[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4531 Engrossed in House (EH)]

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118th CONGRESS
  1st Session
                                H. R. 4531

_______________________________________________________________________

                                 AN ACT


 
 To reauthorize certain programs that provide for opioid use disorder 
      prevention, recovery, and treatment, and for other purposes.

    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 ``Support for Patients and Communities 
Reauthorization Act''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
                         TITLE I--PUBLIC HEALTH

Sec. 101. Prenatal and postnatal health.
Sec. 102. Monitoring and education regarding infections associated with 
                            illicit drug use and other risk factors.
Sec. 103. Preventing overdoses of controlled substances.
Sec. 104. Residential treatment programs for pregnant and postpartum 
                            women.
Sec. 105. Youth prevention and recovery.
Sec. 106. First responder training.
Sec. 107. Building communities of recovery.
Sec. 108. National Peer-Run Training and Technical Assistance Center 
                            for Addiction Recovery Support.
Sec. 109. Comprehensive opioid recovery centers.
Sec. 110. Grants to address the problems of persons who experience 
                            violence related stress.
Sec. 111. Mental and behavioral health education and training grants.
Sec. 112. Loan repayment program for the substance use disorder 
                            treatment workforce.
Sec. 113. Pilot program for public health laboratories to detect 
                            fentanyl and other synthetic opioids.
Sec. 114. Monitoring and reporting of child, youth, and adult trauma.
Sec. 115. Task force to develop best practices for trauma-informed 
                            identification, referral, and support.
Sec. 116. Treatment, recovery, and workforce support grants.
Sec. 117. Grant program for State and Tribal response to opioid use 
                            disorders.
Sec. 118. References to opioid overdose reversal agents in HHS grant 
                            programs.
Sec. 119. Addressing other concurrent substance use disorders through 
                            grant program for State and Tribal response 
                            to opioid use disorders.
Sec. 120. Providing for a study on the effects of remote monitoring on 
                            individuals who are prescribed opioids.
                    TITLE II--CONTROLLED SUBSTANCES

Sec. 201. Delivery of certain substances by a pharmacy to an 
                            administering practitioner.
Sec. 202. Reviewing the scheduling of approved products containing a 
                            combination of buprenorphine and naloxone.
Sec. 203. Combating illicit xylazine.
Sec. 204. Technical corrections.
Sec. 205. Required training for prescribers of controlled substances.
                          TITLE III--MEDICAID

Sec. 301. Extending requirement for State Medicaid plans to provide 
                            coverage for medication-assisted treatment.
Sec. 302. Expanding required reports on T-MSIS substance use disorder 
                            data to include mental health condition 
                            data.
Sec. 303. Monitoring prescribing of antipsychotic medications.
Sec. 304. Lifting the IMD exclusion for substance use disorder.
Sec. 305. Prohibition on termination of enrollment due to 
                            incarceration.
Sec. 306. State option relating to inmates who are pregnant women 
                            pending disposition of charges.
Sec. 307. Permitting access to medical assistance under the Medicaid 
                            program for foster youth.
                           TITLE IV--OFFSETS

Sec. 401. Promoting value in Medicaid managed care.

                         TITLE I--PUBLIC HEALTH

SEC. 101. PRENATAL AND POSTNATAL HEALTH.

    Section 317L(d) of the Public Health Service Act (42 U.S.C. 247b-
13(d)) is amended by striking ``such sums as may be necessary for each 
of the fiscal years 2019 through 2023'' and inserting ``$4,250,000 for 
each of fiscal years 2024 through 2028''.

SEC. 102. MONITORING AND EDUCATION REGARDING INFECTIONS ASSOCIATED WITH 
              ILLICIT DRUG USE AND OTHER RISK FACTORS.

    Section 317N of the Public Health Service Act (42 U.S.C. 247b-15) 
is amended--
            (1) in the section heading, by striking ``surveillance 
        and'' and inserting ``monitoring and'' ; and
            (2) in subsection (d), by striking ``fiscal years 2019 
        through 2023'' and inserting ``fiscal years 2024 through 
        2028''.

SEC. 103. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

    (a) Evidence-based Prevention Grants.--Section 392A(a)(2)(D) of the 
Public Health Service Act (42 U.S.C. 280b-1(a)(2)(D)) is amended by 
inserting after ``new and emerging public health crises'' the 
following: ``, such as the fentanyl crisis,''.
    (b) Use of Grants by States, Localities, and Indian Tribes to 
Conduct Wastewater Surveillance.--Section 392A(a)(3)(A) of the Public 
Health Service Act (42 U.S.C. 280b-1(a)(3)(A)) is amended by inserting 
``, including through the use of wastewater surveillance to identify 
trends associated with controlled substance use if it is determined by 
appropriate evidence that wastewater surveillance is an effective way 
to survey controlled substance use within a community'' before the 
semicolon.
    (c) Authorization of Appropriations.--Section 392A(e) of the Public 
Health Service Act (42 U.S.C. 280b-1(e)) is amended by striking 
``$496,000,000 for each of fiscal years 2019 through 2023'' and 
inserting ``$505,579,000 for each of fiscal years 2024 through 2028''.

SEC. 104. 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 ``$29,931,000 for each of fiscal years 
2019 through 2023'' and inserting ``$38,931,000 for each of fiscal 
years 2024 through 2028''.

SEC. 105. YOUTH PREVENTION AND RECOVERY.

    Section 7102(c)(9) of the SUPPORT for Patients and Communities Act 
(42 U.S.C. 290bb-7a(c)(9)) is amended by striking ``fiscal years 2019 
through 2023'' and inserting ``fiscal years 2024 through 2028''.

SEC. 106. FIRST RESPONDER TRAINING.

