132D090A675"><enum>(vi)</enum><text>A faith-based or community-based organization.</text></clause><clause id="id3C2743F89D444F75B4CE07C65AE26B37"><enum>(vii)</enum><text>Other State or local agencies, including counties or local governments.</text></clause><clause id="id3D3313E2C0954D85BD5763699341E0AA"><enum>(viii)</enum><text>Other organizations, as determined to be necessary by the local board.</text></clause><clause id="idE5682538C8214432A0A410033F6F00CB"><enum>(ix)</enum><text>Indian Tribes or tribal organizations.</text></clause></subparagraph></paragraph><paragraph commented="no" id="id1DBDDDEF21BF41F587EC182554C074BE"><enum>(5)</enum><header>Program participant</header><text>The term <term>program participant</term> means an individual who—</text><subparagraph commented="no" id="id17B06F8D70184A9FB5A369482514559E"><enum>(A)</enum><text>is a member of a population of workers described in subsection (e)(2) that is served by a participating partnership through the pilot program under this section; and</text></subparagraph><subparagraph commented="no" id="id23BFE776915F468683BDC510CD596FC3"><enum>(B)</enum><text>enrolls with the applicable participating partnership to receive any of the services described in subsection (e)(3).</text></subparagraph></paragraph><paragraph commented="no" id="id2B4CBD4616614B1D8E941697C0EEF756"><enum>(6)</enum><header>Provider of peer recovery support services</header><text>The term <term>provider of peer recovery support services</term> means a provider that delivers peer recovery support services through an organization described in section 547(a) of the Public Health Service Act (42 U.S.C. 290ee–2(a)).</text></paragraph><paragraph id="idF88751E1BC234C9B9DA7E2F299FB5EAD"><enum>(7)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Labor.</text></paragraph><paragraph id="idC59D1C2F7CD0497C9D47EA004F0111F2"><enum>(8)</enum><header>State workforce agency</header><text>The term <term>State workforce agency</term> means the lead State agency with responsibility for the administration of a program under chapter 2 or 3 of subtitle B of title I of the Workforce Innovation and Opportunity Act (29 U.S.C. 3161 et seq., 3171 et seq.).</text></paragraph><paragraph commented="no" id="id96DFF413DC6441F795EF1F364AFE1FC1"><enum>(9)</enum><header>Substance use disorder</header><text>The term <term>substance use disorder</term> has the meaning given such term by the Assistant Secretary for Mental Health and Substance Use.</text></paragraph><paragraph id="idB714F580952B425694944D75D737E353"><enum>(10)</enum><header>Treatment provider</header><text>The term <term>treatment provider</term>—</text><subparagraph id="id6b49f24060784c9c8aef249596733409"><enum>(A)</enum><text>means a health care provider that—</text><clause id="id74678818A60F42A7824B6F2C7063E109"><enum>(i)</enum><text>offers services for treating substance use disorders and is licensed in accordance with applicable State law to provide such services; and</text></clause><clause id="id0b67210e40b44ed7bf7f408bf5570044"><enum>(ii)</enum><text>accepts health insurance for such services, including coverage under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); and</text></clause></subparagraph><subparagraph id="id6f809dff890c4618b85a722fa3456dc5"><enum>(B)</enum><text>may include—</text><clause id="id625b29fd7a5444b3a14e5777082c84b9"><enum>(i)</enum><text>a nonprofit provider of peer recovery support services;</text></clause><clause id="id72870370b6e449df86280296fe34c059"><enum>(ii)</enum><text>a community health care provider;</text></clause><clause id="id0cdb71fe67ff4395a9e7db3923c4cd10"><enum>(iii)</enum><text>a Federally qualified health center (as defined in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x));</text></clause><clause commented="no" id="idfe6f5df4e37c460cb8d8915e257dfa93"><enum>(iv)</enum><text>an Indian health program (as defined in section 3 of the Indian Health Care Improvement Act (25 U.S.C. 1603)), including an Indian health program that serves an urban center (as defined in such section); and</text></clause><clause id="id7ffa09771b9e4f8698659481e7ac7682"><enum>(v)</enum><text>a Native Hawaiian health center (as defined in section 12 of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11711)).</text></clause></subparagraph></paragraph><paragraph id="id880B04D8CB2547F896CFE6A99E247298"><enum>(11)</enum><header>Tribal entity</header><text>The term <term>Tribal entity</term> includes any Indian Tribe, tribal organization, Indian-controlled organization serving Indians, Native Hawaiian organization, or Alaska Native entity, as such terms are defined or used in section 166 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3221).</text></paragraph></subsection><subsection id="id5BCF508DD2C04A39A7476468153EB2BC"><enum>(b)</enum><header>Pilot program and grants authorized</header><paragraph id="id9624661137474F88BF6A068AAEFA122B"><enum>(1)</enum><header>In general</header><text>The Secretary, in consultation with the Secretary of Health and Human Services, shall carry out a pilot program to address economic and workforce impacts associated with a high rate of a substance use disorder. In carrying out the pilot program, the Secretary shall make grants, on a competitive basis, to eligible entities to enable such entities to make subgrants to local boards to address the economic and workforce impacts associated with a high rate of a substance use disorder.</text></paragraph><paragraph id="idA65A02495D554C74968C915273981712"><enum>(2)</enum><header>Grant amounts</header><text>The Secretary shall make each such grant in an amount that is not less than $500,000, and not more than $5,000,000, for a fiscal year.</text></paragraph></subsection><subsection id="idA4100A3979CA40E59A54A13A0B53CB7F"><enum>(c)</enum><header>Grant applications</header><paragraph id="idCA06E53CDE2549D7B08A52F604549545"><enum>(1)</enum><header>In general</header><text>An eligible entity applying for a grant under this section shall submit an application to the Secretary at such time and in such form and manner as the Secretary may reasonably require, including the information described in this subsection.</text></paragraph><paragraph id="id0AC44F51DE6C4542A120A02342B19F33"><enum>(2)</enum><header>Significant impact on community by opioid and substance use disorder-related problems</header><subparagraph id="idB65F61BCEF8541EF827A5AE801469DBA"><enum>(A)</enum><header>Demonstration</header><text>An eligible entity shall include in the application—</text><clause id="id9F0BC56EEDD64A5BAB2A71943E169E0C"><enum>(i)</enum><text>information that demonstrates significant impact on the community by problems related to opioid abuse or another substance use disorder, by—</text><subclause id="id7B23746F17DE4C188E225204DE1BB1C6"><enum>(I)</enum><text>identifying the counties, communities, regions, or local areas that have been significantly impacted and will be served through the grant (each referred to in this section as a <quote>service area</quote>); and</text></subclause><subclause id="id4B984A3D73694213B30AD0DE3C192F87"><enum>(II)</enum><text>demonstrating for each such service area, an increase equal to or greater than the national increase in such problems, between—</text><item id="id00AF82F1777F4ABFA55D1544131436E5"><enum>(aa)</enum><text>1999; and</text></item><item id="id0A5AC025330644999A96309F304BDB84"><enum>(bb)</enum><text>2016 or the latest year for which data are available; and</text></item></subclause></clause><clause id="id0D381B4B1EFF479C846F41D2337845F0"><enum>(ii)</enum><text>a description of how the eligible entity will prioritize support for significantly impacted service areas described in clause (i)(I).</text></clause></subparagraph><subparagraph id="id24234426CA12432CAD659A82318C081C"><enum>(B)</enum><header>Information</header><text>To meet the requirements described in subparagraph (A)(i)(II), the eligible entity may use information including data on—</text><clause id="id953B0235D675455F8CAFDB4FCDAA5D1A"><enum>(i)</enum><text>the incidence or prevalence of opioid abuse and other substance use disorders;</text></clause><clause id="id919A074F073C418794FB6F7F41302201"><enum>(ii)</enum><text>the age-adjusted rate of drug overdose deaths, as determined by the Director of the Centers for Disease Control and Prevention;</text></clause><clause id="id12360E4C6BFD4C9E87F06A850060605D"><enum>(iii)</enum><text>the rate of non-fatal hospitalizations related to opioid abuse or other substance use disorders;</text></clause><clause id="id5135D0A6D0C9435886120F100DE903EF"><enum>(iv)</enum><text>the number of arrests or convictions, or a relevant law enforcement statistic, that reasonably shows an increase in opioid abuse or another substance use disorder; or</text></clause><clause id="idaa0fda19ad0c46cdb06008eba54d5d49"><enum>(v)</enum><text>in the case of an eligible entity described in subsection (a)(3)(C), other alternative relevant data as determined appropriate by the Secretary.</text></clause></subparagraph><subparagraph id="id288c475f4c6b431eb66d1bf52b265e2d"><enum>(C)</enum><header>Support for state strategy</header><text>The eligible entity may include in the application information describing how the proposed services and activities are aligned with the State, outlying area, or Tribal strategy, as applicable, for addressing problems described in subparagraph (A) in specific service areas or across the State, outlying area, or Tribal land.</text></subparagraph></paragraph><paragraph id="id9D4325196BEC415FB29D68736FFCC504"><enum>(3)</enum><header>Economic and employment conditions demonstrate additional Federal support needed</header><subparagraph id="idE04BC169C44044AF9289A87A93E8B9F1"><enum>(A)</enum><header>Demonstration</header><text>An eligible entity shall include in the application information that demonstrates that a high rate of a substance use disorder has caused, or is coincident to—</text><clause id="idA2775885802C400C83EFB0A70B766136"><enum>(i)</enum><text>an economic or employment downturn in the service area; or</text></clause><clause id="ide9ef770ed0a94473b948a4163a5ad40d"><enum>(ii)</enum><text>persistent economically depressed conditions in such service area.</text></clause></subparagraph><subparagraph id="idF069FBB491984EC6A1C0FE21B0823D07"><enum>(B)</enum><header>Information</header><text>To meet the requirements of subparagraph (A), an eligible entity may use information including—</text><clause id="id79B75549EBA3476C928DF1D23DBBE7D0"><enum>(i)</enum><text>documentation of any layoff, announced future layoff, legacy industry decline, decrease in an employment or labor market participation rate, or economic impact, whether or not the result described in this clause is overtly related to a high rate of a substance use disorder;</text></clause><clause id="idB3A1338313314BC5BB3850C3A2F7AF94"><enum>(ii)</enum><text>documentation showing decreased economic activity related to, caused by, or contributing to a high rate of a substance use disorder, including a description of how the service area has been impacted, or will be impacted, by such a decrease;</text></clause><clause id="idA7490AFABC744BC0ACE94F230C4191D7"><enum>(iii)</enum><text>information on economic indicators, labor market analyses, information from public announcements, and demographic and industry data;</text></clause><clause id="id3245D4B2A56A48D3B5FD1AB88E0FB70D"><enum>(iv)</enum><text>information on rapid response activities (as defined in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102)) that have been or will be conducted, including demographic data gathered by employer or worker surveys or through other methods;</text></clause><clause id="id946DCE75BA504EBBAB7F9EDD73658AF7"><enum>(v)</enum><text>data or documentation, beyond anecdotal evidence, showing that employers face challenges filling job vacancies due to a lack of skilled workers able to pass a drug test; or</text></clause><clause id="idE5B0463805074801A469BB1363CEE923"><enum>(vi)</enum><text>any additional relevant data or information on the economy, workforce, or another aspect of the service area to support the application.</text></clause></subparagraph></paragraph></subsection><subsection id="idCAD6E17306D24055A8C4197F6C32DA17"><enum>(d)</enum><header>Subgrant authorization and application process</header><paragraph id="id57DFA75DDBF04CD0AA68ECF3EF95F8B4"><enum>(1)</enum><header>Subgrants authorized</header><subparagraph id="id6960503346024A0681420D624928C229"><enum>(A)</enum><header>In general</header><text>An eligible entity receiving a grant under subsection (b)—</text><clause id="idCC5043D8790E403EAA95AAC926BF469D"><enum>(i)</enum><text>may use not more than 5 percent of the grant funds for the administrative costs of carrying out the grant;</text></clause><clause id="idBA615C4677814B258FACE66E3193403C"><enum>(ii)</enum><text>in the case of an eligible entity described in subparagraph (A) or (B) of subsection (a)(3), shall use the remaining grant funds to make subgrants to local entities in the service area to carry out the services and activities described in subsection (e); and</text></clause><clause id="id9c113d811eec4581b3b373e8fbf05253"><enum>(iii)</enum><text>in the case of an eligible entity described in subsection (a)(3)(C), shall use the remaining grant funds to carry out the services and activities described in subsection (e).</text></clause></subparagraph><subparagraph id="ida1bd808f729d4db69b4bbba589ddad00"><enum>(B)</enum><header>Equitable distribution</header><text>In making subgrants under this subsection, an eligible entity shall ensure, to the extent practicable, the equitable distribution of subgrants, based on—</text><clause id="idee3b7b8375b44be2a9a5e9ac2b11c92f"><enum>(i)</enum><text>geography (such as urban and rural distribution); and</text></clause><clause id="idfad683b739dd4958bab8d9c65535b0b0"><enum>(ii)</enum><text>significantly impacted service areas as described in subsection (c)(2).</text></clause></subparagraph><subparagraph id="idbcb2dffb13174bcba6b4bf0d59c991fc"><enum>(C)</enum><header>Timing of subgrant funds distribution</header><text>An eligible entity making subgrants under this subsection shall disburse subgrant funds to a local board receiving a subgrant from the eligible entity by the later of—</text><clause id="id8AB7A71618CF4FFA8A41D4C0FD13396F"><enum>(i)</enum><text>the date that is 90 days after the date on which the Secretary makes the funds available to the eligible entity; or</text></clause><clause id="id90B1098C7EFF4D808C7C003FE51E51DD"><enum>(ii)</enum><text>the date that is 15 days after the date that the eligible entity makes the subgrant under subparagraph (A)(ii).</text></clause></subparagraph></paragraph><paragraph id="idD89E810E56D44263A6D777BF41DF206F"><enum>(2)</enum><header>Subgrant application</header><subparagraph id="id98AF656BA54544B48725AA5C4B5C1A8D"><enum>(A)</enum><header>In general</header><text>A local board desiring to receive a subgrant under this subsection from an eligible entity shall submit an application at such time and in such manner as the eligible entity may reasonably require, including the information described in this paragraph.</text></subparagraph><subparagraph id="id0BDC1811FD2B491284B7815D339C8F97"><enum>(B)</enum><header>Contents</header><text>Each application described in subparagraph (A) shall include—</text><clause id="idF486A73596C241BB9710058A77456294"><enum>(i)</enum><text>an analysis of the estimated performance of the local board in carrying out the proposed services and activities under the subgrant—</text><subclause id="id81F81ABBE5EF4202B63B2F6ED0252E5C"><enum>(I)</enum><text>based on—</text><item id="idFBCF00BE5551432BAD2B20D2D9D70F4E"><enum>(aa)</enum><text>primary indicators of performance described in section 116(c)(1)(A)(i) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3141(c)(1)(A)(i), to assess estimated effectiveness of the proposed services and activities, including the estimated number of individuals with a substance use disorder who may be served by the proposed services and activities;</text></item><item id="id061D2C67E6994CFDADD17D9FAA732D90"><enum>(bb)</enum><text>the record of the local board in serving individuals with a barrier to employment; and</text></item><item id="id5872D5C7FDCE4CA4A7FB09E76C856439"><enum>(cc)</enum><text>the ability of the local board to establish a participating partnership; and</text></item></subclause><subclause commented="no" id="id36A9DAC1A3D04344BAE1AB87E38E15BE"><enum>(II)</enum><text>which may include or utilize—</text><item id="id5A8C4164DD30469AA236D55C2BAE71B8"><enum>(aa)</enum><text>data from the National Center for Health Statistics of the Centers for Disease Control and Prevention;</text></item><item id="id082DB549118047D9854BEB109717FFE8"><enum>(bb)</enum><text>data from the Center for Behavioral Health Statistics and Quality of the Substance Abuse and Mental Health Services Administration;</text></item><item id="id15236CB954F44E6DB61BFDED25884A23"><enum>(cc)</enum><text>State vital statistics;</text></item><item id="id3ABDCF6A00A14BFFB4894FF4B9C3BBD7"><enum>(dd)</enum><text>municipal police department records;</text></item><item id="idA3E59C01EF0A4E28AAD50AACE4266496"><enum>(ee)</enum><text>reports from local coroners; or</text></item><item commented="no" id="id9C085BD0393E40E78A698F2FC7EB7409"><enum>(ff)</enum><text>other relevant data; and</text></item></subclause></clause><clause id="idf41a08593ba243a98460e2df2ded98f3"><enum>(ii)</enum><text>in the case of a local board proposing to serve a population described in subsection (e)(2)(B), a demonstration of the workforce shortage in the professional area to be addressed under the subgrant (which may include substance use disorder treatment and related services, non-addictive pain therapy and pain management services, mental health care treatment services, emergency response services, or mental health care), which shall include information that can demonstrate such a shortage, such as—</text><subclause id="id30a08ee73d4244a0a5a8b1d3a8c700b6"><enum>(I)</enum><text>the distance between—</text><item id="id31a6c191c8604f24a9612606dd25944b"><enum>(aa)</enum><text>communities affected by opioid abuse or another substance use disorder; and</text></item><item id="id569f19a7c8b147dea811d8a16eac566a"><enum>(bb)</enum><text>facilities or professionals offering services in the professional area; or</text></item></subclause><subclause id="id646a6550f8b843cd905c46b36b52d504"><enum>(II)</enum><text>the maximum capacity of facilities or professionals to serve individuals in an affected community, or increases in arrests related to opioid or another substance use disorder, overdose deaths, or nonfatal overdose emergencies in the community.</text></subclause></clause></subparagraph></paragraph></subsection><subsection id="id25976AFF8FA44886A25C14D6D7DFFB0C"><enum>(e)</enum><header>Subgrant services and activities</header><paragraph id="idEDF10F5F8F364B1C8BD6B9DE60BD4F42"><enum>(1)</enum><header>In general</header><text>Each local board that receives a subgrant under subsection (d) shall carry out the services and activities described in this subsection through a participating partnership.</text></paragraph><paragraph id="id49B70E1AE85340A7AA18FBCAC66EE5B1"><enum>(2)</enum><header>Selection of Population to be served</header><text>A participating partnership shall elect to provide services and activities under the subgrant to one or both of the following populations of workers:</text><subparagraph id="idD03F472F173E42BDB30503292B5FB98B"><enum>(A)</enum><text>Workers, including dislocated workers, individuals with barriers to employment, new entrants in the workforce, or incumbent workers (employed or underemployed), each of whom—</text><clause id="id38519E9B1E244078A63C37EDFB60BA99"><enum>(i)</enum><text>is directly or indirectly affected by a high rate of a substance use disorder; and</text></clause><clause id="idE377387CE7484F69B96B9C2693EF5705"><enum>(ii)</enum><text>voluntarily confirms that the worker, or a friend or family member of the worker, has a history of opioid abuse or another substance use disorder.</text></clause></subparagraph><subparagraph id="idFA0014D43993471699854A41458D1CFE"><enum>(B)</enum><text>Workers, including dislocated workers, individuals with barriers to employment, new entrants in the workforce, or incumbent workers (employed or underemployed), who—</text><clause id="id5DA3B2EF1B7643C0AA16EAAA9462EDA7"><enum>(i)</enum><text>seek to transition to professions that support individuals with a substance use disorder or at risk for developing such disorder, such as professions that provide—</text><subclause id="idBECDC3B657DB47E3B7B2AE486121467C"><enum>(I)</enum><text>substance use disorder treatment and related services;</text></subclause><subclause id="id63B2229C226D4D98A70992DA8BA6E5DE"><enum>(II)</enum><text>services offered through providers of peer recovery support services;</text></subclause><subclause id="id6B217588C12A4C84A99548EC37CA6162"><enum>(III)</enum><text>non-addictive pain therapy and pain management services;</text></subclause><subclause id="idA073F168CA3C48C19321AB2A282186FD"><enum>(IV)</enum><text>emergency response services; or</text></subclause><subclause id="idCB8C54D9FAB14F909187C8C2968727F7"><enum>(V)</enum><text>mental health care; and</text></subclause></clause><clause id="idA8CF2FF349F24505A45901D400AA6011"><enum>(ii)</enum><text>need new or upgraded skills to better serve such a population of struggling or at-risk individuals.</text></clause></subparagraph></paragraph><paragraph id="id5302CA69D4ED4F1E85687A55FD66276C"><enum>(3)</enum><header>Services and activities</header><text>Each participating partnership shall use funds available through a subgrant under this subsection to carry out 1 or more of the following:</text><subparagraph id="id366DD1B6BD564E869D521F351A342CF3"><enum>(A)</enum><header>Engaging employers</header><text>Engaging with employers to—</text><clause id="idB7DF6ADA82254ED3922551F29F4C96B8"><enum>(i)</enum><text>learn about the skill and hiring requirements of employers;</text></clause><clause id="id3BDAAF851E8F44A481D5A919E7DC53CC"><enum>(ii)</enum><text>learn about the support needed by employers to hire and retain program participants, and other individuals with a substance use disorder, and the support needed by such employers to obtain their commitment to testing creative solutions to employing program participants and such individuals;</text></clause><clause id="idF094B327FE2247DEAC32C301250644DE"><enum>(iii)</enum><text>connect employers and workers to on-the-job or customized training programs before or after layoff to help facilitate reemployment;</text></clause><clause id="id3F6EACF718DF4F688D5EA1A4902263BA"><enum>(iv)</enum><text>connect employers with an education provider to develop classroom instruction to complement on-the-job learning for program participants and such individuals;</text></clause><clause id="idB03A94CF6DA0485A858CAD832D9DE94B"><enum>(v)</enum><text>help employers develop the curriculum design of a work-based learning program for program participants and such individuals;</text></clause><clause id="id6F0E45D13E424D8AA9309E2397387868"><enum>(vi)</enum><text>help employers employ program participants or such individuals engaging in a work-based learning program for a transitional period before hiring such a program participant or individual for full-time employment of not less than 30 hours a week; or</text></clause><clause id="idfec82b7260d940439de26d52d50c1065"><enum>(vii)</enum><text>connect employers to program participants receiving concurrent outpatient treatment and job training services.</text></clause></subparagraph><subparagraph id="idA12D0086059A40B4AFB9763FE10E7D0D"><enum>(B)</enum><header>Screening services</header><text>Providing screening services, which may include—</text><clause id="id4051D3FF50144A18A7E21618D1557F28"><enum>(i)</enum><text>using an evidence-based screening method to screen each individual seeking participation in the pilot program to determine whether the individual has a substance use disorder;</text></clause><clause id="idE87E082FBFBF4584A6EE71D666255EDE"><enum>(ii)</enum><text>conducting an assessment of each such individual to determine the services needed for such individual to obtain or retain employment, including an assessment of strengths and general work readiness; or</text></clause><clause id="idB1F07A098E094A8DA94C8FEED9D7CE32"><enum>(iii)</enum><text>accepting walk-ins or referrals from employers, labor organizations, or other entities recommending individuals to participate in such program.</text></clause></subparagraph><subparagraph id="id11139E365FCD4F48AC34A6EBF57E5662"><enum>(C)</enum><header>Individual treatment and employment plan</header><text>Developing an individual treatment and employment plan for each program participant—</text><clause id="idFDBD1DE9B47B4A2495F8456E7C2918D4"><enum>(i)</enum><text>in coordination, as appropriate, with other programs serving the participant such as the core programs within the workforce development system under the Workforce Innovation and Opportunity Act (29 U.S.C. 3101 et seq.); and</text></clause><clause id="id870FB3253064449EA47C2D26DBC7EAEE"><enum>(ii)</enum><text>which shall include providing a case manager to work with each participant to develop the plan, which may include—</text><subclause id="idD8999840E39241E09DE93302D1288E79"><enum>(I)</enum><text>identifying employment and career goals;</text></subclause><subclause commented="no" id="id83348C505899443C8ED6177D1DAB2D25"><enum>(II)</enum><text>exploring career pathways that lead to in-demand industries and sectors, as determined by the State board and the head of the State workforce agency or, as applicable, the Tribal entity;</text></subclause><subclause id="id2D04EF75F9C4416084E0611F46BBD782"><enum>(III)</enum><text>setting appropriate achievement objectives to attain the employment and career goals identified under subclause (I); or</text></subclause><subclause id="id77CE6952115A406BBD5C6704014A1D34"><enum>(IV)</enum><text>developing the appropriate combination of services to enable the participant to achieve the employment and career goals identified under subclause (I).</text></subclause></clause></subparagraph><subparagraph id="id156E034854024A748592EC8F6F7D74D9"><enum>(D)</enum><header>Outpatient treatment and recovery care</header><text>In the case of a participating partnership serving program participants described in paragraph (2)(A) with a substance use disorder, providing individualized and group outpatient treatment and recovery services for such program participants that are offered during the day and evening, and on weekends. Such treatment and recovery services—</text><clause id="id8FA4E73BA25C433DAB43943E96D247E9"><enum>(i)</enum><text>shall be based on a model that utilizes combined behavioral interventions and other evidence-based or evidence-informed interventions; and</text></clause><clause id="id3B2FF39701A54B349F81ED8D72D05647"><enum>(ii)</enum><text>may include additional services such as—</text><subclause id="id6E55F5F302A443419F4C1492C5D7C31A"><enum>(I)</enum><text>health, mental health, addiction, or other forms of outpatient treatment that may impact a substance use disorder and co-occurring conditions;</text></subclause><subclause id="id1BD612CD202A409AB70E80E66AE1404C"><enum>(II)</enum><text>drug testing for a current substance use disorder prior to enrollment in career or training services or prior to employment;</text></subclause><subclause id="id972EA08D77074EDBBDCD6DE23E5DD294"><enum>(III)</enum><text>linkages to community services, including services offered by partner organizations designed to support program participants; or</text></subclause><subclause id="id6C2389898DB34F7C923A93DFCD1A79DD"><enum>(IV)</enum><text>referrals to health care, including referrals to substance use disorder treatment and mental health services.</text></subclause></clause></subparagraph><subparagraph id="id849FD7BB7629445895C62E17A3381684"><enum>(E)</enum><header>Supportive services</header><text>Providing supportive services, which shall include services such as—</text><clause id="id2FFF19FA433640DA949B385242DBACDD"><enum>(i)</enum><text>coordinated wraparound services to provide maximum support for program participants to assist the program participants in maintaining employment and recovery for not less than 12 months, as appropriate;</text></clause><clause id="id334E2AC4B1964E3F96390092D42050EC"><enum>(ii)</enum><text>assistance in establishing eligibility for assistance under Federal, State, Tribal, and local programs providing health services, mental health services, vocational services, housing services, transportation services, social services, or services through early childhood education programs (as defined in section 103 of the Higher Education Act of 1965 (20 U.S.C. 1003));</text></clause><clause id="id0ED27AF8969F407BBCE3727BCD9D001F"><enum>(iii)</enum><text>services offered through providers of peer recovery support services;</text></clause><clause id="id7B2C4ADE4774483CAB17CB5E8A3675CA"><enum>(iv)</enum><text>networking and mentorship opportunities; or</text></clause><clause id="id3E5EDFEED273468EB879F2EDE358D6C5"><enum>(v)</enum><text>any supportive services determined necessary by the local board.</text></clause></subparagraph><subparagraph id="id47CB4C42A2794F378F558CD92AC7DCE3"><enum>(F)</enum><header>Career and job training services</header><text>Offering career services and training services, and related services, concurrently or sequentially with the services provided under subparagraphs (B) through (E). Such services shall include the following:</text><clause id="id49E1D9C7EFF943DC8ED63DAA035DA6FC"><enum>(i)</enum><text>Services provided to program participants who are in a pre-employment stage of the program, which may include—</text><subclause id="idC184AC37CCF8413D8DD68FA6A89C439E"><enum>(I)</enum><text>initial education and skills assessments;</text></subclause><subclause id="idD96FA692C7E74348814E3FCF794FA46B"><enum>(II)</enum><text>traditional classroom training funded through individual training accounts under chapter 3 of subtitle B of title I of the Workforce Innovation and Opportunity Act (29 U.S.C. 3171 et seq.);</text></subclause><subclause id="id54A18F3E13B84322889B4C8496CB113E"><enum>(III)</enum><text>services to promote employability skills such as punctuality, personal maintenance skills, and professional conduct;</text></subclause><subclause id="id2346219B4A8A4E2C8446317BDBB991C3"><enum>(IV)</enum><text>in-depth interviewing and evaluation to identify employment barriers and to develop individual employment plans;</text></subclause><subclause id="id9FE226D3589748898C061FE5DE90FC95"><enum>(V)</enum><text>career planning that includes—</text><item id="idED7D418DFB0B4776995208948D93A846"><enum>(aa)</enum><text>career pathways leading to in-demand, high-wage jobs; and</text></item><item id="idDE9898E02A234B5CB08802DE5D046D17"><enum>(bb)</enum><text>job coaching, job matching, and job placement services;</text></item></subclause><subclause id="idD24B47D22E71478C9AE9050AD3E205C5"><enum>(VI)</enum><text>provision of payments and fees for employment and training-related applications, tests, and certifications; or</text></subclause><subclause id="id4D32DCAB08A74A87B47D63F457EA28EB"><enum>(VII)</enum><text>any other appropriate career service or training service described in section 134(c) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3174(c)).</text></subclause></clause><clause id="idADD411D142E44447996C97328BE1C693"><enum>(ii)</enum><text>Services provided to program participants during their first 6 months of employment to ensure job retention, which may include—</text><subclause id="id1F6F1CEC0959436D8743FDF1056E1E75"><enum>(I)</enum><text>case management and support services, including a continuation of the services described in clause (i);</text></subclause><subclause id="id91E105760AEE4F42A6F1412286A7C062"><enum>(II)</enum><text>a continuation of skills training, and career and technical education, described in clause (i) that is conducted in collaboration with the employers of such participants;</text></subclause><subclause id="idB14E9EA255914EC7AC9A40F8043D51EC"><enum>(III)</enum><text>mentorship services and job retention support for such participants; or</text></subclause><subclause id="id1A8EAF59F6494EEFB712CD77F97A9B2B"><enum>(IV)</enum><text>targeted training for managers and workers working with such participants (such as mentors), and human resource representatives in the business in which such participants are employed.</text></subclause></clause><clause id="id198320492FB34E0D91986004DEF7FB5F"><enum>(iii)</enum><text>Services to assist program participants in maintaining employment for not less than 12 months, as appropriate.</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id3EEF19A57257479BB0E761D918C30CC0"><enum>(G)</enum><header display-inline="yes-display-inline">Proven and promising practices</header><text display-inline="yes-display-inline">Leading efforts in the service area to identify and promote proven and promising strategies and initiatives for meeting the needs of employers and program participants.</text></subparagraph></paragraph><paragraph id="id7DEA86F4BD374941BD2257E2253C3B62"><enum>(4)</enum><header>Limitations</header><text>A participating partnership may not use—</text><subparagraph id="idFB90EE7B1B1B4AD49953EFBDEAEA8695"><enum>(A)</enum><text>more than 10 percent of the funds received under a subgrant under subsection (d) for the administrative costs of the partnership;</text></subparagraph><subparagraph id="id42BA2E63E0F44BE0A9F4266CB3953259"><enum>(B)</enum><text>more than 10 percent of the funds received under such subgrant for the provision of treatment and recovery services, as described in paragraph (3)(D); and</text></subparagraph><subparagraph id="idF3D486CE92664D38BEFF2B2AF46BA693"><enum>(C)</enum><text>more than 10 percent of the funds received under such subgrant for the provision of supportive services described in paragraph (3)(E) to program participants.</text></subparagraph></paragraph></subsection><subsection id="id9B01897B07574275B2D31C7B0C42E9C7"><enum>(f)</enum><header>Performance accountability</header><paragraph id="id0D043463EDB5462986E46D56AF55DF5C"><enum>(1)</enum><header>Reports</header><text>The Secretary shall establish quarterly reporting requirements for recipients of grants and subgrants under this section that, to the extent practicable, are based on the performance accountability system under section 116 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3141) and, in the case of a grant awarded to an eligible entity described in subsection (a)(3)(C), section 166(h) of such Act (29 U.S.C. 3221(h)), including the indicators described in subsection (c)(1)(A)(i) of such section 116 and the requirements for local area performance reports under subsection (d) of such section 116.</text></paragraph><paragraph id="id2E098EA7BBF647C6B83D2F87C88D15AA"><enum>(2)</enum><header>Evaluations</header><subparagraph id="idCC7FAF30C9A74AE1A8D6701D3A928C6C"><enum>(A)</enum><header>Authority to enter into agreements</header><text>The Secretary shall ensure that an independent evaluation is conducted on the pilot program carried out under this section to determine the impact of the program on employment of individuals with substance use disorders. The Secretary shall enter into an agreement with eligible entities receiving grants under this section to pay for all or part of such evaluation.</text></subparagraph><subparagraph id="id9B42B1EAE9304D5B91639E92CE0EAD59"><enum>(B)</enum><header>Methodologies to be used</header><text>The independent evaluation required under this paragraph shall use experimental designs using random assignment or, when random assignment is not feasible, other reliable, evidence-based research methodologies that allow for the strongest possible causal inferences.</text></subparagraph></paragraph></subsection><subsection id="idD78EBA070D59484C97CF37CA08B1792F"><enum>(g)</enum><header>Funding</header><paragraph id="id91E29CB8F13E4E76A35106AAE328FE94"><enum>(1)</enum><header>Covered fiscal year</header><text>In this subsection, the term <term>covered fiscal year</term> means any of fiscal years 2018 through 2023.</text></paragraph><paragraph id="id06F84D2CA9AF4BC487217921EADAC279"><enum>(2)</enum><header>Using funding for national dislocated worker grants</header><text>Subject to paragraph (4) and notwithstanding section 132(a)(2)(A) and subtitle D of the Workforce Innovation and Opportunity Act (29 U.S.C. 3172(a)(2)(A), 3221 et seq.), the Secretary may use, to carry out the pilot program under this section for a covered fiscal year—</text><subparagraph id="id2CA21A1D8EA54A53B1D906D01B330311"><enum>(A)</enum><text>funds made available to carry out section 170 of such Act (29 U.S.C. 3225) for that fiscal year;</text></subparagraph><subparagraph id="idF859929E502B47F7858A75A3D7A5D36D"><enum>(B)</enum><text>funds made available to carry out section 170 of such Act that remain available for that fiscal year; and</text></subparagraph><subparagraph id="idCFAD22E146CA4A909C871F3283EA1C5E"><enum>(C)</enum><text>funds that remain available under section 172(f) of such Act (29 U.S.C. 3227(f)).</text></subparagraph></paragraph><paragraph id="id2E7021DE24184AE1880FC1E32550E993"><enum>(3)</enum><header>Availability of funds</header><text>Funds appropriated under section 136(c) of such Act (29 U.S.C. 3181(c)) and made available to carry out section 170 of such Act for a fiscal year shall remain available for use under paragraph (2) for a subsequent fiscal year until expended.</text></paragraph><paragraph id="id9D848644BE2B4C85AE71584DB4969A5B"><enum>(4)</enum><header>Limitation</header><text>The Secretary may not use more than $100,000,000 of the funds described in paragraph (2) for any covered fiscal year under this section.</text></paragraph></subsection></section><section id="id433AD342E12D470FA7018B5D8CF60ABE"><enum>1411.</enum><header>Career Act</header><subsection id="idd47b4e072e1d4516a0e90dee86e4c7c5"><enum>(a)</enum><header>In general</header><text>The Secretary, in consultation with the Secretary of Labor, shall continue or establish a program to support individuals in recovery from a substance use disorder transition to independent living and the workforce.</text></subsection><subsection id="iddd70e8da6ffa4cc5b68a923e7cef2f70"><enum>(b)</enum><header>Grants authorized</header><text>In carrying out the activities under this section, the Secretary shall, on a competitive basis, award grants for a period of not more than 5 years to entities to enable such entities to carry out evidence-based programs to help individuals in recovery from a substance use disorder transition from treatment to independent living and the workforce. Such entities shall coordinate, as applicable, with Indian tribes or tribal organizations (as applicable), State boards and local boards (as defined in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102), lead State agencies with responsibility for a workforce investment activity (as defined in such section 3), and State agencies responsible for carrying out substance use disorder prevention and treatment programs.</text></subsection><subsection id="id033e38193503457d8a9acb7a2ff3b584"><enum>(c)</enum><header>Priority</header><text>In awarding grants under this section, the Secretary shall give priority to entities located in a State with—</text><paragraph id="id4284f7975f28436f93317d035f04bef7"><enum>(1)</enum><text>an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, as determined by the Director of the Centers for Disease Control and Prevention;</text></paragraph><paragraph id="id4ff528cbe83841de93daf2579abfbb62"><enum>(2)</enum><text>a rate of unemployment, based on data provided by the Bureau of Labor Statistics for calendar years 2013 through 2017, that is above the national average; and</text></paragraph><paragraph id="id69c9f50a8b0d42f5aafb06b0e2848519"><enum>(3)</enum><text>a rate of labor force participation, based on data provided by the Bureau of Labor Statistics for calendar years 2013 through 2017, that is below the national average.</text></paragraph></subsection><subsection id="id3d145c991a6b4e57922ba77aec33c117"><enum>(d)</enum><header>Preference</header><text>In awarding grants under this section, the Secretary shall, as appropriate, give preference to entities located in an area with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate.</text></subsection><subsection id="id9923567f9cf34bdf9cb465c88cb2f9d7"><enum>(e)</enum><header>Applications</header><text>An eligible entity shall submit an application at such time and in such manner as the Secretary may require. In submitting an application, the entity shall demonstrate the ability to partner with local stakeholders, which may include local employers, community stakeholders, the local workforce development board, and local and State governments, to—</text><paragraph id="ideece7eea792849cface299c8cc5109df"><enum>(1)</enum><text>identify gaps in the workforce due to the prevalence of substance use disorders;</text></paragraph><paragraph id="id62dc6bb35f9346f3b723dced3848681f"><enum>(2)</enum><text>in coordination with statewide employment and training activities, including coordination and alignment of activities carried out by entities provided grant funds under section 1410, help individuals in recovery from a substance use disorder transition into the workforce, including by providing career services, training services as described in paragraph (2) of section 134(c) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3174(c)), and related services described in section 134(a)(3) of such Act (42 U.S.C. 3174(a)); and</text></paragraph><paragraph id="id8000e00c395f40b9af9195b64f72022b"><enum>(3)</enum><text>assist employers with informing their employees of the resources, such as resources related to substance use disorders that are available to their employees.</text></paragraph></subsection><subsection id="idd946385f98c44bc4aab30613f986c8ec"><enum>(f)</enum><header>Use of funds</header><text>An entity receiving a grant under this section shall use the funds to conduct one or more of the following activities:</text><paragraph id="idfb57a1d3ca6e434d8e66311d776b4e8a"><enum>(1)</enum><text>Hire case managers, care coordinators, providers of peer recovery support services, as described in section 547(a) of the Public Health Service Act (42 U.S.C. 290ee–2(a)), or other professionals, as appropriate, to provide services that support treatment, recovery, and rehabilitation, and prevent relapse, recidivism, and overdose, including by encouraging—</text><subparagraph id="ide78bb9c9210945dc8df85402d0142e27"><enum>(A)</enum><text>the development of daily living skills; and</text></subparagraph><subparagraph id="id21b9fd75c092443f88af288b0619706c"><enum>(B)</enum><text>the use of counseling, care coordination, and other services, as appropriate, to support recovery from substance use disorders.</text></subparagraph></paragraph><paragraph id="idc6beb1388cbc4bfb8e2cc6fe9db13f1e"><enum>(2)</enum><text>Implement or utilize innovative technologies, which may include the use of telemedicine.</text></paragraph><paragraph id="id1A178263796048CEAEA69E3F7C91BF0A"><enum>(3)</enum><text>In coordination with the lead State agency with responsibility for a workforce investment activity or local board described in subsection (b), provide—</text><subparagraph id="id703F3A7A506B425393B27DCAF77FBDFF"><enum>(A)</enum><text>short-term prevocational training services; and</text></subparagraph><subparagraph id="idD973A93DE141496490E21DE623009C53"><enum>(B)</enum><text>training services that are directly linked to the employment opportunities in the local area or the planning region.</text></subparagraph></paragraph></subsection><subsection id="ide2bc506e25c74f65a063596ba841a89a"><enum>(g)</enum><header>Support for State strategy</header><text>An eligible entity shall include in its application under subsection (e) information describing how the services and activities proposed in such application are aligned with the State, outlying area, or Tribal strategy, as applicable, for addressing issues described in such application and how such entity will coordinate with existing systems to deliver services as described in such application.</text></subsection><subsection id="id144738a84c504270ad5f3837c024d946"><enum>(h)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated such sums as may be necessary for each of fiscal years 2019 through 2023 for purposes of carrying out this section.</text></subsection></section><section id="id7497450c5ab44692bb9fa4831544b78d"><enum>1412.</enum><header>Pilot program to help individuals in recovery from a substance use disorder become stably housed</header><subsection id="id1fa04a10df6b48d4ac168a46e5a42252"><enum>(a)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated under this section such sums as may be necessary for each of fiscal years 2019 through 2023 for assistance to States to provide individuals in recovery from a substance use disorder stable, temporary housing for a period of not more than 2 years or until the individual secures permanent housing, whichever is earlier.</text></subsection><subsection id="idd59ecf59d0ec4395b042cfe4b5f78de9"><enum>(b)</enum><header>Allocation of appropriated amounts</header><paragraph id="id8F43F81A972E42768E7EAE4BCF40F65C"><enum>(1)</enum><header>In general</header><text>The amounts appropriated or otherwise made available to States under this section shall be allocated based on a funding formula established by the Secretary of Housing and Urban Development (referred to in this section as the <quote>Secretary</quote>) not later than 60 days after the date of enactment of this Act.</text></paragraph><paragraph id="id8287D72FF8C54045BF0E6DEA6261387E"><enum>(2)</enum><header>Criteria</header><text>The funding formula required under paragraph (1) shall ensure that any amounts appropriated or otherwise made available under this section are allocated to States with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate, according to the Centers for Disease Control and Prevention. Among such States, priority shall be given to States with the greatest need, as such need is determined by the Secretary based on—</text><subparagraph id="id6D805C83920643119CF180D4B11808D0"><enum>(A)</enum><text>the highest average rates of unemployment based on data provided by the Bureau of Labor Statistics for calendar years 2013 through 2017;</text></subparagraph><subparagraph id="idb414aaf98250488a8f4bee24fd98f533"><enum>(B)</enum><text>the lowest average labor force participation rates based on data provided by the Bureau of Labor Statistics for calendar years 2013 through 2017; and</text></subparagraph><subparagraph id="ide6426667ef124dd9bfd5f309a1245497"><enum>(C)</enum><text>the highest prevalence of opioid use disorder based on data provided by the Substance Abuse and Mental Health Services Administration for calendar years 2013 through 2017.</text></subparagraph></paragraph><paragraph id="id0a3ddb1ef1d14408b4e18511bd0113da"><enum>(3)</enum><header>Distribution</header><text>Amounts appropriated or otherwise made available under this section shall be distributed according to the funding formula established by the Secretary under paragraph (1) not later than 30 days after the establishment of such formula.</text></paragraph></subsection><subsection id="id2fa5d388bb5b4b6fbd63e3c5e9b2f5be"><enum>(c)</enum><header>Use of funds</header><paragraph id="id5169732E4BA7477F84BDEB1F9931B44D"><enum>(1)</enum><header>In general</header><text>Any State that receives amounts pursuant to this section shall expend at least 30 percent of such funds within one year of the date funds become available to the grantee for obligation.</text></paragraph><paragraph id="idEB808A3428BE41679F54CAB17C9865B2"><enum>(2)</enum><header>Priority</header><text>Any State that receives amounts pursuant to this section shall distribute such amounts giving priority to entities with the greatest need and ability to deliver effective assistance in a timely manner.</text></paragraph><paragraph id="id647003dd945845ad87c11275c61e6f8c"><enum>(3)</enum><header>Administrative costs</header><text>Any State that receives amounts pursuant to this section may use up to 5 percent of any grant for administrative costs.</text></paragraph></subsection><subsection id="id4353f49b82e44eb58a83ea87f52726de"><enum>(d)</enum><header>Rules of construction</header><paragraph id="id30A98E0251A54F11A3BDF63AF175C49A"><enum>(1)</enum><header>In general</header><text>Except as otherwise provided by this section, amounts appropriated, or amounts otherwise made available to States under this section shall be treated as though such funds were community development block grant funds under title I of the Housing and Community Development Act of 1974 (42 U.S.C. 5301 et seq.).</text></paragraph><paragraph id="idf60a2cbfd82b4a138857f10457105115"><enum>(2)</enum><header>No match</header><text>No matching funds shall be required in order for a State to receive any amounts under this section.</text></paragraph></subsection><subsection id="id7cd64a9237cf463ca6a62e5d4af09d02"><enum>(e)</enum><header>Authority to waive or specify alternative requirements</header><paragraph id="id7ABBB5BA89304FD4AE2449A2863F6BA2"><enum>(1)</enum><header>In general</header><text>In administering any amounts appropriated or otherwise made available under this section, the Secretary may waive or specify alternative requirements for any provision of any statute or regulation in connection with the obligation by the Secretary or the use of funds except for requirements related to fair housing, nondiscrimination, labor standards, and the environment, upon a finding that such a waiver is necessary to expedite or facilitate the use of such funds.</text></paragraph><paragraph id="id063eb11b578c498586c45400fea9a520"><enum>(2)</enum><header>Notice</header><text>The Secretary shall provide written notice of its intent to exercise the authority to specify alternative requirements under paragraph (1) to the Committee on Banking, Housing, and Urban Affairs of the Senate and the Committee on Financial Services of the House of Representatives not later than 5 business days before such exercise of authority occurs.</text></paragraph></subsection><subsection id="id8137e6ea704e4968801436630063cce4"><enum>(f)</enum><header>Technical assistance</header><text>For the 2-year period following the date of enactment of this Act, the Secretary may use not more than 2 percent of the funds made available under this section for technical assistance to grantees.</text></subsection><subsection id="idFB6D6CB639CF483AB309A4CE0B8E0616"><enum>(g)</enum><header>State</header><text>For purposes of this section the term <term>State</term> includes any State as defined in section 102 of the Housing and Community Development Act of 1974 (42 U.S.C. 5302) and the District of Columbia.</text></subsection></section><section id="id6223BD2F3501468995C028751C87C849"><enum>1413.</enum><header>Youth prevention and recovery</header><subsection commented="no" id="H1C97B8C8275F47CA9BCCE32DC1C00E32"><enum>(a)</enum><header> Substance abuse treatment services for children, adolescents, and young adults</header><text display-inline="yes-display-inline">Section 514 of the Public Health Service Act (42 U.S.C. 290bb–7) is amended—</text><paragraph id="H66E37256A00D41D88F59E182E3CA784A"><enum>(1)</enum><text>in the section heading, by striking <quote><header-in-text level="section" style="OLC">children and adolescents</header-in-text></quote> and inserting <quote><header-in-text level="section" style="OLC">children, adolescents, and young adults</header-in-text></quote>;</text></paragraph><paragraph id="HAD41C9F5C6674DB7AF414012DF01903F"><enum>(2)</enum><text display-inline="yes-display-inline">in subsection (a)(2), by striking <quote>children, including</quote> and inserting <quote>children, adolescents, and young adults, including</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HEAB046361D394FD5B1B4CCA192AC3694"><enum>(3)</enum><text>by striking <quote>children and adolescents</quote> each place it appears and inserting <quote>children, adolescents, and young adults</quote>.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idC3901B514CD54E59AC511B4A0CB780D5"><enum>(b)</enum><header>Resource center</header><text>The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use and, as appropriate, in consultation with the Secretary of Education and other agencies, shall establish a resource center to provide technical support to recipients of grants under subsection (c).</text></subsection><subsection commented="no" display-inline="no-display-inline" id="idCCB65CC6A9A74D7FBAE3510F236D6563"><enum>(c)</enum><header>Youth prevention and recovery initiative</header><paragraph commented="no" display-inline="no-display-inline" id="id0AC08A2D763B446D8E119AB5A46E65C0"><enum>(1)</enum><header>In general</header><text>The Secretary, in consultation with the Secretary of Education, shall administer a program to provide support for communities to support the prevention of, treatment of, and recovery from, substance use disorders for children, adolescents, and young adults.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id9A0EF083354E43138E413AA1E9132493"><enum>(2)</enum><header>Definitions</header><text>In this subsection:</text><subparagraph commented="no" display-inline="no-display-inline" id="idE0B675738CFE456FA087006E6E9AF0DC"><enum>(A)</enum><header>Eligible entity</header><text>The term <term>eligible entity</term> means—</text><clause commented="no" display-inline="no-display-inline" id="id21864EDDCE88454594161D7D3429DBB6"><enum>(i)</enum><text>a local educational agency that is seeking to establish or expand substance use prevention or recovery support services at one or more high schools;</text></clause><clause commented="no" display-inline="no-display-inline" id="id1363B315276947E0AA23A0CEC4EEEDA1"><enum>(ii)</enum><text>a State educational agency;</text></clause><clause commented="no" display-inline="no-display-inline" id="id3585E0D7D46F4E588AA1DF571B2355DC"><enum>(iii)</enum><text>an institution of higher education (or consortia of such institutions), which may include a recovery program at an institution of higher education;</text></clause><clause commented="no" display-inline="no-display-inline" id="idA2006B70CB864EC3900F94C6B9B2B3B8"><enum>(iv)</enum><text>a local board or one-stop operator;</text></clause><clause commented="no" display-inline="no-display-inline" id="id6DEF2BD19C82480CA0B1806A02C0A5F8"><enum>(v)</enum><text>a nonprofit organization with appropriate expertise in providing services or programs for children, adolescents, or young adults, excluding a school;</text></clause><clause commented="no" display-inline="no-display-inline" id="id864D3F5C08F547BA9C6813BAE502ACDD"><enum>(vi)</enum><text>a State, political subdivision of a State, Indian Tribe, or tribal organization; or</text></clause><clause commented="no" display-inline="no-display-inline" id="id40011D7F30114B2E977A7C0BD68A0922"><enum>(vii)</enum><text>a high school or dormitory serving high school students that receives funding from the Bureau of Indian Education.