[Congressional Record Volume 169, Number 203 (Monday, December 11, 2023)]
[House]
[Pages H6789-H6798]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        SUPPORT FOR PATIENTS AND COMMUNITIES REAUTHORIZATION ACT

  Mr. GUTHRIE. Mr. Speaker, I move to suspend the rules and pass the 
bill

[[Page H6790]]

(H.R. 4531) to reauthorize certain programs that provide for opioid use 
disorder prevention, recovery, and treatment, and for other purposes, 
as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4531

       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

[[Page H6791]]

     ``$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:

[[Page H6792]]

       ``(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)'';

[[Page H6793]]

       (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

[[Page H6794]]

     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)''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Kentucky (Mr. Guthrie) and the gentleman from New Jersey (Mr. Pallone) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Kentucky.


                             General Leave

  Mr. GUTHRIE. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous material in the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Kentucky?
  There was no objection.
  Mr. GUTHRIE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today to speak in strong support of my bill, H.R. 
4531, the Support for Patients and Communities Reauthorization Act.
  Over the past 2 years, we have lost over 200,000 Americans to drug 
overdoses and poisonings. This is a step in the wrong direction, as the 
United States saw decreases in year-over-year drug overdoses between 
2018 and 2019.
  Tragically, our best efforts to drive down these overdose rates were 
disrupted by the COVID-19 pandemic, which left millions of Americans 
isolated and shuttered from support systems that helped those 
struggling with substance use disorder stay on track.
  These statistics show the policies and programs we enacted in 2018 
were working prior to the pandemic. However, since 2018 we have seen 
the horrors that illicit fentanyl and other illicit substances, like 
xylazine, have caused our local communities.
  In the past 3 years, over 70 percent of all drug overdoses in the 
Commonwealth of Kentucky have been the direct result of poisonings from 
fentanyl or fentanyl-related substances.
  Earlier this year, I convened an Energy and Commerce Health 
Subcommittee field hearing in Gettysburg, Pennsylvania, where we heard 
firsthand accounts from law enforcement and treatment providers about 
the harsh realities of the crisis.
  We heard the heart-wrenching testimony from Michael Straley, who lost 
daughter, Leah, a few years ago to fentanyl poisoning, underscoring the 
daily stresses of families with loved ones battling substance use 
disorder. That work has helped inform the bill before us today.
  We are reauthorizing important programs such as State-level 
prescription drug monitoring programs, residential treatment for 
pregnant and postpartum women, and other prevention, treatment, and 
recovery services.
  We are also placing xylazine into schedule III of the Controlled 
Substances Act, while maintaining access for veterinarians and ranchers 
to use in animals.
  Xylazine is an emerging lethal street drug that is a unique threat as 
it is not an opioid, and so it does not respond to FDA-approved opioid 
reversal medications.
  That said, H.R. 4531 provides even greater access for treatment 
providers to use Federal funds to purchase over-the-counter opioid 
overdose reversal medications, which we know have helped reduce opioid 
overdose rates in communities across the country.
  We are also building on important steps we took in 2018 to help those 
who rely on the Medicaid program access care.
  We are permanently requiring Medicaid programs to provide lifesaving 
medication-assisted treatment. We are permanently codifying the 
flexibility for States to waive outdated policies that prevent 
vulnerable individuals from seeking comprehensive wraparound and 
substance use disorder care. We are also assisting foster care youth by 
ensuring they do not lose their Medicaid services if they are receiving 
the behavioral care they need at qualified residential treatment 
programs.
  Finally, the legislation before us today promotes access to long-term 
recovery and support services like workforce training for individuals 
in recovery.
  In closing, Mr. Speaker, I thank my Democratic colleague, 
Representative

[[Page H6795]]