    Section 546(h) of the Public Health Service Act (42 U.S.C. 290ee-
1(h)) is amending by striking ``$36,000,000 for each of fiscal years 
2019 through 2023'' and inserting ``$56,000,000 for each of fiscal 
years 2024 through 2028''.

SEC. 107. BUILDING COMMUNITIES OF RECOVERY.

    Section 547(f) of the Public Health Service Act (42 U.S.C. 290ee-
2(f)) is amended by striking ``$5,000,000 for each of fiscal years 2019 
through 2023'' and inserting ``$16,000,000 for each of fiscal years 
2024 through 2028''.

SEC. 108. NATIONAL PEER-RUN TRAINING AND TECHNICAL ASSISTANCE CENTER 
              FOR ADDICTION RECOVERY SUPPORT.

    Section 547A(e) of the Public Health Service Act (42 U.S.C. 290ee-
2a(e)) is amended by striking ``$1,000,000 for each of fiscal years 
2019 through 2023'' and inserting ``$2,000,000 for each of fiscal years 
2024 through 2028''.

SEC. 109. COMPREHENSIVE OPIOID RECOVERY CENTERS.

    (a) Reauthorization.--Section 552(j) of the Public Health Service 
Act (42 U.S.C. 290ee-7(j)) is amended by striking ``2019 through 2023'' 
and inserting ``2024 through 2028''.
    (b) Documentation for Evidence of Capacity To Carry Out Required 
Activities.--Section 552(d) of the Public Health Service Act (42 U.S.C. 
290ee-7(d)) is amended by adding at the end the following:
            ``(3) Documentation.--
                    ``(A) In general.--Evidence required to be provided 
                under paragraph (1) may be provided through a letter of 
                intent from partner agencies or other relevant 
                documentation (as defined by the Secretary).
                    ``(B) Partner agency defined.--In this paragraph, 
                the term `partner agency' means a non-governmental 
                organization or other public or private entity--
                            ``(i) the primary purpose of which is the 
                        delivery of mental health or substance use 
                        disorder treatment services; and
                            ``(ii) with which the applicant coordinates 
                        to provide the full continuum of treatment 
                        services (as specified in subsection (g)(1)(B)) 
                        that the applicant is unable to offer on 
                        site.''.
    (c) Center Activities Carried Out Through Third Parties.--Section 
552(g) of the Public Health Service Act (42 U.S.C. 290ee-7(g)) is 
amended in the matter preceding paragraph (1) by striking ``Each Center 
shall'' and all that follows through ``subsection (f):'' and inserting 
the following: ``Each Center shall, at a minimum, carry out the 
activities specified in this subsection directly, through referral, or 
through contractual arrangements. If a Center elects to carry out such 
activities through contractual arrangements, the Secretary may issue 
guidance on best practices to ensure that the Center is capable of 
carrying out such activities, including carrying out such activities 
through technology-enabled collaborative learning and capacity building 
models described in subsection (f) and coordinating the full continuum 
of treatment services specified in subparagraph (B). Such activities 
include the following:''.

SEC. 110. GRANTS TO ADDRESS THE PROBLEMS OF PERSONS WHO EXPERIENCE 
              VIOLENCE RELATED STRESS.

    Section 582(j) of the Public Health Service Act (42 U.S.C. 290hh-
1(j)) is amended by striking ``$63,887,000 for each of fiscal years 
2019 through 2023'' and inserting ``$93,887,000 for each of fiscal 
years 2024 through 2028''.

SEC. 111. 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 by striking ``fiscal years 2023 through 2027'' and 
inserting ``fiscal years 2024 through 2028''.

SEC. 112. LOAN REPAYMENT PROGRAM FOR THE SUBSTANCE USE DISORDER 
              TREATMENT WORKFORCE.

    Section 781(j) of the Public Health Service Act (42 U.S.C. 295h(j)) 
is amended by striking ``$25,000,000 for each of fiscal years 2019 
through 2023'' and inserting ``$40,000,000 for each of fiscal years 
2024 through 2028''.

SEC. 113. PILOT PROGRAM FOR PUBLIC HEALTH LABORATORIES TO DETECT 
              FENTANYL AND OTHER SYNTHETIC OPIOIDS.

    (a) Detection Activities.--Section 7011(b) of the SUPPORT for 
Patients and Communities Act (42 U.S.C. 247d-10 note) is amended--
            (1) in paragraph (2), by striking ``and'' at the end;
            (2) in paragraph (3), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following:
            ``(4) public, private, and academic entities with expertise 
        in detection and testing activities, such as wastewater 
        surveillance, with respect to synthetic opioids, including 
        fentanyl and its analogues.''.
    (b) Authorization of Appropriations.--Section 7011(d) of the 
SUPPORT for Patients and Communities Act (42 U.S.C. 247d-10(d)) is 
amended by striking ``fiscal years 2019 through 2023'' and inserting 
``fiscal years 2024 through 2028''.

SEC. 114. MONITORING AND REPORTING OF CHILD, YOUTH, AND ADULT TRAUMA.

    Section 7131(e) of the SUPPORT for Patients and Communities Act (42 
U.S.C. 242t(e)) is amended by striking ``$2,000,000 for each of fiscal 
years 2019 through 2023'' and inserting ``$9,000,000 for each of fiscal 
years 2024 through 2028''.

SEC. 115. TASK FORCE TO DEVELOP BEST PRACTICES FOR TRAUMA-INFORMED 
              IDENTIFICATION, REFERRAL, AND SUPPORT.

    Section 7132 of the SUPPORT for Patients and Communities Act 
(Public Law 115-271) is amended--
            (1) in subsection (g)--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(3) additional reports and updates to existing reports, 
        as necessary.''; and
            (2) by amending subsection (i) to read as follows:
    ``(i) Sunset.--The task force shall sunset on September 30, 
2026.''.

SEC. 116. TREATMENT, RECOVERY, AND WORKFORCE SUPPORT GRANTS.