</text></clause></subparagraph><subparagraph id="id61f67a0e410a4cb2aa182b8ab1f01b76"><enum>(B)</enum><header>Evidence-based</header><text>The term <term>evidence-based</term> has the meaning given such term in section 8101 of the Elementary and Secondary Education Act (20 U.S.C. 7801).</text></subparagraph><subparagraph id="id3997141288CE438591F4D6576710E6F1"><enum>(C)</enum><header>Foster care</header><text>The term <term>foster care</term> has the meaning given such term in section 1355.20(a) of title 45, Code of Federal Regulations (or any successor regulations).</text></subparagraph><subparagraph id="id04620be64ece409e8e7f61297cbd3a80"><enum>(D)</enum><header>High school</header><text>The term <term>high school</term> has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).</text></subparagraph><subparagraph id="id97b345b248fd49abbd7c3b7f67cd7c17"><enum>(E)</enum><header>Homeless youth</header><text>The term <term>homeless youth</term> has the meaning given the term <quote>homeless children or youths</quote> in section 725 of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11434a);</text></subparagraph><subparagraph id="idc60b847fabc1425ab1b9b107240026b7"><enum>(F)</enum><header>Institution of higher education</header><text>The term <term>institution of higher education</term> has the meaning given such term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001) and includes a <quote>postsecondary vocational institution</quote> as defined in section 102(c) of such Act (20 U.S.C. 1002(c)).</text></subparagraph><subparagraph id="idf2ccee8ea8fc4a40b94ef79716f39de2"><enum>(G)</enum><header>Local educational agency</header><text>The term <term>local educational agency</term> has the meaning given the term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).</text></subparagraph><subparagraph id="id97c65dab373e4f1dbdd481e0f30c4bc0"><enum>(H)</enum><header>Local board; one-stop operator</header><text>The terms <term>local board</term> and <term>one-stop operator</term> have the meanings given such terms in section 3 of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102).</text></subparagraph><subparagraph id="id22d85aa6d9d44fa892c45187855f51da"><enum>(I)</enum><header>Out of School Youth</header><text>The term <term>out-of-school youth</term> has the meaning given such term in section 129(a)(1)(B) of the Workforce Innovation and Opportunity Act (29 U.S.C. 3164(a)(1)(B)).</text></subparagraph><subparagraph id="id7bdba12b3c05445f823aa8b677d95496"><enum>(J)</enum><header>Recovery program</header><text>The term <term>recovery program</term> means a program—</text><clause id="id6d9b9760c29c4ab8b5ebf6c2f78701f6"><enum>(i)</enum><text>to help children, adolescents, or young adults who are recovering from substance use disorders to initiate, stabilize, and maintain healthy and productive lives in the community; and</text></clause><clause id="id652418c1b1a24b91811b210bbea73f19"><enum>(ii)</enum><text>that includes peer-to-peer support delivered by individuals with lived experience in recovery, and communal activities to build recovery skills and supportive social networks.</text></clause></subparagraph><subparagraph id="id15d121ca04274784a7ef6892827262fc"><enum>(K)</enum><header>State Educational Agency</header><text>The term <term>State educational agency</term> has the meaning given the term in section 8101 of the Elementary and Secondary Education Act (20 U.S.C. 7801).</text></subparagraph></paragraph><paragraph id="idA3E5526071094AEF9CF0302B494F804B"><enum>(3)</enum><header>Best practices</header><text>The Secretary, in consultation with the Secretary of Education, shall—</text><subparagraph id="id6E4C7839A9C74C27B92189331CEDB107"><enum>(A)</enum><text>identify or facilitate the development of evidence-based best practices for prevention of substance misuse and abuse by children, adolescents, and young adults, including for specific populations such as youth in foster care, homeless youth, out-of-school youth, and youth who are at risk of or have experienced trafficking that address—</text><clause id="id1E704C91EA6F4562807DE2A2AD204B49"><enum>(i)</enum><text>primary prevention;</text></clause><clause id="id6565AC3E282D45AF98E5755B57C0508B"><enum>(ii)</enum><text>appropriate recovery support services;</text></clause><clause id="idF088B8300B484FA29E6C8B53AA11FB51"><enum>(iii)</enum><text>appropriate use of medication-assisted treatment for such individuals, if applicable, and ways of overcoming barriers to the use of medication-assisted treatment in such population; and</text></clause><clause id="id4C1D21599D3847ED8A40C5039F440F58"><enum>(iv)</enum><text>efficient and effective communication, which may include the use of social media, to maximize outreach efforts;</text></clause></subparagraph><subparagraph id="idCEC849C2D1D6448D826D43E478EB513F"><enum>(B)</enum><text>disseminate such best practices to State educational agencies, local educational agencies, schools and dormitories funded by the Bureau of Indian Education, institutions of higher education, recovery programs at institutions of higher education, local boards, one-stop operators, family and youth homeless providers, and nonprofit organizations, as appropriate;</text></subparagraph><subparagraph id="idA256E96365314BAD882A76C04C4642C3"><enum>(C)</enum><text>conduct a rigorous evaluation of each grant funded under this subsection, particularly its impact on the indicators described in paragraph (8)(B); and</text></subparagraph><subparagraph id="id07DD024EEEF5475DAC2E92E161272A40"><enum>(D)</enum><text>provide technical assistance for grantees under this subsection.</text></subparagraph></paragraph><paragraph id="idee92879b4ce34965825fa720f41c62c3"><enum>(4)</enum><header>Grants authorized</header><text>The Secretary, in consultation with the Secretary of Education, shall award 3-year grants, on a competitive basis, to eligible entities to enable such entities, in coordination with Indian Tribes, if applicable, and State agencies responsible for carrying out substance use disorder prevention and treatment programs, to carry out evidence-based programs for—</text><subparagraph id="id718032fd9cb84bf0938c58710dbf52b0"><enum>(A)</enum><text>prevention of substance misuse and abuse by children, adolescents, and young adults, which may include primary prevention;</text></subparagraph><subparagraph id="id3476851cbe3d4277b17aab7502fdb585"><enum>(B)</enum><text>recovery support services for children, adolescents, and young adults, which may include counseling, job training, linkages to community-based services, family support groups, peer mentoring, and recovery coaching; or</text></subparagraph><subparagraph id="id25fe5502913c41afa7ff07cbe9b57ad8"><enum>(C)</enum><text>treatment or referrals for treatment of substance use disorders, which may include the use of medication-assisted treatment, as appropriate.</text></subparagraph></paragraph><paragraph id="id8c0f1b477d96485e98035a00f1cfb6ad"><enum>(5)</enum><header>Special consideration</header><text>In awarding grants under this subsection, the Secretary shall give special consideration to the unique needs of tribal, urban, suburban, and rural populations.</text></paragraph><paragraph id="id4eb1acb8492f4a62976ef428611a2b6f"><enum>(6)</enum><header>Application</header><text>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. Such application shall include—</text><subparagraph id="id650b03c3d2d34b52a7c623fc6f6320c4"><enum>(A)</enum><text>a description of—</text><clause id="idB6D5DD97439745588A754F9193D26F53"><enum>(i)</enum><text>the impact of substance use disorders in the population that will be served by the grant program;</text></clause><clause id="id79135d8245b540ad88c529d489cd9f77"><enum>(ii)</enum><text>how the eligible entity has solicited input from relevant stakeholders, which may include faculty, teachers, staff, families, students, and experts in substance use prevention and treatment in developing such application;</text></clause><clause id="id3F774A8B4D16475D834FAD9E9BA0FE7F"><enum>(iii)</enum><text>the goals of the proposed project, including the intended outcomes;</text></clause><clause id="id66FF5CCF932047E788F01DC7D2690B80"><enum>(iv)</enum><text>how the eligible entity plans to use grant funds for evidence-based activities, in accordance with this subsection to prevent, provide recovery support for, or treat substance use disorders amongst such individuals, or a combination of such activities; and</text></clause><clause id="id426463eccd3e4b8d85417ab4cfaaf12f"><enum>(v)</enum><text>how the eligible entity will collaborate with relevant partners, which may include State educational agencies, local educational agencies, institutions of higher education, juvenile justice agencies, prevention and recovery support providers, local service providers, including substance use disorder treatment programs, providers of mental health services, youth serving organizations, family and youth homeless providers, child welfare agencies, and primary care providers, in carrying out the grant program; and</text></clause></subparagraph><subparagraph id="id3CC1659BD41547CFA7FA9EC756859972"><enum>(B)</enum><text>an assurance that the eligible entity will participate in the evaluation described in paragraph (3)(C).</text></subparagraph></paragraph><paragraph id="id9b0f63ee14b14b8f9caa69a21ac929b4"><enum>(7)</enum><header>Priority</header><text>In awarding grants under this subsection, the Secretary shall give priority to eligible entities that propose to use grant funds for activities that meet the criteria described in subclauses (I) and (II) of section 8101(21)(A)(i) of the Elementary and Secondary Education Act (20 U.S.C. 7801(21)(A)(i)).</text></paragraph><paragraph id="id1f866fc6c8a24b86ac1d43dd01b6819f"><enum>(8)</enum><header>Reports to the Secretary</header><text>Each eligible entity awarded a grant under this subsection shall submit to the Secretary a report at such time and in such manner as the Secretary may require. Such report shall include—</text><subparagraph id="id361c7101a58d49a6b757d59942e5cf97"><enum>(A)</enum><text>a description of how the eligible entity used grant funds, in accordance with this subsection, including the number of children, adolescents, and young adults reached through programming; and</text></subparagraph><subparagraph id="id17e35b9e4956496eb6e852ff8a5a1bcf"><enum>(B)</enum><text>a description, including relevant data, of how the grant program has made an impact on the intended outcomes described in paragraph (6)(A)(iii), including—</text><clause id="id087dd94d36fb471b8d31274f2bbbb3f9"><enum>(i)</enum><text>indicators of student success, which, if the eligible entity is an educational institution, shall include student well-being and academic achievement;</text></clause><clause id="id9a3e2ac85ce24498be6b15546250b689"><enum>(ii)</enum><text>substance use disorders amongst children, adolescents, and young adults, including the number of overdoses and deaths amongst children, adolescents, and young adults during the grant period; and</text></clause><clause id="idA29DA1889DEB46C7A7BB349240426DFE"><enum>(iii)</enum><text>other indicators, as the Secretary determines appropriate.</text></clause></subparagraph></paragraph><paragraph id="id589550FD32C54E4FB2CF1241AE7C8640"><enum>(9)</enum><header>Report to Congress</header><text>The Secretary shall, not later than October 1, 2022, submit a report to the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce and the Committee on Education and the Workforce of the House of Representatives, a report summarizing the effectiveness of the grant program under this subsection, based on the information submitted in reports required under paragraph (8).</text></paragraph><paragraph id="idf497a6fd6f144025a12a1fd5cd4470c1"><enum>(10)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated such sums as may be necessary to carry out this subsection for each of fiscal years 2019 through 2023.</text></paragraph></subsection></section><section id="id2e5ee1a6b645412ebde410105f2259b7"><enum>1414.</enum><header>Plans of safe care</header><text display-inline="no-display-inline">Section 105(a) of the Child Abuse Prevention and Treatment Act (42 U.S.C. 5106(a)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id1e80ccdaae7b46ada28a8a541893e925" style="OLC"><paragraph id="id2196B23870CD4192BB32E821CEFD4E4A"><enum>(7)</enum><header>Grants to States to improve and coordinate their response to ensure the safety, permanency, and well-being of infants affected by substance use</header><subparagraph id="id36bc6d4bd1dd467aa4ec455f90b3e58b"><enum>(A)</enum><header>Program authorized</header><text>The Secretary shall make grants to States for the purpose of assisting child welfare agencies, social services agencies, substance use disorder treatment agencies, hospitals with labor and delivery units, medical staff, public health and mental health agencies, and maternal and child health agencies to facilitate collaboration in developing, updating, implementing, and monitoring plans of safe care described in section 106(b)(2)(B)(iii).</text></subparagraph><subparagraph id="id50100c73d8e64cd2935b51d66aada74c"><enum>(B)</enum><header>Distribution of funds</header><clause id="ideea730aa12af409b937ef06cadf4b29f"><enum>(i)</enum><header>Reservations</header><text>Of the amounts appropriated under subparagraph (H), the Secretary shall reserve—</text><subclause id="id912C1554AFE140C9A1A9F916FF0D56CF"><enum>(I)</enum><text>no more than 3 percent for the purposes described in subparagraph (G); and</text></subclause><subclause id="id1C9844550D424BA796440735D56BFD1F"><enum>(II)</enum><text>up to 3 percent for grants to Indian Tribes and tribal organizations to address the needs of infants born with, and identified as being affected by, substance abuse or withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder and their families or caregivers, which to the extent practicable, shall be consistent with the uses of funds described under subparagraph (D).</text></subclause></clause><clause id="id65c70c225f36426096540908c9a57d33"><enum>(ii)</enum><header>Allotments to States and territories</header><text>The Secretary shall allot the amount appropriated under subparagraph (H) that remains after application of clause (i) to each State that applies for such a grant, in an amount equal to the sum of—</text><subclause id="idda87802a91cb4efdb8d027651e7be2be"><enum>(I)</enum><text>$500,000; and</text></subclause><subclause id="id48d930a741a04aeaa08326c8cb804688"><enum>(II)</enum><text>an amount that bears the same relationship to any funds appropriated under subparagraph (H) and remaining after application of clause (i), as the number of live births in the State in the previous calendar year bears to the number of live births in all States in such year.</text></subclause></clause><clause id="ida3b0658921bf4cb69f003655a7db5dda"><enum>(iii)</enum><header>Ratable reduction</header><text>If the amount appropriated under subparagraph (H) is insufficient to satisfy the requirements of clause (ii), the Secretary shall ratably reduce each allotment to a State.</text></clause></subparagraph><subparagraph id="id8b5ef5c4d1f64fdc964f353ef7848db9"><enum>(C)</enum><header>Application</header><text>A State desiring a grant under this paragraph shall submit an application to the Secretary at such time and in such manner as the Secretary may require. Such application shall include—</text><clause id="id1edba0394f1c49d487cd6a47c9863706"><enum>(i)</enum><text>a description of—</text><subclause id="id8C6BB55480A64A31AC5EF013CC87F995"><enum>(I)</enum><text>the impact of substance use disorder in such State, including with respect to the substance or class of substances with the highest incidence of abuse in the previous year in such State, including—</text><item id="id727B2EB990C84540ADF745EFCDAAD790"><enum>(aa)</enum><text>the prevalence of substance use disorder in such State;</text></item><item commented="no" id="id216232E08B0947A8AE33AA4C452AE956"><enum>(bb)</enum><text>the aggregate rate of births in the State of infants affected by substance abuse or withdrawal symptoms or a fetal alcohol spectrum disorder (as determined by hospitals, insurance claims, claims submitted to the State Medicaid program, or other records), if available and to the extent practicable; and</text></item><item commented="no" id="id2BE90B587B464856AAEC91E71B162FCF"><enum>(cc)</enum><text>the number of infants identified, for whom a plan of safe care was developed, and for whom a referral was made for appropriate services, as reported under section 106(d)(18);</text></item></subclause><subclause id="id8437352ccb7c46b9bc71c158e522f5b9"><enum>(II)</enum><text>the challenges the State faces in developing, implementing, and monitoring plans of safe care in accordance with section 106(b)(2)(B)(iii);</text></subclause><subclause id="id531a59878b27469d9c0df970e5ddb1cc"><enum>(III)</enum><text>the State’s lead agency for the grant program and how that agency will coordinate with relevant State entities and programs, including the child welfare agency, the substance use disorder treatment agency, hospitals with labor and delivery units, health care providers, the public health and mental health agencies, programs funded by the Substance Abuse and Mental Health Services Administration that provide substance use disorder treatment for women, the State Medicaid program, the State agency administering the block grant program under title V of the Social Security Act (42 U.S.C. 701 et seq.), the State agency administering the programs funded under part C of the Individuals with Disabilities Education Act (20 U.S.C. 1431 et seq.), the maternal, infant, and early childhood home visiting program under section 511 of the Social Security Act (42 U.S.C. 711), the State judicial system, and other agencies, as determined by the Secretary, and Indian Tribes and tribal organizations, as appropriate;</text></subclause><subclause id="id979d7d8f6ad24fdaa42652ad42dee24a"><enum>(IV)</enum><text>how the State will monitor local development and implementation of plans of safe care, in accordance with section 106(b)(2)(B)(iii)(II), including how the State will monitor to ensure plans of safe care address differences between substance use disorder and medically supervised substance use, including for the treatment of a substance use disorder;</text></subclause><subclause id="idded360e12a9042ecb81fc94d6e8bb354"><enum>(V)</enum><text>how the State meets the requirements of section 1927 of the Public Health Service Act (42 U.S.C. 300x–27);</text></subclause><subclause id="id4721BECA60564674AC7809307DA7156B"><enum>(VI)</enum><text>how the State plans to utilize funding authorized under part E of title IV of the Social Security Act (42 U.S.C. 670 et seq.) to assist in carrying out any plan of safe care, including such funding authorized under section 471(e) of such Act (as in effect on October 1, 2018) for mental health and substance abuse prevention and treatment services and in-home parent skill-based programs and funding authorized under such section 472(j) (as in effect on October 1, 2018) for children with a parent in a licensed residential family-based treatment facility for substance abuse; and</text></subclause><subclause id="idBE98B5DF75404A009BC6C920FEA8BA08"><enum>(VII)</enum><text>an assessment of the treatment and other services and programs available in the State, to effectively carry out any plan of safe care developed, including identification of needed treatment, and other services and programs to ensure the well-being of young children and their families affected by substance use disorder, such as programs carried out under part C of the Individuals with Disabilities Education Act and comprehensive early childhood development services and programs such as Head Start programs;</text></subclause></clause><clause id="ide008b7d682734c94825b20c32d29f702"><enum>(ii)</enum><text>a description of how the State plans to use funds for activities described in subparagraph (D) for the purposes of ensuring State compliance with requirements under clauses (ii) and (iii) of section 106(b)(2)(B); and</text></clause><clause id="id82db32e5464a41ca8c564018b2f4b0aa"><enum>(iii)</enum><text>an assurance that the State will—</text><subclause id="id0e9486d208bc4b2f8190a78d9d217917"><enum>(I)</enum><text>comply with this Act and parts B and E of title IV of the Social Security Act (42 U.S.C. 621 et seq., 670 et seq.); and</text></subclause><subclause id="iddba991dc341d49e6a2bec2bfd04b8ad1"><enum>(II)</enum><text>comply with requirements to refer a child identified as substance-exposed to early intervention services as required pursuant to a grant under part C of the Individuals with Disabilities Education Act (20 U.S.C. 1431 et seq.).</text></subclause></clause></subparagraph><subparagraph id="idb11f54671bab4fc7b3f2b87a83c95526"><enum>(D)</enum><header>Uses of funds</header><text>Funds awarded to a State under this paragraph may be used for the following activities, which may be carried out by the State directly, or through grants or subgrants, contracts, or cooperative agreements:</text><clause id="id9b8713ff905349f1af7b298bfb5768c6"><enum>(i)</enum><text>Improving State and local systems with respect to the development and implementation of plans of safe care, which—</text><subclause id="id9A7E0E11C12E4F82A7C7C4ED11CDBCBB"><enum>(I)</enum><text>shall include parent and caregiver engagement, as required under section 106(b)(2)(B)(iii)(I), regarding available treatment and service options, which may include resources available for pregnant, perinatal, and postnatal women; and</text></subclause><subclause id="idB92D3BD229D84F20B74D4C6E6D39FC11"><enum>(II)</enum><text>may include activities such as—</text><item id="idDA0B8B0943BE4D4C9E065CE98425145B"><enum>(aa)</enum><text>developing policies, procedures, or protocols for the administration or development of evidence-based and validated screening tools for infants who may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder and pregnant, perinatal, and postnatal women whose infants may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder;</text></item><item id="id990EF3902B0F46A5A078AF38905CBEA4"><enum>(bb)</enum><text>improving assessments used to determine the needs of the infant and family;</text></item><item id="id84E862D42E624D8E940FF6E14CC57A1F"><enum>(cc)</enum><text>improving ongoing case management services; and</text></item><item id="idC75778DD2E354D7DA799C97A8CDDAFE4"><enum>(dd)</enum><text>improving access to treatment services, which may be prior to the pregnant woman’s delivery date.</text></item></subclause></clause><clause id="id1bfa6405d0874266838feeb0cef50ac7"><enum>(ii)</enum><text>Developing policies, procedures, or protocols in consultation and coordination with health professionals, public and private health facilities, and substance use disorder treatment agencies to ensure that—</text><subclause id="id6AE0992ABA5C40C780D1D92CC6640700"><enum>(I)</enum><text>appropriate notification to child protective services is made in a timely manner;</text></subclause><subclause id="idCD2871BAED3D4167AC7144DC4BC2AF03"><enum>(II)</enum><text>a plan of safe care is in place, in accordance with section 106(b)(2)(B)(iii), before the infant is discharged from the birth or health care facility; and</text></subclause><subclause id="idA02DBDC71A2849F4A193C03E61AA1106"><enum>(III)</enum><text>such health and related agency professionals are trained on how to follow such protocols and are aware of the supports that may be provided under a plan of safe care.</text></subclause></clause><clause id="idb780e3cb16b84354b29ae0c42803e852"><enum>(iii)</enum><text>Training health professionals and health system leaders, child welfare workers, substance use disorder treatment agencies, and other related professionals such as home visiting agency staff and law enforcement in relevant topics including—</text><subclause id="id4632209F20394E2DB47F5C695E72E9BB"><enum>(I)</enum><text>State mandatory reporting laws and the referral and process requirements for notification to child protective services when child abuse or neglect reporting is not mandated;</text></subclause><subclause id="idA91DA8B864C34574A0621B8940868616"><enum>(II)</enum><text>the co-occurrence of pregnancy and substance use disorder, and implications of prenatal exposure;</text></subclause><subclause id="idAD79DF513E2D446DB9B6ED716C89B6A4"><enum>(III)</enum><text>the clinical guidance about treating substance use disorder in pregnant and postpartum women;</text></subclause><subclause id="id07D3DECFFA9D4D22B4E1E63628F4A379"><enum>(IV)</enum><text>appropriate screening and interventions for infants affected by substance use disorder, withdrawal symptoms, or a fetal alcohol spectrum disorder and the requirements under section 106(b)(2)(B)(iii); and</text></subclause><subclause commented="no" id="id14B1201AB6F7403B9D85E638A06D291A"><enum>(V)</enum><text>appropriate multigenerational strategies to address the mental health needs of the parent and child together.</text></subclause></clause><clause id="ida3a4080476e64a62afc412dbd1209218"><enum>(iv)</enum><text>Establishing partnerships, agreements, or memoranda of understanding between the lead agency and health professionals, health facilities, child welfare professionals, juvenile and family court judges, substance use and mental disorder treatment programs, early childhood education programs, and maternal and child health and early intervention professionals, including home visiting providers, peer-to-peer recovery programs such as parent mentoring programs, and housing agencies to facilitate the implementation of, and compliance with section 106(b)(2) and clause (ii) of this subparagraph, in areas which may include—</text><subclause id="idC4BF5CE96F79493384FEF9F26361227B"><enum>(I)</enum><text>developing a comprehensive, multi-disciplinary assessment and intervention process for infants, pregnant women, and their families who are affected by substance use disorder, withdrawal symptoms, or a fetal alcohol spectrum disorder, that includes meaningful engagement with and takes into account the unique needs of each family and addresses differences between medically supervised substance use, including for the treatment of substance use disorder, and substance use disorder;</text></subclause><subclause id="id319400cf977c4e5db3b299431ef3b141"><enum>(II)</enum><text>ensuring that treatment approaches for serving infants, pregnant women, and perinatal and postnatal women whose infants may be affected by substance use, withdrawal symptoms, or a fetal alcohol spectrum disorder, are designed to, where appropriate, keep infants with their mothers during both inpatient and outpatient treatment; and</text></subclause><subclause id="id0589E49CD24141EEA19F4213A35E722A"><enum>(III)</enum><text>increasing access to all evidence-based medication-assisted treatment approved by the Food and Drug Administration, behavioral therapy, and counseling services for the treatment of substance use disorders, as appropriate.</text></subclause></clause><clause id="idf941db6ce9464a1081dee82dc72e55d7"><enum>(v)</enum><text>Developing and updating systems of technology for improved data collection and monitoring under section 106(b)(2)(B)(iii), including existing electronic medical records, to measure the outcomes achieved through the plans of safe care, including monitoring systems to meet the requirements of this Act and submission of performance measures.</text></clause></subparagraph><subparagraph id="id48f7be6743eb46d5b0a962e2a70c929c"><enum>(E)</enum><header>Reporting</header><text>Each State that receives funds under this paragraph, for each year such funds are received, shall submit a report to the Secretary, disaggregated by geographic location, economic status, and major racial and ethnic groups, except that such disaggregation shall not be required if the results would reveal personally identifiable information on, with respect to infants identified under section 106(b)(2)(B)(ii)—</text><clause id="idB2E7727E0A7C4CDFB3B049B02C3BCAF1"><enum>(i)</enum><text>the number who experienced removal associated with parental substance use;</text></clause><clause id="id10B441EA08DC4C93B4EF9E06344E708C"><enum>(ii)</enum><text>the number who experienced removal and subsequently are reunified with parents, and the length of time between such removal and reunification;</text></clause><clause id="idE872F34074CB401185995ABFCEE81DAF"><enum>(iii)</enum><text>the number who are referred to community providers without a child protection case;</text></clause><clause id="id1E713A6B04354D88953EB0BC96419422"><enum>(iv)</enum><text>the number who receive services while in the care of their birth parents;</text></clause><clause id="idC4E3709D1EB44FF99DDAD5D0223D1987"><enum>(v)</enum><text>the number who receive post-reunification services within 1 year after a reunification has occurred; and</text></clause><clause id="id8bcfa6c19c334dd8b59e64fe8433dc0a"><enum>(vi)</enum><text>the number who experienced a return to out-of-home care within 1 year after reunification.</text></clause></subparagraph><subparagraph id="id20035ea1206841b9a9fbe985398ac2eb"><enum>(F)</enum><header>Secretary’s report to congress</header><text>The Secretary shall submit an annual report to the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate and the Committee on Education and the Workforce and the Committee on Appropriations of the House of Representatives that includes the information described in subparagraph (E) and recommendations or observations on the challenges, successes, and lessons derived from implementation of the grant program.</text></subparagraph><subparagraph id="idb30383a2af294beabd3d26e87268dc8c"><enum>(G)</enum><header>Reservation of funds</header><text>The Secretary shall use the amount reserved under subparagraph (B)(i)(I) for the purposes of—</text><clause id="id44afb4c4206042aab31dcc60cf1f0424"><enum>(i)</enum><text>providing technical assistance, including programs of in-depth technical assistance, to additional States, territories, and Indian Tribes and tribal organizations in accordance with the substance-exposed infant initiative developed by the National Center on Substance Abuse and Child Welfare;</text></clause><clause id="iddfc2dfa5c45f4d39ab93dbeea30f8852"><enum>(ii)</enum><text>issuing guidance on the requirements of this Act with respect to infants born with and identified as being affected by substance use or withdrawal symptoms or fetal alcohol spectrum disorder, as described in clauses (ii) and (iii) of section 106(b)(2)(B), including by—</text><subclause id="idc78453c272a140d688d578ce3a4bc4bd"><enum>(I)</enum><text>clarifying key terms; and</text></subclause><subclause id="idc82a5bfb680349f8a44b3a1b77512c68"><enum>(II)</enum><text>disseminating best practices on implementation of plans of safe care, on such topics as differential response, collaboration and coordination, and identification and delivery of services for different populations;</text></subclause></clause><clause id="id5b4cc2889c6d492791db82fd8ce081e8"><enum>(iii)</enum><text>supporting State efforts to develop information technology systems to manage plans of safe care; and</text></clause><clause id="id39636d96d7374cd2b93bcfd9cd5c61c2"><enum>(iv)</enum><text>preparing the Secretary’s report to Congress described in subparagraph (F).</text></clause></subparagraph><subparagraph id="idbdfd31af58474c37aec597f228da411d"><enum>(H)</enum><header>Authorization of appropriations</header><text>To carry out the program under this paragraph, there is authorized to be appropriated $60,000,000 for each of fiscal years 2019 through 2023.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="HF0174FC92A164CB8AC59D999436B841A"><enum>1415.</enum><header>Regulations relating to special registration for telemedicine</header><text display-inline="no-display-inline">Section 311(h) of the Controlled Substances Act (21 U.S.C. 831(h)) is amended by striking paragraph (2) and inserting the following:</text><quoted-block display-inline="no-display-inline" id="id27492D4BED0E4EF995FEB235FBF92B52" style="traditional"><paragraph id="id3F16D56B498A4BE9AE0282534A880E13"><enum>(2)</enum><header>Regulations</header><subparagraph id="idA5912326E3164F28BCC62FC23662510B"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of the <short-title>Opioid Crisis Response Act of 2018</short-title>, in consultation with the Secretary, and in accordance with the procedure described in subparagraph (B), the Attorney General shall promulgate final regulations specifying—</text><clause id="idBE7D015303C646219A995DE2105F1985"><enum>(i)</enum><text display-inline="yes-display-inline">the limited circumstances in which a special registration under this subsection may be issued; and</text></clause><clause id="id210D8165D7A04F00B37EB088034D741B"><enum>(ii)</enum><text display-inline="yes-display-inline">the procedure for obtaining a special registration under this subsection.</text></clause></subparagraph><subparagraph id="idA7D4899B64E548A19605EE68D54529D1"><enum>(B)</enum><header>Procedure</header><text>In promulgating final regulations under subparagraph (A), the Attorney General shall—</text><clause id="ide5669ffa8bea400893bf217b6fe5500e"><enum>(i)</enum><text>issue a notice of proposed rulemaking that includes a copy of the proposed regulations;</text></clause><clause id="id5CA7348487C641FDA0F2448719A83B3D"><enum>(ii)</enum><text>provide a period of not less than 60 days for comments on the proposed regulations;</text></clause><clause id="id68fe7d527b594726b10f88e190290076"><enum>(iii)</enum><text>finalize the proposed regulation not later than 6 months after the close of the comment period; and</text></clause><clause id="idCA424FEB1FB34C2DAAF9C68AD9747A14"><enum>(iv)</enum><text>publish the final regulations not later than 30 days before the effective date of the final regulations.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id109E27CF78EA48E1803DD441AF0A32EF"><enum>1416.</enum><header>National Health Service Corps behavioral and mental health professionals providing obligated service in schools and other community-based settings</header><text display-inline="no-display-inline">Subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254<italic>l </italic>et seq.) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idAB214DD0E4E343039841578FDD92544B" style="OLC"><section id="id9C4CC340BF054E7AB76D700C2ECBEFBA"><enum>338N.</enum><header>Behavioral and mental health professionals providing obligated service in schools and other community-based settings</header><subsection id="idE0CE9AD68CDF40918FC4604ABDE3658A"><enum>(a)</enum><header>Schools and community-based settings</header><text>An entity to which a participant in the Scholarship Program or the Loan Repayment Program (referred to in this section as a <quote>participant</quote>) is assigned under section 333 may direct such participant to provide service as a behavioral or mental health professional at a school or other community-based setting located in a health professional shortage area.</text></subsection><subsection id="idCA98BF2325EB4A8E9FA83E1C2011835F"><enum>(b)</enum><header>Obligated service</header><paragraph id="id6668C24A5BE34732BC64BAA0C9823263"><enum>(1)</enum><header>In general</header><text>Any service described in subsection (a) that a participant provides may count towards such participant's completion of any obligated service requirements under the Scholarship Program or the Loan Repayment Program, subject to any limitation imposed under paragraph (2).</text></paragraph><paragraph id="id06154EB07F484BC1BA7197C0BE17EADC"><enum>(2)</enum><header>Limitation</header><text>The Secretary may impose a limitation on the number of hours of service described in subsection (a) that a participant may credit towards completing obligated service requirements, provided that the limitation allows a member to credit service described in subsection (a) for not less than 50 percent of the total hours required to complete such obligated service requirements.</text></paragraph></subsection><subsection id="idE7E0A6710F4E46C09BC45E7B5E2B401E"><enum>(c)</enum><header>Rule of construction</header><text>The authorization under subsection (a) shall be notwithstanding any other provision of this subpart or subpart II.</text></subsection></section><after-quoted-block>. </after-quoted-block></quoted-block></section><section id="idEB95B6AF95DF40FE93ACBD43B7664967"><enum>1417.</enum><header>Loan repayment for substance use disorder treatment providers</header><subsection id="idBB61BA16655C48B79D378E548652514E"><enum>(a)</enum><header>Loan repayment for substance use treatment providers</header><text display-inline="yes-display-inline">The Secretary shall enter into contracts under section 338B of the Public Health Service Act (42 U.S.C. 254l–1) with eligible health professionals providing substance use disorder treatment services in substance use disorder treatment facilities, as defined by the Secretary.</text></subsection><subsection id="id408ea1925ce54b9fa11f701d0601c0c6"><enum>(b)</enum><header>Provision of substance use disorder treatment</header><text>In carrying out the activities described in subsection (a)—</text><paragraph id="idad4d4f3c6f114902bc9384a2c6cc35d8"><enum>(1)</enum><text>each such facility shall be located in or serving a mental health professional shortage area designated under section 332 of the Public Health Service Act (42 U.S.C. 254e), or, as the Secretary determines appropriate, an area with an age-adjusted rate of drug overdose deaths that is above the national overdose mortality rate;</text></paragraph><paragraph id="id29eb0c7ecf9242dfb765620a0e426cd3"><enum>(2)</enum><text>section 331(a)(3)(D) of such Act (42 U.S.C. 254d(a)(3)(D)) shall be applied as if the term <term>primary health services</term> includes health services regarding substance use disorder treatment and infections associated with illicit drug use;</text></paragraph><paragraph id="id103647a89d5746a7aadb763f2642ea89"><enum>(3)</enum><text>section 331(a)(3)(E)(i) of such Act (42 U.S.C. 254d(a)(3)(E)(i)) shall be applied as if the term <term>behavioral and mental health professionals</term> includes master's level, licensed substance use disorder treatment counselors, and other relevant professionals or paraprofessionals, as the Secretary determines appropriate; and</text></paragraph><paragraph id="id8c777771d59b46ff8bebfa6361058973"><enum>(4)</enum><text>such professionals and facilities shall provide—</text><subparagraph id="idbcd9f5de08b14c13920cd9314d456f99"><enum>(A)</enum><text>directly, or through the use of telehealth technology, and pursuant to Federal and State law, counseling by a program counselor or other certified professional who is licensed and qualified by education, training, or experience to assess the psychological and sociological background of patients, to contribute to the appropriate treatment plan for the patient, and to monitor progress; and</text></subparagraph><subparagraph id="id02cd27d7d36b4983a2ed77956ebae762"><enum>(B)</enum><text>medication-assisted treatment, including, to the extent practicable, all drugs approved by the Food and Drug Administration to treat substance use disorders, pursuant to Federal and State law.</text></subparagraph></paragraph></subsection><subsection id="id2f93f7b40f5044a1a8bade5230d08ede"><enum>(c)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section $25,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section><section id="ida8ac151fab1c49b0b8da63c1a53775b3"><enum>1418.</enum><header>Protecting moms and infants</header><subsection id="idE1137AB2AE7B4C9DAEB1999FF8AB68F1"><enum>(a)</enum><header>Report</header><paragraph id="idBB4283B65BB249ACAAFE8DFB47B2D3AD"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 60 days after the date of enactment of this Act, the Secretary shall submit to the appropriate committees of Congress and make available to the public on the internet website of the Department of Health and Human Services a report regarding the implementation of the recommendations in the strategy relating to prenatal opioid use, including neonatal abstinence syndrome, developed pursuant to section 2 of the Protecting Our Infants Act of 2015 (Public Law 114–91). Such report shall include—</text><subparagraph id="id83E13A46627F41E1840CE741964EC8EE"><enum>(A)</enum><text display-inline="yes-display-inline">an update on the implementation of the recommendations in the strategy, including information regarding the agencies involved in the implementation; and</text></subparagraph><subparagraph id="id4748EBB6B0284A43BF436BD021B8D2CE"><enum>(B)</enum><text display-inline="yes-display-inline">information on additional funding or authority the Secretary requires, if any, to implement the strategy, which may include authorities needed to coordinate implementation of such strategy across the Department of Health and Human Services.</text></subparagraph></paragraph><paragraph id="id9066E8883183450B867935C715A73252"><enum>(2)</enum><header>Periodic updates</header><text>The Secretary shall periodically update the report under paragraph (1).</text></paragraph></subsection><subsection id="id61D05BCCEC05493F9E442B5788629FC3"><enum>(b)</enum><header>Residential treatment programs for pregnant and postpartum women</header><text display-inline="yes-display-inline">Section 508(s) of the Public Health Service Act (42 U.S.C. 290bb–1(s)) is amended by striking <quote>$16,900,000 for each of fiscal years 2017 through 2021</quote> and inserting <quote>$29,931,000 for each of fiscal years 2019 through 2023</quote>.</text></subsection></section><section id="HF7C77631D62345AE81384E9E0790136F"><enum>1419.</enum><header>Early interventions for pregnant women and infants</header><subsection id="HC5313C29C89A43BAA48F14AF75277247"><enum>(a)</enum><header>Development of educational materials by Center for Substance Abuse Prevention</header><text display-inline="yes-display-inline">Section 515(b) of the Public Health Service Act (42 U.S.C. 290bb–21(b)) is amended—</text><paragraph id="H7AD6AFA28A144743B595D2D93DC83837"><enum>(1)</enum><text>in paragraph (13), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H7CC4DDC559D5431C87404316D60513D5"><enum>(2)</enum><text>in paragraph (14), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph id="H502B0D06439B452F8B444C8589A06023"><enum>(3)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="H260F86A1F2D84B3FA596396C4D653EBB" style="OLC"><paragraph id="HFA3019BECFAB4CA8867CFEB2944217D5"><enum>(15)</enum><text display-inline="yes-display-inline">in cooperation with relevant stakeholders and the Director of the Centers for Disease Control and Prevention, develop educational materials for clinicians to use with pregnant women for shared decisionmaking regarding pain management during pregnancy.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="HB4F6C53ADFA24AF2931EF758425215CF"><enum>(b)</enum><header>Guidelines and recommendations by Center for Substance Abuse Treatment</header><text>Section 507(b) of the Public Health Service Act (42 U.S.C. 290bb(b)) is amended—</text><paragraph id="HED667F5AD0DB4564B628331546157906"><enum>(1)</enum><text>in paragraph (13), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H529CAAFBF5BB4A8682C0CE83AD870DD1"><enum>(2)</enum><text>in paragraph (14), by striking the period at the end and inserting a semicolon; and</text></paragraph><paragraph id="H216280156E684EC8BB4038A8372B0692"><enum>(3)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="HEBBCA86701204DA9B785B518ECDBF704" style="OLC"><paragraph id="H13BDDE4E1FBA49CDA21F5AC1EB376528"><enum>(15)</enum><text display-inline="yes-display-inline">in cooperation with the Secretary, implement and disseminate, as appropriate, the recommendations in the report entitled <quote>Protecting Our Infants Act: Final Strategy</quote> issued by the Department of Health and Human Services in 2017; and</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="HC287CFA4C19B445EA58A6B5BF92D1390"><enum>(c)</enum><header>Support of partnerships by Center for Substance Abuse Treatment</header><text>Section 507(b) of the Public Health Service Act (42 U.S.C. 290bb(b)), as amended by subsection (b), is further amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="H60C2D8D841B34D1C8F2E099A087E8EB1" style="OLC"><paragraph id="HAA480A255437495396257AFF81D10512"><enum>(16)</enum><text display-inline="yes-display-inline">in cooperation with relevant stakeholders, support public-private partnerships to assist with education about, and support with respect to, substance use disorder for pregnant women and health care providers who treat pregnant women and babies.</text></paragraph><after-quoted-block>. </after-quoted-block></quoted-block></subsection></section><section id="id0AFAE36D062E4D85B0886BAB8D75006D"><enum>1420.</enum><header>Report on investigations regarding parity in mental health and substance use disorder benefits</header><subsection id="id015B651770614FC8977C4C45FFD15180"><enum>(a)</enum><header>In general</header><text>Section 13003 of the 21st Century Cures Act (Public Law 114–255) is amended—</text><paragraph id="id8F2AA462E08F40F988827A7DEB8BB1E0"><enum>(1)</enum><text>in subsection (a), by striking <quote>with findings of any serious violation regarding</quote> and inserting <quote>concerning</quote>; and</text></paragraph><paragraph id="id051389EA3C514F76A0B1D1393B7F8ACF"><enum>(2)</enum><text>in subsection (b)(1)—</text><subparagraph id="idB7941A2E441346FA89595EDB5F67D91D"><enum>(A)</enum><text>by inserting <quote>complaints received and number of</quote> before <quote>closed</quote>; and</text></subparagraph><subparagraph id="idEC260E9C1E764B76981E336C2B0A5165"><enum>(B)</enum><text>by inserting before the period <quote>, and, for each such investigation closed, which agency conducted the investigation, whether the health plan that is the subject of the investigation is fully insured or not fully insured and a summary of any coordination between the applicable State regulators and the Department of Labor, the Department of Health and Human Services, or the Department of the Treasury, and references to any guidance provided by the agencies addressing the category of violation committed</quote>.</text></subparagraph></paragraph></subsection><subsection id="id9F5FE18BC17949998ECDF527785D2915"><enum>(b)</enum><header>Applicability</header><text>The amendments made by subsection (a) shall apply with respect to the second annual report required under such section 13003 and each such annual report thereafter.</text></subsection></section></subtitle><subtitle id="id2992F1C7577C4BF89320631A9F059863"><enum>E</enum><header>Prevention</header><section id="idA382B0BD730849A08967C8A02B9B5EF0"><enum>1501.</enum><header>Study on prescribing limits</header><text display-inline="no-display-inline">Not later than 2 years after the date of enactment of this Act, the Secretary, in consultation with the Attorney General, shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report on the impact of Federal and State laws and regulations that limit the length, quantity, or dosage of opioid prescriptions. Such report shall address—</text><paragraph id="idBE97E5B1983D445CB0BE81DCFE59484A"><enum>(1)</enum><text display-inline="yes-display-inline">the impact of such limits on—</text><subparagraph id="idCB7B9A7ACD154789AB9C2C731AA12ABF"><enum>(A)</enum><text display-inline="yes-display-inline">the incidence and prevalence of overdose related to prescription opioids;</text></subparagraph><subparagraph id="id68397a49c7174125bcd4fb0bb0bdc108"><enum>(B)</enum><text>the incidence and prevalence of overdose related to illicit opioids;</text></subparagraph><subparagraph id="id9F125D56B1BE4871BA74CBD8AC1961C8"><enum>(C)</enum><text>the prevalence of opioid use disorders;</text></subparagraph><subparagraph id="id797334C915B0411983590E98E3859EEC"><enum>(D)</enum><text>medically appropriate use of, and access to, opioids, including any impact on travel expenses and pain management outcomes for patients, whether such limits are associated with significantly higher rates of negative health outcomes, including suicide, and whether the impact of such limits differs based on the clinical indication for which opioids are prescribed;</text></subparagraph></paragraph><paragraph id="id647C352F08604490B8CF89B54173AE21"><enum>(2)</enum><text>whether such limits lead to a significant increase in burden for prescribers of opioids or prescribers of treatments for opioid use disorder, including any impact on patient access to treatment, and whether any such burden is mitigated by any factors such as electronic prescribing or telemedicine; and</text></paragraph><paragraph id="idC7B47C5FC97D405DA415DE91837367E1"><enum>(3)</enum><text>the impact of such limits on diversion or misuse of any controlled substance in schedule II, III, or IV of section 202(c) of the Controlled Substances Act (21 U.S.C. 812(c)).</text></paragraph></section><section id="id056A5A345D00420188CE4EA6A5FA2D55"><enum>1502.</enum><header>Programs for health care workforce</header><subsection id="id3C5EA240E1E74BD8A00A322B43FE7FC4"><enum>(a)</enum><header>Program for education and training in pain care</header><text display-inline="yes-display-inline">Section 759 of the Public Health Service Act (42 U.S.C. 294i) is amended—</text><paragraph id="idf4a89a0a0f5e40119ef1680ee77c067e"><enum>(1)</enum><text>in subsection (a), by striking <quote>hospices, and other public and private entities</quote> and inserting <quote>hospices, tribal health programs (as defined in section 4 of the Indian Health Care Improvement Act), and other public and nonprofit private entities</quote>;</text></paragraph><paragraph id="id3DE92BC2C9464944AF868575F2119CD4"><enum>(2)</enum><text>in subsection (b)—</text><subparagraph id="id4B0567D6A6DF44A684DB6A340BA44843"><enum>(A)</enum><text>in the matter preceding paragraph (1), by striking <quote>award may be made under subsection (a) only if the applicant for the award agrees that the program carried out with the award will include</quote> and inserting <quote>entity receiving an award under this section shall develop a comprehensive education and training plan that includes</quote>;</text></subparagraph><subparagraph id="id8C8067385E34434CBC79D9A702CEEB31"><enum>(B)</enum><text>in paragraph (1)—</text><clause id="id93D768F2D64742A2BEC926BCBB9A0A75"><enum>(i)</enum><text>by inserting <quote>preventing,</quote> after <quote>diagnosing,</quote>; and</text></clause><clause id="idCD5710397E544621B233A6AB1EAB0940"><enum>(ii)</enum><text>by inserting <quote>non-addictive medical products and non-pharmacologic treatments and</quote> after <quote>including</quote>;</text></clause></subparagraph><subparagraph id="idB7D34816D75D47BB87B5A2F6CE3CA48E"><enum>(C)</enum><text>in paragraph (2)—</text><clause id="idB41943FC417E479196F36CC23680E6FA"><enum>(i)</enum><text>by inserting <quote>Federal, State, and local</quote> after <quote>applicable</quote>; and</text></clause><clause id="id9E95DABC1ECD40BCAE6F5E27832F65EF"><enum>(ii)</enum><text>by striking <quote>the degree to which</quote> and all that follows through <quote>effective pain care</quote> and inserting <quote>opioids</quote>;</text></clause></subparagraph><subparagraph id="id6B8235C2478341D2A815D47B5F4605B3"><enum>(D)</enum><text>in paragraph (3), by inserting <quote>, integrated, evidence-based pain management, and, as appropriate, non-pharmacotherapy</quote> before the semicolon;</text></subparagraph><subparagraph id="idF885B4A757DB4584A9C2B370C13E1D8C"><enum>(E)</enum><text>in paragraph (4), by striking <quote>; and</quote> and inserting <quote>;</quote>; and</text></subparagraph><subparagraph id="id027450BDC6B94B65871AE503F6ACF259"><enum>(F)</enum><text>by striking paragraph (5) and inserting the following:</text><quoted-block display-inline="no-display-inline" id="id245E7364912C40E7A6405D6B15C44D58" style="OLC"><paragraph id="idFDDA8B7A4E4C46ABA1B92B8E511B806D"><enum>(5)</enum><text>recent findings, developments, and advancements in pain care research and the provision of pain care, which may include non-addictive medical products and non-pharmacologic treatments intended to treat pain; and</text></paragraph><paragraph id="idF8B9260A85844421B5779944624C2DD2"><enum>(6)</enum><text>the dangers of opioid abuse and misuse, detection of early warning signs of opioid use disorders (which may include best practices related to screening for opioid use disorders, training on screening, brief intervention, and referral to treatment), and safe disposal options for prescription medications (including such options provided by law enforcement or other innovative deactivation mechanisms).</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id2AB67E29C06F49BD8C4196FD6B6DFF18"><enum>(3)</enum><text>in subsection (d), by inserting <quote>prevention,</quote> after <quote>diagnosis,</quote>; and</text></paragraph><paragraph id="id0FD7933D6302418B91F02F67A1DA837E"><enum>(4)</enum><text>in subsection (e), by striking <quote>2010 through 2012</quote> and inserting <quote>2019 through 2023</quote>.</text></paragraph></subsection><subsection id="id5ae40742e3e54bf29da55b6c333e4051"><enum>(b)</enum><header>Mental and behavioral health education and training program</header><text>Section 756(a) of the Public Health Service Act (42 U.S.C. 294e–1(a)) is amended—</text><paragraph id="id90ab590ec70f42388357c7f49e634e1a"><enum>(1)</enum><text>in paragraph (1), by inserting <quote>, trauma,</quote> after <quote>focus on child and adolescent mental health</quote>; and</text></paragraph><paragraph id="idea93bd2edbc3404ebf1aea9dd1d80fe2"><enum>(2)</enum><text>in paragraphs (2) and (3), by inserting <quote>trauma-informed care and</quote> before <quote>substance use disorder prevention and treatment services</quote>.</text></paragraph></subsection></section><section id="id52C8DE82A10A4C52AE2BF631C8F93205"><enum>1503.