[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2102 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 2102
To provide funding for programs and activities under the SUPPORT for
Patients and Communities Act.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 11, 2019
Mrs. Shaheen introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To provide funding for programs and activities under the SUPPORT for
Patients and Communities Act.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Turn the Tide Act''.
SEC. 2. CONTROLLED SUBSTANCE PROVISIONS OF THE SUPPORT FOR PATIENTS AND
COMMUNITIES ACT.
(a) Grants To Enhance Access to Substance Use Disorder Treatment.--
Section 3203(b) of the Substance Use-Disorder Prevention that Promotes
Opioid Recovery and Treatment for Patients and Communities Act (Public
Law 115-271) is amended to read as follows:
``(b) Appropriations.--For grants under subsection (a), there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $4,000,000 for each
of fiscal years 2020 through 2023.''.
(b) Access to Increased Drug Disposal.--Section 3260 of the
Substance Use-Disorder Prevention that Promotes Opioid Recovery and
Treatment for Patients and Communities Act (Public Law 115-271) is
amended to read as follows:
``SEC. 3260. APPROPRIATIONS.
``To carry out this chapter, there is authorized to be
appropriated, and there is appropriated, out of any monies in the
Treasury not otherwise appropriated, such sums as may be necessary for
each fiscal year.''.
SEC. 3. PUBLIC HEALTH PROVISIONS OF THE SUPPORT FOR PATIENTS AND
COMMUNITIES ACT.
(a) First Responder Training.--Section 546(h) of the Public Health
Service Act (42 U.S.C. 290ee-1(h)) is amended to read as follows:
``(h) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $36,000,000 for each
of fiscal years 2020 through 2023.''.
(b) Public Health Laboratories Pilot Program.--Section 7011(d) of
the Substance Use-Disorder Prevention that Promotes Opioid Recovery and
Treatment for Patients and Communities Act (Public Law 115-271) is
amended to read as follows:
``(d) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $15,000,000 for each
of fiscal years 2020 through 2023.''.
(c) National Recovery Housing Best Practices.--Section 550(g) of
the Public Health Service Act (42 U.S.C. 290ee-5(g)) is amended to read
as follows:
``(g) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $3,000,000 for the
period of fiscal years 2020 through 2021.''.
(d) Model Training Programs for Substance Use Disorder Patient
Records.--Section 7053(e) of the Substance Use-Disorder Prevention that
Promotes Opioid Recovery and Treatment for Patients and Communities Act
(Public Law 115-271) is amended to read as follows:
``(e) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated--
``(1) $4,000,000 for fiscal years 2020;
``(2) $2,000,000 for each of fiscal year 2021; and
``(3) $1,000,000 for each of fiscal years 2022 and 2023.''.
(e) Residential Treatment Programs for Pregnant and Postpartum
Women.--Section 508(s) of the Public Health Service Act (42 U.S.C.
290bb-1(s)) is amended by striking the first sentence and inserting the
following: ``To carry out this section, there is authorized to be
appropriated, and there is appropriated, out of any monies in the
Treasury not otherwise appropriated, $29,931,000 for each of fiscal
years 2020 through 2023.''.
(f) Prenatal and Postnatal Health.--Section 317L(d) of the Public
Health Service Act (42 U.S.C. 247b-13(d)) is amended to read as
follows:
``(d) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, such sums as may be
necessary for each of fiscal years 2020 through 2023.''.
(g) Program for Education and Training in Pain Care.--Section
759(e) of the Public Health Service Act (42 U.S.C. 294i(e)) is amended
to read as follows:
``(e) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, such sums as may be
necessary for each of fiscal years 2020 through 2023. Amounts
appropriated under this subsection shall remain available until
expended.''.
(h) Mental and Behavioral Health Education and Training Grants.--
Section 756(f) of the Public Health Service Act (42 U.S.C. 294e-1(f))
is amended to read as follows:
``(f) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $50,000,000 for each
of fiscal years 2020 through 2023.''.
(i) Coordination and Continuation of Care for Drug Overdose
Patients.--Section 7081(f) of the Substance Use-Disorder Prevention
that Promotes Opioid Recovery and Treatment for Patients and
Communities Act (Public Law 115-271) is amended to read as follows:
``(f) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $10,000,000 for each
of fiscal years 2020 through 2023.''.
(j) Emergency Department Alternatives to Opioids Demonstration
Program.--Section 7091(g) of the Substance Use-Disorder Prevention that
Promotes Opioid Recovery and Treatment for Patients and Communities Act
(Public Law 115-271) is amended to read as follows:
``(g) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $10,000,000 for each
of fiscal years 2020 through 2023.''.
(k) Regional Centers of Excellence in Substance Use Disorder
Education.--Section 551(f) of the Public Health Service Act (42 U.S.C.
290ee-6(f)) is amended to read as follows:
``(f) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $4,000,000 for each
of fiscal years 2020 through 2023.''.
