[House Report 117-149]
[From the U.S. Government Publishing Office]


117th Congress    }                                   {        Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                   {       117-149

======================================================================



 
         STATE OPIOID RESPONSE GRANT AUTHORIZATION ACT OF 2021

                                _______
                                

October 19, 2021.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 2379]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 2379) to amend the 21st Century Cures Act to 
reauthorize and expand a grant program for State response to 
the opioid use disorders crisis, and for other purposes, having 
considered the same, reports favorably thereon with an 
amendment and recommends that the bill as amended do pass.

                                CONTENTS

                                                                    Page
   I. Purpose and Summary............................................. 4
  II. Background and Need for the Legislation......................... 4
 III. Committee Hearings.............................................. 5
  IV. Committee Consideration......................................... 6
   V. Committee Votes................................................. 6
  VI. Oversight Findings.............................................. 6
 VII. New Budget Authority, Entitlement Authority, and Tax Expenditure 6
VIII. Federal Mandates Statement...................................... 6
  IX. Statement of General Performance Goals and Objectives........... 7
   X. Duplication of Federal Programs................................. 7
  XI. Committee Cost Estimate......................................... 7
 XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits..... 7
XIII. Advisory Committee Statement.................................... 7
 XIV. Applicability to Legislative Branch............................. 7
  XV. Section-by-Section Analysis of the Legislation.................. 7
 XVI. Changes in Existing Law Made by the Bill, as Reported........... 8

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``State Opioid Response Grant 
Authorization Act of 2021''.

SEC. 2. GRANT PROGRAM FOR STATE AND TRIBAL RESPONSE TO OPIOID AND 
                    STIMULANT USE AND MISUSE.

  Section 1003 of the 21st Century Cures Act (42 U.S.C. 290ee-3 note) 
is amended to read as follows:

``SEC. 1003. GRANT PROGRAM FOR STATE AND TRIBAL RESPONSE TO OPIOID AND 
                    STIMULANT USE AND MISUSE.

