[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4531 Engrossed in House (EH)]
<DOC>
118th CONGRESS
1st Session
H. R. 4531
_______________________________________________________________________
AN ACT
To reauthorize certain programs that provide for opioid use disorder
prevention, recovery, and treatment, 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 ``Support for Patients and Communities
Reauthorization Act''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--PUBLIC HEALTH
Sec. 101. Prenatal and postnatal health.
Sec. 102. Monitoring and education regarding infections associated with
illicit drug use and other risk factors.
Sec. 103. Preventing overdoses of controlled substances.
Sec. 104. Residential treatment programs for pregnant and postpartum
women.
Sec. 105. Youth prevention and recovery.
Sec. 106. First responder training.
Sec. 107. Building communities of recovery.
Sec. 108. National Peer-Run Training and Technical Assistance Center
for Addiction Recovery Support.
Sec. 109. Comprehensive opioid recovery centers.
Sec. 110. Grants to address the problems of persons who experience
violence related stress.
Sec. 111. Mental and behavioral health education and training grants.
Sec. 112. Loan repayment program for the substance use disorder
treatment workforce.
Sec. 113. Pilot program for public health laboratories to detect
fentanyl and other synthetic opioids.
Sec. 114. Monitoring and reporting of child, youth, and adult trauma.
Sec. 115. Task force to develop best practices for trauma-informed
identification, referral, and support.
Sec. 116. Treatment, recovery, and workforce support grants.
Sec. 117. Grant program for State and Tribal response to opioid use
disorders.
Sec. 118. References to opioid overdose reversal agents in HHS grant
programs.
Sec. 119. Addressing other concurrent substance use disorders through
grant program for State and Tribal response
to opioid use disorders.
Sec. 120. Providing for a study on the effects of remote monitoring on
individuals who are prescribed opioids.
TITLE II--CONTROLLED SUBSTANCES
Sec. 201. Delivery of certain substances by a pharmacy to an
administering practitioner.
Sec. 202. Reviewing the scheduling of approved products containing a
combination of buprenorphine and naloxone.
Sec. 203. Combating illicit xylazine.
Sec. 204. Technical corrections.
Sec. 205. Required training for prescribers of controlled substances.
TITLE III--MEDICAID
Sec. 301. Extending requirement for State Medicaid plans to provide
coverage for medication-assisted treatment.
Sec. 302. Expanding required reports on T-MSIS substance use disorder
data to include mental health condition
data.
Sec. 303. Monitoring prescribing of antipsychotic medications.
Sec. 304. Lifting the IMD exclusion for substance use disorder.
Sec. 305. Prohibition on termination of enrollment due to
incarceration.
Sec. 306. State option relating to inmates who are pregnant women
pending disposition of charges.
Sec. 307. Permitting access to medical assistance under the Medicaid
program for foster youth.
TITLE IV--OFFSETS
Sec. 401. Promoting value in Medicaid managed care.
TITLE I--PUBLIC HEALTH
SEC. 101. PRENATAL AND POSTNATAL HEALTH.
Section 317L(d) of the Public Health Service Act (42 U.S.C. 247b-
13(d)) is amended by striking ``such sums as may be necessary for each
of the fiscal years 2019 through 2023'' and inserting ``$4,250,000 for
each of fiscal years 2024 through 2028''.
SEC. 102. MONITORING AND EDUCATION REGARDING INFECTIONS ASSOCIATED WITH
ILLICIT DRUG USE AND OTHER RISK FACTORS.
Section 317N of the Public Health Service Act (42 U.S.C. 247b-15)
is amended--
(1) in the section heading, by striking ``surveillance
and'' and inserting ``monitoring and'' ; and
(2) in subsection (d), by striking ``fiscal years 2019
through 2023'' and inserting ``fiscal years 2024 through
2028''.
SEC. 103. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.
(a) Evidence-based Prevention Grants.--Section 392A(a)(2)(D) of the
Public Health Service Act (42 U.S.C. 280b-1(a)(2)(D)) is amended by
inserting after ``new and emerging public health crises'' the
following: ``, such as the fentanyl crisis,''.
(b) Use of Grants by States, Localities, and Indian Tribes to
Conduct Wastewater Surveillance.--Section 392A(a)(3)(A) of the Public
Health Service Act (42 U.S.C. 280b-1(a)(3)(A)) is amended by inserting
``, including through the use of wastewater surveillance to identify
trends associated with controlled substance use if it is determined by
appropriate evidence that wastewater surveillance is an effective way
to survey controlled substance use within a community'' before the
semicolon.
(c) Authorization of Appropriations.--Section 392A(e) of the Public
Health Service Act (42 U.S.C. 280b-1(e)) is amended by striking
``$496,000,000 for each of fiscal years 2019 through 2023'' and
inserting ``$505,579,000 for each of fiscal years 2024 through 2028''.
SEC. 104. RESIDENTIAL TREATMENT PROGRAMS FOR PREGNANT AND POSTPARTUM
WOMEN.
Section 508(s) of the Public Health Service Act (42 U.S.C. 290bb-
1(s)) is amended by striking ``$29,931,000 for each of fiscal years
2019 through 2023'' and inserting ``$38,931,000 for each of fiscal
years 2024 through 2028''.
SEC. 105. YOUTH PREVENTION AND RECOVERY.