</enum><header>Education and awareness campaigns</header><text display-inline="no-display-inline">Section 102 of the Comprehensive Addiction and Recovery Act of 2016 (Public Law 114–198) is amended—</text><paragraph id="id4D445A22FCB446BC8575AAE9CB9D766A"><enum>(1)</enum><text>by amending subsection (a) to read as follows:</text><quoted-block display-inline="no-display-inline" id="id60A808BC929D45DB910E99FC64512206" style="OLC"><subsection id="id36A477D771314B40ACDED60CD2CB28A3"><enum>(a)</enum><header>In general</header><text>The Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention and in coordination with the heads of other departments and agencies, shall advance education and awareness regarding the risks related to misuse and abuse of opioids, as appropriate, which may include developing or improving existing programs, conducting activities, and awarding grants that advance the education and awareness of—</text><paragraph id="idA6D0E8DF1C80485191D2FEF399F3BD37"><enum>(1)</enum><text>the public, including patients and consumers;</text></paragraph><paragraph id="id9B94C783D29E466F932DCF2FED7B5EBB"><enum>(2)</enum><text>patients, consumers, and other appropriate members of the public, regarding such risks related to unused opioids and the dispensing options under section 309(f) of the Controlled Substances Act, as applicable;</text></paragraph><paragraph id="id80C9AC54422F48D88620B1177D6DEEA8"><enum>(3)</enum><text>providers, which may include—</text><subparagraph id="id9B8F63E8AA714073BB9B471D2625E049"><enum>(A)</enum><text>providing for continuing education on appropriate prescribing practices;</text></subparagraph><subparagraph id="id5F9429A3E3434A42A0AC919F9407EEE0"><enum>(B)</enum><text>education related to applicable State or local prescriber limit laws, information on the use of non-addictive alternatives for pain management, and the use of overdose reversal drugs, as appropriate;</text></subparagraph><subparagraph id="id079513AEB26A48C0941118F17FB12A3A"><enum>(C)</enum><text>disseminating and improving the use of evidence-based opioid prescribing guidelines across relevant health care settings, as appropriate, and updating guidelines as necessary;</text></subparagraph><subparagraph id="id3F5926473D8041AFAD7F250024A354BE"><enum>(D)</enum><text>implementing strategies, such as best practices, to encourage and facilitate the use of prescriber guidelines, in accordance with State and local law;</text></subparagraph><subparagraph id="id665E475F1A614E5181ED2D20D6AA9C9B"><enum>(E)</enum><text>disseminating information to providers about prescribing options for controlled substances, including such options under section 309(f) of the Controlled Substances Act, as applicable; and</text></subparagraph><subparagraph id="idE8BBB8B8A39F429087FDC0BC7B2B120A"><enum>(F)</enum><text>disseminating information, as appropriate, on the National Pain Strategy developed by or in consultation with the Assistant Secretary for Health; and</text></subparagraph></paragraph><paragraph id="id137929D08B0F4B22810CCFC1E53DE65C"><enum>(4)</enum><text>other appropriate entities.</text></paragraph></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="idBD31C92BF4DE406A806F352F0058BE6D"><enum>(2)</enum><text>in subsection (b)—</text><subparagraph id="idB97B0773436C40EDAD6B0CEA4EB013F1"><enum>(A)</enum><text>by striking <quote>opioid abuse</quote> each place such term appears and inserting <quote>opioid misuse and abuse</quote>; and</text></subparagraph><subparagraph id="id7AF51C9A6DEE492FA20317C9D0BB1133"><enum>(B)</enum><text>in paragraph (2), by striking <quote>safe disposal of prescription medications and other</quote> and inserting <quote>non-addictive treatment options, safe disposal options for prescription medications, and other applicable</quote>.</text></subparagraph></paragraph></section><section id="idBAC2D1D46F4A43E385AF651062766CD5"><enum>1504.</enum><header>Enhanced controlled substance overdoses data collection, analysis, and dissemination</header><text display-inline="no-display-inline">Part J of title III of the Public Health Service Act is amended by inserting after section 392 (42 U.S.C. 280b–1) the following:</text><quoted-block display-inline="no-display-inline" id="idB1278A622FD74CF4AEF44D45581B7705" style="OLC"><section id="idB37ADFB0790C4C3ABD9BB802A9A03A49"><enum>392A.</enum><header>Enhanced controlled substance overdoses data collection, analysis, and dissemination</header><subsection id="id9ddd5b57f46d4a60895af287776cc05d"><enum>(a)</enum><header>In general</header><text>The Director of the Centers for Disease Control and Prevention, using the authority provided to the Director under section 392, may—</text><paragraph id="id072779bb7cdc4781a78b03a8c90e8223"><enum>(1)</enum><text>to the extent practicable, carry out and expand any controlled substance overdose data collection, analysis, and dissemination activity described in subsection (b);</text></paragraph><paragraph id="id3f2cc7ec18e64edc8191c569e8bc8143"><enum>(2)</enum><text>provide training and technical assistance to States, localities, and Indian Tribes for the purpose of carrying out any such activity; and</text></paragraph><paragraph id="id0d8136d181744e8aba9ad6cd82cee539"><enum>(3)</enum><text>award grants to States, localities, and Indian Tribes for the purpose of carrying out any such activity.</text></paragraph></subsection><subsection id="ide66909d2f6774d2e9f5efaec5a72c542"><enum>(b)</enum><header>Controlled substance overdose data collection and analysis activities</header><text>A controlled substance overdose data collection, analysis, and dissemination activity described in this subsection is any of the following activities:</text><paragraph id="id65871372ea474cfdaa64d25dd50ddb8a"><enum>(1)</enum><text>Improving the timeliness of reporting aggregate data to the public, including data on fatal and nonfatal controlled substance overdoses.</text></paragraph><paragraph id="id3eca175d0b434c248af0823ad9cec10e"><enum>(2)</enum><text>Enhancing the comprehensiveness of controlled substance overdose data by collecting information on such overdoses from appropriate sources such as toxicology reports, autopsy reports, death scene investigations, and emergency department services.</text></paragraph><paragraph id="idc3dca686f2384432ab4c27785b367e0b"><enum>(3)</enum><text>Modernizing the system for coding causes of death related to controlled substance overdoses to use an electronic-based system.</text></paragraph><paragraph id="idcc79878897ef43bd87dc5a9beba69039"><enum>(4)</enum><text>Using data to help identify risk factors associated with controlled substance overdoses, including the delivery of certain health care services.</text></paragraph><paragraph id="idf9dfef427aec42acaa05e574af771a84"><enum>(5)</enum><text>Supporting entities involved in reporting information on controlled substance overdoses, such as coroners and medical examiners, to improve accurate testing and standardized reporting of causes and contributing factors of such overdoses, and analysis of various opioid analogues to controlled substance overdoses.</text></paragraph><paragraph id="id74a1041e8b734bb09af1e82c351b80a6"><enum>(6)</enum><text>Working to enable and encourage the access, exchange, and use of data regarding controlled substances overdoses among data sources and entities.</text></paragraph></subsection><subsection id="id4ADDA5688A794A0FA3DBE247FB2A4306"><enum>(c)</enum><header>Definitions</header><text>In this section—</text><paragraph id="id1FC7A594FE08460B87E4E25833C53A71"><enum>(1)</enum><text>the term <term>controlled substance</term> has the meaning given that term in section 102 of the Controlled Substances Act; and</text></paragraph><paragraph id="id85608046BA704B37B0CB455DED7BD39D"><enum>(2)</enum><text>the term <term>Indian Tribe</term> has the meaning given the term <term>Indian tribe</term> in section 4 of the Indian Self-Determination and Education Assistance Act.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id9765edf84a8244419eaba375f9ddad0a"><enum>1505.</enum><header>Preventing overdoses of controlled substances</header><text display-inline="no-display-inline">Part J of title III of the Public Health Service Act (42 U.S.C. 280b et seq.), as amended by section 504, is further amended by inserting after section 392A the following:</text><quoted-block display-inline="no-display-inline" id="id22DCC190072C424DB392512D0D0B1DF7" style="OLC"><section id="id3c0707b69c5e415899cdd45edac579a3"><enum>392B.</enum><header>Preventing overdoses of controlled substances</header><subsection id="id5F4D2DCC985345869EAA9173B92294E6"><enum>(a)</enum><header>Prevention activities</header><paragraph id="id18c4f79c432f4d0486ee1fcc5977fe19"><enum>(1)</enum><header>In general</header><text>The Director of the Centers for Disease Control and Prevention (referred to in this section as the <quote>Director</quote>), using the authority provided to the Director under section 392, may—</text><subparagraph id="id96beebfeb562437d8aff2396fd2bfe26"><enum>(A)</enum><text>to the extent practicable, carry out and expand any prevention activity described in paragraph (2);</text></subparagraph><subparagraph id="idba9bded7fd874b24ae99b30693b5da87"><enum>(B)</enum><text>provide training and technical assistance to States, localities, and Indian Tribes to carry out any such activity; and</text></subparagraph><subparagraph id="id49F9D8C1B2224A0882AD4AEC68A7ADBE"><enum>(C)</enum><text>award grants to States, localities, and Indian Tribes for the purpose of carrying out any such activity.</text></subparagraph></paragraph><paragraph id="id7996db687e95476f8729fb0f7af0e07d"><enum>(2)</enum><header>Prevention activities</header><text>A prevention activity described in this paragraph is an activity to improve the efficiency and use of a new or currently operating prescription drug monitoring program, such as—</text><subparagraph id="id3330934992d643588b060ae5f67c5429"><enum>(A)</enum><text>encouraging all authorized users (as specified by the State or other entity) to register with and use the program;</text></subparagraph><subparagraph id="id94c031ed989a44fcba14c4b688677f04"><enum>(B)</enum><text>enabling such users to access any data updates in as close to real-time as practicable;</text></subparagraph><subparagraph id="id7cddd3d3783542b2bcff046b06ab5a3f"><enum>(C)</enum><text>providing for a mechanism for the program to notify authorized users of any potential misuse or abuse of controlled substances and any detection of inappropriate prescribing or dispensing practices relating to such substances;</text></subparagraph><subparagraph id="idb72958fa68874931a7054cc2e298627c"><enum>(D)</enum><text>encouraging the analysis of prescription drug monitoring data for purposes of providing de-identified, aggregate reports based on such analysis to State public health agencies, State alcohol and drug agencies, State licensing boards, and other appropriate State agencies, as permitted under applicable Federal and State law and the policies of the prescription drug monitoring program and not containing any protected health information, to prevent inappropriate prescribing, drug diversion, or abuse and misuse of controlled substances, and to facilitate better coordination among agencies;</text></subparagraph><subparagraph id="id66032C5F76B5434B8B1D03E121A7AED2"><enum>(E)</enum><text>enhancing interoperability between the program and any health information technology (including certified health information technology), including by integrating program data into such technology;</text></subparagraph><subparagraph id="id834e00c96ac14cbda44716dd5c0f5ade"><enum>(F)</enum><text>updating program capabilities to respond to technological innovation for purposes of appropriately addressing the occurrence and evolution of controlled substance overdoses;</text></subparagraph><subparagraph id="idA15F99F416C6492181774511E70AF1C3"><enum>(G)</enum><text>developing or enhancing data exchange with other sources such as the Medicaid agency, the Medicare program, pharmacy benefit managers, coroners’ reports, and workers’ compensation data;</text></subparagraph><subparagraph id="idbddb1f61f9c54d728f56c3374a21b47e"><enum>(H)</enum><text>facilitating and encouraging data exchange between the program and the prescription drug monitoring programs of other States;</text></subparagraph><subparagraph id="id3a7484c5c7f54804b336daf4324b11c4"><enum>(I)</enum><text>enhancing data collection and quality, including improving patient matching and proactively monitoring data quality; and</text></subparagraph><subparagraph id="id43717B08C79D4C91B6CBFD154BB3CDA3"><enum>(J)</enum><text>providing prescriber and dispenser practice tools, including prescriber practice insight reports for practitioners to review their prescribing patterns in comparison to such patters of other practitioners in the specialty.</text></subparagraph></paragraph></subsection><subsection id="id202a4dbda0264cbe93e66a7a212990b4"><enum>(b)</enum><header>Additional grants</header><text>The Director may award grants to States, localities, and Indian Tribes—</text><paragraph id="idd76f9c0aff134510816b8d3d78985c2d"><enum>(1)</enum><text>to carry out innovative projects for grantees to rapidly respond to controlled substance misuse, abuse, and overdoses, including changes in patterns of controlled substance use; and</text></paragraph><paragraph id="idce1e28aa1dd84ccc932f606d493dde02"><enum>(2)</enum><text>for any other evidence-based activity for preventing controlled substance misuse, abuse, and overdoses as the Director determines appropriate.</text></paragraph></subsection><subsection id="idcb4f0a2c73b441d0adc336a29a42060c"><enum>(c)</enum><header>Research</header><text>The Director, in coordination with the Assistant Secretary for Mental Health and Substance Use and the National Mental Health and Substance Use Policy Laboratory established under section 501A, as appropriate and applicable, may conduct studies and evaluations to address substance use disorders, including preventing substance use disorders or other related topics the Director determines appropriate.</text></subsection><subsection id="id09c6ac6831c8419c9801501257c3ca54"><enum>(d)</enum><header>Public and prescriber education</header><text>Pursuant to section 102 of the Comprehensive Addiction and Recovery Act of 2016, the Director may advance the education and awareness of prescribers and the public regarding the risk of abuse and misuse of prescription opioids.</text></subsection><subsection id="ide5bfc6d8378f4391adb8980285e4de1b"><enum>(e)</enum><header>Definitions</header><text>In this section—</text><paragraph id="id4096D0B85E54466BAF1088727BDDA907"><enum>(1)</enum><text>the term <term>controlled substance</term> has the meaning given that term in section 102 of the Controlled Substances Act; and</text></paragraph><paragraph id="id30A3BCDA03614B03B158104EEB18CA91"><enum>(2)</enum><text>the term <term>Indian Tribe</term> has the meaning given the term <term>Indian tribe</term> in section 4 of the Indian Self-Determination and Education Assistance Act.</text></paragraph></subsection><subsection id="idf2d401769e384759b2d715a0e84559ae"><enum>(f)</enum><header>Authorization of appropriations</header><text>For purposes of carrying out this section, section 392A of this Act, and section 102 of the Comprehensive Addiction and Recovery Act of 2016, there is authorized to be appropriated $486,000,000 for each of fiscal years 2019 through 2024.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id27c00e7b95fc435ea1ec2dfddee559d5"><enum>1506.</enum><header>CDC surveillance and data collection for child, youth, and adult trauma</header><subsection id="ida2e513c141394e14b6b10368a1ae89eb"><enum>(a)</enum><header>Data collection</header><text>The Director of the Centers for Disease Control and Prevention (referred to in this section as the <quote>Director</quote>) may, in cooperation with the States, collect and report 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.</text></subsection><subsection id="idf1423bd1ae71406d9dddf0dcb0f5132a"><enum>(b)</enum><header>Timing</header><text>The collection of data under subsection (a) may occur in fiscal year 2019 and every 2 years thereafter.</text></subsection><subsection id="id6b30d32f2e2d4320b6d3f0633d3aad22"><enum>(c)</enum><header>Data from rural areas</header><text>The Director shall encourage each State that participates in collecting and reporting data under subsection (a) to collect and report data from tribal and rural areas within such State, in order to generate a statistically reliable representation of such areas.</text></subsection><subsection id="idcd215e3790834395a34fcbd9853699b8"><enum>(d)</enum><header>Data from tribal areas</header><text>The Director may, in cooperation with Indian Tribes and pursuant to a written request from an Indian Tribe, provide technical assistance to such Indian Tribe to collect and report data on adverse childhood experiences through the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior Surveillance System, or another relevant public health survey or questionnaire.</text></subsection><subsection id="id2CF3965FB2284A79B74448E8993274F1"><enum>(e)</enum><header>Authorization of appropriations</header><text>To carry out this section, there is authorized to be appropriated such sums as may be necessary for the period of fiscal years 2019 through 2021.</text></subsection></section><section id="idB9433AF5F8394E6D8E0AD7AEF3370E58"><enum>1507.</enum><header>Reauthorization of NASPER</header><text display-inline="no-display-inline">Section 399O of the Public Health Service Act (42 U.S.C. 280g–3) is amended—</text><paragraph id="id2ADEC45FB999411BB57C70C684AF5F9B"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="id09F28660B50D419E9605DA73B4365580"><enum>(A)</enum><text>in paragraph (1), in the matter preceding subparagraph (A), by striking <quote>in consultation with the Administrator of the Substance Abuse and Mental Health Services Administration and Director of the Centers for Disease Control and Prevention</quote> and inserting <quote>in coordination with the Director of the Centers for Disease Control and the heads of other departments and agencies as appropriate</quote>; and</text></subparagraph><subparagraph id="idD378730CA3814548BFAC42D4AECB2708"><enum>(B)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idFE1BD00C64D440F581374E4067BDBEAA" style="OLC"><paragraph id="id72D779C22EB04069B55F75B0075FC6AB"><enum>(4)</enum><header>States and local governments</header><subparagraph id="id1f477201c1a143e6a26f276916733816"><enum>(A)</enum><header>In general</header><text>In the case of a State that does not have a prescription drug monitoring program, a county or other unit of local government within the State that has a prescription drug monitoring program shall be treated as a State for purposes of this section, including for purposes of eligibility for grants under paragraph (1).</text></subparagraph><subparagraph id="ida4f38049810944e2a1078c14af1bd165"><enum>(B)</enum><header>Plan for interoperability</header><text>For purposes of meeting the interoperability requirements under subsection (c)(3), a county or other unit of local government shall submit a plan outlining the methods such county or unit of local government will use to ensure the capability of data sharing with other counties and units of local government within the State and with other States, as applicable.</text></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="idD491230462A4434FB54FADCDF9082440"><enum>(2)</enum><text>in subsection (c)—</text><subparagraph id="id5A2833686AC544EF8AE5555FE8661091"><enum>(A)</enum><text>in paragraph (1)(A)(iii)—</text><clause id="id503662D589184301823C7D18DE5093E0"><enum>(i)</enum><text>by inserting <quote>as such standards become available,</quote> after <quote>interoperability standards,</quote>; and</text></clause><clause id="id06EBA3E26E034355ACC70E99E0125745"><enum>(ii)</enum><text>by striking <quote>generated or identified by the Secretary or his or her designee</quote> and inserting <quote>recognized by the Office of the National Coordinator for Health Information Technology</quote>; and</text></clause></subparagraph><subparagraph id="id157AAB85F66049B99E7AC637ECC1D652"><enum>(B)</enum><text>in paragraph (3)(A), by inserting <quote>including electronic health records,</quote> after <quote>technology systems,</quote>;</text></subparagraph></paragraph><paragraph id="id8B16723E484A4E918CE61D4D2A3B604B"><enum>(3)</enum><text>in subsection (d)(1), by striking <quote>not later than 1 week after the date of such dispensing</quote> and inserting <quote>in as close to real time as practicable</quote>;</text></paragraph><paragraph id="id59513B28283749418C1DDC35177347A5"><enum>(4)</enum><text>in subsection (f)—</text><subparagraph id="idBC7533BABDF941099AC1E62FEAB4ADAA"><enum>(A)</enum><text>in paragraph (1)(D), by striking <quote>medicaid</quote> and inserting <quote>Medicaid</quote>; and</text></subparagraph><subparagraph id="idA3595167E0F049A3BDC085AFFC86F86D"><enum>(B)</enum><text>in paragraph (2)—</text><clause id="idBCA6CC8728A645A1948B99EE9E37CC52"><enum>(i)</enum><text>in subparagraph (A), by striking <quote>and</quote> at the end;</text></clause><clause id="id513B79598E824CB38DB4B603DC8BC0F7"><enum>(ii)</enum><text>in subparagraph (B), by striking the period and inserting a semicolon; and</text></clause><clause id="id04F54C0185474501BA62A82765A807E9"><enum>(iii)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id7DBFD578465E46DB865C695CD6ADA59A" style="OLC"><subparagraph id="id755B9B54EC4E4A47AF0C4794C55A0A33"><enum>(C)</enum><text>may conduct analyses of controlled substance program data for purposes of providing appropriate State agencies with aggregate reports based on such analyses in as close to real-time as practicable, regarding prescription patterns flagged as potentially presenting a risk of misuse, abuse, addiction, overdose, and other aggregate information, as appropriate and in compliance with applicable Federal and State laws and provided that such reports shall not include protected health information; and</text></subparagraph><subparagraph id="id416740DD088841DDA4BC9F4AF0DEF34B"><enum>(D)</enum><text>may access information about prescriptions, such as claims data, to ensure that such prescribing and dispensing history is updated in as close to real-time as practicable, in compliance with applicable Federal and State laws and provided that such information shall not include protected health information.</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></clause></subparagraph></paragraph><paragraph id="id2556A6B1820E4BC9A4DCDC5A01F40BF1"><enum>(5)</enum><text>in subsection (i), by inserting <quote>, in collaboration with the National Coordinator for Health Information Technology and the Director of the National Institute of Standards and Technology,</quote> after <quote>The Secretary</quote>; and</text></paragraph><paragraph id="idE5E7559B9251411FBB24307BD8DC8C32"><enum>(6)</enum><text>in subsection (n), by striking <quote>2021</quote> and inserting <quote>2026</quote>.</text></paragraph></section><section id="idb0d423213cb64a5c8bf8f112cc215fb3"><enum>1508.</enum><header>Jessie’s law</header><subsection id="idf470e9d8fe7943c3af26cc25a5b35f22"><enum>(a)</enum><header>Best practices</header><paragraph id="idad134c851acf48b1a2889fcb91620f5d"><enum>(1)</enum><header>In general</header><text>Not later than 1 year after the date of enactment of this Act, the Secretary, in consultation with appropriate stakeholders, including a patient with a history of opioid use disorder, an expert in electronic health records, an expert in the confidentiality of patient health information and records, and a health care provider, shall identify or facilitate the development of best practices regarding—</text><subparagraph id="id1881d33b8c264079a7d332dfe4be0ca1"><enum>(A)</enum><text>the circumstances under which information that a patient has provided to a health care provider regarding such patient’s history of opioid use disorder should, only at the patient’s request, be prominently displayed in the medical records (including electronic health records) of such patient;</text></subparagraph><subparagraph id="id5161a7ca6dba43dc9e2925890fae14cb"><enum>(B)</enum><text>what constitutes the patient’s request for the purpose described in subparagraph (A); and</text></subparagraph><subparagraph id="id6dc0f5e191a145a1913cc670895f6b76"><enum>(C)</enum><text>the process and methods by which the information should be so displayed.</text></subparagraph></paragraph><paragraph id="id606bb0a0afe64b0b81b09b1aed6ff7ff"><enum>(2)</enum><header>Dissemination</header><text>The Secretary shall disseminate the best practices developed under paragraph (1) to health care providers and State agencies.</text></paragraph></subsection><subsection id="id36f85c0c8ae048e1872b5c4cfc4fe245"><enum>(b)</enum><header>Requirements</header><text>In identifying or facilitating the development of best practices under subsection (a), as applicable, the Secretary, in consultation with appropriate stakeholders, shall consider the following:</text><paragraph id="ida3a9145b286a4552b186734e6dbdbe7d"><enum>(1)</enum><text>The potential for addiction relapse or overdose, including overdose death, when opioid medications are prescribed to a patient recovering from opioid use disorder.</text></paragraph><paragraph id="id629772c773a548468bae421ec3283a11"><enum>(2)</enum><text>The benefits of displaying information about a patient’s opioid use disorder history in a manner similar to other potentially lethal medical concerns, including drug allergies and contraindications.</text></paragraph><paragraph id="id17af81262b7b42578a8c536990a12654"><enum>(3)</enum><text>The importance of prominently displaying information about a patient’s opioid use disorder when a physician or medical professional is prescribing medication, including methods for avoiding alert fatigue in providers.</text></paragraph><paragraph id="id17e329f9400e44d4b6dc7f4cff91e595"><enum>(4)</enum><text>The importance of a variety of appropriate medical professionals, including physicians, nurses, and pharmacists, having access to information described in this section when prescribing or dispensing opioid medication, consistent with Federal and State laws and regulations.</text></paragraph><paragraph id="id28fe3993adf345c19b414fc3c00f66ac"><enum>(5)</enum><text>The importance of protecting patient privacy, including the requirements related to consent for disclosure of substance use disorder information under all applicable laws and regulations.</text></paragraph><paragraph id="idE94AFF71256B4775AEA9EDFAB1F98175"><enum>(6)</enum><text>All applicable Federal and State laws and regulations.</text></paragraph></subsection></section><section id="id79C50FF831C24A9CAC79B9CC52FBB2ED"><enum>1509.</enum><header>Development and dissemination of model training programs for substance use disorder patient records</header><subsection id="id490740ac80924680845b11306e35c7a5"><enum>(a)</enum><header>Initial programs and materials</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary, in consultation with appropriate experts, shall identify the following model programs and materials (or if no such programs or materials exist, recognize private or public entities to develop and disseminate such programs and materials):</text><paragraph id="id3e279cd6bc084cfda9e88619b942491c"><enum>(1)</enum><text>Model programs and materials for training health care providers (including physicians, emergency medical personnel, psychiatrists, psychologists, counselors, therapists, nurse practitioners, physician assistants, behavioral health facilities and clinics, care managers, and hospitals, including individuals such as general counsels or regulatory compliance staff who are responsible for establishing provider privacy policies) concerning the permitted uses and disclosures, consistent with the standards and regulations governing the privacy and security of substance use disorder patient records promulgated by the Secretary under section 543 of the Public Health Service Act (42 U.S.C. 290dd–2) for the confidentiality of patient records.</text></paragraph><paragraph id="id189d049c6d934ab9bbce649dad30eed0"><enum>(2)</enum><text>Model programs and materials for training patients and their families regarding their rights to protect and obtain information under the standards and regulations described in paragraph (1).</text></paragraph></subsection><subsection id="id3105CB003E8B458BB94813D5EF2AFA49"><enum>(b)</enum><header>Requirements</header><text>The model programs and materials described in paragraphs (1) and (2) of subsection (a) shall address circumstances under which disclosure of substance use disorder patient records is needed to—</text><paragraph id="idd295560fddc84427921c09adf475725d"><enum>(1)</enum><text>facilitate communication between substance use disorder treatment providers and other health care providers to promote and provide the best possible integrated care;</text></paragraph><paragraph id="id210f832e39464de7afa50e12120e5f4f"><enum>(2)</enum><text>avoid inappropriate prescribing that can lead to dangerous drug interactions, overdose, or relapse; and</text></paragraph><paragraph id="id52999abc7802426ab839558d10a2b98a"><enum>(3)</enum><text>notify and involve families and caregivers when individuals experience an overdose.</text></paragraph></subsection><subsection id="ide5ae5a6513b3465197fbb8e4ee51f55c"><enum>(c)</enum><header>Periodic updates</header><text>The Secretary shall—</text><paragraph id="id76dab2f6dcf34d2aae7586da64294220"><enum>(1)</enum><text>periodically review and update the model program and materials identified or developed under subsection (a); and</text></paragraph><paragraph id="idf3268d91a5b64815bdfbd8f04756591a"><enum>(2)</enum><text>disseminate such updated programs and materials to the individuals described in subsection (a)(1).</text></paragraph></subsection><subsection id="id731b8c1cffec4c5998cf2b02cc3fb2c4"><enum>(d)</enum><header>Input of certain entities</header><text>In identifying, reviewing, or updating the model programs and materials under this section, the Secretary shall solicit the input of relevant stakeholders.</text></subsection><subsection id="id807f53782d2b424e9c15f28359167f9f"><enum>(e)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2019 through 2023.</text></subsection></section><section id="idDE2D26FA23EE481C9F53922F78AF3A75"><enum>1510.</enum><header>Communication with families during emergencies</header><subsection id="idA95344319A964C43A64FF876537CB8A6"><enum>(a)</enum><header>Promoting Awareness of Authorized Disclosures during Emergencies</header><text display-inline="yes-display-inline">The Secretary shall annually notify health care providers regarding permitted disclosures during emergencies, including overdoses, of certain health information to families and caregivers under Federal health care privacy laws and regulations.</text></subsection><subsection id="idCA74AF000B9346A28E2C135D700B7096"><enum>(b)</enum><header>Use of material</header><text display-inline="yes-display-inline">For the purposes of carrying out subsection (a), the Secretary may use material produced under section 1509 of this Act or under section 11004 of the 21st Century Cures Act (42 U.S.C. 1320d–2 note).</text></subsection></section><section id="id1224A42D216E47BB99BDEAA24B5631CF"><enum>1511.</enum><header>Prenatal and postnatal health</header><text display-inline="no-display-inline">Section 317L of the Public Health Service Act (42 U.S.C. 247b–13) is amended—</text><paragraph id="id7BB4C54320A84C7A84A2D8FA071DEEBD"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="idEAD70C1DF4A44E689ABD4A66F89ADABC"><enum>(A)</enum><text>by amending paragraph (1) to read as follows:</text><quoted-block display-inline="no-display-inline" id="id74CE7E2EEC6C405CA2E8B9D70B53EB81" style="OLC"><paragraph id="id343A44157CE84486A4AD2BA0E4D2D916"><enum>(1)</enum><text>to collect, analyze, and make available data on prenatal smoking and alcohol and substance abuse and misuse, including—</text><subparagraph id="idDFE6C86D51DD4028B28C77A462593171"><enum>(A)</enum><text>data on—</text><clause id="id6B9716794893493791DF0767A67009E3"><enum>(i)</enum><text>the incidence, prevalence, and implications of such activities; and</text></clause><clause id="id2753F2C5FFA14759890493E0BC289394"><enum>(ii)</enum><text>the incidence and prevalence of implications and outcomes, including neonatal abstinence syndrome and other maternal and child health outcomes associated with such activities; and</text></clause></subparagraph><subparagraph id="id911527534BD54802AEB29D5EE51577C8"><enum>(B)</enum><text>to inform such analysis, additional information or data on family health history, medication exposures during pregnancy, demographic information, such as race, ethnicity, geographic location, and family history, and other relevant information, as appropriate;</text></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph><subparagraph id="id8426D4941B0944608C66797FDCE06AB3"><enum>(B)</enum><text>in paragraph (2)—</text><clause id="id1783541E773F4F8395B4BC1D7D93602A"><enum>(i)</enum><text>by striking <quote>prevention of</quote> and inserting <quote>prevention and long-term outcomes associated with</quote>; and</text></clause><clause id="id499CC2F85BD34BC9BD1C5CB738A68082"><enum>(ii)</enum><text>by striking <quote>illegal drug use</quote> and inserting <quote>substance abuse and misuse</quote>;</text></clause></subparagraph><subparagraph id="idE0DA96CA3BDF421288B782DC11D7055E"><enum>(C)</enum><text>in paragraph (3), by striking <quote>and cessation programs; and</quote> and inserting <quote>, treatment, and cessation programs;</quote>;</text></subparagraph><subparagraph id="id54292BDC27584938BDB9E528BE1DE363"><enum>(D)</enum><text>in paragraph (4), by striking <quote>illegal drug use.</quote> and inserting <quote>substance abuse and misuse; and</quote>; and</text></subparagraph><subparagraph id="idBB46C26E743046B8A95B546F6CBC07D6"><enum>(E)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id756F233F812C4E9EB568FD86E129838E" style="OLC"><paragraph id="idEAE8313BC66A406AB8AE5E2FF0698801"><enum>(5)</enum><text>to issue public reports on the analysis of data described in paragraph (1), including analysis of—</text><subparagraph id="idd725c0e8579d4a9ca91737889c2d8f57"><enum>(A)</enum><text>long-term outcomes of children affected by neonatal abstinence syndrome;</text></subparagraph><subparagraph id="id737e374a759b4292a79a7be6cdfda137"><enum>(B)</enum><text>health outcomes associated with prenatal smoking, alcohol, and substance abuse and misuse; and</text></subparagraph><subparagraph id="idbabae9a993324d659d9297f46e1008bc"><enum>(C)</enum><text>relevant studies, evaluations, or information the Secretary determines to be appropriate.</text></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id49552DA854C043A8B8DE521BB399E4B5"><enum>(2)</enum><text>in subsection (b), by inserting <quote>tribal entities,</quote> after <quote>local governments,</quote>;</text></paragraph><paragraph id="id2ECF8F94F78342A989DCC6EE8029F55C"><enum>(3)</enum><text>by redesignating subsection (c) as subsection (d);</text></paragraph><paragraph id="id6BD733F398A5426BBADC0439CB7E10D6"><enum>(4)</enum><text>by inserting after subsection (b) the following:</text><quoted-block display-inline="no-display-inline" id="id7953CF6FA6AC46888ADB2AB8C49A66D2" style="OLC"><subsection id="id6CC7C5B626B2474780DD5C161329E8E6"><enum>(c)</enum><header>Coordinating activities</header><text>To carry out this section, the Secretary may—</text><paragraph id="id72A9422D9B40416F926B724F5F8EE33A"><enum>(1)</enum><text>provide technical and consultative assistance to entities receiving grants under subsection (b);</text></paragraph><paragraph id="idB26D480872F8446397B14B203FCB006E"><enum>(2)</enum><text>ensure a pathway for data sharing between States, tribal entities, and the Centers for Disease Control and Prevention;</text></paragraph><paragraph id="idB579971B11874966B3CD224DD8769048"><enum>(3)</enum><text>ensure data collection under this section is consistent with applicable State, Federal, and Tribal privacy laws; and</text></paragraph><paragraph id="id4227BA76A0C546E2B17A0192FDA0EA89"><enum>(4)</enum><text>coordinate with the National Coordinator for Health Information Technology, as appropriate, to assist States and Tribes in implementing systems that use standards recognized by such National Coordinator, as such recognized standards are available, in order to facilitate interoperability between such systems and health information technology systems, including certified health information technology.</text></paragraph></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="id035311EADDB14C7AA02DCDD7C87AC448"><enum>(5)</enum><text>in subsection (d), as so redesignated, by striking <quote>2001 through 2005</quote> and inserting <quote>2019 through 2023</quote>.</text></paragraph></section><section id="id894caec65d7745bfb7eaac169f942c35"><enum>1512.</enum><header>Surveillance and education regarding infections associated with illicit drug use and other risk factors</header><text display-inline="no-display-inline">Section 317N of the Public Health Service Act (42 U.S.C. 247b–15) is amended—</text><paragraph id="id8486B78F5DA74B568904FAE12D428B1D"><enum>(1)</enum><text>by amending the section heading to read as follows: <quote><header-in-text level="section" style="OLC">Surveillance and education regarding infections associated with illicit drug use and other risk factors</header-in-text></quote>;</text></paragraph><paragraph id="id42631D3F91884C7586136B5DAC7B0013"><enum>(2)</enum><text>in subsection (a)—</text><subparagraph id="id180D7269FF43454C903B4447197D0961"><enum>(A)</enum><text>in the matter preceding paragraph (1), by inserting <quote>activities</quote> before the colon;</text></subparagraph><subparagraph id="id04022EEEE73944FC8F9F7AB29B135E3D"><enum>(B)</enum><text>in paragraph (1)—</text><clause id="id6E6CDDE16D954ACE99FEE75621F8DAC8"><enum>(i)</enum><text>by inserting <quote>or maintaining</quote> after <quote>implementing</quote>;</text></clause><clause id="id1539498B997D417AB238A504C84C4846"><enum>(ii)</enum><text>by striking <quote>hepatitis C virus infection (in this section referred to as <quote>HCV infection</quote>)</quote> and inserting <quote>infections commonly associated with illicit drug use, which may include viral hepatitis, human immunodeficiency virus, and infective endocarditis,</quote>; and</text></clause><clause id="id342099EAFFF449C09D3F38CB3D987CED"><enum>(iii)</enum><text>by striking <quote>such infection</quote> and all that follows through the period at the end and inserting <quote>such infections, which may include the reporting of cases of such infections.</quote>;</text></clause></subparagraph><subparagraph id="idB738FE77AD104319990D1C6AFB73B612"><enum>(C)</enum><text>in paragraph (2), by striking <quote>HCV infection</quote> and all that follows through the period at the end and inserting <quote>infections as a result of illicit drug use, receiving blood transfusions prior to July 1992, or other risk factors.</quote>;</text></subparagraph><subparagraph id="id091B564CB920444FBA66F2805EABD593"><enum>(D)</enum><text>in paragraphs (4) and (5), by striking <quote>HCV infection</quote> each place such term appears and inserting <quote>infections described in paragraph (1)</quote>; and</text></subparagraph><subparagraph id="id617AB9CE620D489BB468E8D466599814"><enum>(E)</enum><text>in paragraph (5), by striking <quote>pediatricians and other primary care physicians, and obstetricians and gynecologists</quote> and inserting <quote>substance use disorder treatment providers, pediatricians, other primary care providers, and obstetrician-gynecologists</quote>;</text></subparagraph></paragraph><paragraph id="id715E3824D22E4748BFD1D6DF71125E15"><enum>(3)</enum><text>in subsection (b)—</text><subparagraph id="idDE63AAF11E5A4C0C889E9EA5291470C7"><enum>(A)</enum><text>by striking <quote>directly and</quote> and inserting <quote>directly or</quote>; and</text></subparagraph><subparagraph id="id7074F2F3FB934F6F8A882F409CF493FD"><enum>(B)</enum><text>by striking <quote>hepatitis C,</quote> and all that follows through the period at the end and inserting <quote>infections described in subsection (a)(1).</quote>; and</text></subparagraph></paragraph><paragraph id="id437D05531BEF471B8C8BF49C9A6070E9"><enum>(4)</enum><text>in subsection (c), by striking <quote>such sums as may be necessary for each of the fiscal years 2001 through 2005</quote> and inserting <quote>$40,000,000 for each of fiscal years 2019 through 2023</quote>.</text></paragraph></section><section id="id122EC9015A204152A8B1D164ACA79A2D"><enum>1513.</enum><header>Task force to develop best practices for trauma-informed identification, referral, and support</header><subsection id="id48276928CA304F17B88D6FA2E530DAB8"><enum>(a)</enum><header>Establishment</header><text>There is established a task force, to be known as the Interagency Task Force on Trauma-Informed Care (in this section referred to as the <quote>task force</quote>) that shall identify, evaluate, and make recommendations regarding best practices with respect to children and youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma.</text></subsection><subsection id="id3DB078ACA2C44D9FABF86C96AFEAF92C"><enum>(b)</enum><header>Membership</header><paragraph commented="no" id="id0E74A8CAFCA448B1BB3B3D48402E6A1E"><enum>(1)</enum><header>Composition</header><text>The task force shall be composed of the heads of the following Federal departments and agencies, or their designees:</text><subparagraph commented="no" id="id54380FD1340D496FA4DA2413F8A00FC2"><enum>(A)</enum><text>The Centers for Medicare & Medicaid Services.</text></subparagraph><subparagraph commented="no" id="id20F8D6F92E7E43F9985F0F8837C8AEA0"><enum>(B)</enum><text>The Substance Abuse and Mental Health Services Administration.</text></subparagraph><subparagraph commented="no" id="id0cbb5a4b877148c086ff0d9a5fb9111c"><enum>(C)</enum><text>The Agency for Healthcare Research and Quality.</text></subparagraph><subparagraph commented="no" id="id74c401869fca40b490a192a37b058dc2"><enum>(D)</enum><text>The Centers for Disease Control and Prevention.</text></subparagraph><subparagraph commented="no" id="id16a18fa56c3945258afb273d64021271"><enum>(E)</enum><text>The Indian Health Service.</text></subparagraph><subparagraph commented="no" id="id6fbfa875254b414fb8b1a5486504bbe1"><enum>(F)</enum><text>The Department of Veterans Affairs.</text></subparagraph><subparagraph commented="no" id="id4d5109e72d384f369213be9048239c5b"><enum>(G)</enum><text>The National Institutes of Health.</text></subparagraph><subparagraph commented="no" id="ida83245c9d909469b86bb909829acfb84"><enum>(H)</enum><text>The Food and Drug Administration.</text></subparagraph><subparagraph commented="no" id="id6b712c4492534281b55f0d0dedc6c530"><enum>(I)</enum><text>The Health Resources and Services Administration.</text></subparagraph><subparagraph commented="no" id="id8be878271219413e9d34a2dac2313b21"><enum>(J)</enum><text>The Department of Defense.</text></subparagraph><subparagraph commented="no" id="id1a59369b5fa34bb39cf3c39ecd4b8608"><enum>(K)</enum><text>The Office of Minority Health.</text></subparagraph><subparagraph commented="no" id="id8754A80F2EC24B09A2136AFE1F917DC6"><enum>(L)</enum><text>The Administration for Children and Families.</text></subparagraph><subparagraph commented="no" id="id9ccec11133c044879a19d971886b7e7f"><enum>(M)</enum><text>The Office of the Assistant Secretary for Planning and Evaluation.</text></subparagraph><subparagraph commented="no" id="id717d954206a64b48b36d30e58b9c11f6"><enum>(N)</enum><text>The Office for Civil Rights of the Department of Health and Human Services.</text></subparagraph><subparagraph commented="no" id="idC30E772B18A94BC49C2FD31790F0C093"><enum>(O)</enum><text>The Office of Juvenile Justice and Delinquency Prevention of the Department of Justice.</text></subparagraph><subparagraph commented="no" id="id99989395FE884C35B6B14517B6EAD784"><enum>(P)</enum><text>The Office of Community Oriented Policing Services of the Department of Justice.</text></subparagraph><subparagraph commented="no" id="idEE44B44792874B5AAA2759AF63590354"><enum>(Q)</enum><text>The Office on Violence Against Women of the Department of Justice.</text></subparagraph><subparagraph commented="no" id="idBCCFBA7B54E54887BAEE5D0995D22CEE"><enum>(R)</enum><text>The National Center for Education Evaluation and Regional Assistance of the Department of Education.</text></subparagraph><subparagraph commented="no" id="id828f157e966d400792994f988dc2a14b"><enum>(S)</enum><text>The National Center for Special Education Research of the Institute of Education Science.</text></subparagraph><subparagraph commented="no" id="id88F0EDC5475B4A9EB0752BFB61F8BA6D"><enum>(T)</enum><text>The Office of Elementary and Secondary Education of the Department of Education.</text></subparagraph><subparagraph commented="no" id="idf53ce1a081224258ae03dc6a8f419d20"><enum>(U)</enum><text>The Office for Civil Rights of the Department of Education.</text></subparagraph><subparagraph commented="no" id="idd3bf5342c3e04db49c782f32c8093b73"><enum>(V)</enum><text>The Office of Special Education and Rehabilitative Services of the Department of Education.</text></subparagraph><subparagraph commented="no" id="id4884A91A9528468AA3A514ED8D3F1F7A"><enum>(W)</enum><text>The Bureau of Indian Affairs of the Department of the Interior.</text></subparagraph><subparagraph commented="no" id="idA712B748D7CC42388D4B6809C3AE6928"><enum>(X)</enum><text>The Veterans Health Administration of the Department of Veterans Affairs.</text></subparagraph><subparagraph commented="no" id="id1B1FDA83C5F34F6F81E53EDD9D843303"><enum>(Y)</enum><text>The Office of Special Needs Assistance Programs of the Department of Housing and Urban Development.</text></subparagraph><subparagraph id="id5ec95f625ac14bd5acf38596d954d11a"><enum>(Z)</enum><text>The Office of Head Start of the Administration for Children and Families.</text></subparagraph><subparagraph id="id29df5ac957dc4794bb02d4e13f7bc54e"><enum>(AA)</enum><text>The Children’s Bureau of the Administration for Children and Families.</text></subparagraph><subparagraph id="id228852F993BF4AF3A1698AFBD8038434"><enum>(BB)</enum><text>The Bureau of Indian Education of the Department of the Interior.</text></subparagraph><subparagraph commented="no" id="idFC206F42E89F4CDCA30652213159D8AA"><enum>(CC)</enum><text>Such other Federal agencies as the Secretaries determine to be appropriate.</text></subparagraph></paragraph><paragraph id="id7F6BD62EE4EB4AB28498E69293D97E39"><enum>(2)</enum><header>Date of appointments</header><text>The heads of Federal departments and agencies shall appoint the corresponding members of the task force not later than 6 months after the date of enactment of this Act.</text></paragraph><paragraph id="id1FA2F3B5572A4CA9870CDD1CAEBAFD43"><enum>(3)</enum><header>Chairperson</header><text>The task force shall be chaired by the Assistant Secretary for Mental Health and Substance Use.</text></paragraph></subsection><subsection id="id25FCE2A39783482E837F7FB52817A088"><enum>(c)</enum><header>Task force duties</header><text>The task force shall—</text><paragraph id="id9B263C0E17BC4458A39CC1AA28526639"><enum>(1)</enum><text>solicit input from stakeholders, including frontline service providers, educators, mental health professionals, researchers, experts in infant, child, and youth trauma, child welfare professionals, and the public, in order to inform the activities under paragraph (2); and</text></paragraph><paragraph id="id5266D2AA3CCF436FA0B82AB786D0BD1C"><enum>(2)</enum><text>identify, evaluate, make recommendations, and update such recommendations not less than annually, to the general public, the Secretary of Education, the Secretary of Health and Human Services, the Secretary of Labor, the Secretary of the Interior, the Attorney General, and other relevant cabinet Secretaries, and Congress regarding—</text><subparagraph id="idD6C4C74347D54759A7A93FA67927D221"><enum>(A)</enum><text>a set of evidence-based, evidence-informed, and promising best practices with respect to—</text><clause id="idC7C91177E7174FD1AAD844473C0BB9C5"><enum>(i)</enum><text>the identification of infants, children and youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma; and</text></clause><clause id="idB7564D9028344ED1B03095E0DD9BD4C5"><enum>(ii)</enum><text>the expeditious referral to and implementation of trauma-informed practices and supports that prevent and mitigate the effects of trauma;</text></clause></subparagraph><subparagraph id="id9A90D5DB4D1B43D3BB20D512A5C12A12"><enum>(B)</enum><text>a national strategy on how the task force and member agencies will collaborate, prioritize options for, and implement a coordinated approach which may include data sharing and the awarding of grants that support infants, children, and youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma; and</text></subparagraph><subparagraph id="id797b7609dbb84d0eb3eb7e3d2fc878b2"><enum>(C)</enum><text>existing Federal authorities at the Department of Education, Department of Health and Human Services, Department of Justice, Department of Labor, Department of the Interior, and other relevant agencies, and specific Federal grant programs to disseminate best practices on, provide training in, or deliver services through, trauma-informed practices, and disseminate such information—</text><clause id="id0A084442DD5C4C32B3FBD7CBB4690F76"><enum>(i)</enum><text>in writing to relevant program offices at such agencies to encourage grant applicants in writing to use such funds, where appropriate, for trauma-informed practices; and</text></clause><clause id="idF578FD03FE8740DF88AC9BAE32244F67"><enum>(ii)</enum><text>to the general public through the internet website of the task force.</text></clause></subparagraph></paragraph></subsection><subsection id="id74B9F9D6FDDD4801BD0AD9A958789504"><enum>(d)</enum><header>Best practices</header><text>In identifying, evaluating, and recommending the set of best practices under subsection (c), the task force shall—</text><paragraph id="id9A273E28CFE74594A31B81FA448178A9"><enum>(1)</enum><text>include guidelines for providing professional development for front-line services providers, including school personnel, early childhood education program providers, providers from child- or youth-serving organizations, housing and homeless providers, primary and behavioral health care providers, child welfare and social services providers, juvenile and family court personnel, health care providers, individuals who are mandatory reporters of child abuse or neglect, trained nonclinical providers (including peer mentors and clergy), and first responders, in—</text><subparagraph id="id9BCB0C95A0FA44C5AD95B3350ACA7BD5"><enum>(A)</enum><text>understanding and identifying early signs and risk factors of trauma in infants, children, and youth, and their families as appropriate, including through screening processes;</text></subparagraph><subparagraph id="idfbae4a2bb9cb4a06b81a7a37d75da6f2"><enum>(B)</enum><text>providing practices to prevent and mitigate the impact of trauma, including by fostering safe and stable environments and relationships; and</text></subparagraph><subparagraph id="idb16473c3074241c3ab7c397ed7a6f10b"><enum>(C)</enum><text>developing and implementing policies, procedures, or systems that—</text><clause id="idD0AC82F78A1B4BDC951E06F8830DD834"><enum>(i)</enum><text>are designed to quickly refer infants, children, youth, and their families as appropriate, who have experienced or are at risk of experiencing trauma to the appropriate trauma-informed screening and support, including age-appropriate treatment, and to ensure such infants, children, youth, and family members receive such support;</text></clause><clause id="idDA265ECE434B4BB39A9C149D3067455A"><enum>(ii)</enum><text>utilize and develop partnerships with early childhood education programs, local social services organizations, such as organizations serving youth, and clinical mental health or health care service providers with expertise in providing support services (including age-appropriate trauma-informed and evidence-based treatment) aimed at preventing or mitigating the effects of trauma;</text></clause><clause id="id0A24A08C3D0D4EB186616857175EBFED"><enum>(iii)</enum><text>educate children and youth to—</text><subclause id="idC052AA2063FA442BB7751659706DED5B"><enum>(I)</enum><text>understand and identify the signs, effects, or symptoms of trauma; and</text></subclause><subclause id="idB53C262899414AE98771689A24A23356"><enum>(II)</enum><text>build the resilience and coping skills to mitigate the effects of experiencing trauma;</text></subclause></clause><clause id="idDDDA988129E341E0A7FFA916DE21B403"><enum>(iv)</enum><text>promote and support multi-generational practices that assist parents, foster parents, and kinship and other caregivers in accessing resources related to, and developing environments conducive to, the prevention and mitigation of trauma; and</text></clause><clause id="id7ED181AB7F5543309889D5ED3DC537BF"><enum>(v)</enum><text>collect and utilize data from screenings, referrals, or the provision of services and supports to evaluate and improve processes for trauma-informed support and outcomes that are culturally sensitive, linguistically appropriate, and specific to age ranges and sex, as applicable; and</text></clause></subparagraph></paragraph><paragraph id="id90D0DB4EDE254EF99408AE1EC87A008E"><enum>(2)</enum><text>recommend best practices that are designed to avoid unwarranted custody loss or criminal penalties for parents or guardians in connection with infants, children, and youth who have experienced or are at risk of experiencing trauma.</text></paragraph></subsection><subsection id="id612C953D40074A18AABC7618B9081265"><enum>(e)</enum><header>Operating plan</header><text>Not later than 1 year after the date of enactment of this Act, the task force shall hold the first meeting. Not later than 2 years after such date of enactment, the task force shall submit to the Secretary of Education, Secretary of Health and Human Services, Secretary of Labor, Secretary of the Interior, the Attorney General, and Congress an operating plan for carrying out the activities of the task force described in subsection (c)(2). Such operating plan shall include—</text><paragraph id="id9391f442140745e6a31db83d079684bd"><enum>(1)</enum><text>a list of specific activities that the task force plans to carry out for purposes of carrying out duties described in subsection (c)(2), which may include public engagement;</text></paragraph><paragraph id="ida42a4bea73904cbdb00698421197f9bf"><enum>(2)</enum><text>a plan for carrying out the activities under subsection (c)(2);</text></paragraph><paragraph id="id56f1eadf713f4a33a085da44ddb97a64"><enum>(3)</enum><text>a list of members of the task force and other individuals who are not members of the task force that may be consulted to carry out such activities;</text></paragraph><paragraph id="id89c66e16523440c0b71ee6e9f82374c2"><enum>(4)</enum><text>an explanation of Federal agency involvement and coordination needed to carry out such activities, including any statutory or regulatory barriers to such coordination;</text></paragraph><paragraph id="id635c47c85e504b26b24dc6fb5265b467"><enum>(5)</enum><text>a budget for carrying out such activities; and</text></paragraph><paragraph id="id97d3e24ee11d44848b963e915ba5ef6a"><enum>(6)</enum><text>other information that the task force determines appropriate.</text></paragraph></subsection><subsection id="ide3f647c23a9e4b548162dba22de29a0d"><enum>(f)</enum><header>Final report</header><text>Not later than 3 years after the date of the first meeting of the task force, the task force shall submit to the general public, Secretary of Education, Secretary of Health and Human Services, Secretary of Labor, Secretary of the Interior, the Attorney General, and other relevant cabinet Secretaries, and Congress, a final report containing all of the findings and recommendations required under this section.</text></subsection><subsection id="id755594341DC249DBA359D51A7E5CE71F"><enum>(g)</enum><header>Definition</header><text>In this section, the term <term>early childhood education program</term> has the meaning given such term in section 103 of the Higher Education Act of 1965 (20 U.S.C. 1003).</text></subsection><subsection commented="no" display-inline="no-display-inline" id="idD24EE8C2FC0B45CDB56D3C7D265AD814"><enum>(h)</enum><header>Authorization of appropriations</header><text>To carry out this section, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2019 through 2022.