[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 4482 Introduced in Senate (IS)]
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117th CONGRESS
2d Session
S. 4482
To help persons in the United States experiencing homelessness and
significant behavioral health issues, including substance use
disorders, by authorizing a grant program within the Department of
Housing and Urban Development to assist State and local governments,
Continuums of Care, community-based organizations that administer both
health and homelessness services, and providers of services to people
experiencing homelessness, better coordinate health care and
homelessness services, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 23, 2022
Mr. Padilla (for himself and Mrs. Feinstein) introduced the following
bill; which was read twice and referred to the Committee on Banking,
Housing, and Urban Affairs
_______________________________________________________________________
A BILL
To help persons in the United States experiencing homelessness and
significant behavioral health issues, including substance use
disorders, by authorizing a grant program within the Department of
Housing and Urban Development to assist State and local governments,
Continuums of Care, community-based organizations that administer both
health and homelessness services, and providers of services to people
experiencing homelessness, better coordinate health care and
homelessness services, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Coordinating Substance Use and
Homelessness Care Act of 2022''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) The United States has a homelessness crisis, with more
than 580,000 people experiencing homelessness on a single night
according to the Department of Housing and Urban Development's
2020 Annual Homeless Assessment Report to Congress.
(2) While the lack of affordable housing is the primary
driver of homelessness, behavioral health conditions, including
substance use disorders, can exacerbate homelessness and can
also be a consequence of homelessness.
(3) Research shows that people experiencing homelessness
have higher rates of substance use disorder than people with
housing stability. Some people who experience homelessness use
substances to cope with the trauma and deprivations of their
circumstances, but substance use disorders frequently make it
more difficult for people experiencing homelessness to secure
permanent housing.
(4) Many individuals with substance use disorder who
experience homelessness have co-occurring illnesses. The
combined effect of physical illness, mental illness, and lack
of housing results in higher mortality rates for individuals
experiencing homelessness.
(5) Safely and securely housing individuals who are
experiencing both homelessness and behavioral health issues,
including substance use disorders, often requires supportive
services and close coordination between housing and social
service providers, in addition to low-barrier, affordable
housing. Subsidized housing is critical, but not enough--access
to additional voluntary person-centered supportive services is
needed.
(6) Nevertheless, it is imperative that when people
experiencing homelessness, including those with a behavioral
health condition such as substance use disorder, choose to seek
help that housing as well as health care and person-centered
supportive services be coordinated, particularly given their
acute needs and the significant costs incurred by communities
for law enforcement, correctional, and emergency department
care for failing to do so.
(7) Providing access to health care and voluntary person-
centered supportive services can be beneficial in securing and
successfully maintaining stable housing.
(8) Integration of health and homelessness services to
achieve optimal outcomes for people experiencing homelessness,
significant behavioral health conditions such as substance use
disorder, and other health conditions can be challenging for
State and local governments, continuums of care, and community-
based organizations that administer both health and
homelessness services and providers of homelessness services.
(9) Capacity-building is needed to create systems-level
linkages between the 2 sets of services to allow for smoother
pathways and simpler navigation.
(10) Black, Hispanic, and Indigenous people are
disproportionately underserved by person-centered supportive
services. In order to address critical services deficits and
affirmatively serve protected classes of people with
significant behavioral health conditions, including substance
use disorders, who are experiencing homelessness, the grant
program established under this Act can be used to build the
capacities of homelessness services providers that have
demonstrated cultural competencies in service provision and a
record of serving Black, Hispanic, and Indigenous people and
other underserved populations experiencing homelessness that
also suffer from substance use disorders.
SEC. 3. DEFINITIONS.
In this Act:
(1) Indian tribe; tribal organization.--The terms ``Indian
Tribe'' and ``Tribal organization''--
(A) have the meanings given those terms in section
4 of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 5304); and
(B) include entities that serve Native Hawaiians,
as defined in section 338K(c) of the Public Health
Service Act (42 U.S.C. 254s(c)).
(2) Person experiencing homelessness.--The term ``person
experiencing homelessness'' has the same meaning as the terms
``homeless'', ``homeless individual'', and ``homeless person'',
as those terms are defined in the McKinney-Vento Homeless
Assistance Act (42 U.S.C. 11302).
(3) Public housing agency.--The term ``public housing
agency'' has the meaning given the term in section 3(b) of the
United States Housing Act of 1937 (42 U.S.C. 1437a(b)).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Housing and Urban Development.
(5) Substance use disorder.--The term ``substance use
disorder'' means the disorder that occurs when the recurrent
use of alcohol or drugs, or both, causes clinically significant
impairment, including health problems, disability, and failure
to meet major responsibilities at work, school, or home.
(6) Tribally designated housing entity.--The term
``tribally designated housing entity'' has the meaning given
the term in section 4 of the Native American Housing Assistance
and Self-Determination Act of 1996.
SEC. 4. ESTABLISHMENT OF GRANT PROGRAM.
(a) In General.--The Secretary, in consultation with the working
group established pursuant to subsection (b), shall establish a grant
program to award competitive grants to eligible entities described in
subsection (c)(4) to build or increase their capacities for the better
coordination of health care and homelessness services for people who
are experiencing homelessness and significant behavioral health issues,
including substance use disorders, and are voluntarily seeking
assistance.