Section 7102(c)(9) of the SUPPORT for Patients and Communities Act
(42 U.S.C. 290bb-7a(c)(9)) is amended by striking ``fiscal years 2019
through 2023'' and inserting ``fiscal years 2024 through 2028''.
SEC. 106. FIRST RESPONDER TRAINING.
Section 546(h) of the Public Health Service Act (42 U.S.C. 290ee-
1(h)) is amending by striking ``$36,000,000 for each of fiscal years
2019 through 2023'' and inserting ``$56,000,000 for each of fiscal
years 2024 through 2028''.
SEC. 107. BUILDING COMMUNITIES OF RECOVERY.
Section 547(f) of the Public Health Service Act (42 U.S.C. 290ee-
2(f)) is amended by striking ``$5,000,000 for each of fiscal years 2019
through 2023'' and inserting ``$16,000,000 for each of fiscal years
2024 through 2028''.
SEC. 108. NATIONAL PEER-RUN TRAINING AND TECHNICAL ASSISTANCE CENTER
FOR ADDICTION RECOVERY SUPPORT.
Section 547A(e) of the Public Health Service Act (42 U.S.C. 290ee-
2a(e)) is amended by striking ``$1,000,000 for each of fiscal years
2019 through 2023'' and inserting ``$2,000,000 for each of fiscal years
2024 through 2028''.
SEC. 109. COMPREHENSIVE OPIOID RECOVERY CENTERS.
(a) Reauthorization.--Section 552(j) of the Public Health Service
Act (42 U.S.C. 290ee-7(j)) is amended by striking ``2019 through 2023''
and inserting ``2024 through 2028''.
(b) Documentation for Evidence of Capacity To Carry Out Required
Activities.--Section 552(d) of the Public Health Service Act (42 U.S.C.
290ee-7(d)) is amended by adding at the end the following:
``(3) Documentation.--
``(A) In general.--Evidence required to be provided
under paragraph (1) may be provided through a letter of
intent from partner agencies or other relevant
documentation (as defined by the Secretary).
``(B) Partner agency defined.--In this paragraph,
the term `partner agency' means a non-governmental
organization or other public or private entity--
``(i) the primary purpose of which is the
delivery of mental health or substance use
disorder treatment services; and
``(ii) with which the applicant coordinates
to provide the full continuum of treatment
services (as specified in subsection (g)(1)(B))
that the applicant is unable to offer on
site.''.
(c) Center Activities Carried Out Through Third Parties.--Section
552(g) of the Public Health Service Act (42 U.S.C. 290ee-7(g)) is
amended in the matter preceding paragraph (1) by striking ``Each Center
shall'' and all that follows through ``subsection (f):'' and inserting
the following: ``Each Center shall, at a minimum, carry out the
activities specified in this subsection directly, through referral, or
through contractual arrangements. If a Center elects to carry out such
activities through contractual arrangements, the Secretary may issue
guidance on best practices to ensure that the Center is capable of
carrying out such activities, including carrying out such activities
through technology-enabled collaborative learning and capacity building
models described in subsection (f) and coordinating the full continuum
of treatment services specified in subparagraph (B). Such activities
include the following:''.
SEC. 110. GRANTS TO ADDRESS THE PROBLEMS OF PERSONS WHO EXPERIENCE
VIOLENCE RELATED STRESS.
Section 582(j) of the Public Health Service Act (42 U.S.C. 290hh-
1(j)) is amended by striking ``$63,887,000 for each of fiscal years
2019 through 2023'' and inserting ``$93,887,000 for each of fiscal
years 2024 through 2028''.
SEC. 111. MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS.
Section 756(f) of the Public Health Service Act (42 U.S.C. 294e-
1(f)) is amended by striking ``fiscal years 2023 through 2027'' and
inserting ``fiscal years 2024 through 2028''.
SEC. 112. LOAN REPAYMENT PROGRAM FOR THE SUBSTANCE USE DISORDER
TREATMENT WORKFORCE.
Section 781(j) of the Public Health Service Act (42 U.S.C. 295h(j))
is amended by striking ``$25,000,000 for each of fiscal years 2019
through 2023'' and inserting ``$40,000,000 for each of fiscal years
2024 through 2028''.
SEC. 113. PILOT PROGRAM FOR PUBLIC HEALTH LABORATORIES TO DETECT
FENTANYL AND OTHER SYNTHETIC OPIOIDS.
(a) Detection Activities.--Section 7011(b) of the SUPPORT for
Patients and Communities Act (42 U.S.C. 247d-10 note) is amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(4) public, private, and academic entities with expertise
in detection and testing activities, such as wastewater
surveillance, with respect to synthetic opioids, including
fentanyl and its analogues.''.
(b) Authorization of Appropriations.--Section 7011(d) of the
SUPPORT for Patients and Communities Act (42 U.S.C. 247d-10(d)) is
amended by striking ``fiscal years 2019 through 2023'' and inserting
``fiscal years 2024 through 2028''.
SEC. 114. MONITORING AND REPORTING OF CHILD, YOUTH, AND ADULT TRAUMA.
Section 7131(e) of the SUPPORT for Patients and Communities Act (42
U.S.C. 242t(e)) is amended by striking ``$2,000,000 for each of fiscal
years 2019 through 2023'' and inserting ``$9,000,000 for each of fiscal
years 2024 through 2028''.
SEC. 115. TASK FORCE TO DEVELOP BEST PRACTICES FOR TRAUMA-INFORMED
IDENTIFICATION, REFERRAL, AND SUPPORT.
