[Congressional Record Volume 170, Number 113 (Tuesday, July 9, 2024)]
[Senate]
[Pages S4283-S4285]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 2083. Ms. CANTWELL (for herself and Mr. Cassidy) submitted an 
amendment intended to be proposed by her to the bill S. 4638, to 
authorize appropriations for fiscal year 2025 for military activities 
of the Department of Defense, for military construction, and for 
defense activities of the Department of Energy, to prescribe military 
personnel strengths for such fiscal year, and for other purposes; which 
was ordered to lie on the table; as follows:

       At the end of subtitle H of title X, add the following:

     SEC. 1095. HEALTH ENGAGEMENT HUB DEMONSTRATION PROGRAM UNDER 
                   MEDICAID.

       (a) In General.--Section 1903 of the Social Security Act 
     (42 U.S.C. 1396b) is amended by adding at the end the 
     following new subsection:
       ``(cc) Health Engagement Hub Demonstration Program.--
       ``(1) Authority.--The Secretary shall conduct a 
     demonstration program (referred to in this subsection as the 
     `demonstration program') for the purpose of increasing access 
     to treatment for opiate use disorder and other drug use 
     treatment through the establishment of Health Engagement Hubs 
     that meet the criteria published by the Secretary under 
     paragraph (2)(A).
       ``(2) Publication of guidance.--Not later than 6 months 
     after the date of enactment of this subsection, the Secretary 
     shall publish the following:
       ``(A) Certification criteria.--The criteria described in 
     paragraph (3) for an organization to be certified by a State 
     as a Health Engagement Hub for purposes of participating in 
     the demonstration program.
       ``(B) Prospective payment system.--Guidance for States 
     selected to participate in the demonstration program to use 
     to establish a prospective payment system for services 
     permitted under paragraph (3)(B) that are provided by a 
     certified Health Engagement Hub participating in the 
     demonstration program.
       ``(3) Criteria for certification of health engagement 
     hubs.--
       ``(A) General requirements.--In order to be certified as a 
     Health Engagement Hub, an organization shall--
       ``(i) demonstrate that the organization is able to serve as 
     an all-in-one location where individuals who are eligible for 
     medical assistance under a State plan under this title or 
     under a waiver of such plan who seek treatment for opiate use 
     disorder or other drug use may access a range of social and 
     medical services, in a drop-in manner and without prior 
     appointment or proof of payment;
       ``(ii) provide the services specified in subparagraph (B) 
     (in a manner reflecting person-centered care) which, if not 
     available directly through the organization, shall be 
     provided through formal relationships with other providers;
       ``(iii) demonstrate that in selecting the location for the 
     Health Engagement Hub, the organization prioritized placement 
     in communities disproportionately impacted by overdose, 
     health issues, and other harms related to drug use, as well 
     as areas that are medically underserved, rural, 
     geographically isolated areas, tribal areas, or urban centers 
     with under-resourced behavioral health infrastructure, 
     including disadvantaged communities based on race, 
     individuals experiencing homelessness, and communities 
     negatively impacted by the criminal-legal system;
       ``(iv) give priority to establishing or adopting evidence-
     based models to increase engagement or improve outcomes for 
     individuals with active, ongoing substance use, such as 
     social work empowerment models approved by the Secretary, 
     motivational interviewing models approved by the Secretary, 
     or shared decision making models approved by the Secretary; 
     and
       ``(v) meet--

       ``(I) the minimum staffing requirements described in 
     subparagraph (C);
       ``(II) the experience requirement described in subparagraph 
     (D); and
       ``(III) the community advisory board requirement described 
     in subparagraph (E).

       ``(B) Scope of services.--The services specified in this 
     subparagraph are the following:
       ``(i) Required services.--

       ``(I) Harm reduction services and supplies provided 
     directly by the organization or under an arrangement with an 
     organization that offers harm reduction services (which may 
     include a syringe service program, a Federally-qualified 
     health center, a community health center, a Tribal health 
     program, or an opioid treatment program that offers such 
     services), that include--

       ``(aa) overdose education and naloxone distribution;
       ``(bb) safer drug use education and supplies;
       ``(cc) safer-sex supplies;
       ``(dd) emotional support and counseling services to reduce 
     harms associated with substance use, including trauma-
     informed care; and
       ``(ee) access or referral to medications and drugs approved 
     by the Food and Drug Administration for treatment of opioid 
     use disorder with a strong evidence base of significantly 
     reducing mortality (such as methadone and buprenorphine) and 
     other substances, including stimulants, within 4 hours.

       ``(II) Substance use disorder screening and brief 
     intervention.