Ann Kuster, for her help on this important legislation and historical 
leadership on addressing the opioid crisis.
  I also thank all of my colleagues for working with us to ensure the 
policies of H.R. 4531 are fully offset, which was essential to ensuring 
this legislation could get to this point.
  Again, I thank my colleague from New Hampshire for working with me on 
this bill.
  Mr. Speaker, I urge my colleagues to vote ``yes'' on H.R. 4531, and I 
reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise to speak in support of H.R. 4531, the Support for 
Patients and Communities Reauthorization Act. This bill addresses the 
ongoing public health emergency posed by the opioid and overdose 
crisis.
  The opioid epidemic is still a tragic reality for millions of 
Americans and their families every day. Last year, nearly 110,000 
Americans died from a drug overdose.
  Five years ago, Congress worked to enact the SUPPORT Act, bipartisan 
legislation to address the opioid epidemic, and that legislation 
expanded access to treatment, invested in public health, and 
strengthened prevention efforts.
  Today, the nature of the opioid epidemic has changed. Where it was 
once illicit prescription drugs, now it is illicit fentanyl, its 
analogues, and xylazine that are claiming the lives of too many people 
every single day.
  H.R. 4531 builds on the success of existing law. It extends the 
programs that have worked, makes commonsense changes to the programs 
that need to be updated, and includes new policies designed to combat 
the new reality of the opioid epidemic.
  The bill before us today provides critical training to first 
responders, supports recovery centers, and helps individuals in 
recovery lead normal lives. It makes important investments in Medicaid 
to support the treatment of opioid use disorder.
  It requires all State Medicaid programs to cover medication-assisted 
treatment, expands access to coverage to pregnant women in pretrial 
detention, and makes it easier for incarcerated individuals to regain 
their coverage after being released.

  I must say, I am disappointed that we were not able to include 
several bipartisan policies that would ensure greater access to 
Medicaid for justice-involved populations, and I will continue to work 
to find a path forward on those provisions.
  Nevertheless, that said, the bill before us will make meaningful 
changes to Federal law that will strengthen our ability to respond to 
the ongoing opioid epidemic.
  Mr. Speaker, I thank Chairwoman Rodgers, Subcommittee Chairman 
Guthrie, and Subcommittee Ranking Member Eshoo for their hard work to 
advance this important bipartisan bill.
  Mr. Speaker, I urge my colleagues to support this legislation, and I 
reserve the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield 2 minutes to the distinguished 
gentlewoman from Washington (Mrs. Rodgers), who is the chair of the 
Energy and Commerce Committee.
  Mrs. RODGERS of Washington. Mr. Speaker, I rise today in support of 
the SUPPORT Act.
  This bill is about offering hope to those in despair: those battling 
substance use disorder, their families and loved ones, and the 
healthcare workers and law enforcement officers who need continued 
support to help save lives.
  Since 2020, overdose deaths have surged to more than 100,000 lives 
lost per year. Today, illicit fentanyl poisonings are now the number 
one cause of death among adults aged 18 to 49, and my home State of 
Washington has seen the greatest increase in drug overdose and 
poisoning deaths nationwide in the past year.
  The House took a critical step to help get illicit fentanyl off our 
streets by passing the HALT Fentanyl Act earlier this year. Now we are 
moving forward with this legislation to increase support for 
individuals suffering from substance use disorder and to help make sure 
they receive the treatment they need.