(l) Youth Prevention and Recovery.--Section 7102(c)(9) of the
Substance Use-Disorder Prevention that Promotes Opioid Recovery and
Treatment for Patients and Communities Act (Public Law 115-271) is
amended to read as follows:
``(9) Appropriations.--To carry out this subsection, there
is authorized to be appropriated, and there is appropriated,
out of any monies in the Treasury not otherwise appropriated,
$10,000,000 for each of fiscal years 2020 through 2023.''.
(m) Comprehensive Opioid Recovery Centers.--Section 552(j) of the
Public Health Service Act (42 U.S.C. 290ee-7(j)) is amended to read as
follows:
``(j) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $10,000,000 for each
of fiscal years 2020 through 2023.''.
(n) CDC Surveillance and Data Collection.--Section 7131(e) of the
Substance Use-Disorder Prevention that Promotes Opioid Recovery and
Treatment for Patients and Communities Act (Public Law 115-271) is
amended to read as follows:
``(e) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $2,000,000 for each
of fiscal years 2020 through 2023.''.
(o) National Child Traumatic Stress Initiative.--Section 582(j) of
the Public Health Service Act (42 U.S.C. 290hh-1(j)) is amended to read
as follows:
``(j) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $63,887,000 for each
of fiscal years 2020 through 2023.''.
(p) Trauma Support Services and Mental Health Care.--Section
7134(l) of the Substance Use-Disorder Prevention that Promotes Opioid
Recovery and Treatment for Patients and Communities Act (Public Law
115-271) is amended to read as follows:
``(l) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $50,000,000 for each
of fiscal years 2020 through 2023.''.
(q) Surveillance and Education Regarding Infections Associated With
Illicit Drug Use and Other Risk Factors.--Section 317N(d) of the Public
Health Service Act (42 U.S.C. 247b-15(d)) is amended to read as
follows:
``(d) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $40,000,000 for each
of fiscal years 2020 through 2023.''.
(r) Building Communities of Recovery.--Section 547(f) of the Public
Health Service Act (42 U.S.C. 290ee-2(f)) is amended to read as
follows:
``(f) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $5,000,000 for each
of fiscal years 2020 through 2023.''.
(s) Peer Support Technical Assistance Center.--Section 547A(e) of
the Public Health Service Act (42 U.S.C. 290ee-2a(e)) is amended to
read as follows:
``(e) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $1,000,000 for each
of fiscal years 2020 through 2023.''.
(t) Preventing Overdoses of Controlled Substances.--Section 392A(d)
of the Public Health Service Act (42 U.S.C. 280b-1(d)) is amended to
read as follows:
``(d) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $496,000,000 for
each of fiscal years 2020 through 2023.''.
(u) Career Act.--Section 7183(k) of the Substance Use-Disorder
Prevention that Promotes Opioid Recovery and Treatment for Patients and
Communities Act (Public Law 115-271) is amended to read as follows:
``(k) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $5,000,000 for each
of fiscal years 2020 through 2023.''.
SEC. 4. HOUSING AND DEPARTMENT OF JUSTICE PROVISIONS OF THE SUPPORT FOR
PATIENTS AND COMMUNITIES ACT.
(a) Assistance To Help Individuals in Recovery From Substance Use
Disorder Become Stably Housed.--Section 8071(a) of the Substance Use-
Disorder Prevention that Promotes Opioid Recovery and Treatment for
Patients and Communities Act (Public Law 115-271) is amended by
inserting ``, and there are appropriated, out of any monies in the
Treasury not otherwise appropriated,'' after ``appropriated under this
section''.
(b) Building Capacity for Family-Focused Residential Treatment.--
Section 8083(c) of the Substance Use-Disorder Prevention that Promotes
Opioid Recovery and Treatment for Patients and Communities Act (Public
Law 115-271) is amended to read as follows:
``(c) Appropriations.--To carry out this section, there is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, $20,000,000 for
fiscal years 2020, which shall remain available through fiscal year
2023.''.
(c) Comprehensive Opioid Abuse Grant Program.--Section 1001(a)(27)
of title I of the Omnibus Crime Control and Safe Streets Act of 1968
(34 U.S.C. 10261(a)(27)) is amended to read as follows:
``(27) To carry out part LL, there is authorized to be
appropriated, and there is appropriated, out of any monies in the
Treasury not otherwise appropriated, $500,000,000 for each of fiscal
years 2020 through 2023.''.
(d) Office of National Drug Control Policy.--Section 714 of the
Office of National Drug Control Policy Reauthorization Act of 1998 (21
U.S.C. 1711) is amended to read as follows:
``SEC. 714. AUTHORIZATION OF APPROPRIATIONS; APPROPRIATIONS.
``To carry out this title, except activities otherwise specified,
there is authorized to be appropriated, and there is appropriated, out
of any monies in the Treasury not otherwise appropriated, $50,000,000
for each of fiscal years 2020 through 2023, to remain available until
expended.''.