[[Page S4284]]

       ``(III) Patient-centered and patient-driven physical and 
     behavioral health care that has walk-in availability, is 
     offered during non-traditional hours, including evenings and 
     weekends, and includes--

       ``(aa) shared decision making for patients and providers 
     for opioid use disorder, stimulant use disorder, or both, 
     under which a patient and provider discuss the patient's 
     diagnosis and condition together and evaluate treatment 
     options together;
       ``(bb) primary mental health and substance use disorder 
     services, including screening, assessment, and referrals to 
     higher levels of care;
       ``(cc) wound care;
       ``(dd) infectious disease vaccination, screening, testing, 
     and, to the extent practicable, treatment (including for HIV, 
     sexually transmitted infections, and hepatitis testing and 
     treatment);
       ``(ee) access or referral to sexual and reproductive health 
     services;
       ``(ff) assessment and linkage or referrals to psychiatric 
     services and other specialty care; and
       ``(gg) secure medication storage and inventory policies and 
     procedures for patients experiencing homelessness or housing 
     insecurity.

       ``(IV) Care coordination, complex case management, and 
     other case management, care navigation, and care coordination 
     services that may include--

       ``(aa) education and assistance with obtaining housing, 
     transportation, and other public assistance benefits, 
     including enrollment in the State plan under this title or 
     under a waiver of such plan;
       ``(bb) identification services (such as assistance with 
     obtaining a government-recognized form of identification);
       ``(cc) employment counseling;
       ``(dd) recovery support counseling;
       ``(ee) family reunification services; and
       ``(ff) criminal-legal services.

       ``(V) All services that may be provided under the Outreach 
     Site/Street Place of Service code (POS Code 27 as of October 
     1, 2023) (or a successor place of service code).
       ``(VI) Community health outreach and navigation services to 
     engage with and conduct outreach to community members that is 
     provided by outreach and engagement staff described in 
     subparagraph (C)(i)(IV).

       ``(ii) Optional services.--

       ``(I) Services and supplies to meet basic needs, including 
     food, clothing, and hygiene supplies.
       ``(II) Evidence-based and culturally appropriate behavioral 
     health services.
       ``(III) Medication management for physical and mental 
     health conditions.

       ``(C) Minimum staffing requirements.--
       ``(i) In general.--The minimum staffing requirements 
     specified in this subparagraph are the following:

       ``(I) At least 1 part-time or full-time health care 
     provider who is licensed to practice in the State and is 
     licensed, registered, or otherwise permitted, by the United 
     States to prescribe controlled substances (as defined in 
     section 102 of the Controlled Substances Act) in the course 
     of professional practice.
       ``(II) At least 1 part-time or full-time registered 
     professional nurse or licensed practical nurse who can 
     provide medication management, medical case management, care 
     coordination, wound care, vaccine administration, and 
     community-based outreach.
       ``(III) At least 1 part-time or full-time licensed 
     behavioral health staff who is qualified to assess and 
     provide counseling and treatment recommendations for 
     substance use and mental health diagnoses.
       ``(IV) Full-time outreach, engagement, and ongoing care 
     navigation staff, including peer counselors, community health 
     workers, and recovery coaches. At least 50 percent of such 
     staff shall be individuals with a personal history of drug 
     use.

       ``(ii) Staffing through arrangements with partner 
     agencies.--An organization may enter into an arrangement with 
     a partner agency, such as a Federally-qualified health 
     center, to satisfy the minimum staffing requirements 
     specified in clause (i).
       ``(D) Experience.--An organization shall have a 
     demonstrated history of at least 12 months of service 
     provision to individuals who use drugs, including those who 
     continue with substance use while receiving health and social 
     services.
       ``(E) Community advisory board.--An organization shall have 
     a community advisory board composed of individuals with a 
     history of substance use, or who continue with substance use, 
     that meets, at a minimum, on--
       ``(i) a monthly basis, to review program utilization data 
     and provide feedback to the organization; and
       ``(ii) on a quarterly basis, with the executives or board 
     of directors of the organization to provide input on service 
     delivery and receive feedback on actions taken based on 
     previous feedback provided by the community advisory board.
       ``(4) Planning grants.--
       ``(A) In general.--Not later than 1 year after the date of 
     enactment of this subsection, the Secretary shall award 
     planning grants to States for the purpose of developing 
     proposals to participate in the demonstration program.
       ``(B) Amount of grant.--The amount of a grant awarded to a 
     State under this paragraph shall be sufficient to pay 100 
     percent of the actual costs expended by a State to carry out 
     the activities required under subparagraph (C).
       ``(C) Use of funds.--A State awarded a planning grant under 
     this paragraph shall solicit input on the development of a 
     proposal to participate in the demonstration program from 
     patients, providers, harm reduction service providers, social 
     service providers, and other stakeholders, with respect to--
       ``(i) identifying and certifying organizations as Health 
     Engagement Hubs for purposes of participating in the 
     demonstration program; and
       ``(ii) establishing a prospective payment system for 
     services provided by a certified Health Engagement Hub 
     participating in the demonstration program, in accordance 
     with the guidance issued under paragraph (2)(B).
       ``(D) Funding.--Out of any funds in the Treasury not 
     otherwise appropriated, there are appropriated to the 
     Secretary such sums as are necessary to carry out this 
     paragraph, to remain available until expended.
       ``(5) State demonstration programs.--
       ``(A) In general.--Not later than 2 years after the date of 
     enactment of this subsection, the Secretary shall solicit 
     applications solely from the States awarded a planning grant 
     under paragraph (4) to participate in the demonstration 
     program.
       ``(B) Application requirements.--An application to 
     participate in the demonstration program shall include the 
     following:
       ``(i) A description of, including the estimated number of 
     individuals in, the target population to be served by the 
     State under the demonstration program.
       ``(ii) An assurance that at least \1/2\ of the Health 
     Engagement Hubs in the State shall be located in--

