[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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