    Section 7183 of the SUPPORT for Patients and Communities Act (42 
U.S.C. 290ee-8) is amended--
            (1) in subsection (b), by inserting ``each'' before ``for a 
        period'';
            (2) by amending subsection (c)(2) to read as follows:
            ``(2) Rates.--The rates described in this paragraph are the 
        following:
                    ``(A) The amount by which the average rate of drug 
                overdose deaths in the State, adjusted for age, for the 
                period of 5 calendar years for which there is available 
                data, including if necessary provisional data, 
                immediately preceding the grant cycle (which shall be 
                the period of calendar years 2018 through 2022 for the 
                first grant cycle following the enactment of the 
                Support for Patients and Communities Reauthorization 
                Act) is above the average national overdose mortality 
                rate, as determined by the Director of the Centers for 
                Disease Control and Prevention, for the same period.
                    ``(B) The amount by which the average rate of 
                unemployment for the State, based on data provided by 
                the Bureau of Labor Statistics, for the period of 5 
                calendar years for which there is available data, 
                including if necessary provisional data, immediately 
                preceding the grant cycle (which shall be the period of 
                calendar years 2018 through 2022 for the first grant 
                cycle following the enactment of the Support for 
                Patients and Communities Reauthorization Act) is above 
                the national average for the same period.
                    ``(C) The amount by which the average rate of labor 
                force participation in the State, based on data 
                provided by the Bureau of Labor Statistics, for the 
                period of 5 calendar years for which there is available 
                data, including if necessary provisional data, 
                immediately preceding the grant cycle (which shall be 
                the period of calendar years 2018 through 2022 for the 
                first grant cycle following the enactment of the 
                Support for Patients and Communities Reauthorization 
                Act) is below the national average for the same 
                period.'';
            (3) in subsection (g)--
                    (A) in paragraphs (1) and (3), by redesignating 
                subparagraphs (A) and (B) as clauses (i) and (ii), 
                respectively, and adjusting the margins accordingly;
                    (B) by redesignating paragraphs (1) through (3) as 
                subparagraphs (A) through (C), respectively, and 
                adjusting the margins accordingly;
                    (C) by striking ``An entity'' and inserting the 
                following:
            ``(1) In general.--An entity''; and
                    (D) by adding at the end the following:
            ``(2) Transportation services.--An entity receiving a grant 
        under this section may use not more than 5 percent of the funds 
        for providing transportation for individuals to participate in 
        an activity supported by a grant under this section, which 
        transportation shall be to or from a place of work or a place 
        where the individual is receiving vocational education or job 
        training services or receiving services directly linked to 
        treatment of or recovery from a substance use disorder.
            ``(3) No other authorized uses.--An entity receiving a 
        grant under this section may not use the funds for any activity 
        other than the activities listed in paragraphs (1) and (2).'';
            (4) in subsection (i)(2), by inserting ``, which shall 
        include the employment and earnings outcomes as described in 
        subclauses (I) and (III) of section 116(b)(2)(A)(i) of the 
        Workforce Innovation and Opportunity Act (29 U.S.C. 
        3141(b)(2)(A)(i))'' after ``subsection (g)'';
            (5) in subsection (j)--
                    (A) in paragraph (1), by inserting ``for each grant 
                cycle'' after ``grant period''; and
                    (B) in paragraph (2)--
                            (i) in the matter preceding subparagraph 
                        (A)--
                                    (I) by striking ``the preliminary 
                                report'' and inserting ``each 
                                preliminary report''; and
                                    (II) by inserting ``for the grant 
                                cycle'' after ``final report''; and
                            (ii) in subparagraph (A), by striking 
                        ``(g)(3)'' and inserting ``(g)(1)(C)''; and
            (6) in subsection (k), by striking ``$5,000,000 for each of 
        fiscal years 2019 through 2023'' and inserting ``$12,000,000 
        for each of fiscal years 2024 through 2028''.

SEC. 117. GRANT PROGRAM FOR STATE AND TRIBAL RESPONSE TO OPIOID USE 
              DISORDERS.

    Section 1003(b)(4)(A) of the 21st Century Cures Act (42 U.S.C. 
290ee-3a(b)(4)(A)) is amended after ``which may include drugs or 
devices approved, cleared, or otherwise legally marketed under the 
Federal Food, Drug, and Cosmetic Act'' by inserting ``or fentanyl or 
xylazine test strips''.

SEC. 118. REFERENCES TO OPIOID OVERDOSE REVERSAL AGENTS IN HHS GRANT 
              PROGRAMS.

    (a) In General.--The Secretary of Health and Human Services shall 
ensure that, as appropriate, whenever the Department of Health and 
Human Services issues a regulation or guidance for any grant program 
addressing opioid misuse and use disorders, any reference to an opioid 
overdose reversal drug (such as a reference to naloxone) is inclusive 
of any opioid overdose reversal drug that has been approved under 
section 505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355) 
for emergency treatment of a known or suspected opioid overdose.
    (b) Existing References.--
            (1) Update.--Not later than one year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall update all references described in paragraph (2) 
        to be inclusive of any opioid overdose reversal drug that has 
        been approved or otherwise authorized for use by the Food and 
        Drug Administration.
            (2) References.--A reference described in this paragraph is 
        any reference to an opioid overdose reversal drug (such as 
        naloxone) in any regulation or guidance of the Department of 
        Health and Human Services that--
                    (A) was issued before the date of enactment of this 
                Act; and
                    (B) is included in--
                            (i) the grant program for State and Tribal 
                        response to opioid use disorders under section 
                        1003 of the 21st Century Cures Act (42 U.S.C. 
                        290ee-3 note) (commonly referred to as ``State 
                        Opioid Response Grants'' and ``Tribal Opioid 
                        Response Grants''); or
                            (ii) the grant program for priority 
                        substance use disorder prevention needs of 
                        regional and national significance under 
                        section 516 of the Public Health Service Act 
                        (42 U.S.C. 290bb-22).