                              {time}  1645

  H.R. 4531, the Support for Patients and Communities Reauthorization 
Act modifies and reauthorizes key programs that expand access to 
substance use disorder prevention, treatment, and recovery.
  Specifically, this bill increases treatment options for intensive 
inpatient care, allows law enforcement to crack down on illicit 
xylazine distribution, and continues support for at-risk youth, among 
many other important provisions.
  Mr. Speaker, I thank Kristin Flukey and Seth Gold from the Energy and 
Commerce Committee staff for their dedicated work on this legislation. 
I am hopeful that by reauthorizing programs with proven success and 
increasing access to treatment, we can address the troubling trend in 
drug-related deaths, saving lives and restoring hope and healing to 
those who need it.
  Mr. PALLONE. Mr. Speaker, I yield 4 minutes to the gentleman from New 
York (Mr. Tonko), ranking member of our Environment Subcommittee.
  Mr. TONKO. Mr. Speaker, I appreciate the gentleman from New Jersey 
for yielding.
  Mr. Speaker, I rise today in support of this legislation. I thank my 
colleagues and friends, Representative Guthrie and Representative 
Kuster, for their work on the Support for Patients and Communities 
Reauthorization Act.
  As you may know, I serve as co-chair of the Addiction, Treatment, and 
Recovery Caucus, or better known as the ATR Caucus.
  The ATR Caucus is a bipartisan group of over 70 members committed to 
advancing bipartisan solutions to the country's multifaceted addiction 
crisis. Next year will mark the 20th anniversary of the caucus, the 
first in Congress to recognize that addiction, indeed, is a disease.
  As a longtime champion for those facing addiction, I am all too 
familiar with the devastating impact of the disease for individuals, 
their families, and their communities. This is a loss many of us know 
too well--the loss of a daughter, a son, a father, a mother, a sister, 
or brother. The loss of a neighbor dying much too young and leaving 
behind a grieving family and communities being ripped apart by poison 
seemingly beyond their control.
  Last year, in our Nation, there was an estimated 109,680 overdose 
deaths. That is 109,680 lives lost.
  Let's think of how many people that is every day needlessly dying and 
having their lives cut so short. Think of the magnitude of all those 
impacted by those 109,680 loved ones. For each of those individuals, 
there is a whole universe of friends, of family, and, of course, 
communities impacted.
  As we consider the SUPPORT Act reauthorization, let me share that 
clearly there are some good policies we are moving forward. I am glad 
that we are reauthorizing several programs that have been successful. I 
am pleased that we are including my Extending Access to Addiction 
Treatment Act that I was proud to work on with my friend, 
Representative Armstrong.
  As you may know, medication-assisted treatment for addiction 
significantly reduces the risk of overdose death. However, despite the 
effectiveness, approximately 87 percent of individuals with opioid use 
disorder who may benefit from lifesaving medication-assisted treatment 
simply do not receive it.
  My Extending Access to Addiction Treatment Act makes permanent the 
requirement that Medicaid provide coverage for addiction medication for 
Americans who need it. I also think we are taking a step in the right 
direction by requiring States to suspend rather than terminate coverage 
of Medicaid for justice-involved individuals making it easier to 
restart those benefits upon release.
  We also include a provision to allow pregnant incarcerated 
individuals who are being detained pretrial to maintain their Medicaid 
coverage. I fully support the legislation and remind everyone that we 
have a lot more work to do in order to take the necessary steps to 
address the deep need of this crisis.
  We all know the scale of the devastating disease of addiction. We 
also know that our justice system is a revolving door for those 
struggling with addiction and mental health issues. Over one-half of 
people in State prisons and two-thirds of individuals in jails have 
substance use disorder, or SUD.
  To truly address it, I urge us to take bold action and move forward 
as soon

[[Page H6796]]

as possible with the Reentry Act and the Due Process Continuity of Care 
Act. By allowing inmates to receive addiction treatment and other 
services before returning home, my Reentry Act would bring targeted 
treatment to those at the highest risk of overdose.
  The Reentry Act would be a game changer for reducing overdose deaths 
and suicides by allowing all States to provide prerelease care to 
Medicaid-eligible individuals up to 30 days prior to release from 
incarceration.
  The Due Process Continuity of Care Act would make certain that 
pretrial detainees are not kicked off Medicaid prior to even being 
found guilty of a crime.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. PALLONE. Mr. Speaker, I yield an additional 30 seconds to the 
gentleman from New York.
  Mr. TONKO. Mr. Speaker, we know the human cost of inaction. To be 
precise, last year it was 109,680 lives we lost. Is that a cost we are 
willing to bear?
  With that in mind, our work is not done, and I hope we can find the 
will to truly meet the moment.
  This legislation is a good step forward, but it is not the end of the 
road. Again, this disease of despair requires hope, and we can provide 
that hope to the individuals who look to us to be the agents of that 
hope.
  Mr. Speaker, again, I would urge my colleagues to support this bill.
  Mr. GUTHRIE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Florida (Mr. Bilirakis).
  Mr. BILIRAKIS. Mr. Speaker, I thank the chairman for his 
extraordinary work and the chairperson for her extraordinary work on 
this particular bill.
  Mr. Speaker, I rise today in favor of H.R. 4531, the SUPPORT for 
Patients and Communities Reauthorization Act.