Section 7132 of the SUPPORT for Patients and Communities Act
(Public Law 115-271) is amended--
(1) in subsection (g)--
(A) in paragraph (1), by striking ``and'' at the
end;
(B) in paragraph (2), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following:
``(3) additional reports and updates to existing reports,
as necessary.''; and
(2) by amending subsection (i) to read as follows:
``(i) Sunset.--The task force shall sunset on September 30,
2026.''.
SEC. 116. TREATMENT, RECOVERY, AND WORKFORCE SUPPORT GRANTS.
Section 7183 of the SUPPORT for Patients and Communities Act (42
U.S.C. 290ee-8) is amended--
(1) in subsection (b), by inserting ``each'' before ``for a
period'';
(2) by amending subsection (c)(2) to read as follows:
``(2) Rates.--The rates described in this paragraph are the
following:
``(A) The amount by which the average rate of drug
overdose deaths in the State, adjusted for age, for the
period of 5 calendar years for which there is available
data, including if necessary provisional data,
immediately preceding the grant cycle (which shall be
the period of calendar years 2018 through 2022 for the
first grant cycle following the enactment of the
Support for Patients and Communities Reauthorization
Act) is above the average national overdose mortality
rate, as determined by the Director of the Centers for
Disease Control and Prevention, for the same period.
``(B) The amount by which the average rate of
unemployment for the State, based on data provided by
the Bureau of Labor Statistics, for the period of 5
calendar years for which there is available data,
including if necessary provisional data, immediately
preceding the grant cycle (which shall be the period of
calendar years 2018 through 2022 for the first grant
cycle following the enactment of the Support for
Patients and Communities Reauthorization Act) is above
the national average for the same period.
``(C) The amount by which the average rate of labor
force participation in the State, based on data
provided by the Bureau of Labor Statistics, for the
period of 5 calendar years for which there is available
data, including if necessary provisional data,
immediately preceding the grant cycle (which shall be
the period of calendar years 2018 through 2022 for the
first grant cycle following the enactment of the
Support for Patients and Communities Reauthorization
Act) is below the national average for the same
period.'';
(3) in subsection (g)--
(A) in paragraphs (1) and (3), by redesignating
subparagraphs (A) and (B) as clauses (i) and (ii),
respectively, and adjusting the margins accordingly;
(B) by redesignating paragraphs (1) through (3) as
subparagraphs (A) through (C), respectively, and
adjusting the margins accordingly;
(C) by striking ``An entity'' and inserting the
following:
``(1) In general.--An entity''; and
(D) by adding at the end the following:
``(2) Transportation services.--An entity receiving a grant
under this section may use not more than 5 percent of the funds
for providing transportation for individuals to participate in
an activity supported by a grant under this section, which
transportation shall be to or from a place of work or a place
where the individual is receiving vocational education or job
training services or receiving services directly linked to
treatment of or recovery from a substance use disorder.
``(3) No other authorized uses.--An entity receiving a
grant under this section may not use the funds for any activity
other than the activities listed in paragraphs (1) and (2).'';
(4) in subsection (i)(2), by inserting ``, which shall
include the employment and earnings outcomes as described in
subclauses (I) and (III) of section 116(b)(2)(A)(i) of the
Workforce Innovation and Opportunity Act (29 U.S.C.
3141(b)(2)(A)(i))'' after ``subsection (g)'';
(5) in subsection (j)--
(A) in paragraph (1), by inserting ``for each grant
cycle'' after ``grant period''; and
(B) in paragraph (2)--
(i) in the matter preceding subparagraph
(A)--
(I) by striking ``the preliminary
report'' and inserting ``each
preliminary report''; and
(II) by inserting ``for the grant
cycle'' after ``final report''; and
(ii) in subparagraph (A), by striking
``(g)(3)'' and inserting ``(g)(1)(C)''; and
(6) in subsection (k), by striking ``$5,000,000 for each of
fiscal years 2019 through 2023'' and inserting ``$12,000,000
for each of fiscal years 2024 through 2028''.
SEC. 117. GRANT PROGRAM FOR STATE AND TRIBAL RESPONSE TO OPIOID USE
DISORDERS.
Section 1003(b)(4)(A) of the 21st Century Cures Act (42 U.S.C.
290ee-3a(b)(4)(A)) is amended after ``which may include drugs or
devices approved, cleared, or otherwise legally marketed under the
Federal Food, Drug, and Cosmetic Act'' by inserting ``or fentanyl or
xylazine test strips''.
SEC. 118. REFERENCES TO OPIOID OVERDOSE REVERSAL AGENTS IN HHS GRANT
PROGRAMS.
(a) In General.--The Secretary of Health and Human Services shall
ensure that, as appropriate, whenever the Department of Health and
Human Services issues a regulation or guidance for any grant program
addressing opioid misuse and use disorders, any reference to an opioid
overdose reversal drug (such as a reference to naloxone) is inclusive
of any opioid overdose reversal drug that has been approved under
section 505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355)
for emergency treatment of a known or suspected opioid overdose.
(b) Existing References.--
(1) Update.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services shall update all references described in paragraph (2)
to be inclusive of any opioid overdose reversal drug that has
been approved or otherwise authorized for use by the Food and
Drug Administration.
(2) References.--A reference described in this paragraph is
any reference to an opioid overdose reversal drug (such as
naloxone) in any regulation or guidance of the Department of
Health and Human Services that--
(A) was issued before the date of enactment of this
Act; and
(B) is included in--
(i) the grant program for State and Tribal
response to opioid use disorders under section
1003 of the 21st Century Cures Act (42 U.S.C.