  ``(a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the `Secretary') shall carry out the 
grant program described in subsection (b) for purposes of addressing 
opioid and stimulant use and misuse, within States, Indian Tribes, and 
populations served by Tribal organizations and Urban Indian 
organizations.
  ``(b) Grants Program.--
          ``(1) In general.--Subject to the availability of 
        appropriations, the Secretary shall award grants to States, 
        Indian Tribes, Tribal organizations, and Urban Indian 
        organizations for the purpose of addressing opioid and 
        stimulant use and misuse, within such States, such Indian 
        Tribes, and populations served by such Tribal organizations and 
        Urban Indian organizations, in accordance with paragraph (2).
          ``(2) Minimum allocations; preference.--In determining grant 
        amounts for each recipient of a grant under paragraph (1), the 
        Secretary shall--
                  ``(A) ensure that each State receives not less than 
                $4,000,000; and
                  ``(B) give preference to States, Indian Tribes, 
                Tribal organizations, and Urban Indian organizations 
                whose populations have an incidence or prevalence of 
                opioid use disorders or stimulant use or misuse that is 
                substantially higher relative to the populations of 
                other States, other Indian Tribes, Tribal 
                organizations, or Urban Indian organizations, as 
                applicable.
          ``(3) Formula methodology.--
                  ``(A) In general.--Before publishing a funding 
                opportunity announcement with respect to grants under 
                this section, the Secretary shall--
                          ``(i) develop a formula methodology to be 
                        followed in allocating grant funds awarded 
                        under this section among grantees, which 
                        includes performance assessments for 
                        continuation awards; and
                          ``(ii) not later than 30 days after 
                        developing the formula methodology under clause 
                        (i), submit the formula methodology to--
                                  ``(I) the Committee on Energy and 
                                Commerce and the Committee on 
                                Appropriations of the House of 
                                Representatives; and
                                  ``(II) the Committee on Health, 
                                Education, Labor, and Pensions and the 
                                Committee on Appropriations of the 
                                Senate.
                  ``(B) Report.--Not later than two years after the 
                date of the enactment of the State Opioid Response 
                Grant Authorization Act of 2021, the Comptroller 
                General of the United States shall submit to the 
                Committee on Health, Education, Labor, and Pensions of 
                the Senate and the Committee on Energy and Commerce of 
                the House of Representatives a report that--
                          ``(i) assesses how grant funding is allocated 
                        to States under this section and how such 
                        allocations have changed over time;
                          ``(ii) assesses how any changes in funding 
                        under this section have affected the efforts of 
                        States to address opioid or stimulant use or 
                        misuse; and
                          ``(iii) assesses the use of funding provided 
                        through the grant program under this section 
                        and other similar grant programs administered 
                        by the Substance Abuse and Mental Health 
                        Services Administration.
          ``(4) Use of funds.--Grants awarded under this subsection 
        shall be used for carrying out activities that supplement 
        activities pertaining to opioid and stimulant use and misuse, 
        undertaken by the State agency responsible for administering 
        the substance abuse prevention and treatment block grant under 
        subpart II of part B of title XIX of the Public Health Service 
        Act (42 U.S.C. 300x-21 et seq.), which may include public 
        health-related activities such as the following:
                  ``(A) Implementing prevention activities, and 
                evaluating such activities to identify effective 
                strategies to prevent substance use disorders.
                  ``(B) Establishing or improving prescription drug 
                monitoring programs.
                  ``(C) Training for health care practitioners, such as 
                best practices for prescribing opioids, pain 
                management, recognizing potential cases of substance 
                use disorders, referral of patients to treatment 
                programs, preventing diversion of controlled 
                substances, and overdose prevention.
                  ``(D) Supporting access to health care services, 
                including--
                          ``(i) services provided by federally 
                        certified opioid treatment programs;
                          ``(ii) outpatient and residential substance 
                        use disorder treatment services that utilize 
                        medication-assisted treatment, as appropriate; 
                        or
                          ``(iii) other appropriate health care 
                        providers to treat substance use disorders.