SEC. 119. ADDRESSING OTHER CONCURRENT SUBSTANCE USE DISORDERS THROUGH 
              GRANT PROGRAM FOR STATE AND TRIBAL RESPONSE TO OPIOID USE 
              DISORDERS.

    (a) Additional 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:
            ``(5) Other concurrent substance use disorders.--The 
        Secretary may authorize the recipient of a grant under this 
        subsection, in addition to using the grant for activities 
        described in paragraph (4) with respect to opioid misuse and 
        use disorders and stimulant misuse and use disorders, to use 
        the grant for similar activities with respect to other 
        concurrent substance use disorders.''.
    (b) Annual Report to Congress.--Section 1003(f) of the 21st Century 
Cures Act (42 U.S.C. 290ee-3 note) is amended--
            (1) in paragraph (2), strike ``and'' at the end;
            (2) in paragraph (3), strike the period at the end and 
        insert a semicolon; and
            (3) by adding at the end the following:
            ``(4) the amount of funds each State that received a grant 
        under subsection (b) received for the 12-month grant cycle 
        covered by the report;
            ``(5) the amount of grant funds each such State spent for 
        such grant cycle, disaggregated by the uses for which such 
        funds were spent, including each allowable use under paragraphs 
        (4) and (5) of subsection (b);
            ``(6) how many such States for such grant cycle did not 
        spend all of the grant funds before such grant cycle expired;
            ``(7) how many such States for such grant cycle requested 
        no-cost extensions to extend the grant cycle; and
            ``(8) challenges for such States to spend all of the funds 
        allocated and the reason for such challenges, including to what 
        extent reporting requirements or other requirements placed an 
        increased burden on the ability of such States to spend all of 
        the funds.''.
    (c) Other Concurrent Substance Use Disorders Defined.--Section 
1003(h) of the 21st Century Cures Act (42 U.S.C. 290ee-3 note) is 
amended--
            (1) by redesignating paragraphs (2) through (4) as 
        paragraphs (3) through (5); and
            (2) by inserting before paragraph (3), as redesignated, the 
        following:
            ``(2) Other concurrent substance use disorders.--The term 
        `other concurrent substance use disorders' means--
                    ``(A) alcohol use disorders co-occurring with 
                opioid misuse and use disorders as a primary disorder; 
                or
                    ``(B) alcohol use disorders co-occurring with 
                stimulant misuse and use disorders as a primary 
                disorder.''.
    (d) Rule of Construction.--Nothing in this Act or the amendments 
made by this Act shall be construed to change the allocation of funds 
among grantees pursuant to the minimum allocations and formula 
methodology under section 1003 of the 21st Century Cures Act (42 U.S.C. 
290ee-3 note).

SEC. 120. PROVIDING FOR A STUDY ON THE EFFECTS OF REMOTE MONITORING ON 
              INDIVIDUALS WHO ARE PRESCRIBED OPIOIDS.

    (a) In General.--Not later than 18 months after the date of 
enactment of this Act, the Comptroller General of the United States 
shall conduct a study and submit to the Committee on Energy and 
Commerce of the House of Representatives and the Committee on Health, 
Education, Labor, and Pensions and the Committee on Finance of the 
Senate a report on the use of remote monitoring with respect to 
individuals who are prescribed opioids.
    (b) Report.--The report described in subsection (a) shall include 
to the extent information is available and reliable--
            (1) an assessment of scientific evidence related to the 
        efficacy, individual outcomes, and potential cost savings 
        associated with remote monitoring for individuals who are 
        prescribed opioids compared to such individuals who are not so 
        monitored;
            (2) an assessment of the current prevalence of remote 
        monitoring for individuals who are prescribed opioids, 
        including the use of such monitoring for such individuals in 
        other countries; and
            (3) information, including recommendations as appropriate, 
        to improve availability, access, and coverage for remote 
        monitoring for individuals who are prescribed opioids, 
        including through changes to Federal health care programs (as 
        defined in section 1128B of the Social Security Act (42 U.S.C. 
        1320a-7b)).

                    TITLE II--CONTROLLED SUBSTANCES

SEC. 201. DELIVERY OF CERTAIN SUBSTANCES BY A PHARMACY TO AN 
              ADMINISTERING PRACTITIONER.

    Paragraph (2) of section 309A(a) of the Controlled Substances Act 
(21 U.S.C. 829a(a)) is amended to read as follows:
            ``(2) the controlled substance is a drug in schedule III, 
        IV, or V that is, pursuant to the approval or licensure of such 
        drug under the Federal Food, Drug, and Cosmetic Act or section 
        351 of the Public Health Service Act, to be administered by, or 
        under the supervision of, the prescribing practitioner;''.

SEC. 202. REVIEWING THE SCHEDULING OF APPROVED PRODUCTS CONTAINING A 
              COMBINATION OF BUPRENORPHINE AND NALOXONE.

    (a) Secretary of HHS.--The Secretary of Health and Human Services 
shall, consistent with the requirements and procedures set forth in 
sections 201 and 202 of the Controlled Substances Act (21 U.S.C. 811; 
812)--
            (1) review the relevant data pertaining to the scheduling 
        of products containing a combination of buprenorphine and 
        naloxone that have been approved under section 505 of the 
        Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355); and
            (2) if appropriate, request that the Attorney General 
        initiate rulemaking proceedings to revise the schedules 
        accordingly with respect to such products.
    (b) Attorney General.--The Attorney General shall review any 
request made by the Secretary of Health and Human Services under 
subsection (a)(2) and determine whether to initiate proceedings to 
revise the schedules in accordance with the criteria set forth in 
sections 201 and 202 of the Controlled Substances Act (21 U.S.C. 811; 
812).