290ee-3 note) (commonly referred to as ``State
Opioid Response Grants'' and ``Tribal Opioid
Response Grants''); or
(ii) the grant program for priority
substance use disorder prevention needs of
regional and national significance under
section 516 of the Public Health Service Act
(42 U.S.C. 290bb-22).
SEC. 119. ADDRESSING OTHER CONCURRENT SUBSTANCE USE DISORDERS THROUGH
GRANT PROGRAM FOR STATE AND TRIBAL RESPONSE TO OPIOID USE
DISORDERS.
(a) Additional Use of Funds.--Section 1003(b) of the 21st Century
Cures Act (42 U.S.C. 290ee-3 note) is amended by adding at the end the
following:
``(5) Other concurrent substance use disorders.--The
Secretary may authorize the recipient of a grant under this
subsection, in addition to using the grant for activities
described in paragraph (4) with respect to opioid misuse and
use disorders and stimulant misuse and use disorders, to use
the grant for similar activities with respect to other
concurrent substance use disorders.''.
(b) Annual Report to Congress.--Section 1003(f) of the 21st Century
Cures Act (42 U.S.C. 290ee-3 note) is amended--
(1) in paragraph (2), strike ``and'' at the end;
(2) in paragraph (3), strike the period at the end and
insert a semicolon; and
(3) by adding at the end the following:
``(4) the amount of funds each State that received a grant
under subsection (b) received for the 12-month grant cycle
covered by the report;
``(5) the amount of grant funds each such State spent for
such grant cycle, disaggregated by the uses for which such
funds were spent, including each allowable use under paragraphs
(4) and (5) of subsection (b);
``(6) how many such States for such grant cycle did not
spend all of the grant funds before such grant cycle expired;
``(7) how many such States for such grant cycle requested
no-cost extensions to extend the grant cycle; and
``(8) challenges for such States to spend all of the funds
allocated and the reason for such challenges, including to what
extent reporting requirements or other requirements placed an
increased burden on the ability of such States to spend all of
the funds.''.
(c) Other Concurrent Substance Use Disorders Defined.--Section
1003(h) of the 21st Century Cures Act (42 U.S.C. 290ee-3 note) is
amended--
(1) by redesignating paragraphs (2) through (4) as
paragraphs (3) through (5); and
(2) by inserting before paragraph (3), as redesignated, the
following:
``(2) Other concurrent substance use disorders.--The term
`other concurrent substance use disorders' means--
``(A) alcohol use disorders co-occurring with
opioid misuse and use disorders as a primary disorder;
or
``(B) alcohol use disorders co-occurring with
stimulant misuse and use disorders as a primary
disorder.''.
(d) Rule of Construction.--Nothing in this Act or the amendments
made by this Act shall be construed to change the allocation of funds
among grantees pursuant to the minimum allocations and formula
methodology under section 1003 of the 21st Century Cures Act (42 U.S.C.
290ee-3 note).
SEC. 120. PROVIDING FOR A STUDY ON THE EFFECTS OF REMOTE MONITORING ON
INDIVIDUALS WHO ARE PRESCRIBED OPIOIDS.
(a) In General.--Not later than 18 months after the date of
enactment of this Act, the Comptroller General of the United States
shall conduct a study and submit to the Committee on Energy and
Commerce of the House of Representatives and the Committee on Health,
Education, Labor, and Pensions and the Committee on Finance of the
Senate a report on the use of remote monitoring with respect to
individuals who are prescribed opioids.
(b) Report.--The report described in subsection (a) shall include
to the extent information is available and reliable--
(1) an assessment of scientific evidence related to the
efficacy, individual outcomes, and potential cost savings
associated with remote monitoring for individuals who are
prescribed opioids compared to such individuals who are not so
monitored;
(2) an assessment of the current prevalence of remote
monitoring for individuals who are prescribed opioids,
including the use of such monitoring for such individuals in
other countries; and
(3) information, including recommendations as appropriate,
to improve availability, access, and coverage for remote
monitoring for individuals who are prescribed opioids,
including through changes to Federal health care programs (as
defined in section 1128B of the Social Security Act (42 U.S.C.
1320a-7b)).
TITLE II--CONTROLLED SUBSTANCES
SEC. 201. DELIVERY OF CERTAIN SUBSTANCES BY A PHARMACY TO AN
ADMINISTERING PRACTITIONER.
Paragraph (2) of section 309A(a) of the Controlled Substances Act
(21 U.S.C. 829a(a)) is amended to read as follows:
``(2) the controlled substance is a drug in schedule III,
IV, or V that is, pursuant to the approval or licensure of such
drug under the Federal Food, Drug, and Cosmetic Act or section
351 of the Public Health Service Act, to be administered by, or
under the supervision of, the prescribing practitioner;''.
SEC. 202. REVIEWING THE SCHEDULING OF APPROVED PRODUCTS CONTAINING A
COMBINATION OF BUPRENORPHINE AND NALOXONE.
(a) Secretary of HHS.--The Secretary of Health and Human Services
shall, consistent with the requirements and procedures set forth in
sections 201 and 202 of the Controlled Substances Act (21 U.S.C. 811;
812)--
(1) review the relevant data pertaining to the scheduling
of products containing a combination of buprenorphine and
naloxone that have been approved under section 505 of the
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355); and
(2) if appropriate, request that the Attorney General
initiate rulemaking proceedings to revise the schedules
accordingly with respect to such products.