                  ``(E) Recovery support services, including--
                          ``(i) community-based services that include 
                        peer supports;
                          ``(ii) mutual aid recovery programs that 
                        support medication-assisted treatment; or
                          ``(iii) services to address housing needs and 
                        family issues.
                  ``(F) Other public health-related activities, as the 
                State, Indian Tribe, Tribal organization, or Urban 
                Indian organization determines appropriate, related to 
                addressing substance use disorders within the State, 
                Indian Tribe, Tribal organization, or Urban Indian 
                organization, including directing resources in 
                accordance with local needs related to substance use 
                disorders.
  ``(c) Accountability and Oversight.--A State receiving a grant under 
subsection (b) shall include in reporting related to substance use 
disorders submitted to the Secretary pursuant to section 1942 of the 
Public Health Service Act (42 U.S.C. 300x-52), a description of--
          ``(1) the purposes for which the grant funds received by the 
        State under such subsection for the preceding fiscal year were 
        expended and a description of the activities of the State under 
        the grant;
          ``(2) the ultimate recipients of amounts provided to the 
        State; and
          ``(3) the number of individuals served through the grant.
  ``(d) Limitations.--Any funds made available pursuant to subsection 
(i)--
          ``(1) notwithstanding any transfer authority in any 
        appropriations Act, shall not be used for any purpose other 
        than the grant program in subsection (b); and
          ``(2) shall be subject to the same requirements as substance 
        use disorders prevention and treatment programs under titles V 
        and XIX of the Public Health Service Act (42 U.S.C. 290aa et 
        seq., 300w et seq.).
  ``(e) Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations.--The Secretary, in consultation with Indian Tribes, 
Tribal organizations, and Urban Indian organizations, shall identify 
and establish appropriate mechanisms for Indian Tribes, Tribal 
organizations, and Urban Indian organizations to demonstrate or report 
the information as required under subsections (b), (c), and (d).
  ``(f) Report to Congress.--Not later than September 30, 2024, and 
biennially thereafter, the Secretary shall submit to the Committee on 
Health, Education, Labor, and Pensions of the Senate and the Committee 
on Energy and Commerce of the House of Representatives, and the 
Committees on Appropriations of the House of Representatives and the 
Senate, a report that includes a summary of the information provided to 
the Secretary in reports made pursuant to subsections (c) and (e), 
including--
          ``(1) the purposes for which grant funds are awarded under 
        this section;
          ``(2) the activities of the grant recipients; and
          ``(3) for each State, Indian Tribe, Tribal organization, and 
        Urban Indian organization that receives a grant under this 
        section, the funding level provided to such recipient.
  ``(g) Technical Assistance.--The Secretary, including through the 
Tribal Training and Technical Assistance Center of the Substance Abuse 
and Mental Health Services Administration, shall provide States, Indian 
Tribes, Tribal organizations, and Urban Indian organizations, as 
applicable, with technical assistance concerning grant application and 
submission procedures under this section, award management activities, 
and enhancing outreach and direct support to rural and underserved 
communities and providers in addressing substance use disorders.
  ``(h) Definitions.--In this section:
          ``(1) Indian tribe.--The term `Indian Tribe' has the meaning 
        given the term `Indian tribe' in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5304).
          ``(2) Tribal organization.--The term `Tribal organization' 
        has the meaning given the term `tribal organization' in such 
        section 4.
          ``(3) State.--The term `State' has the meaning given such 
        term in section 1954(b) of the Public Health Service Act (42 
        U.S.C. 300x-64(b)).
          ``(4) Urban indian organization.--The term `Urban Indian 
        organization' has the meaning given such term in section 4 of 
        the Indian Health Care Improvement Act.
  ``(i) Authorization of Appropriations.--
          ``(1) In general.--For purposes of carrying out the grant 
        program under subsection (b), there is authorized to be 
        appropriated $1,750,000,000 for each of fiscal years 2022 
        through 2027, to remain available until expended.
          ``(2) Federal administrative expenses.--Of the amounts made 
        available for each fiscal year to award grants under subsection 
        (b), the Secretary shall not use more than 20 percent for 
        Federal administrative expenses, training, technical 
        assistance, and evaluation.
          ``(3) Set aside.--Of the amounts made available for each 
        fiscal year to award grants under subsection (b) for a fiscal 
        year, the Secretary shall--
                  ``(A) award 5 percent to Indian Tribes, Tribal 
                organizations, and Urban Indian organizations; and
                  ``(B) of the amount remaining after application of 
                subparagraph (A), set aside up to 15 percent for awards 
                to States with the highest age-adjusted rate of drug 
                overdose death based on the ordinal ranking of States 
                according to the Director of the Centers for Disease 
                Control and Prevention.''.