  This bipartisan package reflects dozens of bills to reauthorize and 
strengthen critical opioid and substance abuse treatment and prevention 
policies, including four bills I lead with my bipartisan colleagues, 
such as the Combating Illicit Xylazine Act that I co-lead with 
Representative Pfluger and others.
  Our bill will provide permanent schedule III penalties for human use 
of the animal tranquilizer drug xylazine, which is sadly being laced 
into fentanyl, leading to horrific side effects that is killing our 
constituents.
  This is a public health crisis that our bill urgently addresses, all 
while preserving legitimate veterinary use for our farming community.
  This package also contains my bill, the SWIFT Detection Act, which 
updates our methods to track fentanyl, identify public health trends, 
and better target relief using privacy-preserving wastewater 
surveillance.
  Finally, the bill will also remove Medicaid's IMD exclusion to 
permanently provide coverage of treatment services for substance use 
disorder, as well as language from my bipartisan bill with 
Representative Castor of Florida, H.R. 4056, the Ensuring Medicaid 
Continuity for Children in Foster Care Act, which provides coverage for 
services for foster youth children staying in qualified residential 
treatment programs, struggling with serious mental and behavioral 
health needs.
  These are just a few of the many policies that address and provide 
relief for opioid abuse in our communities around the country.
  Mr. Speaker, I thank Chairman Guthrie and Chairman Rodgers and 
Representative Pallone, the ranking member, for their tireless efforts 
on this bill, and I urge my colleagues to support H.R. 4531.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
New Hampshire (Ms. Kuster), member of the Energy and Commerce 
Committee.
  Ms. KUSTER. Mr. Speaker, I rise today to urge my colleagues to vote 
in favor of the SUPPORT Act, comprehensive bipartisan legislation to 
address the overdose crisis across this country.
  In 2022, nearly 110,000 Americans died because of substance use 
disorder or overdose. No community in this country is immune to this 
crisis. As we head into the holidays, thousands of families will have 
an empty seat at their table. We can and must do more to help save 
lives, expand access to treatment, and address the substance use 
disorder crisis. That is why passing the SUPPORT Act is so critical.
  While I wish this legislation had been passed earlier this year 
before these programs expired, I am pleased that the House is now 
taking up this legislation to reauthorize the SUPPORT Act and to ensure 
that local communities nationwide have the tools to address substance 
use disorder at the local level.
  Tackling the overdose crisis requires an all-of-the-above approach. I 
hope this legislation can serve as a building block to strengthen our 
national approach to this crisis and help save lives.
  Mr. Speaker, I thank Chairman Guthrie and his team for his 
partnership to get this over the finish line. I urge my colleagues on 
both sides of the aisle to support this important legislation and to 
work with us to address this crisis.
  Mr. GUTHRIE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Indiana (Mr. Bucshon).
  Mr. BUCSHON. Mr. Speaker, I rise today in favor of H.R. 4531, the 
Support for Patients and Communities Reauthorization Act.
  I was exceedingly proud to work on the SUPPORT Act when it was first 
passed in 2018 in response to the opioid crisis.
  The legislation brought about many positive changes, but substance 
abuse and addiction continue to threaten individuals and communities in 
every congressional district across the country and across all 
socioeconomic classes.
  With over 100,000 drug overdose deaths in the U.S. last year alone, 
we must continue working to increase access to, and availability of, 
lifesaving treatments and recovery services.
  I am particularly happy to be reauthorizing the CORC, or 
Comprehensive Opioid Recovery Centers program, which will directly 
affect my home State of Indiana.
  Regrettably, per capita rates of drug overdose deaths in the Hoosier 
State are higher than the national average. The CORC program helps 
coordinate the targeted resources available for those who need help 
overcoming opioid use disorder.
  Mr. Speaker, I urge all of my colleagues to vote ``yes'' on this 
critical piece of legislation.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Texas (Ms. Crockett).
  Ms. CROCKETT. Mr. Speaker, every Member here likely knows at least 
one family in their district whose life has been impacted by someone 
struggling with addiction.