</text></subsection><subsection id="id6cbbe3725c534198940d819a725b8695"><enum>(i)</enum><header>Sunset</header><text>The task force shall on the date that is 60 days after the submission of the final report under subsection (f), but not later than September 30, 2022.</text></subsection></section><section id="ida427a4eddff24b1cb430b18e5496b210"><enum>1514.</enum><header>Grants to improve trauma support services and mental health care for children and youth in educational settings</header><subsection id="idfa9747e9727f4cc38cb230321c9c3e37"><enum>(a)</enum><header>Grants, contracts, and cooperative agreements authorized</header><text>The Secretary, in coordination with the Assistant Secretary for Mental Health and Substance Use, is authorized to award grants to, or enter into contracts or cooperative agreements with, State educational agencies, local educational agencies, Head Start agencies (including Early Head Start agencies), State or local agencies that administer public preschool programs, Indian Tribes or their tribal educational agencies, a school operated by the Bureau of Indian Education, a Regional Corporation (as defined in section 3 of the Alaska Native Claims Settlement Act (43 U.S.C. 1602)), or a Native Hawaiian educational organization (as defined in section 6207 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7517)), for the purpose of increasing student access to evidence-based trauma support services and mental health care by developing innovative initiatives, activities, or programs to link local school systems with local trauma-informed support and mental health systems, including those under the Indian Health Service.</text></subsection><subsection id="idcb7c82c127404526845864e2308bf4c3"><enum>(b)</enum><header>Duration</header><text>With respect to a grant, contract, or cooperative agreement awarded or entered into under this section, the period during which payments under such grant, contract or agreement are made to the recipient may not exceed 4 years.</text></subsection><subsection id="ideb6aecf10c364575bcf3101bca04fa46"><enum>(c)</enum><header>Use of funds</header><text>An entity that receives a grant, contract, or cooperative agreement under this section shall use amounts made available through such grant, contract, or cooperative agreement for evidence-based activities, which shall include any of the following:</text><paragraph id="ide1897cd8067e4ffb8d46b87f1541df75"><enum>(1)</enum><text>Collaborative efforts between school-based service systems and trauma-informed support and mental health service systems to provide, develop, or improve prevention, screening, referral, and treatment and support services to students, such as by providing universal trauma screenings to identify students in need of specialized support.</text></paragraph><paragraph id="id9cb09ffefb044418ae7db7409dd76b5a"><enum>(2)</enum><text>To implement schoolwide multi-tiered positive behavioral interventions and supports, or other trauma-informed models of support.</text></paragraph><paragraph id="ide8430e29fe2244e297fba1815d9007b7"><enum>(3)</enum><text>To provide professional development to teachers, teacher assistants, school leaders, specialized instructional support personnel, and mental health professionals that—</text><subparagraph id="idA25E29EAA6F14C389DE7E802238AB0F2"><enum>(A)</enum><text>fosters safe and stable learning environments that prevent and mitigate the effects of trauma, including through social and emotional learning;</text></subparagraph><subparagraph id="ida8315a1b77ba417d8253c7adea6bf1c6"><enum>(B)</enum><text>improves school capacity to identify, refer, and provide services to students in need of trauma support or behavioral health services; or</text></subparagraph><subparagraph id="id4A2E2779A2B440A980AA5CE9895041BF"><enum>(C)</enum><text>reflects the best practices developed by the Interagency Task Force on Trauma-Informed Care established under section 513.</text></subparagraph></paragraph><paragraph commented="no" id="idaa51321993fb41329fc298d85d26048e"><enum>(4)</enum><text>To create or enhance services at a full-service community school that focuses on trauma-informed supports, which may include establishing a school-site advisory team, managing, coordinating, or delivering pipeline services, hiring a full-time site coordinator, or other activities consistent with section 4625 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7275).</text></paragraph><paragraph commented="no" id="id3E7D84EC20824C70B605285E761FD1CC"><enum>(5)</enum><text>Engaging families and communities in efforts to increase awareness of child and youth trauma, which may include sharing best practices with law enforcement regarding trauma-informed care and working with mental health professionals to provide interventions, as well as longer term coordinated care within the community for children and youth who have experienced trauma and their families.</text></paragraph><paragraph id="id2A1CB228AAD04A84A88E575418D81891"><enum>(6)</enum><text>To provide technical assistance to school systems and mental health agencies.</text></paragraph><paragraph id="idf8d3779befe04dd993f6faf81615c98d"><enum>(7)</enum><text>To evaluate the effectiveness of the program carried out under this section in increasing student access to evidence-based trauma support services and mental health care.</text></paragraph></subsection><subsection id="id1731d55991ef49c584e35412c682adee"><enum>(d)</enum><header>Applications</header><text>To be eligible to receive a grant, contract, or cooperative agreement under this section, an entity described in subsection (a) shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require, which shall include the following:</text><paragraph id="idb4b0dfc31f224564b30366cc7481f448"><enum>(1)</enum><text>A description of the innovative initiatives, activities, or programs to be funded under the grant, contract, or cooperative agreement, including how such program will increase access to evidence-based trauma support services and mental health care for students, and, as applicable, the families of such students.</text></paragraph><paragraph id="id3ae9dd22bdeb4eff820c4b49ebe03fca"><enum>(2)</enum><text>A description of how the program will provide linguistically appropriate and culturally competent services.</text></paragraph><paragraph id="id33be912d93cf41569b596d2d364a98dd"><enum>(3)</enum><text>A description of how the program will support students and the school in improving the school climate in order to support an environment conducive to learning.</text></paragraph><paragraph id="idd9bf1c5297004f1bb3b3a582224a2551"><enum>(4)</enum><text>An assurance that—</text><subparagraph id="id361947d2d503431f845526847434f9dc"><enum>(A)</enum><text>persons providing services under the grant, contract, or cooperative agreement are adequately trained to provide such services; and</text></subparagraph><subparagraph id="id7ec499387a4b4d7ead1022aa4b21a723"><enum>(B)</enum><text>teachers, school leaders, administrators, specialized instructional support personnel, representatives of local Indian Tribes or tribal organizations as appropriate, other school personnel, and parents or guardians of students participating in services under this section will be engaged and involved in the design and implementation of the services.</text></subparagraph></paragraph><paragraph id="id16057766767c402295a151a7c5a9478c"><enum>(5)</enum><text>A description of how the applicant will support and integrate existing school-based services with the program in order to provide mental health services for students, as appropriate.</text></paragraph></subsection><subsection id="idc21233f27ce8471793a51d7c57f6afc9"><enum>(e)</enum><header>Interagency agreements</header><paragraph id="idd09e236c8d9b441eaeda2d8c8dca6496"><enum>(1)</enum><header>Designation of lead agency</header><text>A recipient of a grant, contract, or cooperative agreement under this section shall designate a lead agency to direct the establishment of an interagency agreement among local educational agencies, agencies responsible for early childhood education programs, juvenile justice authorities, mental health agencies, child welfare agencies, and other relevant entities in the State or Indian Tribe, in collaboration with local entities.</text></paragraph><paragraph id="id80bb7fa23838463099a600d64ba6d6d8"><enum>(2)</enum><header>Contents</header><text>The interagency agreement shall ensure the provision of the services described in subsection (c), specifying with respect to each agency, authority, or entity—</text><subparagraph id="idc58b1993340d4c5d80c390c0194aca3e"><enum>(A)</enum><text>the financial responsibility for the services;</text></subparagraph><subparagraph id="id7c1bc76ad1344320a7a172d731c0f108"><enum>(B)</enum><text>the conditions and terms of responsibility for the services, including quality, accountability, and coordination of the services; and</text></subparagraph><subparagraph id="idc2fb935ced8646c987dbc9974a0e2498"><enum>(C)</enum><text>the conditions and terms of reimbursement among the agencies, authorities, or entities that are parties to the interagency agreement, including procedures for dispute resolution.</text></subparagraph></paragraph></subsection><subsection id="id4294d968deab4ee6952c18955ccb5d1e"><enum>(f)</enum><header>Evaluation</header><text>The Secretary shall reserve not to exceed 3 percent of the funds made available under subsection (l) for each fiscal year to—</text><paragraph id="idC08C42C9F6044B3BAF819E3B592B5E03"><enum>(1)</enum><text>conduct a rigorous, independent evaluation of the activities funded under this section; and</text></paragraph><paragraph id="id6BDEC476EF4142C19215EEDC30347183"><enum>(2)</enum><text>disseminate and promote the utilization of evidence-based practices regarding trauma support services and mental health care.</text></paragraph></subsection><subsection id="id228d7a8dbe1f4fddb2e152b9ce4a6416"><enum>(g)</enum><header>Distribution of awards</header><text>The Secretary shall ensure that grants, contracts, and cooperative agreements awarded or entered into under this section are equitably distributed among the geographical regions of the United States and among tribal, urban, suburban, and rural populations.</text></subsection><subsection id="id224ce072f8304c8ea2dd4263cef86fe2"><enum>(h)</enum><header>Rule of construction</header><text>Nothing in this section shall be construed—</text><paragraph id="id96d81c50711543c2b300805f4a7c968b"><enum>(1)</enum><text>to prohibit an entity involved with a program carried out under this section from reporting a crime that is committed by a student to appropriate authorities; or</text></paragraph><paragraph id="id7febd3de05b541e3b6f452a58f221866"><enum>(2)</enum><text>to prevent Federal, State, and tribal law enforcement and judicial authorities from exercising their responsibilities with regard to the application of Federal, tribal, and State law to crimes committed by a student.</text></paragraph></subsection><subsection id="id0c731a784c8149e9aa68720743f8d869"><enum>(i)</enum><header>Supplement, not supplant</header><text>Any services provided through programs carried out under this section shall supplement, and not supplant, existing mental health services, including any special education and related services provided under the Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.).</text></subsection><subsection id="ida096b9bc80a747b78495885afdfcfe88"><enum>(j)</enum><header>Consultation with indian Tribes</header><text>In carrying out subsection (a), the Secretary shall, in a timely manner, meaningfully consult, engage, and cooperate with Indian Tribes and their representatives to ensure notice of eligibility.</text></subsection><subsection id="idDA9C020C3C354C5EBA71323C9D578A4D"><enum>(k)</enum><header>Definitions</header><text>In this section:</text><paragraph id="id2222D5A0F7844951BC5958AE5D9023FA"><enum>(1)</enum><header>Elementary or secondary school</header><text>The term <term>elementary or secondary school</term> means a public elementary and secondary school as such term is defined in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).</text></paragraph><paragraph commented="no" id="id8F29C6940BA14AB5BD346F6D4F86940F"><enum>(2)</enum><header>Evidence-based</header><text>The term <term>evidence-based</term> has the meaning given such term in section 8101(21)(A)(i) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801(21)(A)(i)).</text></paragraph><paragraph id="id440e7f87835b432c86c16a6b64ac4784"><enum>(3)</enum><header>Native Hawaiian educational organization</header><text>The term <term>Native Hawaiian educational organization</term> has the meaning given such term in section 6207 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7517).</text></paragraph><paragraph id="idcbfb7054cff946af949aaf5d383277d5"><enum>(4)</enum><header>Pipeline services</header><text>The term <term>pipeline services</term> has the meaning given such term in section 4622 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7517).</text></paragraph><paragraph id="id20DDA3CCEC9B4D33BE70020A5924B611"><enum>(5)</enum><header>School leader</header><text>The term <term>school leader</term> has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).</text></paragraph><paragraph id="id330FBDFC9B43489D90BC1774F3ACFBB6"><enum>(6)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Education.</text></paragraph><paragraph id="idc80f1cb33775442984359c3ca18dd081"><enum>(7)</enum><header>Specialized instructional support personnel</header><text>The term <term>specialized instructional support personnel</term> has the meaning given such term in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id5E038BB0618D45B69BA0218E7A35E2A7"><enum>(l)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2019 through 2023.</text></subsection></section><section id="id7d9e76558732405086d6c71a0e1d1509"><enum>1515.</enum><header>National Child Traumatic Stress Initiative</header><text display-inline="no-display-inline">Section 582(j) of the Public Health Service Act (42 U.S.C. 290hh–1(j)) (relating to grants to address the problems of persons who experience violence-related stress) is amended by striking <quote>$46,887,000 for each of fiscal years 2018 through 2022</quote> and inserting <quote>$53,887,000 for each of fiscal years 2019 through 2023</quote>.</text></section><section id="id74384eeb7346473bb19c75ac7b7790e6"><enum>1516.</enum><header>National milestones to measure success in curtailing the opioid crisis</header><subsection id="idef1624d1d33c47b0ba940f69b76be68c"><enum>(a)</enum><header>In general</header><text>Not later than 180 days after the date of enactment of this Act, the Secretary, in consultation with the Administrator of the Drug Enforcement Administration and the Director of the Office of National Drug Control Policy, shall develop or identify existing national indicators (referred to in this section as the <quote>national milestones</quote>) to measure success in curtailing the opioid crisis, with the goal of significantly reversing the incidence and prevalence of opioid misuse and abuse, and opioid-related morbidity and mortality in the United States within 5 years of such date of enactment.</text></subsection><subsection id="ide9d2da3f4b74488abf41d65d60acc041"><enum>(b)</enum><header>National milestones to end the opioid crisis</header><text>The national milestones under subsection (a) shall include the following:</text><paragraph id="id16d0b3566b394a6d86781b958df097e3"><enum>(1)</enum><text>Not fewer than 10 indicators or metrics to accurately and expediently measure progress in meeting the goal described in subsection (a), which shall, as appropriate, include, indicators or metrics related to—</text><subparagraph id="ide62d885e612c4a77941cfe02e53952df"><enum>(A)</enum><text>the number of fatal and non-fatal opioid overdoses;</text></subparagraph><subparagraph id="idf5f6ceba758e48038d9cb5753a94e07f"><enum>(B)</enum><text>the number of emergency room visits related to opioid misuse and abuse;</text></subparagraph><subparagraph id="id5278b386555a4474bb79ab3d36a298ca"><enum>(C)</enum><text>the number of individuals in sustained recovery from opioid use disorder;</text></subparagraph><subparagraph id="id11f29e39130c47d58795e855de8f8323"><enum>(D)</enum><text>the number of infections associated with illicit drug use, such as HIV, viral hepatitis, and infective endocarditis, and available capacity for treating such infections;</text></subparagraph><subparagraph id="id719f75bc7ebc408c8d33df94f9cec9dd"><enum>(E)</enum><text>the number of providers prescribing medication assisted treatment for opioid use disorders, including in primary care settings, community health centers, jails, and prisons;</text></subparagraph><subparagraph id="idc4a66b7c3b3744fa951c351a9ab00893"><enum>(F)</enum><text>the number of individuals receiving treatment for opioid use disorder; and</text></subparagraph><subparagraph id="id1bd1e9d8eafe43768a05c81fa86e1f7e"><enum>(G)</enum><text>additional indicators or metrics, as appropriate, such as metrics pertaining to specific populations, including women and children, American Indians and Alaskan Natives, individuals living in rural and non-urban areas, and justice-involved populations, that would further clarify the progress made in addressing the opioid misuse and abuse crisis.</text></subparagraph></paragraph><paragraph id="id0f59bd2ece81419fa934826804cf2f11"><enum>(2)</enum><text>A reasonable goal, such as a percentage decrease or other specified metric, that signifies progress in meeting the goal described in subsection (a), and annual targets to help achieve that goal.</text></paragraph></subsection><subsection id="ida03b98122c074b1f8c25c99eeca4e2b1"><enum>(c)</enum><header>Consideration of other substance use disorders</header><text>In developing the national milestones under subsection (b), the Secretary shall, as appropriate, consider other substance use disorders in addition to opioid use disorder.</text></subsection><subsection id="id1F76A9C75570406C8E0B0CE0F3817269"><enum>(d)</enum><header>Extension of period</header><text>If the Secretary determines that the goal described in subsection (a) will not be achieved with respect to any indicator or metric established under subsection (b)(2) within 5 years of the date of enactment of this Act, the Secretary may extend the timeline for meeting such goal with respect to that indicator or metric. The Secretary shall include with any such extension a rationale for why additional time is needed and information on whether significant changes are needed in order to achieve such goal with respect to the indicator or metric.</text></subsection><subsection id="idb452a97df1294748b67cc7b3ccd53e70"><enum>(e)</enum><header>Annual status update</header><text>Not later than one year after the enactment of this Act, the Secretary shall make available on the internet website of the Department of Health and Human Services, and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives, an update on the progress, including expected progress in the subsequent year, in achieving the goals detailed in the national milestones. Each such update shall include the progress made in the first year or since the previous report, as applicable, in meeting each indicator or metric in the national milestones.</text></subsection></section></subtitle><enum>II</enum><header>Finance</header><section id="id408B1F9CC3754111A437A9A189EE7705"><enum>2001.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote><short-title>Helping to End Addiction and Lessen Substance Use Disorders Act of 2018</short-title></quote> or the <quote><short-title>HEAL Act of 2018</short-title></quote>.</text></section><subtitle id="idAD3E09FBF4C14DED91D2C13FA962EBF9" style="OLC"><enum>A</enum><header>Medicare</header><section id="HEA083E1556DD4340A5B2D454F95322B6" section-type="subsequent-section"><enum>2101.</enum><header>Medicare opioid safety education</header><subsection id="H4DBEEB4EE10C4A519180D68FB33D3A83"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1804 of the Social Security Act (42 U.S.C. 1395b–2) is amended by adding at the end the following new subsection:</text><quoted-block display-inline="no-display-inline" id="HBF6C3ECA2CC34C0187E2221A27442312" style="OLC"><subsection id="H1CF8B862D9984B9D8660E52B52AD6669"><enum>(d)</enum><text display-inline="yes-display-inline">The notice provided under subsection (a) shall include—</text><paragraph id="HD5D7AA9A57364C67ADF53F6DF3E07C7E"><enum>(1)</enum><text>references to educational resources regarding opioid use and pain management;</text></paragraph><paragraph id="H00922AB4AEE14AC59DBA43B92EFB8588"><enum>(2)</enum><text>a description of categories of alternative, non-opioid pain management treatments covered under this title; and</text></paragraph><paragraph id="idE4C99A0AE64D4F3AB465F83A4383ED71"><enum>(3)</enum><text>a suggestion for the beneficiary to talk to a physician regarding opioid use and pain management.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection commented="no" display-inline="no-display-inline" id="H3D7FABDFA7CF44AEA6DD5EFCABFFA541"><enum>(b)</enum><header>Effective date</header><text>The amendment made by subsection (a) shall apply to notices distributed prior to each Medicare open enrollment period beginning after January 1, 2019.</text></subsection></section><section id="id2FB41F9D576B4FADB84A68C677E1A5BD"><enum>2102.</enum><header>Expanding the use of telehealth services for the treatment of opioid use disorder and other substance use disorders</header><subsection id="idCD25ACB49C454EABAAAEE0A838548FA9"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended—</text><paragraph id="idFB6DCB4E82CB4A378A1B999B2042F8BD"><enum>(1)</enum><text>in paragraph (2)(B)—</text><subparagraph id="id94451A7DD19044B1A0A1C5E47EC42993"><enum>(A)</enum><text>in clause (i), in the matter preceding subclause (I), by striking <quote>clause (ii)</quote> and inserting <quote>clause (ii) and paragraph (6)(C)</quote>; and</text></subparagraph><subparagraph id="idBBF85BE3787D4BDABA7C726A4A0994EE"><enum>(B)</enum><text>in clause (ii), in the heading, by striking <quote><header-in-text level="clause" style="OLC">for home dialysis therapy</header-in-text></quote>;</text></subparagraph></paragraph><paragraph id="id47C8D77E012F400A837210441F71BB56"><enum>(2)</enum><text display-inline="yes-display-inline">in paragraph (4)(C)—</text><subparagraph commented="no" id="id1DD91EE5BBC549AFBB26E98DA8884745"><enum>(A)</enum><text display-inline="yes-display-inline">in clause (i), by striking <quote>paragraph (6)</quote> and inserting <quote>paragraphs (5), (6), and (7)</quote>; and</text></subparagraph><subparagraph id="id085002D349D441AB9D730FB866D3DBEB"><enum>(B)</enum><text>in clause (ii)(X), by inserting <quote>or telehealth services described in paragraph (7)</quote> before the period at the end; and</text></subparagraph></paragraph><paragraph id="idE6C6C6679A704DDD8CE324E7648EE5A5"><enum>(3)</enum><text display-inline="yes-display-inline">by adding at the end the following new paragraph:</text><quoted-block display-inline="no-display-inline" id="id184DDACB8BEE4D08A7121D427184C24F" style="OLC"><paragraph id="id48A74937A35E4C39914CF7C943794028"><enum>(7)</enum><header>Treatment of substance use disorder services furnished through telehealth</header><text>The geographic requirements described in paragraph (4)(C)(i) shall not apply with respect to telehealth services furnished on or after January 1, 2019, to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder, as determined by the Secretary, at an originating site described in paragraph (4)(C)(ii) (other than an originating site described in subclause (IX) of such paragraph).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id9DB6858BE5514938BEB98CE29191231A"><enum>(b)</enum><header>Implementation</header><text>The Secretary of Health and Human Services (in this section referred to as the <quote>Secretary</quote>) may implement the amendments made by this section by interim final rule.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="id14B7B209E16A40E3B5F5CFBC41E89CFF"><enum>(c)</enum><header>Report</header><text>Not later than 5 years after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the impact of the implementation of the amendments made by this section with respect to telehealth services under section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) on—</text><paragraph commented="no" display-inline="no-display-inline" id="id30F9DE1755C143E4BB111BC900DDAE4A"><enum>(1)</enum><text>the utilization of health care items and services under title XVIII of such Act (42 U.S.C. 1395 et seq.) related to substance use disorders, including emergency department visits; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id5ABE6F4291674776ADAE0A8631024EE4"><enum>(2)</enum><text>health outcomes related to substance use disorders, such as opioid overdose deaths.</text></paragraph></subsection></section><section id="id61874C7465964C75B72B1776FD3A781B"><enum>2103.</enum><header>Comprehensive screenings for seniors</header><subsection id="id6a37eb7edfa8497ebca08b580b3e4290"><enum>(a)</enum><header>Initial preventive physical examination</header><text>Section 1861(ww) of the Social Security Act (42 U.S.C. 1395x(ww)) is amended—</text><paragraph id="idD0B86D236BB9414989DA0BE137A3D283"><enum>(1)</enum><text>in paragraph (1)—</text><subparagraph id="idAE096698C00041EDB52A484718EE6BD4"><enum>(A)</enum><text>by striking <quote>paragraph (2) and</quote> and inserting <quote>paragraph (2),</quote>; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idB681CF66D0814E6C9A53A39538C9DE45"><enum>(B)</enum><text>by inserting <quote>and the furnishing of a review of any current opioid prescriptions (as defined in paragraph (4)),</quote> after ‘‘upon the agreement with the individual,”; and</text></subparagraph></paragraph><paragraph id="id2009C4447F574CDAB9F3452819DAE539"><enum>(2)</enum><text>in paragraph (2)—</text><subparagraph id="id2d09669bc09e46168b37b0c3dc8d9f55"><enum>(A)</enum><text>by redesignating subparagraph (N) as subparagraph (O); and</text></subparagraph><subparagraph id="idAC72B389D96F46F7AF34070E2FA9BBB9"><enum>(B)</enum><text>by inserting after subparagraph (M) the following new subparagraph:</text><quoted-block display-inline="no-display-inline" id="idB837BBF00B484E55BF83F54E830E6760" style="OLC"><subparagraph commented="no" display-inline="no-display-inline" id="idF753BDA1677E4002B3BB5D4799B0AD3F"><enum>(N)</enum><text>Screening for potential substance use disorders.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id998A397C5B8A4E2AB211FD53B796CD01"><enum>(3)</enum><text>by adding at the end the following new paragraph:</text><quoted-block display-inline="no-display-inline" id="idC887A73C399D43958A784B8EF551283B" style="OLC"><paragraph id="HA9C84C62ACA94AB0BB13240BB466D1BA" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">For purposes of paragraph (1), the term <quote>a review of any current opioid prescriptions</quote> means, with respect to an individual determined to have a current prescription for opioids—</text><subparagraph id="H7920D409073E4D648E7A8DDA781230DA"><enum>(A)</enum><text display-inline="yes-display-inline">a review of the potential risk factors to the individual for opioid use disorder;</text></subparagraph><subparagraph id="H59A67BA6828A4498BB10684A966C5101"><enum>(B)</enum><text display-inline="yes-display-inline">an evaluation of the individual's severity of pain and current treatment plan;</text></subparagraph><subparagraph id="H36BA9DB753804B8D92E74B1934446435"><enum>(C)</enum><text display-inline="yes-display-inline">the provision of information on non-opioid treatment options; and</text></subparagraph><subparagraph id="HEAF9AC1A394645529DD001543F3A9D6F"><enum>(D)</enum><text display-inline="yes-display-inline">a referral to a pain management specialist, as appropriate.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="id83FF05F110D34F6583D39CC95C580DCF"><enum>(b)</enum><header>Annual wellness visit</header><text>Section 1861(hhh)(2) of the Social Security Act (42 U.S.C. 1395x(hhh)(2)) is amended—</text><paragraph id="id0F28973DCF714627BB6B3956D9DA9E3D"><enum>(1)</enum><text>by redesignating subparagraph (G) as subparagraph (I); and</text></paragraph><paragraph id="id5E520E7755DA4DEC939259FF99A8B75C"><enum>(2)</enum><text>by inserting after subparagraph (F) the following new subparagraphs:</text><quoted-block display-inline="no-display-inline" id="id6E68FC5259D6463EA7CC773077139117" style="OLC"><subparagraph id="id3E8FF2E0DDD0405FBA4DBDC00DBFF6C2"><enum>(G)</enum><text>Screening for potential substance use disorders and referral for treatment as appropriate.</text></subparagraph><subparagraph id="idF5C36D725534457D857E9D8DDC327FDE"><enum>(H)</enum><text>The furnishing of a review of any current opioid prescriptions (as defined in subsection (ww)(4)).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idECEBE50A93A344DA8AC958150AC228F6"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section shall apply to examinations and visits furnished on or after January 1, 2019.</text></subsection></section><section id="H510CEEE09566494E960ED25E1A221B11"><enum>2104.</enum><header>Every prescription conveyed securely</header><subsection id="HB37C7E67778843B6AF7CA5532B3884EE"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1860D–4(e) of the Social Security Act (42 U.S.C. 1395w–104(e)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="HD3DBF02CF4D9443B940F24688B069551" style="OLC"><paragraph id="H85CACB84F7D947D0BFB63E873920BE59"><enum>(7)</enum><header>Requirement of e-prescribing for controlled substances</header><subparagraph id="H38569435E30943E29F193808B52505C7"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to subparagraph (B), a prescription for a covered part D drug under a prescription drug plan (or under an MA–PD plan) for a schedule II, III, IV, or V controlled substance shall be transmitted by a health care practitioner electronically in accordance with an electronic prescription drug program that meets the requirements of paragraph (2).</text></subparagraph><subparagraph id="H0678534E43504C609426C4108633C1A2"><enum>(B)</enum><header>Exception for certain circumstances</header><text display-inline="yes-display-inline">The Secretary shall, through rulemaking, specify circumstances and processes by which the Secretary may waive the requirement under subparagraph (A), with respect to a covered part D drug, including in the case of—</text><clause id="HAE1AA34270C44ACAA7B5F479B9671422"><enum>(i)</enum><text display-inline="yes-display-inline">a prescription issued when the practitioner and dispensing pharmacy are the same entity;</text></clause><clause id="HAF2236104BE14FEA8AFFC083F65FD08F"><enum>(ii)</enum><text>a prescription issued that cannot be transmitted electronically under the most recently implemented version of the National Council for Prescription Drug Programs SCRIPT Standard;</text></clause><clause id="H3A9A7294F4984AFAA73DF1FDD6DBF131"><enum>(iii)</enum><text>a prescription issued by a practitioner who received a waiver or a renewal thereof for a period of time as determined by the Secretary, not to exceed one year, from the requirement to use electronic prescribing due to demonstrated economic hardship, technological limitations that are not reasonably within the control of the practitioner, or other exceptional circumstance demonstrated by the practitioner;</text></clause><clause id="H10B88C0F60D84316A9294D346473FD41"><enum>(iv)</enum><text>a prescription issued by a practitioner under circumstances in which, notwithstanding the practitioner’s ability to submit a prescription electronically as required by this subsection, such practitioner reasonably determines that it would be impractical for the individual involved to obtain substances prescribed by electronic prescription in a timely manner, and such delay would adversely impact the individual’s medical condition involved;</text></clause><clause id="HB1479979658A4357839951A58709C61A"><enum>(v)</enum><text>a prescription issued by a practitioner prescribing a drug under a research protocol;</text></clause><clause id="H7D77A1AE3ED9459AAA0834725DD1C9DB"><enum>(vi)</enum><text display-inline="yes-display-inline">a prescription issued by a practitioner for a drug for which the Food and Drug Administration requires a prescription to contain elements that are not able to be included in electronic prescribing such as, a drug with risk evaluation and mitigation strategies that include elements to assure safe use;</text></clause><clause commented="no" id="id4d353a0540054de19b588fd040b29a87"><enum>(vii)</enum><text>a prescription issued by a practitioner—</text><subclause commented="no" id="id7893806E843E49138E795B5C362B8407"><enum>(I)</enum><text>for an individual who receives hospice care under this title; and</text></subclause><subclause commented="no" id="idDF14E75B23F44087AE1EFD649D8E7C46"><enum>(II)</enum><text>that is not covered under the hospice benefit under this title; and</text></subclause></clause><clause commented="no" id="idccd2cad740c44b1b931c96b51d720617"><enum>(viii)</enum><text>a prescription issued by a practitioner for an individual who is—</text><subclause commented="no" id="idB3FC73F9403D4F84A9E28901C8E0A7D8"><enum>(I)</enum><text>a resident of a nursing facility (as defined in section 1919(a)); and</text></subclause><subclause commented="no" id="id2D1D3441E7AA4D0CA9BDC2A45536206D"><enum>(II)</enum><text>dually eligible for benefits under this title and title XIX.</text></subclause></clause></subparagraph><subparagraph id="HB22F5C732CEA4CC29D1D61B76556CC19"><enum>(C)</enum><header>Dispensing</header><clause commented="no" display-inline="yes-display-inline" id="idA2033CC3CE394685A40997124C57FCE7"><enum>(i)</enum><text display-inline="yes-display-inline">Nothing in this paragraph shall be construed as requiring a sponsor of a prescription drug plan under this part, MA organization offering an MA–PD plan under part C, or a pharmacist to verify that a practitioner, with respect to a prescription for a covered part D drug, has a waiver (or is otherwise exempt) under subparagraph (B) from the requirement under subparagraph (A).</text></clause><clause id="id469783D2044A404BAD19758257534F1C" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">Nothing in this paragraph shall be construed as affecting the ability of the plan to cover or the pharmacists’ ability to continue to dispense covered part D drugs from otherwise valid written, oral or fax prescriptions that are consistent with laws and regulations.</text></clause><clause id="id92A8B69091C34ECFABC6DD0D7D2EFA4A" indent="up1"><enum>(iii)</enum><text display-inline="yes-display-inline">Nothing in this paragraph shall be construed as affecting the ability of an individual who is being prescribed a covered part D drug to designate a particular pharmacy to dispense the covered part D drug to the extent consistent with the requirements under subsection (b)(1) and under this paragraph.</text></clause></subparagraph><subparagraph id="H1D7B9DBB0AC142208B6E00D0DAC8F05E"><enum>(D)</enum><header>Enforcement</header><text display-inline="yes-display-inline">The Secretary shall, through rulemaking, have authority to enforce and specify appropriate penalties for non-compliance with the requirement under subparagraph (A).</text></subparagraph></paragraph><after-quoted-block>. </after-quoted-block></quoted-block></subsection><subsection commented="no" display-inline="no-display-inline" id="HA664FF55FEC244E3AFA440E6779C7FAD"><enum>(b)</enum><header>Effective date</header><text>The amendment made by subsection (a) shall apply to coverage of drugs prescribed on or after January 1, 2021.</text></subsection></section><section commented="no" display-inline="no-display-inline" id="idE86F9C3576A9473A987ED3394A8B4C2B" section-type="subsequent-section"><enum>2105.</enum><header display-inline="yes-display-inline">Standardizing electronic prior authorization for safe prescribing</header><text display-inline="no-display-inline">Section 1860D–4(e)(2) of the Social Security Act (42 U.S.C. 1395w–104(e)(2)) is amended by adding at the end the following new subparagraph:</text><quoted-block display-inline="no-display-inline" id="idEDC9C88C9F0A4624AC541AC7192E2FDF" style="OLC"><subparagraph id="id1E3FDACE4ABE4EBE8954DE939977235E"><enum>(E)</enum><header>Electronic prior authorization</header><clause id="idE361590F044B42088768A03F54AA781D"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than January 1, 2021, the program shall provide for the secure electronic transmittal of—</text><subclause id="id88191697EF1B448AA5BD1B0EE055C054"><enum>(I)</enum><text>a prior authorization request from the prescribing health care professional for coverage of a covered part D drug for a part D eligible individual enrolled in a part D plan (as defined in section 1860D–23(a)(5)) to the PDP sponsor or Medicare Advantage organization offering such plan; and</text></subclause><subclause id="id2D85F234C4C74A139298E99628E1ECB2"><enum>(II)</enum><text>a response, in accordance with this subparagraph, from such PDP sponsor or Medicare Advantage organization, respectively, to such professional.</text></subclause></clause><clause id="id27D70E6740384C519F055AB3DA56D251"><enum>(ii)</enum><header>Electronic transmission</header><subclause id="id306F4F6284FF4CAEBCCDA237AE647812"><enum>(I)</enum><header>Exclusions</header><text>For purposes of this subparagraph, a facsimile, a proprietary payer portal that does not meet standards specified by the Secretary, or an electronic form shall not be treated as an electronic transmission described in clause (i).</text></subclause><subclause id="id883E80EC4AC942F4B8F45EB73597552D"><enum>(II)</enum><header>Standards</header><text display-inline="yes-display-inline">In order to be treated, for purposes of this subparagraph, as an electronic transmission described in clause (i), such transmission shall comply with technical standards adopted by the Secretary in consultation with the National Council for Prescription Drug Programs, other standard setting organizations determined appropriate by the Secretary, and stakeholders including PDP sponsors, Medicare Advantage organizations, health care professionals, and health information technology software vendors.</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id78b3bf02105f4190911d48400fd1bd0b"><enum>(III)</enum><header>Application</header><text>Notwithstanding any other provision of law, for purposes of this subparagraph, the Secretary may require the use of such standards adopted under subclause (II) in lieu of any other applicable standards for an electronic transmission described in clause (i) for a covered part D drug for a part D eligible individual.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id839E780E05174BD7B3618859CC2B3184"><enum>2106.</enum><header>Strengthening partnerships to prevent opioid abuse</header><subsection id="H0E3A61EBA18E453C93FE50F44D135E3A"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1859 of the Social Security Act (42 U.S.C. 1395w–28) is amended by adding at the end the following new subsection:</text><quoted-block display-inline="no-display-inline" id="H3CA4345286924D0EA0385AC7E0A145EF" style="OLC"><subsection id="HE4767EFAE6224C0B9C8133EF32B8F837"><enum>(i)</enum><header>Program integrity transparency measures</header><paragraph id="HB014EFD5FF294FB8AC27EC2C2F77B94F"><enum>(1)</enum><header>Program integrity portal</header><subparagraph id="H355137621EA14977A2DA0D23A96BCE37"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 2 years after the date of the enactment of this subsection, the Secretary shall, after consultation with stakeholders, establish a secure Internet website portal that would allow a secure path for communication between the Secretary, MA plans under this part, prescription drug plans under part D, and an eligible entity with a contract under section 1893 (such as a Medicare drug integrity contractor or any successor entity to a Medicare drug integrity contractor), in accordance with subsection (j)(3) of such section, for the purpose of enabling through such portal—</text><clause id="H509102672A384649BF03C0DCEB285198"><enum>(i)</enum><text>the referral by such plans of suspicious activities of a provider of services (including a prescriber) or supplier related to fraud, waste, and abuse for initiating or assisting investigations conducted by the eligible entity; and</text></clause><clause id="HC4821DCC6371429498000DDC42D81B1E"><enum>(ii)</enum><text>data sharing among such MA plans, prescription drug plans, and the Secretary.</text></clause></subparagraph><subparagraph id="HA59B06DB6AE44B2ABC8EB6D1FF1128F4"><enum>(B)</enum><header>Required uses of portal</header><text display-inline="yes-display-inline">The Secretary shall disseminate the following information to MA plans under this part and prescription drug plans under part D through the secure Internet website portal established under subparagraph (A):</text><clause commented="no" id="HB43189B2C1B542079FD493819666CFDE"><enum>(i)</enum><text display-inline="yes-display-inline">Providers of services and suppliers that have been referred pursuant to subparagraph (A)(i) during the previous 12-month period.</text></clause><clause id="H314380632F9D4078A171A2F3600D8FC5"><enum>(ii)</enum><text>Providers of services and suppliers who are the subject of an active exclusion under section 1128 or who are subject to a suspension of payment under this title pursuant to section 1862(o) or otherwise.</text></clause><clause commented="no" id="H56BF8F5DB7A64C8C817DB730466B2E29"><enum>(iii)</enum><text>Providers of services and suppliers who are the subject of an active revocation of participation under this title, including for not satisfying conditions of participation.</text></clause><clause id="H3B27F171D8DB47C893E73781CA876385"><enum>(iv)</enum><text>In the case of such a plan that makes a referral under subparagraph (A)(i) through the portal with respect to suspicious activities of a provider of services (including a prescriber) or supplier, if such provider (or prescriber) or supplier has been the subject of an administrative action under this title or title XI with respect to similar activities, a notification to such plan of such action so taken.</text></clause></subparagraph><subparagraph id="H6115EBDF2135445C946D57D38A528AD7"><enum>(C)</enum><header>Rulemaking</header><text>For purposes of this paragraph, the Secretary shall, through rulemaking, specify what constitutes suspicious activities related to fraud, waste, and abuse, using guidance such as what is provided in the Medicare Program Integrity Manual 4.7.1.</text></subparagraph></paragraph><paragraph id="HE2B9907D3B874405A86502F0A539F857"><enum>(2)</enum><header>Quarterly reports</header><text display-inline="yes-display-inline">Beginning not later than 2 years after the date of the enactment of this subsection, the Secretary shall make available to MA plans under this part and prescription drug plans under part D in a timely manner (but no less frequently than quarterly) and using information submitted to an entity described in paragraph (1) through the portal described in such paragraph or pursuant to section 1893, information on fraud, waste, and abuse schemes and trends in identifying suspicious activity. Information included in each such report shall—</text><subparagraph id="HDD10E0362BBB4CB6AE21EBED1FA6C9C0"><enum>(A)</enum><text>include administrative actions, pertinent information related to opioid overprescribing, and other data determined appropriate by the Secretary in consultation with stakeholders; and</text></subparagraph><subparagraph id="H46D4B1E734154D9EA04858F3505A447A"><enum>(B)</enum><text>be anonymized information submitted by plans without identifying the source of such information.</text></subparagraph></paragraph><paragraph id="id3276F180F7F046D480E905252664C013"><enum>(3)</enum><header>Clarification</header><text>Nothing in this subsection shall preclude or otherwise affect referrals to the Inspector General of the Department of Health and Human Services or other law enforcement entities.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="HF9532DA9972547289BBDCB4476BB2818"><enum>(b)</enum><header>Contract requirement to communicate plan corrective actions against opioids over-prescribers</header><text display-inline="yes-display-inline">Section 1857(e)(4)(C) of the Social Security Act (42 U.S.C. 1395w–27(e)(4)(C)) is amended by adding at the end the following new paragraph:</text><quoted-block display-inline="no-display-inline" id="H1C1FB16511304151B19322C9398C8BB3" style="OLC"><paragraph id="H5AFD4CCC9E3740C38DFD3366A9FB477B"><enum>(5)</enum><header>Communicating plan corrective actions against opioids over-prescribers</header><subparagraph id="H10ECA022BF5144C2B9DB858D8B5F1BC5"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Beginning with plan years beginning on or after January 1, 2021, a contract under this section with an MA organization shall require the organization to submit to the Secretary, through the process established under subparagraph (B), information on credible evidence of suspicious activities of a provider of services (including a prescriber) or supplier related to fraud and other actions taken by such plans related to inappropriate prescribing of opioids.</text></subparagraph><subparagraph id="HEAB860E5033243919509417E330E2B42"><enum>(B)</enum><header>Process</header><text display-inline="yes-display-inline">Not later than January 1, 2021, the Secretary shall, in consultation with stakeholders, establish a process under which MA plans and prescription drug plans shall submit to the Secretary information described in subparagraph (A).</text></subparagraph><subparagraph id="H608B1E722F184858B534303F64DD283E"><enum>(C)</enum><header>Regulations</header><text display-inline="yes-display-inline">For purposes of this paragraph, including as applied under section 1860D–12(b)(3)(D), the Secretary shall, pursuant to rulemaking—</text><clause id="HEBEF529E8A8B40F3B1965A821DCD77A9"><enum>(i)</enum><text>specify a definition for the term <quote>inappropriate prescribing of opioids</quote> and a method for determining if a provider of services prescribes such a high volume; and</text></clause><clause id="H6691C981214C480ABDCCEDD3B60A3153"><enum>(ii)</enum><text>establish the process described in subparagraph (B) and the types of information that may be submitted through such process.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H20E42A3AF6B349A597970F215AC91B36"><enum>(c)</enum><header>Reference under part D to program integrity transparency measures</header><text display-inline="yes-display-inline">Section 1860D–4 of the Social Security Act (42 U.S.C. 1395w–104) is amended by adding at the end the following new subsection:</text><quoted-block display-inline="no-display-inline" id="HEEDC1B44C71941C9A8243B7C0EFA6A19" style="OLC"><subsection commented="no" display-inline="no-display-inline" id="H0865FADDB68D46BB9E6948017BF2ECB4"><enum>(m)</enum><header>Program integrity transparency measures</header><text display-inline="yes-display-inline">For program integrity transparency measures applied with respect to prescription drug plan and MA plans, see section 1859(i).</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="id3200CC12AABE4694AFFBC61EC1AFE07A" section-type="subsequent-section"><enum>2107.</enum><header>Commit to opioid medical prescriber accountability and safety for seniors</header><text display-inline="no-display-inline">Section 1860D–4(c)(4) of the Social Security Act (42 U.S.C. 1395w–104(c)(4)) is amended by adding at the end the following new subparagraph:</text><quoted-block display-inline="no-display-inline" id="idAE13C314E21B422884157409DC4F6976" style="OLC"><subparagraph id="H9E6E69A8390943409646D9B1144C3A5E"><enum>(D)</enum><header>Notification and additional requirements with respect to statistical outlier prescribers of opioids</header><clause id="H1A1B1F1C31674D27B12AAF283B324D12"><enum>(i)</enum><header>Notification</header><text display-inline="yes-display-inline">Not later than January 1, 2021, the Secretary shall, in the case of a prescriber identified by the Secretary under clause (ii) to be a statistical outlier prescriber of opioids, provide, subject to clause (iv), an annual notification to such prescriber that such prescriber has been so identified that includes resources on proper prescribing methods and other information as specified in accordance with clause (iii).</text></clause><clause id="H54FD8C7F1B5C4A1598093BC1FEFF131C"><enum>(ii)</enum><header>Identification of statistical outlier prescribers of opioids</header><subclause id="HCB01222655CC44E6972D1815F1A56AC7"><enum>(I)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall, subject to subclause (III), using the valid prescriber National Provider Identifiers included pursuant to subparagraph (A) on claims for covered part D drugs for part D eligible individuals enrolled in prescription drug plans under this part or MA–PD plans under part C and based on the thresholds established under subclause (II), identify prescribers that are statistical outlier opioids prescribers for a period of time specified by the Secretary.</text></subclause><subclause id="H60F739BCCFA847D0A27FAAAFE7D5D7D4"><enum>(II)</enum><header>Establishment of thresholds</header><text display-inline="yes-display-inline">For purposes of subclause (I) and subject to subclause (III), the Secretary shall, after consultation with stakeholders, establish thresholds, based on prescriber specialty and, as determined appropriate by the Secretary, geographic area, for identifying whether a prescriber in a specialty and geographic area is a statistical outlier prescriber of opioids as compared to other prescribers of opioids within such specialty and area.</text></subclause><subclause id="H2B6FA6BCBF314204B8DFAE068E7A0292"><enum>(III)</enum><header>Exclusions</header><text display-inline="yes-display-inline">The following shall not be included in the analysis for identifying statistical outlier prescribers of opioids under this clause:</text><item id="H64CA82D637D2497490437032652782FF"><enum>(aa)</enum><text>Claims for covered part D drugs for part D eligible individuals who are receiving hospice care under this title.</text></item><item id="HDF97C8F7414D4966AFC10429DD1C17C2"><enum>(bb)</enum><text>Claims for covered part D drugs for part D eligible individuals who are receiving oncology services under this title.</text></item><item id="HFCAB5BF9D8FF4B779A8AFAAE964C25F2"><enum>(cc)</enum><text>Prescribers who are the subject of an investigation by the Centers for Medicare & Medicaid Services or the Inspector General of the Department of Health and Human Services.</text></item></subclause></clause><clause id="HA5594CEBA2A041D78A6D119ECA7C1591"><enum>(iii)</enum><header>Contents of notification</header><text>The Secretary shall include the following information in the notifications provided under clause (i):</text><subclause id="iddd0e7d39df8c443dbd4c25e544eb6c56"><enum>(I)</enum><text>Information on how such prescriber compares to other prescribers within the same specialty and, if determined appropriate by the Secretary, geographic area.</text></subclause><subclause id="idCF809123518C4D9AB7284C28F7F6BC45"><enum>(II)</enum><text>Information on opioid prescribing guidelines, based on input from stakeholders, that may include the Centers for Disease Control and Prevention guidelines for prescribing opioids for chronic pain and guidelines developed by physician organizations.</text></subclause><subclause id="id22dd7820191542759d7ce03c1fac7341"><enum>(III)</enum><text>Other information determined appropriate by the Secretary.</text></subclause></clause><clause id="H1891458C31E04889877C3E858AE0F944"><enum>(iv)</enum><header>Modifications and expansions</header><subclause id="H0053EBF48B5E49629D6C4DAF371DAC8A"><enum>(I)</enum><header>Frequency</header><text display-inline="yes-display-inline">Beginning 5 years after the date of the enactment of this subparagraph, the Secretary may change the frequency of the notifications described in clause (i) based on stakeholder input and changes in opioid prescribing utilization and trends.</text></subclause><subclause id="H7D001E4F987546C883E02B4DB6B414A6"><enum>(II)</enum><header>Expansion to other prescriptions</header><text display-inline="yes-display-inline">The Secretary may expand notifications under this subparagraph to include identifications and notifications with respect to concurrent prescriptions of covered Part D drugs used in combination with opioids that are considered to have adverse side effects when so used in such combination, as determined by the Secretary.</text></subclause></clause><clause commented="no" display-inline="no-display-inline" id="idD25D5444C483496B9CA9E3B138F9132B"><enum>(v)</enum><header>Additional requirements for persistent statistical outlier prescribers</header><text>In the case of a prescriber who the Secretary determines is persistently identified under clause (ii) as a statistical outlier prescriber of opioids, the following shall apply:</text><subclause id="id9a0a8aa5430e40b58dc16a2381d86f9a"><enum>(I)</enum><text>The Secretary shall provide an opportunity for such prescriber to receive technical assistance or educational resources on opioid prescribing guidelines (such as the guidelines described in clause (iii)(II)) from an entity that furnishes such assistance or resources, which may include a quality improvement organization under part B of title XI, as available and appropriate.</text></subclause><subclause id="idee1e47ea26fa4c9cbf0f449f5fbe4c54"><enum>(II)</enum><text>Such prescriber may be required to enroll in the program under this title under section 1866(j) if such prescriber is not otherwise required to enroll. The Secretary shall determine the length of the period for which such prescriber is required to maintain such enrollment.</text></subclause><subclause id="idcb47907e2c2240ae9fa017f50dad8dcb"><enum>(III)</enum><text>Not less frequently than annually (and in a form and manner determined appropriate by the Secretary), the Secretary shall communicate information on such prescribers to sponsors of a prescription drug plan and Medicare Advantage organizations offering an MA–PD plan.</text></subclause></clause><clause id="ide112d498bb6346c1b4831605e5292569"><enum>(vi)</enum><header>Public availability of information</header><text>The Secretary shall make aggregate information under this subparagraph available on the Internet website of the Centers for Medicare & Medicaid Services. Such information shall be in a form and manner determined appropriate by the Secretary and shall not identify any specific prescriber. In carrying out this clause, the Secretary shall consult with interested stakeholders.</text></clause><clause commented="no" display-inline="no-display-inline" id="H85CCC563B2D549079ACD2759104E90BC"><enum>(vii)</enum><header>Opioids defined</header><text>For purposes of this subparagraph, the term <quote>opioids</quote> has such meaning as specified by the Secretary.</text></clause><clause commented="no" display-inline="no-display-inline" id="id66EDAEB6966E4F659424C6BADBD7A7D0"><enum>(viii)</enum><header>Other activities</header><text>Nothing in this subparagraph shall preclude the Secretary from conducting activities that provide prescribers with information as to how they compare to other prescribers that are in addition to the activities under this subparagraph, including activities that were being conducted as of the date of the enactment of this subparagraph.