(e) Drug-Free Communities Program.--Section 1024 of the Anti-Drug
Abuse Act of 1988 (21 U.S.C. 1524) is amended--
(1) in the heading, by inserting ``; appropriations'' after
``authorization of appropriations''; and
(2) by striking subsection (a) and inserting the following:
``(a) In General.--To carry out this chapter, there is authorized
to be appropriated to the Office of National Drug Control Policy, and
there is appropriated, out of any monies in the Treasury not otherwise
appropriated, $150,000,000 for each of fiscal years 2020 through
2023.''.
(f) High-Intensity Drug Trafficking Area Program.--Section 707(p)
of the Office of National Drug Control Policy Reauthorization Act of
1988 (21 U.S.C. 1706(p)) is amended--
(1) by redesignating paragraphs (1) through (6) as
subparagraphs (A) through (F), respectively, and adjusting the
margins accordingly;
(2) by striking ``There is authorized'' and inserting the
following:
``(1) In general.--There is authorized'';
(3) in paragraph (1), as so designated--
(A) in subparagraph (E), as so redesignated, by
striking ``each of''; and
(B) in subparagraph (F), as so redesignated, by
striking ``each of fiscal years 2018 through 2023'' and
inserting ``fiscal year 2018''; and
(4) by adding at the end the following:
``(2) Appropriations.--To carry out this section, there is
authorized to be appropriated to the Office of National Drug
Control Policy, and there is appropriated, out of any monies in
the Treasury not otherwise appropriated, $280,000,000 for each
of fiscal years 2020 through 2023.''.
(g) Drug Court Program.--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 to read as follows:
``(25)(A) Except as provided in subparagraph (C), to carry out part
EE, there is authorized to be appropriated, and there is appropriated,
out of any monies in the Treasury not otherwise appropriated,
$75,000,000 for each of fiscal years 2020 through 2023.''.
(h) Drug Court Training and Technical Assistance.--Section
705(e)(2) of the Office of National Drug Control Policy Reauthorization
Act of 1988 (21 U.S.C. 1704(e)(2)) is amended to read as follows:
``(2) Authorization of appropriations; appropriations.--To
carry out this subsection, there is authorized to be
appropriated, and there is appropriated, out of any monies in
the Treasury not otherwise appropriated, $2,000,000 for each of
fiscal years 2020 through 2023.''.
(i) Administration of the Office of National Drug Control Policy.--
Section 704(i)(2) of the Office of National Drug Control Policy
Reauthorization Act of 1998 (21 U.S.C. 1703(i)(2)) is amended to read
as follows:
``(2) Authorization of appropriations; appropriations.--To
carry out this subsection, there is authorized to be
appropriated, and there is appropriated, out of any monies in
the Treasury not otherwise appropriated, $1,250,000 for each of
fiscal years 2020 through 2023.''.
(j) Emerging Threats Committee, Plan, and Media Campaign.--Section
709(g) of the Office of National Drug Control Policy Reauthorization
Act of 1998 (21 U.S.C. 1708(g)) is amended to read as follows:
``(g) Authorization of Appropriations; Appropriations.--To carry
out this section, there is authorized to be appropriated to the Office,
and there is appropriated, out of any monies in the Treasury not
otherwise appropriated, $25,000,000 for each of fiscal years 2020
through 2023.''.
SEC. 5. BOLSTERING COMMITMENTS TO STATE GRANTS FOR SUBSTANCE USE
DISORDER TREATMENT AND PREVENTION.
(a) State Opioid Response Grants.--
(1) In general.--To carry out activities under section 1003
of the 21st Century Cures Act (42 U.S.C. 290ee-3 note) relating
to opioids by the State agency responsible for administering
the substance abuse prevention and treatment block grant under
subpart II of part B of title XIX of the Public Health Service
Act (42 U.S.C. 300x-21 et seq.), there is authorized to be
appropriated, and there is appropriated, $5,500,000,000 for
each of fiscal years 2020 through 2024.
(2) Flexibility in use of funds.--Section 1003(b) of the
21st Century Cures Act (42 U.S.C. 290ee-3 note) is amended by
adding at the end the following:
``(3) Flexibility.--States and Indian tribes may use
amounts provided under grants under this subsection to support
substance use disorder treatment care and related services
regardless of whether the patient involved has a primary
diagnosis of opioid use disorder, so long as the individual has
a substance use disorder diagnosis.
``(4) Rule of construction.--Nothing in this subsection
shall be construed to prohibit States from using grant funds
under this subsection to allocate amounts to local governments
to establish subgrantee awards in such localities.''.
(3) Substance abuse prevention and treatment block
grants.--Section 1935(a) of the Public Health Service Act (42
U.S.C. 300x-35(a)) is amended to read as follows:
``(a) Appropriations.--To carry out this subpart, subpart III, and
section 505(d), there is authorized to be appropriated, and there is
appropriated, out of any monies in the Treasury not otherwise
appropriated, $3,000,000,000 for each of fiscal years 2020 through
2024, and $2,500,000,000 for each of fiscal years 2025 through 2029.''.
