[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4430 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  2d Session
                                S. 4430

  To amend title XIX of the Social Security Act to establish a Health 
 Engagement Hub demonstration program to increase access to treatment 
  for opiate use disorder and other drug use treatment, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 23, 2024

  Ms. Cantwell (for herself and Mr. Cassidy) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend title XIX of the Social Security Act to establish a Health 
 Engagement Hub demonstration program to increase access to treatment 
  for opiate use disorder and other drug use 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 ``Fatal Overdose Reduction Act of 
2024''.

SEC. 2. HEALTH ENGAGEMENT HUB DEMONSTRATION PROGRAM UNDER MEDICAID.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection:
    ``(cc) Health Engagement Hub Demonstration Program.--
            ``(1) Authority.--The Secretary shall conduct a 
        demonstration program (referred to in this subsection as the 
        `demonstration program') for the purpose of increasing access 
        to treatment for opiate use disorder and other drug use 
        treatment through the establishment of Health Engagement Hubs 
        that meet the criteria published by the Secretary under 
        paragraph (2)(A).
            ``(2) Publication of guidance.--Not later than 6 months 
        after the date of enactment of this subsection, the Secretary 
        shall publish the following:
                    ``(A) Certification criteria.--The criteria 
                described in paragraph (3) for an organization to be 
                certified by a State as a Health Engagement Hub for 
                purposes of participating in the demonstration program.
                    ``(B) Prospective payment system.--Guidance for 
                States selected to participate in the demonstration 
                program to use to establish a prospective payment 
                system for services permitted under paragraph (3)(B) 
                that are provided by a certified Health Engagement Hub 
                participating in the demonstration program.
            ``(3) Criteria for certification of health engagement 
        hubs.--
                    ``(A) General requirements.--In order to be 
                certified as a Health Engagement Hub, an organization 
                shall--
                            ``(i) demonstrate that the organization is 
                        able to serve as an all-in-one location where 
                        individuals who are eligible for medical 
                        assistance under a State plan under this title 
                        or under a waiver of such plan who seek 
                        treatment for opiate use disorder or other drug 
                        use may access a range of social and medical 
                        services, in a drop-in manner and without prior 
                        appointment or proof of payment;
                            ``(ii) provide the services specified in 
                        subparagraph (B) (in a manner reflecting 
                        person-centered care) which, if not available 
                        directly through the organization, shall be 
                        provided through formal relationships with 
                        other providers;
                            ``(iii) demonstrate that in selecting the 
                        location for the Health Engagement Hub, the 
                        organization prioritized placement in 
                        communities disproportionately impacted by 
                        overdose, health issues, and other harms 
                        related to drug use, as well as areas that are 
                        medically underserved, rural, geographically 
                        isolated areas, tribal areas, or urban centers 
                        with under-resourced behavioral health 
                        infrastructure, including disadvantaged 
                        communities based on race, individuals 
                        experiencing homelessness, and communities 
                        negatively impacted by the criminal-legal 
                        system;
                            ``(iv) give priority to establishing or 
                        adopting evidence-based models to increase 
                        engagement or improve outcomes for individuals 
                        with active, ongoing substance use, such as 
                        social work empowerment models approved by the 
                        Secretary, motivational interviewing models 
                        approved by the Secretary, or shared decision 
                        making models approved by the Secretary; and
                            ``(v) meet--
                                    ``(I) the minimum staffing 
                                requirements described in subparagraph 
                                (C);
                                    ``(II) the experience requirement 
                                described in subparagraph (D); and
                                    ``(III) the community advisory 
                                board requirement described in 
                                subparagraph (E).