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id405DEC1AFE354D4D85A1693BF44F7B6F"><enum>2108.</enum><header>Fighting the opioid epidemic with sunshine</header><subsection id="idDAC44ACB8FC8489DB4371B6CE6F52CA4"><enum>(a)</enum><header>Inclusion of information regarding payments to advance practice nurses</header><paragraph id="id29CC3437AB414BB488851408A16EA662"><enum>(1)</enum><header>In general</header><text>Section 1128G(e)(6) of the Social Security Act (42 U.S.C. 1320a–7h(e)(6)) is amended—</text><subparagraph id="id0DF9B12BF7DC4CCBA3FF2D00AC58575E"><enum>(A)</enum><text>in subparagraph (A), by adding at the end the following new clauses:</text><quoted-block act-name="" id="idDD26480B5C8741B9B172AE8872C4CDF6" style="OLC"><clause id="id554C9FCC5DB54DEA91829439B8853787"><enum>(iii)</enum><text>A physician assistant, nurse practitioner, or clinical nurse specialist (as such terms are defined in section 1861(aa)(5)).</text></clause><clause id="id6F71A4C75A0F40559EE6ADC061B35CC5"><enum>(iv)</enum><text>A certified registered nurse anesthetist (as defined in section 1861(bb)(2)).</text></clause><clause id="id1958B2F1E4DB4090AA2BCF144DD05107"><enum>(v)</enum><text>A certified nurse-midwife (as defined in section 1861(gg)(2)).</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph><subparagraph id="id542F87E18D944013989EDB385E7AFCAD"><enum>(B)</enum><text>in subparagraph (B), by inserting <quote>, physician assistant, nurse practitioner, clinical nurse specialist, certified nurse anesthetist, or certified nurse-midwife</quote> after <quote>physician</quote>.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id27AC2DAC676B449980A350803BDCB3A2"><enum>(2)</enum><header>Effective date</header><text>The amendments made by this subsection shall apply with respect to information required to be submitted under section 1128G of the Social Security Act (42 U.S.C. 1320a–7h) on or after January 1, 2022.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id3DB225D6A5D84797B76FFD661470709B"><enum>(b)</enum><header display-inline="yes-display-inline">Sunset of exclusion of National Provider Identifier of covered recipient in information made publicly available</header><text display-inline="yes-display-inline">Section 1128G(c)(1)(C)(viii) of the Social Security Act (42 U.S.C. 1320a–7h(c)(1)(C)(viii))) is amended by striking <quote>does not contain</quote> and inserting <quote>in the case of information made available under this subparagraph prior to January 1, 2022, does not contain</quote>.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="idACC68E0B90C340AF8517A38576C7C41A"><enum>(c)</enum><header>Administration</header><text display-inline="yes-display-inline">Chapter 35 of title 44, United States Code, shall not apply to this section or the amendments made by this section.</text></subsection></section><section id="id6CB33800A7554D588582DA0FB0A8F893"><enum>2109.</enum><header>Demonstration testing coverage of certain services furnished by opioid treatment programs</header><text display-inline="no-display-inline">Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by inserting after section 1866E the following:</text><quoted-block display-inline="no-display-inline" id="id960BE59182864EC79BA259E164662145" style="traditional"><section commented="no" display-inline="no-display-inline" id="ID5B7217E277A0498E9FEB18D405FF6241" section-type="subsequent-section"><enum>1866F.</enum><header>Demonstration testing coverage of certain services furnished by opioid treatment programs</header><subsection commented="no" display-inline="yes-display-inline" id="IDB89C76721A7646A1BDD800C9DBF8059D"><enum>(a)</enum><header>Establishment</header><paragraph id="IDD1A4415B3DF44FE8959E3FD5ED9019BD"><enum>(1)</enum><header>In general</header><text>The Secretary shall conduct a demonstration (in this section referred to as the <quote>demonstration</quote>) to test coverage of and payment for opioid use disorder treatment services (as defined in paragraph (2)(B)) furnished by opioid treatment programs (as defined in paragraph (2)(A)) to individuals under part B using a bundled payment as described in paragraph (3).</text></paragraph><paragraph id="idC24F848EACCC4E7287DC8C8FB78A9E2D"><enum>(2)</enum><header>Definitions</header><text>In this section:</text><subparagraph id="H1C2A6587C11C478E88642D58CF1AB370"><enum>(A)</enum><header>Opioid treatment program</header><text display-inline="yes-display-inline">The term <term>opioid treatment program</term> means an entity that is an opioid treatment program (as defined in section 8.2 of title 42 of the Code of Federal Regulations, or any successor regulation) that—</text><clause id="H6BDDEC050ACA458CBC8594EB6D03A88B"><enum>(i)</enum><text display-inline="yes-display-inline">is selected for participation in the demonstration;</text></clause><clause id="H614672F02EC74DFD9FDD88F308C4E104"><enum>(ii)</enum><text>has in effect a certification by the Substance Abuse and Mental Health Services Administration for such a program;</text></clause><clause id="H37304426849B4E429E5E90B9D2A60A00"><enum>(iii)</enum><text>is accredited by an accrediting body approved by the Substance Abuse and Mental Health Services Administration;</text></clause><clause id="idEF5EE417F8F1426BB19A75A73DB1DBE1"><enum>(iv)</enum><text>submits to the Secretary data and information needed to monitor the quality of services furnished and conduct the evaluation described in subsection (c); and</text></clause><clause id="H52DD6AFA45784930989C5FB9489CC313"><enum>(v)</enum><text>meets such additional requirements as the Secretary may find necessary.</text></clause></subparagraph><subparagraph id="H96685764309F40C0A2F057C705A125AA"><enum>(B)</enum><header>Opioid use disorder treatment services</header><text display-inline="yes-display-inline">The term <term>opioid use disorder treatment services</term> means items and services that are furnished by an opioid treatment program for the treatment of opioid use disorder, including—</text><clause id="HF8AA0A1BBC584973AE543B989156383D"><enum>(i)</enum><text display-inline="yes-display-inline">opioid agonist and antagonist treatment medications (including oral, injected, or implanted versions) that are approved by the Food and Drug Administration under section 505 of the Federal Food, Drug and Cosmetic Act for use in the treatment of opioid use disorder;</text></clause><clause id="H6BED2373BA0146038371FD83CFB2F7D8"><enum>(ii)</enum><text display-inline="yes-display-inline">dispensing and administration of such medications, if applicable;</text></clause><clause id="HA9449AA17EC444209EBFB866F03E5CCB"><enum>(iii)</enum><text display-inline="yes-display-inline">substance use counseling by a professional to the extent authorized under State law to furnish such services;</text></clause><clause id="H46FBF99BB63B4C1CA9276335A44B0A2E"><enum>(iv)</enum><text display-inline="yes-display-inline">individual and group therapy with a physician or psychologist (or other mental health professional to the extent authorized under State law);</text></clause><clause id="HB715107B33C2478E81E3E1622BE730DC"><enum>(v)</enum><text display-inline="yes-display-inline">toxicology testing; and</text></clause><clause id="H761F38E2D2AB4D95885FDB0615E118C1"><enum>(vi)</enum><text display-inline="yes-display-inline">other items and services that the Secretary determines are appropriate (but in no case to include meals or transportation).</text></clause></subparagraph></paragraph><paragraph id="H8DA1E68ADB0848538B36E6C2C48DF5E1"><enum>(3)</enum><header>Bundled payment under part B</header><subparagraph id="id80091B11DC4E4A57ADDDE9BB2F0F0C41"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall pay, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, to an opioid treatment program participating in the demonstration a bundled payment as determined by the Secretary for opioid use disorder treatment services that are furnished by such treatment program to an individual under part B during an episode of care (as defined by the Secretary).</text></subparagraph><subparagraph id="H96332F7C526142DC8E9BD8F00A6B963F"><enum>(B)</enum><header>Considerations</header><text display-inline="yes-display-inline">The Secretary may implement this paragraph through one or more bundles based on the type of medication provided (such as buprenorphine, methadone, naltrexone, or a new innovative drug), the frequency of services furnished, the scope of services furnished, characteristics of the individuals furnished such services, or other factors as the Secretary determines appropriate. In developing such bundles, the Secretary may consider payment rates paid to opioid treatment programs for comparable services under State plans under title XIX or under the TRICARE program under chapter 55 of title 10 of the United States Code.</text></subparagraph></paragraph></subsection><subsection id="id57D92AE6516A42F792E457CAF14B4A91"><enum>(b)</enum><header>Implementation</header><paragraph id="idA9C1CEAC1C494F86A448AA74B9401863"><enum>(1)</enum><header>Duration</header><text>The demonstration shall be conducted for a period of 5 years, beginning not later than January 1, 2021.</text></paragraph><paragraph id="id09B3F65E33A54CD19E6BD922455ED8A0"><enum>(2)</enum><header>Scope</header><text>In carrying out the demonstration, the Secretary shall limit the number of beneficiaries that may participate at any one time in the demonstration to 2,000.</text></paragraph><paragraph id="ID6352E938AD1C4CDFAC28D41407332285"><enum>(3)</enum><header>Waiver</header><text>The Secretary may waive such provisions of this title and title XI as the Secretary determines necessary in order to implement the demonstration.</text></paragraph><paragraph id="IDD9ED09A4AC504C49951C4C2BEC8AE13B"><enum>(4)</enum><header>Administration</header><text>Chapter 35 of title 44, United States Code, shall not apply to this section.</text></paragraph></subsection><subsection id="id9B6481E76F9F43AAA50295486460081E"><enum>(c)</enum><header>Evaluation and report</header><paragraph id="idBCE5CEDCADDC4BC1A45DE906D6EBBD92"><enum>(1)</enum><header>Evaluation</header><text>The Secretary shall conduct an evaluation of the demonstration. Such evaluation shall include analyses of—</text><subparagraph id="id49F7762CA56A42919F841314A9A1D4F5"><enum>(A)</enum><text>the impact of the demonstration on—</text><clause id="idDD57387D6C794DCFB7AC5EB44E913A30"><enum>(i)</enum><text>utilization of health care items and services related to opioid use disorder, including hospitalizations and emergency department visits;</text></clause><clause id="id5293BADB4B344CCAAD6FBD5DF431EF56"><enum>(ii)</enum><text>beneficiary health outcomes related to opioid use disorder, including opioid overdose deaths; and</text></clause><clause id="idC8C9CA55EF48459D8A3EC99CF68394DB"><enum>(iii)</enum><text>overall expenditures under this title; and</text></clause></subparagraph><subparagraph id="idAF083E47A5F644B7B7EF6DFB15A30DA8"><enum>(B)</enum><text>the performance of opioid treatment programs participating in the demonstration with respect to applicable quality and cost metrics, including whether any additional quality measures related to opioid use disorder treatment are needed with respect to such programs under this title.</text></subparagraph></paragraph><paragraph id="id43D62906D316442AADE057E1752866A5"><enum>(2)</enum><header>Report</header><text>Not later than 2 years after the completion of the demonstration, the Secretary shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.</text></paragraph></subsection><subsection commented="no" id="idA8A9EBE076294821AEACF5E24F39EACE"><enum>(d)</enum><header>Funding</header><text>For purposes of administering and carrying out the demonstration, in addition to funds otherwise appropriated, there shall be transferred to the Secretary for the Center for Medicare & Medicaid Services Program Management Account from the Federal Supplementary Medical Insurance Trust Fund under section 1841 $5,000,000, to remain available until expended.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="idE60EA3EA89834ECFA955116CCCAFC5F6"><enum>2110.</enum><header>Encouraging appropriate prescribing under Medicare for victims of opioid overdose</header><text display-inline="no-display-inline">Section 1860D–4(c)(5)(C) of the Social Security Act (42 U.S.C. 1395w–104(c)(5)(C)) is amended—</text><paragraph id="id1155AE9EE8D7462EBCD186ECFCBC17BA"><enum>(1)</enum><text display-inline="yes-display-inline">in clause (i), in the matter preceding subclause (I), by striking <quote>For purposes</quote> and inserting <quote>Except as provided in clause (v), for purposes</quote>; and</text></paragraph><paragraph id="id76EE969F93F44CCFAB753E73188B7992"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following new clause:</text><quoted-block display-inline="no-display-inline" id="idE961D28494C34A7DBDA570AD4D17251A" style="OLC"><clause id="id91CF12E4E726432DA53DF66812C1524C"><enum>(v)</enum><header>Treatment of enrollees with a history of opioid-related overdose</header><subclause id="id9D9FE222C1924375BAB1FAB691DDF4E4"><enum>(I)</enum><header>In general</header><text>For plan years beginning not later than January 1, 2021, a part D eligible individual who is not an exempted individual described in clause (ii) and who is identified under this clause as a part D eligible individual with a history of opioid-related overdose (as defined by the Secretary) shall be included as a potentially at-risk beneficiary for prescription drug abuse under the drug management program under this paragraph.</text></subclause><subclause id="id66F538CED67D4DC38CC4DAE7D22A7D17"><enum>(II)</enum><header>Identification and notice</header><text>For purposes of this clause, the Secretary shall—</text><item id="idE4B74ECA4BEB409B93F3F15F6456B4B1"><enum>(aa)</enum><text>identify part D eligible individuals with a history of opioid-related overdose (as so defined); and</text></item><item commented="no" display-inline="no-display-inline" id="id54D151B258B9401E933A0A97D155D87D"><enum>(bb)</enum><text>notify the PDP sponsor of the prescription drug plan in which such an individual is enrolled of such identification.</text></item></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><section id="id1AC4EB264DBA4E77BB96973E2736354A"><enum>2111.</enum><header>Automatic escalation to external review under a Medicare part D drug management program for at-risk beneficiaries</header><subsection id="id58072604669D4B3DBE76E2695DFFF6CA"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1860D–4(c)(5) of the Social Security Act (42 U.S.C. 1395ww–10(c)(5)) is amended—</text><paragraph id="idC9187EB7FFB6426899E46BB988F6999F"><enum>(1)</enum><text>in subparagraph (B), in each of clauses (ii)(III) and (iii)(IV), by striking <quote>and the option of an automatic escalation to external review</quote> and inserting <quote>, including notice that if on reconsideration a PDP sponsor affirms its denial, in whole or in part, the case shall be automatically forwarded to the independent, outside entity contracted with the Secretary for review and resolution</quote>; and</text></paragraph><paragraph id="id5E5B524AE3A848B2B1E50A301E50DB07"><enum>(2)</enum><text display-inline="yes-display-inline">in subparagraph (E), by striking <quote>and the option</quote> and all that follows and inserting the following: <quote>and if on reconsideration a PDP sponsor affirms its denial, in whole or in part, the case shall be automatically forwarded to the independent, outside entity contracted with the Secretary for review and resolution.</quote>.</text></paragraph></subsection><subsection id="id3C582A58306C49DF93FF05B992C5F002"><enum>(b)</enum><header>Effective date</header><text>The amendments made by subsection (a) shall apply beginning not later January 1, 2021.</text></subsection></section><section commented="no" display-inline="no-display-inline" id="id9F24F73BB74745D1AAD4FE9B288C5088" section-type="subsequent-section"><enum>2112.</enum><header display-inline="yes-display-inline">Testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology</header><text display-inline="no-display-inline">Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end the following new clause:</text><quoted-block display-inline="no-display-inline" id="id5569ADB70E6F4ED8B3A210E5B72B6076" style="OLC"><clause commented="no" display-inline="no-display-inline" id="id09A30D9690314FD18A82A65A9D52EB08"><enum>(xxv)</enum><text display-inline="yes-display-inline">Providing incentive payments to behavioral health providers for the adoption and use of certified electronic health record technology (as defined in section 1848(o)(4)) to improve the quality and coordination of care through the electronic documentation and exchange of health information. Behavioral health providers may include—</text><subclause commented="no" display-inline="no-display-inline" id="id3EB5208DD8924E23BF2BBFD5A14EDCE2"><enum>(I)</enum><text display-inline="yes-display-inline">psychiatric hospitals (as defined in section 1861(f));</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id63FDA5D9E3F94FD3B5FBBD6CD64D4147"><enum>(II)</enum><text display-inline="yes-display-inline">community mental health centers (as defined in section 1861(ff)(3)(B));</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id2CA1A58624E6490290D889918586BA7E"><enum>(III)</enum><text display-inline="yes-display-inline">clinical psychologists (as defined in section 1861(ii));</text></subclause><subclause commented="no" display-inline="no-display-inline" id="idF2275399F2C34AEEBB5B2557D3996DD2"><enum>(IV)</enum><text display-inline="yes-display-inline">clinical social workers (as defined in section 1861(hh)(1)); and</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id61567F112B884B5ABFDA77393291BC2E"><enum>(V)</enum><text display-inline="yes-display-inline">hospitals, treatment facilities, and mental health or substance use disorder providers that participate in a State plan under title XIX or a waiver of such plan.</text></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id5fe49fdb101a49c89569d707872bdb00"><enum>2113.</enum><header>Medicare Improvement Fund</header><text display-inline="no-display-inline">Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)) is amended by striking <quote>fiscal year 2021, $0</quote> and inserting <quote>fiscal year 2024, $65,000,000</quote>.</text></section></subtitle><subtitle id="id2F7B36A5F2E44C969A6E24EA1174AECB" style="OLC"><enum>B</enum><header>Medicaid</header><section id="id94CF8625548F49709C0554700687C076"><enum>2201.</enum><header>Caring recovery for infants and babies</header><subsection id="id357878C2EABF4E83AF4DD81AEF5AE925"><enum>(a)</enum><header>State plan amendment</header><text display-inline="yes-display-inline">Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended—</text><paragraph id="id7D544BF0F1F54282ABE7C18DA8F1D63A"><enum>(1)</enum><text>in paragraph (82), by striking <quote>and</quote> after the semicolon;</text></paragraph><paragraph id="idC1C6A13004F745A5B7C8F73BA1C67A86"><enum>(2)</enum><text>in paragraph (83), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph id="id1398A90949D84B7C8C2B62ED0A0EE326"><enum>(3)</enum><text>by inserting after paragraph (83), the following new paragraph:</text><quoted-block display-inline="no-display-inline" id="id5C2EAB5F29DC417982AEFA68438E9823" style="OLC"><paragraph id="idAABB3AC4BBF44E35AD9DB36FD9DE0C16"><enum>(84)</enum><text>provide, at the option of the State, for making medical assistance available on an inpatient or outpatient basis at a residential pediatric recovery center (as defined in subsection (nn)) to infants with neonatal abstinence syndrome.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="id536EC56C681D4F4A9433A35776D036C5"><enum>(b)</enum><header>Residential pediatric recovery center defined</header><text>Section 1902 of such Act (42 U.S.C. 1396a) is amended by adding at the end the following new subsection:</text><quoted-block display-inline="no-display-inline" id="idE1CBAC91105D46839F38F92250535BD4" style="OLC"><subsection id="id7A27305CED7C4ABDA49520643936AE93"><enum>(nn)</enum><header>Residential pediatric recovery center defined</header><paragraph id="id027150E39F2446DA9E12E2F819B84678"><enum>(1)</enum><header>In general</header><text>For purposes of section 1902(a)(84), the term <term>residential pediatric recovery center</term> means a center or facility that furnishes items and services for which medical assistance is available under the State plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors.</text></paragraph><paragraph id="idCBF10B708D1740FF8015C28C4892B5C3"><enum>(2)</enum><header>Counseling and services</header><text>A residential pediatric recovery center may offer counseling and other services to mothers (and other appropriate family members and caretakers) of infants receiving treatment at such centers if such services are otherwise covered under the State plan under this title or under a waiver of such plan. Such other services may include the following:</text><subparagraph id="id7620FAE02E9C454A942EF7DCBA06A260"><enum>(A)</enum><text>Counseling or referrals for services.</text></subparagraph><subparagraph id="idCF1B26B9119A478EB0A13E6B5E9C728E"><enum>(B)</enum><text>Activities to encourage caregiver-infant bonding.</text></subparagraph><subparagraph id="idE1B4763098054F549012F49D54514D9C"><enum>(C)</enum><text>Training on caring for such infants.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection commented="no" display-inline="no-display-inline" id="id86C5EC9E21C94A6B87E2A24FF656F573"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section take effect on the date of enactment of this Act and shall apply to medical assistance furnished on or after that date, without regard to final regulations to carry out such amendments being promulgated as of such date.</text></subsection></section><section id="id7D8C4224CBED4438B4629021C21BC388"><enum>2202.</enum><header>Peer support enhancement and evaluation review</header><subsection id="id98ABFF2197084BE08B18BF28164D9194"><enum>(a)</enum><header>In general</header><text>Not later than 2 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Energy and Commerce of the House of Representatives, the Committee on Finance of the Senate, and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the provision of peer support services under the Medicaid program.</text></subsection><subsection id="id93D30033BD7F4C04910C917219FC4266"><enum>(b)</enum><header>Content of report</header><paragraph id="idA5E843891F35455AA76F417CBC880A6A"><enum>(1)</enum><header>In general</header><text>The report required under subsection (a) shall include the following information:</text><subparagraph id="idA24002E48B894AB78AFDDB0EBEC8E027"><enum>(A)</enum><text>Information on State coverage of peer support services under Medicaid, including—</text><clause id="id6D35BEDE2AC745C8B3CD91242A353CF6"><enum>(i)</enum><text>the mechanisms through which States may provide such coverage, including through existing statutory authority or through waivers;</text></clause><clause id="idB22C0B7D0C7043BDBD5517FED5CAEC3B"><enum>(ii)</enum><text>the populations to which States have provided such coverage;</text></clause><clause id="id369F37B3853E4D0AA859F8FE1CF18F07"><enum>(iii)</enum><text>the payment models, including any alternative payment models, used by States to pay providers of such services; and</text></clause><clause id="id899CFFA7A7FA49A48A73148791ADC717"><enum>(iv)</enum><text>where available, information on Federal and State spending under Medicaid for peer support services.</text></clause></subparagraph><subparagraph id="id4850E5EC7B4E4598A6067690F16673B2"><enum>(B)</enum><text>Information on selected State experiences in providing medical assistance for peer support services under State Medicaid plans and whether States measure the effects of providing such assistance with respect to—</text><clause id="idA90289D81E64439BBA95E7B9326C48FE"><enum>(i)</enum><text>improving access to behavioral health services;</text></clause><clause id="id2BD6680AEE3740E6B1339AC9D3CEFBF9"><enum>(ii)</enum><text>improving early detection, and preventing worsening, of behavioral health disorders;</text></clause><clause id="id4D2D4C1DD3814A6EAE536C6DAA528E3C"><enum>(iii)</enum><text>reducing chronic and comorbid conditions; and</text></clause><clause id="id4F312AC3E65F4967ACA281C528077874"><enum>(iv)</enum><text>reducing overall health costs.</text></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id80A27C97D13443FF999BEEC71F29AC2A"><enum>(2)</enum><header>Recommendations</header><text>The report required under subsection (a) shall include recommendations, including recommendations for such legislative and administrative actions related to improving services, including peer support services, and access to peer support services under Medicaid as the Comptroller General of the United States determines appropriate.</text></paragraph></subsection></section><section id="id0117867411764678BAA2C18F9E0763E1"><enum>2203.</enum><header>Medicaid substance use disorder treatment via telehealth</header><subsection id="idFEB79B63C35741F293922B4E258A0CE8"><enum>(a)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text><paragraph id="idE65F03D5F86D48CB852C4E483072B8D4"><enum>(1)</enum><header>Comptroller General</header><text>The term <term>Comptroller General</term> means the Comptroller General of the United States.</text></paragraph><paragraph id="id53283B7AB7E748D484EFAC25E1ACABD8"><enum>(2)</enum><header>School-based health center</header><text>The term <term>school-based health center</term> has the meaning given that term in section 2110(c)(9) of the Social Security Act (42 U.S.C. 1397jj(c)(9)).</text></paragraph><paragraph id="id64A88124F77748738B751D6D7A50686B"><enum>(3)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text></paragraph><paragraph id="id0928BE736CD84BDFA6AD2F3F86C61384"><enum>(4)</enum><header>Teleheath services</header><text>The term <term>telehealth services</term> includes remote patient monitoring and other key modalities such as live video or synchronous telehealth, store-and-forward or asynchronous telehealth, mobile health, telephonic consultation, and electronic consult including provider-to-provider e-consults.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id623C638B0F6445A1A037D84C3DDF73D4"><enum>(5)</enum><header>Underserved area</header><text>The term <term>underserved area</term> means a health professional shortage area (as defined in section 332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 254e(a)(1)(A))) and a medically underserved area (according to a designation under section 330(b)(3)(A) of the Public Health Service Act (42 U.S.C. 254b(b)(3)(A))).</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idF25F56E0AF624349B4C562377DAB3002"><enum>(b)</enum><header>Guidance to States regarding Federal reimbursement for furnishing services and treatment for substance use disorders under Medicaid using telehealth services, including in school-based health centers</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of this Act, the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall issue guidance to States on the following:</text><paragraph commented="no" display-inline="no-display-inline" id="id5F735F8454B64CB5882006C7E83E39F4"><enum>(1)</enum><text display-inline="yes-display-inline">State options for Federal reimbursement of expenditures under Medicaid for furnishing services and treatment for substance use disorders, including assessment, medication-assisted treatment, counseling, and medication management, using telehealth services. Such guidance shall also include guidance on furnishing services and treatments that address the needs of high risk individuals, including at least the following groups:</text><subparagraph commented="no" display-inline="no-display-inline" id="id268D5A37FB3842348EFD504FECBAC528"><enum>(A)</enum><text display-inline="yes-display-inline">American Indians and Alaska Natives.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id572326F57C8F4D14BF4DE5797E37E6BD"><enum>(B)</enum><text display-inline="yes-display-inline">Adults under the age of 40.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idF7FFCC49086D4240A70D0BAD78FC81FF"><enum>(C)</enum><text display-inline="yes-display-inline">Individuals with a history of nonfatal overdose.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id5F3C496D801741B691BB13C581B971F8"><enum>(2)</enum><text>State options for Federal reimbursement of expenditures under Medicaid for education directed to providers serving Medicaid beneficiaries with substance use disorders using the hub and spoke model, through contracts with managed care entities, through administrative claiming for disease management activities, and under Delivery System Reform Incentive Payment (<quote>DSRIP</quote>) programs.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id932CE77AAB88430E8E087FB98320955D"><enum>(3)</enum><text>State options for Federal reimbursement of expenditures under Medicaid for furnishing services and treatment for substance use disorders for individuals enrolled in Medicaid in a school-based health center using telehealth services.</text></paragraph></subsection><subsection id="id615F807F0E1E48CC938E897462572A78"><enum>(c)</enum><header>GAO evaluation of children's access to services and treatment for substance use disorders under Medicaid</header><paragraph commented="no" display-inline="no-display-inline" id="id1DC10436F9B34F288A950BABEC0561DF"><enum>(1)</enum><header display-inline="yes-display-inline">Study</header><text display-inline="yes-display-inline">The Comptroller General shall evaluate children's access to services and treatment for substance use disorders under Medicaid. The evaluation shall include an analysis of State options for improving children's access to such services and treatment and for improving outcomes, including by increasing the number of Medicaid providers who offer services or treatment for substance use disorders in a school-based health center using telehealth services, particularly in rural and underserved areas. The evaluation shall include an analysis of Medicaid provider reimbursement rates for services and treatment for substance use disorders.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id39D4A41C10D64F0F8F9652E4B811CD79"><enum>(2)</enum><header display-inline="yes-display-inline">Report</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.</text></paragraph></subsection><subsection id="idBCC04E0A985B4ADDAF48FEB1C7C3F54D"><enum>(d)</enum><header>Report on reducing barriers to using telehealth services and remote patient monitoring for pediatric populations under Medicaid</header><paragraph id="id9965076C4E904CA69D17C7A20851A6A5"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of this Act, the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall issue a report to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representative identifying best practices and potential solutions for reducing barriers to using telehealth services to furnish services and treatment for substance use disorders among pediatric populations under Medicaid. The report shall include—</text><subparagraph id="id38096715563C4959BD1A1E126F4490F1"><enum>(A)</enum><text display-inline="yes-display-inline">analyses of the best practices, barriers, and potential solutions for using telehealth services to diagnose and provide services and treatment for children with substance use disorders, including opioid use disorder; and</text></subparagraph><subparagraph id="id538C7F2AE4AB4DCDA717B01E9B66D8B2"><enum>(B)</enum><text display-inline="yes-display-inline">identification and analysis of the differences, if any, in furnishing services and treatment for children with substance use disorders using telehealth services and using services delivered in person, such as, and to the extent feasible, with respect to—</text><clause id="idF255830E9C754E37A7EE5C20D7645C70"><enum>(i)</enum><text display-inline="yes-display-inline">utilization rates;</text></clause><clause id="id4E8771FD5AA24EA4987B7DFEA2D3AE8B"><enum>(ii)</enum><text display-inline="yes-display-inline">costs;</text></clause><clause id="idFC609EE6C54F4234A986C2EF79E44992"><enum>(iii)</enum><text display-inline="yes-display-inline">avoidable inpatient admissions and readmissions;</text></clause><clause id="id1AB80A4A227D4F55A64614E5A95EFE60"><enum>(iv)</enum><text display-inline="yes-display-inline">quality of care; and</text></clause><clause id="idD50122EB4D5F46C3A071EA0539A8865D"><enum>(v)</enum><text display-inline="yes-display-inline">patient, family, and provider satisfaction.</text></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id0EADED184BBF4E3EA6463C3DEC9A1B3C"><enum>(2)</enum><header>Publication</header><text>The Secretary shall publish the report required under paragraph (1) on a public Internet website of the Department of Health and Human Services.</text></paragraph></subsection></section><section id="id1424E73FF31A4D8783BE2219F3E09D22"><enum>2204.</enum><header>Enhancing patient access to non-opioid treatment options</header><text display-inline="no-display-inline">Not later than January 1, 2019, the Secretary of Health and Human Services, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall issue 1 or more final guidance documents, or update existing guidance documents, to States regarding mandatory and optional items and services that may be provided under a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), or under a waiver of such a plan, for non-opioid treatment and management of pain, including, but not limited to, evidence-based non-opioid pharmacological therapies and non-pharmacological therapies.</text></section><section id="id440A0F5A57B9405DB5FA2F5207E916C6"><enum>2205.</enum><header>Assessing barriers to opioid use disorder treatment</header><subsection id="id46C132C5F1E04DBC8FE3C6CD5D36CE05"><enum>(a)</enum><header>Study</header><paragraph id="id7A2936F528E64553A7235934CA69E7AC"><enum>(1)</enum><header>In general</header><text>The Comptroller General of the United States (in this section referred to as the <quote>Comptroller General</quote>) shall conduct a study regarding the barriers to providing medication used in the treatment of substance use disorders under Medicaid distribution models such as the <quote>buy-and-bill</quote> model, and options for State Medicaid programs to remove or reduce such barriers. The study shall include analyses of each of the following models of distribution of substance use disorder treatment medications, particularly buprenorphine, naltrexone, and buprenorphine-naloxone combinations:</text><subparagraph id="idBDDD24FE34C7432A85F474B0F1C47B5C"><enum>(A)</enum><text>The purchasing, storage, and administration of substance use disorder treatment medications by providers.</text></subparagraph><subparagraph id="id6ED89E6B72054B02B9EDC18F654E9C6D"><enum>(B)</enum><text>The dispensing of substance use disorder treatment medications by pharmacists.</text></subparagraph><subparagraph id="idE42AEA2E2D5640AF9B3611DA7883C3CB"><enum>(C)</enum><text>The ordering, prescribing, and obtaining substance use disorder treatment medications on demand from specialty pharmacies by providers.</text></subparagraph></paragraph><paragraph id="id19657AF1B5A9491584DC1075B872055D"><enum>(2)</enum><header>Requirements</header><text>For each model of distribution specified in paragraph (1), the Comptroller General shall evaluate how each model presents barriers or could be used by selected State Medicaid programs to reduce the barriers related to the provision of substance use disorder treatment by examining what is known about the effects of the model of distribution on—</text><subparagraph id="id2DA4BE0E01CD45CC95C88401849E1288"><enum>(A)</enum><text>Medicaid beneficiaries’ access to substance use disorder treatment medications;</text></subparagraph><subparagraph id="id8FE6A3E122B2428D8E800BA4D88327F5"><enum>(B)</enum><text>the differential cost to the program between each distribution model for medication assisted treatment; and</text></subparagraph><subparagraph id="id8DEE40654ED04F2D91375195301587E5"><enum>(C)</enum><text>provider willingness to provide or prescribe substance use disorder treatment medications.</text></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idFB147D25CCDB447A8070621841B663FC"><enum>(b)</enum><header>Report</header><text>Not later than 15 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.</text></subsection></section><section id="H91B2FB9E20DA4F37886BA4469055BE2A"><enum>2206.</enum><header>Help for moms and babies</header><subsection id="idA3CE36501FD14C7981A106DA02909DB6"><enum>(a)</enum><header>Medicaid state plan</header><text>Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended by adding at the end the following new sentence: <quote>In the case of a woman who is eligible for medical assistance on the basis of being pregnant (including through the end of the month in which the 60-day period beginning on the last day of her pregnancy ends), who is a patient in an institution for mental diseases for purposes of receiving treatment for a substance use disorder, and who was enrolled for medical assistance under the State plan immediately before becoming a patient in an institution for mental diseases or who becomes eligible to enroll for such medical assistance while such a patient, the exclusion from the definition of <term>medical assistance</term> set forth in the subdivision (B) following paragraph (29) of the first sentence of this subsection shall not be construed as prohibiting Federal financial participation for medical assistance for items or services that are provided to the woman outside of the institution.</quote>.</text></subsection><subsection id="id9F9EC57961874B2EBC36852B1186AE7A"><enum>(b)</enum><header>Effective date</header><paragraph id="idD4A89191304E43A989D5883BAF0B8E83"><enum>(1)</enum><header>In general</header><text>Except as provided in paragraph (2), the amendment made by subsection (a) shall take effect on the date of enactment of this Act.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1301F7919FFA4456AF610D5C32A0692B"><enum>(2)</enum><header>Rule for changes requiring state legislation</header><text>In the case of a State plan under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendment made by subsection (a), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.</text></paragraph></subsection></section><section id="id917F402592344673850C7534B0458E4F"><enum>2207.</enum><header>Securing flexibility to treat substance use disorders</header><text display-inline="no-display-inline">Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)) is amended by adding at the end the following new paragraph:</text><quoted-block display-inline="no-display-inline" id="idDD42DA3E0388422E840BFCE24C4BC238" style="OLC"><paragraph commented="no" display-inline="no-display-inline" id="id0AEC90ED67EF4250992D0F97C552EB46" indent="up1"><enum>(7)</enum><text display-inline="yes-display-inline">Payment shall be made under this title to a State for expenditures for capitation payments described in section 438.6(e) of title 42, Code of Federal Regulations (or any successor regulation).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id47C6261EB81440EBAE2337A1845B3ED4"><enum>2208.</enum><header>MACPAC study and report on MAT utilization controls under State Medicaid programs</header><subsection id="id26D13F05ACC8418D9A6248CE1BDC6221"><enum>(a)</enum><header>Study</header><text>The Medicaid and CHIP Payment and Access Commission shall conduct a study and analysis of utilization control policies applied to medication-assisted treatment for substance use disorders under State Medicaid programs, including policies and procedures applied both in fee-for-service Medicaid and in risk-based managed care Medicaid, which shall—</text><paragraph id="idC142A6A561434B5BA57F0AA17C253610"><enum>(1)</enum><text>include an inventory of such utilization control policies and related protocols for ensuring access to medically necessary treatment;</text></paragraph><paragraph id="id81F55700ACF34150B740AA002EEC59CD"><enum>(2)</enum><text>determine whether managed care utilization control policies and procedures for medication assisted treatment for substance use disorders are consistent with section 438.210(a)(4)(ii) of title 42, Code of Federal Regulations; and</text></paragraph><paragraph id="id963393BF72944C6D9890CA3C46BE23BB"><enum>(3)</enum><text>identify policies that—</text><subparagraph id="id492D9852518C42278CC29C8A0A14DCD7"><enum>(A)</enum><text>limit an individual's access to medication-assisted treatment for a substance use disorder by limiting the quantity of medication-assisted treatment prescriptions, or the number of refills for such prescriptions, available to the individual as part of a prior authorization process or similar utilization protocols; and</text></subparagraph><subparagraph id="id488FABD7D2C24E48BDF2EA3D8C900EBB"><enum>(B)</enum><text>apply without evaluating individual instances of fraud, waste, or abuse.</text></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idD2272F5654454E5F8DCAE4FFCA51FC59"><enum>(b)</enum><header>Report</header><text>Not later than 1 year after the date of the enactment of this Act, the Medicaid and CHIP Payment and Access Commission shall make publicly available a report containing the results of the study conducted under subsection (a).</text></subsection></section><section id="id3BC5CC3BE7D44B1D81A399698B8901A6"><enum>2209.</enum><header>Opioid addiction treatment programs enhancement</header><subsection id="idD2953927F7F84AC09077B40B475AFBF6"><enum>(a)</enum><header>T–MSIS substance use disorder data book</header><paragraph id="id305029CADE8C4C5595B41723F0EFDC4C"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than the date that is 12 months after the date of enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the <term>Secretary</term>) shall publish on the public website of the Centers for Medicare & Medicaid Services a report with comprehensive data on the prevalence of substance use disorders in the Medicaid beneficiary population and services provided for the treatment of substance use disorders under Medicaid.</text></paragraph><paragraph id="idBA439C7E0FA84F84933489221CE583DB"><enum>(2)</enum><header>Content of report</header><text>The report required under paragraph (1) shall include, at a minimum, the following data for each State (including, to the extent available, for the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa):</text><subparagraph id="id23E6685322994323BC01B7B046A98B96"><enum>(A)</enum><text>The number and percentage of individuals enrolled in the State Medicaid plan or waiver of such plan in each of the major enrollment categories (as defined in a public letter from the Medicaid and CHIP Payment and Access Commission to the Secretary) who have been diagnosed with a substance use disorder and whether such individuals are enrolled under the State Medicaid plan or a waiver of such plan, including the specific waiver authority under which they are enrolled, to the extent available.</text></subparagraph><subparagraph id="idC7F5E07CED5D428E92FB382A7FF66982"><enum>(B)</enum><text>A list of the substance use disorder treatment services by each major type of service, such as counseling, medication assisted treatment, peer support, residential treatment, and inpatient care, for which beneficiaries in each State received at least 1 service under the State Medicaid plan or a waiver of such plan.</text></subparagraph><subparagraph id="idD07A2E1B92864688A58CDE0CEB5180D6"><enum>(C)</enum><text>The number and percentage of individuals with a substance use disorder diagnosis enrolled in the State Medicaid plan or waiver of such plan who received substance use disorder treatment services under such plan or waiver by each major type of service under subparagraph (B) within each major setting type, such as outpatient, inpatient, residential, and other home and community-based settings.</text></subparagraph><subparagraph id="idC1AE66110E594DEFA63E97DDAF1FABA9"><enum>(D)</enum><text>The number of services provided under the State Medicaid plan or waiver of such plan per individual with a substance use disorder diagnosis enrolled in such plan or waiver for each major type of service under subparagraph (B).</text></subparagraph><subparagraph id="id10D9498F0C5043E5BF697949C23E7DEC"><enum>(E)</enum><text>The number and percentage of individuals enrolled in the State Medicaid plan or waiver, by major enrollment category, who received substance use disorder treatment through—</text><clause id="id6EB15D9FEFA347219A9E1E81080A3B80"><enum>(i)</enum><text>a medicaid managed care entity (as defined in section 1932(a)(1)(B) of the Social Security Act (42 U.S.C. 1396u–2(a)(1)(B))), including the number of such individuals who received such assistance through a prepaid inpatient health plan or a prepaid ambulatory health plan;</text></clause><clause id="id03638F7CC19B417CB37FD61AD49A9354"><enum>(ii)</enum><text>a fee-for-service payment model; or</text></clause><clause id="idC3E46D0C89054E3B99D88096AB00656B"><enum>(iii)</enum><text>an alternative payment model, to the extent available.</text></clause></subparagraph><subparagraph id="id278F4F2C92B24C56B128A8987E22DEE8"><enum>(F)</enum><text>The number and percentage of individuals with a substance use disorder who receive substance use disorder treatment services in an outpatient or home and community-based setting after receiving treatment in an inpatient or residential setting, and the number of services received by such individuals in the outpatient or home and community-based setting.</text></subparagraph></paragraph><paragraph id="idE2C3FAE5C8F1433B90F11E05FC01FA34"><enum>(3)</enum><header>Annual updates</header><text>The Secretary shall issue an updated version of the report required under paragraph (1) not later than January 1 of each calendar year through 2024.</text></paragraph><paragraph id="idEDA67DDE9F804400AFF7D93EA1569A98"><enum>(4)</enum><header>Use of T–MSIS data</header><text>The report required under paragraph (1) and updates required under paragraph (3) shall—</text><subparagraph commented="no" display-inline="no-display-inline" id="idEDF3BF2204764580904C6A5B65437986"><enum>(A)</enum><text>use data and definitions from the Transformed Medicaid Statistical Information System (<quote>T–MSIS</quote>) data set that is no more than 12 months old on the date that the report or update is published; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id390BADCAD0104F79B33DFD4BAE4BCAC4"><enum>(B)</enum><text>as appropriate, include a description with respect to each State of the quality and completeness of the data and caveats describing the limitations of the data reported to the Secretary by the State that is sufficient to communicate the appropriate uses for the information.</text></subparagraph></paragraph></subsection><subsection id="id0771216F139843B799AD6DF9B5AFC738"><enum>(b)</enum><header>Making T–MSIS data on substance use disorders available to researchers</header><paragraph id="id000DABA8E42E42679A87DC4E606B08C3"><enum>(1)</enum><header>In general</header><text>The Secretary shall publish in the Federal Register a system of records notice for the data specified in paragraph (2) for the Transformed Medicaid Statistical Information System, in accordance with section 552a(e)(4) of title 5, United States Code. The notice shall outline policies that protect the security and privacy of the data that, at a minimum, meet the security and privacy policies of SORN 09–70–0541 for the Medicaid Statistical Information System.</text></paragraph><paragraph id="idA2C567F1DA14442C846BF7201CDA7D5B"><enum>(2)</enum><header>Required data</header><text>The data covered by the systems of records notice required under paragraph (1) shall be sufficient for researchers and States to analyze the prevalence of substance use disorders in the Medicaid beneficiary population and the treatment of substance use disorders under Medicaid across all States (including the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa), forms of treatment, and treatment settings.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idAA4B44E6E82148F08648984D6F58ECA7"><enum>(3)</enum><header>Initiation of data-sharing activities</header><text>Not later than January 1, 2019, the Secretary shall initiate the data-sharing activities outlined in the notice required under paragraph (1).</text></paragraph></subsection></section><section id="id9FE362ED325146FC8642D086B76F12A6"><enum>2210.</enum><header>Better data sharing to combat the opioid crisis</header><subsection id="idDC31906A2288447ABBAB159A86686328"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)), as amended by section 2207, is amended by adding at the end the following new paragraph:</text><quoted-block display-inline="no-display-inline" id="idAAD9B928AF7046D99492DC344A420213" style="OLC"><paragraph id="idA70B500693804AB2B90AA7B67E062754" indent="up1"><enum>(8)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idA9A44D2A65194F1ABA3F17ADE2F2B544"><enum>(A)</enum><text display-inline="yes-display-inline">The State agency administering the State plan under this title may have reasonable access, as determined by the State, to 1 or more prescription drug monitoring program databases administered or accessed by the State to the extent the State agency is permitted to access such databases under State law.</text></subparagraph><subparagraph id="id454FA442FEC644A880FD342A10594D51" indent="up1"><enum>(B)</enum><text>Such State agency may facilitate reasonable access, as determined by the State, to 1 or more prescription drug monitoring program databases administered or accessed by the State, to same extent that the State agency is permitted under State law to access such databases, for—</text><clause id="idDAB7FA7CEB6D402BA81C575EBF563AC4"><enum>(i)</enum><text>any provider enrolled under the State plan to provide services to Medicaid beneficiaries; and</text></clause><clause id="idE42ECD37D15D47F78EDD61885F328925"><enum>(ii)</enum><text>any managed care entity (as defined under section 1932(a)(1)(B)) that has a contract with the State under this subsection or under section 1905(t)(3).</text></clause></subparagraph><subparagraph id="id1F53259ACF244D29B16785EBD1B560AC" indent="up1"><enum>(C)</enum><text>Such State agency may share information in such databases, to the same extent that the State agency is permitted under State law to share information in such databases, with—</text><clause id="id9C48018FEAC94B90A471735C855D8575"><enum>(i)</enum><text>any provider enrolled under the State plan to provide services to Medicaid beneficiaries; and</text></clause><clause id="id5E9021295C0B484B8E139C3768E8A21C"><enum>(ii)</enum><text>any managed care entity (as defined under section 1932(a)(1)(B)) that has a contract with the State under this subsection or under section 1905(t)(3).</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="idE8227074F5A24C7ABD44D9E8F2F2DEC2"><enum>(b)</enum><header>Security and privacy</header><text>All applicable State and Federal security and privacy protections and laws shall apply to any State agency, individual, or entity accessing 1 or more prescription drug monitoring program databases or obtaining information in such databases in accordance with section 1903(m)(8) of the Social Security Act (42 U.S.C. 1396b(m)(8)) (as added by subsection (a)).</text></subsection><subsection commented="no" display-inline="no-display-inline" id="id9C07DB4AC25847ADA4A33A1BC0B768ED"><enum>(c)</enum><header>Effective date</header><text>The amendment made by subsection (a) shall take effect on the date of enactment of this Act.</text></subsection></section><section id="H320BCCC9738B4DD5A8611CAE76FDBFEB" section-type="subsequent-section"><enum>2211.</enum><header>Mandatory reporting with respect to adult behavioral health measures</header><text display-inline="no-display-inline">Section 1139B of the Social Security Act (42 U.S.C. 1320b–9b) is amended—</text><paragraph id="H672C6BCC1AA643C396E4CE1A1BF82C75"><enum>(1)</enum><text>in subsection (b)—</text><subparagraph id="HEA2A9F37EEA741F6B5F4D455173D3133"><enum>(A)</enum><text>in paragraph (3)—</text><clause id="H1499FFBBE2DE4F448DBD50BE24056AD1"><enum>(i)</enum><text>by striking <quote>Not later than January 1, 2013</quote> and inserting the following:</text><quoted-block display-inline="no-display-inline" id="H606969053CBC483AB13DD949CA89A676" style="OLC"><subparagraph id="HC8C4DE477FD54C139C8333CFB4A39E0A"><enum>(A)</enum><header>Voluntary reporting</header><text display-inline="yes-display-inline">Not later than January 1, 2013</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></clause><clause id="HE9956DAE339F48F88F43ECCCB7F06E53"><enum>(ii)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="H9BEC3B7998224727B207A83D11417D42" style="OLC"><subparagraph id="H741F8CE9B5B845ECBFF32A671DA5D0D0"><enum>(B)</enum><header>Mandatory reporting with respect to behavioral health measures</header><text display-inline="yes-display-inline">Beginning with the State report required under subsection (d)(1) for 2024, the Secretary shall require States to use all behavioral health measures included in the core set of adult health quality measures and any updates or changes to such measures to report information, using the standardized format for reporting information and procedures developed under subparagraph (A), regarding the quality of behavioral health care for Medicaid eligible adults.</text></subparagraph><after-quoted-block>; </after-quoted-block></quoted-block></clause></subparagraph><subparagraph id="H6E09435EEF844D908B4BBA68B5AC7447"><enum>(B)</enum><text>in paragraph (5), by adding at the end the following new subparagraph:</text><quoted-block display-inline="no-display-inline" id="HC380D0813D1143BF9C8D0FA2E30D8091" style="OLC"><subparagraph id="HDF735AFD49B549B3814724451DFCC375"><enum>(C)</enum><header>Behavioral health measures</header><text display-inline="yes-display-inline">Beginning with respect to State reports required under subsection (d)(1) for 2024, the core set of adult health quality measures maintained under this paragraph (and any updates or changes to such measures) shall include behavioral health measures.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="HEE2F9B95E1964D1DB91B869CB977B16F"><enum>(2)</enum><text>in subsection (d)(1)(A)—</text><subparagraph id="H31EC8C5C8310418CBA02E8DA9CE10716"><enum>(A)</enum><text>by striking <quote>the such plan</quote> and inserting <quote>such plan</quote>; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H38B1E06AF7A746FDA3037778D34BC643"><enum>(B)</enum><text>by striking <quote>subsection (a)(5)</quote> and inserting <quote>subsection (b)(5) and, beginning with the report for 2024, all behavioral health measures included in the core set of adult health quality measures maintained under such subsection (b)(5) and any updates or changes to such measures (as required under subsection (b)(3))</quote>.</text></subparagraph></paragraph></section><section id="idD17E065AD13D4656A0710218B5130B5E"><enum>2212.