(b) Requirements.--For the purposes of carrying out activities with
amounts appropriated under this section (and the amendment made by this
section), the Secretary of Health and Human Services shall ensure that
the following requirements are complied with:
(1) Of the amount appropriated for each fiscal year under
subsection (a) (and the amendment made by such subsection),
$50,000,000 shall be made available to Indian Tribes or tribal
organizations.
(2) Of such remaining amounts for each such fiscal year, 15
percent shall be made available to the States with the highest
mortality rate related to opioid use disorders.
(3) Of the amount made available for each fiscal year under
subsections (a)(1) for State Opioid Response Grants, not more
than 2 percent of such amount shall be available for Federal
administrative expenses, training, technical assistance, and
evaluation.
(4) Of the amounts not reserved under paragraphs (1)
through (3), the Secretary shall make allocations to States,
territories, and the District of Columbia according to a
formula using national survey results that the Secretary
determines are the most objective and reliable measure of drug
use and drug-related deaths.
(5) The formula methodology under paragraph (4) shall be
submitted to the Committees on Appropriations of the House of
Representatives and the Committee on Appropriations of the
Senate not less than 15 days prior to publishing a Funding
Opportunity Announcement.
(6) The prevention and treatment activities funded through
grants under this section may include education, treatment
(including the provision of medication), behavioral health
services for individuals in treatment programs, referral to
treatment services, recovery support, and medical screening
associated with such treatment.
(7) Each State, including the District of Columbia, shall
receive not less than $4,000,000 under grants under this
section.
(8) In addition to amounts appropriated under this section
(and the amendment made by this section), the following amounts
shall be available under section 241 of the Public Health
Service Act (42 U.S.C. 238j):
(A) $79,200,000 to carry out subpart II of part B
of title XIX of the Public Health Service Act to fund
section 1935(b) (42 U.S.C. 300x-35) (relating to
technical assistance, national data, data collection
and evaluation activities) and the total available
under this Act for activities under such section
1935(b) shall not exceed 5 percent of the amounts
appropriated for such subpart II of part B of title
XIX.
(B) $2,000,000 to evaluate substance abuse
treatment programs.
(9) None of the funds provided for under section 1921 of
the Public Health Service Act (42 U.S.C. 300x-21) or State
Opioid Response Grants under this section shall be subject to
section 241 of such Act (42 U.S.C. 238j).
SEC. 6. ELIMINATING INSURANCE BARRIERS TO MEDICATION-ASSISTED
TREATMENT.
(a) Limitation on Use of Utilization Control Policies or Procedures
for Medication-Assisted Treatments.--Subpart II of part A of title
XXVII of the Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is
amended by adding at the end the following:
``SEC. 2729A. ELIMINATING BARRIERS TO MEDICATION-ASSISTED TREATMENT.
``A group health plan (other than a self-insured plan) or a health
insurance issuer offering group or individual health insurance coverage
shall not impose any utilization control policies or procedures (as
defined by the Secretary), including prior authorization requirements,
with respect to medication-assisted treatment covered under the plan or
coverage.''.
(b) No Prior Authorization or Other Utilization Restrictions Under
Medicaid.--
(1) Prohibition.--Section 1903(i) of the Social Security
Act (42 U.S.C. 1396b(i)) is amended by inserting after
paragraph (8), the following:
``(9) with respect to any amount expended for medical
assistance for medication-assisted treatment (as defined in
section 1905(ee)) if the State imposes any utilization control
policies or procedures (as defined by the Secretary), including
any prior authorization requirements, with respect to the
provision of such assistance; or''.
(2) Conforming amendment.--Section 1905(a)(29) of the
Social Security Act (42 U.S.C. 1396d(a)(29)) is amended by
inserting ``and section 1903(i)(9)'' after ``subsection (ee)''.
(3) Effective date.--The amendments made by this subsection
take effect on October 1, 2019.
SEC. 7. LIMITATIONS ON COST-SHARING FOR OPIOID OVERDOSE REVERSAL
MEDICATIONS.
(a) Limitations on Cost-Sharing.--Subpart II of part A of title
XXVII of the Public Health Service Act (42 U.S.C. 300gg-11 et seq.), as
amended by section 6, is further amended by adding at the end the
following:
``SEC. 2729B. LIMITATIONS ON COST-SHARING FOR OPIOID OVERDOSE REVERSAL
MEDICATIONS.
``(a) In General.--A group health plan (other than a self-insured
plan) or a health insurance issuer offering group or individual health
insurance coverage shall not impose any cost-sharing requirement under
the plan or coverage with respect to at least one brand or generic
version of opioid overdose reversal drug.
``(b) Definition.--In this section, the term `opioid overdose
reversal drug' means a drug or biological approved by the Food and Drug
Administration for--
``(1) complete or partial reversal of opioid depression,
including respiratory depression, induced by opioids; or
``(2) emergency treatment of a known or suspected opioid
overdose, as manifested by respiratory or central nervous
system depression.''.