                         I. Purpose and Summary

    H.R. 2379, the ``State Opioid Response Grant Authorization 
Act of 2021,'' amends the 21st Century Cures Act to authorize 
the State Opioid Response (SOR) Program administered by the 
Substance Abuse and Mental Health Services Administration 
(SAMHSA).\1\ This grant program would support efforts in the 
states, territories, and Washington, DC, as well as tribes, 
populations served by tribal organizations, and Urban Indian 
organizations to address opioid and stimulant use and misuse. 
The funding provided through this legislation may support 
public health-related activities such as substance use disorder 
prevention efforts, establishing or improving prescription drug 
monitoring programs, health care practitioner training, and 
substance use disorder treatment, among other activities. The 
Secretary of Health and Human Services (HHS) is also required 
to submit a biennial report to Congress on the SOR program. 
H.R. 2379 authorizes $1.75 billion for each of the fiscal years 
(FY) 2022 through 2027.
---------------------------------------------------------------------------
    \1\Pub. L. No. 114-255 (2016).
---------------------------------------------------------------------------

                II. Background and Need for Legislation

    Substance use disorders (SUD) are complex, treatable 
diseases that impact physical and mental health.\2\ In 2019, 
roughly 20.3 million Americans--including over one million 
children ages 12 to 17--had a SUD.\3\ Of the 20.3 million with 
a SUD, over ten million experienced opioid misuse.\4\ If 
untreated, SUDs can lead to severe health outcomes and in the 
most tragic cases, death.
---------------------------------------------------------------------------
    \2\National Institute on Drug Abuse, The Science of Drug Use and 
Addiction: The Basics, (www.drugabuse.gov/publications/media-guide/
science-drug-use-addiction-basics) (accessed Feb. 12, 2020).
    \3\Substance Abuse and Mental Health Services Association, 2018-
2019 National Surveys on Drug Use and Health Estimated Totals by State, 
(https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-
drug-use-and-health) (Jan. 28, 2021).
    \4\Substance Abuse and Mental Health Services Administration, Dr. 
Elinore F. McCance-Katz Webcast Slides, National Survey on Drug Use and 
Health: 2019 (https://www.samhsa.gov/data/data-we-collect/nsduh-
national-survey-drug-use-and-health) (Sept. 11, 2020).
---------------------------------------------------------------------------
    Prior to the coronavirus disease of 2019 (COVID-19) 
pandemic, opioid overdose deaths were increasing in the United 
States.\5\ Recent data from the Centers for Disease Control and 
Prevention (CDC) indicate an acceleration of overdose deaths 
during the pandemic. In the 12 months leading up to January 
2021, 94,134 drug overdose deaths were reported; the highest 
total ever recorded in a 12-month period.\6\ Further, CDC 
estimates that three in five overdose deaths presented 
opportunities for care and prevention.\7\ They observed that a 
significant number of overdose deaths involved individuals 
recently released from institutions, who previously experienced 
overdose, with mental health diagnoses, or were treated for a 
SUD.\8\
---------------------------------------------------------------------------
    \5\Centers for Disease Control and Prevention, Trends and 
Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths--
United States, 2013-2019 (www.cdc.gov/mmwr/volumes/70/wr/
mm7006a4.htm?s_cid=mm7006a4_w) (Feb. 21, 2021).
    \6\Centers for Disease Control and Prevention, National Center for 
Health Statistics, Provisional drug overdose death counts (www.cdc.gov/
nchs/nvss/vsrr/drug-overdose-data.htm) (accessed Aug. 20, 2021).
    \7\Center for Disease Control and Prevention, Overdose Deaths and 
the Involvement of Illicit Drugs: Urgent Need for Overdose Prevention 
Interventions (www.cdc.gov/drugoverdose/pubs/featured-topics/VS-
overdose-deaths-illicit-drugs.html) (Sept. 4, 2020).
    \8\Id.
---------------------------------------------------------------------------
    The SAMHSA SOR grant program has been funded through 
appropriations legislation since FY 2018.\9\ This grant 
program, however, does not have a statutory authorization.\10\ 
Currently, SOR grants aim to address the opioid crisis by 
increasing access to medication-assisted treatment using the 
three Food and Drug Administration-approved medications for the 
treatment of opioid use disorder, reducing unmet treatment 
needs, and reducing opioid overdose related deaths through the 
provision of prevention, treatment, and recovery activities for 
opioid use disorder.\11\ H.R. 2379 would ensure continued, 
predictable support for substance use disorder prevention, 
treatment, and recovery efforts through 2027 by authorizing 
this program.
---------------------------------------------------------------------------
    \9\Pub. L. No. 115-141 (2018).
    \10\House Committee on Energy and Commerce, Testimony of ADM Brett 
P. Giroir, M.D., Assistant Secretary for Health and Senior Adviser to 
the Secretary on Opioid Policy, Department of Health and Human 
Services, Hearing on Combatting an Epidemic: Legislation to Help 
Patients with Substance Use Disorders, 116th Cong. (March 3, 2020).
    \11\Substance Abuse and Mental Health Services Administration, 
State Opioid Response Grants Funding Opportunity Announcement (FOA) 
Information (https://www.samhsa.gov/grants/grant-announcements/ti-20-
012) (accessed October 19, 2020).
---------------------------------------------------------------------------

                        III. Committee Hearings

    For the purposes of section 3(c) of rule XIII of the Rules 
of the House of Representatives, the following hearing was used 
to develop or consider H.R. 2379:
    The Subcommittee on Health held a legislative hearing on 
Wednesday, April 14, 2021, entitled ``An Epidemic within a 
Pandemic: Understanding Substance Use and Misuse in America.'' 
The Subcommittee received testimony from the following 
witnesses:
    Panel I:
           Regina M. LaBelle, Acting Director, White 
        House Office of National Drug Control Policy
    Panel II:
           Geoffrey M. Laredo, Principal Santa Cruz 
        Strategies, LLC;
           Patricia L. Richman, National Sentencing 
        Resource Counsel, Federal Public and Community 
        Defenders;
           Mark Vargo, Pennington County State's 
        Attorney Legislative Committee Chairman, National 
        District Attorneys Association;
           Timothy Westlake, M.D., F.F.S.M.B., 
        F.A.C.E.P., Emergency Department Medical Director, Pro 
        Health Care Oconomowoc Memorial Hospital; and
           J. Deanna Wilson, MD, MPH, Assistant 
        Professor of Medicine and Pediatrics, University of 
        Pittsburgh School of Medicine.