(b) Attorney General.--The Attorney General shall review any
request made by the Secretary of Health and Human Services under
subsection (a)(2) and determine whether to initiate proceedings to
revise the schedules in accordance with the criteria set forth in
sections 201 and 202 of the Controlled Substances Act (21 U.S.C. 811;
812).
SEC. 203. COMBATING ILLICIT XYLAZINE.
(a) Definitions.--
(1) In general.--In this section, the term ``xylazine'' has
the meaning given the term in paragraph (60) of section 102 of
the Controlled Substances Act, as added by paragraph (2).
(2) Controlled substances act.--Section 102 of the
Controlled Substances Act (21 U.S.C. 802) is amended--
(A) by redesignating the second paragraph (57)
(relating to serious drug felony) and paragraph (58) as
paragraphs (58) and (59), respectively;
(B) by moving the margin of paragraph (57) 2 ems to
the left;
(C) by moving the margins of paragraphs (58) and
(59), as redesignated, 2 ems to the left; and
(D) by adding at the end the following:
``(60)(A) The term `xylazine' means the substance xylazine as well
as its salts, isomers, and salts of isomers whenever the existence of
such salts, isomers, and salts of isomers is possible.
``(B) Except as provided in subparagraph (E), such term does not
include a substance described in subparagraph (A) to the extent--
``(i) such substance is an animal drug that has been
approved by the Secretary of Health and Human Services under
section 512 of the Federal Food, Drug, and Cosmetic Act and
such substance's use or intended use conforms to the approved
application, including the manufacturing, importation, holding,
or distribution for such use; or
``(ii) such substance is used or intended for use in
animals other than humans as permitted under section 512(a)(4)
of the Federal Food, Drug, and Cosmetic Act.
``(C) If any person prescribes, dispenses, distributes,
manufactures, or imports xylazine for human use, such person shall be
considered to have prescribed, dispensed, distributed, manufactured, or
imported xylazine not subject to an exclusion under subparagraph
(B).''.
(b) Placement of Xylazine on Schedule III.--Schedule III in section
202(c) of the Controlled Substances Act (21 U.S.C. 812(c)) is amended
by adding at the end the following:
``(f) Xylazine.''.
(c) ARCOS Tracking.--Section 307(i) of the Controlled Substances
Act (21 U.S.C. 827(i)) is amended--
(1) in the matter preceding paragraph (1)--
(A) by inserting ``or xylazine'' after ``gamma
hydroxybutyric acid'';
(B) by inserting ``or 512'' after ``section 505'';
and
(C) by inserting ``respectively,'' after ``the
Federal Food, Drug, and Cosmetic Act,''; and
(2) in paragraph (6), by inserting ``or xylazine'' after
``gamma hydroxybutyric acid''.
(d) Report to Congress on Xylazine.--
(1) Initial report.--Not later than 1 year after the date
of enactment of this Act, the Attorney General, acting through
the Administrator of the Drug Enforcement Administration and in
coordination with the Commissioner of Food and Drugs, shall
submit to Congress a report on the prevalence of illicit use of
xylazine in the United States and the impacts of such use,
including--
(A) where the drug is being diverted;
(B) where the drug is originating;
(C) whether any analogues to such drug present a
substantial risk of abuse;
(D) whether and to what extent the illicit supply
of xylazine derives from the licit supply chain; and
(E) recommendations for Congress with respect to
whether xylazine should be transferred to another
schedule under section 202 of the Controlled Substances
Act (21 U.S.C. 812).
(2) Additional report.--Not later than 3 years after the
date of enactment of this Act, the Attorney General, acting
through the Administrator of the Drug Enforcement
Administration and in coordination with the Commissioner of
Food and Drugs, shall submit to Congress a report updating
Congress on the prevalence of xylazine trafficking, misuse, and
proliferation in the United States, including--
(A) the status and results of research on the
impact xylazine has on human health; and
(B) the effects of the classification of xylazine
under the Controlled Substances Act (21 U.S.C. 801 et
seq.) on the prevalence of xylazine trafficking,
misuse, and proliferation in the United States.
(3) Obtaining official data.--The Attorney General, acting
through the Administrator of the Drug Enforcement
Administration and in coordination with the Commissioner of
Food and Drugs, may secure directly from any department or
agency of the United States documents, statistical data, and
other information necessary to carry out paragraphs (1) and
(2). Upon receipt of a request from the Attorney General for
such documents, data, and information, the head of the
department or agency shall, in accordance with applicable
procedures for the appropriate handling of classified
information, promptly provide reasonable access to such
documents, data, and information.
(4) Views of experts from non-federal entities.--In
developing the reports under paragraphs (1) and (2), the
Attorney General, acting through the Administrator of the Drug
Enforcement Administration and in coordination with the
Commissioner of Food and Drugs, shall consult with, and take
into consideration the views of, experts from appropriate non-
Federal entities, including such experts from--
(A) the scientific and medical research community;
(B) the State and local law enforcement community;
and
(C) community-based organizations.
SEC. 204. TECHNICAL CORRECTIONS.