(b) Limitations on Cost-Sharing Under Medicare Part D.--
(1) In general.--Section 1860D-2(b) of the Social Security
Act (42 U.S.C. 1395w-102(b)) is amended--
(A) in paragraph (1)(A), by striking ``The
coverage'' and inserting ``Subject to paragraph (8),
the coverage'';
(B) in paragraph (2)(A), by striking ``and (D)''
and inserting ``and (D) and paragraph (8)'';
(C) in paragraph (3)(A), by striking ``and (4)''
and inserting ``(4), and (8)'';
(D) in paragraph (4)(A)(i), by striking ``The
coverage'' and inserting ``Subject to paragraph (8),
the coverage''; and
(E) by adding at the end the following new
paragraph:
``(8) Limitations on cost-sharing for opioid overdose
reversal drugs.--
``(A) In general.--For plan year 2021 and each
subsequent plan year, each prescription drug plan and
MA-PD plan shall not impose any cost-sharing
requirement under the plan with respect to at least one
brand or generic version of an opioid overdose reversal
drug (as defined in section 2729B of the Public Health
Service Act). The requirement under the preceding
sentence shall also apply to cost-sharing applicable to
subsidy eligible individuals under section 1814D-14.
``(B) Cost-sharing.--For purposes of subparagraph
(A), the elimination of cost-sharing shall include the
following:
``(i) No application of deductible.--The
waiver of the deductible under paragraph (1).
``(ii) No application of coinsurance.--The
waiver of coinsurance under paragraph (2).
``(iii) No application of initial coverage
limit.--The initial coverage limit under
paragraph (3) shall not apply.
``(iv) No cost-sharing above annual out-of-
pocket threshold.--The waiver of cost-sharing
under paragraph (4).''.
(2) Conforming amendments to cost-sharing for low-income
individuals.--Section 1860D-14(a) of the Social Security Act
(42 U.S.C. 1395w-114(a)) is amended--
(A) in paragraph (1), in the matter preceding
subparagraph (A), by striking ``In the case'' and
inserting ``Subject to section 1860D-2(b)(8), in the
case''; and
(B) in paragraph (2), in the matter preceding
subparagraph (A), by striking ``In the case'' and
inserting ``Subject to section 1860D-2(b)(8), in the
case''.
SEC. 8. TARGETING HEALTH WORKFORCE LOAN REPAYMENT ASSISTANCE TO
HARDEST-HIT STATES.
(a) Loan Repayment Program for Substance Use Disorder Treatment
Workforce.--Section 781(j) of the Public Health Service Act (42 U.S.C.
295h(j)) is amended to read as follows:
``(j) Appropriations.--
``(1) In general.--To carry out this section (other than
paragraph (2)), there is authorized to be appropriated, and
there is appropriated, out of any monies in the Treasury not
otherwise appropriated, $25,000,000 for each of fiscal years
2020 through 2023.
``(2) States with highest drug overdose death rates.--
``(A) In general.--To carry out the program under
this section with respect to individuals who agree to
provide obligated service in States described in
subparagraph (B), there is authorized to be
appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated,
$25,000,000 for each of fiscal years 2020 through 2024.
``(B) States described.--A State described in this
subparagraph is a State that is in the top quintile of
all States in terms of the highest mean drug overdose
death rate per 100,000 residents for the 3-year period
immediately preceding the year for which the
determination is being made, as determined by the
Secretary.
``(C) Application of section.--Except as provided
in this paragraph, the requirements of this section
otherwise applicable to individuals under this section
shall apply to individuals receiving assistance under
this paragraph.''.
(b) Training Demonstration Program.--Section 760(g) of the Public
Health Service Act (42 U.S.C. 294k(g)) is amended to read as follows:
``(g) Appropriations.--
``(1) In general.--To carry out this section (other than
paragraph (2)), there is authorized to be appropriated, and
there is appropriated, out of any monies in the Treasury not
otherwise appropriated, $10,000,000 for each of fiscal years
2020 through 2024.
``(2) States with highest drug overdose death rates.--
``(A) In general.--To carry out the program under
this section with respect to grantees located in States
described in subparagraph (B), there is authorized to
be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated,
$20,000,000 for each of fiscal years 2020 through 2024.
``(B) States described.--A State described in this
subparagraph is a State that is in the top quintile of
all States in terms of the highest mean drug overdose
death rate per 100,000 residents for the 3-year period
immediately preceding the year for which the
determination is being made, as determined by the
Secretary.
``(C) Application of section.--Except as provided
in this paragraph, the requirements of this section
otherwise applicable to grantees under this section
shall apply to grantees receiving assistance under this
paragraph.''.
SEC. 9. MEDICAID PAYMENTS FOR BEHAVIORAL HEALTH AND MENTAL HEALTH
PROVIDERS.