                      IV. Committee Consideration

    Representatives David Trone (D-MD) and Mikie Sherrill (D-
NJ) introduced H.R. 2379, the ``State Opioid Response Grant 
Authorization Act of 2021,'' on April 8, 2021, and it was 
referred to the Committee on Energy and Commerce. Subsequently, 
on April 13, 2021, H.R. 2379 was referred to the Subcommittee 
on Health. A legislative hearing was held on the bill on April 
14, 2021.
    On July 15, 2021, the Subcommittee on Health met in open 
markup session, pursuant to notice, to consider H.R. 2379 and 
18 other bills. During consideration of the bill, an amendment 
in the nature of a substitute (AINS) offered by Representative 
Trahan (D-MA) was agreed to by a voice vote. Upon conclusion of 
consideration of the bill, the Subcommittee on Health agreed to 
report the bill favorably to the full Committee, amended, by a 
voice vote.
    On July 21, 2021, the full Committee met in open markup 
session, pursuant to notice, to consider H.R. 2379 and 23 other 
bills. An amendment offered by Representative Trahan was agreed 
to by a voice vote. Upon conclusion of consideration of the 
bill, the full Committee agreed to a motion on final passage 
offered by Representative Pallone (D-NJ), Chairman of the 
Committee, to order H.R. 2379 reported favorably to the House, 
amended, by a voice vote.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
2379.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.
    The Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether this bill contains any new budget authority, spending 
authority, credit authority, or an increase or decrease in 
revenues or tax expenditures.

                    VIII. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

       IX. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
authorize the State Opioid Response Grant program, which 
provides support for States, Tribes, and the territories to 
respond to substance use disorder needs, and to extend such 
funding through FY 2027.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 2379 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XI. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

    XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 2379 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIII. Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XIV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``State Opioid Response Grant Authorization Act of 2021.''

Sec. 2. Grant program for State and Tribal response to opioid and 
        stimulant use and misuse

    Section 2 amends the 21st Century Cures Act to authorize 
the Secretary to carry out a grant program that addresses 
opioid and stimulant use and misuse within states, territories, 
Washington, DC, as well as Indian tribes, populations served by 
tribal organizations, and Urban Indian Organizations. The 
minimum allocation for eligible entities is $4 million, with 
preference given to entities with an incidence or prevalence of 
opioid use disorders that is substantially higher relative to 
other entities. The Secretary is directed to develop a formula 
methodology for allocating grant funds, including performance 
assessments for continuation awards, and is directed to submit 
such formula methodology to Congress no later than 30 days 
prior to publishing a funding opportunity for grants under this 
section. The Comptroller General of the United States must 
submit a report to Congress within two years of enactment that 
assesses the grant funding allocations, how changes to 
allocations have impacted state efforts to address opioid 
misuse, and if the projects funded by the grants are similar to 
those supported by other grant programs administered by the 
Substance Abuse and Mental Health Services Administration.
    Grants awarded under the legislation must be for carrying 
out activities pertaining to opioid and stimulant use and 
misuse, which may include implementing substance use disorder 
prevention activities and evaluating such activities, 
establishing or improving prescription drug monitoring 
programs, providing training for health care practitioners, and 
supporting access to health care services through federally 
certified opioid treatment programs, outpatient and residential 
substance use disorder treatment services that utilize 
medication-assisted treatment, and recovery support services. 
Grantees may also direct resources in accordance with local 
needs related to substance use disorders. Grantees are required 
to report activities, ultimate recipients of the grant, number 
of individuals served, and the funding level to the Secretary 
not later than September 30, 2024, and biennially thereafter. 
The Secretary is directed to provide technical assistance to 
eligible entities.
    The authorization for appropriations is $1.75 billion for 
each of the FYs 2022 through 2027. The legislation sets a 20 
percent cap for administrative expenses, training, technical 
assistance, and evaluations. A set aside of five percent is 
available for Indian tribes, tribal organizations, and Urban 
Indian Organizations, and, of the remaining amount, 15 percent 
is reserved for the states with the highest age-adjusted rate 
of drug overdose deaths.

       XVI. Changes in Existing Law Made by the Bill, as Reported

      In compliance with clause 3(e) of rule XIII of the Rules 
of the House of Representatives, changes in existing law made 
by the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

                         21ST CENTURY CURES ACT




           *       *       *       *       *       *       *
DIVISION A--21ST CENTURY CURES

           *       *       *       *       *       *       *


TITLE I--INNOVATION PROJECTS AND STATE RESPONSES TO OPIOID ABUSE

           *       *       *       *       *       *       *


[SEC. 1003. ACCOUNT FOR THE STATE RESPONSE TO THE OPIOID ABUSE CRISIS.