</enum><header>Report on innovative State initiatives and strategies to provide housing-related services and supports to individuals struggling with substance use disorders under Medicaid</header><subsection id="id5D1587966EC94ED1ABDD7332F2569384"><enum>(a)</enum><header>In general</header><text>Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall issue a report to Congress describing innovative State initiatives and strategies for providing housing-related services and supports under a State Medicaid program to individuals with substance use disorders who are experiencing or at risk of experiencing homelessness.</text></subsection><subsection id="id703EAA69B39A4DCC8A2C0B250A824FBB"><enum>(b)</enum><header>Content of report</header><text>The report required under subsection (a) shall describe the following:</text><paragraph id="id40856d6e4d2b442b8028e818e69d8bd7"><enum>(1)</enum><text>Existing methods and innovative strategies developed and adopted by State Medicaid programs that have achieved positive outcomes in increasing housing stability among Medicaid beneficiaries with substance use disorders who are experiencing or at risk of experiencing homelessness, including Medicaid beneficiaries with substance use disorders who are—</text><subparagraph id="id9156717EA53C41C8B20DAE2B81C2D2C3"><enum>(A)</enum><text>receiving treatment for substance use disorders in inpatient, residential, outpatient, or home and community-based settings;</text></subparagraph><subparagraph id="idA1895E1048B04A35B66D21D97D36BDF8"><enum>(B)</enum><text>transitioning between substance use disorder treatment settings; or</text></subparagraph><subparagraph id="id338D3DB6974A45B68F87513CD78E0F39"><enum>(C)</enum><text>living in supportive housing or another model of affordable housing.</text></subparagraph></paragraph><paragraph id="id442243425c344ac184c6a5b1722578a9"><enum>(2)</enum><text>Strategies employed by Medicaid managed care organizations, primary care case managers, hospitals, accountable care organizations, and other care coordination providers to deliver housing-related services and supports and to coordinate services provided under State Medicaid programs across different treatment settings.</text></paragraph><paragraph id="id674456c3332c47519f754a1de22147ae"><enum>(3)</enum><text>Innovative strategies and lessons learned by States with Medicaid waivers approved under section 1115 or 1915 of the Social Security Act (42 U.S.C. 1315, 1396n), including—</text><subparagraph id="idC5BD6991E41A45B9A4EC34E8EBA6632C"><enum>(A)</enum><text>challenges experienced by States in designing, securing, and implementing such waivers or plan amendments;</text></subparagraph><subparagraph id="id6BFB1285F74F4C298D56205174502BB5"><enum>(B)</enum><text>how States developed partnerships with other organizations such as behavioral health agencies, State housing agencies, housing providers, health care services agencies and providers, community-based organizations, and health insurance plans to implement waivers or State plan amendments; and</text></subparagraph><subparagraph id="id14818CA052A34140A77EED5CBEA5B14D"><enum>(C)</enum><text>how and whether States plan to provide Medicaid coverage for housing-related services and supports in the future, including by covering such services and supports under State Medicaid plans or waivers.</text></subparagraph></paragraph><paragraph id="id503c1bd45ab54f20b3ca26b2fb0e661d"><enum>(4)</enum><text>Existing opportunities for States to provide housing-related services and supports through a Medicaid waiver under sections 1115 or 1915 of the Social Security Act (42 U.S.C. 1315, 1396n) or through a State Medicaid plan amendment, such as the Assistance in Community Integration Service pilot program, which promotes supportive housing and other housing-related supports under Medicaid for individuals with substance use disorders and for which Maryland has a waiver approved under such section 1115 to conduct the program.</text></paragraph><paragraph id="ide57f0709d04342c2b0394845cd7457d5"><enum>(5)</enum><text>Innovative strategies and partnerships developed and implemented by State Medicaid programs or other entities to identify and enroll eligible individuals with substance use disorders who are experiencing or at risk of experiencing homelessness in State Medicaid programs.</text></paragraph></subsection></section><section id="id335B46175FF14791B29E5CEB603D0B86"><enum>2213.</enum><header>Technical assistance and support for innovative State strategies to provide housing-related supports under Medicaid</header><subsection id="idFA4B8EF7F9134872A985F2B2FB2E8BF3"><enum>(a)</enum><header>In general</header><text>The Secretary of Health and Human Services shall provide technical assistance and support to States regarding the development and expansion of innovative State strategies (including through State Medicaid demonstration projects) to provide housing-related supports and services and care coordination services under Medicaid to individuals with substance use disorders.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="idDA5B544C1B754A87A5238AB1191A86EC"><enum>(b)</enum><header>Report</header><text>Not later than 180 days after the date of enactment of this Act, the Secretary shall issue a report to Congress detailing a plan of action to carry out the requirements of subsection (a).</text></subsection></section></subtitle><subtitle id="id549DEF8D77AE428B8B353684B72BC679" style="OLC"><enum>C</enum><header>Human Services</header><section id="idF36670C8F2D14B57B715A1DC2E3DD4F4"><enum>2301.</enum><header>Supporting family-focused residential treatment</header><subsection id="id49A3AA02B36344C2977CAC877FF8F7E6"><enum>(a)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text><paragraph id="id3F000027F79C401BA26EB3655CF9B9B8"><enum>(1)</enum><header>Family-focused residential treatment program</header><text>The term <term>family-focused residential treatment program</term> means a trauma-informed residential program primarily for substance use disorder treatment for pregnant and postpartum women and parents and guardians that allows children to reside with such women or their parents or guardians during treatment to the extent appropriate and applicable.</text></paragraph><paragraph id="id586CBAAFC5D94AF3AF591205FA02E414"><enum>(2)</enum><header>Medicaid program</header><text>The term <term>Medicaid program</term> means the program established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).</text></paragraph><paragraph id="idA50D8E1C285648518F473EE6BF263C8A"><enum>(3)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id2ACE2DA675554A4DA5686460D6E21792"><enum>(4)</enum><header>Title IV–E program</header><text>The term <term>title IV–E program</term> means the program for foster care, prevention, and permanency established under part E of title IV of the Social Security Act (42 U.S.C. 670 et seq.).</text></paragraph></subsection><subsection id="id87685F484A5F4AB1A96F7D0CB366892F"><enum>(b)</enum><header>Guidance on family-focused residential treatment programs</header><paragraph id="id17E7CFB5AB2A445486211924849C5270"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 180 days after the date of enactment of this Act, the Secretary, in consultation with divisions of the Department of Health and Human Services administering substance use disorder or child welfare programs, shall develop and issue guidance to States identifying opportunities to support family-focused residential treatment programs for the provision of substance use disorder treatment. Before issuing such guidance, the Secretary shall solicit input from representatives of States, health care providers with expertise in addiction medicine, obstetrics and gynecology, neonatology, child trauma, and child development, health plans, recipients of family-focused treatment services, and other relevant stakeholders.</text></paragraph><paragraph id="id4E6010F37EB04D0D8E6A6C8752BC8A01"><enum>(2)</enum><header>Additional requirements</header><text>The guidance required under paragraph (1) shall include descriptions of the following:</text><subparagraph id="idDEEDDCE55EB64B188331BBE3E4A77268"><enum>(A)</enum><text>Existing opportunities and flexibilities under the Medicaid program, including under waivers authorized under section 1115 or 1915 of the Social Security Act (42 U.S.C. 1315, 1396n), for States to receive Federal Medicaid funding for the provision of substance use disorder treatment for pregnant and postpartum women and parents and guardians and, to the extent applicable, their children, in family-focused residential treatment programs.</text></subparagraph><subparagraph id="id8E3AFE32ADE443568C45DB4EAE69280F"><enum>(B)</enum><text>How States can employ and coordinate funding provided under the Medicaid program, the title IV-E program, and other programs administered by the Secretary to support the provision of treatment and services provided by a family-focused residential treatment facility such as substance use disorder treatment and services, including medication-assisted treatment, family, group, and individual counseling, case management, parenting education and skills development, the provision, assessment, or coordination of care and services for children, including necessary assessments and appropriate interventions, non-emergency transportation for necessary care provided at or away from a program site, transitional services and supports for families leaving treatment, and other services.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idC92BB1E8AA494BD6B3E7CE70338FF762"><enum>(C)</enum><text>How States can employ and coordinate funding provided under the Medicaid program and the title IV–E program (including as amended by the Family First Prevention Services Act enacted under title VII of division E of Public Law 115–123, and particularly with respect to the authority under subsections (a)(2)(C) and (j) of section 472 and section 474(a)(1) of the Social Security Act (42 U.S.C. 672, 674(a)(1)) (as amended by section 50712 of Public Law 115–123) to provide foster care maintenance payments for a child placed with a parent who is receiving treatment in a licensed residential family-based treatment facility for a substance use disorder) to support placing children with their parents in family-focused residential treatment programs.</text></subparagraph></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="idF13ADA8B1A584417B56B757477ADA10B"><enum>2302.</enum><header>Improving recovery and reunifying families</header><subsection commented="no" display-inline="no-display-inline" id="idA99536380F39476687F0F0B64D4CED31"><enum>(a)</enum><header>Family Recovery and Reunification Program Replication Project</header><text display-inline="yes-display-inline">Section 435 of the Social Security Act (42 U.S.C. 629e) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id8D2E78919BD745F09A9DA55C12C84AA0" style="OLC"><subsection id="id7E01FA5108894479B98BFC2159A5D512"><enum>(e)</enum><header>Family Recovery and Reunification Program Replication Project</header><paragraph id="id221CD567B1FA47979BC1E24C7BA5F988"><enum>(1)</enum><header>Purpose</header><text>The purpose of this subsection is to provide resources to the Secretary to support the conduct and evaluation of a family recovery and reunification program replication project (referred to in this subsection as the <term>project</term>) and to determine the extent to which such programs may be appropriate for use at different intervention points (such as when a child is at risk of entering foster care or when a child is living with a guardian while a parent is in treatment). The family recovery and reunification program conducted under the project shall use a recovery coach model that is designed to help reunify families and protect children by working with parents or guardians with a substance use disorder who have temporarily lost custody of their children.</text></paragraph><paragraph id="id05bf8b3f6f1c442a9684ff852bf21f44"><enum>(2)</enum><header>Program components</header><text>The family recovery and reunification program conducted under the project shall adhere closely to the elements and protocol determined to be most effective in other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children and, consistent with such elements and protocol, shall provide such items and services as—</text><subparagraph id="id96a4bf9e13094a75b41f0e78fdfd6f31"><enum>(A)</enum><text>assessments to evaluate the needs of the parent or guardian;</text></subparagraph><subparagraph id="id8897a4c034574243aa0d2c96af5e398c"><enum>(B)</enum><text>assistance in receiving the appropriate benefits to aid the parent or guardian in recovery;</text></subparagraph><subparagraph id="id1e498067e28a42cf9ff622c8098cf809"><enum>(C)</enum><text>services to assist the parent or guardian in prioritizing issues identified in assessments, establishing goals for resolving such issues that are consistent with the goals of the treatment provider, child welfare agency, courts, and other agencies involved with the parent or guardian or their children, and making a coordinated plan for achieving such goals;</text></subparagraph><subparagraph id="id10446b4aad404435a0a2489a73f841f9"><enum>(D)</enum><text>home visiting services coordinated with the child welfare agency and treatment provider involved with the parent or guardian or their children;</text></subparagraph><subparagraph id="id2bf0359bb6424ef289c536e8725392c8"><enum>(E)</enum><text>case management services to remove barriers for the parent or guardian to participate and continue in treatment, as well as to re-engage a parent or guardian who is not participating or progressing in treatment;</text></subparagraph><subparagraph id="id8312d2f0f7b54a52a13a7549a4c9e83b"><enum>(F)</enum><text>access to services needed to monitor the parent’s or guardian's compliance with program requirements;</text></subparagraph><subparagraph id="id4298f898e59642eea46d19366ab2bf33"><enum>(G)</enum><text>frequent reporting between the treatment provider, child welfare agency, courts, and other agencies involved with the parent or guardian or their children to ensure appropriate information on the parent’s or guardian's status is available to inform decision-making; and</text></subparagraph><subparagraph id="ide20ed0341fce4e3f835e47dccab97043"><enum>(H)</enum><text>assessments and recommendations provided by a recovery coach to the child welfare caseworker responsible for documenting the parent’s or guardian's progress in treatment and recovery as well as the status of other areas identified in the treatment plan for the parent or guardian, including a recommendation regarding the expected safety of the child if the child is returned to the custody of the parent or guardian that can be used by the caseworker and a court to make permanency decisions regarding the child.</text></subparagraph></paragraph><paragraph id="ida2cbaa515a8649f2951f34a8836def4e"><enum>(3)</enum><header>Responsibilities of the secretary</header><subparagraph id="id32447DF3B57E4B71A901802C8BD79370"><enum>(A)</enum><header>In general</header><text>The Secretary shall, through a grant or contract with 1 or more entities, conduct and evaluate the family recovery and reunification program under the project.</text></subparagraph><subparagraph id="idA20C2382E51B4800A3CB8C6D9BBE842C"><enum>(B)</enum><header>Requirements</header><text>In identifying 1 or more entities to conduct the evaluation of the family recovery and reunification program, the Secretary shall—</text><clause id="idcadcfce94a6f48e6b9c5556fab6ac499"><enum>(i)</enum><text>determine that the area or areas in which the program will be conducted have sufficient substance use disorder treatment providers and other resources (other than those provided with funds made available to carry out the project) to successfully conduct the program;</text></clause><clause id="id13ac53784445437f8b80d0e00d8e39fb"><enum>(ii)</enum><text>determine that the area or areas in which the program will be conducted have enough potential program participants, and will serve a sufficient number of parents or guardians and their children, so as to allow for the formation of a control group, evaluation results to be adequately powered, and preliminary results of the evaluation to be available within 4 years of the program's implementation;</text></clause><clause id="id7e37a7b394064626b586e307589c7335"><enum>(iii)</enum><text>provide the entity or entities with technical assistance for the program design, including by working with 1 or more entities that are or have been involved in recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children so as to make sure the program conducted under the project adheres closely to the elements and protocol determined to be most effective in such other recovery coaching programs;</text></clause><clause id="ida17828dcb65b4192b71a9413f6f1ff99"><enum>(iv)</enum><text>assist the entity or entities in securing adequate coaching, treatment, child welfare, court, and other resources needed to successfully conduct the family recovery and reunification program under the project; and</text></clause><clause id="ide4d1175dd28d4384b7576f2cf4b2e4d3"><enum>(v)</enum><text>ensure the entity or entities will be able to monitor the impacts of the program in the area or areas in which it is conducted for at least 5 years after parents or guardians and their children are randomly assigned to participate in the program or to be part of the program's control group.</text></clause></subparagraph></paragraph><paragraph id="ide659d2f75c774b70930dac1c841fb7d5"><enum>(4)</enum><header>Evaluation requirements</header><subparagraph id="ide079240a68ca4fcba02ec824b5e64992"><enum>(A)</enum><header>In general</header><text>The Secretary, in consultation with the entity or entities conducting the family recovery and reunification program under the project, shall conduct an evaluation to determine whether the program has been implemented effectively and resulted in improvements for children and families. The evaluation shall have 3 components: a pilot phase, an impact study, and an implementation study.</text></subparagraph><subparagraph id="id37efa7609d3940f19b093c0ed52e4b0b"><enum>(B)</enum><header>Pilot phase</header><text>The pilot phase component of the evaluation shall consist of the Secretary providing technical assistance to the entity or entities conducting the family recovery and reunification program under the project to ensure—</text><clause id="idEA721A81D9F34EDAB5A76241B07BB0DF"><enum>(i)</enum><text>the program's implementation adheres closely to the elements and protocol determined to be most effective in other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children; and</text></clause><clause id="idA9957D4D16A144D28653A1415C33A261"><enum>(ii)</enum><text>random assignment of parents or guardians and their children to be participants in the program or to be part of the program's control group is being carried out.</text></clause></subparagraph><subparagraph id="idd7b2fe18e4304ab7b3dba0a8db0894e7"><enum>(C)</enum><header>Impact study</header><text>The impact study component of the evaluation shall determine the impacts of the family recovery and reunification program conducted under the project on the parents and guardians and their children participating in the program. The impact study component shall—</text><clause id="ida70d4e2465e54e5c809d15b921a13ca5"><enum>(i)</enum><text>be conducted using an experimental design that uses a random assignment research methodology;</text></clause><clause id="id40ec98fbee0441ec89c2d85b5660ec1f"><enum>(ii)</enum><text>consistent with previous studies of other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children, measure outcomes for parents and guardians and their children over multiple time periods, including for a period of 5 years; and</text></clause><clause id="id430c3ed78b434ffd98cc063621c018c9"><enum>(iii)</enum><text>include measurements of family stability and parent, guardian, and child safety for program participants and the program control group that are consistent with measurements of such factors for participants and control groups from previous studies of other recovery coaching programs so as to allow results of the impact study to be compared with the results of such prior studies, including with respect to comparisons between program participants and the program control group regarding—</text><subclause id="idfc261002eae14dd39a89da109fc63dac"><enum>(I)</enum><text>safe family reunification;</text></subclause><subclause id="id7c6c085343534c4eaeb1bba456c2d621"><enum>(II)</enum><text>time to reunification;</text></subclause><subclause id="id2ff900f4fc5042b484c214da7f2d735f"><enum>(III)</enum><text>permanency (such as through measures of reunification, adoption, or placement with guardians);</text></subclause><subclause id="id363f14c447d544e68aeb44aef8ca7380"><enum>(IV)</enum><text>safety (such as through measures of subsequent maltreatment);</text></subclause><subclause id="id43577c6987e946f581b3ca3fbff1019c"><enum>(V)</enum><text>parental or guardian treatment persistence and engagement;</text></subclause><subclause id="id31028a86b23f4e31a8de83b1ee7357a1"><enum>(VI)</enum><text>parental or guardian substance use;</text></subclause><subclause id="idf48efcaf9e0b4a47a90539848f107ff4"><enum>(VII)</enum><text>juvenile delinquency;</text></subclause><subclause id="id363f25abc6b64fd19d1bfe4c83c0306b"><enum>(VIII)</enum><text>cost; and</text></subclause><subclause id="ida4c2dd46397e49308bdee5f267471963"><enum>(IX)</enum><text>other measurements agreed upon by the Secretary and the entity or entities operating the family recovery and reunification program under the project.</text></subclause></clause></subparagraph><subparagraph id="idc7a532a2654d4978befd0a71118c504f"><enum>(D)</enum><header>Implementation study</header><text>The implementation study component of the evaluation shall be conducted concurrently with the conduct of the impact study component and shall include, in addition to such other information as the Secretary may determine, descriptions and analyses of—</text><clause id="idD094EFA1C1614C8192EB8187BE082B37"><enum>(i)</enum><text>the adherence of the family recovery and reunification program conducted under the project to other recovery coaching programs that have been rigorously evaluated and shown to increase family reunification and protect children; and</text></clause><clause id="id11030EDF2C4A4505B4F3A71D4CB07509"><enum>(ii)</enum><text>the difference in services received or proposed to be received by the program participants and the program control group.</text></clause></subparagraph><subparagraph commented="no" id="id0861DBEB89A24B4CA2F7E4A57BA67F77"><enum>(E)</enum><header>Report</header><text>The Secretary shall publish on an internet website maintained by the Secretary the following information:</text><clause commented="no" id="id6AC8771E9D1548CCA6D0ABF7524F9F12"><enum>(i)</enum><text>A report on the pilot phase component of the evaluation.</text></clause><clause commented="no" id="idCC84294E40964A94AE6C0BC2B99B8BF2"><enum>(ii)</enum><text>A report on the impact study component of the evaluation.</text></clause><clause commented="no" id="id497E64C3D1C142A494B7AD9D53CB964A"><enum>(iii)</enum><text>A report on the implementation study component of the evaluation.</text></clause><clause commented="no" id="idCA90F037CE9E4CD893460D014852D7DA"><enum>(iv)</enum><text>A report that includes—</text><subclause commented="no" id="id1CAB234060F64E8E9016686485F65FEE"><enum>(I)</enum><text>analyses of the extent to which the program has resulted in increased reunifications, increased permanency, case closures, net savings to the State or States involved (taking into account both costs borne by States and the Federal government), or other outcomes, or if the program did not produce such outcomes, an analysis of why the replication of the program did not yield such results;</text></subclause><subclause commented="no" id="idDFA613A0B81A43159B3FA325C4A3E553"><enum>(II)</enum><text>if, based on such analyses, the Secretary determines the program should be replicated, a replication plan; and</text></subclause><subclause commented="no" id="idF5BD3D3DA7604C9782A09D22CE41A3BA"><enum>(III)</enum><text>such recommendations for legislation and administrative action as the Secretary determines appropriate.</text></subclause></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ide68765e7d9944522ab16cc6dc864f7f7"><enum>(5)</enum><header>Appropriation</header><text>In addition to any amounts otherwise made available to carry out this subpart, out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated $15,000,000 for fiscal year 2019 to carry out the project, which shall remain available through fiscal year 2026.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id3A2468BF1D4F4CD29077B729D1040D18"><enum>(b)</enum><header>Clarification of payer of last resort application to child welfare prevention and family services</header><text>Section 471(e)(10) of the Social Security Act (42 U.S.C. 671(e)(10)), as added by section 50711(a)(2) of division E of Public Law 115–123, is amended—</text><paragraph id="idBCD07F67FADF4920836CE2D71CAD8F29"><enum>(1)</enum><text>in subparagraph (A), by inserting <quote>, nor shall the provision of such services or programs be construed to permit the State to reduce medical or other assistance available to a recipient of such services or programs</quote> after <quote>under this Act</quote>; and</text></paragraph><paragraph id="id0F9780E7BD2A4159867A52C9CDC8FC12"><enum>(2)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id8CCC10F0ED7A4537B81452E1628D7237" style="OLC"><subparagraph id="id10ECAAA83A924B8EA7EB5A40F52A651D"><enum>(C)</enum><header>Payer of last resort</header><text>In carrying out its responsibilities to ensure access to services or programs under this subsection, the State agency shall not be considered to be a legally liable third party for purposes of satisfying a financial commitment for the cost of providing such services or programs with respect to any individual for whom such cost would have been paid for from another public or private source but for the enactment of this subsection (except that whenever considered necessary to prevent a delay in the receipt of appropriate early intervention services by a child or family in a timely fashion, funds provided under section 474(a)(6) may be used to pay the provider of services or programs pending reimbursement from the public or private source that has ultimate responsibility for the payment).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="idED28ACED54D945DAAEB8814BFFA6EA38"><enum>(c)</enum><header>Effective date</header><text>The amendments made by subsection (b) shall take effect as if included in section 50711 of division E of Public Law 115–123.</text></subsection></section><section commented="no" display-inline="no-display-inline" id="id1A7F245BD4244F80A47ADD7604D9273E"><enum>2303.</enum><header>Building capacity for family-focused residential treatment</header><subsection id="id9DE60BAEA8F94A5DBB797FE0003F6942"><enum>(a)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text><paragraph id="idA81173D0F4574589B1B1105BD8C4262A"><enum>(1)</enum><header>Eligible entity</header><text>The term <term>eligible entity</term> means a State, county, local, or tribal health or child welfare agency, a private nonprofit organization, a research organization, a treatment service provider, an institution of higher education (as defined under section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001)), or another entity specified by the Secretary.</text></paragraph><paragraph id="id3F5EEAAC99384728973913323070590F"><enum>(2)</enum><header>Family-focused residential treatment program</header><text>The term <term>family-focused residential treatment program</term> means a trauma-informed residential program primarily for substance use disorder treatment for pregnant and postpartum women and parents and guardians that allows children to reside with such women or their parents or guardians during treatment to the extent appropriate and applicable.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id68B5FC93AEE04DD9BA4B06F4F80835A6"><enum>(3)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text></paragraph></subsection><subsection id="id3aa0dfaea90945248e233a40003e1d08"><enum>(b)</enum><header>Support for the development of evidence-based family-focused residential treatment programs</header><paragraph id="idfda0ed02b09c461296cbcbbd3d885e16"><enum>(1)</enum><header>Authority to award grants</header><text>The Secretary shall award grants to eligible entities for purposes of developing, enhancing, or evaluating family-focused residential treatment programs to increase the availability of such programs that meet the requirements for promising, supported, or well-supported practices specified in section 471(e)(4)(C) of the Social Security Act (42 U.S.C. 671(e)(4)(C))) (as added by the Family First Prevention Services Act enacted under title VII of division E of Public Law 115–123).</text></paragraph><paragraph id="id420b6b915860413a89326591880a9dcd"><enum>(2)</enum><header>Evaluation requirement</header><text>The Secretary shall require any evaluation of a family-focused residential treatment program by an eligible entity that uses funds awarded under this section for all or part of the costs of the evaluation be designed to assist in the determination of whether the program may qualify as a promising, supported, or well-supported practice in accordance with the requirements of such section 471(e)(4)(C).</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id9965F5E7ECA64030A9C82D482D2EB87D"><enum>(c)</enum><header>Authorization of appropriations</header><text display-inline="yes-display-inline">There is authorized to be appropriated to the Secretary to carry out this section, $20,000,000 for fiscal year 2019, which shall remain available through fiscal year 2023.</text></subsection></section></subtitle><subtitle id="idE8E5AB7D961B42CEA45F5B518452984E" style="OLC"><enum>D</enum><header>Synthetics Trafficking and Overdose Prevention</header><section id="idD9B8C0F97F27412682B7A0A6786B1180"><enum>2401.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Synthetics Trafficking and Overdose Prevention Act of 2018</short-title></quote> or <quote><short-title>STOP Act of 2018</short-title></quote>.</text></section><section id="HAC03D0C300A24BC6B07464D2E837D7AB"><enum>2402.</enum><header>Customs fees</header><subsection id="H2D5216FA6B6A45E9B61BAD18B9B10A87"><enum>(a)</enum><header>In general</header><text>Section 13031(b)(9) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 58c(b)(9)) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="HA47E99359B7F4B55A04BC2548BF7FF89" style="OLC"><subparagraph id="H997DB1CA7ED54C2299C322F297E50457" indent="up1"><enum>(D)</enum><clause commented="no" display-inline="yes-display-inline" id="HFCFF16DE02154F18BF462936BDC5C0CD"><enum>(i)</enum><text>With respect to the processing of items that are sent to the United States through the international postal network by <quote>Inbound Express Mail service</quote> or <quote>Inbound EMS</quote> (as that service is described in the mail classification schedule referred to in section 3631 of title 39, United States Code), the following payments are required:</text><subclause id="HB5D4A39043224ADEB1A6D4EC8BE85A3F" indent="up1"><enum>(I)</enum><text>$1 per Inbound EMS item.</text></subclause><subclause id="H7F0EC3AA68314325B62001F450406231" indent="up1"><enum>(II)</enum><text>If an Inbound EMS item is formally entered, the fee provided for under subsection (a)(9), if applicable.</text></subclause></clause><clause id="H5DF7E9224FFA4E97BEDA69DA6A893CBB" indent="up1"><enum>(ii)</enum><text>Notwithstanding section 451 of the Tariff Act of 1930 (19 U.S.C. 1451), the payments required by clause (i), as allocated pursuant to clause (iii)(I), shall be the only payments required for reimbursement of U.S. Customs and Border Protection for customs services provided in connection with the processing of an Inbound EMS item.</text></clause><clause id="H36E084F19C104B97B5FD1625A02E48A5" indent="up1"><enum>(iii)</enum><subclause commented="no" display-inline="yes-display-inline" id="HB01FEE550A304C0B804013BA4B0FCE62"><enum>(I)</enum><text>The payments required by clause (i)(I) shall be allocated as follows:</text><item id="HE7C82C43983644DFBAFAC0798B22E1D4" indent="up1"><enum>(aa)</enum><text>50 percent of the amount of the payments shall be paid on a quarterly basis by the United States Postal Service to the Commissioner of U.S. Customs and Border Protection in accordance with regulations prescribed by the Secretary of the Treasury to reimburse U.S. Customs and Border Protection for customs services provided in connection with the processing of Inbound EMS items.</text></item><item id="HF0A966F65F0A4615B04C684A9D9D4EE2" indent="up1"><enum>(bb)</enum><text>50 percent of the amount of the payments shall be retained by the Postal Service to reimburse the Postal Service for services provided in connection with the customs processing of Inbound EMS items.</text></item></subclause><subclause id="H8834AFE1AA624F46B82ED262F3E52AE0" indent="up1"><enum>(II)</enum><text>Payments received by U.S. Customs and Border Protection under subclause (I)(aa) shall, in accordance with section 524 of the Tariff Act of 1930 (19 U.S.C. 1524), be deposited in the Customs User Fee Account and used to directly reimburse each appropriation for the amount paid out of that appropriation for the costs incurred in providing services to international mail facilities. Amounts deposited in accordance with the preceding sentence shall be available until expended for the provision of such services.</text></subclause><subclause id="H2D23FFC2DB524B51945A864F8D927F53" indent="up1"><enum>(III)</enum><text>Payments retained by the Postal Service under subclause (I)(bb) shall be used to directly reimburse the Postal Service for the costs incurred in providing services in connection with the customs processing of Inbound EMS items.</text></subclause></clause><clause id="H5C2D71462BD440FDAF87DD30238D2065" indent="up1"><enum>(iv)</enum><text>Beginning in fiscal year 2021, the Secretary, in consultation with the Postmaster General, may adjust, not more frequently than once each fiscal year, the amount described in clause (i)(I) to an amount commensurate with the costs of services provided in connection with the customs processing of Inbound EMS items, consistent with the obligations of the United States under international agreements.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H3D2A2CD049FD4DA9BB7AF976F5280F6F"><enum>(b)</enum><header>Conforming amendments</header><text>Section 13031(a) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 58c(a)) is amended—</text><paragraph commented="no" display-inline="no-display-inline" id="H3CD7920ED4014218823C3318BD2688C2"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (6), by inserting <quote>(other than an item subject to a fee under subsection (b)(9)(D))</quote> after <quote>customs officer</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HD6A7849384D1443DBD9832F545C2481D"><enum>(2)</enum><text>in paragraph (10)—</text><subparagraph id="H892956FD5B584F41BAE26CCC2287BDCF"><enum>(A)</enum><text>in subparagraph (C), in the matter preceding clause (i), by inserting <quote>(other than Inbound EMS items described in subsection (b)(9)(D))</quote> after <quote>release</quote>; and</text></subparagraph><subparagraph id="H5E4D1EC24B51411A9355010EC643C546"><enum>(B)</enum><text>in the flush at the end, by inserting <quote>or of Inbound EMS items described in subsection (b)(9)(D),</quote> after <quote>(C),</quote>.</text></subparagraph></paragraph></subsection><subsection id="H102BAD5C52D744FBBD1A4E67DF4BD046"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section shall take effect on January 1, 2020.</text></subsection></section><section id="HFD2B65820DD84D4F8F4D448CB74D2A00"><enum>2403.</enum><header>Mandatory advance electronic information for postal shipments</header><subsection id="H92471F37B2B94EC3BFBB9C27673AF5B0"><enum>(a)</enum><header>Mandatory advance electronic information</header><paragraph id="H457CA8413F524007BC9950BAFAF619AA"><enum>(1)</enum><header>In general</header><text>Section 343(a)(3)(K) of the Trade Act of 2002 (Public Law 107–210; 19 U.S.C. 2071 note) is amended to read as follows:</text><quoted-block display-inline="no-display-inline" id="H4186E1666ED94C5AAABAACDDE4495EF2" style="OLC"><subparagraph id="HFF076628FB994A2EBE5091808085CAE5"><enum>(K)</enum><clause commented="no" display-inline="yes-display-inline" id="H59379326D649461DB2E1635FE9803FF9"><enum>(i)</enum><text>The Secretary shall prescribe regulations requiring the United States Postal Service to transmit the information described in paragraphs (1) and (2) to the Commissioner of U.S. Customs and Border Protection for international mail shipments by the Postal Service (including shipments to the Postal Service from foreign postal operators that are transported by private carrier) consistent with the requirements of this subparagraph.</text></clause><clause id="H491B1F1755614257BF02641E6931E87D" indent="up1"><enum>(ii)</enum><text>In prescribing regulations under clause (i), the Secretary shall impose requirements for the transmission to the Commissioner of information described in paragraphs (1) and (2) for mail shipments described in clause (i) that are comparable to the requirements for the transmission of such information imposed on similar non-mail shipments of cargo, taking into account the parameters set forth in subparagraphs (A) through (J).</text></clause><clause commented="no" display-inline="no-display-inline" id="HF31E447A9E0E49709AC0209EEDB87C3F" indent="up1"><enum>(iii)</enum><text display-inline="yes-display-inline">The regulations prescribed under clause (i) shall require the transmission of the information described in paragraphs (1) and (2) with respect to a shipment as soon as practicable in relation to the transportation of the shipment, consistent with subparagraph (H).</text></clause><clause id="H211FBE2CEBAE46BD93C1AF2FF716CE04" indent="up1"><enum>(iv)</enum><text>Regulations prescribed under clause (i) shall allow for the requirements for the transmission to the Commissioner of information described in paragraphs (1) and (2) for mail shipments described in clause (i) to be implemented in phases, as appropriate, by—</text><subclause id="H9DA1730601D842F8925D9C9F8E9FEFF8"><enum>(I)</enum><text>setting incremental targets for increasing the percentage of such shipments for which information is required to be transmitted to the Commissioner; and</text></subclause><subclause id="H01E9198150214ADCA28A9C99A0DDA9C7"><enum>(II)</enum><text>taking into consideration—</text><item id="HA30E0BE0D3C64AC1A9927635A662C66D"><enum>(aa)</enum><text>the risk posed by such shipments;</text></item><item id="HB893BAC50C9B463D92D71AAAB0311AC5"><enum>(bb)</enum><text>the volume of mail shipped to the United States by or through a particular country; and</text></item><item id="HD1191465BC65462CB0CFE9ECA6DBBFB5"><enum>(cc)</enum><text>the capacities of foreign postal operators to provide that information to the Postal Service.</text></item></subclause></clause><clause id="H841573A1DD774DC492A219974B8DD998" indent="up1"><enum>(v)</enum><subclause commented="no" display-inline="yes-display-inline" id="H1BFA130E08C64C0D97321AEF407637DF"><enum>(I)</enum><text display-inline="yes-display-inline">Notwithstanding clause (iv), the Postal Service shall, not later than December 31, 2018, arrange for the transmission to the Commissioner of the information described in paragraphs (1) and (2) for not less than 70 percent of the aggregate number of mail shipments, including 100 percent of mail shipments from the People’s Republic of China, described in clause (i).</text></subclause><subclause id="H442CF3DD56164856A9258280C93008CF" indent="up1"><enum>(II)</enum><text>If the requirements of subclause (I) are not met, the Comptroller General of the United States shall submit to the appropriate congressional committees, not later than June 30, 2019, a report—</text><item id="H98D8521469CD47B9812A265E8A2EFB4E"><enum>(aa)</enum><text>assessing the reasons for the failure to meet those requirements; and</text></item><item id="HCDD49FD7696F41F1BFBE004DFF5E93ED"><enum>(bb)</enum><text>identifying recommendations to improve the collection by the Postal Service of the information described in paragraphs (1) and (2).</text></item></subclause></clause><clause id="HF5899DC4ACA24F68B45152E509119AC3" indent="up1"><enum>(vi)</enum><subclause commented="no" display-inline="yes-display-inline" id="idD432FCE277F14491BEA3E517428FD4C7"><enum>(I)</enum><text display-inline="yes-display-inline">Notwithstanding clause (iv), the Postal Service shall, not later than December 31, 2020, arrange for the transmission to the Commissioner of the information described in paragraphs (1) and (2) for 100 percent of the aggregate number of mail shipments described in clause (i).</text></subclause><subclause id="H0BCD30683F05463793C51A1B2B8EA843" indent="up1"><enum>(II)</enum><text display-inline="yes-display-inline">The Commissioner, in consultation with the Postmaster General, may determine to exclude a country from the requirement described in subclause (I) to transmit information for mail shipments described in clause (i) from the country if the Commissioner determines that the country—</text><item id="H1C9C38583EA64C5986B4C9C6ACAA97B7"><enum>(aa)</enum><text>does not have the capacity to collect and transmit such information;</text></item><item id="H5FB098E756CD4FE0BCE272DB8D6787C1"><enum>(bb)</enum><text>represents a low risk for mail shipments that violate relevant United States laws and regulations; and</text></item><item id="H92CB71DEE5F64F308D393C7C946BCBFC"><enum>(cc)</enum><text>accounts for low volumes of mail shipments that can be effectively screened for compliance with relevant United States laws and regulations through an alternate means.</text></item></subclause><subclause id="H7CB5AA762D814F6386FEEF80736E9707" indent="up1"><enum>(III)</enum><text display-inline="yes-display-inline">The Commissioner shall, at a minimum on an annual basis, re-evaluate any determination made under subclause (II) to exclude a country from the requirement described in subclause (I). If, at any time, the Commissioner determines that a country no longer meets the requirements under subclause (II), the Commissioner may not further exclude the country from the requirement described in subclause (I).</text></subclause><subclause id="HBD1DD4FD23464558BE871B54695E3646" indent="up1"><enum>(IV)</enum><text>The Commissioner shall, on an annual basis, submit to the appropriate congressional committees—</text><item id="HC27DA17EDC504BA8B97D92916FCE20E7"><enum>(aa)</enum><text display-inline="yes-display-inline">a list of countries with respect to which the Commissioner has made a determination under subclause (II) to exclude the countries from the requirement described in subclause (I); and</text></item><item id="HCD5F5791A0674BF39CF103F7ED6FDD0A"><enum>(bb)</enum><text>information used to support such determination with respect to such countries.</text></item></subclause></clause><clause id="H01916459EAA242EFA42EC1A5E020B88C" indent="up1"><enum>(vii)</enum><subclause commented="no" display-inline="yes-display-inline" id="H392053661CC54079B9D4296A7DD50A0A"><enum>(I)</enum><text display-inline="yes-display-inline">The Postmaster General shall, in consultation with the Commissioner, refuse any shipments received after December 31, 2020, for which the information described in paragraphs (1) and (2) is not transmitted as required under this subparagraph, except as provided in subclause (II).</text></subclause><subclause id="H33630A0782B24790B6D4F1068CBA1419" indent="up1"><enum>(II)</enum><text>If remedial action is warranted in lieu of refusal of shipments pursuant to subclause (I), the Postmaster General and the Commissioner shall take remedial action with respect to the shipments, including destruction, seizure, controlled delivery or other law enforcement initiatives, or correction of the failure to provide the information described in paragraphs (1) and (2) with respect to the shipment.</text></subclause></clause><clause id="H9571A346D8514D7FBE3210BA72AFBF8D" indent="up1"><enum>(viii)</enum><text>Nothing in this subparagraph shall be construed to limit the authority of the Secretary to obtain information relating to international mail shipments from private carriers or other appropriate parties.</text></clause><clause id="H7439B43E9EF34DD795301ED1D8DF006A" indent="up1"><enum>(ix)</enum><text>In this subparagraph, the term <term>appropriate congressional committees</term> means—</text><subclause id="H8C1E031D8E6146DA8197202B2DFAE5AE"><enum>(I)</enum><text>the Committee on Finance and the Committee on Homeland Security and Governmental Affairs of the Senate; and</text></subclause><subclause id="HD816839C716148AAB0611C3D9EFCAFA8"><enum>(II)</enum><text>the Committee on Ways and Means, the Committee on Oversight and Government Reform, and the Committee on Homeland Security of the House of Representatives.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="H13240A897E6B4B88ABE431A0A2F24FC8"><enum>(2)</enum><header>Joint strategic plan on mandatory advance information</header><text>Not later than 60 days after the date of the enactment of this Act, the Secretary of Homeland Security and the Postmaster General shall develop and submit to the appropriate congressional committees a joint strategic plan detailing specific performance measures for achieving—</text><subparagraph id="H04E0BA21EA2D4EBCA8B13897BD1E83D5"><enum>(A)</enum><text>the transmission of information as required by section 343(a)(3)(K) of the Trade Act of 2002, as amended by paragraph (1); and</text></subparagraph><subparagraph id="H1361D4AB9FB4423AB0980A66627D4E81"><enum>(B)</enum><text>the presentation by the Postal Service to U.S. Customs and Border Protection of all mail targeted by U.S. Customs and Border Protection for inspection.</text></subparagraph></paragraph></subsection><subsection id="HDC56C2E441C341668D5CE59C3F45BA17"><enum>(b)</enum><header>Capacity building</header><paragraph id="HC94E839681EB4D0D938BF360279E8480"><enum>(1)</enum><header>In general</header><text>Section 343(a) of the Trade Act of 2002 (Public Law 107–210; 19 U.S.C. 2071 note) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="H5894831F7DF54CA2877E73D5378990AF" style="OLC"><paragraph id="H6704CFF81D234A1EADD7028E670BE24E"><enum>(5)</enum><header>Capacity building</header><subparagraph id="H81FF28B0C54E438E8A765854A5639636"><enum>(A)</enum><header>In general</header><text>The Secretary, with the concurrence of the Secretary of State, and in coordination with the Postmaster General and the heads of other Federal agencies, as appropriate, may provide technical assistance, equipment, technology, and training to enhance the capacity of foreign postal operators—</text><clause id="HEB7A25FFBA8048939DF6BC4B37A6D7A1"><enum>(i)</enum><text>to gather and provide the information required by paragraph (3)(K); and</text></clause><clause id="HA67D4EFCBC824F4480B020DC6BCE6ADC"><enum>(ii)</enum><text>to otherwise gather and provide postal shipment information related to—</text><subclause id="H5C0992D942414963ABB70B1079A412D2"><enum>(I)</enum><text>terrorism;</text></subclause><subclause id="HE4E2DCE96028486AB83A3DCC081B0BAC"><enum>(II)</enum><text>items the importation or introduction of which into the United States is prohibited or restricted, including controlled substances; and</text></subclause><subclause id="H31709238BA60410E9E79F7AC00F82570"><enum>(III)</enum><text>such other concerns as the Secretary determines appropriate.</text></subclause></clause></subparagraph><subparagraph id="HFC6405041E6A433DB74C50DC333DC6D1"><enum>(B)</enum><header>Provision of equipment and technology</header><text>With respect to the provision of equipment and technology under subparagraph (A), the Secretary may lease, loan, provide, or otherwise assist in the deployment of such equipment and technology under such terms and conditions as the Secretary may prescribe, including nonreimbursable loans or the transfer of ownership of equipment and technology.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="HCBBE5565C80E4658993C2A815191B468"><enum>(2)</enum><header>Joint strategic plan on capacity building</header><text>Not later than one year after the date of the enactment of this Act, the Secretary of Homeland Security and the Postmaster General shall, in consultation with the Secretary of State, jointly develop and submit to the appropriate congressional committees a joint strategic plan—</text><subparagraph id="HD4D5A47BB1344D0BA2101810115BB29E"><enum>(A)</enum><text>detailing the extent to which U.S. Customs and Border Protection and the United States Postal Service are engaged in capacity building efforts under section 343(a)(5) of the Trade Act of 2002, as added by paragraph (1);</text></subparagraph><subparagraph id="HB050D92D9EB247238776C4CA5E8E8EA8"><enum>(B)</enum><text>describing plans for future capacity building efforts; and</text></subparagraph><subparagraph id="H0887CAA267A34F9EA72B6AFBC8D96E35"><enum>(C)</enum><text>assessing how capacity building has increased the ability of U.S. Customs and Border Protection and the Postal Service to advance the goals of this subtitle and the amendments made by this subtitle.</text></subparagraph></paragraph></subsection><subsection id="HF7E60E46C33C4807A0605FBE884C7A12"><enum>(c)</enum><header>Report and consultations by Secretary of Homeland Security and Postmaster General</header><paragraph id="HFE2990877A5742BD8EAC2DBE14F049DE"><enum>(1)</enum><header>Report</header><text>Not later than 180 days after the date of the enactment of this Act, and annually thereafter until 3 years after the Postmaster General has met the requirement under clause (vi) of subparagraph (K) of section 343(a)(3) of the Trade Act of 2002, as amended by subsection (a)(1), the Secretary of Homeland Security and the Postmaster General shall, in consultation with the Secretary of State, jointly submit to the appropriate congressional committees a report on compliance with that subparagraph that includes the following:</text><subparagraph id="H3B3BFE9D35A24D9BB6C4EE90BD5E153F"><enum>(A)</enum><text>An assessment of the status of the regulations required to be promulgated under that subparagraph.</text></subparagraph><subparagraph id="H25B5FDB9F2D74B2BBB9A0ABDAFD099C5"><enum>(B)</enum><text>An update regarding new and existing agreements reached with foreign postal operators for the transmission of the information required by that subparagraph.</text></subparagraph><subparagraph id="H70265E1B6BD345A9B394E69F3C79BE3D"><enum>(C)</enum><text>A summary of deliberations between the United States Postal Service and foreign postal operators with respect to issues relating to the transmission of that information.</text></subparagraph><subparagraph id="H6BA053B80411440DBF765699D7B308A4"><enum>(D)</enum><text>A summary of the progress made in achieving the transmission of that information for the percentage of shipments required by that subparagraph.</text></subparagraph><subparagraph id="H74DC2520396842A69624389B1059D124"><enum>(E)</enum><text>An assessment of the quality of that information being received by foreign postal operators, as determined by the Secretary of Homeland Security, and actions taken to improve the quality of that information.</text></subparagraph><subparagraph id="H1AB41CF4FDF94DA0851238C9328ADDB9"><enum>(F)</enum><text>A summary of policies established by the Universal Postal Union that may affect the ability of the Postmaster General to obtain the transmission of that information.</text></subparagraph><subparagraph id="H3031D9C6349E4B5798D987CD48262E4B"><enum>(G)</enum><text>A summary of the use of technology to detect illicit synthetic opioids and other illegal substances in international mail parcels and planned acquisitions and advancements in such technology.</text></subparagraph><subparagraph id="H5F46BC5AE055410A87470E2B6782E0E2"><enum>(H)</enum><text>Such other information as the Secretary of Homeland Security and the Postmaster General consider appropriate with respect to obtaining the transmission of information required by that subparagraph.</text></subparagraph></paragraph><paragraph id="H1CB0097CFA1344F28C099110E38EC846"><enum>(2)</enum><header>Consultations</header><text display-inline="yes-display-inline">Not later than 180 days after the date of the enactment of this Act, and every 180 days thereafter until the Postmaster General has met the requirement under clause (vi) of section 343(a)(3)(K) of the Trade Act of 2002, as amended by subsection (a)(1), to arrange for the transmission of information with respect to 100 percent of the aggregate number of mail shipments described in clause (i) of that section, the Secretary of Homeland Security and the Postmaster General shall provide briefings to the appropriate congressional committees on the progress made in achieving the transmission of that information for that percentage of shipments.</text></paragraph></subsection><subsection id="HACD4856FE5A54636B3D325C72446E119"><enum>(d)</enum><header>Government Accountability Office report</header><text>Not later than June 30, 2019, the Comptroller General of the United States shall submit to the appropriate congressional committees a report—</text><paragraph id="HBC462B05CA3B45CEA351366E40A2D6AC"><enum>(1)</enum><text>assessing the progress of the United States Postal Service in achieving the transmission of the information required by subparagraph (K) of section 343(a)(3) of the Trade Act of 2002, as amended by subsection (a)(1), for the percentage of shipments required by that subparagraph;</text></paragraph><paragraph id="H5766BEF542CE4FD88B475F2F1917CAD0"><enum>(2)</enum><text>assessing the quality of the information received from foreign postal operators for targeting purposes;</text></paragraph><paragraph id="H4FFE5ED33F5246FFBC2CCC5A5F2A47E9"><enum>(3)</enum><text>assessing the specific percentage of targeted mail presented by the Postal Service to U.S. Customs and Border Protection for inspection;</text></paragraph><paragraph id="H3A0652249A7644DDB6D437CD09B41B0D"><enum>(4)</enum><text>describing the costs of collecting the information required by such subparagraph (K) from foreign postal operators and the costs of implementing the use of that information;</text></paragraph><paragraph id="H38C0DD9E7F1A42349B2FAAA32A7269F2"><enum>(5)</enum><text>assessing the benefits of receiving that information with respect to international mail shipments;</text></paragraph><paragraph id="H726F854D688F4BBA96799F70AFA4C6E0"><enum>(6)</enum><text>assessing the feasibility of assessing a customs fee under section 13031(b)(9) of the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended by section 2402, on international mail shipments other than Inbound Express Mail service in a manner consistent with the obligations of the United States under international agreements; and</text></paragraph><paragraph id="HD28371945EA24ED9AF67DA30E96B8085"><enum>(7)</enum><text>identifying recommendations, including recommendations for legislation, to improve the compliance of the Postal Service with such subparagraph (K), including an assessment of whether the detection of illicit synthetic opioids in the international mail would be improved by—</text><subparagraph id="H11563D67C3004BF79472B84CE751D84D"><enum>(A)</enum><text>requiring the Postal Service to serve as the consignee for international mail shipments containing goods; or</text></subparagraph><subparagraph id="H4AE7F48D51E44F04A27EF44DA718F40E"><enum>(B)</enum><text>designating a customs broker to act as an importer of record for international mail shipments containing goods.