(a) In General.--
(1) Fee-for-service.--Section 1902 of the Social Security
Act (42 U.S.C. 1396a) is amended--
(A) in subsection (a)(13)--
(i) by striking ``and'' at the end of
subparagraph (B);
(ii) by adding ``and'' at the end of
subparagraph (C); and
(iii) by adding at the end the following
new subparagraph:
``(D) payment for mental health and behavioral
health services (as defined in subsection (qq)(1))
furnished on or after October 1, 2019, and before
October 1, 2024, by a physician or applicable
professional (as defined in subsection (qq)(2)) at a
rate not less than 100 percent of the payment rate that
applies to such services and physician or applicable
professional under part B of title XVIII (or, if
greater, the payment rate that would be applicable
under such part if the conversion factor under section
1848(d) for the year involved were the conversion
factor under such section for 2019, and, if such
services are not covered under such part, the
reasonable and customary rate the Secretary determines
would apply to such services and physician or
applicable professional);''; and
(B) by adding at the end the following new
subsection:
``(qq) Mental Health and Behavioral Health Services.--For purposes
of subsection (a)(13)(D):
``(1) Mental health and behavioral health services.--
``(A) In general.--The term `mental health and
behavioral health services' means the following
services, when provided to a patient with a diagnosis
of substance use disorder (as defined in subparagraph
(B)) as a part of the management or treatment of the
patient's substance use disorder (as determined in
accordance with regulations promulgated by the
Secretary under subparagraph (C)):
``(i) Evaluation and management services
that are procedure codes (for services covered
under title XVIII) for services in the category
designated Evaluation and Management in the
Healthcare Common Procedure Coding System
(established by the Secretary under section
1848(c)(5) as of December 31, 2018, and as
subsequently modified).
``(ii) Counseling services, as defined by
the Secretary.
``(iii) Payment codes established by the
Secretary for opioid use disorder treatment
services under section 1866F.
``(iv) Any other services the Secretary
determines are necessary for the management or
treatment of a patient with a diagnosis of
substance use disorder.
``(B) Patient with a diagnosis of substance use
disorder.--For purposes of subparagraph (A), the term
`patient with a diagnosis of substance use disorder'
means an individual who has been diagnosed with 1 or
more diagnosis codes within the code set entitled the
`Mental health and behavioral disorders due to
psychoactive substance use' under the 10th revision of
the International Statistical Classification of
Diseases and Related Health Problems.
``(C) Regulations.--Not later than 90 days after
the enactment of this subsection, the Secretary shall
promulgate regulations regarding when services are
sufficiently related to part of the management or
treatment of a patient's substance use disorder.
``(2) Applicable professional.--The term `applicable
professional' means--
``(A) a clinical psychologist (as defined for
purposes of section 1861(ii));
``(B) a clinical social worker (as defined in
section 1861(hh)(1));
``(C) a medical professional approved to furnish
medication-assisted treatment under section 303(g)(2)
of the Controlled Substances Act; or
``(D) a medical professional that is authorized
under the State plan to furnish mental and behavioral
health services (as defined in paragraph (1)).''.
(2) Managed care.--Section 1932(f) of such Act (42 U.S.C.
1396u-2(f)) is amended--
(A) in the subsection heading, by inserting ``and
Mental Health and Behavioral Health Services'' after
``Care Services''; and
(B) by inserting before the period at the end the
following: ``, and, in the case of mental health and
behavioral health services described in section
1902(a)(13)(D), consistent with the minimum payment
rates specified in such section (regardless of the
manner in which such payments are made, including in
the form of capitation or partial capitation)''.
(b) Increased FMAP for Additional Costs.--
(1) In general.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d) is amended by adding at the end the following
new subsection:
``(ff) Increased FMAP for Additional Expenditures for Mental Health
and Behavioral Health Services.--Notwithstanding subsection (b), with
respect to the portion of the amounts expended for medical assistance
for services described in section 1902(a)(13)(D) furnished on or after
October 1, 2019, and before October 1, 2024, that is attributable to
the amount by which the minimum payment rate required under such
section (or, by application, section 1932(f)) exceeds the payment rate
applicable to such services under the State plan or a waiver of such
plan as of July 1, 2019, the Federal medical assistance percentage for
a State shall be equal to 100 percent. The preceding sentence shall not
be construed as prohibiting the payment of Federal financial
participation based on the Federal medical assistance percentage for
the portion of the amounts expended for medical assistance for such
services that is attributable to the amount (if any) by which the
payment rate applicable to such services under the State plan or waiver
exceeds such minimum payment rate.''.
(2) Disregard of limits on payments to territories.--
Section 1108(g)(4) of the Social Security Act (42 U.S.C.
1308(g)(4)) is amended--
(A) by striking ``With respect to fiscal years
beginning with fiscal year 2009,'' and inserting the
following:
``(A) In general.--With respect to fiscal years
beginning with fiscal year 2009,''; and
(B) by adding at the end the following:
``(B) Other expenditures.--The amounts received by
a commonwealth or territory for a calendar quarter of a
fiscal year that are attributable to the application of
section 1905(ff), shall not be taken into account in
applying subsection (f) (as increased in accordance
with paragraphs (1), (2), (3), and (5) of this
subsection) to such commonwealth or territory for such
fiscal year.''.
