[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 773 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 773

  To help persons in the United States experiencing homelessness and 
     significant behavioral health issues, including substance use 
  disorders, by authorizing a grant program within the Department of 
 Housing and Urban Development to assist State and local governments, 
Continuums of Care, community-based organizations that administer both 
 health and homelessness services, and providers of services to people 
     experiencing homelessness, better coordinate health care and 
             homelessness services, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 2, 2023

    Ms. Dean of Pennsylvania (for herself and Ms. Garcia of Texas) 
 introduced the following bill; which was referred to the Committee on 
                           Financial Services

_______________________________________________________________________

                                 A BILL


 
  To help persons in the United States experiencing homelessness and 
     significant behavioral health issues, including substance use 
  disorders, by authorizing a grant program within the Department of 
 Housing and Urban Development to assist State and local governments, 
Continuums of Care, community-based organizations that administer both 
 health and homelessness services, and providers of services to people 
     experiencing homelessness, better coordinate health care and 
             homelessness services, 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 ``Homelessness and Behavioral Health 
Care Coordination Act of 2023''.

SEC. 2. FINDINGS.

     Congress finds the following:
            (1) The United States has a homelessness crisis, with more 
        than 582,000 people experiencing homelessness on a single night 
        according to the Department of Housing and Urban Development's 
        2022 Annual Homeless Assessment Report to Congress.
            (2) While the lack of affordable housing is the primary 
        driver of homelessness, behavioral health conditions, including 
        substance use disorders, can exacerbate homelessness and can 
        also be a consequence of homelessness.
            (3) Research shows that people experiencing homelessness 
        have higher rates of substance use disorder than people with 
        housing stability. Some people who experience homelessness use 
        substances to cope with the trauma and deprivations of their 
        circumstances, but substance use disorders frequently make it 
        more difficult for people experiencing homelessness to secure 
        permanent housing.
            (4) Many individuals with substance use disorder who 
        experience homelessness have co-occurring illnesses. The 
        combined effect of physical illness, mental illness, and lack 
        of housing results in higher mortality rates for individuals 
        experiencing homelessness.
            (5) Safely and securely housing individuals who are 
        experiencing both homelessness and behavioral health issues, 
        including substance use disorders, often requires supportive 
        services and close coordination between housing and social 
        service providers, in addition to low-barrier, affordable 
        housing. Subsidized housing is critical, but not enough--access 
        to additional voluntary person-centered supportive services is 
        needed.
            (6) It is imperative that when people experiencing 
        homelessness choose to seek help that housing as well as health 
        care and person-centered supportive services be coordinated, 
        particularly given their acute needs and the significant costs 
        incurred by communities for law enforcement, correctional, and 
        emergency department care for failing to do so.
            (7) While participation in health care and person-centered 
        supportive services should not be a requirement for people 
        experiencing homelessness to receive housing, access to such 
        services can be beneficial in securing and successfully 
        maintaining stable housing.
            (8) Integration of health and homelessness services to 
        achieve optimal outcomes for people experiencing homelessness, 
        significant behavioral health conditions such as substance use 
        disorder, and other health conditions can be challenging for 
        State and local governments, continuums of care, and community-
        based organizations that administer both health and 
        homelessness services and providers of homelessness services.
            (9) Capacity building is needed to create systems-level 
        linkages between the two sets of services to allow for smoother 
        pathways and simpler navigation.
            (10) Black, Hispanic, and Indigenous people are 
        disproportionately underserved by person-centered supportive 
        services. In order to address critical services deficits and 
        affirmatively serve protected classes of people with 
        significant behavioral health conditions, including substance 
        use disorders, who are experiencing homelessness, the grant 
        program established under this Act can be used to build the 
        capacities of homelessness services providers that have 
        demonstrated cultural competencies in service provision and a 
        record of serving Black, Hispanic, and Indigenous people and 
        other underserved populations experiencing homelessness that 
        also suffer from substance use disorders.

SEC. 3. ESTABLISHMENT OF GRANT PROGRAM.