</text></subparagraph></paragraph></subsection><subsection commented="no" id="H4075EDC6AA124F76B0E479D843F3735A"><enum>(e)</enum><header>Technical correction</header><text>Section 343 of the Trade Act of 2002 (Public Law 107–210; 19 U.S.C. 2071 note) is amended in the section heading by striking <quote><header-in-text level="section" style="OLC">advanced</header-in-text></quote> and inserting <quote><header-in-text level="section" style="OLC">advance</header-in-text></quote>.</text></subsection><subsection id="H48FBA8B5F25D4244BDFA4C73F787F715"><enum>(f)</enum><header>Appropriate congressional committees defined</header><text>In this section, the term <term>appropriate congressional committees</term> means—</text><paragraph id="HE37209A1FDF1439CA8FDB5A9DDB69C54"><enum>(1)</enum><text>the Committee on Finance and the Committee on Homeland Security and Governmental Affairs of the Senate; and</text></paragraph><paragraph id="HE912AF7ECD3A4B6C8AA5E318514F3729"><enum>(2)</enum><text>the Committee on Ways and Means, the Committee on Oversight and Government Reform, and the Committee on Homeland Security of the House of Representatives.</text></paragraph></subsection></section><section id="HF1ACCD12E9E8486BBCF6B6B91CD4F387"><enum>2404.</enum><header>International postal agreements</header><subsection commented="no" id="H760A21401F3F476281EE325E51F10DCF"><enum>(a)</enum><header>Existing agreements</header><paragraph id="HCFC0B721E30B4E128A62F93D81334D81"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">In the event that any provision of this subtitle, or any amendment made by this subtitle, is determined to be in violation of obligations of the United States under any postal treaty, convention, or other international agreement related to international postal services, or any amendment to such an agreement, the Secretary of State should negotiate to amend the relevant provisions of the agreement so that the United States is no longer in violation of the agreement.</text></paragraph><paragraph commented="no" id="H5682503578EC4F8FBCADE3E59B853F92"><enum>(2)</enum><header>Rule of construction</header><text>Nothing in this subsection shall be construed to permit delay in the implementation of this subtitle or any amendment made by this subtitle.</text></paragraph></subsection><subsection commented="no" id="HF386F45B089E44E68FD6DB703C3230E0"><enum>(b)</enum><header>Future agreements</header><paragraph commented="no" id="HD29576C3FB964184AEF8E5E351B142A3"><enum>(1)</enum><header>Consultations</header><text>Before entering into, on or after the date of the enactment of this Act, any postal treaty, convention, or other international agreement related to international postal services, or any amendment to such an agreement, that is related to the ability of the United States to secure the provision of advance electronic information by foreign postal operators, the Secretary of State should consult with the appropriate congressional committees (as defined in section 2403(f)).</text></paragraph><paragraph commented="no" id="HFAE7DE7221624A2F8B483856D602F789"><enum>(2)</enum><header>Expedited negotiation of new agreement</header><text>To the extent that any new postal treaty, convention, or other international agreement related to international postal services would improve the ability of the United States to secure the provision of advance electronic information by foreign postal operators as required by regulations prescribed under section 343(a)(3)(K) of the Trade Act of 2002, as amended by section 2403(a)(1), the Secretary of State should expeditiously conclude such an agreement.</text></paragraph></subsection></section><section id="HCD052E0A155B437ABDB8CCECE9042ED8"><enum>2405.</enum><header>Cost recoupment</header><subsection id="H87797AE2588C42D5A579C26CB83F8E97"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The United States Postal Service shall, to the extent practicable and otherwise recoverable by law, ensure that all costs associated with complying with this subtitle and amendments made by this subtitle are charged directly to foreign shippers or foreign postal operators.</text></subsection><subsection id="H7B3FD2936C564C3EAADDA45B2FCFAB4A"><enum>(b)</enum><header>Costs not considered revenue</header><text display-inline="yes-display-inline">The recovery of costs under subsection (a) shall not be deemed revenue for purposes of subchapter I and II of chapter 36 of title 39, United States Code, or regulations prescribed under that chapter.</text></subsection></section><section id="HCA67489BF3964B2FA6EC92036E91C2A3"><enum>2406.</enum><header>Development of technology to detect illicit narcotics</header><subsection id="H76C333C854B442EC8D18DC4AEFE34923"><enum>(a)</enum><header>In general</header><text>The Postmaster General and the Commissioner of U.S. Customs and Border Protection, in coordination with the heads of other agencies as appropriate, shall collaborate to identify and develop technology for the detection of illicit fentanyl, other synthetic opioids, and other narcotics and psychoactive substances entering the United States by mail.</text></subsection><subsection id="HA94A630AEA5B411282D5DF33651C88BE"><enum>(b)</enum><header>Outreach to private sector</header><text>The Postmaster General and the Commissioner shall conduct outreach to private sector entities to gather information regarding the current state of technology to identify areas for innovation relating to the detection of illicit fentanyl, other synthetic opioids, and other narcotics and psychoactive substances entering the United States.</text></subsection></section><section id="HD03330B792094D25BEA733F2BA77ECFA"><enum>2407.</enum><header>Civil penalties for postal shipments</header><text display-inline="no-display-inline">Section 436 of the Tariff Act of 1930 (19 U.S.C. 1436) is amended by adding at the end the following new subsection:</text><quoted-block display-inline="no-display-inline" id="H1F541C6948E743F98B377DA55CED909D" style="OLC"><subsection id="H07913FFC7F214C0DBCA3EB0529212A08"><enum>(e)</enum><header>Civil penalties for postal shipments</header><paragraph id="H5C6D7119623046CAB0ED8242016EE1E1"><enum>(1)</enum><header>Civil penalty</header><text display-inline="yes-display-inline">A civil penalty shall be imposed against the United States Postal Service if the Postal Service accepts a shipment in violation of section 343(a)(3)(K)(vii)(I) of the Trade Act of 2002.</text></paragraph><paragraph commented="no" id="H0AF0263BA3414C1B9B31E067796786A0"><enum>(2)</enum><header>Modification of civil penalty</header><subparagraph id="HF057EA1807E84366942A01C041A4AA72"><enum>(A)</enum><header>In general</header><text>U.S. Customs and Border Protection shall reduce or dismiss a civil penalty imposed pursuant to paragraph (1) if U.S. Customs and Border Protection determines that the United States Postal Service—</text><clause commented="no" id="HFEA3C41957BE4E90B58EFA214A05D9DD"><enum>(i)</enum><text>has a low error rate in compliance with section 343(a)(3)(K) of the Trade Act of 2002;</text></clause><clause commented="no" id="H0F86889D58884975A253608C7F7F1540"><enum>(ii)</enum><text>is cooperating with U.S. Customs and Border Protection with respect to the violation of section 343(a)(3)(K)(vii)(I) of the Trade Act of 2002; or</text></clause><clause commented="no" id="HA6B8611364A54C8B97D613A2E3B42AFC"><enum>(iii)</enum><text display-inline="yes-display-inline">has taken remedial action to prevent future violations of section 343(a)(3)(K)(vii)(I) of the Trade Act of 2002.</text></clause></subparagraph><subparagraph commented="no" id="H0A31B93BD3F74F48880A3BBFB4851C12"><enum>(B)</enum><header>Written notification</header><text display-inline="yes-display-inline">U.S. Customs and Border Protection shall issue a written notification to the Postal Service with respect to each exercise of the authority of subparagraph (A) to reduce or dismiss a civil penalty imposed pursuant to paragraph (1).</text></subparagraph></paragraph><paragraph id="H7C8EAFF96A434946B98419274649A5A1"><enum>(3)</enum><header>Ongoing lack of compliance</header><text display-inline="yes-display-inline">If U.S. Customs and Border Protection determines that the United States Postal Service—</text><subparagraph id="HB914C4D44CAC497CB3A432B1585197EC"><enum>(A)</enum><text display-inline="yes-display-inline">has repeatedly committed violations of section 343(a)(3)(K)(vii)(I) of the Trade Act of 2002,</text></subparagraph><subparagraph id="HC7A9323F083546FDBEBAA1063620BA14"><enum>(B)</enum><text display-inline="yes-display-inline">has failed to cooperate with U.S. Customs and Border Protection with respect to violations of section 343(a)(3)(K)(vii)(I) of the Trade Act of 2002, and</text></subparagraph><subparagraph id="H712DED5220F04DD69562A7ADF252FCCE"><enum>(C)</enum><text display-inline="yes-display-inline">has an increasing error rate in compliance with section 343(a)(3)(K) of the Trade Act of 2002,</text></subparagraph><continuation-text continuation-text-level="paragraph">civil penalties may be imposed against the United States Postal Service until corrective action, satisfactory to U.S. Customs and Border Protection, is taken.</continuation-text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="H4577D1E0898446F8B31F489AE613F50D"><enum>2408.</enum><header>Report on violations of arrival, reporting, entry, and clearance requirements and falsity or lack of manifest</header><subsection id="H5E9A9209A4B645AAB4D77CEBC0219AD0"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Commissioner of U.S. Customs and Border Protection shall submit to the appropriate congressional committees an annual report that contains the information described in subsection (b) with respect to each violation of section 436 of the Tariff Act of 1930 (19 U.S.C. 1436), as amended by section 7, and section 584 of such Act (19 U.S.C. 1584) that occurred during the previous year.</text></subsection><subsection id="H98655BFEACE64A4FAD984F08E06B5759"><enum>(b)</enum><header>Information described</header><text>The information described in this subsection is the following:</text><paragraph id="H42FCA3851E784815918E11B07E9666F2"><enum>(1)</enum><text display-inline="yes-display-inline">The name and address of the violator.</text></paragraph><paragraph id="H69B1ED8C1B90446CB60B4A9D81E88D61"><enum>(2)</enum><text>The specific violation that was committed.</text></paragraph><paragraph id="H5CF1BE183E61423692B5BA35F74BE79C"><enum>(3)</enum><text>The location or port of entry through which the items were transported.</text></paragraph><paragraph id="HB504C447568F4B1CAD12ECA6032561E6"><enum>(4)</enum><text>An inventory of the items seized, including a description of the items and the quantity seized.</text></paragraph><paragraph id="H00E5671CFF5F4C8B969DA40D10AAA5B2"><enum>(5)</enum><text>The location from which the items originated.</text></paragraph><paragraph id="H21BF7A398C4141C78D91551167F356D8"><enum>(6)</enum><text>The entity responsible for the apprehension or seizure, organized by location or port of entry.</text></paragraph><paragraph id="H005D7482A0D943E0956D85CC3F614FD5"><enum>(7)</enum><text>The amount of penalties assessed by U.S. Customs and Border Protection, organized by name of the violator and location or port of entry.</text></paragraph><paragraph id="HC387F7183C884E129667C754F22F9AEA"><enum>(8)</enum><text>The amount of penalties that U.S. Customs and Border Protection could have levied, organized by name of the violator and location or port of entry.</text></paragraph><paragraph id="H86B026B2631A48328AFCC9BD53DDDB41"><enum>(9)</enum><text>The rationale for negotiating lower penalties, organized by name of the violator and location or port of entry.</text></paragraph></subsection><subsection id="H1F4EAE28A88D4397A6AFABE2AE378811"><enum>(c)</enum><header>Appropriate congressional committees defined</header><text>In this section, the term <term>appropriate congressional committees</term> means—</text><paragraph id="H7FB73AEDAB684CB795AC5F882DD98890"><enum>(1)</enum><text>the Committee on Finance and the Committee on Homeland Security and Governmental Affairs of the Senate; and</text></paragraph><paragraph id="HA7DFAB54F3DA4F86B52BD22CC7F9FCCC"><enum>(2)</enum><text>the Committee on Ways and Means, the Committee on Oversight and Government Reform, and the Committee on Homeland Security of the House of Representatives.</text></paragraph></subsection></section><section id="H8245B272FFC048379DDBBEC5DB6A1E8F"><enum>2409.</enum><header>Effective date; regulations</header><subsection id="HCA0FEA09F37E441AA8E3F02A271CC3C8"><enum>(a)</enum><header>Effective date</header><text>This subtitle and the amendments made by this subtitle (other than the amendments made by section 2402) shall take effect on the date of the enactment of this Act.</text></subsection><subsection id="H37C2C9673C2A43C68AFD56FB5B050C01"><enum>(b)</enum><header>Regulations</header><text>Not later than one year after the date of the enactment of this Act, such regulations as are necessary to carry out this subtitle and the amendments made by this subtitle shall be prescribed.</text></subsection></section></subtitle><enum>III</enum><header>Judiciary</header><subtitle id="idBDD8DCD6E6144DE7B3A4FA7BE0930F63" style="OLC"><enum>A</enum><header>Access to Increased Drug Disposal</header><section id="id98D262778F74451BAE84B10011C1BF9A"><enum>3101.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Access to Increased Drug Disposal Act of 2018</short-title></quote>.</text></section><section id="id40DECE0E80584AEB8E6790EF97F4A5BC"><enum>3102.</enum><header>Definitions</header><text display-inline="no-display-inline">In this subtitle—</text><paragraph id="id5ADC391283C74DA7957DED6BF7D1950B"><enum>(1)</enum><text display-inline="yes-display-inline">the term <term>Attorney General</term> means the Attorney General, acting through the Assistant Attorney General for the Office of Justice Programs;</text></paragraph><paragraph id="id3558C409BFD54A45862675D21298104F"><enum>(2)</enum><text display-inline="yes-display-inline">the term <term>authorized collector</term> means a narcotic treatment program, a hospital or clinic with an on-site pharmacy, a retail pharmacy, or a reverse distributor, that is authorized as a collector under section 1317.40 of title 21, Code of Federal Regulations (or any successor regulation);</text></paragraph><paragraph id="idB3FF703B249D40578208B0E657A8F6E4"><enum>(3)</enum><text display-inline="yes-display-inline">the term <term>covered grant</term> means a grant awarded under section 3003; and</text></paragraph><paragraph id="id83D5A6AF32F04A57A7D707E75367D3E3"><enum>(4)</enum><text>the term <term>eligible collector</term> means a person who is eligible to be an authorized collector.</text></paragraph></section><section id="id52E73B017A3F4AFEAB4800D6D4EFBCF4"><enum>3103.</enum><header>Authority to make grants</header><text display-inline="no-display-inline">The Attorney General shall award grants to States to enable the States to increase the participation of eligible collectors as authorized collectors.</text></section><section id="id4B1FEE126D0F449A9C75ABC10038D252"><enum>3104.</enum><header>Application</header><text display-inline="no-display-inline">A State desiring a covered grant shall submit to the Attorney General an application that, at a minimum—</text><paragraph id="idab6fe55cf75642fbb53fa49b4ad04719"><enum>(1)</enum><text>identifies the single State agency that oversees pharmaceutical care and will be responsible for complying with the requirements of the grant;</text></paragraph><paragraph id="idE59EAA7A1AB9470EBE17CDAB27183EB2"><enum>(2)</enum><text>details a plan to increase participation rates of eligible collectors as authorized collectors; and</text></paragraph><paragraph id="id031587F0F8E04F03A526A847776BB4DF"><enum>(3)</enum><text>describes how the State will select eligible collectors to be served under the grant.</text></paragraph></section><section id="id565978B02E6F409787CD8EF6118FFDD2"><enum>3105.</enum><header>Use of grant funds</header><text display-inline="no-display-inline">A State that receives a covered grant, and any subrecipient of the grant, may use the grant amounts only for the costs of installation, maintenance, training, purchasing, and disposal of controlled substances associated with the participation of eligible collectors as authorized collectors.</text></section><section id="id4c377ca936c444bb9b3ddb82996102c2"><enum>3106.</enum><header>Eligibility for grant</header><text display-inline="no-display-inline">The Attorney General shall award a covered grant to 5 States, not less than 3 of which shall be States in the lowest quartile of States based on the participation rate of eligible collectors as authorized collectors, as determined by the Attorney General.</text></section><section id="id2b27ab17d0aa4c9eb958518628c80998"><enum>3107.</enum><header>Duration of grants</header><text display-inline="no-display-inline">The Attorney General shall determine the period of years for which a covered grant is made to a State.</text></section><section id="id3f868076f5c44c7996ad54ea9e022640"><enum>3108.</enum><header>Accountability and oversight</header><text display-inline="no-display-inline">A State that receives a covered grant shall submit to the Attorney General a report, at such time and in such manner as the Attorney General may reasonably require, that—</text><paragraph id="idfb3901d6fe4c44e1a36181f0730ae5ce"><enum>(1)</enum><text>lists the ultimate recipients of the grant amounts;</text></paragraph><paragraph id="id251d79bf3c5d477b9b02f48771dc190f"><enum>(2)</enum><text>describes the activities undertaken by the State using the grant amounts; and</text></paragraph><paragraph id="id97d871a7ae554618ac83e2fadb7759cc"><enum>(3)</enum><text>contains performance measures relating to the effectiveness of the grant, including changes in the participation rate of eligible collectors as authorized collectors.</text></paragraph></section><section id="id69DF9CA50388474E93C5908D7D0FE83F"><enum>3109.</enum><header>Duration of program</header><text display-inline="no-display-inline">The Attorney General may award covered grants for each of the first 5 fiscal years beginning after the date of enactment of this Act.</text></section><section id="id8CFB5AB89225414B8D78D3C3A411ABAB"><enum>3110.</enum><header>Authorization of appropriations</header><text display-inline="no-display-inline">There is authorized to be appropriated to the Attorney General such sums as may be necessary to carry out this subtitle.</text></section></subtitle><subtitle id="id8C53CCC35541473FBF40D7C8DDB4108E" style="OLC"><enum>B</enum><header>Using Data To Prevent Opioid Diversion</header><section id="idEEB893F2C058483FB88436C28D934AE1"><enum>3201.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Using Data to Prevent Opioid Diversion Act of 2018</short-title></quote>.</text></section><section id="idfd794bcd-1e2c-43c2-bc25-62b68010c82f"><enum>3202.</enum><header>Purpose</header><subsection id="id21bea1c7-3981-4522-88a5-035384c00ed5"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The purpose of this subtitle is to provide drug manufacturers and distributors with access to anonymized information through the Automated Reports and Consolidated Orders System to help drug manufacturers and distributors identify, report, and stop suspicious orders of opioids and reduce diversion rates.</text></subsection><subsection id="idc8b3b913-6208-42f3-8501-d3ee2971746b"><enum>(b)</enum><header>Rule of construction</header><text>Nothing in this subtitle should be construed to absolve a drug manufacturer, drug distributor, or other Drug Enforcement Administration registrant from the responsibility of the manufacturer, distributor, or other registrant to—</text><paragraph id="id11958b6f-e12e-4d92-9cd5-1d98ceae0a54"><enum>(1)</enum><text>identify, stop, and report suspicious orders; or</text></paragraph><paragraph id="id563AF00BF0E144A6BBBFF16CB53DE43D"><enum>(2)</enum><text>maintain effective controls against diversion in accordance with section 303 of the Controlled Substances Act (21 U.S.C. 823) or any successor law or associated regulation.</text></paragraph></subsection></section><section id="id58a69494-2a97-4168-9415-9ec232278222"><enum>3203.</enum><header>Amendments</header><subsection id="ida99ee796-f3f6-43ae-ad39-39969fb4e89d"><enum>(a)</enum><header>Records and reports of registrants</header><text display-inline="yes-display-inline">Section 307 of the Controlled Substances Act (21 U.S.C. 827) is amended—</text><paragraph id="id71b917ae-9f84-4109-b460-c2b83a7b3a1a"><enum>(1)</enum><text>by redesignating subsections (f), (g), and (h) as subsections (g), (h), and (i), respectively;</text></paragraph><paragraph id="id4646127f-97a1-4bd7-a8bd-14ea954d25fe"><enum>(2)</enum><text>by inserting after subsection (e) the following:</text><quoted-block display-inline="no-display-inline" id="id0aff8d5b-df46-4730-9245-d4f775c51125" style="OLC"><subsection id="id34748cd1-7cca-4331-9027-16f581cd2f2f"><enum>(f)</enum><paragraph commented="no" display-inline="yes-display-inline" id="id1fe518e7-fb0d-4ff4-802b-c63c7d6ccd78"><enum>(1)</enum><text display-inline="yes-display-inline">The Attorney General shall, not less frequently than quarterly, make the following information available to manufacturer and distributor registrants through the Automated Reports and Consolidated Orders System, or any subsequent automated system developed by the Drug Enforcement Administration to monitor selected controlled substances:</text><subparagraph id="id30af9540-2a4c-43e7-bc93-4be76e60aa42" indent="up1"><enum>(A)</enum><text>The total number of distributor registrants that distribute controlled substances to a pharmacy or practitioner registrant, aggregated by the name and address of each pharmacy and practitioner registrant.</text></subparagraph><subparagraph id="ide8d9e106-e1c2-4f76-ab69-c0d9a78a9686" indent="up1"><enum>(B)</enum><text>The total quantity and type of opioids distributed, listed by Administration Controlled Substances Code Number, to each pharmacy and practitioner registrant described in subparagraph (A).</text></subparagraph></paragraph><paragraph id="idd60a882d-c2d1-4939-b9d9-54c8b9f314d2" indent="up1"><enum>(2)</enum><text>The information required to be made available under paragraph (1) shall be made available not later than the 15th day of the first month following the quarter to which the information relates.</text></paragraph><paragraph commented="no" id="ida5d524c8-64da-495d-a07f-9a46aa41944e" indent="up1"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idcacf1e6d-14e2-4772-8f2a-78e7f5308695"><enum>(A)</enum><text>All registered manufacturers and distributors shall be responsible for reviewing the information made available by the Attorney General under this subsection.</text></subparagraph><subparagraph commented="no" id="id7743c4e1-ec76-4738-a520-d38114d38719" indent="up1"><enum>(B)</enum><text>In determining whether to initiate proceedings under this title against a registered manufacturer or distributor based on the failure of the registrant to maintain effective controls against diversion or otherwise comply with the requirements of this title or the regulations issued thereunder, the Attorney General may take into account that the information made available under this subsection was available to the registrant.</text></subparagraph></paragraph></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="ide9fd0ff7-9245-4141-85b4-26754639c80c"><enum>(3)</enum><text>by inserting after subsection (i), as so redesignated, the following:</text><quoted-block display-inline="no-display-inline" id="idedea1e03-543f-4e0a-b537-7ba480546773" style="OLC"><subsection id="idc032b027-de91-4ef1-b09d-bc4ba641f6ce"><enum>(j)</enum><text>All of the reports required under this section shall be provided in an electronic format.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection commented="no" id="idd7187606-06e8-4756-b6c4-c7d7228ffbc7"><enum>(b)</enum><header>Cooperative arrangements</header><text>Section 503 of the Controlled Substances Act (21 U.S.C. 873) is amended—</text><paragraph commented="no" id="id168d7d86-2454-4745-9da1-e8a23ce4178c"><enum>(1)</enum><text>by striking subsection (c) and inserting the following:</text><quoted-block display-inline="no-display-inline" id="idcfefdb7b-e28f-435e-a2da-cfa4e8824c79" style="OLC"><subsection commented="no" id="ide6aa0942-9256-4728-89c4-e7c0126e752a"><enum>(c)</enum><paragraph commented="no" display-inline="yes-display-inline" id="ide13e1cf7-c949-4a12-9352-2f855e8f166e"><enum>(1)</enum><text display-inline="yes-display-inline">The Attorney General shall, once every 6 months, prepare and make available to regulatory, licensing, attorneys general, and law enforcement agencies of States a standardized report containing descriptive and analytic information on the actual distribution patterns, as gathered through the Automated Reports and Consolidated Orders System, or any subsequent automated system, pursuant to section 307 and which includes detailed amounts, outliers, and trends of distributor and pharmacy registrants, in such States for the controlled substances contained in schedule II, which, in the discretion of the Attorney General, are determined to have the highest abuse.</text></paragraph><paragraph commented="no" id="idfc7a22c2-41c2-4ac7-8aeb-4646638c14ce" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">If the Attorney General publishes the report described in paragraph (1) once every 6 months as required under paragraph (1), nothing in this subsection shall be construed to bring an action in any court to challenge the sufficiency of the information or to compel the Attorney General to produce any documents or reports referred to in this subsection.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection commented="no" id="id1ab968c3-653b-4773-b04f-2d6f20c710cf"><enum>(c)</enum><header>Civil and criminal penalties</header><text>Section 402 of the Controlled Substances Act (21 U.S.C. 842) is amended—</text><paragraph commented="no" id="idbe53198b-1174-4afd-8750-09139ab067f2"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph commented="no" id="id0669d573-17c5-48d5-b598-6067ad067538"><enum>(A)</enum><text>in paragraph (15), by striking <quote>or</quote> at the end;</text></subparagraph><subparagraph commented="no" id="id648de60a-180c-4c31-b5b4-3d6da71addd4"><enum>(B)</enum><text>in paragraph (16), by striking the period at the end and inserting <quote>; or</quote>; and</text></subparagraph><subparagraph commented="no" id="id5f44636c-a4b5-4636-bac0-d49f28d08c5d"><enum>(C)</enum><text>by inserting after paragraph (16) the following:</text><quoted-block display-inline="no-display-inline" id="id57abf9d6-46ae-4dc3-987d-62e77f74a541" style="OLC"><paragraph commented="no" id="id0b269d0c-3029-4e7d-978b-4267d4696718"><enum>(17)</enum><text>in the case of a registered manufacturer or distributor of opioids, to fail to review the most recent information, directly related to the customers of the manufacturer or distributor, made available by the Attorney General in accordance with section 307(f).</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph commented="no" id="id0aa83369-6a03-4cff-b35b-85120eba4d4a"><enum>(2)</enum><text>in subsection (c)—</text><subparagraph commented="no" id="id5091829e-7111-4334-9991-2b5f489cf196"><enum>(A)</enum><text>in paragraph (1), by striking subparagraph (B) and inserting the following:</text><quoted-block display-inline="no-display-inline" id="id40387c69-bd5d-4251-904a-e837ee8de5ae" style="OLC"><subparagraph commented="no" id="id4ceb4983-0327-48f8-8b25-de0eedb68b3f" indent="up2"><enum>(B)</enum><clause commented="no" display-inline="yes-display-inline" id="idbad4f010-d19f-419d-8ed5-1130151d2cd7"><enum>(i)</enum><text>Except as provided in clause (ii), in the case of a violation of paragraph (5), (10), or (17) of subsection (a), the penalty shall not exceed $10,000.</text></clause><clause commented="no" id="id7252d32c-af2f-4d87-be05-219a52b09475" indent="up1"><enum>(ii)</enum><text>In the case of a violation described in clause (i) committed by a registered manufacturer or distributor of opioids and related to the reporting of suspicious orders for opioids, failing to maintain effective controls against diversion of opioids, or failing to review the most recent information made available by the Attorney General in accordance with section 307(f), the penalty shall not exceed $100,000.</text></clause></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph><subparagraph commented="no" id="id991dbcd8-808a-4244-9a7c-09fa88a87ec2"><enum>(B)</enum><text>in paragraph (2)—</text><clause commented="no" id="id71f717eb-e357-4221-9fb9-140a9857159b"><enum>(i)</enum><text>in subparagraph (A), by inserting <quote>or (D)</quote> after <quote>subparagraph (B)</quote>; and</text></clause><clause commented="no" id="id66abf9cc-cad5-4f05-87de-57d4d165cfd4"><enum>(ii)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id14d99dea-26eb-41ec-b55b-605b9ac2a76d" style="OLC"><subparagraph commented="no" id="id998564a9-03a8-41ab-99b0-e1203ff9b134" indent="up2"><enum>(D)</enum><text>In the case of a violation described in subparagraph (A) that was a violation of paragraph (5), (10), or (17) of subsection (a) committed by a registered manufacturer or distributor of opioids that relates to the reporting of suspicious orders for opioids, failing to maintain effective controls against diversion of opioids, or failing to review the most recent information made available by the Attorney General in accordance with section 307(f), the criminal fine under title 18, United States Code, shall not exceed $500,000.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></clause></subparagraph></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="idfaa548ad-26d5-4c42-86bc-36377be5f73c" section-type="subsequent-section"><enum>3204.</enum><header>Report</header><text display-inline="no-display-inline">Not later than 1 year after the date of enactment of this Act, the Attorney General shall submit to Congress a report that provides information about how the Attorney General is using data in the Automation of Reports and Consolidated Orders System to identify and stop suspicious activity, including whether the Attorney General is looking at aggregate orders from individual pharmacies to multiple distributors that in total are suspicious, even if no individual order rises to the level of a suspicious order to a given distributor.</text></section></subtitle><subtitle id="id17996200DB394F7FA3B50378FE711705" style="OLC"><enum>C</enum><header>Substance Abuse Prevention</header><section id="id93CB0EB3DC2749D79B9A318719CFF21C"><enum>3301.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Substance Abuse Prevention Act of 2018</short-title></quote>.</text></section><section id="id8354438c-8be2-4a54-aaf7-c05e39a8c0e4"><enum>3302.</enum><header>Reauthorization of the Office of National Drug Control Policy</header><subsection id="id25322a39-fc7b-4b2a-8b5f-dfd7a39edb37"><enum>(a)</enum><header>Office of National Drug Control Policy Reauthorization Act of 1998</header><paragraph id="id0d1e768a-6e2a-4da4-9b41-8e15d6baac8c"><enum>(1)</enum><header>In general</header><text>The Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1701 et seq.), as in effect on September 29, 2003, and as amended by the laws described in paragraph (2), is revived and restored.</text></paragraph><paragraph id="id7b6d4cba-fdc6-4d84-a1b4-a53d45c9ec25"><enum>(2)</enum><header>Laws described</header><text>The laws described in this paragraph are:</text><subparagraph id="idbd687052-1a59-4cda-be23-ece96306c273"><enum>(A)</enum><text>The Office of National Drug Control Policy Reauthorization Act of 2006 (Public Law 109–469; 120 Stat. 3502).</text></subparagraph><subparagraph id="idf488a9e6-ea12-4320-9b6a-4795cdb96bd0"><enum>(B)</enum><text>The Presidential Appointment Efficiency and Streamlining Act of 2011 (Public Law 112–166; 126 Stat. 1283).</text></subparagraph></paragraph></subsection><subsection id="id1e67501d-31c8-480d-aa57-0d240decdc9a"><enum>(b)</enum><header>Reauthorization</header><text>Section 715(a) of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1712(a)) is amended by striking <quote>2010</quote> and inserting <quote>2022</quote>.</text></subsection></section><section id="id859d8e1e-2486-4bdd-847f-27f636f78779"><enum>3303.</enum><header>Reauthorization of the Drug-Free Communities Program</header><text display-inline="no-display-inline">Section 1024 of the National Narcotics Leadership Act of 1988 (21 U.S.C. 1524(a)) is amended by striking subsections (a) and (b) and inserting the following:</text><quoted-block display-inline="no-display-inline" id="id2a4b5bd6-69e6-44d4-ae7e-8228d59c97ac" style="OLC"><subsection id="idbac1b6d3-b132-4a64-9059-9085864fd338"><enum>(a)</enum><header>In general</header><text>There is authorized to be appropriated to the Office of National Drug Control Policy to carry out this chapter $99,000,000 for each of fiscal years 2018 through 2022.</text></subsection><subsection id="idd1029b7d-1859-46a8-9a61-e9e13cf9a700"><enum>(b)</enum><header>Administrative costs</header><text>Not more than 8 percent of the funds appropriated to carry out this chapter may be used by the Office of National Drug Control Policy to pay administrative costs associated with the responsibilities of the Office under this chapter.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="idead3b1d5-0ae9-4940-8a07-3b875b0cb4d5"><enum>3304.</enum><header>Reauthorization of the National Community Anti-Drug Coalition Institute</header><text display-inline="no-display-inline">Section 4(c)(4) of Public Law 107–82 (21 U.S.C. 1521 note) is amended by striking <quote>2008 through 2012</quote> and inserting <quote>2018 through 2022</quote>.</text></section><section id="id38d91aec-edd3-42b1-874d-18e141734de3"><enum>3305.</enum><header>Reauthorization of the High-Intensity Drug Trafficking Area Program</header><text display-inline="no-display-inline">Section 707(p) of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1706(p)) is amended—</text><paragraph id="id9d44c331-3d6b-4979-9cf5-9026bd0f781b"><enum>(1)</enum><text>in paragraph (4), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="id3e42b8e7-9384-4bb9-9d3b-358e5f81aa6b"><enum>(2)</enum><text>in paragraph (5), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph id="id56241d6b-3103-4a32-8342-b25747c26761"><enum>(3)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id6cc801cf-a5b0-4bff-b6fa-872089c2cacd" style="OLC"><paragraph id="id84fb6056-1754-4a73-9b4b-ea94453f2ab3"><enum>(6)</enum><text>$280,000,000 for each of fiscal years 2018 through 2022.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><section id="ide98c8e08-9440-43cc-b9f4-85f51120f18a"><enum>3306.</enum><header>Reauthorization of drug court program</header><text display-inline="no-display-inline">Section 1001(a)(25)(A) of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10261(a)(25)(A)) is amended by striking <quote>Except as provided</quote> and all that follows and inserting the following: <quote>Except as provided in subparagraph (C), there is authorized to be appropriated to carry out part EE $75,000,000 for each of fiscal years 2018 through 2022.</quote>.</text></section><section id="id56d7e07d-08e6-4fcd-a7f9-52a49a6aa7bd"><enum>3307.</enum><header>Drug court training and technical assistance</header><text display-inline="no-display-inline">Section 705 of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1704) is amended by adding at the end the following—</text><quoted-block display-inline="no-display-inline" id="id01c79500-b3ad-49b9-aac3-35c2a136e246" style="OLC"><subsection id="idd34c0aea-03c5-4c9b-bf03-908116207184"><enum>(e)</enum><header>Drug Court Training and Technical Assistance Program</header><text>Using funds appropriated to carry out this title, the Director may make grants to nonprofit organizations for the purpose of providing training and technical assistance to drug courts.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="idfc32ccd2-6a72-47a8-881a-253e94c0f899"><enum>3308.</enum><header>Drug overdose response strategy</header><text display-inline="no-display-inline">Section 707 of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1706) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id762bd365-6372-4de5-9041-c55cd417a26d" style="OLC"><subsection id="idd1074766-aa45-4cb6-8ffa-5dfe5204aef6"><enum>(r)</enum><header>Drug overdose response strategy implementation</header><text>The Director may use funds appropriated to carry out this section to implement a drug overdose response strategy in high intensity drug trafficking areas on a nationwide basis by—</text><paragraph id="id50953e41-1b92-43ae-bf7d-f9a4a5b50628"><enum>(1)</enum><text>coordinating multi-disciplinary efforts to prevent, reduce, and respond to drug overdoses, including the uniform reporting of fatal and non-fatal overdoses to public health and safety officials;</text></paragraph><paragraph id="id62193923-7f1f-4f90-bbf9-3dd370c131c4"><enum>(2)</enum><text>increasing data sharing among public safety and public health officials concerning drug-related abuse trends, including new psychoactive substances, and related crime; and</text></paragraph><paragraph id="id860b7e38-5ce2-40b6-9749-43d6d94bd3b1"><enum>(3)</enum><text>enabling collaborative deployment of prevention, intervention, and enforcement resources to address substance use addiction and narcotics trafficking.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id0b59b7a2-8fc1-4d97-82c9-1350f9640051"><enum>3309.</enum><header>Protecting law enforcement officers from accidental exposure</header><text display-inline="no-display-inline">Section 707 of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1706), as amended by section 3308, is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id62d44641-9eba-4d58-8d99-058eb60c2245" style="OLC"><subsection id="id68ef271e-ad83-4035-8dd8-e0a3ddf228f6"><enum>(s)</enum><header>Supplemental grants</header><text>The Director is authorized to use not more than $10,000,000 of the amounts otherwise appropriated to carry out this section to provide supplemental competitive grants to high intensity drug trafficking areas that have experienced high seizures of fentanyl and new psychoactive substances for the purposes of—</text><paragraph id="id8c3d8e30-4f5e-4269-8639-4fe1b0e640dd"><enum>(1)</enum><text>purchasing portable equipment to test for fentanyl and other substances;</text></paragraph><paragraph id="idaa25e996-1396-4ff0-8b94-2615b63b1812"><enum>(2)</enum><text>training law enforcement officers and other first responders on best practices for handling fentanyl and other substances; and</text></paragraph><paragraph id="id84e758a3-596c-4236-a091-11ff26b15e49"><enum>(3)</enum><text>purchasing protective equipment, including overdose reversal drugs.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id2deaf4a2-5445-40db-93ce-cf16c271fab6"><enum>3310.</enum><header>COPS Anti-Meth Program</header><text display-inline="no-display-inline">Section 1701 of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10381) is amended—</text><paragraph id="id552d2edf-c266-48f8-b3f1-ea599d1382a6"><enum>(1)</enum><text display-inline="yes-display-inline">by redesignating subsection (k) as subsection (l); and</text></paragraph><paragraph id="idd6467be2-4f70-458f-af96-219d99e585cb"><enum>(2)</enum><text>by inserting after subsection (j) the following:</text><quoted-block display-inline="no-display-inline" id="id5b233c5f-d0bf-4014-908f-1bb7139f6a55" style="OLC"><subsection id="ideb6f92df-4064-41f2-a2b4-ae8c5217d05f"><enum>(k)</enum><header>COPS Anti-Meth Program</header><text>The Attorney General shall use amounts otherwise appropriated to carry out this section to make competitive grants, in amounts of not less than $1,000,000 for a fiscal year, to State law enforcement agencies with high seizures of precursor chemicals, finished methamphetamine, laboratories, and laboratory dump seizures for the purpose of locating or investigating illicit activities, such as precursor diversion, laboratories, or methamphetamine traffickers.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><section id="id5ffe1c6fa438415781f14940d3e202ac"><enum>3311.</enum><header>COPS anti-heroin task force program</header><text display-inline="no-display-inline">Section 1701 of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10381) is amended—</text><paragraph id="idc3efde12aa2a447b9cf9a0e58566d5ef"><enum>(1)</enum><text>by redesignating subsection (l), as so redesignated by section 3310, as subsection (m); and</text></paragraph><paragraph id="id5aa0c69288b0466db1eeca45955aa20b"><enum>(2)</enum><text>by inserting after subsection (k), as added by section 3310, the following:</text><quoted-block display-inline="no-display-inline" id="id4bd1f46ec721412db74185bd86799934" style="OLC"><subsection id="ide8df4a16ba2649dd8b0e0d2a4a1cb18d"><enum>(l)</enum><header>Cops anti-heroin task force program</header><text>The Attorney General shall use amounts otherwise appropriated to carry out this section, or other amounts as appropriated, to make competitive grants to State law enforcement agencies in States with high per capita rates of primary treatment admissions, for the purpose of locating or investigating illicit activities, through Statewide collaboration, relating to the distribution of heroin, fentanyl, or carfentanil or relating to the unlawful distribution of prescription opioids.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><section id="id7a4e08fd-ece9-4967-a0a2-88b285d05ba9"><enum>3312.</enum><header>Comprehensive Addiction and Recovery Act education and awareness</header><text display-inline="no-display-inline">Title VII of the Comprehensive Addiction and Recovery Act of 2016 (Public Law 114–198; 130 Stat. 735) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id22C71715E7C448379EABC5B85EB22DBA" style="OLC"><section id="idFAE89532EDB2426395C984084EBC0977"><enum>709.</enum><header>Services for families and patients in crisis</header><subsection id="id7160063064c14bf683908d0d5db54570"><enum>(a)</enum><header>In general</header><text>The Attorney General may make grants to entities that focus on addiction and substance use disorders and specialize in family and patient services, advocacy for patients and families, and educational information.</text></subsection><subsection id="idb21d41b0f5aa4792a318186da63c31ce"><enum>(b)</enum><header>Allowable uses</header><text>A grant awarded under this section may be used for private, nonprofit national organizations that engage in all of the following activities:</text><paragraph id="id0d34000c01704260b69ba95d46bccab3"><enum>(1)</enum><text>Expansion of phone line or call center services with professional, clinical staff that provide, for families and individuals impacted by a substance use disorder, support, access to treatment resources, brief assessments, medication and overdose prevention education, compassionate listening services, recovery support or peer specialists, bereavement and grief support, and case management.</text></paragraph><paragraph id="idfed4daf58eca49ceb247affa686de3e0"><enum>(2)</enum><text>Continued development of health information technology systems that leverage new and upcoming technology and techniques for prevention, intervention, and filling resource gaps in communities that are underserved.</text></paragraph><paragraph id="idfdc6e45c442744baa66fbd7f9f41c2df"><enum>(3)</enum><text>Enhancement and operation of treatment and recovery resources, easy-to-read scientific and evidence-based education on addiction and substance use disorders, and other informational tools for families and individuals impacted by a substance use disorder and community stakeholders, such as law enforcement agencies.</text></paragraph><paragraph id="idacb656fd3da9488b9f37f384b12bddec"><enum>(4)</enum><text>Provision of training and technical assistance to State and local governments, law enforcement agencies, health care systems, research institutions, and other stakeholders.</text></paragraph><paragraph id="ida9a46272ca03454c8cd58411908f5e53"><enum>(5)</enum><text>Expanding upon and implementing educational information using evidence-based information on substance use disorders.</text></paragraph><paragraph id="ideb513a2f101b47f3bb4518b6204630f4"><enum>(6)</enum><text>Expansion of training of community stakeholders, law enforcement officers, and families across a broad-range of addiction, health, and related topics on substance use disorders, local issues and community-specific issues related to the drug epidemic.</text></paragraph><paragraph id="id7dfba21c51514020a9f9d63f3bd3d072"><enum>(7)</enum><text>Program evaluation.</text></paragraph></subsection><subsection id="id10a4b62bd1fc4cb287d6835685e76a06"><enum>(c)</enum><header>Authorization of appropriations</header><text>For each of fiscal years 2018 through 2022, the Attorney General is authorized to award not more than $10,000,000 of amounts otherwise appropriated to the Attorney General for comprehensive opioid abuse reduction activities for purposes of carrying out this section.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="idd65d6ccf-f188-4116-9c62-f55690a669b0"><enum>3313.</enum><header>Protecting children with addicted parents</header><text display-inline="no-display-inline">Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id46fd79a9-b9c5-4acd-802c-ef18d976b573" style="OLC"><section id="idd34cbc61-88db-4f9c-a5a9-72b32d0e57ab"><enum>550.</enum><header>Protecting children with addicted parents</header><subsection id="id7ff13022-41af-44bb-8f36-131648616b44"><enum>(a)</enum><header>Best practices</header><text>The Secretary, acting through the Assistant Secretary and in cooperation with the Commissioner of the Administration on Children, Youth and Families, shall collect and disseminate best practices for States regarding interventions and strategies to keep families affected by a substance use disorder together, when it can be done safely. Such best practices shall—</text><paragraph id="id12451b73-648c-4b02-a7c6-f5c8aa7f7cbc"><enum>(1)</enum><text>utilize comprehensive family-centered approaches;</text></paragraph><paragraph id="idce8a3a86-e9f0-4bdf-bec3-2f5620e58309"><enum>(2)</enum><text>ensure that families have access to drug screening, substance use disorder treatment, medication-assisted treatment approved by the Food and Drug Administration, and parental support; and</text></paragraph><paragraph id="idc3fe89ec-ba41-4ddd-8a67-a7a335ccb1a9"><enum>(3)</enum><text>build upon lessons learned from—</text><subparagraph id="idAE26D0B8336649DEAF346839AA174A9E"><enum>(A)</enum><text>programs such as the maternal, infant, and early childhood home visiting program under section 511 of the Social Security Act; and</text></subparagraph><subparagraph id="idd159ec1e56654c06aaa260d279c9a8b5"><enum>(B)</enum><text>identifying substance abuse prevention and treatment services that meet the requirements for promising, supported, or well-supported practices specified in section 471(e)(4)(C) of the Social Security Act (as such section shall be in effect beginning on October 1, 2018).</text></subparagraph></paragraph></subsection><subsection id="id2f65adc1-f8ef-4d46-bc23-fbe02e4f774c"><enum>(b)</enum><header>Grant program</header><text>The Secretary shall award grants to States, units of local government, and tribal governments to—</text><paragraph id="id184DC2E7B26C4B62B9F254538790707C"><enum>(1)</enum><text>develop programs and models designed to keep pregnant and post-partum women who have a substance use disorder together with their newborns, including programs and models that provide for screenings of pregnant and post-partum women for substance use disorders, treatment interventions, supportive housing, nonpharmacological interventions for children born with neonatal abstinence syndrome, medication assisted treatment, and other recovery supports; and</text></paragraph><paragraph id="idD6215DD1F3964E4AB26209A24B1965B3"><enum>(2)</enum><text>support the attendance of children who have a family member living with a substance use disorder at therapeutic camps or other therapeutic programs aimed at addiction prevention education and delaying the onset of first use, providing trusted mentors and education on coping strategies that these children can use in their daily lives, and family support initiatives aimed at keeping these families together.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id44daa69b-dc3f-475c-9a2f-d899a6b8e461"><enum>3314.</enum><header>Reimbursement of substance use disorder treatment professionals</header><text display-inline="no-display-inline">Not later than January 1, 2020, the Comptroller General of the United States shall submit to Congress a report examining how substance use disorder services are reimbursed.</text></section><section id="id407249c7-d427-4586-b08a-ff1a5811b5fc"><enum>3315.</enum><header>Sobriety Treatment and Recovery Teams (START)</header><text display-inline="no-display-inline">Title V of the Public Health Service Act (42 U.S.C. 290dd et seq.), as amended by section 3313, is further amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id41253cde-6475-4ed4-a7f0-8373ffed8b2b" style="OLC"><section id="id19c36d6b-5f43-4120-ad26-2901a89cabb0"><enum>551.</enum><header>Sobriety Treatment and Recovery Teams</header><subsection id="ide8454bf1-ec99-4fc4-8036-23b4f3246576"><enum>(a)</enum><header>In general</header><text>The Secretary may make grants to States, units of local government, or tribal governments to establish or expand Sobriety Treatment And Recovery Team (referred to in this section as <quote>START</quote>) or other similar programs to determine the effectiveness of pairing social workers or mentors with families that are struggling with a substance use disorder and child abuse or neglect in order to help provide peer support, intensive treatment, and child welfare services to such families.</text></subsection><subsection id="idfe4fcf9a-e3f1-4b7a-ba5b-565e4b7c0e0c"><enum>(b)</enum><header>Allowable uses</header><text>A grant awarded under this section may be used for one or more of the following activities:</text><paragraph id="id575f4c6b-5ede-4ee0-ac68-16f654d23809"><enum>(1)</enum><text>Training eligible staff, including social workers, social services coordinators, child welfare specialists, substance use disorder treatment professionals, and mentors.</text></paragraph><paragraph id="idf3708ff5-523d-4020-bb3a-72506140c4cd"><enum>(2)</enum><text>Expanding access to substance use disorder treatment services and drug testing.</text></paragraph><paragraph id="id9abeb0ab-7b8a-4179-9213-be9f0208e7e0"><enum>(3)</enum><text>Enhancing data sharing with law enforcement agencies, child welfare agencies, substance use disorder treatment providers, judges, and court personnel.</text></paragraph><paragraph id="id351966fb-521e-4c8b-9084-fed5ccb35ba1"><enum>(4)</enum><text>Program evaluation and technical assistance.</text></paragraph></subsection><subsection id="id4881f2ba-cec0-4e9a-a6e8-11477a202060"><enum>(c)</enum><header>Program requirements</header><text>A State, unit of local government, or tribal government receiving a grant under this section shall—</text><paragraph id="id0A7787E9109B4A0C811681A0483D961A"><enum>(1)</enum><text>serve only families for which—</text><subparagraph id="idA962F1F5B15C48D9BE7AF25871822925"><enum>(A)</enum><text>there is an open record with the child welfare agency; and</text></subparagraph><subparagraph id="idCECFCDCCB92C4DA3A9198F5439860E0F"><enum>(B)</enum><text>substance use disorder was a reason for the record or finding described in paragraph (1); and</text></subparagraph></paragraph><paragraph id="id6CB031C0357641DD8E81C1A022CC3885"><enum>(2)</enum><text>coordinate any grants awarded under this section with any grant awarded under section 437(f) of the Social Security Act focused on improving outcomes for children affected by substance abuse.</text></paragraph></subsection><subsection id="idcea020b0-2344-4ec2-99e8-163ad09fa7f7"><enum>(d)</enum><header>Technical assistance</header><text>The Secretary may reserve not more than 5 percent of funds provided under this section to provide technical assistance on the establishment or expansion of programs funded under this section from the National Center on Substance Abuse and Child Welfare.</text></subsection><subsection id="id41D4B375F992460FAC00BD2A49EF3AAF"><enum>(e)</enum><header>Authorization of appropriations</header><text>For each of fiscal years 2018 through 2022, the Secretary is authorized to award not more than $10,000,000 of amounts otherwise appropriated to the Secretary for comprehensive opioid abuse reduction activities for purposes of carrying out this section.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section><section commented="no" display-inline="no-display-inline" id="idf797b318-a454-480e-b2f2-b9f708e6917b" section-type="subsequent-section"><enum>3316.</enum><header>Provider education</header><text display-inline="no-display-inline">Not later than 60 days after the date of enactment of this Act, the Attorney General, in consultation with the Secretary of Health and Human Services, shall complete the plan related to medical registration coordination required by Senate Report 114–239, which accompanied the Veterans Care Financial Protection Act of 2017 (Public Law 115–131; 132 Stat. 334).</text></section><section id="id1ba2b8d5b5d84e4d9d1fc09ecf4eed3a"><enum>3317.</enum><header>Demand reduction</header><text display-inline="no-display-inline">Section 702(1) of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1701(1)) is amended—</text><paragraph id="id5e1e433f699340fc826a43232c37d967"><enum>(1)</enum><text>by redesignating subparagraphs (F) through (J) as subparagraphs (G) through (K), respectively; and</text></paragraph><paragraph id="ida744c93eb42d4bc9b632f298e37d9dd9"><enum>(2)</enum><text>by inserting after subparagraph (E) the following:</text><quoted-block display-inline="no-display-inline" id="idb905c090b0b7492e95d7f8bb8a1cb7d4" style="OLC"><subparagraph id="id5f36bc4ee3724eaabc0c0e074c5a4637"><enum>(F)</enum><text>support for long-term recovery from substance use disorders;</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><section id="idcf0593ef9339468f9fc416fc00c865de"><enum>3318.