[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 773 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 773
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 HOUSE OF REPRESENTATIVES
February 2, 2023
Ms. Dean of Pennsylvania (for herself and Ms. Garcia of Texas)
introduced the following bill; which was referred to the Committee on
Financial Services
_______________________________________________________________________
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 ``Homelessness and Behavioral Health
Care Coordination Act of 2023''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) The United States has a homelessness crisis, with more
than 582,000 people experiencing homelessness on a single night
according to the Department of Housing and Urban Development's
2022 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) It is imperative that when people experiencing
homelessness 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) While participation in health care and person-centered
supportive services should not be a requirement for people
experiencing homelessness to receive housing, access to such
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 two 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. ESTABLISHMENT OF GRANT PROGRAM.
(a) In General.--The Secretary of Housing and Urban Development (in
this Act referred to as 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 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). The working
group shall include representatives from the Department of
Housing and Urban Development, the United States Interagency
Council on Homelessness, Department of Health and Human
Services, Department of Agriculture, and Bureau of Indian
Affairs, to be appointed by the heads of such agencies.
(2) Development of assistance tools.--The working group
shall, not later than 12 months after the date of the enactment
of this Act, 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 shall circulate such materials to
interested entities, particularly those who apply for grants
awarded pursuant to this Act.
(c) Capacity-Building Grants.--
(1) In general.--The Secretary shall award 5-year grants to
eligible entities, 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 health
care, with the exception of efforts to increase the
availability of Naloxone and provide training for its
administration, or rent.
(3) Amount.--The amount awarded to an entity under a grant
under this subsection 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, a Tribal organization, or an
urban Indian 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 its capacity 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 co-occurring 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 such
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 behavioral health care services
and other health care services.
(5) Eligible activities.--An eligible grantee receiving a
grant under this subsection 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 grantee receiving a
grant under this subsection 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, such entity shall submit to the
Secretary a report on the activities carried out under
the grant. Such report 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
an entity that received a grant--
(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 subsection.
(8) Definitions.--In this section:
(A) Behavioral health.--The term ``behavioral
health'' includes mental health and substance use.
(B) Indian tribe; tribal organization.--The terms
``Indian Tribe'' and ``Tribal organization'' have the
meanings given such terms in section 4 of the Indian
Self-Determination and Education Assistance Act (25
U.S.C. 5304) and shall include tribally designated
housing entities (as such term is defined in section 4
of the Native American Housing Assistance and Self-
Determination Act of 1996 (25 U.S.C. 4103)) and
entities that serve Native Hawaiians (as such term is
defined in section 338K(c) of the Public Health Service
Act (42 U.S.C. 254s(c))).
(C) 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 Act (42 U.S.C.
11302).
(D) 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.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $20,000,000 for each of fiscal
years 2023 through 2028, of which not less than 5 percent of such funds
shall be awarded to Indian tribes and tribal organizations.
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