SEC. 203. COMBATING ILLICIT XYLAZINE.

    (a) Definitions.--
            (1) In general.--In this section, the term ``xylazine'' has 
        the meaning given the term in paragraph (60) of section 102 of 
        the Controlled Substances Act, as added by paragraph (2).
            (2) Controlled substances act.--Section 102 of the 
        Controlled Substances Act (21 U.S.C. 802) is amended--
                    (A) by redesignating the second paragraph (57) 
                (relating to serious drug felony) and paragraph (58) as 
                paragraphs (58) and (59), respectively;
                    (B) by moving the margin of paragraph (57) 2 ems to 
                the left;
                    (C) by moving the margins of paragraphs (58) and 
                (59), as redesignated, 2 ems to the left; and
                    (D) by adding at the end the following:
    ``(60)(A) The term `xylazine' means the substance xylazine as well 
as its salts, isomers, and salts of isomers whenever the existence of 
such salts, isomers, and salts of isomers is possible.
    ``(B) Except as provided in subparagraph (E), such term does not 
include a substance described in subparagraph (A) to the extent--
            ``(i) such substance is an animal drug that has been 
        approved by the Secretary of Health and Human Services under 
        section 512 of the Federal Food, Drug, and Cosmetic Act and 
        such substance's use or intended use conforms to the approved 
        application, including the manufacturing, importation, holding, 
        or distribution for such use; or
            ``(ii) such substance is used or intended for use in 
        animals other than humans as permitted under section 512(a)(4) 
        of the Federal Food, Drug, and Cosmetic Act.
    ``(C) If any person prescribes, dispenses, distributes, 
manufactures, or imports xylazine for human use, such person shall be 
considered to have prescribed, dispensed, distributed, manufactured, or 
imported xylazine not subject to an exclusion under subparagraph 
(B).''.
    (b) Placement of Xylazine on Schedule III.--Schedule III in section 
202(c) of the Controlled Substances Act (21 U.S.C. 812(c)) is amended 
by adding at the end the following:
    ``(f) Xylazine.''.
    (c) ARCOS Tracking.--Section 307(i) of the Controlled Substances 
Act (21 U.S.C. 827(i)) is amended--
            (1) in the matter preceding paragraph (1)--
                    (A) by inserting ``or xylazine'' after ``gamma 
                hydroxybutyric acid'';
                    (B) by inserting ``or 512'' after ``section 505''; 
                and
                    (C) by inserting ``respectively,'' after ``the 
                Federal Food, Drug, and Cosmetic Act,''; and
            (2) in paragraph (6), by inserting ``or xylazine'' after 
        ``gamma hydroxybutyric acid''.
    (d) Report to Congress on Xylazine.--
            (1) Initial report.--Not later than 1 year after the date 
        of enactment of this Act, the Attorney General, acting through 
        the Administrator of the Drug Enforcement Administration and in 
        coordination with the Commissioner of Food and Drugs, shall 
        submit to Congress a report on the prevalence of illicit use of 
        xylazine in the United States and the impacts of such use, 
        including--
                    (A) where the drug is being diverted;
                    (B) where the drug is originating;
                    (C) whether any analogues to such drug present a 
                substantial risk of abuse;
                    (D) whether and to what extent the illicit supply 
                of xylazine derives from the licit supply chain; and
                    (E) recommendations for Congress with respect to 
                whether xylazine should be transferred to another 
                schedule under section 202 of the Controlled Substances 
                Act (21 U.S.C. 812).
            (2) Additional report.--Not later than 3 years after the 
        date of enactment of this Act, the Attorney General, acting 
        through the Administrator of the Drug Enforcement 
        Administration and in coordination with the Commissioner of 
        Food and Drugs, shall submit to Congress a report updating 
        Congress on the prevalence of xylazine trafficking, misuse, and 
        proliferation in the United States, including--
                    (A) the status and results of research on the 
                impact xylazine has on human health; and
                    (B) the effects of the classification of xylazine 
                under the Controlled Substances Act (21 U.S.C. 801 et 
                seq.) on the prevalence of xylazine trafficking, 
                misuse, and proliferation in the United States.
            (3) Obtaining official data.--The Attorney General, acting 
        through the Administrator of the Drug Enforcement 
        Administration and in coordination with the Commissioner of 
        Food and Drugs, may secure directly from any department or 
        agency of the United States documents, statistical data, and 
        other information necessary to carry out paragraphs (1) and 
        (2). Upon receipt of a request from the Attorney General for 
        such documents, data, and information, the head of the 
        department or agency shall, in accordance with applicable 
        procedures for the appropriate handling of classified 
        information, promptly provide reasonable access to such 
        documents, data, and information.
            (4) Views of experts from non-federal entities.--In 
        developing the reports under paragraphs (1) and (2), the 
        Attorney General, acting through the Administrator of the Drug 
        Enforcement Administration and in coordination with the 
        Commissioner of Food and Drugs, shall consult with, and take 
        into consideration the views of, experts from appropriate non-
        Federal entities, including such experts from--
                    (A) the scientific and medical research community;
                    (B) the State and local law enforcement community; 
                and
                    (C) community-based organizations.

SEC. 204. TECHNICAL CORRECTIONS.

