[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).
______