       ``(I) a county (or a municipality, if not contained within 
     any county) where the mean drug overdose death rate per 
     100,000 people over the past 3 years for which official data 
     is available from the State, is higher than the most recent 
     available national average overdose death rate per 100,000 
     people, as reported by the Centers for Disease Control and 
     Prevention; or
       ``(II) an area of the State that is designated under 
     section 332(a)(1)(A) of the Public Health Service Act as a 
     mental health professional shortage area.

       ``(iii) A description of the prospective payment system 
     that is to be tested under the demonstration program.
       ``(iv) A list of the certified Health Engagement Hubs 
     located in the State that will participate in the 
     demonstration program.
       ``(v) Verification that each such certified Health 
     Engagement Hub satisfies the requirements described in 
     paragraph (3)(A).
       ``(vi) A description of the scope of the services that will 
     be paid for under the prospective payment system (which 
     includes at a minimum the required services described in 
     paragraph (3)(B)(i)) that is to be tested under the 
     demonstration program.
       ``(vii) Verification that the State has agreed to pay for 
     such services at the at the rate established under the 
     prospective payment system.
       ``(viii) Any other information that the Secretary may 
     require relating to the demonstration program with respect to 
     determining the soundness of the proposed prospective payment 
     system.
       ``(C) Selection criteria.--
       ``(i) In general.--The Secretary shall select from among 
     the applications submitted at least 10 States to participate 
     in the demonstration program based on geographic and 
     demographic diversity.
       ``(ii) Priority.--In addition to the criteria specified in 
     clause (i), the Secretary shall prioritize selecting States 
     with the highest rates of opioid- or stimulant-involved 
     overdose death rates.
       ``(D) Length of demonstration programs.--A State selected 
     to participate in the demonstration program shall participate 
     in the program for a 2-year period.
       ``(E) Waiver of certain requirements.--The Secretary shall 
     waive section 1902(a)(1) (relating to statewideness), section 
     1902(a)(10)(B) (relating to comparability), and any other 
     provision of this title which would be directly contrary to 
     the authority under this subsection as may be necessary for a 
     State to participate in the demonstration program in 
     accordance with this paragraph.
       ``(F) Payments to states.--
       ``(i) In general.--The Secretary shall pay a State 
     participating in the demonstration program the Federal 
     matching percentage specified in clause (ii) for amounts 
     expended by the State for medical assistance for services 
     provided through certified Health Engagement Hubs to 
     individuals enrolled under the State plan (or under a waiver 
     of such plan) consisting of medications and drugs approved by 
     the Food and Drug Administration for treatment of opioid use 
     disorder and other substances, including stimulants, and the 
     services specified by the State in its application under 
     subparagraph (B)(vi), at the rate established under the 
     prospective payment system established by the State for 
     purposes of the demonstration program.
       ``(ii) Federal matching percentage.--The Federal matching 
     percentage specified in this clause is--

       ``(I) with respect to medical assistance described in 
     clause (i) that is furnished to a newly eligible individual 
     described in paragraph (2) of section 1905(y), the matching 
     rate applicable under paragraph (1) of that section; and
       ``(II) with respect to medical assistance described in 
     clause (i) that is furnished to an individual who is not a 
     newly eligible individual (as so described), but who is 
     eligible for medical assistance under the State plan under 
     this title or under a waiver of such

[[Page S4285]]

     plan, the enhanced FMAP applicable to the State under section 
     2105(b).