    Effective as if included in the enactment of Public Law 117-328--
            (1) section 1252(a) of division FF of Public Law 117-328 is 
        amended, in the matter being inserted into section 302(e) of 
        the Controlled Substances Act, by striking ``303(g)'' and 
        inserting ``303(h)'';
            (2) section 1262 of division FF of Public Law 117-328 is 
        amended--
                    (A) in subsection (a)--
                            (i) in the matter preceding paragraph (1), 
                        by striking ``303(g)'' and inserting 
                        ``303(h)'';
                            (ii) in the matter being stricken by 
                        subsection (a)(2), by striking ``(g)(1)'' and 
                        inserting ``(h)(1)''; and
                            (iii) in the matter being inserted by 
                        subsection (a)(2), by striking ``(g) 
                        Practitioners'' and inserting ``(h) 
                        Practitioners''; and
                    (B) in subsection (b)--
                            (i) in the matter being stricken by 
                        paragraph (1), by striking ``303(g)(1)'' and 
                        inserting ``303(h)(1)'';
                            (ii) in the matter being inserted by 
                        paragraph (1), by striking ``303(g)'' and 
                        inserting ``303(h)'';
                            (iii) in the matter being stricken by 
                        paragraph (2)(A), by striking ``303(g)(2)'' and 
                        inserting ``303(h)(2)'';
                            (iv) in the matter being stricken by 
                        paragraph (3), by striking ``303(g)(2)(B)'' and 
                        inserting ``303(h)(2)(B)'';
                            (v) in the matter being stricken by 
                        paragraph (5), by striking ``303(g)'' and 
                        inserting ``303(h)''; and
                            (vi) in the matter being stricken by 
                        paragraph (6), by striking ``303(g)'' and 
                        inserting ``303(h)''; and
            (3) section 1263(b) of division FF of Public Law 117-328 is 
        amended--
                    (A) by striking ``303(g)(2)'' and inserting 
                ``303(h)(2)''; and
                    (B) by striking ``(21 U.S.C. 823(g)(2))'' and 
                inserting ``(21 U.S.C. 823(h)(2))''.

SEC. 205. REQUIRED TRAINING FOR PRESCRIBERS OF CONTROLLED SUBSTANCES.

    Section 303 of the Controlled Substances Act (21 U.S.C. 823) is 
amended--
            (1) by redesignating the second subsection (l) (added by 
        section 1263 of division FF of Public Law 117-328) as 
        subsection (m); and
            (2) in subsection (m), as redesignated--
                    (A) in paragraph (1)(A)(iv)--
                            (i) in subclause (I), by striking ``or the 
                        Commission for Continuing Education Provider 
                        Recognition (CCEPR)'' and inserting ``the 
                        Commission for Continuing Education Provider 
                        Recognition (CCEPR), the American Podiatric 
                        Medical Association, the Council on Podiatric 
                        Medical Education (CPME), or the Academy of 
                        General Dentistry'';
                            (ii) by redesignating subclauses (II), 
                        (III), and (IV) as subclauses (III), (IV), and 
                        (V), respectively; and
                            (iii) by inserting after subclause (I) the 
                        following:
                                    ``(II) the American Academy of 
                                Family Physicians or any organization 
                                whose continuing medical education 
                                activity has been approved or 
                                accredited by the American Academy of 
                                Family Physicians;''; and
                            (iv) in subclause (V), as redesignated, by 
                        striking ``any organization approved by the 
                        Assistant Secretary for Mental Health and 
                        Substance Use, the ACCME, or the CCEPR'' and 
                        inserting ``any organization approved by the 
                        ACCME or the CCEPR'';
                    (B) in paragraph (1)(A)(v)--
                            (i) by inserting ``podiatric medicine,'' 
                        after ``allopathic medicine, osteopathic 
                        medicine,''; and
                            (ii) by striking ``allopathic or 
                        osteopathic medicine curriculum'' and inserting 
                        ``allopathic, osteopathic, or podiatric 
                        medicine curriculum'';
                    (C) in paragraph (1)(B)(i), by striking ``or any 
                other organization approved or accredited by the 
                Assistant Secretary for Mental Health and Substance Use 
                or the Accreditation Council for Continuing Medical 
                Education'' and inserting ``the American Podiatric 
                Medical Association, the Council on Podiatric Medical 
                Education (CPME), the American Pharmacists Association, 
                the Accreditation Council for Pharmacy Education, the 
                American Optometric Association, the Academy of General 
                Dentistry, the American Psychiatric Nurses Association, 
                the American Academy of Nursing, the American Academy 
                of Family Physicians, or any other organization 
                approved or accredited by the American Academy of 
                Family Physicians or the Accreditation Council for 
                Continuing Medical Education''; and
                    (D) in paragraph (1)(B)(ii), by striking ``from an 
                accredited physician assistant school or accredited 
                school of advanced practice nursing'' and inserting 
                ``from an accredited physician assistant school, an 
                accredited school of advanced practice nursing, or an 
                accredited school of pharmacy''.

                          TITLE III--MEDICAID

SEC. 301. EXTENDING REQUIREMENT FOR STATE MEDICAID PLANS TO PROVIDE 
              COVERAGE FOR MEDICATION-ASSISTED TREATMENT.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (a)(29), by striking ``for the period 
        beginning October 1, 2020, and ending September 30, 2025,'' and 
        inserting ``beginning on October 1, 2020,''; and
            (2) in subsection (ee)(2), by striking ``for the period 
        specified in such paragraph, if before the beginning of such 
        period the State certifies to the satisfaction of the 
        Secretary'' and inserting ``if such State certifies, not less 
        than every 5 years and to the satisfaction of the Secretary,''.
    (b) Conforming Amendment.--Section 1006(b)(4)(A) of the Substance 
Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for 
Patients and Communities Act (42 U.S.C. 1396a note) is amended by 
striking ``, and before October 1, 2025''.

SEC. 302. EXPANDING REQUIRED REPORTS ON T-MSIS SUBSTANCE USE DISORDER 
              DATA TO INCLUDE MENTAL HEALTH CONDITION DATA.