Effective as if included in the enactment of Public Law 117-328--
(1) section 1252(a) of division FF of Public Law 117-328 is
amended, in the matter being inserted into section 302(e) of
the Controlled Substances Act, by striking ``303(g)'' and
inserting ``303(h)'';
(2) section 1262 of division FF of Public Law 117-328 is
amended--
(A) in subsection (a)--
(i) in the matter preceding paragraph (1),
by striking ``303(g)'' and inserting
``303(h)'';
(ii) in the matter being stricken by
subsection (a)(2), by striking ``(g)(1)'' and
inserting ``(h)(1)''; and
(iii) in the matter being inserted by
subsection (a)(2), by striking ``(g)
Practitioners'' and inserting ``(h)
Practitioners''; and
(B) in subsection (b)--
(i) in the matter being stricken by
paragraph (1), by striking ``303(g)(1)'' and
inserting ``303(h)(1)'';
(ii) in the matter being inserted by
paragraph (1), by striking ``303(g)'' and
inserting ``303(h)'';
(iii) in the matter being stricken by
paragraph (2)(A), by striking ``303(g)(2)'' and
inserting ``303(h)(2)'';
(iv) in the matter being stricken by
paragraph (3), by striking ``303(g)(2)(B)'' and
inserting ``303(h)(2)(B)'';
(v) in the matter being stricken by
paragraph (5), by striking ``303(g)'' and
inserting ``303(h)''; and
(vi) in the matter being stricken by
paragraph (6), by striking ``303(g)'' and
inserting ``303(h)''; and
(3) section 1263(b) of division FF of Public Law 117-328 is
amended--
(A) by striking ``303(g)(2)'' and inserting
``303(h)(2)''; and
(B) by striking ``(21 U.S.C. 823(g)(2))'' and
inserting ``(21 U.S.C. 823(h)(2))''.
SEC. 205. REQUIRED TRAINING FOR PRESCRIBERS OF CONTROLLED SUBSTANCES.
Section 303 of the Controlled Substances Act (21 U.S.C. 823) is
amended--
(1) by redesignating the second subsection (l) (added by
section 1263 of division FF of Public Law 117-328) as
subsection (m); and
(2) in subsection (m), as redesignated--
(A) in paragraph (1)(A)(iv)--
(i) in subclause (I), by striking ``or the
Commission for Continuing Education Provider
Recognition (CCEPR)'' and inserting ``the
Commission for Continuing Education Provider
Recognition (CCEPR), the American Podiatric
Medical Association, the Council on Podiatric
Medical Education (CPME), or the Academy of
General Dentistry'';
(ii) by redesignating subclauses (II),
(III), and (IV) as subclauses (III), (IV), and
(V), respectively; and
(iii) by inserting after subclause (I) the
following:
``(II) the American Academy of
Family Physicians or any organization
whose continuing medical education
activity has been approved or
accredited by the American Academy of
Family Physicians;''; and
(iv) in subclause (V), as redesignated, by
striking ``any organization approved by the
Assistant Secretary for Mental Health and
Substance Use, the ACCME, or the CCEPR'' and
inserting ``any organization approved by the
ACCME or the CCEPR'';
(B) in paragraph (1)(A)(v)--
(i) by inserting ``podiatric medicine,''
after ``allopathic medicine, osteopathic
medicine,''; and
(ii) by striking ``allopathic or
osteopathic medicine curriculum'' and inserting
``allopathic, osteopathic, or podiatric
medicine curriculum'';
(C) in paragraph (1)(B)(i), by striking ``or any
other organization approved or accredited by the
Assistant Secretary for Mental Health and Substance Use
or the Accreditation Council for Continuing Medical
Education'' and inserting ``the American Podiatric
Medical Association, the Council on Podiatric Medical
Education (CPME), the American Pharmacists Association,
the Accreditation Council for Pharmacy Education, the
American Optometric Association, the Academy of General
Dentistry, the American Psychiatric Nurses Association,
the American Academy of Nursing, the American Academy
of Family Physicians, or any other organization
approved or accredited by the American Academy of
Family Physicians or the Accreditation Council for
Continuing Medical Education''; and
(D) in paragraph (1)(B)(ii), by striking ``from an
accredited physician assistant school or accredited
school of advanced practice nursing'' and inserting
``from an accredited physician assistant school, an
accredited school of advanced practice nursing, or an
accredited school of pharmacy''.
TITLE III--MEDICAID
SEC. 301. EXTENDING REQUIREMENT FOR STATE MEDICAID PLANS TO PROVIDE
COVERAGE FOR MEDICATION-ASSISTED TREATMENT.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)(29), by striking ``for the period
beginning October 1, 2020, and ending September 30, 2025,'' and
inserting ``beginning on October 1, 2020,''; and
(2) in subsection (ee)(2), by striking ``for the period
specified in such paragraph, if before the beginning of such
period the State certifies to the satisfaction of the
Secretary'' and inserting ``if such State certifies, not less
than every 5 years and to the satisfaction of the Secretary,''.
(b) Conforming Amendment.--Section 1006(b)(4)(A) of the Substance
Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for
Patients and Communities Act (42 U.S.C. 1396a note) is amended by
striking ``, and before October 1, 2025''.
SEC. 302. EXPANDING REQUIRED REPORTS ON T-MSIS SUBSTANCE USE DISORDER
DATA TO INCLUDE MENTAL HEALTH CONDITION DATA.