       ``(iii) Application.--Payments to States made under this 
     subparagraph shall be considered to have been made under, and 
     are subject to, the requirements of this section.
       ``(6) Reports.--
       ``(A) Annual state reports.--
       ``(i) In general.--Each State selected to participate in 
     the demonstration program under paragraph (5) shall submit an 
     annual report to the Secretary on the demonstration program 
     that includes the following:

       ``(I) An assessment of the extent to which Health 
     Engagement Hubs funded under the demonstration program have 
     increased access to treatment for opiate use disorder and 
     other drug use treatment, health services for individuals who 
     use drugs, and other social services under State plans under 
     this title or under waivers of such plans in the area or 
     areas of States targeted by the demonstration program 
     compared to other areas of the State.
       ``(II) An assessment on the impact of Health Engagement 
     Hubs on reducing opioid and stimulant overdose mortality 
     rates and the rate of adherence to prescribed medication for 
     opioid use, hospitalization rates, and housing status for the 
     population served by a Health Engagement Hub as compared to 
     populations that are not served by a Health Engagement Hub.
       ``(III) A description of the successes of the demonstration 
     program.
       ``(IV) Recommendations for improvements to the 
     demonstration program, including whether the demonstration 
     program should be continued, expanded, modified, or 
     terminated.

       ``(ii) Funding.--Out of any funds in the Treasury not 
     otherwise appropriated, there are appropriated such sums as 
     are necessary, to remain available until expended, for 
     purposes of making payments to States for expenditures 
     attributable to collecting and reporting the information 
     required under this subparagraph.
       ``(B) Reports to congress.--
       ``(i) In general.--The Secretary shall submit an annual 
     report to Congress that describes the information, findings, 
     and recommendations in the annual State reports submitted to 
     the Secretary under subparagraph (A).
       ``(ii) Implementation evaluation results.--The Secretary 
     shall include with the first 3 annual reports submitted by 
     the Secretary under this subparagraph the findings and 
     conclusions of the implementation evaluation required by 
     paragraph (7).
       ``(7) Implementation evaluation.--
       ``(A) In general.--The Secretary shall solicit public input 
     and fund an implementation evaluation of the planning grants 
     awarded under paragraph (4) and the initial set of States 
     selected for the demonstration program under paragraph (5) to 
     determine the reach, effectiveness, adoption, and 
     implementation of the demonstration program in each such 
     State to document the degree to which the services were 
     implemented as intended and allow for a complete assessment 
     of the impact of the Health Engagement Hubs in each such 
     State.
       ``(B) Requirements.--
       ``(i) Information.--The evaluation shall include 
     information on the characteristics of the individuals who 
     receive services, service utilization metrics over time 
     (including by staff role), and input from interviews with 
     such individuals and staff.
       ``(ii) Eligible entities.--In order to be eligible to 
     conduct the evaluation, an entity shall have documented 
     experience conducting implementation evaluations of health 
     and social services programs for individuals who use drugs.
       ``(C) Funding.--Out of any funds in the Treasury not 
     otherwise appropriated, there are appropriated to the 
     Secretary such sums as are necessary to carry out this 
     paragraph, to remain available until expended.''.
       (b) Government Accountability Office Report.--
       (1) In general.--Not later than 6 months after the 
     conclusion of the demonstration program established under 
     subsection (cc) of section 1903 of the Social Security Act 
     (42 U.S.C. 1396b), as added by subsection (a), the 
     Comptroller General of the United States shall conduct and 
     publish a comparative analysis on the impacts of the health 
     engagement hubs certified under such program (in this section 
     referred to as ``health engagement hubs'') compared to the 
     impacts of other opioid treatment programs and health care 
     organizations that offer behavioral health care or substance 
     use disorder services.
       (2) Content of analysis.--The analysis required under this 
     section shall include the following:
       (A) Data and information analyzing differences in rates 
     among individuals who receive behavioral health care or 
     substance use disorder services through a health engagement 
     hub and among individuals who receive such care or services 
     through a program or organization referred to in paragraph 
     (1) for each of the following factors:
       (i) Changes in rates of mortality.
       (ii) Changes in rates of recidivism.
       (iii) Rates of relapse.
       (iv) Rates of hospital and emergency department 
     utilization.
       (v) Frequency of visits for care or services.
       (vi) Rates of successful intervention through the 
     administration of buprenorphine or other medication approved 
     by the Food and Drug Administration for the treatment of 
     substance use disorder.
       (B) Data and information comparing the racial and 
     socioeconomic demographics, housing status, employment, and 
     other metrics, as recommended by the Secretary of Health and 
     Human Services, of the population groups that receive 
     behavioral health care or substance use disorder services 
     through a health engagement hub or through a program or 
     organization referred to in paragraph (1).
                                 ______