    (a) In General.--The Secretary of Housing and Urban Development (in 
this Act referred to as the ``Secretary''), in consultation with the 
working group established pursuant to subsection (b), shall establish a 
grant program to award competitive grants to eligible entities to build 
or increase their capacities for the better coordination of health care 
and homelessness services for people who are experiencing homelessness 
and significant behavioral health issues, including substance use 
disorders, and are voluntarily seeking assistance.
    (b) Working Group.--
            (1) Establishment.--The Secretary shall establish an 
        interagency working group to provide advice to the Secretary in 
        carrying out the program under subsection (a). The working 
        group shall include representatives from the Department of 
        Housing and Urban Development, the United States Interagency 
        Council on Homelessness, Department of Health and Human 
        Services, Department of Agriculture, and Bureau of Indian 
        Affairs, to be appointed by the heads of such agencies.
            (2) Development of assistance tools.--The working group 
        shall, not later than 12 months after the date of the enactment 
        of this Act, develop training, tools, and other technical 
        assistance materials that simplify homelessness services for 
        providers of health care and simplify health care services for 
        providers of homelessness services by identifying the basic 
        elements the health and homelessness sectors need to understand 
        about the other, and shall circulate such materials to 
        interested entities, particularly those who apply for grants 
        awarded pursuant to this Act.
    (c) Capacity-Building Grants.--
            (1) In general.--The Secretary shall award 5-year grants to 
        eligible entities, which shall be used only to build or 
        increase their capacities to coordinate health care and 
        homelessness services.
            (2) Prohibition.--None of the proceeds from the grants 
        awarded pursuant to this Act may be used to pay for health 
        care, with the exception of efforts to increase the 
        availability of Naloxone and provide training for its 
        administration, or rent.
            (3) Amount.--The amount awarded to an entity under a grant 
        under this subsection shall not exceed $500,000.
            (4) Eligibility.--To be eligible to receive a grant under 
        this subsection an entity shall--
                    (A) be--
                            (i) a governmental entity (at the county, 
                        city, regional, or locality level);
                            (ii) an Indian tribe, a Tribally designated 
                        housing entity, a Tribal organization, or an 
                        urban Indian organization;
                            (iii) a public housing agency administering 
                        housing choice vouchers; or
                            (iv) a continuum of care or nonprofit 
                        organization designated by the continuum of 
                        care;
                    (B) be responsible for homelessness services;
                    (C) provide such assurances as the Secretary shall 
                require that, in carrying out activities with amounts 
                from the grant, the entity will ensure that services 
                are culturally competent, meet the needs of the people 
                being served, and follow trauma-informed best practices 
                to address those needs using a harm reduction approach; 
                and
                    (D) demonstrate how its capacity to coordinate 
                health care and homelessness services to better serve 
                people experiencing homelessness and significant 
                behavioral health issues, including substance use 
                disorders, can be increased through--
                            (i) the designation of a governmental 
                        official as a coordinator for making 
                        connections between health and homelessness 
                        services and developing a strategy for using 
                        those services in a holistic way to help people 
                        experiencing homelessness and behavioral health 
                        conditions such as substance use disorders, 
                        including those with co-occurring conditions;
                            (ii) improvements in infrastructure at the 
                        systems level;
                            (iii) improvements in technology for 
                        voluntary remote monitoring capabilities, 
                        including internet and video, which can allow 
                        for more home- and community-based behavioral 
                        health care services and ensure such 
                        improvements maintain effective communication 
                        requirements for persons with disabilities and 
                        program access for persons with limited English 
                        proficiency;
                            (iv) improvements in connections to health 
                        care services delivered by providers 
                        experienced in behavioral health care and 
                        people experiencing homelessness;
                            (v) efforts to increase the availability of 
                        Naloxone and provide training for its 
                        administration; and
                            (vi) any additional activities identified 
                        by the Secretary that will advance the 
                        coordination of homelessness assistance, 
                        housing, and behavioral health care services 
                        and other health care services.
            (5) Eligible activities.--An eligible grantee receiving a 
        grant under this subsection may use the grant to cover costs 
        related to--
                    (A) hiring system coordinators; and
                    (B) administrative costs, including staffing costs, 
                technology costs, and other such costs identified by 
                the Secretary.
            (6) Distribution of funds.--An eligible grantee receiving a 
        grant under this subsection may distribute all or a portion of 
        the grant amounts to private nonprofit organizations, other 
        government entities, public housing agencies, tribally 
        designated housing entities, or other entities as determined by 
        the Secretary to carry out programs and activities in 
        accordance with this section.
            (7) Oversight requirements.--
                    (A) Annual reports.--Not later than 6 years after 
                the date on which grant amounts are first received by 
                an eligible entity, such entity shall submit to the 
                Secretary a report on the activities carried out under 
                the grant. Such report shall include, with respect to 
                activities carried out with grant amounts in the 
                community served--
                            (i) measures of outcomes relating to 
                        whether people experiencing homelessness and 
                        significant behavioral health issues, including 
                        substance use disorders, who sought help from 
                        an entity that received a grant--
                                    (I) were housed and did not 
                                experience intermittent periods of 
                                homelessness;
                                    (II) were voluntarily enrolled in 
                                treatment and recovery programs;
                                    (III) experienced improvements in 
                                their health;
                                    (IV) obtained access to specific 
                                primary care providers; and
                                    (V) have health care plans that 
                                meet their individual needs, including 
                                access to mental health and substance 
                                use disorder treatment and recovery 
                                services;
                            (ii) how grant funds were used; and
                            (iii) any other matters determined 
                        appropriate by the Secretary.
                    (B) Rule of construction.--Nothing in this 
                subsection may be construed to condition the receipt of 
                future housing and other services by individuals 
                assisted with activities and services provided with 
                grant amounts on the outcomes detailed in the reports 
                submitted under this subsection.
            (8) Definitions.--In this section:
                    (A) Behavioral health.--The term ``behavioral 
                health'' includes mental health and substance use.
                    (B) Indian tribe; tribal organization.--The terms 
                ``Indian Tribe'' and ``Tribal organization'' have the 
                meanings given such terms in section 4 of the Indian 
                Self-Determination and Education Assistance Act (25 
                U.S.C. 5304) and shall include tribally designated 
                housing entities (as such term is defined in section 4 
                of the Native American Housing Assistance and Self-
                Determination Act of 1996 (25 U.S.C. 4103)) and 
                entities that serve Native Hawaiians (as such term is 
                defined in section 338K(c) of the Public Health Service 
                Act (42 U.S.C. 254s(c))).
                    (C) Person experiencing homelessness.--The term 
                ``person experiencing homelessness'' has the same 
                meaning as the terms ``homeless'', ``homeless 
                individual'', and ``homeless person'' as those terms 
                are defined in the McKinney-Vento Act (42 U.S.C. 
                11302).
                    (D) Substance use disorder.--The term ``substance 
                use disorder'' means the disorder that occurs when the 
                recurrent use of alcohol or drugs, or both, causes 
                clinically significant impairment, including health 
                problems, disability, and failure to meet major 
                responsibilities at work, school, or home.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $20,000,000 for each of fiscal 
years 2023 through 2028, of which not less than 5 percent of such funds 
shall be awarded to Indian tribes and tribal organizations.
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