(b) Working Group.--
(1) Establishment.--The Secretary shall establish an
interagency working group to provide advice to the Secretary in
carrying out the program under subsection (a).
(2) Composition.--The working group established under
paragraph (1) shall include representatives from the Department
of Housing and Urban Development, the United States Interagency
Council on Homelessness, the Department of Health and Human
Services, the Department of Agriculture, and the Bureau of
Indian Affairs, to be appointed by the heads of those agencies.
(3) Development of assistance tools.--Not later than 1 year
after the date of enactment of this Act, the working group
established under paragraph (1) shall--
(A) develop training, tools, and other technical
assistance materials that simplify homelessness
services for providers of health care and simplify
health care services for providers of homelessness
services by identifying the basic elements the health
and homelessness sectors need to understand about the
other; and
(B) circulate the materials described in
subparagraph (A) to interested entities, particularly
those that apply for grants awarded under this section.
(c) Capacity-Building Grants.--
(1) In general.--The Secretary shall award 5-year grants to
eligible entities described in paragraph (4), which shall be
used only to build or increase their capacities to coordinate
health care and homelessness services.
(2) Prohibition.--None of the proceeds from the grants
awarded pursuant to this Act may be used to pay for--
(A) health care, with the exception of efforts to
increase the availability of Naloxone and provide
training for its administration; or
(B) rent.
(3) Amount.--The amount awarded to an entity under a grant
under this section shall not exceed $500,000.
(4) Eligibility.--To be eligible to receive a grant under
this subsection an entity shall--
(A) be--
(i) a governmental entity at the county,
city, regional, or locality level;
(ii) an Indian Tribe, a tribally designated
housing entity, or a Tribal organization;
(iii) a public housing agency administering
housing choice vouchers; or
(iv) a continuum of care or nonprofit
organization designated by the continuum of
care;
(B) be responsible for homelessness services;
(C) provide such assurances as the Secretary shall
require that, in carrying out activities with amounts
from the grant, the entity will ensure that services
are culturally competent, meet the needs of the people
being served, and follow trauma-informed best practices
to address those needs using a harm reduction approach;
and
(D) demonstrate how the capacity of the entity to
coordinate health care and homelessness services to
better serve people experiencing homelessness and
significant behavioral health issues, including
substance use disorders, can be increased through--
(i) the designation of a governmental
official as a coordinator for making
connections between health and homelessness
services and developing a strategy for using
those services in a holistic way to help people
experiencing homelessness and behavioral health
conditions such as substance use disorders,
including those with cooccurring conditions;
(ii) improvements in infrastructure at the
systems level;
(iii) improvements in technology for
voluntary remote monitoring capabilities,
including internet and video, which can allow
for more home- and community-based behavioral
health care services and ensure those
improvements maintain effective communication
requirements for persons with disabilities and
program access for persons with limited English
proficiency;
(iv) improvements in connections to health
care services delivered by providers
experienced in behavioral health care and
people experiencing homelessness;
(v) efforts to increase the availability of
Naloxone and provide training for its
administration; and
(vi) any additional activities identified
by the Secretary that will advance the
coordination of homelessness assistance,
housing, and substance use services and other
health care services.
(5) Eligible activities.--An eligible entity receiving a
grant under this section may use the grant to cover costs
related to--
(A) hiring system coordinators; and
(B) administrative costs, including staffing costs,
technology costs, and other such costs identified by
the Secretary.
(6) Distribution of funds.--An eligible entity receiving a
grant under this section may distribute all or a portion of the
grant amounts to private nonprofit organizations, other
government entities, public housing agencies, tribally
designated housing entities, or other entities as determined by
the Secretary to carry out programs and activities in
accordance with this section.
(7) Oversight requirements.--
(A) Annual reports.--Not later than 6 years after
the date on which grant amounts are first received by
an eligible entity under this section, the entity shall
submit to the Secretary a report on the activities
carried out under the grant, which shall include, with
respect to activities carried out with grant amounts in
the community served--
(i) measures of outcomes relating to
whether people experiencing homelessness and
significant behavioral health issues, including
substance use disorders, who sought help from
the entity--
(I) were housed and did not
experience intermittent periods of
homelessness;
(II) were voluntarily enrolled in
treatment and recovery programs;
(III) experienced improvements in
their health;
(IV) obtained access to specific
primary care providers; and
(V) have health care plans that
meet their individual needs, including
access to mental health and substance
use disorder treatment and recovery
services;
(ii) how grant funds were used; and
(iii) any other matters determined
appropriate by the Secretary.
(B) Rule of construction.--Nothing in this
subsection may be construed to condition the receipt of
future housing and other services by individuals
assisted with activities and services provided with
grant amounts on the outcomes detailed in the reports
submitted under this paragraph.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $20,000,000 for each of fiscal
years 2022 through 2027, of which not less than 5 percent of such funds
shall be awarded to Indian Tribes, tribally designated housing
entities, and Tribal organizations.
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