  [(a) In general.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall use 
any funds appropriated pursuant to subsection (h) to carry out 
the grant program described in subsection (b) for purposes of 
addressing the opioid abuse crisis within the States and Indian 
Tribes.
  [(b) Opioid Grant Program.--
          [(1) State and tribal response to the opioid abuse 
        crisis.--Subject to the availability of appropriations, 
        the Secretary shall award grants to States and Indian 
        Tribes for the purpose of addressing the opioid abuse 
        crisis within such States and Indian Tribes, in 
        accordance with subparagraph (B). In awarding such 
        grants, the Secretary shall give preference to States 
        or Indian Tribes with an incidence or prevalence of 
        opioid use disorders that is substantially higher 
        relative to other States or other Indian Tribes, as 
        applicable.
          [(2) Opioid grants.--Grants awarded under this 
        subsection shall be used for carrying out activities 
        that supplement activities pertaining to opioids 
        undertaken by the State agency responsible for 
        administering the substance abuse prevention and 
        treatment block grant under subpart II of part B of 
        title XIX of the Public Health Service Act (42 U.S.C. 
        300x-21 et seq.), which may include public health-
        related activities such as the following:
                  [(A) Establishing or improving prescription 
                drug monitoring programs.
                  [(B) Implementing prevention activities, and 
                evaluating such activities to identify 
                effective strategies to prevent opioid abuse.
                  [(C) Training for health care practitioners, 
                such as best practices for prescribing opioids, 
                pain management, recognizing potential cases of 
                substance abuse, referral of patients to 
                treatment programs, preventing diversion of 
                controlled substances, and overdose prevention.
                  [(D) Supporting access to health care 
                services, including those services provided by 
                Federally certified opioid treatment programs 
                or other appropriate health care providers to 
                treat substance use disorders.
                  [(E) Other public health-related activities, 
                as the State or Indian Tribe determines 
                appropriate, related to addressing the opioid 
                abuse crisis within the State or Indian Tribe, 
                including directing resources in accordance 
                with local needs related to substance use 
                disorders.
  [(c) Accountability and Oversight.--A State receiving a grant 
under subsection (b) shall include in a report related to 
substance abuse submitted to the Secretary pursuant to section 
1942 of the Public Health Service Act (42 U.S.C. 300x-52), a 
description of--
          [(1) the purposes for which the grant funds received 
        by the State under such subsection for the preceding 
        fiscal year were expended and a description of the 
        activities of the State under the program; and
          [(2) the ultimate recipients of amounts provided to 
        the State in the grant.
  [(d) Limitations.--Any funds made available pursuant to 
subsection (h)--
          [(1) notwithstanding any transfer authority in any 
        appropriations Act, shall not be used for any purpose 
        other than the grant program in subsection (b); and
          [(2) shall be subject to the same requirements as 
        substance abuse prevention and treatment programs under 
        titles V and XIX of the Public Health Service Act (42 
        U.S.C. 290aa et seq., 300w et seq.).
  [(e) Indian Tribes.--
          [(1) Definition.--For purposes of this section, the 
        term ``Indian Tribe'' has the meaning given the term 
        ``Indian tribe'' in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        5304).
          [(2) Appropriate mechanisms.--The Secretary, in 
        consultation with Indian Tribes, shall identify and 
        establish appropriate mechanisms for Tribes to 
        demonstrate or report the information as required under 
        subsections (b), (c), and (d).
  [(f) Report to Congress.--Not later than 1 year after the 
date on which amounts are first awarded after the date of 
enactment of this subsection, pursuant to subsection (b), and 
annually thereafter, the Secretary shall submit to the 
Committee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Energy and Commerce of the House of 
Representatives a report summarizing the information provided 
to the Secretary in reports made pursuant to subsection (c), 
including the purposes for which grant funds are awarded under 
this section and the activities of such grant recipients.
  [(g) Technical Assistance.--The Secretary, including through 
the Tribal Training and Technical Assistance Center of the 
Substance Abuse and Mental Health Services Administration, 
shall provide State agencies and Indian Tribes, as applicable, 
with technical assistance concerning grant application and 
submission procedures under this section, award management 
activities, and enhancing outreach and direct support to rural 
and underserved communities and providers in addressing the 
opioid crisis.
  [(h) Authorization of Appropriations.--For purposes of 
carrying out the grant program under subsection (b), there is 
authorized to be appropriated $500,000,000 for each of fiscal 
years 2019 through 2021, to remain available until expended.
  [(i) Set Aside.--Of the amounts made available for each 
fiscal year to award grants under subsection (b) for a fiscal 
year, 5 percent of such amount for such fiscal year shall be 
made available to Indian Tribes, and up to 15 percent of such 
amount for such fiscal year may be set aside for States with 
the highest age-adjusted rate of drug overdose death based on 
the ordinal ranking of States according to the Director of the 
Centers for Disease Control and Prevention.
  [(j) Sunset.--This section shall expire on September 30, 
2026.]