                    ``(B) Scope of services.--The services specified in 
                this subparagraph are the following:
                            ``(i) Required services.--
                                    ``(I) Harm reduction services and 
                                supplies provided directly by the 
                                organization or under an arrangement 
                                with an organization that offers harm 
                                reduction services (which may include a 
                                syringe service program, a Federally-
                                qualified health center, a community 
                                health center, a Tribal health program, 
                                or an opioid treatment program that 
                                offers such services), that include--
                                            ``(aa) overdose education 
                                        and naloxone distribution;
                                            ``(bb) safer drug use 
                                        education and supplies;
                                            ``(cc) safer-sex supplies;
                                            ``(dd) emotional support 
                                        and counseling services to 
                                        reduce harms associated with 
                                        substance use, including 
                                        trauma-informed care; and
                                            ``(ee) access or referral 
                                        to medications and drugs 
                                        approved by the Food and Drug 
                                        Administration for treatment of 
                                        opioid use disorder with a 
                                        strong evidence base of 
                                        significantly reducing 
                                        mortality (such as methadone 
                                        and buprenorphine) and other 
                                        substances, including 
                                        stimulants, within 4 hours.
                                    ``(II) Substance use disorder 
                                screening and brief intervention.
                                    ``(III) Patient-centered and 
                                patient-driven physical and behavioral 
                                health care that has walk-in 
                                availability, is offered during non-
                                traditional hours, including evenings 
                                and weekends, and includes--
                                            ``(aa) shared decision 
                                        making for patients and 
                                        providers for opioid use 
                                        disorder, stimulant use 
                                        disorder, or both, under which 
                                        a patient and provider discuss 
                                        the patient's diagnosis and 
                                        condition together and evaluate 
                                        treatment options together;
                                            ``(bb) primary mental 
                                        health and substance use 
                                        disorder services, including 
                                        screening, assessment, and 
                                        referrals to higher levels of 
                                        care;
                                            ``(cc) wound care;
                                            ``(dd) infectious disease 
                                        vaccination, screening, 
                                        testing, and, to the extent 
                                        practicable, treatment 
                                        (including for HIV, sexually 
                                        transmitted infections, and 
                                        hepatitis testing and 
                                        treatment);
                                            ``(ee) access or referral 
                                        to sexual and reproductive 
                                        health services;
                                            ``(ff) assessment and 
                                        linkage or referrals to 
                                        psychiatric services and other 
                                        specialty care; and
                                            ``(gg) secure medication 
                                        storage and inventory policies 
                                        and procedures for patients 
                                        experiencing homelessness or 
                                        housing insecurity.
                                    ``(IV) Care coordination, complex 
                                case management, and other case 
                                management, care navigation, and care 
                                coordination services that may 
                                include--
                                            ``(aa) education and 
                                        assistance with obtaining 
                                        housing, transportation, and 
                                        other public assistance 
                                        benefits, including enrollment 
                                        in the State plan under this 
                                        title or under a waiver of such 
                                        plan;
                                            ``(bb) identification 
                                        services (such as assistance 
                                        with obtaining a government-
                                        recognized form of 
                                        identification);
                                            ``(cc) employment 
                                        counseling;
                                            ``(dd) recovery support 
                                        counseling;
                                            ``(ee) family reunification 
                                        services; and
                                            ``(ff) criminal-legal 
                                        services.
                                    ``(V) All services that may be 
                                provided under the Outreach Site/Street 
                                Place of Service code (POS Code 27 as 
                                of October 1, 2023) (or a successor 
                                place of service code).
                                    ``(VI) Community health outreach 
                                and navigation services to engage with 
                                and conduct outreach to community 
                                members that is provided by outreach 
                                and engagement staff described in 
                                subparagraph (C)(i)(IV).
                            ``(ii) Optional services.--
                                    ``(I) Services and supplies to meet 
                                basic needs, including food, clothing, 
                                and hygiene supplies.
                                    ``(II) Evidence-based and 
                                culturally appropriate behavioral 
                                health services.
                                    ``(III) Medication management for 
                                physical and mental health conditions.
                    ``(C) Minimum staffing requirements.--
                            ``(i) In general.--The minimum staffing 
                        requirements specified in this subparagraph are 
                        the following:
                                    ``(I) At least 1 part-time or full-
                                time health care provider who is 
                                licensed to practice in the State and 
                                is licensed, registered, or otherwise 
                                permitted, by the United States to 
                                prescribe controlled substances (as 
                                defined in section 102 of the 
                                Controlled Substances Act) in the 
                                course of professional practice.