SEC. 10. EXTENSION OF MEDICAID DELIVERY SYSTEM REFORM AND INCENTIVE
PAYMENT WAIVERS.
(a) Extension of Waivers.--In the case of a Medicaid section 1115
waiver described in subsection (b), not later than 60 days after the
date of enactment of this Act, the Secretary of Health and Human
Services shall--
(1) extend the termination date for the waiver to December
31, 2025 (or such earlier date as the State conducting the
waiver may elect);
(2) apply the same annual dollar allotment for the period
for which the waiver is extended under paragraph (1) as the
annual dollar allotment that applied to the waiver period in
effect on the date of enactment of this Act; and
(3) allow any State with such a waiver to use funds
provided during the period for which the waiver is extended
under paragraph (1) to support the training of direct service
workers that provide home and community-based services.
(b) Medicaid Section 1115 Waiver Described.--The Medicaid section
1115 waiver described in this subsection is a waiver approved under
section 1115 of the Social Security Act (42 U.S.C. 1315) relating to
delivery system reform incentive payments that--
(1) as of the date of enactment of this Act, is to
terminate on or before December 31, 2020;
(2) is in effect on the date of enactment of this Act; and
(3) was approved for any State that ranks in the top
quintile of all States in terms of the highest mean drug
overdose death rate per 100,000 residents for the most recent
3-year period preceding the date of enactment of this Act for
which data is available.
SEC. 11. SEPARATE AMBULATORY PAYMENT CLASSIFICATIONS (APC) CODES UNDER
THE MEDICARE HOSPITAL OUTPATIENT DEPARTMENT PROSPECTIVE
PAYMENT SYSTEM AND THE MEDICARE AMBULATORY SURGICAL
CENTER PAYMENT SYSTEM FOR SURGERIES UTILIZING NON-OPIOID
PAIN MANAGEMENT DRUGS.
(a) Hospital Outpatient Department Prospective Payment System.--
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is
amended--
(1) in paragraph (2)(A), by striking ``the Secretary'' and
inserting ``subject to paragraph (23), the Secretary''; and
(2) by adding at the end the following new paragraph:
``(23) Separate apcs for surgeries using non-opioid pain
management drugs.--
``(A) In general.--In the case of covered OPD
services furnished on or after January 1, 2021, the
classification system developed under paragraph (2)(A)
shall provide for separate ambulatory payment
classification codes for--
``(i) surgeries that utilize non-opioid
drugs, including such drugs delivered using an
external infusion pump and the delivery
mechanisms necessary for the delivery of such
drugs, to treat pain after the surgery; and
``(ii) surgeries that utilize opioid drugs
to treat pain after the surgery.
``(B) Application.--For purposes of this paragraph,
the Secretary shall--
``(i) treat any drug with a Food and Drug
Administration indication for pain management
during and after surgery that is also non-
opioid as a `non-opioid drug'; and
``(ii) establish a clear definition for
non-opioid pain management drugs that do not
have a Food and Drug Administration indication
for pain management during or after the
surgery.''.
(b) Ambulatory Surgical Center Payment System.--Section
1833(i)(2)(D) of the Social Security Act (42 U.S.C. 1395l(i)(2)(D)) is
amended--
(1) by aligning the margins of clause (v) with the margins
of clause (iv);
(2) by redesignating clause (vi) as clause (vii); and
(3) by inserting after clause (v) the following new clause:
``(vi) In the case of surgical services furnished on or after
January 1, 2021, the payment system described in clause (i) shall
provide for separate ambulatory payment classification codes for--
``(I) consistent with subsection (t)(23), surgeries that
utilize non-opioid drugs, including such drugs delivered using
an external infusion pump and the delivery mechanisms necessary
for the delivery of such drugs, to treat pain after the
surgery; and
``(II) surgeries that utilize opioid drugs to treat pain
after the surgery.''.
SEC. 12. ADVERSE CHILDHOOD EXPERIENCES RESPONSE TEAM GRANT PROGRAM.
Title I of the Omnibus Crime Control and Safe Streets Act of 1968
(34 U.S.C. 10101 et seq.) is amended by adding at the end the
following:
``PART OO--ADVERSE CHILDHOOD EXPERIENCES RESPONSE TEAM GRANT PROGRAM
``SEC. 3051. GRANTS FOR ADVERSE CHILDHOOD EXPERIENCES RESPONSE TEAMS.
``(a) Grants Authorized.--From amounts made available to carry out
this section, the Attorney General, in coordination with the Secretary
of Health and Human Services, shall make grants to States, units of
local government, Indian Tribes, and neighborhood or community-based
organizations to address adverse childhood experiences associated with
exposure to trauma.