(a) In General.--Section 1015(a) of the SUPPORT for Patients and
Communities Act (42 U.S.C. 1320d-2 note) is amended--
(1) in the heading, by striking ``Substance Use Disorder
Data Book'' and inserting ``Behavioral Health Data Book'';
(2) in paragraph (2)--
(A) in the matter preceding subparagraph (A), by
inserting ``, including as updated in accordance with
paragraph (3),'' after ``paragraph (1)'';
(B) in subparagraph (A), by inserting ``, mental
health condition, or a mental health condition co-
occurring with substance use disorder'' after
``substance use disorder'';
(C) in subparagraph (B), by inserting ``and mental
health treatment services'' after ``substance use
disorder treatment services'';
(D) in subparagraph (C)--
(i) by inserting ``, mental health
condition, or a mental health condition co-
occurring with a substance use disorder
diagnosis'' after ``substance use disorder
diagnosis''; and
(ii) by inserting ``or mental health
treatment services, respectively,'' after
``substance use disorder treatment services'';
(E) in subparagraph (D), by inserting ``, mental
health condition, or a mental health condition co-
occurring with substance use disorder'' after
``substance use disorder diagnosis'';
(F) in subparagraph (E), by inserting ``or mental
health treatment'' after ``substance use disorder
treatment''; and
(G) in subparagraph (F), by inserting ``,
individuals with a mental health condition who receive
mental health treatment services, and individuals with
a co-occurring mental health condition and substance
use disorder who receive substance use disorder
treatment services and mental health treatment
services,'' after ``substance use disorder treatment
services''; and
(3) in paragraph (3), by striking ``through 2024''.
(b) Application.--The amendments made by subsection (a)(1) shall
apply beginning with respect to the first update made pursuant to
section 1015(a)(3) of the SUPPORT for Patients and Communities Act (42
U.S.C. 1320d-2 note) after the date that is 12 months after the date of
enactment of this Act.
SEC. 303. MONITORING PRESCRIBING OF ANTIPSYCHOTIC MEDICATIONS.
Section 1902(oo)(1)(B) of the Social Security Act (42 U.S.C.
1396a(oo)(1)(B)) is amended--
(1) in the subparagraph heading, by striking ``by
children'';
(2) by inserting ``, and beginning on the date that is 24
months after the date of enactment of Support for Patients and
Communities Reauthorization Act, individuals over the age of
18, individuals receiving home and community-based services (as
defined in section 9817(a)(2)(B) of Public Law 117-2), and
individuals residing in institutional care settings (including
nursing facilities, intermediate care facilities for
individuals with intellectual disabilities, and other such
institutional care settings) enrolled,'' after ``children
enrolled''; and
(3) by striking ``not more than the age of 18 years'' and
inserting ``subject to the program''.
SEC. 304. LIFTING THE IMD EXCLUSION FOR SUBSTANCE USE DISORDER.
(a) Making Permanent State Plan Amendment Option To Provide Medical
Assistance for Certain Individuals Who Are Patients in Certain
Institutions for Mental Diseases.--Section 1915(l)(1) of the Social
Security Act (42 U.S.C. 1396n(l)(1)) is amended by striking ``With
respect to calendar quarters beginning during the period beginning
October 1, 2019, and ending September 30, 2023,'' and inserting ``With
respect to calendar quarters beginning on or after October 1, 2019,''.
(b) Maintenance of Effort Revision.--Section 1915(l)(3) of the
Social Security Act (42 U.S.C. 1396n(l)(3)) is amended--
(1) in subparagraph (A)---
(A) in the matter preceding clause (i), by striking
``other than under this title''; and
(B) in clause (i), by striking ``or, if higher,''
and all that follows through ``in accordance with this
subsection''; and
(2) by adding at the end the following new subparagraph:
``(D) Application of maintenance of effort
requirements to certain states.--In the case of a State
with a State plan amendment in effect on the date of
the enactment of this subparagraph, for the 1-year
period beginning on such date, the provisions of
subparagraph (A) shall be applied as if the amendments
to such subparagraph made by the Support for Patients
and Communities Reauthorization Act had never been
made.''.
(c) Additional Requirements.--
(1) In general.--
(A) General requirements.--Section 1915(l)(4) of
the Social Security Act (42 U.S.C. 1396n(l)(4)) is
amended--
(i) in subparagraph (A), by striking
``through (D)'' and inserting ``through (F)'';
(ii) in subparagraph (D), in the matter
preceding clause (i), by inserting ``have in
place evidence-based, substance use disorder-
specific individual placement criteria and
utilization management approach to ensure
placement of such individual in an appropriate
level of care and shall'' after ``State
shall''; and
(iii) by adding at the end the following
new subparagraph:
``(E) Review process.--The State shall have in
place a process to review the compliance of eligible
institutions for mental diseases with evidence-based,
substance use disorder-specific program standards for
eligible individuals specified by the State.''.
(B) Effective date.--The amendments made by
subparagraph (A) shall apply with respect to medical
assistance furnished in calendar quarters beginning on
or after October 1, 2025.
(2) One-time assessment.--Section 1915(l)(4) of the Social
Security Act (42 U.S.C. 1396n(l)(4)), as amended by paragraph
(1), is further amended by adding at the end the following new
subparagraph:
``(F) Assessment.--
``(i) In general.--The State shall, not
later than 12 months after the approval of a
State plan amendment described in this
subsection (or, in the case such State has such
an amendment approved as of the date of the
enactment of this subparagraph, not later than
12 months after such date), commence an
assessment of--
``(I) the availability of treatment
for individuals enrolled under a State
plan under this title (or waiver of
such plan) in each level of care
described in subparagraph (C); and
``(II) the availability of
medication-assisted treatment and
medically supervised withdrawal
management services for such
individuals.