                                    ``(II) At least 1 part-time or 
                                full-time registered professional nurse 
                                or licensed practical nurse who can 
                                provide medication management, medical 
                                case management, care coordination, 
                                wound care, vaccine administration, and 
                                community-based outreach.
                                    ``(III) At least 1 part-time or 
                                full-time licensed behavioral health 
                                staff who is qualified to assess and 
                                provide counseling and treatment 
                                recommendations for substance use and 
                                mental health diagnoses.
                                    ``(IV) Full-time outreach, 
                                engagement, and ongoing care navigation 
                                staff, including peer counselors, 
                                community health workers, and recovery 
                                coaches. At least 50 percent of such 
                                staff shall be individuals with a 
                                personal history of drug use.
                            ``(ii) Staffing through arrangements with 
                        partner agencies.--An organization may enter 
                        into an arrangement with a partner agency, such 
                        as a Federally-qualified health center, to 
                        satisfy the minimum staffing requirements 
                        specified in clause (i).
                    ``(D) Experience.--An organization shall have a 
                demonstrated history of at least 12 months of service 
                provision to individuals who use drugs, including those 
                who continue with substance use while receiving health 
                and social services.
                    ``(E) Community advisory board.--An organization 
                shall have a community advisory board composed of 
                individuals with a history of substance use, or who 
                continue with substance use, that meets, at a minimum, 
                on--
                            ``(i) a monthly basis, to review program 
                        utilization data and provide feedback to the 
                        organization; and
                            ``(ii) on a quarterly basis, with the 
                        executives or board of directors of the 
                        organization to provide input on service 
                        delivery and receive feedback on actions taken 
                        based on previous feedback provided by the 
                        community advisory board.
            ``(4) Planning grants.--
                    ``(A) In general.--Not later than 1 year after the 
                date of enactment of this subsection, the Secretary 
                shall award planning grants to States for the purpose 
                of developing proposals to participate in the 
                demonstration program.
                    ``(B) Amount of grant.--The amount of a grant 
                awarded to a State under this paragraph shall be 
                sufficient to pay 100 percent of the actual costs 
                expended by a State to carry out the activities 
                required under subparagraph (C).
                    ``(C) Use of funds.--A State awarded a planning 
                grant under this paragraph shall solicit input on the 
                development of a proposal to participate in the 
                demonstration program from patients, providers, harm 
                reduction service providers, social service providers, 
                and other stakeholders, with respect to--
                            ``(i) identifying and certifying 
                        organizations as Health Engagement Hubs for 
                        purposes of participating in the demonstration 
                        program; and
                            ``(ii) establishing a prospective payment 
                        system for services provided by a certified 
                        Health Engagement Hub participating in the 
                        demonstration program, in accordance with the 
                        guidance issued under paragraph (2)(B).
                    ``(D) Funding.--Out of any funds in the Treasury 
                not otherwise appropriated, there are appropriated to 
                the Secretary such sums as are necessary to carry out 
                this paragraph, to remain available until expended.
            ``(5) State demonstration programs.--
                    ``(A) In general.--Not later than 2 years after the 
                date of enactment of this subsection, the Secretary 
                shall solicit applications solely from the States 
                awarded a planning grant under paragraph (4) to 
                participate in the demonstration program.
                    ``(B) Application requirements.--An application to 
                participate in the demonstration program shall include 
                the following:
                            ``(i) A description of, including the 
                        estimated number of individuals in, the target 
                        population to be served by the State under the 
                        demonstration program.
                            ``(ii) An assurance that at least \1/2\ of 
                        the Health Engagement Hubs in the State shall 
                        be located in--
                                    ``(I) a county (or a municipality, 
                                if not contained within any county) 
                                where the mean drug overdose death rate 
                                per 100,000 people over the past 3 
                                years for which official data is 
                                available from the State, is higher 
                                than the most recent available national 
                                average overdose death rate per 100,000 
                                people, as reported by the Centers for 
                                Disease Control and Prevention; or
                                    ``(II) an area of the State that is 
                                designated under section 332(a)(1)(A) 
                                of the Public Health Service Act as a 
                                mental health professional shortage 
                                area.
                            ``(iii) A description of the prospective 
                        payment system that is to be tested under the 
                        demonstration program.