    (a) In General.--Section 1015(a) of the SUPPORT for Patients and 
Communities Act (42 U.S.C. 1320d-2 note) is amended--
            (1) in the heading, by striking ``Substance Use Disorder 
        Data Book'' and inserting ``Behavioral Health Data Book'';
            (2) in paragraph (2)--
                    (A) in the matter preceding subparagraph (A), by 
                inserting ``, including as updated in accordance with 
                paragraph (3),'' after ``paragraph (1)'';
                    (B) in subparagraph (A), by inserting ``, mental 
                health condition, or a mental health condition co-
                occurring with substance use disorder'' after 
                ``substance use disorder'';
                    (C) in subparagraph (B), by inserting ``and mental 
                health treatment services'' after ``substance use 
                disorder treatment services'';
                    (D) in subparagraph (C)--
                            (i) by inserting ``, mental health 
                        condition, or a mental health condition co-
                        occurring with a substance use disorder 
                        diagnosis'' after ``substance use disorder 
                        diagnosis''; and
                            (ii) by inserting ``or mental health 
                        treatment services, respectively,'' after 
                        ``substance use disorder treatment services'';
                    (E) in subparagraph (D), by inserting ``, mental 
                health condition, or a mental health condition co-
                occurring with substance use disorder'' after 
                ``substance use disorder diagnosis'';
                    (F) in subparagraph (E), by inserting ``or mental 
                health treatment'' after ``substance use disorder 
                treatment''; and
                    (G) in subparagraph (F), by inserting ``, 
                individuals with a mental health condition who receive 
                mental health treatment services, and individuals with 
                a co-occurring mental health condition and substance 
                use disorder who receive substance use disorder 
                treatment services and mental health treatment 
                services,'' after ``substance use disorder treatment 
                services''; and
            (3) in paragraph (3), by striking ``through 2024''.
    (b) Application.--The amendments made by subsection (a)(1) shall 
apply beginning with respect to the first update made pursuant to 
section 1015(a)(3) of the SUPPORT for Patients and Communities Act (42 
U.S.C. 1320d-2 note) after the date that is 12 months after the date of 
enactment of this Act.

SEC. 303. MONITORING PRESCRIBING OF ANTIPSYCHOTIC MEDICATIONS.

    Section 1902(oo)(1)(B) of the Social Security Act (42 U.S.C. 
1396a(oo)(1)(B)) is amended--
            (1) in the subparagraph heading, by striking ``by 
        children'';
            (2) by inserting ``, and beginning on the date that is 24 
        months after the date of enactment of Support for Patients and 
        Communities Reauthorization Act, individuals over the age of 
        18, individuals receiving home and community-based services (as 
        defined in section 9817(a)(2)(B) of Public Law 117-2), and 
        individuals residing in institutional care settings (including 
        nursing facilities, intermediate care facilities for 
        individuals with intellectual disabilities, and other such 
        institutional care settings) enrolled,'' after ``children 
        enrolled''; and
            (3) by striking ``not more than the age of 18 years'' and 
        inserting ``subject to the program''.

SEC. 304. LIFTING THE IMD EXCLUSION FOR SUBSTANCE USE DISORDER.

    (a) Making Permanent State Plan Amendment Option To Provide Medical 
Assistance for Certain Individuals Who Are Patients in Certain 
Institutions for Mental Diseases.--Section 1915(l)(1) of the Social 
Security Act (42 U.S.C. 1396n(l)(1)) is amended by striking ``With 
respect to calendar quarters beginning during the period beginning 
October 1, 2019, and ending September 30, 2023,'' and inserting ``With 
respect to calendar quarters beginning on or after October 1, 2019,''.
    (b) Maintenance of Effort Revision.--Section 1915(l)(3) of the 
Social Security Act (42 U.S.C. 1396n(l)(3)) is amended--
            (1) in subparagraph (A)---
                    (A) in the matter preceding clause (i), by striking 
                ``other than under this title''; and
                    (B) in clause (i), by striking ``or, if higher,'' 
                and all that follows through ``in accordance with this 
                subsection''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Application of maintenance of effort 
                requirements to certain states.--In the case of a State 
                with a State plan amendment in effect on the date of 
                the enactment of this subparagraph, for the 1-year 
                period beginning on such date, the provisions of 
                subparagraph (A) shall be applied as if the amendments 
                to such subparagraph made by the Support for Patients 
                and Communities Reauthorization Act had never been 
                made.''.
    (c) Additional Requirements.--
            (1) In general.--
                    (A) General requirements.--Section 1915(l)(4) of 
                the Social Security Act (42 U.S.C. 1396n(l)(4)) is 
                amended--
                            (i) in subparagraph (A), by striking 
                        ``through (D)'' and inserting ``through (F)'';
                            (ii) in subparagraph (D), in the matter 
                        preceding clause (i), by inserting ``have in 
                        place evidence-based, substance use disorder-
                        specific individual placement criteria and 
                        utilization management approach to ensure 
                        placement of such individual in an appropriate 
                        level of care and shall'' after ``State 
                        shall''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(E) Review process.--The State shall have in 
                place a process to review the compliance of eligible 
                institutions for mental diseases with evidence-based, 
                substance use disorder-specific program standards for 
                eligible individuals specified by the State.''.
                    (B) Effective date.--The amendments made by 
                subparagraph (A) shall apply with respect to medical 
                assistance furnished in calendar quarters beginning on 
                or after October 1, 2025.
            (2) One-time assessment.--Section 1915(l)(4) of the Social 
        Security Act (42 U.S.C. 1396n(l)(4)), as amended by paragraph 
        (1), is further amended by adding at the end the following new 
        subparagraph:
                    ``(F) Assessment.--
                            ``(i) In general.--The State shall, not 
                        later than 12 months after the approval of a 
                        State plan amendment described in this 
                        subsection (or, in the case such State has such 
                        an amendment approved as of the date of the 
                        enactment of this subparagraph, not later than 
                        12 months after such date), commence an 
                        assessment of--
                                    ``(I) the availability of treatment 
                                for individuals enrolled under a State 
                                plan under this title (or waiver of 
                                such plan) in each level of care 
                                described in subparagraph (C); and
                                    ``(II) the availability of 
                                medication-assisted treatment and 
                                medically supervised withdrawal 
                                management services for such 
                                individuals.
                            ``(ii) Required completion.--The State 
                        compete an assessment described in clause (i) 
                        not later than 12 months after the date the 
                        State commences such assessment.''.
            (3) Clarification of levels of care.--Section 1915(l)(7)(A) 
        of the Social Security Act (42 U.S.C. 1396n(l)(7)(A)) is 
        amended by inserting ``(or any successor publication)'' before 
        the period.