SEC. 1003. GRANT PROGRAM FOR STATE AND TRIBAL RESPONSE TO OPIOID AND 
                    STIMULANT USE AND MISUSE.

  (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall carry 
out the grant program described in subsection (b) for purposes 
of addressing opioid and stimulant use and misuse, within 
States, Indian Tribes, and populations served by Tribal 
organizations and Urban Indian organizations.
  (b) Grants Program.--
          (1) In general.--Subject to the availability of 
        appropriations, the Secretary shall award grants to 
        States, Indian Tribes, Tribal organizations, and Urban 
        Indian organizations for the purpose of addressing 
        opioid and stimulant use and misuse, within such 
        States, such Indian Tribes, and populations served by 
        such Tribal organizations and Urban Indian 
        organizations, in accordance with paragraph (2).
          (2) Minimum allocations; preference.--In determining 
        grant amounts for each recipient of a grant under 
        paragraph (1), the Secretary shall--
                  (A) ensure that each State receives not less 
                than $4,000,000; and
                  (B) give preference to States, Indian Tribes, 
                Tribal organizations, and Urban Indian 
                organizations whose populations have an 
                incidence or prevalence of opioid use disorders 
                or stimulant use or misuse that is 
                substantially higher relative to the 
                populations of other States, other Indian 
                Tribes, Tribal organizations, or Urban Indian 
                organizations, as applicable.
          (3) Formula methodology.--
                  (A) In general.--Before publishing a funding 
                opportunity announcement with respect to grants 
                under this section, the Secretary shall--
                          (i) develop a formula methodology to 
                        be followed in allocating grant funds 
                        awarded under this section among 
                        grantees, which includes performance 
                        assessments for continuation awards; 
                        and
                          (ii) not later than 30 days after 
                        developing the formula methodology 
                        under clause (i), submit the formula 
                        methodology to--
                                  (I) the Committee on Energy 
                                and Commerce and the Committee 
                                on Appropriations of the House 
                                of Representatives; and
                                  (II) the Committee on Health, 
                                Education, Labor, and Pensions 
                                and the Committee on 
                                Appropriations of the Senate.
                  (B) Report.--Not later than two years after 
                the date of the enactment of the State Opioid 
                Response Grant Authorization Act of 2021, the 
                Comptroller General of the United States shall 
                submit to the Committee on Health, Education, 
                Labor, and Pensions of the Senate and the 
                Committee on Energy and Commerce of the House 
                of Representatives a report that--
                          (i) assesses how grant funding is 
                        allocated to States under this section 
                        and how such allocations have changed 
                        over time;
                          (ii) assesses how any changes in 
                        funding under this section have 
                        affected the efforts of States to 
                        address opioid or stimulant use or 
                        misuse; and
                          (iii) assesses the use of funding 
                        provided through the grant program 
                        under this section and other similar 
                        grant programs administered by the 
                        Substance Abuse and Mental Health 
                        Services Administration.
          (4) Use of funds.--Grants awarded under this 
        subsection shall be used for carrying out activities 
        that supplement activities pertaining to opioid and 
        stimulant use and misuse, undertaken by the State 
        agency responsible for administering the substance 
        abuse prevention and treatment block grant under 
        subpart II of part B of title XIX of the Public Health 
        Service Act (42 U.S.C. 300x-21 et seq.), which may 
        include public health-related activities such as the 
        following:
                  (A) Implementing prevention activities, and 
                evaluating such activities to identify 
                effective strategies to prevent substance use 
                disorders.
                  (B) Establishing or improving prescription 
                drug monitoring programs.
                  (C) Training for health care practitioners, 
                such as best practices for prescribing opioids, 
                pain management, recognizing potential cases of 
                substance use disorders, referral of patients 
                to treatment programs, preventing diversion of 
                controlled substances, and overdose prevention.
                  (D) Supporting access to health care 
                services, including--
                          (i) services provided by federally 
                        certified opioid treatment programs;
                          (ii) outpatient and residential 
                        substance use disorder treatment 
                        services that utilize medication-
                        assisted treatment, as appropriate; or
                          (iii) other appropriate health care 
                        providers to treat substance use 