``(ii) Required completion.--The State
compete an assessment described in clause (i)
not later than 12 months after the date the
State commences such assessment.''.
(3) Clarification of levels of care.--Section 1915(l)(7)(A)
of the Social Security Act (42 U.S.C. 1396n(l)(7)(A)) is
amended by inserting ``(or any successor publication)'' before
the period.
SEC. 305. PROHIBITION ON TERMINATION OF ENROLLMENT DUE TO
INCARCERATION.
(a) Medicaid.--
(1) In general.--Section 1902(a)(84)(A) of the Social
Security Act (42 U.S.C. 1396a(a)(86)(A)), as amended by section
5122(a)(2) of the Consolidated Appropriations Act, 2023 (Public
Law 117-328), is further amended--
(A) by striking ``under the State plan'' and
inserting ``under the State plan (or waiver of such
plan)'';
(B) by striking ``who is an eligible juvenile (as
defined in subsection (nn)(2))'';
(C) by striking ``because the juvenile'' and
inserting ``because the individual'';
(D) by striking ``during the period the juvenile''
and inserting ``during the period the individual''; and
(E) by inserting ``such an individual who is an
eligible juvenile (as defined in subsection (nn)(2)) or
a woman during pregnancy (and during the 60-day
beginning on the last day of pregnancy) and'' after
``or in the case of''.
(2) Effective date.--The amendments made by--
(A) subparagraph (A) of paragraph (1) shall take
effect on the date of the enactment of this Act; and
(B) subparagraphs (B) through (E) of paragraph (1)
shall take effect on January 1, 2025.
(b) CHIP.--
(1) In general.--Section 2102(d)(1)(A) of the Social
Security Act (42 U.S.C. 1397bb(d)(1)(A)) is amended--
(A) by inserting ``or pregnancy-related'' after
``child health'';
(B) by inserting ``or targeted low-income pregnant
woman'' after ``targeted low-income child'';
(C) by inserting ``or pregnant woman'' after
``because the child''; and
(D) by inserting ``or pregnant woman'' after
``during the period the child''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply beginning January 1, 2025.
(c) Technical Correction.--Section 1902(nn)(2)(A) of the Social
Security Act (42 U.S.C. 1395a(a)(nn)(2)(A)) is amended by striking
``State plan'' and inserting ``State plan (or waiver of such plan)''.
SEC. 306. STATE OPTION RELATING TO INMATES WHO ARE PREGNANT WOMEN
PENDING DISPOSITION OF CHARGES.
(a) State Option.--
(1) Medicaid.--The subdivision (A) of section 1905(a) of
the Social Security Act (42 U.S.C. 1396d(a)) following
paragraph (31) of such section, as amended by section 5122 of
the Consolidated Appropriations Act, 2023 (Public Law 117-328),
is further amended by inserting ``or a woman during pregnancy
(and during the 60-day beginning on the last day of
pregnancy)'' after ``(as defined in section 1902(nn)(2))''.
(2) CHIP.--Section 2110(b)(7) of the Social Security Act
(42 U.S.C. 1397jj(b)(10)), as amended by section 5122 of the
Consolidated Appropriations Act, 2023 (Public Law 117-328), is
further amended--
(A) by inserting ``a woman during pregnancy (and
during the 60-day beginning on the last day of
pregnancy) or'' after ``At the option of the State,'';
and
(B) by striking ``during the period that the
child'' and inserting ``during the period that the
woman or child''.
(3) Effective date.--The amendments made by this subsection
shall take effect on January 1, 2025.
(b) Technical Correction.--Section 5122(a)(1) of the Consolidated
Appropriations Act, 2023 (Public Law 117-328) is amended by striking
``after'' and all that follows through the period at the end and
inserting ``after `or in the case of an eligible juvenile described in
section 1902(a)(84)(D) with respect to the screenings, diagnostic
services, referrals, and targeted case management services required
under such section'.''.
SEC. 307. PERMITTING ACCESS TO MEDICAL ASSISTANCE UNDER THE MEDICAID
PROGRAM FOR FOSTER YOUTH.
(a) In General.--Section 1905(a) of the Social Security Act (42
U.S.C. 1396d(a)) is amended by adding at the end the following new
sentence: ``In the case of an individual who is under the age of 21 and
who is a patient in an institution for mental diseases that is a
qualified residential treatment program (as defined in section
472(k)(4)), the exclusion from the definition of medical assistance set
forth in the subdivision (B) following the last numbered paragraph of
this subsection shall not apply with respect to items and services
furnished to such an individual when received outside of such
program.''.
(b) Effective Date.--The amendment made by paragraph (1) shall
apply with respect to medical assistance furnished in calendar quarters
beginning on or after January 1, 2025.
TITLE IV--OFFSETS
SEC. 401. PROMOTING VALUE IN MEDICAID MANAGED CARE.
Section 1903(m)(9)(A) of the Social Security Act (42 U.S.C.
1396b(m)(9)(A)) is amended by striking ``(and before fiscal year
2024)''.
Passed the House of Representatives December 12, 2023.
Attest:
Clerk.
118th CONGRESS
1st Session
H. R. 4531
_______________________________________________________________________
AN ACT
To reauthorize certain programs that provide for opioid use disorder
prevention, recovery, and treatment, and for other purposes.