``(b) Use of Funds.--Amounts received under a grant under this
section may be used to establish an adverse childhood experiences
response team, including by--
``(1) establishing protocols to follow when encountering a
child or youth exposed to trauma to facilitate access to
services;
``(2) developing referral partnership agreements with
behavioral health providers, substance treatment facilities,
and recovery services for family members of children exposed to
trauma;
``(3) integrating law enforcement, mental health, and
crisis services to respond to situations where children have
been exposed to trauma;
``(4) implementing comprehensive, evidence-based programs
and practices to support children exposed to trauma;
``(5) identifying barriers for children to access trauma-
informed care in their communities;
``(6) providing training in trauma-informed care to
emergency response providers, victim service providers, child
protective service professionals, educational institutions, and
other community partners; and
``(7) supporting cross-system planning and collaboration
among officers and employees who work in law enforcement, court
systems, child welfare services, correctional reentry programs,
emergency medical services, health care services, public
health, and substance abuse treatment and recovery support.
``(c) Application.--A State, unit of local government, Indian
Tribe, or neighborhood or community-based organization desiring a grant
under this section shall submit to the Attorney General an application
in such form, and containing such information, as the Attorney General
may reasonably require.
``(d) Funding.--To carry out this section, there is authorized to
be appropriated, and there is appropriated, out of any monies in the
Treasury not otherwise appropriated, $20,000,000 for each of fiscal
years 2020 through 2023.''.
SEC. 13. EXPANDING DRUG FREE COMMUNITIES SUPPORT GRANTS.
Section 1032 of the Anti-Drug Abuse Act of 1988 (21 U.S.C. 1532) is
amended--
(1) in subsection (b)--
(A) in paragraph (3)--
(i) in subparagraph (A), by striking
``subparagraph (F)'' and inserting
``subparagraph (H)'';
(ii) by redesignating subparagraphs (D),
(E), and (F) as subparagraphs (F), (G), and
(H), respectively;
(iii) by inserting after subparagraph (C)
the following:
``(D) Subsequent additional grants.--Subject to
subparagraph (H), the Administrator may award a
subsequent additional grant to a grant recipient under
subparagraph (A), for each fiscal year during the 4-
fiscal-year period following the fiscal year for which
the initial additional grant under subparagraph (A) is
awarded, in an amount not to exceed the amount of non-
Federal funds, including in-kind contributions, raised
by the grant recipient for the fiscal year for which
the subsequent additional grant is awarded.
``(E) Renewal grants.--Subject to subparagraph (H),
the Administrator may award a renewal grant to a grant
recipient under subparagraph (D), for the first fiscal
year following the 4-fiscal-year period for which the
subsequent additional grant under subparagraph (D) is
awarded, in an amount not to exceed the amount of non-
Federal funds, including in-kind contributions, raised
by the grant recipient for the fiscal year for which
the renewal grant is awarded.''; and
(iv) in subparagraph (F), as so
redesignated--
(I) in the subparagraph heading, by
striking ``renewal'' and inserting
``subsequent renewal''; and
(II) in the matter preceding clause
(i)--
(aa) by striking
``subparagraph (F)'' and
inserting ``subparagraph (H)'';
(bb) by striking ``renewal
grant to a grant recipient
under this paragraph'' and
inserting ``subsequent renewal
grant to a grant recipient
under subparagraph (E)''; and
(cc) by striking ``initial
additional grant under
subparagraph (A)'' and
inserting ``renewal grant under
subparagraph (E)''; and
(B) in paragraph (4), by striking ``(3)(E)'' and
inserting ``(3)(G)'';
(2) in subsection (d)--
(A) by striking ``In awarding'' and inserting the
following:
``(1) Priority for economically disadvantaged areas.--In
awarding''; and
(B) by adding at the end the following:
``(2) Priority for states demonstrating high mortality
rates relating to opioid use disorder.--
``(A) Grants to more than 1 eligible coalition
representing a community.--In awarding grants under
subsection (b)(1)(B)(ii), the Administrator shall give
priority to eligible coalitions that serve 1 or more
communities in a State that has a high mortality rate
relating to opioid use disorder.
``(B) Subsequent additional grants.--In awarding
subsequent additional grants under subsection
(b)(3)(D), the Administrator shall give priority to an
eligible coalition that serves 1 or more communities in
a State that has a high mortality rate relating to
opioid use disorder.''; and
(3) by adding at the end the following:
``(e) Limitation on Subsequent Renewal Grants.--A recipient of a
subsequent renewal grant awarded under subsection (b)(3)(F) may not be
awarded any further grant under this section.''.
SEC. 14. SUPPORT FOR LAW ENFORCEMENT MENTAL HEALTH AND WELLNESS.
There is authorized to be appropriated, and there is appropriated,
out of any monies in the Treasury not otherwise appropriated,
$10,000,000 for each of fiscal years 2020 through 2023 for grants under
section 1701(b)(23) of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (34 U.S.C. 10381(b)(23)) to establish peer
mentoring mental health and wellness pilot programs within State,
tribal, and local law enforcement agencies.
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