SEC. 305. PROHIBITION ON TERMINATION OF ENROLLMENT DUE TO 
              INCARCERATION.

    (a) Medicaid.--
            (1) In general.--Section 1902(a)(84)(A) of the Social 
        Security Act (42 U.S.C. 1396a(a)(86)(A)), as amended by section 
        5122(a)(2) of the Consolidated Appropriations Act, 2023 (Public 
        Law 117-328), is further amended--
                    (A) by striking ``under the State plan'' and 
                inserting ``under the State plan (or waiver of such 
                plan)'';
                    (B) by striking ``who is an eligible juvenile (as 
                defined in subsection (nn)(2))'';
                    (C) by striking ``because the juvenile'' and 
                inserting ``because the individual'';
                    (D) by striking ``during the period the juvenile'' 
                and inserting ``during the period the individual''; and
                    (E) by inserting ``such an individual who is an 
                eligible juvenile (as defined in subsection (nn)(2)) or 
                a woman during pregnancy (and during the 60-day 
                beginning on the last day of pregnancy) and'' after 
                ``or in the case of''.
            (2) Effective date.--The amendments made by--
                    (A) subparagraph (A) of paragraph (1) shall take 
                effect on the date of the enactment of this Act; and
                    (B) subparagraphs (B) through (E) of paragraph (1) 
                shall take effect on January 1, 2025.
    (b) CHIP.--
            (1) In general.--Section 2102(d)(1)(A) of the Social 
        Security Act (42 U.S.C. 1397bb(d)(1)(A)) is amended--
                    (A) by inserting ``or pregnancy-related'' after 
                ``child health'';
                    (B) by inserting ``or targeted low-income pregnant 
                woman'' after ``targeted low-income child'';
                    (C) by inserting ``or pregnant woman'' after 
                ``because the child''; and
                    (D) by inserting ``or pregnant woman'' after 
                ``during the period the child''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply beginning January 1, 2025.
    (c) Technical Correction.--Section 1902(nn)(2)(A) of the Social 
Security Act (42 U.S.C. 1395a(a)(nn)(2)(A)) is amended by striking 
``State plan'' and inserting ``State plan (or waiver of such plan)''.

SEC. 306. STATE OPTION RELATING TO INMATES WHO ARE PREGNANT WOMEN 
              PENDING DISPOSITION OF CHARGES.

    (a) State Option.--
            (1) Medicaid.--The subdivision (A) of section 1905(a) of 
        the Social Security Act (42 U.S.C. 1396d(a)) following 
        paragraph (31) of such section, as amended by section 5122 of 
        the Consolidated Appropriations Act, 2023 (Public Law 117-328), 
        is further amended by inserting ``or a woman during pregnancy 
        (and during the 60-day beginning on the last day of 
        pregnancy)'' after ``(as defined in section 1902(nn)(2))''.
            (2) CHIP.--Section 2110(b)(7) of the Social Security Act 
        (42 U.S.C. 1397jj(b)(10)), as amended by section 5122 of the 
        Consolidated Appropriations Act, 2023 (Public Law 117-328), is 
        further amended--
                    (A) by inserting ``a woman during pregnancy (and 
                during the 60-day beginning on the last day of 
                pregnancy) or'' after ``At the option of the State,''; 
                and
                    (B) by striking ``during the period that the 
                child'' and inserting ``during the period that the 
                woman or child''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect on January 1, 2025.
    (b) Technical Correction.--Section 5122(a)(1) of the Consolidated 
Appropriations Act, 2023 (Public Law 117-328) is amended by striking 
``after'' and all that follows through the period at the end and 
inserting ``after `or in the case of an eligible juvenile described in 
section 1902(a)(84)(D) with respect to the screenings, diagnostic 
services, referrals, and targeted case management services required 
under such section'.''.

SEC. 307. PERMITTING ACCESS TO MEDICAL ASSISTANCE UNDER THE MEDICAID 
              PROGRAM FOR FOSTER YOUTH.

    (a) In General.--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: ``In the case of an individual who is under the age of 21 and 
who is a patient in an institution for mental diseases that is a 
qualified residential treatment program (as defined in section 
472(k)(4)), the exclusion from the definition of medical assistance set 
forth in the subdivision (B) following the last numbered paragraph of 
this subsection shall not apply with respect to items and services 
furnished to such an individual when received outside of such 
program.''.
    (b) Effective Date.--The amendment made by paragraph (1) shall 
apply with respect to medical assistance furnished in calendar quarters 
beginning on or after January 1, 2025.

                           TITLE IV--OFFSETS

SEC. 401. PROMOTING VALUE IN MEDICAID MANAGED CARE.

    Section 1903(m)(9)(A) of the Social Security Act (42 U.S.C. 
1396b(m)(9)(A)) is amended by striking ``(and before fiscal year 
2024)''.

            Passed the House of Representatives December 12, 2023.

            Attest:

                                                                 Clerk.
118th CONGRESS

  1st Session

                               H. R. 4531

_______________________________________________________________________

                                 AN ACT

 To reauthorize certain programs that provide for opioid use disorder 
      prevention, recovery, and treatment, and for other purposes.