  This comes at a time where companies are also now trying to use the 
courts to avoid liability and escape having to compensate families for 
their role in targeting communities and peddling pills all in the name 
of increasing profits.
  Addiction is painful and it is dangerous. It is a dangerous struggle 
that too many Americans suffer from. Today, this illness is exacerbated 
by the prevalence of fentanyl. Fentanyl is 50 percent stronger than 
heroin and 100 times stronger than morphine. Because people can't see, 
taste, or smell it, those struggling with addiction don't even know 
when they are putting their life at risk.
  To be clear, fentanyl is one of the leading causes of overdose-
related deaths today. Now, more than ever, we need to attack this 
problem from a holistic approach. This is coming from, again, the 
gentlewoman from the State of Texas. We know that there is not just a 
one-trick pony on this. We have got to make sure that we address this 
side of it, as well as our struggles at the border.
  Not only do we need more technology at our points of entry to 
interdict fentanyl, but we will also need to give our constituents the 
necessary tools to know whether or not they are about to subject 
themselves to fentanyl. One way to do this is to arm them with fentanyl 
testing strips.
  I am grateful to Representative Gooden, my Republican co-lead, for 
supporting my bill, the Test Strip Access Act, to Senators Hassan and 
Cornyn for introducing it in the Senate, and to the Energy and Commerce 
Committee for incorporating it into the SUPPORT reauthorization.
  My bill will allow fentanyl and xylazine testing strips to be 
purchased

[[Page H6797]]

under the overdose prevention programs grants. Access to these testing 
strips can literally mean the difference between life and death.
  Accordingly, I urge my colleagues to vote in favor of the SUPPORT Act 
so we can give our constituents the tools to be safe and ultimately get 
them the help they desperately need to treat their illness.