                            ``(iv) A list of the certified Health 
                        Engagement Hubs located in the State that will 
                        participate in the demonstration program.
                            ``(v) Verification that each such certified 
                        Health Engagement Hub satisfies the 
                        requirements described in paragraph (3)(A).
                            ``(vi) A description of the scope of the 
                        services that will be paid for under the 
                        prospective payment system (which includes at a 
                        minimum the required services described in 
                        paragraph (3)(B)(i)) that is to be tested under 
                        the demonstration program.
                            ``(vii) Verification that the State has 
                        agreed to pay for such services at the at the 
                        rate established under the prospective payment 
                        system.
                            ``(viii) Any other information that the 
                        Secretary may require relating to the 
                        demonstration program with respect to 
                        determining the soundness of the proposed 
                        prospective payment system.
                    ``(C) Selection criteria.--
                            ``(i) In general.--The Secretary shall 
                        select from among the applications submitted at 
                        least 10 States to participate in the 
                        demonstration program based on geographic and 
                        demographic diversity.
                            ``(ii) Priority.--In addition to the 
                        criteria specified in clause (i), the Secretary 
                        shall prioritize selecting States with the 
                        highest rates of opioid- or stimulant-involved 
                        overdose death rates.
                    ``(D) Length of demonstration programs.--A State 
                selected to participate in the demonstration program 
                shall participate in the program for a 2-year period.
                    ``(E) Waiver of certain requirements.--The 
                Secretary shall waive section 1902(a)(1) (relating to 
                statewideness), section 1902(a)(10)(B) (relating to 
                comparability), and any other provision of this title 
                which would be directly contrary to the authority under 
                this subsection as may be necessary for a State to 
                participate in the demonstration program in accordance 
                with this paragraph.
                    ``(F) Payments to states.--
                            ``(i) In general.--The Secretary shall pay 
                        a State participating in the demonstration 
                        program the Federal matching percentage 
                        specified in clause (ii) for amounts expended 
                        by the State for medical assistance for 
                        services provided through certified Health 
                        Engagement Hubs to individuals enrolled under 
                        the State plan (or under a waiver of such plan) 
                        consisting of medications and drugs approved by 
                        the Food and Drug Administration for treatment 
                        of opioid use disorder and other substances, 
                        including stimulants, and the services 
                        specified by the State in its application under 
                        subparagraph (B)(vi), at the rate established 
                        under the prospective payment system 
                        established by the State for purposes of the 
                        demonstration program.
                            ``(ii) Federal matching percentage.--The 
                        Federal matching percentage specified in this 
                        clause is--
                                    ``(I) with respect to medical 
                                assistance described in clause (i) that 
                                is furnished to a newly eligible 
                                individual described in paragraph (2) 
                                of section 1905(y), the matching rate 
                                applicable under paragraph (1) of that 
                                section; and
                                    ``(II) with respect to medical 
                                assistance described in clause (i) that 
                                is furnished to an individual who is 
                                not a newly eligible individual (as so 
                                described), but who is eligible for 
                                medical assistance under the State plan 
                                under this title or under a waiver of 
                                such plan, the enhanced FMAP applicable 
                                to the State under section 2105(b).
                            ``(iii) Application.--Payments to States 
                        made under this subparagraph shall be 
                        considered to have been made under, and are 
                        subject to, the requirements of this section.
            ``(6) Reports.--
                    ``(A) Annual state reports.--
                            ``(i) In general.--Each State selected to 
                        participate in the demonstration program under 
                        paragraph (5) shall submit an annual report to 
                        the Secretary on the demonstration program that 
                        includes the following:
                                    ``(I) An assessment of the extent 
                                to which Health Engagement Hubs funded 
                                under the demonstration program have 
                                increased access to treatment for 
                                opiate use disorder and other drug use 
                                treatment, health services for 
                                individuals who use drugs, and other 
                                social services under State plans under 
                                this title or under waivers of such 
                                plans in the area or areas of States 
                                targeted by the demonstration program 
                                compared to other areas of the State.