</enum><header>Anti-drug media campaign</header><text display-inline="no-display-inline">Section 709 of the Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1708) is amended—</text><paragraph id="id8fa3f6890f8b4110a87b7980aaed12bb"><enum>(1)</enum><text>in the section heading, by striking <quote><header-in-text level="section" style="OLC">youth</header-in-text></quote>;</text></paragraph><paragraph id="id2e35c2a603c34998a37f4979f17746a0"><enum>(2)</enum><text>in subsection (a)—</text><subparagraph id="idab5c4d2be948414bb3623731b7b9f66f"><enum>(A)</enum><text>in the matter preceding paragraph (1), by striking <quote>youth</quote>;</text></subparagraph><subparagraph id="idb7c0a609b8da4d6a8f6d4189a24677e1"><enum>(B)</enum><text>in paragraph (1), by striking <quote>young</quote>;</text></subparagraph><subparagraph id="id546b2a2c2a7d4e59a377e0f25f455b01"><enum>(C)</enum><text>in paragraph (2), by striking <quote>of adults of the impact of drug abuse on young people</quote> and inserting <quote>among the population about the impact of drug abuse</quote>; and</text></subparagraph><subparagraph id="id29e0d4a95d644571b878dc7a2abf66f7"><enum>(D)</enum><text>in paragraph (3), by striking <quote>parents and other interested adults to discuss with young people</quote> and inserting <quote>interested persons to discuss</quote>; and</text></subparagraph></paragraph><paragraph id="id828447aff9d749fb985eddfb4901d3ff"><enum>(3)</enum><text>in subsection (b)(2)(C)(ii), by striking <quote>among youth</quote>.</text></paragraph></section><section id="id48349fe6a91c4c07beb543168654a0ea"><enum>3319.</enum><header>Technical corrections to the office of national drug control policy reauthorization act of 1998</header><text display-inline="no-display-inline">The Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1701 et seq.) is amended—</text><paragraph id="id09addddfdb634dd5a304f978e136cda9"><enum>(1)</enum><text>in section 703(b)(3)(E) (21 U.S.C. 1702(b)(3)(E))—</text><subparagraph id="id1902e912cda94099953fae7f883fe9b8"><enum>(A)</enum><text>in clause (i), by adding <quote>and</quote> at the end;</text></subparagraph><subparagraph id="id5de554da40fb44108ab305df8133ca33"><enum>(B)</enum><text>in clause (ii), by striking <quote>; and</quote> and inserting a period; and</text></subparagraph><subparagraph id="ida0c150d8fd794f5fbd64549f485e92a7"><enum>(C)</enum><text>by striking clause (iii);</text></subparagraph></paragraph><paragraph id="id99e558bce16e42069a0198499def8fff"><enum>(2)</enum><text>in section 704 (21 U.S.C. 1703)—</text><subparagraph id="idd120101a42f547bfa7fd00d3a70e28ef"><enum>(A)</enum><text>in subsection (c)(3)(C)—</text><clause id="idd0cb9a76f96340b2b010f0b990559900"><enum>(i)</enum><text>in clause (v), by adding <quote>and</quote> at the end;</text></clause><clause id="idb3eee61a79d6434db999c2ef9dceaadd"><enum>(ii)</enum><text>in clause (vi), by striking <quote>; and</quote> and inserting a period; and</text></clause><clause id="id62e5a6050533480291e88d428cab9753"><enum>(iii)</enum><text>by striking clause (vii); and</text></clause></subparagraph><subparagraph id="idbfa08349e0844650892d1ed2165f538f"><enum>(B)</enum><text>in subsection (f)—</text><clause id="id66766aeb6e504451b343830960e511a5"><enum>(i)</enum><text>by striking the first paragraph (5); and</text></clause><clause id="id2dbd28e685144644b48646502f52263e"><enum>(ii)</enum><text>by striking the second paragraph (4);</text></clause></subparagraph></paragraph><paragraph id="id0d5de20b96fe4cd2bcf7501db5460302"><enum>(3)</enum><text>in section 706(a)(2)(A) (21 U.S.C. 1705(a)(2)(A))—</text><subparagraph id="idcb3f1fcc9d964e0c910135747a4a47c9"><enum>(A)</enum><text>by striking clause (ix); and</text></subparagraph><subparagraph id="id63652c0394424cb1b1ddf82d95eb7d40"><enum>(B)</enum><text>by redesignating clauses (x) through (xiv) as clauses (ix) through (xiii), respectively; and</text></subparagraph></paragraph><paragraph id="id055f75202f894ae68c718638cc69c4f4"><enum>(4)</enum><text>by striking section 708 (21 U.S.C. 1707).</text></paragraph></section></subtitle><subtitle id="id6B45214243984CCFA08444FDDC154F36" style="OLC"><enum>D</enum><header>Synthetic Abuse and Labeling of Toxic Substances</header><section id="id3621E83FE56D4E7DBF94345A23469ED9"><enum>3401.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Synthetic Abuse and Labeling of Toxic Substances Act of 2017</short-title></quote> or the <quote>SALTS Act</quote>.</text></section><section id="id10D114B5ACA94FE1B7145CB2EE1B864C" section-type="subsequent-section"><enum>3402.</enum><header>Controlled substance analogues</header><text display-inline="no-display-inline">Section 203 of the Controlled Substances Act (21 U.S.C. 813) is amended—</text><paragraph id="id2A6C6D2757144DD3B6FA4159E53942CA"><enum>(1)</enum><text>by striking <quote>A controlled</quote> and inserting <quote>(a) <header-in-text level="subsection" style="OLC">In general</header-in-text>.—A controlled</quote>; and</text></paragraph><paragraph id="id03199480C98F43B5A6429DC8A3B1FBBB"><enum>(2)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id80EE26A65B8B4244AE732977A2E3795C" style="OLC"><subsection id="idA13896C2F54E438F9E8F16A47E87D02F"><enum>(b)</enum><header>Determination</header><text>In determining whether a controlled substance analogue was intended for human consumption under subsection (a), evidence related to the following factors may be considered, along with all other relevant evidence:</text><paragraph id="id74813ba469d84b8eacb1f15381b7de05"><enum>(1)</enum><text>The marketing, advertising, and labeling of the substance.</text></paragraph><paragraph id="ide3d777d52ab64a8c9dfa428703a44c4c"><enum>(2)</enum><text>The known efficacy or usefulness of the substance for the marketed, advertised, or labeled purpose.</text></paragraph><paragraph id="id37ff210446df4ab78868aa35776109e0"><enum>(3)</enum><text>The difference between the price at which the substance is sold and the price at which the substance it is purported to be or advertised as is normally sold.</text></paragraph><paragraph id="id6da3061a85ad4bb4bcd4054a26665e1f"><enum>(4)</enum><text>The diversion of the substance from legitimate channels and the clandestine importation, manufacture, or distribution of the substance.</text></paragraph><paragraph id="id7d2e30f28d734fe29389380fa4ec4c10"><enum>(5)</enum><text>Whether the defendant knew or should have known the substance was intended to be consumed by injection, inhalation, ingestion, or any other immediate means.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ida59a47467e5d416bb89f39995dc2bb2c"><enum>(c)</enum><header>Limitation</header><text>For purposes of this section, the existence of evidence that a substance was not marketed, advertised, or labeled for human consumption shall not preclude the Government from establishing, based on all the evidence, that the substance was intended for human consumption.</text></subsection><after-quoted-block>. </after-quoted-block></quoted-block></paragraph></section></subtitle><subtitle id="idC320E473D99F4E99B397228F79659310" style="OLC"><enum>E</enum><header>Opioid Quota Reform</header><section id="idE878FFF90BFF44FF9B69CF02B2456F4D"><enum>3501.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Opioid Quota Reform Act</short-title></quote>.</text></section><section id="id64272a63d732477fb68f1667d103206a"><enum>3502.</enum><header>Strengthening considerations for DEA opioid quotas</header><subsection id="id903C1B3E1B194E7EA6874690B93C71AD"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 306 of the Controlled Substances Act (21 U.S.C. 826) is amended—</text><paragraph id="id149036969f9e44038481cd9fefcd90ae"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="id46E73B999BF34F6BA30A10417DAF38BD"><enum>(A)</enum><text>by inserting <quote>(1)</quote> after <quote>(a)</quote>;</text></subparagraph><subparagraph id="id56BA7C1050A64FFDA05CF77456B3869D"><enum>(B)</enum><text>in the second sentence, by striking <quote>Production</quote> and inserting <quote>Except as provided in paragraph (2), production</quote>; and</text></subparagraph><subparagraph id="id0a7f802179324254862765152137a670"><enum>(C)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id7FBA69049A6D461AB3F210901AA3FF8F" style="OLC"><paragraph id="id18BB7E3B4C1A485FB5970D873C96CA9D" indent="up1"><enum>(2)</enum><text>The Attorney General may, if the Attorney General determines it will assist in avoiding the overproduction, shortages, or diversion of a controlled substance, establish an aggregate or individual production quota under this subsection, or a procurement quota established by the Attorney General by regulation, in terms of pharmaceutical dosage forms prepared from or containing the controlled substance.</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph commented="no" id="id4d396bae35a74fdbbbc25e675782efbb"><enum>(2)</enum><text>in subsection (b), in the first sentence, by striking <quote>production</quote> and inserting <quote>manufacturing</quote>;</text></paragraph><paragraph id="id56eec472a16649be83719e4738524d05"><enum>(3)</enum><text>in subsection (c), by striking <quote>October</quote> and inserting <quote>December</quote>; and</text></paragraph><paragraph id="id7f68f81dce684794978f9fa02967a389"><enum>(4)</enum><text>by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="id2805cc86721b4e83a68301c5b5e38720" style="OLC"><subsection id="idbc1df1415ab143b9b74e290bc411602e"><enum>(i)</enum><paragraph commented="no" display-inline="yes-display-inline" id="id2AD8A99853D94F138EE5CD0D55FBAE83"><enum>(1)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id7957F1110C8640CE97146AEED15CB7F0"><enum>(A)</enum><text>In establishing any quota under this section, or any procurement quota established by the Attorney General by regulation, for fentanyl, oxycodone, hydrocodone, oxymorphone, or hydromorphone (in this subsection referred to as a <quote>covered controlled substance</quote>), the Attorney General shall estimate the amount of diversion of the covered controlled substance that occurs in the United States.</text></subparagraph><subparagraph id="id8273B07345D14E558E67CE297FCDB295" indent="up2"><enum>(B)</enum><text>In estimating diversion under this paragraph, the Attorney General—</text><clause id="id1F754733BA3F4635BF016A9110D775BA"><enum>(i)</enum><text>shall consider information the Attorney General, in consultation with the Secretary of Health and Human Services, determines reliable on rates of overdose deaths and abuse and overall public health impact related to the covered controlled substance in the United States; and</text></clause><clause id="id27B4D9D98B6D498D940F6FA58629F9BB"><enum>(ii)</enum><text>may take into consideration whatever other sources of information the Attorney General determines reliable.</text></clause></subparagraph><subparagraph id="id1949DECFC6EC49CDAE86385723EE0796" indent="up2"><enum>(C)</enum><text>After estimating the amount of diversion of a covered controlled substance, the Attorney General shall make appropriate quota reductions, as determined by the Attorney General, from the quota the Attorney General would have otherwise established had such diversion not been considered.</text></subparagraph></paragraph><paragraph id="id5a0bbdbae96b4338aadea93ca649f1d3" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id0EDAD8EEE0974F379BBFC998AD7C90FD"><enum>(A)</enum><text>For any year for which the approved aggregate production quota for a covered controlled substance is higher than the approved aggregate production quota for the covered controlled substance for the previous year, the Attorney General shall include in the final order an explanation of why the public health benefits of increasing the quota clearly outweigh the consequences of having an increased volume of the covered controlled substance available for sale, and potential diversion, in the United States.</text></subparagraph><subparagraph id="iddd052aea6b0741eb85b8dac0e18cb211" indent="up1"><enum>(B)</enum><text>Not later than 1 year after the date of enactment of this subsection, and every year thereafter, the Attorney General shall submit to the Caucus on International Narcotics Control, the Committee on the Judiciary, the Committee on Health, Education, Labor, and Pensions, and the Committee on Appropriations of the Senate and the Committee on the Judiciary, the Committee on Energy and Commerce, and the Committee on Appropriations of the House of Representatives the following information with regard to each covered controlled substance:</text><clause id="id171e13c787bd459bb789787ab066c317"><enum>(i)</enum><text>An anonymized count of the total number of manufacturers issued individual manufacturing quotas that year for the covered controlled substance.</text></clause><clause id="idf24348c788d347c9961fd4875cc30208"><enum>(ii)</enum><text>An anonymized count of how many such manufacturers were issued an approved manufacturing quota that was higher than the quota issued to that manufacturer for the covered controlled substance in the previous year.</text></clause></subparagraph></paragraph><paragraph id="id9f584aba60a84eee9884ad431c09c583" indent="up1"><enum>(3)</enum><text>Not later than 1 year after the date of enactment of this subsection, the Attorney General shall submit to Congress a report on how the Attorney General, when fixing and adjusting production and manufacturing quotas under this section for covered controlled substances, will—</text><subparagraph id="ide2d1434d89704ca09f44d683c53d7c63"><enum>(A)</enum><text>take into consideration changes in the accepted medical use of the covered controlled substances; and</text></subparagraph><subparagraph id="id91ca07f215e548a5a16e41f214e26cc5"><enum>(B)</enum><text>work with the Secretary of Health and Human Services on methods to appropriately and anonymously estimate the type and amount of covered controlled substances that are submitted for collection from approved drug collection receptacles, mail-back programs, and take-back events.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="id3237D297CB1F45B0B9334AA7273561B8"><enum>(b)</enum><header>Conforming change</header><text>The Law Revision Counsel is directed to amend the heading for subsection (b) of section 826 of title 21, United States Code, by striking <quote><header-in-text level="subsection" style="USC">production</header-in-text></quote> and inserting <quote><header-in-text level="subsection" style="USC">manufacturing</header-in-text></quote>.</text></subsection></section></subtitle><subtitle id="id6BE79A37629A4EA3998CFF4CC4569F8F" style="OLC"><enum>F</enum><header>Preventing Drug Diversion</header><section id="id1C45273EBBFF4BBD98D1465BAB6D9953"><enum>3601.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Preventing Drug Diversion Act of 2018</short-title></quote>.</text></section><section id="id23461268-db4d-41d1-b340-d6252629350d"><enum>3602.</enum><header>Improvements to prevent drug diversion</header><subsection id="ida81bc37d-a438-4ec2-9b46-6bc83ae75ee5"><enum>(a)</enum><header>Definition</header><text>Section 102 of the Controlled Substances Act (21 U.S.C. 802) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idf9963c38-69d6-447e-a6f0-00bbf0db1a1c" style="OLC"><paragraph id="id63b2e9eb-acf0-43ff-a314-8b2c0e2dfaa1"><enum>(57)</enum><text>The term <term>suspicious order</term> includes—</text><subparagraph id="ida14b86f9-6bbd-4e58-af91-a8ad01962044"><enum>(A)</enum><text>an order of a controlled substance of unusual size;</text></subparagraph><subparagraph id="id2dd614f1-5e78-4ec4-a638-c14c0bd5c7be"><enum>(B)</enum><text>an order of a controlled substance deviating substantially from a normal pattern;</text></subparagraph><subparagraph id="id06f18765-bb8c-4b15-bbf6-bb5330eb9be0"><enum>(C)</enum><text>orders of controlled substances of unusual frequency; and</text></subparagraph><subparagraph id="id3C388D250A2F497181D9EE134AAA0308"><enum>(D)</enum><text>an order having any characteristic that would indicate to a reasonable registrant that it is suspicious or not legitimate.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id15e1b97c-140a-42e7-844f-b81d3aeecabc"><enum>(b)</enum><header>Suspicious orders</header><text>Part C of the Controlled Substances Act (21 U.S.C. 821 et seq.) is amended by adding at the end the following:</text><quoted-block display-inline="no-display-inline" id="idec272bee-644d-4593-bc6a-3ae81d12e5c5" style="OLC"><section id="idb8db7405-9ae7-4c7a-bf6b-92d1cdf10242"><enum>312.</enum><header>Suspicious orders</header><subsection id="id1e6ca93b-a3fa-4106-b619-276e5a1746aa"><enum>(a)</enum><header>Reporting</header><text display-inline="yes-display-inline">Each registrant shall—</text><paragraph id="id3f59eeac-5d8e-4f18-908c-8127ccda5549"><enum>(1)</enum><text>design and operate a system to identify suspicious orders for the registrant;</text></paragraph><paragraph id="id1bff60c4-fafc-4ad2-b086-34a1ae0b0ac0"><enum>(2)</enum><text>ensure that the system designed and operated under paragraph (1) by the registrant complies with applicable Federal and State privacy laws; and</text></paragraph><paragraph id="idc750cc02-70fa-46e6-8770-59ecabda9baf"><enum>(3)</enum><text>upon discovering a suspicious order or series of orders, notify the Administrator of the Drug Enforcement Administration and the Special Agent in Charge of the Division Office of the Drug Enforcement Administration for the area in which the registrant is located or conducts business.</text></paragraph></subsection><subsection id="id2a27c059-058b-4c24-88c8-50d3820dc8eb"><enum>(b)</enum><header>Suspicious order database</header><paragraph id="id8E724BA738BB44E39B7349042C9017AD"><enum>(1)</enum><header>In general</header><text>Not later than 1 year after the date of enactment of this section, the Attorney General shall establish a centralized database for collecting reports of suspicious orders.</text></paragraph><paragraph id="idC7D030EE259B48778254C2129E0A55BB"><enum>(2)</enum><header>Satisfaction of reporting requirements</header><text>If a registrant reports a suspicious order to the centralized database established under paragraph (1), the registrant shall be considered to have complied with the requirement under subsection (a)(3) to notify the Administrator of the Drug Enforcement Administration and the Special Agent in Charge of the Division Office of the Drug Enforcement Administration for the area in which the registrant is located or conducts business.</text></paragraph></subsection><subsection id="id5c8d1274-fa99-4147-96f1-918507d0d6d8"><enum>(c)</enum><header>Sharing information with the States</header><paragraph id="id996e707c-477e-407f-90c7-04a1c3ada00c"><enum>(1)</enum><header>In general</header><text>The Attorney General shall prepare and make available information regarding suspicious orders in a State, including information in the database established under subsection (b)(1), to the point of contact for purposes of administrative, civil, and criminal oversight relating to the diversion of controlled substances for the State, as designated by the Governor or chief executive officer of the State.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id38e91891-6b4a-4681-b7da-b230f0e255c9"><enum>(2)</enum><header display-inline="yes-display-inline">Timing</header><text display-inline="yes-display-inline">The Attorney General shall provide information in accordance with paragraph (1) within a reasonable period of time after obtaining the information.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idd222af58-5c5c-4b6a-a85c-51c9a6bf717d"><enum>(3)</enum><header>Coordination</header><text>In establishing the process for the provision of information under this subsection, the Attorney General shall coordinate with States to ensure that the Attorney General has access to information, as permitted under State law, possessed by the States relating to prescriptions for controlled substances that will assist in enforcing Federal law.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id7450a45c-a4e1-4d48-b8ce-864325ac2de8"><enum>(c)</enum><header>Reports to Congress</header><paragraph id="id968fa045-09dd-4cb8-8e0a-9952b2394c5b"><enum>(1)</enum><header>Definition</header><text>In this subsection, the term <term>suspicious order</term> has the meaning given that term in section 102 of the Controlled Substances Act, as amended by this subtitle.</text></paragraph><paragraph id="id3aa82b85-a578-4750-a5dd-23ef4b942bd8"><enum>(2)</enum><header>One time report</header><text>Not later than 1 year after the date of enactment of this Act, the Attorney General shall submit to Congress a report on the reporting of suspicious orders, which shall include—</text><subparagraph id="id2e66bbe4-2c49-45cf-99db-7b92cf11f0a8"><enum>(A)</enum><text>a description of the centralized database established under section 312 of the Controlled Substances Act, as added by this section, to collect reports of suspicious orders;</text></subparagraph><subparagraph id="id51b7c3cc-3bef-4717-a669-9af0cae6c53f"><enum>(B)</enum><text>a description of the system and reports established under section 312 of the Controlled Substances Act, as added by this section, to share information with States;</text></subparagraph><subparagraph id="idcb7dc1ad-1785-419c-8486-e967ebab3b89"><enum>(C)</enum><text>information regarding how the Attorney General used reports of suspicious orders before the date of enactment of this Act and after the date of enactment of this Act, including how the Attorney General received the reports and what actions were taken in response to the reports; and</text></subparagraph><subparagraph id="idf0575ed7-37ca-46cd-b939-346d2b0a0617"><enum>(D)</enum><text>descriptions of the data analyses conducted on reports of suspicious orders to identify, analyze, and stop suspicious activity.</text></subparagraph></paragraph><paragraph id="id67a5e569-787c-4d2e-b295-12fa89ef6410"><enum>(3)</enum><header>Additional reports</header><text>Not later than 1 year after the date of enactment of this Act, and annually thereafter until the date that is 5 years after the date of enactment of this Act, the Attorney General shall submit to Congress a report providing, for the previous year—</text><subparagraph id="idfc1e9ce2-7c9f-4808-9b72-4201a4c5d2aa"><enum>(A)</enum><text>the number of reports of suspicious orders;</text></subparagraph><subparagraph id="id556c08ac-6c1f-4893-8364-70e1f69dc7c2"><enum>(B)</enum><text>a summary of actions taken in response to reports, in the aggregate, of suspicious orders; and</text></subparagraph><subparagraph id="id91d6de52-3ee8-46f6-a45f-12a481059e89"><enum>(C)</enum><text>a description of the information shared with States based on reports of suspicious orders.</text></subparagraph></paragraph><paragraph id="id8d08373766a54bce8b0fb257993c93dd"><enum>(4)</enum><header>One time GAO report</header><text>Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States, in consultation with the Administrator of the Drug Enforcement Administration, shall submit to Congress a report on the reporting of suspicious orders, which shall include an evaluation of the utility of real-time reporting of potential suspicious orders of opioids on a national level using computerized algorithms, including the extent to which such algorithms—</text><subparagraph id="id71550d2baa634e28b4f3c9ec392a3256"><enum>(A)</enum><text>would help ensure that potentially suspicious orders are more accurately captured, identified, and reported in real-time to suppliers before orders are filled;</text></subparagraph><subparagraph id="ida9fa3004f0154de0bc9fb39770db4796"><enum>(B)</enum><text>may produce false positives of suspicious order reports that could result in market disruptions for legitimate orders of opioids; and</text></subparagraph><subparagraph id="id24c17f60add047dcaba9042787886ac5"><enum>(C)</enum><text>would reduce the overall length of an investigation that prevents the diversion of suspicious orders of opioids.</text></subparagraph></paragraph></subsection></section></subtitle><subtitle id="idD5FF5414282B4A04A6EE6A8F0B8D2C06" style="OLC"><enum>G</enum><header>Sense of Congress</header><section id="idB52D4343FF184B11AD560A5E375FABC1"><enum>3701.</enum><header>Sense of Congress</header><text display-inline="no-display-inline">It is the sense of Congress that:</text><paragraph id="ida55d14f13d894832a5fde8620469762b"><enum>(1)</enum><text>Americans with substance use disorders often seek treatment through recovery homes and clinical treatment facilities that offer detoxification, risk reduction, outpatient treatment, residential treatment, or rehabilitation for substance use. Most of those facilities provide a critical function in addressing substance misuse and abuse, particularly as the incidence and prevalence of substance use disorders, and drug overdose numbers continue to rise.</text></paragraph><paragraph id="id89a66bb27c764f6a9a29a10a7b5e4e4b"><enum>(2)</enum><text>Despite the necessity of such treatment facilities and the important services most provide, there are some bad actors in the industry who, through telemarketing and other schemes, actively recruit patients with private insurance so that programs can bill the insurers without providing the necessary treatment services. Often these <quote>patient brokers</quote> are paid for each patient successfully recruited. Payments are also made as a percentage of billings, which incentivizes brokers to recommend patients even at low risk levels to the most aggressive and most expensive treatment programs.</text></paragraph><paragraph id="id35f75842b7404a6d8ae0130aad465a97"><enum>(3)</enum><text>Unless the patient is enrolled in a Federal health care program, a gap in Federal law exists with respect to patient brokers who are improperly recruiting unsuspecting patients to defraud insurance companies.</text></paragraph><paragraph id="idf9f3a9c799474ff3a6bb2c89e7bbd953"><enum>(4)</enum><text>It is important that Congress provide a mechanism to penalize these bad actors, while minding legitimate entities who continue to help patients find reputable treatment programs.</text></paragraph></section></subtitle><enum>IV</enum><header>Commerce</header><subtitle id="id04C808DB984441C5B8F9B116F5691434" style="OLC"><enum>A</enum><header>Fighting Opioid Abuse in Transportation</header><section id="id7B59A863D390436D8AFFBAAC97FE3F05"><enum>4101.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Fighting Opioid Abuse in Transportation Act</short-title></quote>.</text></section><section id="iddc75a7b9-e98f-461f-9c05-51334cf69aba"><enum>4102.</enum><header>Rail mechanical employee controlled substances and alcohol testing</header><subsection id="idc8aca51a-939d-414b-b8b8-1367a8e68f26"><enum>(a)</enum><header>Rail mechanical employees</header><text>Not later than 2 years after the date of enactment of this Act, the Secretary of Transportation shall publish a final rule in the Federal Register revising the regulations promulgated under section 20140 of title 49, United States Code, to designate a rail mechanical employee as a railroad employee responsible for safety-sensitive functions for purposes of that section.</text></subsection><subsection id="id1e0bb847-964d-487d-9cf3-fc87e700c553"><enum>(b)</enum><header>Definition of rail mechanical employee</header><text>The Secretary shall define the term <term>rail mechanical employee</term> by regulation under subsection (a).</text></subsection><subsection id="id3db4e542-7d39-4057-873e-e405c28e75a4"><enum>(c)</enum><header>Savings clause</header><text>Nothing in this section may be construed as limiting or otherwise affecting the discretion of the Secretary of Transportation to set different requirements by railroad size or other factors, consistent with applicable law.</text></subsection></section><section id="id46a14eb3-fdea-43d0-91e6-e4d493f48cc3"><enum>4103.</enum><header>Rail yardmaster controlled substances and alcohol testing</header><subsection id="id5703a4d0-011b-4de1-8874-a5989e58487b"><enum>(a)</enum><header>Yardmasters</header><text>Not later than 2 years after the date of enactment of this Act, the Secretary of Transportation shall publish a final rule in the Federal Register revising the regulations promulgated under section 20140 of title 49, United States Code, to designate a yardmaster as a railroad employee responsible for safety-sensitive functions for purposes of that section.</text></subsection><subsection id="idb0fa17aa-bb8a-4432-98f9-bdce3278058e"><enum>(b)</enum><header>Definition of yardmaster</header><text>The Secretary shall define the term <term>yardmaster</term> by regulation under subsection (a).</text></subsection><subsection id="ida19c62d5-811a-49d0-b619-9e635f5ed615"><enum>(c)</enum><header>Savings clause</header><text>Nothing in this section may be construed as limiting or otherwise affecting the discretion of the Secretary of Transportation to set different requirements by railroad size or other factors, consistent with applicable law.</text></subsection></section><section id="idc8671528b7af44a28ab26ddd6bf7115b"><enum>4104.</enum><header>Department of Transportation public drug and alcohol testing database</header><subsection id="idb2371e6fb0614bf38085e24e423cfbf2"><enum>(a)</enum><header>In general</header><text>Subject to subsection (c), the Secretary of Transportation shall—</text><paragraph id="idC6589FB5978444A483C948B1BF0A8A11"><enum>(1)</enum><text>not later than March 31, 2019, establish and make publicly available on its website a database of the drug and alcohol testing data reported by employers for each mode of transportation; and</text></paragraph><paragraph id="id993CA239359048089AFC50CE300A8B79"><enum>(2)</enum><text>update the database annually.</text></paragraph></subsection><subsection id="idf3c9cfdb07404269bad2c7951ef89b8d"><enum>(b)</enum><header>Contents</header><text>The database under subsection (a) shall include, for each mode of transportation—</text><paragraph id="id900793ce1f234d03a11a7d60a6bd7629"><enum>(1)</enum><text>the total number of drug and alcohol tests by type of substance tested;</text></paragraph><paragraph id="idCFF26EF455B443508065304E72CD7569"><enum>(2)</enum><text>the drug and alcohol test results by type of substance tested;</text></paragraph><paragraph id="id3d46b491c4354350b8ddda36ad8671ec"><enum>(3)</enum><text>the reason for the drug or alcohol test, such as pre-employment, random, post-accident, reasonable suspicion or cause, return-to-duty, or follow-up, by type of substance tested; and</text></paragraph><paragraph id="id643350aaf76a4578b8a4f7b54bd22328"><enum>(4)</enum><text>the number of individuals who refused testing.</text></paragraph></subsection><subsection id="id78C21A725EB94D8F8F87BF81E8E9615F"><enum>(c)</enum><header>Commercially sensitive data</header><text>The Department of Transportation shall not release any commercially sensitive data furnished by an employer under this section unless the data is aggregated or otherwise in a form that does not identify the employer providing the data.</text></subsection><subsection id="idEA356F83BA9149FFAD8C222798C17790"><enum>(d)</enum><header>Savings clause</header><text>Nothing in this section may be construed as limiting or otherwise affecting the requirements of the Secretary of Transportation to adhere to requirements applicable to confidential business information and sensitive security information, consistent with applicable law.</text></subsection></section><section id="id98b07d5e-9fb3-468b-978a-de44274cbf52"><enum>4105.</enum><header>GAO report on Department of Transportation’s collection and use of drug and alcohol testing data</header><subsection id="id670d169a-bf99-4e41-beee-3016d395f15d"><enum>(a)</enum><header>In general</header><text>Not later than 2 years after the date the Department of Transportation public drug and alcohol testing database is established under section 4104, the Comptroller General of the United States shall—</text><paragraph id="id168825f5-b3da-45cd-a1cc-73ed1f0e2245"><enum>(1)</enum><text>review the Department of Transportation Drug and Alcohol Testing Management Information System; and</text></paragraph><paragraph id="idb1227cc2-fe5b-4cdc-8c8e-417156748d9d"><enum>(2)</enum><text>submit to the <committee-name committee-id="SSCM00">Committee on Commerce, Science, and Transportation of the Senate</committee-name> and the <committee-name committee-id="">Committee on Transportation and Infrastructure of the House of Representatives</committee-name> a report on the review, including recommendations under subsection (c).</text></paragraph></subsection><subsection id="id744acd27-d28b-40f3-841c-02775600e2ae"><enum>(b)</enum><header>Contents</header><text>The report under subsection (a) shall include—</text><paragraph id="id472495e6-d470-4d32-89ad-ac0f5bdc02cb"><enum>(1)</enum><text>a description of the process the Department of Transportation uses to collect and record drug and alcohol testing data submitted by employers for each mode of transportation;</text></paragraph><paragraph id="id5e104d70-4b69-4578-a17f-6dfd7ce89774"><enum>(2)</enum><text>an assessment of whether and, if so, how the Department of Transportation uses the data described in paragraph (1) in carrying out its responsibilities; and</text></paragraph><paragraph id="idcda55add-bc7f-49ac-a241-ff5b8ac72061"><enum>(3)</enum><text>an assessment of the Department of Transportation public drug and alcohol testing database under section 4104.</text></paragraph></subsection><subsection id="id08839800-0057-466b-9681-37ed0f860a25"><enum>(c)</enum><header>Recommendations</header><text>The report under subsection (a) may include recommendations regarding—</text><paragraph id="id2a45e3d4-d45e-4c33-996c-f95019403884"><enum>(1)</enum><text>how the Department of Transportation can best use the data described in subsection (b)(1);</text></paragraph><paragraph id="id831b2866-f945-4e40-b90e-cd181310e1a6"><enum>(2)</enum><text>any improvements that could be made to the process described in subsection (b)(1);</text></paragraph><paragraph id="idfb966bd2-5f15-4a2f-94a9-190e11adcdc7"><enum>(3)</enum><text>whether and, if so, how the Department of Transportation public drug and alcohol testing database under section 4104 could be made more effective; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id5c45c8f5-f182-45f2-8051-bf1bfa05b3ef"><enum>(4)</enum><text>such other recommendations as the Comptroller General considers appropriate.</text></paragraph></subsection></section><section id="id80ce9530-404c-4504-8406-825428151df2"><enum>4106.</enum><header>Transportation Workplace Drug and Alcohol Testing Program; addition of fentanyl</header><subsection id="id16f3fade-810c-4aa7-b774-d0c403e68a9c"><enum>(a)</enum><header>Mandatory Guidelines for Federal Workplace Drug Testing Programs</header><paragraph id="ida886b20f-8a28-4a85-9e58-f74cd4eb9472"><enum>(1)</enum><header>In general</header><text>Not later than 180 days after the date of enactment of this Act, the Secretary of Health and Human Services shall determine whether a revision of the Mandatory Guidelines for Federal Workplace Drug Testing Programs to expand the opioid category on the list of authorized drug testing to include fentanyl is justified, based on the reliability and cost-effectiveness of available testing.</text></paragraph><paragraph id="id760ad8f8-4b4e-4818-901c-bc1245a690ae"><enum>(2)</enum><header>Revision of guidelines</header><text>If the expansion of the opioid category is determined to be justified under paragraph (1), the Secretary of Health and Human Services shall—</text><subparagraph id="id06F75A63364D4DBA810947EED96B31E9"><enum>(A)</enum><text>notify the <committee-name committee-id="SSCM00">Committee on Commerce, Science, and Transportation of the Senate</committee-name> and the <committee-name committee-id="">Committee on Transportation and Infrastructure of the House of Representatives</committee-name> of the determination; and</text></subparagraph><subparagraph id="id9B1F6FEEB2F545B6915E058C4456E6EE"><enum>(B)</enum><text>publish in the Federal Register, not later than 18 months after the date of the determination under that paragraph, a final notice of the revision of the Mandatory Guidelines for Federal Workplace Drug Testing Programs to expand the opioid category on the list of authorized drug testing to include fentanyl.</text></subparagraph></paragraph><paragraph id="idEC3D3511387C4C53BDA9E65C6AFAF1C5"><enum>(3)</enum><header>Report</header><text>If the expansion of the opioid category is determined not to be justified under paragraph (1), the Secretary of Health and Human Services shall submit to the <committee-name committee-id="SSCM00">Committee on Commerce, Science, and Transportation of the Senate</committee-name> and the <committee-name committee-id="">Committee on Transportation and Infrastructure of the House of Representatives</committee-name> a report explaining, in detail, the reasons the expansion of the opioid category on the list of authorized drugs to include fentanyl is not justified.</text></paragraph></subsection><subsection id="id943d6a85-8e8a-4b0f-97fb-0b25fc3b8891"><enum>(b)</enum><header>Department of Transportation drug-testing panel</header><text>If the expansion of the opioid category is determined to be justified under subsection (a)(1), the Secretary of Transportation shall publish in the Federal Register, not later than 18 months after the date the final notice is published under subsection (a)(2), a final rule revising part 40 of title 49, Code of Federal Regulations, to include fentanyl in the Department of Transportation's drug-testing panel, consistent with the Mandatory Guidelines for Federal Workplace Drug Testing Programs as revised by the Secretary of Health and Human Services under subsection (a).</text></subsection><subsection id="id7942cf52-89c5-4c31-8c27-b2d47c5f7649"><enum>(c)</enum><header>Savings provision</header><text>Nothing in this section may be construed as—</text><paragraph id="id63272C8769964B52BF01DE4C5C82F701"><enum>(1)</enum><text>delaying the publication of the notices described in sections 4107 and 4108 until the Secretary of Health and Human Services makes a determination or publishes a notice under this section; or</text></paragraph><paragraph id="idAA8F2A2B6507429A92A0D13863EDD103"><enum>(2)</enum><text>limiting or otherwise affecting any authority of the Secretary of Health and Human Services or the Secretary of Transportation to expand the list of authorized drug testing to include an additional substance.</text></paragraph></subsection></section><section id="id54352671-3eb4-42a4-8e49-cfd1124b9160"><enum>4107.</enum><header>Status reports on hair testing guidelines</header><subsection id="id08DACAC91C1D4591BB63D4475F25EBF0"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 30 days after the date of enactment of this Act, and every 180 days thereafter until the date that the Secretary of Health and Human Services publishes in the Federal Register a final notice of scientific and technical guidelines for hair testing in accordance with section 5402(b) of the Fixing America's Surface Transportation Act (Public Law 114–94; 129 Stat. 1312), the Secretary of Health and Human Services shall submit to the <committee-name committee-id="SSCM00">Committee on Commerce, Science, and Transportation of the Senate</committee-name> and the <committee-name committee-id="">Committee on Transportation and Infrastructure of the House of Representatives</committee-name> a report on—</text><paragraph id="idb338e984-afe6-45cf-a258-c0707f4c672a"><enum>(1)</enum><text>the status of the hair testing guidelines;</text></paragraph><paragraph id="id445383fb-0331-4ab0-ab64-0a2c6068537d"><enum>(2)</enum><text>an explanation for why the hair testing guidelines have not been issued;</text></paragraph><paragraph id="id953ea416-db46-48f8-9b94-7b773a129ef3"><enum>(3)</enum><text>a schedule, including benchmarks, for the completion of the hair testing guidelines; and</text></paragraph><paragraph id="idb0ec3d6f-f01b-4969-ad61-2582cf959287"><enum>(4)</enum><text>an estimated date of completion of the hair testing guidelines.</text></paragraph></subsection><subsection id="idC7BC605C810C4A2882DF0E0A37C6C040"><enum>(b)</enum><header>Requirement</header><text>To the extent practicable and consistent with the objective of the hair testing described in subsection (a) to detect illegal or unauthorized use of substances by the individual being tested, the final notice of scientific and technical guidelines under that subsection, as determined by the Secretary of Health and Human Services, shall eliminate the risk of positive test results of the individual being tested caused solely by the drug use of others and not caused by the drug use of the individual being tested.</text></subsection></section><section id="idcb66f7cb-b74f-4b25-8060-12c42baeb396"><enum>4108.</enum><header>Mandatory Guidelines for Federal Workplace Drug Testing Programs Using Oral Fluid</header><subsection id="id98b85754-f9ba-4de3-bd8b-1a9590e8e942"><enum>(a)</enum><header>Deadline</header><text>Not later than December 31, 2018, the Secretary of Health and Human Services shall publish in the Federal Register a final notice of the Mandatory Guidelines for Federal Workplace Drug Testing Programs using Oral Fluid, based on the notice of proposed mandatory guidelines published in the Federal Register on May 15, 2015 (80 Fed. Reg. 28054).</text></subsection><subsection id="idBF3B104B14494F34A35E33C0FEC09AF4"><enum>(b)</enum><header>Requirement</header><text>To the extent practicable and consistent with the objective of the testing described in subsection (a) to detect illegal or unauthorized use of substances by the individual being tested, the final notice of scientific and technical guidelines under that subsection, as determined by the Secretary of Health and Human Services, shall eliminate the risk of positive test results of the individual being tested caused solely by the drug use of others and not caused by the drug use of the individual being tested.</text></subsection><subsection id="id9d536ea8-c57a-42ce-9e1a-36fa93b76821"><enum>(c)</enum><header>Rule of construction</header><text>Nothing in this section may be construed as requiring the Secretary of Health and Human Services to reissue a notice of proposed mandatory guidelines to carry out subsection (a).</text></subsection></section><section commented="no" display-inline="no-display-inline" id="ida8c4d3fb-58e2-4a42-bf94-476cde087c3c" section-type="subsequent-section"><enum>4109.</enum><header>Electronic recordkeeping</header><subsection commented="no" display-inline="no-display-inline" id="id24C10DC623A748F3A84E2630FF8CC035"><enum>(a)</enum><header>Deadline</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall—</text><paragraph commented="no" display-inline="no-display-inline" id="id2A7FDDAB94944C6D9B163668FF010A64"><enum>(1)</enum><text display-inline="yes-display-inline">ensure that each certified laboratory that requests approval for the use of completely paperless electronic Federal Drug Testing Custody and Control Forms from the National Laboratory Certification Program’s Electronic Custody and Control Form systems receives approval for those completely paperless electronic forms instead of forms that include any combination of electronic traditional handwritten signatures executed on paper forms; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idC8E703C4F3634E38A329AC19571E58B7"><enum>(2)</enum><text display-inline="yes-display-inline">establish a deadline for a certified laboratory to request approval under paragraph (1).</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id371EA955F2DC46D7AFE4D273C317BA01"><enum>(b)</enum><header>Savings clause</header><text display-inline="yes-display-inline">Nothing in this section may be construed as limiting or otherwise affecting any authority of the Secretary of Health and Human Services to grant approval to a certified laboratory for use of completely paperless electronic Federal Drug Testing Custody and Control Forms, including to grant approval outside of the process under subsection (a).</text></subsection><subsection commented="no" display-inline="no-display-inline" id="id7912646D5D02457792005E05BC2E8F1A"><enum>(c)</enum><header>Electronic signatures</header><text display-inline="yes-display-inline">Not later than 18 months after the date of the deadline under subsection (a)(2), the Secretary of Transportation shall issue a final rule revising part 40 of title 49, Code of Federal Regulations, to authorize, to the extent practicable, the use of electronic signatures or digital signatures executed to electronic forms instead of traditional handwritten signatures executed on paper forms.</text></subsection></section><section commented="no" display-inline="no-display-inline" id="id8413602DD42B468282DE80D8EA245829"><enum>4110.</enum><header>Status reports on Commercial Driver's License Drug and Alcohol Clearinghouse</header><subsection commented="no" display-inline="no-display-inline" id="idC55A113824FE4E69B366B6BF99AC1F31"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 180 days after the date of enactment of this Act, and biannually thereafter until the compliance date, the Administrator of the Federal Motor Carrier Safety Administration shall submit to the <committee-name committee-id="SSCM00">Committee on Commerce, Science, and Transportation of the Senate</committee-name> and the <committee-name committee-id="">Committee on Transportation and Infrastructure of the House of Representatives</committee-name> a status report on implementation of the final rule for the Commercial Driver's License Drug and Alcohol Clearinghouse (81 Fed. Reg. 87686), including—</text><paragraph id="id1e09be4137e24783b913f860efb3bfc5"><enum>(1)</enum><text>an updated schedule, including benchmarks, for implementing the final rule as soon as practicable, but not later than the compliance date; and</text></paragraph><paragraph id="id72b3a902ba754cf08b540a6da7e45484"><enum>(2)</enum><text>a description of each action the Federal Motor Carrier Safety Administration is taking to implement the final rule before the compliance date.</text></paragraph></subsection><subsection id="idA343246CDA6F442786895336C373F711"><enum>(b)</enum><header>Definition of compliance date</header><text>In this section, the term <term>compliance date</term> means the earlier of—</text><paragraph id="idA26D01455FED4F2BB8A6F24D38E55620"><enum>(1)</enum><text>January 6, 2020; or</text></paragraph><paragraph id="id608AACF382BC455DB30D6983947204A8"><enum>(2)</enum><text>the date that the national clearinghouse required under section 31306a of title 49, United States Code, is operational.</text></paragraph></subsection></section></subtitle><subtitle id="idC1105448920746A58EA029228FDCB9E1" style="OLC"><enum>B</enum><header>Opioid Addiction Recovery Fraud Prevention</header><section id="id5D6A81687BB04249A2893D0C5AA80869"><enum>4201.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Opioid Addiction Recovery Fraud Prevention Act of 2018</short-title></quote>.</text></section><section id="id2991631a-1486-4982-9177-5ce54af3d78c"><enum>4202.</enum><header>Definitions</header><text display-inline="no-display-inline">In this subtitle:</text><paragraph id="ide2313328-7019-491b-aebd-eec169520f63"><enum>(1)</enum><header>Opioid treatment product</header><text>The term <term>opioid treatment product</term> means a product, including any supplement or medication, for use or marketed for use in the treatment, cure, or prevention of an opioid use disorder.</text></paragraph><paragraph id="idd45cd34c-34b8-47e4-a3e3-7a7859b6fad4"><enum>(2)</enum><header>Opioid treatment program</header><text>The term <term>opioid treatment program</term> means a program that provides treatment for people diagnosed with, having, or purporting to have an opioid use disorder.</text></paragraph><paragraph id="id9740a981-2370-4e26-87af-213b83bcc1fb"><enum>(3)</enum><header>Opioid use disorder</header><text>The term <term>opioid use disorder</term> means a cluster of cognitive, behavioral, or physiological symptoms in which the individual continues use of opioids despite significant opioid-induced problems, such as adverse health effects.</text></paragraph></section><section id="id369d4905-95e8-4fe1-95c1-d91f58c9225b"><enum>4203.</enum><header>False or misleading representations with respect to opioid treatment programs and products</header><subsection id="id46fcc426-537f-4091-b93c-948c60606163"><enum>(a)</enum><header>Unlawful activity</header><text>It is unlawful to make any deceptive representation with respect to the cost, price, efficacy, performance, benefit, risk, or safety of any opioid treatment program or opioid treatment product.</text></subsection><subsection id="idea3eec3c-36b9-4795-87a3-c377d0b1972b"><enum>(b)</enum><header>Enforcement by the Federal Trade Commission</header><paragraph id="iddaec6634-d2a2-4e6e-ade0-3ce8d4eaf39c"><enum>(1)</enum><header>Unfair or deceptive acts or practices</header><text>A violation of subsection (a) shall be treated as a violation of a rule under section 18 of the Federal Trade Commission Act (15 U.S.C. 57a) regarding unfair or deceptive acts or practices.</text></paragraph><paragraph id="idb09dbc40-f31b-4cf7-84fa-a4bb83172bf1"><enum>(2)</enum><header>Powers of the Federal Trade Commission</header><subparagraph id="id1d1da99e-5fcf-4c21-a886-fc94c4028b12"><enum>(A)</enum><header>In general</header><text>The Federal Trade Commission shall enforce this section in the same manner, by the same means, and with the same jurisdiction, powers, and duties as though all applicable terms and provisions of the Federal Trade Commission Act (15 U.S.C. 41 et seq.) were incorporated into and made a part of this section.</text></subparagraph><subparagraph id="id984c9eba-b586-4f72-9670-9a461df0f129"><enum>(B)</enum><header>Privileges and immunities</header><text>Any person who violates subsection (a) shall be subject to the penalties and entitled to the privileges and immunities provided in the Federal Trade Commission Act as though all applicable terms and provisions of the Federal Trade Commission Act (15 U.S.C. 41 et seq.) were incorporated and made part of this section.</text></subparagraph></paragraph></subsection><subsection id="id1b33d64f-9758-477f-b977-8c5d524c0802"><enum>(c)</enum><header>Enforcement by States</header><paragraph id="id411551ab-f994-498d-bf09-96632a131af3"><enum>(1)</enum><header>In general</header><text>Except as provided in paragraph (4), in any case in which the attorney general of a State has reason to believe that an interest of the residents of the State has been or is threatened or adversely affected by any person who violates subsection (a), the attorney general of the State, as parens patriae, may bring a civil action on behalf of the residents of the State in an appropriate district court of the United States to obtain appropriate relief.</text></paragraph><paragraph id="id3640444a-63a9-404d-b747-9145ac6368f5"><enum>(2)</enum><header>Rights of Federal Trade Commission</header><subparagraph id="id7f0464b0-b40d-4f3a-9ecf-e97db1f2a113"><enum>(A)</enum><header>Notice to Federal Trade Commission</header><clause id="ida66c2f81-24cf-4969-a570-6bff031c3588"><enum>(i)</enum><header>In general</header><text>Except as provided in clause (iii), the attorney general of a State shall notify the Federal Trade Commission in writing that the attorney general intends to bring a civil action under paragraph (1) before initiating the civil action.</text></clause><clause id="id6017c79a-21be-4888-8abe-40370b9c1538"><enum>(ii)</enum><header>Contents</header><text>The notification required by clause (i) with respect to a civil action shall include a copy of the complaint to be filed to initiate the civil action.</text></clause><clause id="id8eed3cf3-33de-44b9-bed9-9814718961ee"><enum>(iii)</enum><header>Exception</header><text>If it is not feasible for the attorney general of a State to provide the notification required by clause (i) before initiating a civil action under paragraph (1), the attorney general shall notify the Federal Trade Commission immediately upon instituting the civil action.</text></clause></subparagraph><subparagraph id="idbb32fa99-e8e3-4fb3-9e82-60b55be12499"><enum>(B)</enum><header>Intervention by Federal Trade Commission</header><text>The Federal Trade Commission may—</text><clause id="id966296f5-533a-4368-939f-77993e83fd9b"><enum>(i)</enum><text>intervene in any civil action brought by the attorney general of a State under paragraph (1); and</text></clause><clause id="idb81270f6-cffe-472d-89bb-2d0ef551df5c"><enum>(ii)</enum><text>upon intervening—</text><subclause id="id25561dac-4da2-4612-aaf3-c0e94a0ebfd1"><enum>(I)</enum><text>be heard on all matters arising in the civil action; and</text></subclause><subclause id="idba094bf4-4516-4fef-95c0-a94b6b492b4c"><enum>(II)</enum><text>file petitions for appeal.</text></subclause></clause></subparagraph></paragraph><paragraph id="idb77d0c43-08ca-4697-a52d-53416eeb7eb8"><enum>(3)</enum><header>Investigatory powers</header><text>Nothing in this subsection shall be construed to prevent the attorney general of a State from exercising the powers conferred on the attorney general by the laws of the State to conduct investigations, to administer oaths or affirmations, or to compel the attendance of witnesses or the production of documentary or other evidence.</text></paragraph><paragraph id="id370bfa0d-9f91-4de5-bc54-3b4301f5dd5e"><enum>(4)</enum><header>Preemptive action by Federal Trade Commission</header><text>If the Federal Trade Commission or the Attorney General on behalf of the Commission institutes a civil action, or the Federal Trade Commission institutes an administrative action, with respect to a violation of subsection (a), the attorney general of a State may not, during the pendency of that action, bring a civil action under paragraph (1) against any defendant or respondent named in the complaint of the Commission for the violation with respect to which the Commission instituted such action.</text></paragraph><paragraph id="id48bb9e6f-8b90-4f6b-a6c5-253d177d894a"><enum>(5)</enum><header>Venue; service of process</header><subparagraph id="idc3cf58e3-fe6a-4a40-8572-c019c03b84d2"><enum>(A)</enum><header>Venue</header><text>Any action brought under paragraph (1) may be brought in any district court of the United States that meets applicable requirements relating to venue under section 1391 of title 28, United States Code.</text></subparagraph><subparagraph id="id1769c72b-5e41-4038-9fde-c0ecf7576262"><enum>(B)</enum><header>Service of process</header><text>In an action brought under paragraph (1), process may be served in any district in which the defendant—</text><clause id="id153acd73-e27f-4e67-ab5e-a13385c3cc69"><enum>(i)</enum><text>is an inhabitant; or</text></clause><clause id="idfe36bc93-52e5-48a9-8a7b-5dd519236f70"><enum>(ii)</enum><text>may be found.</text></clause></subparagraph></paragraph><paragraph id="id9e3e6941-644a-495f-bbc8-f6a34e54ac4c"><enum>(6)</enum><header>Actions by other State officials</header><text>In addition to civil actions brought by attorneys general under paragraph (1), any other consumer protection officer of a State who is authorized by the State to do so may bring a civil action under paragraph (1), subject to the same requirements and limitations that apply under this subsection to civil actions brought by attorneys general.</text></paragraph></subsection><subsection id="idb940ebe05a2f4c0787e59777311b36c2"><enum>(d)</enum><header>Authority preserved</header><text>Nothing in this title shall be construed to limit the authority of the Federal Trade Commission or the Food and Drug Administration under any other provision of law.</text></subsection></section></subtitle>

Secretary