                              {time}  1700

  Mr. GUTHRIE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Georgia (Mr. Carter), my good friend.
  Mr. CARTER of Georgia. Mr. Speaker, I rise today in strong support of 
the Support for Patients and Communities Reauthorization Act, which 
reauthorizes important programs that bolster prevention, treatment, and 
recovery services for Americans with substance use disorders and mental 
illnesses.
  Mr. Speaker, it is no secret that the opioid and mental health crises 
are continuing to tear our families and communities apart. In 2022, a 
record number of our sons' and daughters' lives were taken by opioid 
overdoses, the majority of which were caused by illicit fentanyl 
poisoning.
  Every day we are losing almost 300 Americans as a result of drug 
overdoses and poisonings. This is impacting every single one of us in 
the communities we call home. Fortunately, we have an opportunity here 
today to pass one of the single largest congressional efforts to 
address our opioid and mental health crises.
  The SUPPORT Act is responsible for increasing access to prevention, 
treatment, and recovery services for opioid and substance use 
disorders, including fentanyl.
  Another important part of this legislation is making opioid overdose 
reversal agents, like naloxone, easier to obtain. The SUPPORT Act also 
includes my Responsible Mental Health Medications Prescribing Act, 
which standardizes the oversight and reporting of antipsychotic 
medications prescribed to Medicaid recipients.
  This reauthorization ensures that programs supporting our most 
vulnerable Americans do not lapse and can reach all communities. I urge 
my colleagues to support the reauthorization of this bill, which will 
help save lives and help us fight the opioid crisis.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. GUTHRIE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Texas (Mr. Pfluger), my good friend.
  Mr. PFLUGER. Mr. Speaker, I thank Chair Guthrie, as well as Chair 
Rodgers for their work on this bill. I rise in strong support of H.R. 
4531, the Support for Patients and Communities Reauthorization Act, the 
SUPPORT Act.
  Looking back, it was originally created in 2018 as a significant 
investment in overdose prevention. There is an urgent need to actually 
reauthorize the SUPPORT Act, with nearly 110,000 annual overdose deaths 
in this country last year. This reauthorization ensures that 
individuals seeking assistance for substance use disorders have access 
to critical lifesaving treatments, recovery support services, 
prevention programming, and long-term recovery services.
  I draw attention to an emerging public health concern addressed by 
this legislation, the illicit use of xylazine. Xylazine is a veterinary 
tranquilizer that has become drug traffickers' preferred substance for 
cutting fentanyl. Xylazine's current ease of access--as it can just be 
purchased online for as little as $6 per kilogram--directly threatens 
our communities.
  DEA Administrator Milgram warned that ``Xylazine is making the 
deadliest drug threat our country has ever faced, fentanyl, even 
deadlier.''
  To counter this growing threat, the bill proposes scheduling illicit 
xylazine under schedule III of the Controlled Substances Act, while 
safeguarding--and this is important--crucial access for veterinary use 
and the livestock industry.
  The fentanyl crisis has already inflicted severe damage on treatment 
clinics and public health agencies throughout our entire country. 
Adding another highly toxic substance to the illicit drug supply only 
intensifies the crisis. Congress must take action against this emerging 
threat.
  I am pleased that the SUPPORT Act builds upon the collaboration of 
Congressman Panetta and I with the agricultural and veterinary 
industries and law enforcement to ensure this legislation cracks down 
on illicit uses of xylazine while preserving its critical role within 
agriculture and veterinary medicine.
  I urge my colleagues to support the SUPPORT Act. This is not just 
legislation. It is a response to help save lives within our 
communities.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time. I may have one more speaker, but they are not here at this time.
  Mr. GUTHRIE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Iowa (Mr. Nunn), my friend.
  Mr. NUNN of Iowa. Mr. Speaker, I rise in support of the Support for 
Patients and Communities Reauthorization Act, which includes my 
bipartisan Communities of Recovery Reauthorization Act with the 
gentlewoman from Colorado (Ms. Pettersen).
  Communities across this country are struggling with the opioid 
epidemic. More than 60 million Americans are fighting substance abuse 
disorders. These are our families, friends, and America's sons and 
daughters. Tragically, death due to overdoses are skyrocketing, with 
more than 150 citizens dying every day. That is why we must work 
together to help pass this bill.
  There is no doubt that we must do more to stop the illegal flow of 
fentanyl and other drugs into our country--fentanyl made in China and 
arriving on U.S. shores daily.
  We can do much to help right here at home. By passing this critical 
legislation, we will enhance support for community organizations that 
are on the front line, helping people recover from addiction and return 
to their communities and families through the use of rehabilitation 
programs.
  This is not a battle that anyone should have to fight alone. I urge 
my colleagues to lead with compassion and vote for this critical 
bipartisan piece of legislation and start saving lives today.
  Mr. PALLONE. Mr. Speaker, I yield myself the balance of my time.
  This is very important in the ongoing efforts of our committee to 
continue the battle against opiates and other related illicit drugs 
that are very dangerous. The number of overdoses, unfortunately, 
continues to be way out of proportion to what it should be. We need to 
support this bill and other measures that deal with this crisis that 
continues to plague the American people.

  Mr. Speaker, I yield back the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I appreciate the chair of the committee, the ranking 
member, and the gentlewoman from New Hampshire (Ms. Kuster) all working 
together to solve this problem which every American family is facing or 
knows of someone or has some relation to someone who is. This touches 
everybody far and wide, urban and rural, suburbs and small towns. 
Particularly in my home State, the Commonwealth of Kentucky, we have 
really had families just devastated by this.
  We have to close the border. We have to get a handle on what is 
coming across the border. We have to make sure that we have things in 
place to prevent people from bringing these to our young people and 
adults. We are here today, though, to make sure those who have this 
substance use disorder have access to proper care, the opportunity to 
not just recover, but to have full and productive lives.
  We believe that on both sides of the aisle, and we have worked 
together for this. I urge my colleagues to vote ``yes,'' and I yield 
back the balance of my time.
  The SPEAKER pro tempore (Mr. Cloud). The question is on the motion 
offered by the gentleman from Kentucky (Mr. Guthrie) that the House 
suspend the rules and pass the bill, H.R. 4531, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. GUTHRIE. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

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