                                    ``(II) An assessment on the impact 
                                of Health Engagement Hubs on reducing 
                                opioid and stimulant overdose mortality 
                                rates and the rate of adherence to 
                                prescribed medication for opioid use, 
                                hospitalization rates, and housing 
                                status for the population served by a 
                                Health Engagement Hub as compared to 
                                populations that are not served by a 
                                Health Engagement Hub.
                                    ``(III) A description of the 
                                successes of the demonstration program.
                                    ``(IV) Recommendations for 
                                improvements to the demonstration 
                                program, including whether the 
                                demonstration program should be 
                                continued, expanded, modified, or 
                                terminated.
                            ``(ii) Funding.--Out of any funds in the 
                        Treasury not otherwise appropriated, there are 
                        appropriated such sums as are necessary, to 
                        remain available until expended, for purposes 
                        of making payments to States for expenditures 
                        attributable to collecting and reporting the 
                        information required under this subparagraph.
                    ``(B) Reports to congress.--
                            ``(i) In general.--The Secretary shall 
                        submit an annual report to Congress that 
                        describes the information, findings, and 
                        recommendations in the annual State reports 
                        submitted to the Secretary under subparagraph 
                        (A).
                            ``(ii) Implementation evaluation results.--
                        The Secretary shall include with the first 3 
                        annual reports submitted by the Secretary under 
                        this subparagraph the findings and conclusions 
                        of the implementation evaluation required by 
                        paragraph (7).
            ``(7) Implementation evaluation.--
                    ``(A) In general.--The Secretary shall solicit 
                public input and fund an implementation evaluation of 
                the planning grants awarded under paragraph (4) and the 
                initial set of States selected for the demonstration 
                program under paragraph (5) to determine the reach, 
                effectiveness, adoption, and implementation of the 
                demonstration program in each such State to document 
                the degree to which the services were implemented as 
                intended and allow for a complete assessment of the 
                impact of the Health Engagement Hubs in each such 
                State.
                    ``(B) Requirements.--
                            ``(i) Information.--The evaluation shall 
                        include information on the characteristics of 
                        the individuals who receive services, service 
                        utilization metrics over time (including by 
                        staff role), and input from interviews with 
                        such individuals and staff.
                            ``(ii) Eligible entities.--In order to be 
                        eligible to conduct the evaluation, an entity 
                        shall have documented experience conducting 
                        implementation evaluations of health and social 
                        services programs for individuals who use 
                        drugs.
                    ``(C) Funding.--Out of any funds in the Treasury 
                not otherwise appropriated, there are appropriated to 
                the Secretary such sums as are necessary to carry out 
                this paragraph, to remain available until expended.''.

SEC. 3. GOVERNMENT ACCOUNTABILITY OFFICE REPORT.

    (a) In General.--Not later than 6 months after the conclusion of 
the demonstration program established under subsection (cc) of section 
1903 of the Social Security Act (42 U.S.C. 1396b), as added by section 
2, the Comptroller General of the United States shall conduct and 
publish a comparative analysis on the impacts of the health engagement 
hubs certified under such program (in this section referred to as 
``health engagement hubs'') compared to the impacts of other opioid 
treatment programs and health care organizations that offer behavioral 
health care or substance use disorder services.
    (b) Content of Analysis.--The analysis required under this section 
shall include the following:
            (1) Data and information analyzing differences in rates 
        among individuals who receive behavioral health care or 
        substance use disorder services through a health engagement hub 
        and among individuals who receive such care or services through 
        a program or organization referred to in subsection (a) for 
        each of the following factors:
                    (A) Changes in rates of mortality.
                    (B) Changes in rates of recidivism.
                    (C) Rates of relapse.
                    (D) Rates of hospital and emergency department 
                utilization.
                    (E) Frequency of visits for care or services.
                    (F) Rates of successful intervention through the 
                administration of buprenorphine or other medication 
                approved by the Food and Drug Administration for the 
                treatment of substance use disorder.
            (2) Data and information comparing the racial and 
        socioeconomic demographics, housing status, employment, and 
        other metrics, as recommended by the Secretary of Health and 
        Human Services, of the population groups that receive 
        behavioral health care or substance use disorder services 
        through a health engagement hub or through a program or 
        organization referred to in subsection (a).
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