                        disorders.
                  (E) Recovery support services, including--
                          (i) community-based services that 
                        include peer supports;
                          (ii) mutual aid recovery programs 
                        that support medication-assisted 
                        treatment; or
                          (iii) services to address housing 
                        needs and family issues.
                  (F) Other public health-related activities, 
                as the State, Indian Tribe, Tribal 
                organization, or Urban Indian organization 
                determines appropriate, related to addressing 
                substance use disorders within the State, 
                Indian Tribe, Tribal organization, or Urban 
                Indian organization, including directing 
                resources in accordance with local needs 
                related to substance use disorders.
  (c) Accountability and Oversight.--A State receiving a grant 
under subsection (b) shall include in reporting related to 
substance use disorders submitted to the Secretary pursuant to 
section 1942 of the Public Health Service Act (42 U.S.C. 300x-
52), a description of--
          (1) the purposes for which the grant funds received 
        by the State under such subsection for the preceding 
        fiscal year were expended and a description of the 
        activities of the State under the grant;
          (2) the ultimate recipients of amounts provided to 
        the State; and
          (3) the number of individuals served through the 
        grant.
  (d) Limitations.--Any funds made available pursuant to 
subsection (i)--
          (1) notwithstanding any transfer authority in any 
        appropriations Act, shall not be used for any purpose 
        other than the grant program in subsection (b); and
          (2) shall be subject to the same requirements as 
        substance use disorders prevention and treatment 
        programs under titles V and XIX of the Public Health 
        Service Act (42 U.S.C. 290aa et seq., 300w et seq.).
  (e) Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations.--The Secretary, in consultation with Indian 
Tribes, Tribal organizations, and Urban Indian organizations, 
shall identify and establish appropriate mechanisms for Indian 
Tribes, Tribal organizations, and Urban Indian organizations to 
demonstrate or report the information as required under 
subsections (b), (c), and (d).
  (f) Report to Congress.--Not later than September 30, 2024, 
and biennially thereafter, the Secretary shall submit to the 
Committee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Energy and Commerce of the House of 
Representatives, and the Committees on Appropriations of the 
House of Representatives and the Senate, a report that includes 
a summary of the information provided to the Secretary in 
reports made pursuant to subsections (c) and (e), including--
          (1) the purposes for which grant funds are awarded 
        under this section;
          (2) the activities of the grant recipients; and
          (3) for each State, Indian Tribe, Tribal 
        organization, and Urban Indian organization that 
        receives a grant under this section, the funding level 
        provided to such recipient.
  (g) Technical Assistance.--The Secretary, including through 
the Tribal Training and Technical Assistance Center of the 
Substance Abuse and Mental Health Services Administration, 
shall provide States, Indian Tribes, Tribal organizations, and 
Urban Indian organizations, as applicable, with technical 
assistance concerning grant application and submission 
procedures under this section, award management activities, and 
enhancing outreach and direct support to rural and underserved 
communities and providers in addressing substance use 
disorders.
  (h) Definitions.--In this section:
          (1) Indian tribe.--The term ``Indian Tribe'' has the 
        meaning given the term ``Indian tribe'' in section 4 of 
        the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 5304).
          (2) Tribal organization.--The term ``Tribal 
        organization'' has the meaning given the term ``tribal 
        organization'' in such section 4.
          (3) State.--The term ``State'' has the meaning given 
        such term in section 1954(b) of the Public Health 
        Service Act (42 U.S.C. 300x-64(b)).
          (4) Urban indian organization.--The term ``Urban 
        Indian organization'' has the meaning given such term 
        in section 4 of the Indian Health Care Improvement Act.
  (i) Authorization of Appropriations.--
          (1) In general.--For purposes of carrying out the 
        grant program under subsection (b), there is authorized 
        to be appropriated $1,750,000,000 for each of fiscal 
        years 2022 through 2027, to remain available until 
        expended.
          (2) Federal administrative expenses.--Of the amounts 
        made available for each fiscal year to award grants 
        under subsection (b), the Secretary shall not use more 
        than 20 percent for Federal administrative expenses, 
        training, technical assistance, and evaluation.
          (3) Set aside.--Of the amounts made available for 
        each fiscal year to award grants under subsection (b) 
        for a fiscal year, the Secretary shall--
                  (A) award 5 percent to Indian Tribes, Tribal 
                organizations, and Urban Indian organizations; 
                and
                  (B) of the amount remaining after application 
                of subparagraph (A), set aside up to 15 percent 
                for awards to States with the highest age-
                adjusted rate of drug overdose death based on 
                the ordinal ranking of States according to the 
                Director of the Centers for Disease Control and 
                Prevention.

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